 Okay, so Shayla thank you for being here. I know that people have reached out and chatted with you about our mental health bills and you have a limited timeframe so we welcome your testimony. Hello committee thank you so much for accommodating my schedule this morning I do appreciate that I'm Shayla Livingston and the director of policy for the agency of human services. And we, the Department of Mental Health I'm here representing the Department of Mental Health, as I have been their policy director as well, up until recently, and I'm supporting them in that manner as well. So, you've heard from the commissioner of mental health on this topic, and I think also maybe the deputy commissioner but I want to be very clear that the department is incredibly supportive of peer certification and peer respite beds, that that's the department has been looking at and working on. And I, and we sent you a memo, and I'm just going to very briefly hit on the high level of that and then I'm happy to answer questions. Essentially, let me just make sure the committee understands that that's a memo memo from Commissioner Hawes, and it was addressed to Cheryl, Senator Hooker and myself because we had been working on the this this area together with the department as well. But it's on our webpage. Thank you, Chair yeah, exactly. In that memo, the department just outlines briefly the work that is underway right now on peer certification so the department included peer certificate has has requested a white paper request a white paper on peer certification, and, and that was published, and then the department has worked with pathways on a grant application to the department using hcbs funds that we requested in the be a that is pending in front of the legislature. Those hcbs funds would fund, I believe it's pathways but a grant to examine peer certification and come up with a framework for that certification process, including definitions that the committee is considering in that process, that's 194. We've also been in communication more recently with OPR on this topic and would include OPR in that process and in that work group to ensure alignment, and also leverage any of their resources that would make more sense to include in this process. So in this specific process that Lauren is much more, I am able to describe to you that I am, but I do think that it is important that we work hand in hand with them, as well as with pathways and the peers to consider this for Vermont. The department of mental health is, is committed to this we want to do it we don't want to, we, we don't want the committee to feel that we are slowing it down. We want to do it deliberately and we do have this process and this funding already in place and already in legislation pending before you all right now in terms of the funding for it. Following that, and again, I want to be really clear we are supportive of the rest of the bed concept. We do think that it makes sense to to solidify and finalize the peer certification work, and also to potentially leverage the information from the process that we already fund in order to get the committee the information you are looking for in the pilots that are described in S 195. That way we could use existing resources and information as well as the process that would be set up through peer certification in order to then walk into considering a framework for respite beds for the state with more information and with a peer certification already set up. I think the last thing I will say on that topic is simply that the the funding that is outlined and described in S 191 95. Currently we would we would need to make some modifications to that if it were feasible and I do just need to say it's not in the governor's budget right now so I'm not clear where that money would come from, at least in the department's budget. So, again, happy to take questions but I do want to be super clear that we are very supportive of both ideas and concepts and are already working and have been working on the peer certification front, actively and do fund those respite beds, and are interested in Oh, sorry one more thing. We did do an RFI as part of the capital bill, and we did get some responses to that RFI it's there's a report act 50 report that I'm happy to send to Aaron to post on your, on your website, or your website as well. We did that report for this year and six different responses for unlocked community residential beds were provided to the department around ideas for how to improve community access to those residential beds and many of them did include pure aspects. So that also might be of interest to this community. No. I'm happy to take questions. Yeah, I've got questions so I guess we've been working on this now for over a month. So we're, we're happy to finally see something in writing that helps. But but it there is a concern that we have simply because as you know and probably as as a department is and the agency is concerned we'd like to move forward and so we take a step forward we somehow take two steps back with a working group or report or something else and the, the ideas for an from the RFI are ideas were, frankly, you know and I know we've talked about this and I know that the agency has had huge turnover and changes and the pandemic has been going on but we certainly would like to have some recommendations that we can have in the bill and Senator Hooker has been working very hard on this that we can take that step forward without having to interact. So, what is there, as you're looking at the bills before us and then at your memo and we're going to have to call through the memo with our ledge council. It will be helpful to have some proposal that does take us that step forward and I, but, and having said all that of course we do understand the conditions under which you are working, but we know that there are folks in the community who are really ready to go so we we want to make sure that we're capturing the enthusiasm and the energy that exists out there in in our real world and that we can move forward and I'm going to turn to Senator Hooker and first with your questions and then Sheila, please, you know, we welcome your comments. Okay, thank you, Senator Lyons and you've said a lot of what I've been thinking and the, I guess the point is, we have people who are already in the community who are ready to take this on. What do we need to do to move that forward rather than going back and retreading old ground. So if you can, you know, what can we eliminate, I guess, so that we're not duplicating the effort so that we can just, you know, start here and move forward and get this in place as quickly as possible. Increased need. We've seen it through the pandemic and I don't think it's going to go away anytime soon. So the quicker we get on this the better off we're going to be so what would you, what would you look at as a timeline for this I guess if it goes through the process that you're explaining. Absolutely and I appreciate that very much from both of you that the urgency around it. I, if it's okay, I would I do want to phone a friend a little bit with Lauren to describe their sunrise process for this type of certification. I do also want to be super clear that we have we, as soon as the BAA passes that grant to actually propose that goes forward to propose a certification framework is ready to go. So that would it's not like a then we have to write the grant then we have to think but like you all say yes, we are ready to move on that. So I so that process could start basically almost immediately the question around recipe beds and and where to put them and who can catch that work and you know building them so it the Again, I just want to be really clear on the process if we stood that up. There's some questions around if would it be a pilot would a pilot make sense is that actually what would be the best use of resources in this moment given what we already know around this work. It would be more of a consideration going forward once we have peer certification in place in a framework in place of standing up and not necessarily doing a pilot because pilot work in this type of area means that you're building beds and building spaces. Without the security of ongoing funding. We would need to pull diva into this conversation in order to make sure that there is security in that ongoing funding that does have implications I have read the analysis and some of the pieces in the bill as well as other research around the cost savings and you know I do think that that is, you know, that would absolutely be part of that conversation. But again, it does require that consideration in in the budget process. I do apologize for the fact that you guys have been working on this for a month. I'm not going to testify on I know but did not give specific details and feedback. So that has there has been some turnover and staff on our end and so I do apologize for that but if it's okay with the committee if I could hand this to Lauren to answer the question. You can but before you do that I just want to discriminate between what we currently see as peer to peer certified programs in the state and I know that we've heard testimony, for example from Sandy and now who has been doing peer to peer and is certified under federal umbrella and but so this peer to peer support just just to reassure folks. We are not looking at psychotherapy. So we're not looking at master's credentials. We are looking at people with who have known experiences in the area of mental health issues, supporting their peers when they have a short term need so this. I'm trying to understand you mentioned the word sunrise. Listen to to Lauren we always listen to Lauren, and then we'll try to sort out the differences and what we're what we think we're hearing so thank you. Yes, Senator agree with you that we're not talking about psychotherapy. Terrific. I'm glad we're on the same page with that one. Okay, Lauren thanks go ahead. I am Lauren layman with the office professional regulation for the record. It's good to hear that it's not talking about psychotherapy. We OPR just, this is a new concept to us, not being, you know, being more in the licensing space than in the mental health field we regulate a number of mental health professionals but mostly from the licensure perspective. So when reading this bill initially it was unclear to us whether there would be some form of psychotherapy being used by peers in support of other peers, and I and looking at Miss Yandos testimony, it seems she did request some information change in the language to be practicing therapy so that was of concern to us. So what OPR has right now and what the state has, has decided to under its policies is practical is is a roster for anybody providing psychotherapy without qualifications you don't need to have any qualifications or, you know, and by qualifications you don't need to have any qualifications or an education or certain examination, but if you're providing psychotherapy in the state it's a consumer protection element where you just register with OPR so a consumer can check on our website to see, hey this person's is checking in, if there's any discipline, if there's any concern about their practice previously because we recognize the consumers in a uniquely vulnerable position when seeking psychotherapy. So from the perspective, if this is exclusive to a psychotherapy that would bring a new level of, of detail to this. The sunrise report to Sheila's question and to Senator Hooker is really looking at right sizing regulation. The peer support is permissible in the state without regulation, and that is exempt from, they're exempt from all of our, all of our title 26 mental health profession licensure requirements there's an exception for peer counseling regardless of whether consideration is received. The difference I think in this level is that they're asking for state, the S195 asks for state approval it's asking for a state certification and in traditionally when we offer that state certification, we go through this sunrise process which is tied to what we see as a keystone fundamental policy. We don't regulate a profession unless there's a threat of public harm to the public. And once finding that harm, public harm of unregulated practice. And if there is a finding of public harm we do the least restrictive form of regulation possible and this just means that we were trying to stay out of burdening workforce entry. In this situation, I, you know, would think it, obviously there's a positive potential for public harm. If there's an unregulated practice of this industry, maybe not, or if this industry this profession, maybe not, and that would be our kind of threshold in a, in a sunrise report. And then if it is found there is found to be a public harm we would look very closely at, well what what makes sense do we want right roster or registration which means everybody has to register but there, you know, there's no educational requirements or other requirements to obtain it a certification is optional. So folks could choose to be a certified peer support specialist. But to obtain that certification they'd have to demonstrate certain qualifications or a license which would require both qualifications and be mandatory. The reason I think it's necessary to do the report here, if OPR is to play a role in this certification is there's 48 other states doing this. I've done in the past two weeks a cursory review of their approaches there are myriad different number of approaches but there's definitely best practices. There's also the reason for having the state certification is to pull down Medicaid funding and to have funding for the services. And to, I want to make sure that anything we draft anything we put into law is consistent with those policies so we're not just putting something into place where we're not getting reimbursement. So those would be my concerns, we do reports every year. We would have this by December 15. So it could be something that could be taken up quickly next session and passed pretty immediately. I'm not sure what your ideal timeline is but that would be our timeline. Yesterday would be great. So, no thank you for that that's helpful clarification. I guess the question would be that what what I'm hearing you say is that folks can continue to be peer support specialists. If they're not certified whether there's nothing that would state that they would be barred from working in a peer support capacity. Now, so then that raises the question about the, the guidelines the conditions the criteria that are in the bill that would define who in this state could be a peer support specialist and we might add into that until they feel that they were acting appropriately and then also put in your sunrise your certification sunrise is there. I'm going to sort out what the barrier is to having the folks continue the work to be considered peer support specialists, and at the same time, by December 15, getting your sunrise report, because you did indicate that they can, they can do this. Yeah, it from my perspective this the current practices that Miss Yandau and others are engaged in can continue. I think the other benefit of waiting is the grant Sheila was talking about is really designed to provide structure as currently written. It's not clear what the scope of practice as I said I didn't realize that psychotherapy was not a part of it and so it's not. If OPR were to come in to regulate this it wouldn't be clear to us who was providing the service who wasn't providing the service what service was being provided. The grant would help clarify that. But again, I think what S 195 does is it provides a state certification which allows for Medicaid reimbursement. And that does not prevent the current peer counseling services to continue it just wouldn't allow until legislation takes place I don't think it and Diva would have to actually answer that it wouldn't under this structure feel. I don't believe it would allow Medicaid funding for it but yeah this is this is very helpful because I mean the goal is to have an expansion of services and as well to have some reimbursement in place. So now we're beginning to see the dichotomy between the folks who currently are pierces support specialist those who are certified. Those were not those are certified and then what the state might do going forward it's not a dichotomy. Okay. Anyway, Sheila go ahead. Yeah, and just I wanted to be clear that we do have like Lauren said we do have folks already working under current, you know guidelines and regulations and I don't know that we need anything to do in legislation to allow them to continue to do that. But like Lauren said I think that it is the department wants to do this so that we can advance the field. So it's not a, I don't know that we need more in the interim, but we do need this next level, or want this next level in the future. Nobody wants us to pass legislation that's so hard to understand. You can talk. Lord and I are welcoming you to require us to do this. We are going to require something I mean that this committee is very passionate about this area and so we're going to work as hard as we can to have something in place and we need, we need to work with you obviously and that's what we're, that's what we're doing it's unfortunately taken a while to get here. I apologize. I do have to leave. I understand. So we'll, we're going to, we're going to try to, we're going to resolve these issues and we're going to get some language put forward Senator Hooker has been working very hard on this and so we want to make sure we we move forward. Senator Hooker and then Senator Cummings. Thank you. Miss Livingston you talked about wanting to proceed with the certification before doing the, the respite beds and I, I really am concerned about that because I think we have a need for these beds now. We're working in our, you know, at a listen where, you know, they know what they're doing. We've seen the progress and the, and the, all of the good work that this particular program has done. It's our pilot, I think, and I'm, I would like to be able to move forward with the respite beds with the peer support that we have, even though these people are not certified yet. But I would hate to see us hold up the implementation of more peer respite beds waiting for certification of the peer specialists. So I hope that makes sense. I want, you know, we really want to see the beds put into place. Okay, I hear that for sure. Senator Cummings. Yeah, I think the big change here is the Medicaid reimbursement. And that peer support goes on, you know, we have it in substance abuse we've got it mental health. But we don't pay for a treatment with Medicaid. And that's, that's what's going on. The other thing I've been told is that we have a ceiling in our Medicaid waiver, and that for the first time we are coming up close to it. So if we take in another huge program, we may be, you know, stopping our ability to do something else because of the way it's set up so I think that's why folks are being a little cautious is that there's state money going into this or request for the first time. And that is the issue that is a huge issue on this and in my conversation with Senator Kitchell we discussed that. So we would have to, we would have to look to diva to give us some input. We decided to go forward with everything at once and you know it's maybe, maybe it's the expansion that can go on with the current system of support, and then the certification is in place with some guardrails and information from diva on Medicaid reimbursement. So that's one of the kinds of things that we really have to juggle here without stopping forward progress. And thank you Senator Cummings for bringing that up. Shayla, did you want to comment again I see you. No, just agreeing. All right. So, questions committee for Shayla before she has to leave. We're not leaving this one we're going to stick with it. We're going to bring Katie McClinn on board and then we'll hear from Katie and Cheryl. And I know that Lauren you're still here and we'd welcome your, your being here and then will the white has asked to be involved in the discussion this is going to be more of a discussion then testimony time so we want to continue with this. Thank you for having me and I'm sorry. Thank you very much and don't, don't leave, don't leave the issue. We need, we need you and the department to work closely with us to make sure that we have some language that, as we said is going to take us forward so thank you. Absolutely. Thank you very much. So, Cheryl, I'm going to turn to you, because you've been working on this, and let us know where you have gotten with any changes to the bill and then you can bring in Wilda or Katie as you think will be helpful. Okay. I just want to make sure again, I guess I was a little nervous when Miss Livingston mentioned the beds and you know the connection between the certification and the beds and I don't know that that is necessary. And I would like to see the bed certainly moving forward. And I think we can come up with language for the certification piece that would be acceptable to everybody involved. So are you suggesting that the bills be acted on separately. At this point I would think that if there's, you know, I, I wouldn't want to see the respite beds held up, because we don't have the language that we need for the certification bill. So at this point, I would say we should move on them separately. But I can get back to you on that. Well, we'll certainly hear from others on that so Lauren has testified that the certification sunrise could be completed by December 15. And that is that accurate Lauren. Yes. And then the sunrise needs to be you might come back with a negative report but we're not thinking that will happen. I think we OPR supports this concept and has in what we've learned over the last couple of months have it's a valuable resource and a valuable profession I think our interest is making sure it's a defined scope and making sure it's something we can implement as a license or as a certificate. Now, my question for you is as you go through the sunrise process, do you reach out to folks at diva for example, and looking at what the cost implications are. As you make the recommendation or is that left separate. Is it simply as a profession with with criteria for being that professional. Normally, our normal processes in statute and so if it's called a sunrise report or the request is for a sunrise report we look at those questions of it. We wouldn't necessarily reach out to diva unless the questions of unless it relates to a question of like how to regulate what the best way to protect the public that said we have had reports in the past request from the legislature to ask other questions or consult with certain stakeholders, and it is a very stakeholder involved process with public hearings and we reach out to groups independently to ask for their feedback and input. And we try to really find that that that's the right size regulation for the profession. Okay, so I think that as we go forward. If we do ask for a sunrise we may want to put some recommendations in place for you in that process. I mean, yeah. legislative council. You just froze. I'm so sorry am I back again. Now you're back. Chapter 57 in title 26 ledge council might be able to assist with that has our process has all the questions and And that might help figure out what the languages and we're happy to help to. Okay. Go ahead, Senator Hardy. It does seem like we could move forward with S 195, even though my name's not on it. Name is all over it. Exactly I'll just stamp my name on it. I'm just kidding. But, and then with some modifications, like putting Addison County in all caps or something no just kidding. But, and then have on that we can move for as a center hooker shed I just want to reiterate, we could move forward with the peer respite centers, knowing that there are people out there doing this work. And one issue is as Senator Cummings has noted, and others that they might not get the Medicaid reimbursement in this first year or until things but then we could tap on to that the sunrise process and the requiring diva or I'm sorry, dmh to do what we're not doing but making sure it's codified to opium to go to go through the process with the grant etc and do I mean because I think it is important that we go through the right process to make sure that we have the right certification so that we can get Medicaid funding, but also not hold up the good work that's already happening out there in the field. So that would be what I would like to do and do it so that we yeah I think that and you know it seems like that's the direction we're headed so that's Senator Hooker go ahead. I just wondered if Senator Hardy was considering putting them together as we said you know either separating the bills or putting them together I don't know, you know I don't want to put anything on the respite center bill that would delay its implementation sink the bill. So hold that thought hold that thought I mean it's Senator Hardy may want to we may we all want to decide keep them together or not but I think. Yeah. You're talking. You're you are unstable at this time. My internet is unstable so I'm not hearing everything. Yeah, we were. All over the place so but I'll, I see that will that has her hand up I don't know. Yeah I was going to go there in just a sec. So, I'm going to what I'm going to suggest is that as we start collecting all these ideas to Senator Hooker I'm going to have you work again with the Ledge Council and and then we'll we'll talk about one or two bills as we're going forward. Will the thank you for being with us this morning and you've got your hand up. So we're in a conversation mode, but can you please offer your thoughts as you're listening to all of this. Yes, thank you for allowing me to be here today will the white founder of mad freedom and representing the proponents of this legislation the peer led organizations here in Vermont. I really appreciate everyone's concern that we get this right, which is why we propose the certification program to begin with, because we wanted to get it right. I have a couple of things about I'll start with the sunrise. I can understand why OPR would want to do the sunrise because they don't understand what peer support is. And it's, but I feel like if they knew more about it, they would understand how unnecessary the sunrise report is. And remember this is something that is happening in 48 states plus the district of Columbia. Most of the states do not have their office of professional regulation involved in this for the very reason that for peer support to work, it needs to look very much different, because it is from the medical profession. So when we, you know when I go on to the OPR website as I've done over the, you know the year when I was doing this work. I feel like it would scare people away from using peer support, because it doesn't have that same ethos. And when we, when you hear, hear reference to this white paper that was done in this grant that was written, you know I was the one who authored, authored both of those. And I, there's an, there's an, I felt, I feel like there are enough kind of to quote a senator Cummings guardrails that's the term we're using now in that process to to allay all the concerns that have been have been raised. And I think what I would like to propose is that we do separate one for 194 which is the peer respite bill from 195, which is the peer certification bill. And that we look at, and that we approve this, like, there's like three steps in that peer certification bill there's the developing piece of the program, which I think, is attracting much controversy and I think you can approve that piece of it. And then there's the screening and training piece, I think you could approve that as well. And then there's the certification body. And I feel like we, I could offer you some language that I feel like would address all the concerns that have been raised here, and it would be a splitting it into a two step process. So even if OPR were ultimately going to be involved there would still need to be a certifying body that they work with right so they would be doing what they're referring to as regulation, but even there are other professions they work with a certifying body. And so you could approve that piece of the concept. And we could include language that says okay we're going to establish this certifying body, according to the procedure that's been laid out in the bill, and then OPR could have a role as providing that administrative that kind of back office work such as putting you know, creating that roster that you talked about. So there are investigations, if it came to that so I feel like there is a role for OPR and staying true to peer support values. And I feel like we could work that out. If you know just a conversation with OPR just explaining to them exactly what peer support is without completely derailing the bill and lifting the time to get this done. Okay yes you're you're headed in a direction that I was thinking about earlier and I noticed in the in the memo from OPR that there is a paragraph that says an inventory to look at an inventory of certifications across the state and that might help. So, here's, here's, I'm Nolan has a comment to make before he has to leave at 1030. So why don't we know and let you come in and make that comment and I'm going to say I'm not we're not forgetting what you just said, will the. Because I think that Senator Hooker will be working with Ledge Council on this I will also be help making myself available, as well as Laura, Lauren, and probably everybody else in DM, everyone in DMH so it sounds like a team effort outside of committee to get us going here, but Nolan you had some comments to make about 194. For the record no one lying while the joint fiscal office. And also let me just say on the record will the thank you so much. I spent some time talking with a bullet on the phone and she helped me understand the bell and so let me just say thank you publicly. The only things I wanted to sort of flag was on the money if you move forward with the was it seven centers. So we had Madison. It says five. It says $500,000 free center. And I just want to flag that right now the appropriation for the two existing centers was actually 477, but then they got these one time supplementals. But going forward they're only going to get 477, but the new ones are going to get 500 so keep so we can either give the new ones 477, where you give the two existing ones 500 now. That's a lot of money but I just want to just make sure there's some parity, because the $24,000. I don't think is ongoing I think it was supplemental as part of the emergency stuff so that's one thing to keep in mind is how much you get each. The second I think Senator cut or sort of brought up is like, you know, we don't know I don't know if it'll be eligible for global commitment we have concerns there so I have I don't know what kind of federal state match we would be looking at to fund these at you know in the bill right now is you know 3.5 for base and 250 for one time. So it's what the flag that discrepancy in the funding. The second thing I want to raise is, and this gets to the normal we appropriate the money to DMH. My question is maybe Senator hooker can answer this is these centers don't exist currently. But we're, we're giving grants to something that doesn't exist. So, I guess, my question maybe this gets to the level of who is the money going to are these organizations to have to create boards to have to show some kind of fiduciary responsibility, like how we're creating centers and we're giving money but who are these people who you know who is it. Like, do they have to come together and form a 501 C3. So this is like a consideration when you think about putting money together in the short term, so I don't have an answer to that but that was a sort of a concern about like, where does the money go, unless they already exist or some of the work around works being done. That's just sort of a fly. There is some kind of an RFP similar to what the MH is currently doing so. Yeah, that might be the RFP. Okay. Well, the builder might have more information on that as well if it's okay centered alliance. No, go ahead. Yes, Senator Lizer, you're exactly right. It would be similar to the RFP process that the state already uses. And the vision was, you know, as he gets up and running that they would be run as a network to achieve economies of scale so that people weren't duplicating processes like human resources, they would get discounts on insurance. They would co locate, they would, you know, do Medicaid reimbursement at a single location. So, so that's that that's the idea. Is that help. Thank you Nolan. That's helpful. And I know you brought up the issue about the funding discrepancy earlier and it's good to have have it on the table. Yeah, it just helps when when you consideration of when you if you move forward. I would cost it out. That's all so it's what was the what was it's 3.5 base and bill currently has 3.5 base funding, and then 251 time but that's to give that's for the, the partnership for the existing one. Yeah, okay. Go ahead, Senator Hardy. Hopefully my internet holds up. It's really windy and icy here so I think this is a question for will the is that okay if I ask her question. Oh yeah, we're a conversation mode. Is that okay with you will the. So, this has been a confusion of mine. Since the bill came out since what I think it's 195 with the respite centers, the whole concept of the pilot. And it seems to me like there's part of the bill that's creating the actual peer respite centers, the ones that aren't already in existence. And then there's this pilot, which seems to be a sort of collaboration or partnership or interaction between two existing peer respite centers, and a community center. Center to two. So, I don't know if you've asked your question but I'm just kidding if you could explain the pilot part of it that would be great. So this is the pilot so currently we have in the state to community centers for people with mental health challenges one is in Burlington it's called pathways community center and one is in Montpelier it's called another way community center. And the idea is that each of these, if if if 194 with 194 is the peer respite bill. So if one 194 would create these new peer respites one would be located in Burlington, one would be located in Montpelier and then other places. So with the peer respite with the with the Community Center in Burlington, and the Community Center in Montpelier they would each get an additional appropriation of about $100,000 to create programming that would coordinate the program of the new peer respite in Burlington, and the new peer respite in Montpelier to achieve those synergies that we know exists between affiliating community centers and peer respites and Sarah Davidao talked about those she talked about it, it, you know it. There's a seamless transmit transition when somebody leaves the peer respite and go because they're already been introduced to the Community Center. It also helps create wraparound support services to that person at the, when they're in the community so they don't have to wait until they're in crisis to access services. And also, one of the big problems about people with mental health challenges is that we're incredibly isolated and we don't have friends and community and so this helps build that community and then when you can so you can reach out and people are keeping an eye on you. Before you're in crisis and helping you. And then oftentimes we see when people go to the Community Center, and they've been working all day on a problem, and it comes five o'clock, and they have to go home, they freak out. And they go to the ER. Well if you have an affiliated, you know pure respite, you'll know during the day that this person is probably going to need some place to stay tonight. If you work on that you can offer that person this respite service. So they don't head off to the ER or do something worse. They just, they just go to the respite, right. For that night and then the next day they're back at that Community Center working those same problems. So that's, so, you know, ideally we would like every single new peer respite to have an affiliated Community Center but you know that's a big ask and obviously you can't do that that year, but we want to get this idea piloted. Yeah, can I just ask a follow up to that so that that's helpful to understanding it. That the the pure respite, new peer respite center portion of the bill could move forward without the pilot. Yes, I could move forward without the other part of it is that true or do those peer respite centers need to happen first. The pilot couldn't move forward without the peer respite because we are not affiliating the peer respite, but you could remove the pilot out of the bill. That's true and you would still get the seven peer respites. Okay, not that I want to do that I just what what my confusion was when we're creating these new things and then I see pilot, I was like which comes, I was, it was a chicken then egg thing and I wasn't sure if the egg had to come from the chickens. I mean, it's really I think we were trying to we were trying to restrain ourselves, you know, we want to get this idea of affiliating them out and so we thought well, perhaps you can offer a pilot in this bill but if it's confusing, you know, we can, we can take it out of the bill. Maybe it's only confusing to me but that's helpful. It's less confusing now I get it. When you have a community center that gets fitted up with the respite center in Addison County you'll be very sure. If we had one in Addison County I'd get it better. I think there was a little confusion too because Ms. Livingston was talking about piloting the peer respite centers, I think. Yeah, that was, and I should have said something earlier but you know, that's why I said we have a pilot for peer respite in like a system, you know, they've already proven themselves, but the pilot is the connection between the community center and the peer respite center. So this is, this is a really great conversation and the issue of the issue, the issues are beginning to become clearer. I'm going to, I've asked Katie, she will work with Cheryl with you and others to get us to a place where A we understand what the money would be. So that's important. And, and will that we need to be clear on how many people are waiting out in the out there to begin a respite center I mean are there people out there right now, who would be putting in a proposal, if an RFP went out. Yeah, yeah, okay. I mean, it's like so every everybody now who who like so pathways would put in a proposal another way would put in a proposal. Yeah, I think the guys inside five years will put a proposal listen would put in a proposal to open up and you know so there are people waiting to put these proposals in. Yeah, okay this is good. Senator commies go ahead and then I want to finish my thought before Katie has to leave, go ahead. muted. I was talking with my local. And we had just had a meeting with our local mental health agency who said 30% of their workforce is peer to peer. And they I know we I was asking because I know we set up respite beds. That was how we were trying to. And I was told no because they're part of the government. People won't go there. So I'm just wondering are we, how are these going to be integrated with existing peer. These were peer support beds crisis beds. And I know there's some, there's quite a few of them around the state how how are these totally separate. Or are all of these agent peer support people that are presently working for mental health will they be able to get Medicaid coverage. These are questions that absolutely need to be answered. Before Medicaid gets put in place, but but I'm hearing that there, we know there's a need out there. We do it's awful. It's awful. But and we also know that there, there are people ready to help. So if, if there are some funds available to expand the illicit pathways type model, then maybe we'll begin to cover some of the needs that are out there. But that we're not going to be able to answer all the questions, I think, because you're raising a very good point. What does that link in with the current set of respite beds that we have, what about Medicaid payments, and then we move into the other bill on certification. And how do we continue the current peer to peer that we have, while also expanding to a new, I don't know a roster or a certification we we're not sure what it would be. And then doing an inventory across the state for what certifications are out there. So this will help not only adult peer to peer but kid, kid peer to peer so that there's a lot here and a lot of decision making points. And I'm going to let you talk in just a minute will to hang on and then. So my, my, my suggestion is that Senator Hooker that you have a lot of questions to dive into I will work with you on this, and with Katie and with others. Because we need to resolve some of the decision points and get it back into committee. Okay, that's okay. And will do you wanted to comment, go ahead. I just want to make sure you're keeping in mind that, ultimately, whether the services of peer support specialist will be Medicaid reimbursable is not whether it's OPR regulated it's really whether it meets CMS regulations. Yes, we understand. Okay, we get we get that we get that. And their regulations are not like OPR is you know they're very distinct. They only require a statewide certification with continuing education requirements and amendment of the state plan. Okay, they leave it very much up to the state to design the certification program. Okay, this is helpful. And, and I know SAMHSA has its own guidelines. SAMHSA is, yeah, irrelevant when it comes to the certification, they just support certification, and they have created tools to help states implement the programs. Okay. So it sounds like there is a little bit of work to do. And we don't want to leave these bills behind. We want to take a step forward. And the Department of Mental Health has said they're going to do some kind of a RFP so some inclusion, perhaps of that would be important. So working with DMH, mad freedom, OPR, Senator Hooker you have a, and the most important person of all, besides Senator Hooker is Katie McClendon. Okay. That's the direction Katie, I think we're going to head out to cover as respite centers in a way that makes sense stepwise, perhaps through an RFP. And then, and then what else was I going to say, we're good. We'll chat. Katie, I don't want to hold you up because I know you need to leave so is there anything else. Thank you. I appreciate it. I've been listening and taking notes and I sound like that the next step is I will circle back with Senator Hooker. And maybe we can start putting some words on a page. Okay. All right. Anything else committee. Senator Hooker. I'm just having trouble with the traps. So just ignore that. We're going to turn that thing off. I'm not seeing one. Huh. No, did she say just ignore. I thought you told me nor something there's no chat. No, no, no, I'm okay. My chats are going to different places. Yeah, I got that. I didn't get it. All right. Anything else committee on 194 195. Okay. Wilda and Lauren. Thank you very much. We're working at light speed. So warp speed is called I guess. So we want to, we'll, we'll be in touch a Senator Hooker and others will be in touch so we can move forward on this. Thank you for your time. Thank you for including me and I'm very happy to do any kind of writing, if you need language. So don't hesitate to call on me, please. Okay. And, and Lauren, you may want to stay in for the 197 discussion we're touching on certification. But it's not going to be as robust, I think, because Katie is not here. But if you could stick around that would be helpful. Okay, so let's let's just take a few minutes on 197. And then, and I'll tell you where we are with that bill, then. And how I've been, how I've been working on that bill and then we'll try and find some time to take a break. And then when you'll, we'll be back. And Ruth, you're going to be taking over whether with or without a break so. All right, so let's go to 197 there is a little draft that is on under Katie's name. If you refresh, there is also information from Holly Morehouse regarding 197 and you can read that going forward. But so, as we've taken testimony and we completely understand in this committee, and then we've also taken testimony in the Education Committee and Senator Hooker, Senator Taranzini and I have heard that information. So what a crisis we're at with kids in schools where the school doesn't have the capacity to deal with some of the mental health issues that they're seeing. So, and we know also that the after school program has been working closely with the administration through an executive order on a variety of after school programs not necessarily mental health issues. So as, as we heard that testimony became it really becomes apparent that something has to happen with kids with schools and to provide some support services for them, perhaps through the work that people like Holly Morehouse is doing. And what Sunny McNaughton testified to or Sandy Yandau there are different with different levels of certification for peer to peer support, understanding that there are levels for very young kids, levels for adolescents, and kids not not kids in school are not adults yet and but they approaching it but so it's more of how do we put in place programs and the programs that are here are mostly linked in with the after school. So as you go through the bill. And I don't want to spend a lot of time on it today and there because there reasons for that but just that there will be grants. One of the proposals in the bill is to allow for the Department of Mental Health to provide that are defined grants with specific criteria, working closely with the agency of education to provide after school and other support services for kids who may have some, some needs some mental health needs. The issue that we have bumped into as we've talked with after school with DMH and then with the agency of education. The issue that we've run into of course, nothing new it's funding. We have been told that Essar funding which is funding that goes for to schools for educational use and work. We have been told that the guidelines for Essar funding, allow for the proposal that is here and drafted in the legislation. For the Department of Mental Health to work closely with AOE to distribute an RFP or grants, put an RFP out and then distribute grants for coordinated peer to peer or peer peer support for kids, mental health for support for kids. The agency of education disagrees with the interpretation that Essar funds can be used in that way. And that's why I included the Holly more houses memo where she sites the guidelines for the use of Essar funds. And I've been working with JFO on this as well. And so we have not gotten clarity yet on the use of Essar funds because it seems like a real, you know, a win-win situation where schools are in dire need of mental health support for kids, where we have a Department of Mental Health willing to help and funding from the federal government so we're trying to sort out that funding piece. And that may influence the way the draft is written. The other issue is, as I indicated earlier, there was an executive order put out in the fall that would have an interagency after school youth task force. So we're just asking that the reports and the work that they do get reported back to the legislature, because their work will go on as long as funding is available and that goes past this session and I think it actually goes to the end of the next session so having that information and coordination is helpful. As part of the bill, there are, as we started talking about, we started talking about certification with the Andow and Sonny Norton when they were in detestified. So we're, the bill that we just finished talking about and asking OPR to do a kind of a look at what all the certifications are out there would help inform what's available for kids. So that's where this bill is. And Senator Cummings. I have a couple of questions. Essar funds are one time funding. Yeah. And this would be an ongoing program. No, it would only exist as long as there's funding I mean that's the point you know where it's at a crisis point right now so it's like acute care, you know, and, and so see how it. There has to be some reporting back and how it's working and the after school program, theoretically will become embedded into our culture but we can't promise funding for all of this going forward. And the other question I have is my local mental health agency actually runs an alternative school where kids go temporarily when they need counseling. Yeah. I'm assuming some of these kids with ongoing issues have an existing relationship with a counselor. Are we setting up a second system so that have a second counselor after school, and you know, again, how are we going to coordinate these services because that we've got services that are there that were severely underfunding and we're, and we're setting up new kind of temporary program so I just want to make sure that. Program that will be assisted because for kid to start something and build a relationship and then have it end. Could be do a lot of damage. Yeah, I don't think that's what we're talking about. Yeah, so you're talking about kids, the first aid for kids type program where you maybe have some activities that keep kids from mental health outbreaks or behavioral outbreaks. The issue we're facing right now with schools is a huge is an escalation in in need that goes probably above and beyond what we have currently. So but that's a good question and we'll have to, I'm going to have to sort that one out a little bit. Go ahead, Ruth. Just looking at the language sort of scrolling through it for the first time. I mean a couple comments that there are a lot of things that these programs are supposed to do for the program for to get the grant and the grants will undoubtedly be pretty small because $250,000 is not that much money. So I'm just a little concerned about the heavy requirement list for a small one time grant. Not that I disagree with any of the things that are listed. I mean, I think they're all valuable but and to my understanding as reading through this is that these would be grants to existing programs right so if it's like the boys and girls club that already has an after school program they could apply for this grant to do a little bit. Something like that or and that so the folks that we had brought in to testify who are currently doing this and it would help to expand the availability of programs across the state because the after school program now is is after school program but this would help expand it somewhat what people we brought in I don't remember. I'm just wondering about the sandy and owls and the sunny noughtens and the Lynn Kota's those folks were. Oh, I think they were doing after school programming that well they are capable, they can apply for these grants and would be willing to do that. They're not named here but well they are named here for example, youth mental health first aid and other evidence based techniques so their programs that have some track record. Okay, well there are nine things these programs would have to do to get a grant which is, and they're, they're pretty intensive so I wonder if we want to. Yeah, no, I think, I think it looks like a lot, I think it looks like a lot but in reality, I think that these are people, or they won't apply unless they have this capacity, they've already done a lot of capacity though I mean they have to do training, they have to do assisting families they have to do partnerships with teachers and pediatricians they I mean this is a lot to do. But they don't have to do all of it they might do some of it so well that's what it says the way it's drafted that's what I let's let's go through the bill when we have Katie here and we'll fine tune it because it's still a work in progress but. Okay, my other question is there are after school grants that were just announced that are federal grants through the Agency of Education. There are after school and summer programming, and that's $4.25 million. Right. So I'm wondering how they're not. Yeah, so the value of this one is it's mental health. That's the value of this one it is distinct. I don't see that as a different it doesn't. I mean, if these are supposed to be mental health programs after school. I'm not sure. Go to doing this. Go to section two. And it will indicate that the answer funding that whatever the funding is right now it's answer funding. Yeah, to the Department of Mental Health. To establish and administer a two year program in consultation with the AOE. And that programs to support the mental health and wellness needs of students, families and staff. So they don't have to do all of that but they will that there will be a mental health focus. It says the department shall issue grants to after school programs. I think when the applicant meets the following eligibility criteria, this nine things that they have to do to get a small little grant. Yeah, well we can modify that we'll have to go through it and see if that is something to be modified but understanding that the section two is pretty clear about the overall intent. I just don't see that this is materially different than the after school grants that are already it's met it is it is mental health. Those programs are not necessarily related to some mental health issues. So and I so I what I would encourage you to do is to go through the bill again. Everyone I mean we all have to go through it again and then look at the information that's come to us from the after school folks. And then we'll be pursuing the funding piece and related social emotional mental health needs in education because we've talked about this in there as well. Senator Cummings. I want to hear from our local mental health agencies and hear what they're doing. And if they need to plant their programs, and if there's any extra money out there, they can all use it. So, this is a good comment and and as we have heard the local schools some of the schools have working relationships with their local mental health agencies. It's ubiquitous and it isn't covering all the need that's out there so there will be some, you're, you're right there will be some geographic and other decision making that has to go on. So we don't want that conflict, you're absolutely right. Okay, one more because then I just wonder if this $250,000 might be better used for supporting school based clinicians. There are some schools that have them and are and some schools that don't and maybe those school based clinicians could then do some after school or summer work. That's a possibility. I mean it would, the school would have to the AOE would have to agree to that right now that hasn't been the case but we'll see what happens. So we can ask that we'll ask that question, Senator Hooker and, and Senator Taranzini and I will ask that question when we get into education. I think that would be value I mean just I, I, without revealing too much I know from personal experience that base clinicians are super necessary and overwhelmed and if we could direct support directly to them rather than creating new programs because I really feel like there's already there's funding for after school programs that just came out. But this is different, I mean this may be administered through that, but it is different it is mental health. It could become segregated from but having this accessibility will be important to schools overall. And the kids so we'll you know we'll talk about it they're good questions. Okay. One one more. No not on this one I just want to some point we're going to talk about what bills we're going to try and get out. Yes, because there was an article that came out about the wait times being excessive, and you and I have a bill that's aimed at dealing with some of that. I'm just wondering if we're going to be able to get that out. Yeah, I don't know if we're going to be able to get that out I know the house is working on that. So it may be a time when we get something from the house that we can work on that. I do suggest that you that you look at which patients were referenced in the wait time process they were patients without referral. They were patients without primary docs they were patients who just called up to ask for specialty support. Somehow, you know that doesn't some of that, some of that report is problematic but anyway we can talk about that. All right, committee, I need to leave and I'm going to suggest that you guys take a six minute break and then come back or whatever Ruth decides. And we have and on Tuesday, Senator thank you I will send an email out regarding some of the bills that we're going to be looking at and trying to get out ASAP we've been working on a lot of them. But there will be others as well. We'll do that. Lauren, thank you for being here and going through our discussion. And if you have thoughts on certification for children's support services. I had, I had talked with Lauren Hibbert about this so I don't know whether she's conveyed information to you or not about whether the national certification and serves a purpose or how does it serve a purpose in in the state process. Yes, we've discussed it and I think we can offer some support and some thoughts on that. Okay, that's good. All right. So this is not this is not again it's not psychotherapy. It's support to different level. Right. Okay, we're happy to discuss and talk further with will do it with with folks here and with much council as well. Okay, all right, thank you. All right, Ruth I'm turning it over to you and I am leaving so. Okay, enjoy. Thank you. Good luck with your meeting.