 April 14th. And this is the House Education Committee in the Vermont House of Representatives. And today we're going to be looking at some of the special ed mental health issues facing our students in our communities. And we're going to start today with Marilyn Mahusky who's a staff attorney for the disability law project. And I believe you also serve on the EC173 advisory panel. Is that correct? That is correct. Yes. I'm actually the vice chair on that committee. Thank you. So could you tell us how are things going? Well, you know, I have to say we've not heard from a lot of families at this point. I think certainly we've been paying attention to what's going on federally and and doing our best to stay in touch with what's going on more locally. I certainly I've prepared some remarks. I'm not sure that my remarks are going to address your concerns today. I think to some degree it's a little bit early to know how things are going because schools are just as of yesterday, officially it was the deadline for having community of learning plans in place and educating kids. And of course, in my neck of the woods, kids are on vacation this week. So I think we won't see till next week how things are going. But in my conversations, I think that some schools are are responding well. I think other schools are challenged by remote learning. The biggest concern, of course, we have, I'm sure that others share, which is statewide is the lack of connectivity. Our remote learning plans are going to be relying heavily on children having access to computers, to technology. Some students, particularly students with disabilities, they're going to be particularly challenged to access their educations through that medium. So I think it remains to be seen how this is going to play out on the ground from now through the end of this school year. We are somewhat forward looking and thinking about how can the Cares Act funds be used to address some of the needs going forward. So certainly, I'm not saying that schools are relieved of their obligations to do their best. I think they are certainly trying to do their best at this point to deliver educational services to kids and mental health services to kids. But it's good, but it's still really early to some degree to turn to really have a sense of how well that's working on the ground. I have, like I'm sure many of you read in the digger that, you know, some teachers are having a hard time connecting with kids. They're not hearing back from kids. I don't know what the Secretary of Agency of Education, you know, how they're going to respond with respect to kids who are just dropped, have dropped off. Certainly, the Cares Act funds that are focused. We don't know with the amount that's coming into the state currently, but we know that a significant sum, which to my mind, billions of dollars is a significant sum. But what I'm hearing nationally is that folks in education don't feel that that's adequate. So likely we will see more funds from Congress. But nonetheless, we know that 3.5 billion in education related funds are coming to governors, which they have tremendous flexibility in how those funds are used. 1.5 billion are coming to state educational agencies and the balance of about 12.5 billion are coming to local education agencies. Those funds largely are tied to title one funding, which is addresses. You know, that's our free and reduced lunch population. We know that those kids are already disadvantaged in terms of economic opportunity, in terms of their readiness to learn. So those funds are tied to that population of kids. Specifically, states have a lot of flexibility in how they use these funds, but there's been some guidance. We know that funds can be used to purchase one-on-one devices for kids. We know that they can be used for connectivity. I think that could be a great economic development boost in the state of Vermont, but that's my own. Marilyn Mahusky, that law project hat being on my head. The money can also be used for assistive technology devices for kids with disabilities, and that's a really important thing, because that's often where a lot of kids with disabilities are disadvantaged in terms of accessing education, training and professional development, addressing, providing mental health services. I've not actually heard a lot about that in our national community in these conversations, but I was looking at it again this morning, and I saw that there is funding for access to mental health services. I think a big thing that we're looking forward to is seeing that the funds can be used for summer learning and supplemental after-school programs, and so I think we don't know how long the state's going to be closed. We don't know how long schools are going to be closed, but I think it is an opportunity for us to think creatively about how we're going to meet the needs of students, where they are, when we come back together and be able to address their needs moving forward, and I think we will have some funds there to do that. In terms of compensatory education for kids with disabilities, those funds can be used for that, and I would expect that IEP teams will need to meet and reevaluate or assess kids, figure out where they are now, where they were, and make sure that they're getting those supports to bring them back up to speed. So as I said, these CARES Act funds, I think are a real opportunity for the state to meaningfully address the inequities in our educational systems and the delivery of supports to kids, including kids with mental health needs. If we can come together, if stakeholders are brought together and we think about how these funds can best be used and how they can best be delivered, we had sent a letter to the Secretary of the Agency of Education, and I believe all of you received a copy of that. We haven't received any sort of substantive response to what we did receive an acknowledgement of receipt of the letter, but I'm really hoping that stakeholders will be brought into the mix and a conversation can be had about how we can meaningfully address in a very transparent way these challenges going forward. So I don't know if that addresses your concerns about the immediate, like what's going on today. I think that's still evolving, but I think we have an opportunity going forward. Can you help explain the relationship between IEPs and the requirement for compensatory education? So our committee can understand that a little bit going forward. Sure. So under the IDEA, there are requirements as to how school districts determine whether a child needs, I'll tie these together, extended school year services and compensatory education. So extended school year services, IEP teams look at kids prior to the end of the school year and make a determination, not only about regression, but sort of where kids are and where we anticipate they might be in the fall. And so there are four criteria and I'm not gonna get all of them off the top of my head, but one is regression, one is sort of ensuring that kids have some sort of continuity and learning who need that. In terms of compensatory education, we often think about that in terms of when something has not been provided that was required to be provided. So if you file an administrative complaint or a deep process complaint or a parent does, and it's determined by a hearing officer that a kid didn't get the 10 hours a week he was supposed to get in some sort of support, we call that compensatory education and we make it up. So in this context, I think what that is gonna mean is that school districts are gonna need to look at kids, determine where they are when they left school, determined where they are now and determined what supports did they not get that they should have gotten in order for them to continue making meaningful progress in their educational arena. So every IEP team should be making it that kind of decision in terms of what compensatory education a child needs. And it can be creatively provided. Some may be that the child's gonna need to make up for OT or occupational therapy services or physical therapy services or speech language therapy services. Some may mean that we're gonna provide more supports going forward, it may be that we're gonna continue the supports through school vacations, through next school year. The teams are really gonna have to look creatively at that because we can't overload kids. So maybe a child needs more intensive reading supports. Well, you can only add so much more into a child's day. And so teams are gonna need to be thoughtful and creative in how they address those needs going forward. Thank you. What are the legal issues likely to be facing schools when we're out of this emergency? Well, I don't represent schools, I represent children and parents. So, I have to put on a different hat here. I don't think we're going to be looking at, I don't think we're gonna be seeing complaints of procedural violations. I think that hearing officers in courts are gonna recognize that we are in unusual times. So I don't think we're gonna see a lot of frivolous kinds of things. I think legally really where schools are going to be concerned is how do we ensure that children's needs are met going forward and we do our best to make up for the period of time that they lost. So it's hard for me kind of to think about like what liability schools would have because I think it's really gonna be based on individual students and what individual students' needs are. Thank you. Other questions? I don't see any at the moment, but Marilyn, we are probably, we're gonna be taking up delay for 173 at some point and maybe wanting to hear from you then as well. Well, if I have a minute, maybe can I make a plug for 173? I just- Sure, please do. As long as I'm there. Yeah. So just- We're in the middle of- Just for other people that are on Act 173 because our bill related to special ed for students who need additional support and we're talking about a delay because of the challenges we're facing. So go ahead, Marilyn. Thank you. Yes, thank you. That's a good summary. So yes, I believe the secretary has communicated to the legislature that he's recommending a delay. The advisory group will be meeting again remotely in early May and we'll be taking up that issue, but my sense is in communications with Megan Roy, who's a chair that likely the advisory group would support a delay. A couple of things. One is what we're looking at in terms of Act 173 is not just a shift in funding, but a shift in the delivery of services. And as you recall, I'm looking at the reports that form the underlying bill was that these really need to be done hand in hand. Of big concern is that schools are not prepared currently for the rollout and they are completely focused on other things. They are not paying attention to Act 173 at this point in time. If they're even considering their professional development for next year, I doubt this is high on the list, but that is gonna be a big factor. I don't think that schools are ready for this shift yet and there's still gonna be some planning that is gonna be required for schools to be able to make this big shift in the way that's the different delivery system of services, but the State Board of Education did submit rules to the Secretary of State. Their public hearings are scheduled. As an advocate, quite frankly, I have significant concerns about the rulemaking going forward at this time. The first public hearing is scheduled for next week. I don't think parents and I don't think educators are paying attention to this. I think that the comments that are likely to be gotten are gonna be few, I think they're gonna be deluded. That concerns me. We have asked the State Board to push back hearings and so far they've not agreed to do that. So that's a concern. This is that I think the public input is really important because this is gonna be a substantial shift in how we deliver services to kids. And it's gonna be a shift and we know that there's gonna be winners and losers in school districts in terms of the funding that they have currently to meet the needs of kids. But I would be happy to come in at another time and address that more fully. Well, we will be hearing from the State Board of Ed on Friday in relation to this Friday afternoon. And if you have questions that you would recommend that we submit to them, I'd be happy to just send them to me on the email. Thank you. Thank you for that. I'd be happy to do that. Okay, thank you. Thank you very much. Okay, so any other questions on from Marilyn? Okay, then we're gonna go to Laurel O'Mlan from the agency from the Department of Health. Laurel, are you here? Just need to unmute. Can you hear me now? Yep, good. Okay, great. Good afternoon, my name is Laurel O'Mlan. I'm the director of the Child Adolescent and Family Unit at the Vermont Department of Mental Health. So it's mental health, not health. And I was asked to give some overview of where things stand with our Succession 6 Medicaid-funded School Mental Health Programming during this period of the COVID crisis. So I did submit some testimony. If you all have access to that, I'll be talking through it and try to stop and answer questions. Avery, could you pull that up? Yes, I'll share my screen, just one moment. Okay. Should I wait until that's ready or dive in? Why don't you just dive in and we'll pick up the pages as we go along. Great, I thought it would be helpful just to do a quick overview of what is Succession 6 in School Mental Health. So that is the name, as I said, of the Medicaid Program and how we fund publicly the School Mental Health Services that are provided by, I don't know if I have control of this or if... Avery has control, so yeah. Okay, if you could go to the next screen, that would be great, or the next slide. This is how we use Medicaid to fund the partnership between the mental health agencies and the local educational agencies or the school districts essentially. And so in FY20, we had roughly a $70 million budget and that funded 831 FTEs and served over 3,000 students. It was closer to 3,500 students statewide with direct intervention and billing, but that doesn't capture the number of students that are impacted by these positions that are also providing some consultation support in their school-wide efforts to make sure that social-emotional learning is incorporated into some of their work. So there are contracts between these educational districts and designated mental health agencies throughout the state. They are in nearly every school district and also in 13 independent schools. And so there are some numbers there. This information is also included in a legislative report that was submitted in January, and there's a link to that on the right side of the slide if people are interested in reviewing that at a different time. Essentially, this funding supports kind of three, we think about three buckets of services. One is school-based clinical services and that is funded through a monthly case rate and the funding structure will become important as I get into what we have made shifts in response to this crisis. We also have school-based behavioral services and those have been a fee-for-service mechanism and then we have CERT, which is Concurrent Education Rehabilitation and Treatment, also known as therapeutic schools that are run by the designated agencies and those have a daily rate associated with them for the mental health component of those therapeutic schools. There's a separate rate set by Agency of Education for the educational component in those programs. Next slide. So given the shift that happened with first the school closure and now as we're looking into the closure through the remainder of the school year and shifting from the maintenance of learning period to the continuity of learning period, DMH has been looking at different avenues to support the continuation of mental health services for these students because we know that more than ever that type of support is really important for these students and families. We did develop guidance based on emergency information early on and have continued to evolve that based on what's coming out. There is a definition of what are considered essential services to assure the health and safety of individuals and those can be delivered in person to someone if they can't be provided through alternate means such as telehealth or telephonic. We do recognize that for the most part, Success Beyond Six School Mental Health Services can be provided through remote means but it is really based on a clinical determination and conversation with the family. The majority of the services are now done through remote means and if anywhere, there is some in-person that's strictly adhering to the guidance from Department of Health and the provision of those services. So we also issued some specific guidance around Success Beyond Six and again, continue to update that, that guidance was sent out to the agencies but also is posted onto our website and it included the changes that I'll get into of how we adjusted some of the requirements and payment mechanisms to support continuation of funding for the staff to be able to provide these services. As we release that guidance. Yep. Just as a reminder, one of our members did remind us that sometimes we get a little bit bogged down by acronyms so if there are any acronyms in here that aren't notified or noticed, just let us know. Okay, thank you. DASSA, it's Designate Agency or Special Service Agency just to clarify those. We did also hold some office hours or Q&A periods for the agencies to have dialogue with us about what that guidance means and what else they might be experiencing especially in those early weeks that helped us to really refine what our guidance was. And we continue to have those type of conversations with the executive directors on a weekly basis which is again, really a helpful process for our commissioner and leadership team. Next slide. So, specific to the success beyond six, which is the SB6, our School Mental Health Medicaid, the goals of the changes that we made in response to the COVID-19 crisis were to ensure that we could, to the greatest extent possible, continue to have services provided to students and their families. We wanted to be able to support students to be available for learning and also just to address any mental health needs that were going on during this period. We also wanted to make sure that there could be retention of staff because if there wasn't a way to continue to provide these services outside of a school setting, then the Designate Agencies wouldn't have the funding continue to flow to them and wouldn't be able to retain their staff. So that was an important aspect because we need those staff as we come back into the more typical school period in the next year. And we also wanted to ensure that there was obviously safety for everybody in the provision of those services. So working with Diva, the Department of Vermont Health Access, we did look at the changes that they made related to telehealth and applied that to the School-Based Mental Health Services so that all of those school-based services, which typically occurred in a school setting could now be provided through remote means, video and audio through telehealth or just audio through phone with the student in their chosen setting. So it's typically with the student in the home. We also, and I'll talk about some of the challenges which you've already alluded to related to connectivity as well as phone access to be able to connect with families through those means. We also looked at, again, the requirements that were connected with the payment structures. And so we pulled the kind of quick levers that we could, that we had some control over. So on the slide, it speaks to the School-Based Clinicians, which were funded through a monthly case rate. And there's a little bit detailed, but within that case rate, there's a minimum threshold of service that had to be provided in order to draw down that case rate for a particular student. And that minimum was two hours of a qualifying service per month. What we did was we actually lowered that to one hour of a qualifying service per month so that the funding could continue to flow at the same level, recognizing that there wouldn't be as much ability to connect for as lengthy of services as one could in a school setting. Just to clarify, when you say draw down, you're drawing down from Medicaid funds. Yes, thank you. I realize that there's a lot of lingo in here and I do apologize. Similarly for the therapeutic schools, the cert schools, those were a daily rate and they had a minimum of two hours of a qualifying service and we reduced that to 15 minutes. And I do want to note, these are minimums, knowing that for many students, they will receive more than this, but we wanted to have a achievable base that can continue to have those dollars flow. With all of this, just as a reminder, success beyond six through that partnership of the local school system and the doesn't need mental health agency, it's the local school system that actually puts forward the match that is then used to draw down the Medicaid. And so we wanted to get assurance from the doesn't need agencies and their communications with their schools that that match was going to continue to flow because that is, without that, we wouldn't be able to draw down the Medicaid. So we are continuing to have those conversations with the mental health agencies. And again, I'll get into some of the complexities that we're starting to hear in a little bit. So if you could go to the next slide, that would be great. So I talked about two of the three buckets of service, if you will. The other one is the behavioral intervention programming. I'm not sure if you're familiar with this, but this is a fairly intensive service that's provided both in public schools and in independent schools to provide more intensive support for students who are typically on an IEP and have a need for this type of intervention to be able to then access their education. And so this looks like a behavioral interventionist working typically one-on-one, but not always, but then supported by a typically a board certified behavior analyst, a master's level clinician to really draw up what is the plan for that student and to support teachers also and how to structure responses for the particular student's needs. And so because this was a fee for service structure that was based on every time you provide a service, you bill for it. And with the school closure, and these were typically multiple hours in a day. So there was a significant part of the Medicaid programming in here that was seen a drastic potential reduction. And students who had very intensive supports who are now home and trying to continue to participate in their education without that type of intensive support. And so this was an area of concern for everybody. The programs I will say have been very creative in how they're continuing to outreach and support students in this area. But again, it wasn't to the level that it had been. And so what we did was again, we worked with the designated agencies and the department of remote health access in particular their payment reform team. And we are in the process of finalizing a temporary, very interim for this period, emergency case rate to shore up that financial risk and to make sure that we can retain staff during this period. So that case rate will actually be retroactive to March 1st and we'll go through June 30th. And again, we'll allow a minimum amount of service to be provided to draw down the case rate that's established and that's based on their historical typical buildings and where, how many students were on a caseload heading into this period. So what that is allowing us for these programs to continue to provide that type of outreach and support to students, some of them are even able to participate within the school's remote learning platform and provide some of that live chat support to students when they can tell that they're struggling as well as outside of that either telemedicine or phone connecting with them and talking through what some of their challenges are. I'll pause there in case there are questions with that piece. Where does, where does lack of funding fall? Is that fall to the school districts? Lack of, reduced, reduced funding that is. And then Kathleen. Reduced funding as far as. I'm not sure what the question is, sorry. I'm sorry, I wasn't very clear. Right now you're able to draw down, we're able to draw down Medicaid funds through a match from the school district as well as a fee for service and it's calculated by fee for service for services that are provided, that are calculated. And right now that's down quite a bit which would mean that there's probably less money coming in. Is that accurate? Okay. That's accurate and that was our concern. Yes, and does that fall to the school district to figure out the fact that there's less money that will ultimately fall to the school district? So if there was less billing then there was less need for the school district's match but that also meant less revenue for the agency that designated agencies to be able to then pay their staff in these programs to continue to provide these services. So it became a matter of their costs remain what they had been pre COVID but suddenly the revenue was significantly decreased. And so that's where we decided to do this temporary emergency case rate and flip it from a fee for service model to a monthly case rate based on how many students do they have in their case load heading into this and what's the typical level of service delivery and then setting a minimum amount of service that they needed to provide in order to continue to draw down essentially a similar level of revenue to cover the staff and they're continuing to work with the families and the schools to design what does that service delivery look like now that we're in the continuity of learning period but prior to that they had still been reaching out with students talking with families and working through what were some of their challenges that they were facing and then being that point of communication back with schools when they were also hearing what some of the struggles were for students and even just accessing or participating in some of the remote learning. So this actually fell more to the designated agencies but this should help. I have a couple of questions. Kathleen James followed by Peter Conlon. Yeah, thank you. I was curious about what advice you're able to give to I guess to families or to students who are accessing their mental health supports by a telehealth either video conference or audio but maybe in a situation at home where it's hard to find a confidential quiet space to speak with a clinician. Thank you. That's an excellent question and I do believe that we are constantly trying to hear what some of those challenges are and tap into the expertise that we have access to through our department as well as other folks and including psychiatric input. So I think what we are really encouraging the providers to talk about with their students is is there a place you can get to if there's something that is so concerning and that they are not comfortable talking about. They have been able to do some chats as I mentioned through the school educational platforms. I was gonna get to this in a later slide but one of the areas of concern is that there has been an increase in texting between the clients or the family and the providers because you don't have to speak when you're doing that and so it's a different way of communicating that others wouldn't be aware of. Unfortunately at this time that hasn't been recognized as a method of service delivery that's covered through Medicaid. We have brought that kind of within our department and policy team and are taking a look at that but the federal guidance hasn't permitted that at this time. So we recognize that that's an important avenue for students and families and are trying to figure out if there's a way for providers to be able to be recognized for that way of delivering service. The good thing is under a case rate if they've provided a different level, a different service that has met that minimum threshold that will already cover their time and so the texting piece as long as they're documenting clinically, it's not billable but it can still be a way of supporting families. There are some risks within that. So I think it's not something that I would be in a position to provide really specific guidance to providers even. I think that's something they need to work through their own agency avenues to determine what their stance is. Thanks. Peter Conlon. Thank you. This is along the same lines. We've heard reports from teachers that some students are just simply off the grid and can't be reached. So I'm just curious to know how that works if a clinician is making their best effort to reach somebody but doesn't meet that 15 minutes a day of service. And also, I'll follow the question as well if you just would mind, talk about a school district match. What is the match that the school districts have to make? Again, lingo, sorry. So the way, I'll answer the last question first and then I'll go back to the other. The way that Medicaid works just to do it simply is if we had a dollar for every Medicaid dollar, roughly 40 cents of that is state or local match dollars to then draw down the 60 cents of the Medicaid federal dollar. And so it's that 40 cents that either comes from the state or in some cases there can be clean local match, which we, that's kind of how we phrase it, but essentially a school can't have federal dollars coming from some other avenue that is then used to leverage other federal dollars. It has to be non-federal dollars that then can be put up as the match to draw down that federal dollar. So in this case, with our other mental health services, we have general funds through appropriations in the DMH budget for success beyond six. Since 1985, I think it has been this partnership intentionally between the school system and the mental health system to have the dollars come through the educational system to then draw down the Medicaid mental health dollar. So that's what that structure is. Does that make sense? To your other question, I'm gonna hold on that until I get to one of the later slides and then hopefully we'll get to it because that's definitely a concern. Sarita Austin has a question. Okay. Hi, thank you for joining us today. I'm wondering if how you are able, or are you like looking at measuring outcomes in terms of students being able to access learning using the telemedicine or using the remote as opposed to face to face, just as a way of seeing if this works, well, if it works better, if it just to kind of get a sense of how this is working compared to the usual way of delivering mental health services. That's a great question. And I think it gets at something that we've started to hear from the providers, which is there are actually some positive lessons learned to come out of this that we do need to continue to talk about and explore. Do we have a way to measure this? We have our standard through our contracts with the designated agencies for the service. There are outcome measures that we're asking them to report on. And we're actually having conversations right now about what of those are perhaps impacted by this period. So we haven't put anything in place to say matter specifically how the remote service delivery is happening, but I will take that back and maybe do some exploring with both them and our quality team. But I have been hearing more anecdotally that during this period, not just in the school mental health round but our early childhood, early childhood and family mental health services that there has been an ability to connect with families in a more robust way than perhaps they had been before. And is it the remote method of service delivery that's allowing that? Is it that families are our home and are more available than typically? You know, we're just not sure, but it is something that we want to continue to look at. And just one more question. How do you connect with the primary care doctors? Do you know, in terms of medication or whatever? My understanding again, is that the providers can do still that consultation through phone, telehealth as needed. So I haven't heard that that's been as much a challenge, but again, I don't know that everything has raised up to our department related to that. Okay, thank you. Yep, you're welcome. The psychiatric services that designated agencies can provide can also happen through telehealth, which is to acknowledge that. If we could go to the next slide, we're almost there. I did just want to give a current status. So all of the designated agencies have shifted their service delivery to remote methods. There are, as I mentioned, a very small percentage that are still doing some in-person and again, following the guidance related to that. And that's due to the clinical acuity concerns or the intensity of service that's needed. For example, with a student who has autism spectrum disorder who might need that support for a brief period and then be able to shift to remote means. So some of the ways that they're doing this is they're being very creative. And I only gave a couple of examples on the slide of what we're hearing from the agencies and you'll probably hear some others from the testimony that's to follow. But they are still able to do groups even through video conferencing and working on emotion regulation and mindfulness to help students remember those things that they had been working on through the school year as they're now shifting to this remote learning. They have increased time with parents, as I mentioned, doing a lot of psychoeducation with parents about managing stress, supporting the students, helping them to transfer some of the behavioral plans that had been in place to what can that look like in a home setting while also not overburdening parents necessarily. So they're trying to schedule time with students that can also give parents a break. And they're also doing some just concrete supports with families helping to deliver resources. Some of them are going with the food delivery of the school and doing a check-in through that means. So again, those are just a couple of examples. I would say just to reiterate that these services, the school-based mental health is really to help address the mental health needs of students so they can be available for their education. And so it feels like this is even more crucial at this period given the just more isolation and separation that students and families are feeling at this point. So the next slide is the areas of concern which I think some of you have already highlighted and are pretty clear. There are definitely students who don't have internet and even have limited phone access or limited minutes. And we are hearing from our agencies that while families might have a track phone with some minutes they're hesitant to use those because they wanna preserve them in case another emergency comes up. And so to use them for mental health services is just something that families are grappling through. The unfortunate thing is we can't use our federal funds through some of the different grants that we have to actually help purchase minutes or even phones or internet service or devices for families. We can use them to purchase laptops and things for the providers, but not for the receiving end. And so we are trying to think through other avenues of how can we support that? And we're also having those conversations with the agency of education, but it's been quite clear in the federal grants that we currently have that that is it's restricted. So what are these providers doing for those students? That is where they are still doing some face-to-face check-ins. If they have, if there is a phone and there's no response or there's no callback, they're doing some planning with the schools about how best to respond to that. If there's a significant area of concern of risk they might do some coordination with the local police around a well child visit. But I think they're trying to figure out other upstream ways of connecting prior to that. They also are able to communicate, as I mentioned, just another option of communicating with schools about what some of those challenges are that the families are struggling with. If the school hasn't already had that. There are still team meetings that are happening with schools and the mental health providers as well as whoever else is involved with that student so they can also do some brainstorming about what the best approach is. We had heard over the past week or so that some schools were thinking about reducing or significantly changing their success beyond six contracts with the mental health agencies. And it sounds like that might have been somewhat driven by fiscal concerns. And so that was a concern for our department as well as our providers because there was a strong feeling, as I've said, that these services are really important to be able to continue to do. There is a method by which they can continue to happen, but we were concerned about the potential of those contracts being changed. So we did some outreach with Agency of Education. No, on the next slide, there was some guidance that was issued through a joint memo from the Secretary of Education and the Commissioner of Department of Mental Health talking about the importance of these services continuing and encouraging schools to be working with their mental health agencies. But I did wanna make note of that. And then lastly, families have been expressing to the school mental health providers, some families, that they're just feeling inundated because there are multiple people reaching out to them and trying to manage their time around that. And so I think the designated agencies are trying to coordinate with the schools about who's doing that outreach, when is it happening and just to make sure that we're not adding to the stress that families have. And then the last slide is what that coordination with Agency of Education does look like. So there was a joint memo. I didn't put the link, I apologize, but it is on Agency of Education's website. And the shared concern about the lack of internet or phones. So we wanna continue to coordinate about what are some of the potential solutions related to that. And then if there's a need for compensatory services, we wanna continue to do planning with them. There also had been some issues with some schools being concerned about the platforms that designated mental health agencies were using for their telehealth. And just to acknowledge that the Office of Civil Rights through HHS federally announced that it would wave, under its authority, it would wave the potential penalties for HIPAA violations if service providers used kind of the everyday communication technologies like FaceTime or Skype. If it was using good faith and essentially as a last resort if other means weren't possible. But even then the designated agencies, I believe all of them have business associates agreements with whatever platform it is that they use for telehealth. And so we were trying to work through that with AOE. And again, included that in the memo of communication out to the superintendents. But it kind of tapped into an age old topic of HIPAA FERPA and what's at play there because it doesn't sound like those same flexibilities have been offered federally through FERPA. But again, continuing to wanna coordinate with AOE around the provision of school mental health and what are the needs of students and how we can partner together to address those. So that's the information I have. Again, if I didn't answer some of the questions, glad to clarify. I had, well, there's Peter Conlon's question. Are you still there, Peter? I think you basically answered that you're doing your best to make sure that the practitioners are getting connected with the kids, even though some may be just simply off the grid. And I guess my question was a little more specific about whether that's resulting in an inability to bill for services because of the inability to contact the kid. The other thing I just wanted to ask about when you talked about that some schools were considering changing their success beyond six contracts due to fiscal concerns, you were sort of talking about that in the past tense. Is that less of a concern now? I mean, we've heard this mentioned, but also haven't seen any evidence that it's actually happening. I think I had some clear outreach from a few agencies last week and they were headed into continued dialogue. I did hear from one that they were notified that their contract would be ending. They were gonna have some personal outreach with that district and talk about what they were able to still provide with the flexibilities that have been offered through this period and also ensure that they saw the memo. So I actually don't know if anything has been terminated at this time or significant changes made, but I do know that there were multiple conversations happening in several regions across the state. Thank you. Sweet Austin. All these things to do, lower hand, unmute. This is a broad question. When I was watching Governor Cuomo's press conferences a few weeks ago, they have in New York a hotline for mental health for anybody. And I don't know about others, but the constituents I'm talking to are just hanging on by their fingernails in terms of trying to figure out the economic and the health aspects of this. And I was wondering if the Department of Mental Health had maybe thought about doing that, not like a suicide hotline or a drug hotline, but just a hotline to let people to normalize probably some of the emotions that they're feeling and give them strategies. I think they would have to do a lot of research to find out. So I think as an agency, we have been trying to promote 2-1-1 as one of the main sources for people to go to when they have concerns or questions. And that is a resource that can also then help them connect with their designated mental health agency depending on where they live. 2-1-1 has all of that information. We also have been promoting the crisis text line. And I can say what that is here. So it's texting BT to 741, 741. And that is a national text line, but if you text BT, then we see what the Vermont data is and we have seen an uptick in topics related to COVID through that text line in the past month. But that is something certainly that can be made available. We have not stood up some other crisis line specific to COVID. We felt like we wanted to continue to promote the ones that exist. Okay, so if I put that in my post, in a post, that would get them, they could call 2-1-1 and get to their community mental health. Okay, great, thank you so much. Absolutely. If you could also go to Department of Mental Health website under information about coronavirus and there is a box that has, it says you are not alone and it has some of the different crisis numbers to call. And I actually have screen capture that myself and I'm starting to put it into my own emails. Great, thank you. This is sort of on the side and I don't know if you are the person to answer this but I heard in one of the reports that the reports of child abuse, there was not a significant uptick which actually to me was concerning because very often child abuse is recognized when children are in school. What are we doing for those kids? So I think everybody shares that concern and we know that just there aren't as many people connecting with kids to be able to pick up some of those signs. And so I think that's why it is important to be able to continue to have the services occur through other means where possible. I also know that trying to promote other resources for parents around how to manage stress, what are their, where can they outreach for support? So the Vermont Federation of Families for Children's Mental Health, for example, has peer support that can be offered with families, prevent child abuse from a lot, has some information on their page. So it is an area that we are concerned about and concerned of what those might look like as we come back into the typical service engagement. I don't see any other questions right now, Laurel, but I know that you've probably gotten everybody thinking. So I'm very much appreciate hearing from you and if you could hang around for a little while, that would be great, but I understand if you need to run. I was planning to say on, so glad you thank you. Okay, great. So no other questions. I see no other questions at the moment. So I wanted to turn to David Melnick. And David Melnick is with one of the designated agencies, Northeast Family Institute. And one of the reasons I thought he would be so helpful is he's been involved with working with schools to become trauma-informed schools. So I wanted to speak with David today on, you know, tell us what's happening on the ground, how are folks doing? And what should we be watching for now and in the next school year? Thank you. Is that coming across to everybody? You are. So I have some slides, but I think I'm gonna actually ask people to make my testimony a little bit more participatory and interactive if we can. I wanna thank my colleagues in Northeast Kingdom for being willing to swap the time slots a little bit. And I appreciate that. I want to try to cover a few things about my work in schools. And I'll sit a little bit of a context. I work for end of five or months. We're a private nonprofit mental health agency statewide. And my role as director of outpatient services is kind of a variety of roles over the years, but right now most of the work that I do is in the public schools and public and actually a number of day treatment programs as well. My work as stated is to try to help schools become more trauma-informed. And so I'll probably leave that part aside a little bit and talk a little bit about a bit about some of the concerns that I have. And I think shared by most people that have kids at heart, kids and families at heart. I guess I wanna say as a preface that I'm incredibly worried about all kids but I am disproportionately worried about the kids that are experiencing a different level of stress and strain because of the pandemic. And so I think as was noted before, we're all being impacted and affected by this pandemic, but we are impacted disproportionate disproportionately and that depends on a number of factors. I wanna try to address three things in kind of somewhat rapid summary fashion. One is a bit about stress and stress vulnerability. And I wanna talk just for a minute or two about who is most vulnerable while in some ways we're all vulnerable to the pandemic. I wanna talk a bit about what we know about who is more vulnerable in addition to just children as a category. Second, I wanna break down some of the specific concerns that I'm hearing in schools. I work with about seven or eight different districts statewide now. In the last 10 or 12 years, I've probably been physically inside well over a hundred schools and working directly with them. And so I wanna share some of the specific concerns that I'm hearing from educators about students and parents and primary caregivers. Third, I might wanna touch a little bit on certainly some strategies that we're talking about. They will align with the things that Laurel said very strongly, they'll be mostly an overlap there. But I do wanna frame out Chairwoman Webin and I had a brief conversation last week and while the primary focus right now of the pandemic is on, one of the primary focuses on the medical concern, I find myself and many of my colleagues really concerned about the secondary pandemic that's occurring in that or a secondary public health crisis that has emerged since schools have closed down and that is we now have a public health crisis around safety on child safety. I think on a level that has been unparalleled for us. And so the last question to Laurel, many of you maybe have seen a headline recently from the United Nations about the horrifying surge of domestic violence around the globe. And so I'm just assuming, and I'm gonna extend that, that there's a horrifying surge in children being hurt within families domestically. I'm not coming furnished with numbers, I think our colleagues at DCF would be best equipped to talk about numbers as they relate to that. But there's no question to me that the longer lasting public health crisis here is the public health crisis that is secondarily being impacted by children and families that are probably under resourced and in homes together without enough protective factors to help them moderate the experience of stress and overwhelming stress that they're experiencing. So I'm actually gonna ask you to participate if you're willing to by getting a piece of paper, it looks like some of you are taking notes or glancing down. And instead of me showing the slides, I'll just ask you to do it. So if you just draw a simple triangle, if you're willing to do this, I can use a triangle by means of explaining a bit about the vulnerability that people have to this kind of level of stress. And so if you have a, I guess it's called an equilateral triangle, equal sides, on the left side of the triangle, if you'd put the word stressor and then in parentheses underneath it event. And so the most obvious thing that I can say right now, the stressor is the pandemic. The event is this worldwide crisis, medical crisis that is also creating this social, emotional, relational, financial crisis. So that's one part of what we're gonna examine in terms of determining the effect or the response that people are gonna have to the COVID-19 pandemic. So on that one side, you have stressors and the event that helps determine what reaction you're gonna have to that event. On the second line down, the second side of the triangle, if you would put the word stress response and then in parentheses underneath that experience. So we have a stressor that's the pandemic and then each one of us, each human being has a unique stress response, a unique experience of that stressor. It's not equal amongst people. We're having a disequal or disproportionate response. Your response to the event of the pandemic is gonna be determined by two general things. So if you had two offshoots from this stress response, if you had two lines going up, one factor that will determine your response to this stressor is your own personal history. If you have a history of trauma that has been unaddressed, not fully examined, not fully helped, which are most of the kids and families that I work with and have worked with over my 35 years. If you have a trauma history, it is highly likely that if that trauma history has not been dealt with, you're now experiencing echoes from that initial trauma exposure. So the kids and families that I work with and that I worry about most are those that have not fully resolved or cured or healed themselves or progressed far enough along. And so for them, it's not just this event, it's also the historical experience of being traumatized and dealing with high levels of stress. The second general factor that will impact your stress response on that side of the triangle is existing challenges that you have. And so by example, if you're a 16 year old high school student living in a well resourced family with no health problems, you have minimal likely existing challenges outside of the event of the stressor and you're missing school and if you're an athlete or a kid that's in drama, you're missing those after school activities. So I'm not trying to imply that the experience is absent. What I'm recommending is that based on who you are and your own personal history, the existing challenges will be different related to this stressor. And so in comparison to the 16 year old healthy high school student, if you're a 64 year old fifth grade teacher with preexisting health concerns, your response to this stressor is likely to be very different because you're worried at a different level. Is that making sense? Can I see some non-verbals from folks? Does that make sense? And then on the bottom of the triangle, if you would put protective factors or buffering and then maybe in parentheses on the bottom, the kind of seat, the foundation of the triangle would be protective factors or buffering. And in parentheses, you might put your existing strengths and resources. And so what we know from the resilience research that goes back a number of decades now is that the people that fare the best when there's a lot of adversity are people that have protective factors. Those protective factors you can think about is the being divided in two or three different ways. There are genetic protective factors, IQ, competencies, good singer, good dancer, good athlete, good artist. There's certain things that people might be born with that gets elaborated throughout their lives. The vibrancy of your community, the connections and quality of your connections, the kind of quality of your inner circle, that tends to be the most important protective factor that any human being has. So you could live in a working class family and maybe have less financial resources of another family but if you're surrounded by a loving, regarding trustworthy, reliable family, you are in many ways as resilient as a kid whose family might have fancier cars and more stuff. So we take a look at those three things. You take a look at the event, the experience of the event, the experience of the event, again, being determined a bit by your history and a bit by what this existing stressor means to you. And then all of that is mediated by protective factors and buffering existing strengths that you have. One of the concerns and to talk, get to the kind of second area that I just wanted to speak about is the unique experiences of many kids that I'm most concerned about kids that have a trauma history, kids that are living in highly stressful environments. So I'll start with a list of three things that I find myself primarily worrying about with children that are cooped up at home right now. The first thing that I'd want people to recognize is that many children coming from adverse conditions, from stressful conditions, they live a divided life. When they come to school versus some of the conditions that they have to wrestle with at home, they live somewhat of a divided life. And what I mean by that is we work with a number and serve a number of students and clients in mental health that learn to compartmentalize when they come to school, that the rules, the norms, the expectations, the way that business, relational business is comported is often different at school than it is at home. And so many youth learn that they have to live a divided life, that some of the rules and norms that dictate how you survive at home may not be the same kind of norms and rules that you'll use when you're at school. And so one concern that I have now is for kids that are coming to school and have some of the most abundant positive relationships that they're being denied that. And so by virtue of not going to school, many students are experiencing an increase in relational poverty. And unlike financial poverty that is difficult enough for us to figure out as a society, relational poverty requires as its antidote, your ability to have access to people that are trustworthy, reliable, safe, well-boundaried, firm, clear and have high expectations for you. And so I'm worried that there are many students in our communities that go from a very abundant experience at school to an experience at home where they're working as hard as they possibly can with their families to survive the best that they can. And so one of the things that chairman Webb and I talked about last week that I think we were both concerned about is that there are a number of students that right now are feeling terribly abandoned by the situation. Again, nobody is intentionally creating circumstances where we had to close down school. We had to close down school for safety reasons. But I know from my work with kids over these three plus decades that there are a number of students right now sitting very heavily with a sense of abandonment, betrayal and rejection that they're not in school. They can't make cognitive sense whether they're 15, whether they're six, whether they're nine. If some of their most positive relationships are nourished at school, being denied that often doesn't make great sense to them. And so part of what we're talking about in schools and recognizing that is teachers and paraeducators and instructional assistants and counselors are having to reestablish a connection with kids that because of the impermanence, I mean, because of the stress that they're experiencing, a lot of educators and it came up again already today are feeling like they're not able to connect in the ways that they're used to. And so part of the strategy for a number of educators right now is you got to go back to go forward. You can't take for granted the connections that you had for kids because they're living many are now living in environments that are so stressful that you literally as an educator are not the same person to that kid today as you were a month ago. Does that make sense? Some nonverbals just for folks. And then some of my unique concerns about some parents and again, this could be from a variety of different backgrounds. I'm hearing this from my community of family and friends. I'm hearing this from educators that I work with that parents are in survival mode now. You're hearing stories about moms and dads that are hardworking people that either can't get out to work that have to the educators that I work with teachers that have their own three, five, nine year olds at home while they're also heroically trying to teach their classes. And so there is a level of stress and strain that feels to me like many, many families are in survival mode. Second concern that I have about some families is that if you go back to the triangle that I just painted, there are scores of families in each school whose parents did not have a positive experience in school when they were children. It's possible and at times likely that as their stress increases, they are visited by those echoes of their own experience of school. And so if school was not a positive experience for the primary caregivers, then school now being in their home feels dramatically intrusive to them. And so I believe some of the resistance, I don't like that word, but some of the apprehension that some families have in engaging in virtual learning is I don't want you in my house. There's a level of kind of intrusiveness and mistrust, not just about educators, but anybody that might represent an authority figure. Third thing that I'm hearing about families, about parents is again, a level of overwhelmedness and helplessness. When you feel overwhelmed and helpless, you start cutting away the things that don't immediately impact in a positive way your survival. And for some families, school does not increase their Maslow, it does not enrich their basic needs. Fourth thing I'm hearing is parents are feeling exposed that if they don't feel competent to help or assist their kids with the media, the method by which they're engaging with school or helping them a bit with some of their academic tasks, many feel ill-equipped and not competent. They are thrust now in this role that for many families is just not comfortable. So the intrusiveness, and then the final thing I'll say, two final things is teachers, guidance counselors and principals, they're often, while they work very intimately and closely with families, oftentimes in schools, the point of intervention is the child, is the adolescent. And with virtual health now, that's almost flipped where the primary point of intervention is often the parents and the primary caregivers. And while we are rich in resources in Vermont and in gifted educators that know both how to work with kids and how to work with adults, we're asking our educators to tool up very quickly to be experts in working with adults and to be experts in working with adults that are in heightened stress states. We are harder to work with when we are in heightened stress states. And then the final is that, I think I mentioned is that the parents now, some parents are the gatekeepers of education. And so there is a little bit more electability in terms of whether you do it or not. That's not the case so much when schools and session, if children are not sent to school, we have infrastructures that address kids that don't attend school. I don't think we've built yet the infrastructure because there's been so many different priorities to try to figure out how to get education into the hands of people that need it. Let me pause there. I don't know how long I've been talking. So I'm gonna pause. Representative Chairwoman. Yes, yes. So in every crisis, there's an opportunity. Yes. I mean, this is a pretty tough picture and it's gonna make me wanna cry. What are the opportunities that this crisis presents in addressing the needs of our children who are facing stresses that have been exacerbated? Yeah. What are the opportunities? I think we culturally and community-wide have great opportunities, I think. I wanna be careful. I'm a resourced person. I'm a white upper middle class, educated middle-aged guy that has a lot of resources. And so when I speak to opportunity, I see enormous opportunity in terms of resilience, in terms of connectivity, in terms of, we're learning a lot right now about what doesn't work. The kids and families that are not engaging, I would never blame schools or educators for that. But I'm doing a lot of thinking with the colleagues that I work with around, why is that? What can we learn from the current crisis that actually ups our game once we're back into more normal practice with kids in classrooms? And so one thing I suspect will be an opportunity, kind of a resilience opportunity is, there are schools that I work with that do a remarkable job engaging and connecting with kids. However, some of the kids that are coming from the most stressful environments, I don't think that we have nearly optimized our capacity to develop positive relationships with kids. And I think this crisis is gonna give us pause to think about how can we up tool and increase our ability to maximize and optimize relationships. I think there's an incredible workforce opportunity here. And while I may run out of time to talk about it today, most of my work is I'm not working directly with students in these schools, I'm working with the workforce with educators. I believe that if we keep our workforce moderated in terms of their own stress, if we don't place as a state or as an AOE, inappropriate expectations on them, I believe that if we work really closely together as a workforce and keep our workforce in a moderated, mild to moderate stress, that the workforce in education will do what they always will do is they will be remarkably creative and innovative. That one of the opportunities when stress rises is we as a species get really good at being innovative. And I heard a little bit of that people talking about before is the possibility that we will come back from this crisis closer with one another, more innovative with one another. I have been an opponent of telehealth in our clinic, even though it's been available for a decade, I feel like the tools as a therapist are taken away from me by this kind of interaction. And what my staff and I are experiencing now is while we don't want telehealth to replace in-person contact, we're actually sharpening our skills in ways that I don't think that we could have anticipated a month ago and I'm eating a bit of crow about it because I'm seeing some of the benefits and some of the possibilities. So yes, I'll pause there. I see a question, Sarita Austin. So first of all, as a former guidance counselor, I just wanna tell you that everything you said is exactly what I've been thinking. And my concern is putting this stress on parents to provide a certain level of instruction when number one, they're overwhelmed just on their own economically and then asking them to all of a sudden take on these skills and knowledge that they don't have. So that's a concern that we as a system, the AOE and I don't know about our committee, but I just wonder if we're adding to their stress which then passes down to their children. And I just wanted to ask about, you spoke about the antidote that people need in order to gain some strength or calmness which we can't access now. Like the antidote will hurt us. We can't be with our families, we can't be with our friends, we can't be in our community. So what are your, do you have any thoughts about how people can possibly get that help or get that support? I think some of what Laura was talking about before I think again, stress necessitates a level of innovation and creativity. I'm not a very media or online savvy person. So I have no Facebook, I have no Instagram. I have, but what I'm hearing from staff, what I'm hearing from educators is, and as Laurel said, I think there's a level of creativity around texting. What we know actually builds resilience is not a 50 minute therapy session with me. That may help and that may augment but what we know is short moments of action many times a day. When it's all answered this more when life is more normal, when a teacher is in the hallway and asks that nine year old kid how their game went yesterday, that's resilience building. A high five in passing. When a teacher sets a firm limit on a kid and then does it in a benevolent heartfelt way. So I'm going with the mantra of short moments of action many times a day. Whatever that positive action is, whether it's a text, whether it's a Facebook post, whether it's a quick phone call, whether it's a Zoom interaction. And you also I think implied something very important is that not only does stress roll downhill, it is contagious down through the generations. Epigenetically we know that. It's passed down from parents to kids. And so if we, one of the things that I think is happening is that educators are up tooling so that and they're building new capacities so they can engage with parents. If we keep parents regulated, I trust parents. If we keep our workforce regulated, I trust our workforce. So to me, I love working with kids and I'm dedicated to working with kids but this is a time that if we keep adults well moderated if we stick to structures and routines and rituals, if we are in our engagement with families very rich with empathy and validation and care and concern and compassion. And if we don't get stuck with what they're not doing and I think also maybe implied in your question, I would never tell educators to lower expectations too much. I am worried that there's a little, that a focus on academic outcome will only increase the disproportionality. I think right now the outcome that we should be looking for with kids that we're not reaching in particular is connection, that's the outcome. The seed that we're planting by just having short moments of action and connection many times a day, that seed is gonna grow dramatically when we're back in school together, I hope in September. Thank you so much. Welcome. Thank you so much, David really appreciated this and also the opportunity to see some things that might be guiding us in new directions we could well have missed had we not hit this unbelievable crisis. I don't see any other questions. I know you have to leave and we have the folks from the Northeast King, excuse me from the Northeast Kingdom designated agency that we'd love to hear from. So thank you so much. I hope that you are in touch with the agency. Thank you and last thing I wanna say before I sign off is probably like many people one of the experiences of COVID-19 that I'm experiencing personally is a sense of kind of powerlessness and helplessness. I'm not out and about the same way I'm staying in touch with schools I'm having Zoom meetings with the groups that I meet with but one of the ways that I can combat my own experience of helplessness and uncertainty is to be available. So Chairwoman Webb has my email, Avery has that if I can be helpful, I would love for people to reach out when we reach out and help each other there's a reciprocal positive experience the helper feels good and the person being helped feels good. So if I can be more helpful in the future please let me know. Thank you. I am anticipating that we're gonna be taking broad looks at a variety of institutions and the way that they've been functioning and anticipating some changes. So if you see something that we can do at the legislative level, please do be in touch. And as we start to look at what's happening next year if there are things that we can do next school year. Yeah, I have some ideas about that that I can share down the road. Excellent. Thank you so much. Appreciate it. So I'm so happy that we're also gonna be able to hear from the Northeast Kingdom. And we're gonna start with Tomaz who is the president and CEO of the Northeast Kingdom Human Services. So Tomaz, please. Good afternoon. And thank you very much Chair Kate Webb and Representative Lynn Basler for inviting us to this conversation today. And certainly this was a very poignant hour, almost hour and a half now. And I think as we are all sitting around our tables we are all learning from everyone's testimony. I wanted to introduce my colleagues from Northeast Kingdom Human Services. So in my room here I have Marcia Stricker who is our Chief Clinical Officer. Vicky Whitehead who is the Director of our Community Outreach Services. And on the screen we have Noreen Sapiro Berry who is our Director of School-Based Services. And before I turn it over to them I would just say that probably we'll echo or maybe even amplify some of the comments or sentiments that we have heard from the previous speakers. And I think that we are in the process of learning how to merge the practice of online learning, teaching and perhaps providing mental health substance use and intellectual disability services. And I think we all recognize that we have just started doing that practice and it will probably take a little bit of time before we become truly proficient. I think it really comes loudly and clearly that I think we are still learning that curve is still steep and we are climbing it all together. I think as we are doing it I think at least from the vantage point of our organization we want to be mindful that we do not want to sacrifice the good for the perfection. And as we are improving our efforts as we are reaching out to our communities as we are reaching to the children and their parents we do the best that we can hoping that we are going to reach to that level hoping that we can reach that level of perfection. And I think that one question is going to remain are we going to have enough time of learning before the former normal will return? I don't know the answer to that question. So with that said I will turn it now to Noreen Shapiro-Berry who will provide her test for me. Great. Thanks Tamas. Good afternoon everybody. Great to meet you all. Hope to meet you in person. And thanks Lynn Bachelor for inviting us. Lynn is on our Children's Standing Committee and a great advocate for us. I'll appreciate you inviting us. So I wanted to just kind of give you an opportunity to hear how one of the designated mental health agencies is actually implementing all that we've been talking about. And Laurel did a great job summarizing success beyond sex so you understand how it works. And I have to say that the school department was probably the easiest department to make this immediate switch to remote learning. Most of all of the school staff, the majority of them had already had remote access so they all had laptops and remote ability to access our system as well as be able to get set up on Zoom platforms. So really it was seamless really. The last day of school was March 17th and on March 18th we were able to start providing the telehealth and the phone conference supports to our students and their families in the home. We've continued to provide those services. We have treatment team meetings all using Zoom and phone. So really business has changed as far as the environment goes but we are continuing to move right along. And thinking about what Dave was saying about the risk of increase in relational poverty, that's what we're doing. When we have the school-based services department folks reaching out on a daily basis, multiple providers reaching out, they're getting that nurturing from us and we're also there providing support to the parents. So we've really seen it to be an opportunity. Yes, we've seen some of the barriers as you've heard. Internet access is some limitations. Privacy, one of the things that Laurel was mentioning is that texting is something that's not being covered right now. Well, what are you gonna do if you're a high school kid and you're used to talking to your therapist in a private setting and now your mom's in the next room, right? So I mean, if you could text, it would be a lot easier. We don't know if that's gonna be covered yet but so there's definitely some challenges that we're looking at. Other opportunities that I'm thinking about, snow days. I mean, you think about it now, right? Okay, school's closed. I mean, maybe some people aren't so happy about that but the idea is that we could continue education with a snow day. So I think there are lots of opportunities that we just haven't even quite discovered yet because we're still trying to figure out what this new normal is. So just to, I was listening to what Dave was talking about and I think what we're seeing is that triangle he was talking about is basically your trauma response and you either have, most of us have three different ways that we respond to trauma and anything can be considered trauma or trauma is a very subjective term, right? So we're all experiencing trauma right now. So you can either fight, flight or freeze, really. Fight, you get aggressive. When you're fleeing, you're withdrawing, you're afraid and when you're freezing, you're paralyzed. You don't know what to do. Not none of them are better than the other. It's just what we all naturally do. You probably notice within yourself that there's something you naturally do when you're feeling trauma and you have to fight it, right? He was saying, if you have a lot of resources and you have a lot of things that buffers, I think is the word he used and that's gonna help you get through it and move beyond that default stage, but that is what we're seeing. We're seeing that with parents. So for example of fighting would be, we're not gonna do that coursework the teacher wants us to do. We're gonna go on YouTube and we're gonna research how to make masks because that's what we're gonna do. That's what makes us feel good and that's a way that they survive. Another family might be really afraid. Oh my God, you're gonna get retained and oh, there goes your scholarship for this college you're trying to get to and all of these other concerns. And so they're freaking out and trying to get the kids to learn as much as they can and the kids are resistant or the kids are freaking out too. And then you've got your parents that are freezing that are like totally freaked out and paralyzed and they don't know what to do. So, and that's what your teachers are responding that in those same ways. And we ourselves as providers are responding in those ways. So we all have to kind of plow through those responses to be able to support families where they're at. Some of the thoughts about the future, okay, summer. I'd like, I know we all want to think about summer. The students that are enrolled in the school-based services at Northeast Kingdom Human Services are all eligible for our summer program. Now, some of the students who are requiring, they may require extended school year services and that is part of the IEP process that they talk about trying to prevent the summer slide. So let's say before COVID-19, right? I mean, if a kid was not doing well academically and they know that if they don't have services over the summer, they really are able to not able to pick up where they left off in the fall. So a lot of times they'll have tutoring over the summer. So some of the students that we serve will actually be, well, in the past, we would be right with them while they're receiving tutoring in the summertime. Hopefully, we don't know what the summer is gonna show this year, but we would be able to provide those kind of services to our students to help them access their learning over the summer, if that's need be. And we have programming where the kids will be able to provide, I guess I don't have a crystal ball. I wish I did to be able to say what's gonna happen this summer, but I am hopeful that we'll be able to resume our work in July at least. So we can work with at least the kids that are receiving services through us. And then my colleague, Vicki Whitehill, she has a home of community support department where we also have a summer program for those kids as well. So even though they may not be enrolled in the Success Beyond Six School program, they're also receiving services through NKHS. So I'll stop there and see if there's any questions you guys have. Questions? I will jump in and just say one of the things that we've seen as an opportunity at this point is we have been able to staff something called a parent support line. It's a warm line right now. It's 8.30 to five Monday through Friday. It's designed for parents, any parent in the Northeast Kingdom of the state, although anybody in Vermont could call it. It's, we can give you the number after and you can maybe share it. So, because that was a question I think that Rep Austin had about warm lines. And so we are, we're responding to that. We've really seen a great response. It's a free service. The calls are very solution-focused. Behavioral strategies are implemented. Sometimes parents just need to be validated. I've received a call this morning actually from a parent who wasn't necessarily calling for support but wanted to share that she was learning something about herself and about her child and she wanted us to know about it and that she needs to be more silly because her eight year old child just needs to be goofy and she doesn't like being goofy because this is a real serious time. So she discovered this app. I think it's called Marco Polo app and that this is something her child can now play. And so she just wanted us to know that so we could share that with other people. So I mean, that was just, I thought it was great that she called. So that's just an example of one thing we are doing with a plan is to be able to have this go on beyond COVID-19. We're not sure how that's gonna be funded but we'll figure that out. So how many of your kids, if you could give us just an idea, the kids that you have been able to reach, are you at 100%? Are you at 75%? The students that you have on your case list? Yeah, I would say I don't have the exact data on that Taraweb but I would say at least 80% that we're able to access. We do work in some of the therapeutic schools that Dave Melnick is connected with. And so those students are getting multiple contacts throughout the week. And I don't think that we're seeing as much, those students tend to be more of a higher need student because they're in a therapeutic school versus a public school setting. So they are getting what they need and they are getting the responses from us and from their teachers and their educators. And your connection to the school or to the teachers that are the core teacher of certain of your students? Yep, staff are participating in IEP meetings, treatment team meetings, they're consulting with the special ed case managers and the teachers and the guidance counselors. So yeah. And in terms of we heard some of the challenges that are facing us in relation to accessing Medicaid dollars. Are you folks whole? Maybe it's just to Tomas at this point, are you functioning with an acceptable budget at this point in time related to the Medicaid done? Yeah. I mean, we have, as I understand, we have not lost any contracts as a result of this event. And we are managing our organization with the necessary fiscal responsibility. And obviously we are reducing some expenses in areas where we can afford those cuts to be made while we are expanding in other areas, whether or not it's the investment in the PPEs or the investment in technology we have invested over just over the past month, we have invested almost a hundred thousand dollars in expenses that previously we had no idea we would ever have to invest in. So that's the net result of just a month of being in the COVID-19 environment. We are, one of the challenges that we are experiencing have to do with if one is to say that broadband is a challenge in the state of Vermont, it's got to be amplified in the Northeast Kingdom. And if one can say that Caledonia and Orleans are decent, then going to Essex County amplifies it even further. So we are challenged not only by the common, but perhaps also by the kind of uncommon challenges that we face. Our team leverages all sorts of methods of teaching or education or reaching out to all the way from the Zoom technology through telephony, tablets, track phones and pages to the simple putting pen to paper in situations where there's no other alternative. So we have become very nimble as a result of this change in our lifestyles. And then I think when we are on the other side, we are all will be better for it. I certainly cannot be prouder of each and every member of this team and how they have contacted ourselves in working with the families and working with the kids and really trying to be engaging and not waiting to be engaged. So we are doing fine financially. I know Laurel is still on the line. So we are doing fine financially, but we are certainly exercising prudent management practices and we are investing where we need to invest. We are making reductions where we need to make them it is not easy to do it on very small margins, but we are trying to do our best then. And I would also say is that we have to be very grateful to our partners, the Department of Mental Health, the Department of Aging and Disabilities because they have been exemplary in the way that they have interacted, not only with North East Kingdom Human Services, but also with all of the other DAs or the designated agencies and the support services agencies. So I can't think anything other than to believe that this partnership is going to continue and with working together, all of us would be better for it on the other side. I would like to hear from the other two and then we will open up to other questions and we'll hit all of you at that point. So we have Veronica Whitehill. Yes, better known as Vicki. So I think, I mean, the challenges have been put out there already in our time together, so far challenges to internet, to connecting with families. So I want to take a little different spin and really speak to the determined grit and sure will of the Northeast Kingdom, particularly this agency. I have, my department is home and community based outpatient services. So I oversee the service components from Children's Integrated Services, which are itty-bitties, all the way through the jobs, the jump on board for success, which is our vocational for our 16 to 22 year old youths that are either dropped out of school, risk of dropping out and are looking for employment opportunities. So I have a wide range. With that, I currently have 24 people working remotely from their homes, eight have access to our system, 16 are working pen and paper. So that speaks to their level of commitment, sure will and grit to do this work, being almost blind from the technology of having an electronic medical record to look at. So these guys have been troopers. They've been really creative in how we connect with families. I think we're somewhere around 92% of connecting to all the families that we serve in those service components, which is huge, but I wanna speak that someone has spoken to the safety of children. And that of course is like number one for us. But I do wanna reassure people out in Vermont that we're taking that very seriously. We're keeping all of our community partner collaborations. So our lit meetings are still happening. They happen by Zoom. This is where the directors of our local collaboratives all get together. We meet, we just had a meeting yesterday afternoon. Top priority is what's going on in our community. Our kids safe. Are we seeing an uptick at DCF calls coming in? Is there a decrease? What can we do? I was on- Can I interrupt you just a second? Just to explain what the lit team is for our members that you're not gonna be sure. Our local literature agency team, it's part of our Act 264, the directors of the collaboratives. So DCF, school, LEAs. In our case, we have youth services in the South, Northeast King Indian Services, the Department of Health. Whoever, whatever representatives are available, we meet together once a month and we basically look at the gaps in our community services. And then we try to brainstorm how we're gonna meet those gaps and talk about what each community partner is doing. In the Northeast Kingdom, we are very much community partners. We share a lot of stuff. So we all work hand in hand. So it's good to get together to see what we're doing. So those meetings are still happening. I was on a resource team meeting this morning. That's a meeting I have with the Department of Children and Families in St. Jay. We talk about high needs families, families that we know are high needs. We're keeping our pulse on it. Talking about how we're intervening, how we're connecting within our department, within NKHS and I know Noreen Staff are working super hard too. We've been some creative things. I've sent phone cards with minutes on it to families that are running out of phone minutes. I've sent gas cards to families who need to be able to run up the road to the school to sit in the parking lot to access the wifi. We have some resilient moms that are sitting in a car with four kids trying to access distant learning in the parking lot of the school using their wifi. These are pretty challenging things. We've, our collaborative partner in St. Johnsbury, NECA, doing meal preparation. I think they reported out they've done 15 to 1800 meals daily that are being delivered to families in the Northeast Kingdom. Trying to think what are something. Send pedometers to kids so they can count their steps and do some math because they're resistant to the packet that was sent. And we're trying to work on self-regulation and still get some education and learning in place. So I want to highlight some of those positives that in light of all that's going on sort of to what Dave was speaking about is building that resilience, trying to find those protective factors and really capitalize on them for families. And so we're being very open and trying to be very creative. So if there's a, there's a possibility we're sending a lot of stuff via the US mail. So people are getting stuff, snail mail. They're getting cop color pages, art supplies. You name it, we're trying to, we're trying to meet it out there if we can. So I wanted to kind of put a little bit more of an uptick on some of the cool stuff that we're doing. I think that we're probably would love to have just a list of some of the creative things that people are doing. I mean, this is just inspiring. And if you could take a minute and say, here are some of the cool things that are going on and send them to Avery, we'd love to see them. I should be asking that of everybody. And Marcia. Hello, good afternoon everybody. Nice to see you all and meet you all. I'll just kind of summarize, wrap up. I think everybody has done a wonderful job in kind of representing the concerns, the risks, the ways in which we're rising to the occasion and trying to ameliorate those by working with families, by outreaching, by getting creative. I think, we realized as a designated agency that we had technology, but we never expected to need to use it like we're using it now. So it certainly has pushed us to think outside of the box. I think some of the concerns that we have are certainly around child safety, also around the level of alcohol use that we're hearing about across these different states and the high levels of sales of alcohol and how that impacts families negatively and children as a result of that. Those are things that we wanna be prepared for and respond to on the adult side of the equation as well. So we're paying attention to that. I think we've been in community meetings where some of the participants in our provider system are professionals in the school system or in the provider network. And now they're being faced with children at home and school work and everything else. And those professionals that do this for a living are struggling as well. So I think we can't underestimate what this has meant for our folks in Vermont. As Noreen indicated, she started a warmline and is staffing that with the children's staff across her department as well as Vicki's department. We're about to roll out a warmline focused on adults and addictions so that we also have that resource available to folks that may wanna talk to somebody around that, those kinds of concerns. I will tell you that our psychiatrist who's also our medical director has been working from home for probably about four weeks now. And he said that he's seeing more follow through from the adult outpatient psychiatric people involved in service, which I thought was quite interesting. He said, now I could really kind of track them down if we're expecting them to come to the office and they know show an appointment, they know show an appointment. But now if they don't return a call, he can continue to outreach and call them. So he's seeing a higher level of involvement given the technology that he's using. So I thought that was pretty hopeful. I think we're just really trying to keep our finger on the pulse across all of our services we provide. We are a designated agency under mental health, which means that our adult outpatient and children's services all fall under that umbrella. We're SA under the Department of Aging and Independent Living. So they are somebody we're closely involved with. We're also a preferred provider in the ADAP network in terms of providing substance use disorder treatment. So I think we've tried to keep our finger on the pulse across the broader system and are doing our best to respond to the community need. Thank you. Questions from the committee? So just a question to all of you and Laurel as well. Act 264 was the 1988 law, I'm unmuted, right? It's the 1988 law that created the relationship between the schools and mental health to the designated agencies. And I don't think it's really been looked at since about 2003 or maybe five. Is, does that need an update or is it working? Can you hear me? Yes, Laurel, thank you. Okay, thank you. So yes, it is still in place. And then in 2005 and renewed again, I believe 2010, there's an interagency agreement which took Act 264, which was specifically for students identified with severe emotional disturbance and a definition under that and expanded the entitlements, if you will, of coordination across the different AHS and agency of education entities to all disabilities under special education. So it's not just for students with emotional and behavioral challenges, but all disabilities under special ed. So the interagency agreement has been updated. The law itself has not been altered. And I think there were actually some concerns by both the state and advocates about ramifications of reopening that law versus continuing to evolve what the agreement is and the understanding and how it's put into place. So I'm curious what the committee's interest is and are there some conversations that we should be having around that? Probably, I might be the only one at the moment thinking about this. It was some things that came up a couple of years ago when we were looking at toxic stress in children and hearing that some schools were dealing with three different designated agencies based on just the complexity of town versus school district. And I remember that was one issue that was difficult, but just given that we're now in another crisis, are there other things that are being pointed out in the law? And it's certainly not something we can solve now, but I guess I would hold it as a question and not a question that we need to solve by Friday. I think the issue you named is still a current one, Northeast Kingdom, being one of those regions that has some different towns and county lines between the AHS districts versus the school districts. It is challenging. And there's not an easy solution for that. Yeah. You're really flexible in trying to be work the positive aspects of all your collaborative partners. We do have where we have multiple people or multiple agencies involved because of kids go to school in one area when they live in our catchment. And so it required you to be a little creative in trying to do that. Although I will speak to the fact that we still are doing CSPs even in the midst of COVID. It looks a little different. It feels a little different. It's a little bit more challenging to get it done, but we are doing them. Just jargon break CSP. We're new to our NAISC plan. It's part of the Act 264 and the Coordinated Service Plan. We often just refer to it as a CSP. Yes. We're the education committee. We try to break down initials. Thank you. So I will add... Sorry. Yeah, go ahead. Go ahead, Laura. Sorry, the Representative Webb. I was just going to add that the Coordinated Services Plan was also updated September of 2019. So we have been looking at components that are under the Act of Act 264 and trying to keep them as fresh as we can without actually adjusting the Act. And relationships, as Vicki just said, is really key to having the intent and the values within the Act continue to evolve to our current issues. So it is so true, what Vicki says, about where it's complicated. It really is about the coordination, communication between the schools, between the different DAs and different district offices of family services who are overlapping or whose lines are different in those regions and being clear about what falls to wear. And I think people have gotten a sense, but it's confusing for families. And the system providers might understand it. It's more confusing for the families. So I see, I've got a question from Sarita Austin, then Lynn Batchelder, and then we'll go back to Northeast Kingdom. So Sarita. Oh, can you hear me? Yeah. This is, this is probably just to answer maybe your response to Laura, but it is for all the mental health and special educators. Just, I have always looked at outcomes and data, not only because of funding, where we should put our money, but just in terms of best practices. So, I just would invite you, I think it's very helpful for us to look at data in terms of students being able to access learning. I mean, I think why we have all these interventions is because they can't learn in a general classroom and they need support, individual or just mental health or whatever. So any data that you can provide that says, this intervention, help this child access their learning and advance in their learning, is always helpful to me to see if it's working or not. Absolutely. My understanding from the designated agencies, especially the behavioral intervention programs where they have their very data-driven and how they develop their plans and then measure along the way the impact of those plans, they're taking those and translating them for homes and trying to determine how to continue to collect some of that data. So that data is held by the designated agencies. That's not necessarily that level of detail because it's student by student data. That's not submitted to Department of Mental Health, but it's certainly something we can bring back and Nureen being another representative with that group to think about, could the designated agencies use some of that data and look at other patterns within it during this period? As I noted, in our contracts with the designated agencies, we do have measures, including using some specific tools that the child and adolescent needs and strengths tool that we have the designated agencies administer in the beginning of the school year and then again at the end of the school year so we can see what the impact of their services over time is. It's going to be interesting this year because they didn't do it necessarily right before COVID impacted, but they are still able to complete those within this end of the school year period. So we'll have a broad look, but we might see where typically we'll see improvement in some of these areas over a school year with a service delivery. We might see some increased areas of stress and I think again, individual by individual, they might be able to talk about what's behind those shifts in their strengths and their needs, but it's about what data do you have to measure the impact within this particular time period but we can certainly have those conversations. And I'm like really interested in the advancement of learning. That's what I'm really interested in seeing is did this help that student advance in their education? And I just want to say thank you to all of you for the work you're doing. Just it really makes me calm down to know there are people like you out there helping Vermont's children. Lynn, bachelor, thank you, Sreeda. I just have to say I am so proud to be associated with the Northeast Kingdom Human Services and all they do for our communities and the children and the parents. And I am really honored to even have just a teeny bit of a process with them. And thank you very, very much for everybody and all of our people that spoke today. Thank you so much. And I know you and your data, Sreeda. You and I talk about data and I love it, but thank you so very, very much. And there are certainly levels of data that have to do with individuals, groups, and we're looking at the data that actually intersects with funding and law. We don't need to get quite as granular in looking at a treatment. And the Northeast Kingdom, you were going to respond. Yes, I just wanted to certainly echo the desire for data. I think we are all becoming data-driven organizations. And unless we know the numbers, it is very difficult to make any progress. I mean, if you don't know where you are, you certainly have a difficulty figuring out where you are going. So I will just echo representative Austin's point. I also say that I hope that when as we are hopefully going to the peak of it and then sliding down this mountain, I hope that we are going to continue learning our lessons from the experience that we are gaining right now. And I hope that, and I'm speaking probably for the microcosm of which Northeast Kingdom is and Northeast Kingdom human services in particular, we have been challenged in the past and for a long time with our ability to access the community for different reasons, for the reasons of economic difficulties, for the reasons of inadequate transportation, and we can kind of go on. And I hope that what we are going to learn from this experience is that the technology that we are using right now is going to allow us to leverage it in expanding our reach into those communities that we previously could not serve, perhaps influenced by regulations that were in place at that time. So I think that this is going to give us a moment for reflection and really beef up and truly improve the way while we provide services. And number two, how we access, how we make those services accessible to our communities. And the second point that I would like to make is that we have been talking about this microenvironment of the Northeast Kingdom human services, but I just wanted to let you know that we are a part of a much, much bigger network. Our organization participates in multiple accountable healthcare community groups. We are a member of two command centers, one in the Southern Northeast Kingdom and the other one in the Northern Northeast Kingdom that is made up of community-based organizations of different fabrics. And we are staying in a constant communication. We know exactly what's going on almost at times on a daily basis. So we are not really losing the beat. And the reason I say that is because it gives us the confidence that we can sit today and speak with you without an elevated level of anxiety or nervousness or a feeling that we don't know what is happening or where we are going. So I say that it's just for you to be reassured that we have a pretty good control over what's going on here in the Northeast Kingdom. We cannot predict the future. We don't know what's going to happen tomorrow, but I think we are doing everything to plan for tomorrow and for the day after that. Thank you. Any other questions? I see that it's two o'clock and I wanna release everybody. Thank you so much. We are continuing to follow what's happening on the ground. The concerns of the disabled and those with challenges in mental health continue to be a concern of ours. We are certainly well aware of the challenges related to connectivity, access to technology. It's probably the thing that is one of the greatest points of inequity that we find in the state. And we know that the Northeast Kingdom has hit hard with that. I'm checking to see if there are any more questions or comments or anything. I thank you all so very much for participating today. We are bearing witness to something that none of us anticipated a month and a half ago. And thank you so much for your work. And thank you, Laurel, also for helping us to understand a little bit more about success beyond six and where we are now. Very much appreciate that.