 Okay, I think we are now live. This is the house health care committee and it's Tuesday, February 22nd. One in the afternoon. And there's some kind of Just getting our technology sorted out here. Okay, we're all set with that. Okay. Okay, well, welcome to the house health care committee. Heidi. We're pleased to have you join us this afternoon. And we, as you know, have been trying addressing the issue of health, health disparities in Vermont. And as a part of that, we continue to follow the work of the Department of Health. And last week we heard from the commission disparities. And my understanding is that and part of what we're interested in hearing about is the work of the Department of Health is doing. And my understanding is that there's a significant federal grant that the department was successful in applying for. And that. So I'm hoping that you can give us an update information on that grant and the work that will follow that's perhaps happening already and the work that will follow from the grant. And how it relates to the other initiatives around health disparities that are moving forward in Vermont. So with that welcome. Great. Thank you so much for having me. I really appreciate it. For those I haven't met before my name's Heidi Klein. I serve in the commissioner's office as director of planning and health quality. I've been here for about five years in this position. What I'm going to share with you is how we are working pre COVID to try and address health disparities what happened during COVID and most importantly really hone in on this opportunity that we have through a CDC health disparities grant that was specifically given to the health department due to what we were seeing as the same in other parts of the country in terms of the disproportionate impact of COVID on populations of color in particular and in rural populations. So I'm going to see if I can share my screen I think I'm allowed to. Let's try. And where we'll assist you in giving you that. I don't think her presentation is on our committee picture. There's nothing. It is not. It is not. It's not been shot. Can you see my screen. Yeah, hi. We can see your screen. Is it possible that the. I don't know if that's possible at this point in time but it's helpful to our committee to actually be able to see to have the presentation also available on our committee web page. So sure, sure I didn't send it now because I figured there you are probably going to ask questions and then I could make a couple of revisions before I gave it to you but I'm happy to make sure you have it. Is that possible. I don't know I'm not knowledgeable enough to know whether that's something that can just happen now or if that should happen later. Yeah, is that is that something that could be sent Heidi. Sure, hold on let me see. I mean, my ears seem as though they're bleeding but probably. It's a little loud. Okay. I'm just, I got the meeting invitation. I'm sorry we're just having some technical issues right here while you try to send us your presentation I'm going to talk with the committee about a couple things. Just, that's okay. I apologize for doing this. Last we're here, the end of last week. There was a sound that was coming from the speaker in the center of the table that when when loud particularly when I got loud and kind of vibrated it was quite annoying to many people experienced that it came in at the end of the week. And they said what they would try doing instead was moving to the speakers that are in the screen. And I think that's what we're experiencing as different today. That is a different set of speakers. So it's coming into the room differently. And it may also be. It may the volume maybe needs to be adjusted and we'll need to figure out how to have it work well for everybody in the room. So, I don't know how we control that or if we do. Yes. Previously I think it was controlled from a console that is. We have a clicker. Well, it's. It's just point to you is that you're broke. My fault. So if it continues to be bothersome we'll go and ask it to come in and help adjust because they're just down the hall. And they've been very responsive. Okay, so we're able to receive the report or the slide deck. So it sends it to Claire is Claire in the room and able to receive it. Right here. Yeah, the audio is much better. Yeah. Okay, good. Sorry, sorry. We're still adjusting to our new world tidy and. I was amazed to see you all in there and figuring out how to have multiple computers open at the same time because we haven't figured that out yet either. Yeah, there's a lot, there's a lot to sort out here. And email it to you all and then I'll work on posting it. Okay, do you hear that folks. So Claire has emailed it to everyone, but she'll also work on posting it to the website so people can access it that way as well. Thank you Heidi for helping us take that. Absolutely. And if we could, you know, Claire I'll work with you if there's anything that changes or we want to update for what gets posted on the website. If there's additional information that would be helpful. Okay. We can do an update that would be fine too. Okay, beautiful. Let's start again. Hey, hello all. And I think I had the pleasure of meeting many of you last year. And when you were first considering the development of what would be most supportive in advancing our needs to address health equity in the state of Vermont. And at that time, I was completely head down in our, our HSE meeting our health operation center. COVID response. And so what I am happy to say is that since that time we have been able to secure a CDC health disparities grant specific to COVID. And in the disparities we are seeing in our COVID impact in communities of color, in particular, and in some of our rural communities. I did not prepare any presentation on that what I'm going to tell you about right now is just about this grant opportunity and what our plans are, and how it connects to work that we were doing pre pandemic. And I think that will help serve us post pandemic but right now we are still very much in pandemic, particularly with the populations that have been disproportionately impacted. So, let me see if this is going to work so can you now see a full slide that says grant overview link to the state health improvement plan and then the strategies perfect thank you representative boroughs. It's your face nodding that's very helpful feedback. Thank you. And I'll probably move a little fast. And so the grant overview this is a CDC health disparities grant. The official name is the national initiative to address COVID-19 health disparities among populations at high risk and underserved, including racial and ethnic minority populations in rural communities. We prepared and gave funding to all states for this work plus some local health department. They gifted this to us before we were ready to receive it so the timeline was June 1 through 2021 through May 31 2023. Right now we have no assurance but we are very much hoping that there will be a no cost extension. And I say this is while CDC technically made the funding available to us on June 1. We were not able to access this funding before November 1 because of the joint fiscal requirements and the fact that this funding included the creation of a few new positions. So we were only given spending authorities starting November 1. The total budget is 28 and a half million dollars. I want to put this plan in context a little bit for you. And because I think it's really important to recognize that before COVID hit, and this is how we sort of planned to our thinking around the funding that was coming in. Before COVID hit, we had undertaken what we call our state health assessment and our state health improvement plan, the SHA and the SHIP. And in that we had identified that there were certain populations, we call them populations in focus, where if we looked at all of our data across all health outcomes, health behaviors, and wellness, we saw consistently that there were certain populations that were experiencing poorer health and lesser access. And that we plan to work upstream. Well, then COVID we were, you know, had just published the state health improvement plan beginning on our work to really dig in across the state. So the health improvement plan is not just for the health department, but it's for the whole state and includes multiple agencies and partners. And then COVID hit and what we found was not any surprise, which is that COVID-19 actually further demonstrated and intensified many of the health disparities across Vermont. And that it contributed to deepening isolation and inequities within communities. And so all of the communities that we had been seeing previously impacted where health disparities were exacerbated. And it was as if COVID just was shining a bright spotlight on what we had seen before and now has made visible what was perhaps underlying before in terms of certain communities being more impacted by negative health outcomes and under resourced and the ability to access wellness. So we started with this show on the ship. We saw a COVID happened. And then we had this great learning this great opportunity through the CDC grant and these are the four areas of work in the CDC grant resources and service data improvement, public health infrastructure and investments and services to partners. I'm going to walk you through what we're doing. I want to just give you this background so that you understood we were building on the past as we move forward because we hope whatever we do in terms of using this funding and using this, let's call it opportunity of COVID. It should be helping us think about long term change. I just want to just share with you this was from our state health assessment and state health improvement plan that this is how we were thinking about health inequities. Because we were trying to say of all of our monitors which populations are most affected by poor health outcomes. And what we discovered, not surprisingly is that those who've experienced social economics advantage, historical injustice and other unavoidable inequities that are often associated with social category of race, gender, ethnicity, social position, sexual orientation and disability. And these are exactly the same populations that are called out in the CDC health disparities grant of the focus for the work that we could do using the CDC grant. This is not just history, but just so I want to give you a little bit of history, you can see this is from our state health assessment and state health improvement plan when we looked at which populations were most impacted. There they are, the populations that were most of concern were our BIPOC. So our black indigenous people of color and our English language learners are LGBTQ people who are living with disabilities and people living in poverty. So the health conditions, those that were the, that were the highest in where we were seeing the most impact, an opportunity for change for child development, chronic disease, mental health, oral health, and that the conditions of social conditions of most were housing, transportation, food, income and economic stability. You could put here, instead of the state health assessment priorities, the health condition COVID-19, and it would be exactly the same in the left column, meaning the populations that have been most impacted, and the social conditions that have made it so much for these populations to stay well. I'm not even going to pretend to share this, this is history, but for those of you who might need a refresher our state health improvement plan. We came up with the strategies we wanted to work on. It was about investing in policies and infrastructure to create healthy communities. These are social determinants of health. Investing in programs that promote resilience connecting and belonging. Those are all about early childhood mental health substance use investments for wellness, and then expanding access to integrated person centered care. This has intensified in the time of COVID that we really see that the other thing that I really want to culture tension is at the bottom here. The underlying strategy that we said was most important and that was adopting organizational and institutional practices that advance equity. And that's really aimed at us and state government, as well as our health care partners. That these are the ways in which we have to have meaningful community engagement equitable programs policies budgets, respectful care and services and informed action and decisions. I would say that our work in coming up with the CDC disparities grant is completely informed by this lower one. Exactly the same. This is our public health framework. I love this, I would be happy to spend an entire day talking to you about this. This was our way of trying to show that improving public health, but in addressing health disparities and inequities is far beyond the work of just the health department. As well, the health department and public health tends to be in this zone, right. We tend to focus on risk behaviors, disease and injury and mortality. This is our primary zone, right. So I would like to point out by prevention that in fact, what matters equally or more in terms of promoting health equity and addressing in long term sustainable inequities are what's happening at this further upstream by addressing living conditions, institutional inequities, and then social inequities. We can embark on what do we need to do in terms of changing the curve on COVID-19 or changing the curve on health disparities in the state of Vermont. We believe that it is necessary for us as a state to be working in the zones further to the left which are further upstream public health can share our data. We can do our parts here around health education, health care, and civic engagement and policy, but we really need to be working across government and across sector. All right, I'm going to go round us back again into the grant. I just thought it was really helpful for you to know we were building on some work that had been done before COVID was no surprise to us in terms of what was needed. And so what we have learned by COVID is relearning some of what we learned before and we are hoping to use this short term two year funding to invest in ways that help us not only address COVID but perhaps if we can build some sustainability long term. So the intended grant outcomes was very, very clear that it'd be focused among populations at higher risk and that are underserved, including racial and ethnic minority groups and people who are living in rural communities. There were three goals or outcomes according to CDC, the first being reducing COVID related health disparities. Second, improving and increasing testing and contact tracing. So again, very COVID specific. And then third, the outcome was to improve state, local US territory and freely associated state health department capacity and services to prevent. It is very rare that the health department gets a capacity building grant. And what you may have seen, and what we have certainly experienced is that public health was severely under resourced and under understaffed. When the pandemic hit, we had just come out of multiple years of layouts and or holding on positions. And so we did not have the state health capacity, the state health department capacity we needed so you will see that this is one of the goals is to get state health department back up to that ability. So we can be effective on behalf of our communities. And there are four different strategies that CDC outlines that are expected within the use of the CDC grant so one is I think this will look familiar resources and services, data collection and reporting infrastructure and then community partnerships. This is a very high level breakdown of how we were conceptualizing the breakdown of activities and funding that we received and how we would spread it across. So what you'll see here is the resources and services are about expanding existing and or new and or develop new mitigation and prevention resources and services specific to COVID-19. The second is about data collection reporting, and it's really about increasing or improving data collection and reporting for populations experiencing disproportionate burden of COVID-19. The third is the infrastructure building leveraging and expanding infrastructure to support COVID-19 prevention and control. And the last one is community partnership, mobilizing partners and collaborators to advance health equity and address the social determinants of health. So this is how we sort of looked at it all along. In the way that we broke it down. So one of the things that I will point out. I know this is a concern is how much are we using internally versus how much of the funding is going out externally. And I'll just have you know that both the resources and services and the community buckets are almost all going out in various brands or agreements with community-based partners and service agencies. So that is funding that we are intending to put out in community in order to ensure that we are all working together and that this is really addressing the needs of those communities that have been most impacted. I'm going to take you through a very quick tour. Someone should give me a time if I need to speed up. Okay, because what I'm going to do if it makes sense is I have one slide for each of these four strategies so I can tell you a bit more in detail. Does that work for you? It works. Yep. Fabulous. All right. So strategy one was to expand mitigation and prevention services. So there are a couple of things that we have really looked at that we needed to continue our current response. And so the first area was strengthening and expanding the community partnerships activated during the COVID response. We were able to work very hard and quick by state standards to fund some essential community-based partners to help us in setting up testing clinics, setting up vaccine clinics, doing community outreach and education. So we wanted to make sure that we had funding to support those essential partners who have been absolutely a mainstay in ensuring that we reach the BIPOC, ELL, and rural communities. We also put aside some funding we're hoping to expand mental health substance use and suicide prevention supports for these communities. So as you have probably seen, while all eyes were focused on COVID, meaning the infectious disease, we have seen also a tremendous increase in need around mental health substance use and suicide prevention, right? These are the corollary impacts of COVID. The first place we wanted to expand was really investing in workforce development among the community's most impacted in COVID. So this is not about investing in traditional agencies or in healthcare agencies. This is about seeding some funds for community health workers, sometimes they're called cultural workers, sometimes they're called community liaisons. So these are the folks who are actually of the community who are trusted community members who can work in collaboration with us in doing outreach education, setting up services. And then we also realized, as you probably have seen, we have really utilized our emergency medical services providers, and they recognize that they have a long way to go. And then retention of individuals who represent and are of the community's most impacted. So this is all about the combination of reinforcing our current activities and making sure that we have invested in the workforce in a way that brings more people represented the community into that work. The second area is increasing and improving data collection and reporting. And one of this relates very much to some legislation, perhaps you all were involved in it. I forget where it originated. We had a report that we had to provide on ways in which we were expanding our data collection in the department and supporting the collection of race and data and some others. Well, what we totally found out is that we had to spurry during COVID to make sure that we were connecting our data within the health department across the agency of human services, and then of course across our health information exchange. So we have put in some funding for the infrastructure and the individuals to help us connect, broaden and connect our reporting on essential data on race, ethnicity and preferred language. So that's both in the Vermont health information exchange, data systems across the agency of human services and then we used a lot of dashboarding and hopefully they have been useful to you. So we've been trying to make really more easily accessible data for the public that tracks COVID over time. The other big thing that we realized is that we don't actually understand all the community impacts and needs. Historically, the health department and our sister agencies have done what we call community health needs assessments and these are generally place based assessments. We learn a lot about a geography, but when we go with geography rather than subpopulation, even our small numbers in Vermont we often don't get really great data on the populations of concern. What we've did was we put aside some funding in here so that we can do some community needs assessments with the population. So we have a bunch of funding that we hope to do some joint inquiry and or provide funding to community organizations to do their own inquiry. So what are the health impacts and health needs of our BIPOC, ELL, LGBTQ older adults and rural Vermonters. And so that we would really give them work in partnership to look at what are the impacts what are the needs of these communities and therefore how do we jointly inform our work moving forward. So that's what we're hoping to do with our data collection reporting to inform how we can move forward to address persistent inequities. The third strategies around building infrastructure. Next infrastructure we as I mentioned we were stabilizing our staff and our departments. Some of you may have heard about our extraordinary health equity and engagement team that we had to stand up in a moment in our health operations center. When the health department moved into emergency mode. We all got plucked out of our regular jobs and put into different positions and to serve the emergency. We learned pretty quickly that we needed a special unit in that that was focused on equity and community engagement so we pulled staff from their regular jobs to stand this up and we pulled and then we also brought on some temporary staff. What we know now is so sorry, is that we need to formalize that team so we've created some positions we're in the middle of hiring right now for a more permanent semi permanent. So for the two years of the grant anyway that we can stabilize those positions so that we have some staff who can address health equity and community engagement. We invested in staff for communication. We've done a tremendous amount of work and there remain some communication both for translation interpretation for our English language learning communities, but also helping ourselves and our sister agencies understand about plain language use and effective communication to smaller populations. We had added a couple of staff to help us with our data, and then we also added one person to help us work on our own internal workforce, cultural competency. Second place that we looked at building some infrastructure was, as I said really working on improving access to culturally and linguistically appropriate information so we have on our website for translation and then we have also been funding. It used to be called the multilingual task force this is an extraordinary group that sort that sort of just self organized during the pandemic, led by initially a staff member over at the Howard Center who's now moved over to CC TV, and they have been calling the Vermont language justice project and they have been extraordinary as a resource for not only translating. They haven't been doing written translations what they have been doing is creating amazing little videos in 10 to 15 languages, using native speakers to be able to communicate everything covered. And so we have invested in that for the next two years and we would be sunk without that group and it's our hope that that our funding for this group will live will create enough stability for them to find continued funding through partners in both in state government but in our health care system they are providing a tremendous service. And then the last area that we intend that CDC strategy was mobilizing partners and collaborators to advance equity and address the determinants of health. There are two different ways that we're looking at this one is we're looking at what I'm calling investing in community health improvement. Prior to coven, we actually had some traction in two different ways. One is we've been working in partnership through what we called our healthy community design work in partnership with the agency of commerce and community development. The agency of transportation AARP and others on place based grant making to create healthier communities so really communities that are designed to promote health and wellness. We intend to invest some of the funds to with that partnership and have asked them that the funding we give these specifically used for community partners or community projects that are focused on our black indigenous people of color, our English language learners, LGBTQ and rural areas. We also are reinvesting in what we're calling our community collaboratives and pre pandemic. Once upon a time. We actually has some fairly vibrant community collaboratives where public health was sort of at the center connecting on one side our health care system meeting our hospitals are health care system through the blueprint for health. And then the ACO and our health department really looking at investments in population health at the community level. The same time, our health department was reaching out more with local planning municipalities and then the partners that I mentioned before to be trans an ARP to try and say how do we look at population health investment. And so, part of what we are investing in with this grant is to remobilize those partnerships. And while clovered is the issue right now. And what we know is the next wave is going to be mental health substance use and suicide that we're keeping our eyes towards and so having that integration with our health care and mental health system super important. The next step of mobilization is establishing grants directly to community based organizations. So while the former one is going to go through our district offices and through some health and human service organizations we also have established a grant program. That is going to be upwards of $5 million that is going to go directly to community based organizations. We had really hope to get this money out the door far sooner than we have been able to. As I said we were not able to get spending authority until November. We've really been working diligently with two organizations to try and figure out if we could use work with them as intermediaries so that they could help us create a fair and equitable grant system that was less burdensome to community partners. And that fell apart last last in the last within the last month in that as you probably know, and it is no easy job to set up a grant and system or move federal and state funds to community organizations for some very good reasons, but it also means that you already have an established relationship with the department or the agency, and you already have certain high levels insurance, and you have certain 5031 status and you have their multiple layers then you are not going to be able to partner with us at the same time very hard to get around that and not have to go out through a request for proposal process through the state, but that is now where we're at we're getting ready to do our request for proposal process. Thank you to community partners. We hope to launch that within the next month probably realistically April. To be able to that to be able to provide some investment in community based organizations again remember who are of an and led by our black indigenous people of color, LGBTQ and rural communities so that they can deliver programs or services. They feel are needed to address the covert impacts. Here's a list of some of the things that CDC has said are allowable data gathering community health workers outreach and education promotional efforts that are culturally linguistically appropriate education and training for public health. So service providers, etc, and then some wealth wellness and healing programming. This is a non clinical grant I'm going to come back and stop sharing, I think, because I am done with my presentation, I don't know if I did that right. Am I back. And so just so that you know the way that the CDC grant was set up it is it's a prevention grants. It's a public health investment grant. We are not allowed to use it for investments in healthcare services. There are different streams of funding that are available to our healthcare partners. We hope and we know and therefore this the grant funding here will not be used for that. So that was my long and complicated, hopefully not too onerous presentation of what the CDC grant is like we are, it's massive for us. We have probably 15 different activity leads working in partnership throughout the agency human services with the agency of digital services. And then of course all the work that we're doing with multiple community partners that will be funded through this. That's a pretty big undertaking we are hearing while that the formal date for spending is by the end of May 2023 in conversations with our project officers at the CDC. And we have been told that we, they know that we and all of our other counterparts throughout the United States are having a hard time meeting that deadline. And so they are looking to see if they are going to be able to extend the deadline and allow a new cost extension. But for now we're operating as if it is through the end of May 2023. Well, thank you Heidi this is a, I mean as I first heard about it and hearing about it more this is a very exciting and a very well funded initiative. One of the things I'm, I'm very interested in is, given that we established the Vermont Health Equity Advisory Commission last year. Can you talk to us about the intersection and the work that you're doing to use them and to work with them collaboratively because it seems like there's huge opportunities and overlap. In terms of the, the very kinds of having set up a commission that is made up of many of the same communities that your grant is focused on. What, what is the relationship that I'm hoping there is a robust relationship. Yeah, thank you for that question so you may hear the name Sarah Chesbro. Sarah Chesbro is the Health Department staff member who has been assigned to be the collaborator on the Health Equity Advisory Commission. Sarah was the one who got called, popped out of her position in our maternal and child health division and asked to be the lead, our initial lead on health equity within our COVID response and so she was able to meet and know many of the partners who are part of the commission and so she's been working with director Davis from the beginning. Director Davis also is attends now our health equity team meetings internally at the health department so that she's aware of what we're doing. And then the third piece is, we have invited her to be part of a learning project that we have going on. We got, we are part of what's called stretch and I'm never going to remember what it stands for. But it's a opportunity that is supported by the Robert Wood Johnson Foundation and the CDC foundation and to the next two years to be able to look at how we embed equity into our state health operations so we invited her to be part of that so that there would be an intersect with the work that she's leading more directly. I know one of the pieces that the commission had, had been asked to consider was bringing community voice to grant making decisions right then out of sync in terms of timing because of the way the CDC funds came and the way that the, the startup of the commission it was just sort of, as you know, everything just sort of came in in a disjointed way so we've been trying to rectify that. Sarah, just where our representative on the mission and asked to head up on the, there's a subcommittee that specifically looking at grants and funding and each of the committee members were asked to join a subcommittee. And our hope is that that subcommittee actually is going to members of that subcommittee will serve both as the developer reviewer of the RFP process that we're going to use, as well as, excuse me, as well as serve on the review of any of the proposals that come in. So that we would not be making those decisions, except as informed by and advised by the commission. Assistance. Yeah. That's specifically referring to the $5 million in grants that are going out into the communities because it seems there's a huge opportunity there to empower the commission to have a voice in using their experience to inform that part of the federal grant. Exactly. It didn't make sense for for us. It seemed like the commission was exactly the right host of individuals to be able to help us. The one challenge is that because we have to go through an RFP process. Excuse me, we need, there may be some conflict of interest that the commission members need to think about, in terms of being part of the development team or the grant review team, if they are also wanting to buy for grants and so that's something that Sarah is going to be working to figure out how to move through that. I'm very grateful that HB Lozado has offered to partner with us specifically in navigating these these waters so that we're best able to ensure that we have community voice on that RFP process. I do think that one of the other things that we are really hoping the commission will do because we have been stymied. I think one of the, they have been very focused and as the legislation is focused is on how to get community voice in the decision making around grant making. And one of the pieces that I, I did not understand a year ago that I have a much better appreciation for now is the internal barriers we have in state government, and being able to provide granting to communities very small community based organization so for example, right now, we can only provide grants in a way that as I said that meet certain like the organization has to have certain infrastructure in order to be able to receive funding many of them don't. So what we have done is partnered them with another large organization to serve as a fiscal agent that has more capacity is willing to offer up their accounting systems because when we put out money into any organization. We imagine to safeguard the public's funding. We have incredibly high levels of reporting tracking auditing, and that is really onerous and for some of our smallest organizations and the ones who really are working most closely with the communities that are impacted. The other thing, so our reporting is huge cumbersome grant making. Second thing that we have discovered. Excuse me is at least within the agency of human services we can only provide funding after we have been built so it's on a reimbursement basis only. That is a huge barrier to an organization to be able to participate with us if they are on a reimbursement only process because that means they have to ride forever, however long. So paying their staff paying their community members are asking those staff and community members to work for free, until we are able to reimburse them. So inherently it's inequitable. So when I look at what the church is to the advisory committee like that is the bigger hurdle for us. To be able to move to equity and grant making is figuring out how we look at are there ways in state government or through public private partnership that are different to enable the kind of equity and grant making that I think was imagined in the development of this commission. We are committed over is the health department are committed in the next two years to work with the agency of administration with director Davis, and also with the Vermont Community Foundation and the Vermont Public Health Institute through this learning collaborative I hope to see if we can find what's how other states are dealing with it how other programs outside the health department are dealing with this, and what traction we can make because this has been the number one impediment in our covert response and then working with this grant. And it will be the impediment to the intentions of the health equity advisory committee. Like that's that is a very, it's, it's the epitome of systemic barriers to equity that that there are rules that in fact keep the very community that has been disenfranchised and marginalized to keep them marginalized by not saying what you, we can't give you money because we've never given you money. And because we've never given you money you don't have the structure that allows us to give you money. It's a circular, it's a circular systemic system of exclusion. That's why it's called systemic. Yes, exactly. That's why it's called systemic and I, it's, it's, it's great. You know, there must be ways to overcome this and it's interestingly enough it did occur to me that and I think the Vermont Community Foundation, possibly, I mean I don't speak for I couldn't possibly speak for them but having worked with them over the years. Sometimes they can more flexibly leverage some philanthropic dollars to sometimes provide a bridge. I don't know that that I've no no basis to say that at all other than exactly why we partnered with them to is to try and learn from how they've been able to work in other ways and and over the long call is there a way for us to work with them in private philanthropy to set up something because our hands really are quite tied, given state and federal regulations. I'm just interested. I'm just going to use this opportunity to ask a few questions that I've been wanting to ask and I'm not mean to cut off other committee members but that there's such an overlap between our committees, our committee the health healthcare committees take trying to take initiative and give support around data collection and cleaning up the expectations, having data that's actually matches the realities of health care disparities and health inequities. You collect data. That's actually useful data. And I know that Dr Davis has. We provided some some support to her office and others to try to work on that very issues I'm just hoping that we are that there's not parallel initiatives happening with this grant and with other initiatives that we've prior to this grant we tried to support and set in that direction. Because we supported them in the office of racial equity because they in fact are the voices of the community who have a lens that shows what needs to change and how it needs to be spread throughout the health care system. You collect actual data that's useful. Are you is this grant collaborating with director Davis on the data collection issue as well. Absolutely, I mean this is one of those things where at times where it's really nice that Vermont is so small. And really, we are like all of government is so small. So yeah so Jesse Hammond who's our director of public health statistics is working very close with director Davis, as well as the team within the agency of human services that is also quite committed to improving the data that is both collected so collected, analyzed and reported. It's all three layers there right. And so Jesse team is pretty much the backbone from a public health and health care perspective, and we'd be happy. And I have been talking about all the connections so and we will not be recreating the wheel but rather ensuring that we are complimentary in the data that were that we're collecting the systems that we set up. And lastly, it occurs to me the conflict of interest issue is one that must be able to be addressed, and has to have been encountered elsewhere because it's, it's hard to impanel members of the affected community and then say oh you can't apply. Or there's a key of a conflict to apply for the very money that we've invited you to help us to help advise us so that we can have the appropriate advice from the affected community but now there's a conflict so it's a kept. I guess. I think there are ways that one can recuse themselves from certain conversations for sure. And I will say I did ask Sarah Chosborough to reach out because when she when the committee members first signed up for various subgroups, only one committee, only one committee member who represented a community based organization choose to be part of that. So, so Sarah and Dr. Davis and I are going to hook up together and see how we can improve on that, because it really isn't community voice right now. And as I said it was only HB Lizardo who who signed up to work with us directly. And so we have some work to do to make sure it really is inclusive of more voices. So this is the subcommittee of your grant that you're referring to or the subcommittee of the, of the commission of the commission, because we thought why, why create a different advisory panel if the commission already existed. Exactly. It seems like the commission, in fact, indeed the commission was proposed for these very to be useful and empowering of the community affected communities to actually look for opportunities and opportunity that's like a huge opportunity that needs to be taken full advantage of from, from my point of view. I thank you I've indulged myself to open it up to questions from other represent, represent page. I have a different type I want to ask a question about, since you're the refugee health coordinator. How are you going to help, or how's this, these grants going to help expand the health care I guess for Afghan refugees that are that are coming to Vermont is that something that you're, you're working on, particularly when we've never had refugees here so how can you actually expand upon that. Well, I'm actually with there have been a couple of changes. So, as you know, we have a new director of refugee services is that overall our former commissioner deputy, our former deputy commissioner Tracy Dolan is now working within the AHS secretary's office as the director of refugee services. And she took with her, our one position for refugee health coordinators so that work is now placed directly within the secretary of the agency of human services and and the, the work of on setting up medical services and supports for our new Afghani neighbors is being handled out of the secretary's office and not through the health department. We, the, this particular funding stream the CDC health disparities funding stream will be used, continual as it was before in reaching out with our community based refugee partners meaning us CRI, ALB, and now the EC DC, I think that's what it is is the I was a string of letters. Right. Sorry, so US CRI is used to be called the refugee resettlement organization in Vermont, they're now, I don't even know what UCRI stands for. The second one ALB is the Association of Africans living in Vermont, but they serve well beyond any Africans they have been our amazing on the ground folks who have set up interpretation services and support services for English language throughout the state. And now there's a new partner in town, and the Economic Community Development Corporation, I think is what they're called down in Brattleboro, so they are small emerging organization that is being set up to receive and support the Afghani efforts resettlement efforts. And so the agency secretary's office through the through Tracy Dolan is supporting that work. And Medicaid will be used in the beginning to support some of their work we will always be involved in the prevention world but in terms of health care services and supports. That's really in the secretary's office at this point. And I'm sure that answered your question sufficiently. Okay, represent Goldman. Thank you. I'm curious about community health workers and you know sort of what their role is and who pays them as if you could give examples of work that they do. Sure, sure. So, um, it's a big question. And Vermont is one of from what I understand Vermont is one of the last states in the nation to not have a formal community health worker system and supports, just so you know, and in most other states when the affordable care act was started most states got on board and established a community health worker program that was taking advantage of some of the federal funds through the accountable care. And through Medicaid to create a level of training and service for people to work in primarily in healthcare settings as community liaisons. So these are individuals who are not necessarily trained in healthcare but work in concert with healthcare organizations and professionals to work with it, whether individual clients or particular populations so that those populations and clients understand how to access the health care system. And how to access other services that are health promoting, or how to understand information that is being created and delivered perhaps not in their first language. So in Vermont, we have had a tradition of community health workers, but not a system, right. And so through this grant, we are helping to support the creation of a system so we're going to be working with the area health worker at UVM that has been an amazing partner in creating a pipeline for new healthcare professionals and they are very interested in supporting a coordinated approach to establishing healthcare workers that could be everything from what some might know in the international world are promotores, which are health promotion specialists people who live in a particular community who get a modicum of training, and then serve as a cultural broker cultural liaison community health worker, all those words intermixed right all the way up to so that would be the lesser amount of training and really community based versus the embedding someone in say in an FQHC. Like the Community Health Center in Burlington has done an amazing job of funding staff in the FQHC to specifically provide navigation services, right healthcare navigation services because many people may not be aware of how one gets insurance, what it means to go to a primary care versus a specialist and how to interpret what your doctor told you. That's the full range. I don't know if that if that I could, if you're interested we do have a staff member here, and who has been leading efforts for the last few years pre COVID to try and and pull together what is now a pretty robust network of organizations interested in the community health worker model and creating something more long term. One of the big issues is we are going to fund a little bit through this grant, but the big hope is that eventually that community health workers be funded through a routine funding source, such as healthcare insurance, whether it be public or private. So that it's not grant funded because grant funded positions come and go. Well, I'd like to know more about that because we've been spending a lot of time on the health care workforce and this sort of role has not come up. It sounds like they don't have sort of a official degree is more of an on the job kind of training if I'm understanding that right. Does that sound right. So in the community we are also working to establish a certificate program through CCB. So it's a development now. It is a essential component of what's missing in our health care system. And I think what we know is pre pandemic. There was with the accountable care organization and communities for health there was a lot of talk about the need for navigators and social workers connected to health care systems because that was a way of connecting more effectively into healthcare services. And some so that's sort of that same ideas and betting a human being connected to other human beings who share an understanding. So there there was a little bit of that through our pandemic response, we would have been lost without the cultural broker program at the UVM lend program who worked with many of our non English speakers. And as I mentioned ALV USCRI those those commute those on the ground folks who were doing the outreach communication and sometimes hosting testing or vaccination clinics were essential. Yeah, if we could learn more about that I think that would be great. Thank you. Thank you. Thank you. I assume this grant went to all states. And it was allocated based on population population or. I think it was primarily based on population I think you're right and it was one of those. We were told how much money was coming to us. And it was based on a legislative appropriation in Congress. Okay, and I'm looking at the slide that you have news be spent by May 31 2023. Okay, just wanted to clarify it thank you. We're going to be working really hard to spend that money this is why we're really hoping fingers crossed that we get that no cost extension, because it has been very hard to spend that money as fast as we would like to. I have one last question and that is, was this grant did this grant include when you talked about the infrastructure, did this grant include the establishment of a director of health equity in the Department of Health. Good question in fact it did. And we so as I, there was one slide where I talked about needing to shore up our infrastructure. So, what we did is we took, we looked at what did we need to temporarily stand up in the health operation center to see emergency response and how do we create a unit that has that responsibility over time, and can make sure that whatever we learned from coven is applied in our future work and so there's a small unit in the Commissioner's I am that right now that unit is reporting to me in planning. And we do have a director of health equity and community engagement who started all of last Monday. Or I should say, yeah, that's Monday. She started with us. So she, her position will outlive the CDC grant because the health department has made a commitment to keeping that one position and we know we can. Some of the other positions we're going to if we if and when we run out of the CDC funding we will search to ensure that we can continue them some other way. But right now they are dependent on the CDC grant. And can you introduce us by name to the person who's her name is her name is Ashley Crabill. I can send you her bio if you want. And she she's in that drinking from fire hose moments on on morning in the state. I'm really happy to have her because she came to us having led very similar efforts in Wisconsin in the Madison Dane County Health Department and then also in the Wisconsin Department of Health, where she had to look at how do you use the tools and levers of state government to advance equity. So she comes less with a community engagement back and although she did quite a bit of that she really comes strongly with internal systems change for state government which is what we have realized we need to be able to invest in as well. So establishing a position of director of health equity was an issue as we were establishing the commission and we were. So again, I'm hoping that there might be some way that the commission. And that position can be involved in trying to see whether that position complements and works with the desire to have a director of health equity. As we determined wasn't possible to do during the midst of the pandemic but this grant has suddenly made it possible. I do think if I could just add one more thing represented liver to that and that is. I was very hopeful that the commission would be also looking beyond what looking at doesn't need to live in the health department or does the health department need a director of health equity and needs to be elsewhere. Right, because one of the things that was why I took the time to show you my crazy graphic about what contributes to health outcomes. The health department alone cannot solve inequities it needs the power and the backing of all of state government and all sectors of government and inside and out so I do think it is still worth the exploration of what how other states are set up and where their office of health equity sits because it's often not in the health department. And it's often not called an office of health equity it's it's equity injustice and it's looking across the intersection because the roots of inequities for health are the same as the roots of the inequities in education and environmental justice I mean it's the same and so I think that one of the opportunities for us is really to just think about is it either or yes and as we think about where we need to have capacity and leadership to address structural inequities. I appreciate that and I think that that's something still to be engaged with as the commission matures that it's work. And one of the, one of the statutory issues was that they think clearly or and recommend whether there should be a director of health equity inside or external to state government and so that's trying to trying to take note all these initiatives together is is going to take some time but I thought I understood there was a position that had been created and now I understand that it's been filled. Okay. I guess that's the question for me, just, just to make sure we get started, they wish to. Okay, one last question then we're going to take a break and we're going to come back to some other work. Well you may decide this question isn't appropriate for now and then I totally understand. And it may not be our jurisdiction jurisdiction, but Heidi you did mention the issue of the health department being starved. And I'm just wondering what the thoughts, you know what's happening with that prop with that idea and that problem. I really appreciate you're asking that I don't know right now. And I think we're incredibly grateful that we within. Right, you know sort of the silver linings of coven right are the recognition that we need public health infrastructure that had been eroding and so we're very grateful to be able to reinforce some of our work, particularly as you all know. COVID has let us know it's here, it's going to remain here, and we don't want to be caught by surprise, whatever's next. And the second thing that code silver lining with coven was about shining a light on the, the persistence and systemic inequities that we can no longer ignore. And those two pieces I do hope that we are going to be able to continue working on this. And we of course appreciate any support that you all might be able to offer in connecting with us and making sure that our good work continues to move forward. Thank you. This in terms of the legislature structure the house health care for the house human services committee is generally taking the lead on public health and staffing around public health. Although we certainly have a strong interest in this committee room as well. Thank you Heidi and thank you for taking the time to answer the questions that others have closed. Thank you so happy to follow up to any time I really appreciate the leadership of this, this, this committee and the opportunity to share what we're doing and I will make sure that we are firmly connected with director Davis as we move forward. Thank you. All right, thanks so much bye bye. Take care. Let's go off live, and then let's take a break and then we're going to come back.