 All right. Good morning, everybody. We'll just do a quick audio to make sure we've got everything working over at the sound board. Thanks, Don. All right. So my name's Budge Courier. I'm the chair of the 98 Technical Advisor Board. We'll call the meeting to order and we'll start out with a roll call. So Deputy Secretary Stephanie Welch, all right. And then just by way of logistics, your microphone has a little push button. So if they're going to hear you online, that's the only way they'll hear you. We'll hear you in the room, of course, but they won't hear you online. Dr. Goldman. Here. All right. Chief Deputy Director Brian Ayila. Here. All right. Director Zamwick. I don't think she's online. Okay. Erica, Argonne. Here. All right. Dr. Poon. Here. All right. Kristen Miller. Here. All right. Rosa Ramos. I think we know she's not going to be here today. Jeff Abert. Here online. All right. Thank you, Jeff. Tracy Gonzalez. Here. Jennifer Kenton. Here online. Thank you, Jennifer. Erin Riley. Here. And Jennifer Dwyer. Here. All right. So my compliments to the sound crew as everything worked in the room and online, first time out of the gate. So we're pretty excited about that technology achievement there. So nice work team. All right. So next order of business is the approval of the previous minutes from our December 8th meeting that we had. So those meeting minutes should have all been sent out to everybody and want to see if anybody has any edits or updates to those meeting minutes. All right. Seeing, hearing, none. Do we have a motion to approve? Motion to approve the minutes. All right. Motion from Erin. Do we have a second? Tracy seconds. A second from Tracy. All right. And so because this is approving something, we do have to do another roll call order. So get ready with your mute buttons. It's just the standard way of procedure here. So Deputy Secretary Welch. Yes. All right. Dr. Goldman. Yes. Deputy Director, Brian and you. Yes. All right. Director Wick, I don't think he's joined us yet. Erica. Yes. All right. Dr. Poon. Yes. Kristen Miller. Yes. Rose is not here. Jeff Abert. Yes. Tracy Gonzalez. Jennifer Kenton. Yes. All right. Erin Riley. Yes. All right. And Jennifer Dwyer. Yes. Okay. Motion carries. Moving on to our next item. It's item number three on the agenda. It's a legislative update. I'm going to invite Reggie Salvador to come up and give us an update. And as he's coming up to the microphone, we'll do an overview of some of the bills that we're tracking. And if there are other bills that you're tracking, either at the state or federal level that you want us to add to the list, please let us know. We're going to give you what we're looking at so far. So I'll let you take it away. Reggie. Thank you, sir. Thanks, budge. These are just two bills that in relation to 988 that we are tracking. One bill is AB 296 by Assemblymember Rodriguez, which deals with a 911 public education campaign. And this would establish a 911 public education campaign to be administered by OES for the purposes of educating the public on when it is appropriate to call 911 for assistance, but also have a goal of reducing the number of unnecessary calls to 911 call centers and reducing delays in the 911 system caused by non-emergency calls. It would also authorize OES to use federal preparedness grant funds or funds appropriated by the legislature for these purposes. And a second bill that we are tracking in relation to 988 is SB 402 by Senator Wahid, which would limit police response in that it would require 911 or other service center calls for service relating to mental health or homelessness be dispatched to fire districts or department personnel, EMS personnel, mental health professionals or non-sworn unarmed police personnel and not to police officers, except as otherwise provided. Now those are just a couple of bills that we're tracking in relation to 988. And happy to answer any questions if there are any or add. All right. Any questions from the board from Mr. Salvador, the comments? All right. Any questions from the public or online? Okay. Any other bills that any board members are tracking that they want us to sort of add to the list? Okay. Thank you, sir. Appreciate the update. Thank you. All right. Moving on to agenda item number four. Yeah. This is an update from the 98 system director, which is myself. So we're going to go over a number of items. So those of you that think that this middle seat is an advantage, that pole is right in the middle of me see in those slides. So you'll probably see me look at this way a little bit. So we're going to go over just an update on where we are on the call handling solution and the customer relationship management software. So 911 to 98 interface details. And then the information on the set and 98 surcharge is pretty much the same as the last meeting. There's been a lot of updates. And then we'll give you some milestone updates on where we are with AB 98. So the first one we have made significant progress, even though we just met in December, since then we have awarded our contract. All right. See, we have awarded our contract. And it's been awarded to NGA 911. The hyperlink that's here and on our website. And if you want a shortcut way to get to our website, caloes.ca.gov slash 911, we'll take you to the 911 slash page. And in the bottom right hand corner is a 988 link. That's where you'll find all the 988 information. And this contract in its entirety is there available for you to review all the technical requirements, the narrative responses are all available there. The contract was awarded on December 30th. We had an internal kickoff meeting between us and the vendor to make sure we had everything dialed in correctly on January 11th. So we moved pretty quick, obviously for that. And since then what we've done is we've done initial site surveys have been completed at eight locations. Now that was as of Monday and we were doing many of them this week. So all four of these additional may be done. So if you're doing the quick bath, there's one more remaining center. That's YOLO and they're not available till March. So there's not a delay on our side for that. They just requested that we wait to visit them until March, which we honored. So we'll do that final location in March. And that initial survey was really to introduce the vendor to the Lifeline Crisis Center, do a quick survey of their of their facilities, see what gaps they could initially find, and then really start to have those conversation about the workflow needs because the software is going to be critical to meet the needs of the workflow at each of the 13 centers. And all of them function slightly different, although there's some obvious commonalities across them. The number of warm lines that come in the other business businesses and workflows that are served at each of the centers, it does vary quite a bit from center to center. So we had those initial conversations, our vendor will then go back and have one on one, you know, make sure that everything's been addressed, take that folded into the baseline of the software that they already have available. We will test the interface of 901 to 98 and all that the call flow things, which are mainly technical in nature. But it's all those workflows in the customer relationship management software, pulling the data out of an existing system, loading it into the new system and making sure all that's in place. That's going to take some time. And additional surveys and discussions are what's going to kind of flush out that. So I want to pause here to see if anyone on the board has any questions about kind of this initial phase, because we are through most of those surveys and questions or comments. This is Jeff, I have a question. Yeah, Jeff, go ahead. So the I know many or at least some of the 988 centers do remote work for some of their personnel who answered the calls. I'm kind of curious just because I think this this is especially important to the PSAP community with the new call handling solution and it being totally cloud based. I'm wondering if they just encountered any issues with that or if there's any other information that came from those site surveys as how that integration will roll out or any issues that could come with that. Yeah, Jeff, if I understand your question, it's mainly focused on remote call taking at the lifeline crisis centers. And certainly the surveys validated that is happening. And probably the only thing yet to work out is who's going to provide the device to support that exchange of information. If there's a center that has a particularly robust internal device management process where we can validate security and there's no risk, we might be able to support that. But in general, what we've what we've been thinking is that it would be a device issued through our contract, which we have the means to pay for, and then given to whoever those are. So I think that's probably the only detail that we need to solve. And then obviously the training credentialing and you know all that to be able to log into the system is something that we have to to work through. But there's really hasn't been any big aha's so far from the initial survey. Does that answer your question, Jeff? It does. Thank you. I guess that's where my concern is is because it's not just the delivery of the 988 calls to them, but the now the interaction of transferring between 901 and 988 and where that call ends up on the technology on the other side. Like you said, if some centers are using like a bring your own device type thing or something like that. So that answers that. Thank you very much. Yeah. And I guess we can it is a technical committee. So I'll go a little more in depth. The linkage between 911 and 988 will happen in the cloud. And so whatever happens with an individual user device at a center would have the protections from a cybersecurity perspective as it interfaces with the cloud 988 software. From there, there's a yet another level of security between that system and 911. So we certainly have to be very mindful that we don't want to introduce a vulnerability between systems. And because we have a cloud to cloud connection there, we're able to really make sure that that doesn't happen. Can I ask a couple of questions? Yeah. Can you clarify, would this be all calls to 988? Would have their information go into this process or would it only be the calls to 988 that are identified as needing transfer to 911? So all calls will be in the 988 call handling solution software regardless of, you know, whether they came from a warm line, a local line, or they dialed 988 and ultimately chats, texts, everything in one platform. Only those calls that have to go over to 911 would be subject to sort of that next level of interface. But there's also cybersecurity built into the 988 solution as well. So don't think that it's wide open, but there's a different level of interface between the two systems. Okay. And so this is, so that then is suggesting every, all of the 1398 call centers would have the same platform then that they'd be receiving these calls for. They'd all have sort of shared data fields and data capture, presumably. Yes. And is that then, my understanding is that call centers tend to have a solution for the phones and then a solution for documenting information about the calls and those are two separate things. Would this just be the information about the calls, but the documentation about what happens on the call or what the needs are or basic descriptive information sort of more on the clinical side would still be managed separately? No, it'll be both systems managed on a unified platform for the whole state. Okay. Meeting all the needs of everybody, which is the challenging part and why this workflow conversation is just so important. Okay. And then so my last question then really is understanding that a lot of these call centers are staffed by like part-time volunteers, like it's like a few hours a week. I have the training that's required by my call center that's approved by National Association of Prevention, Lifeline, Vibrant, et cetera, whatever creditor, WAS they have, but then like, does that then put that volunteer in a position to be directly interfacing with 911 or is there any expectation for those higher acuity, more challenging calls to be coordinated with a supervisor as part of the Lifeline call center's workflow? Both of those workflows would be supported. Okay. So it's up to the call center how they want to work? Exactly. So if you have a, and we think that's critical. So if you have a workflow where that level of training is equal to everyone, then we shouldn't restrict it to having to bring in a supervisor and change your workflow to meet that need. That's typically not the case. Most of them are using a more trained individual or bringing in a supervisor to facilitate that. That's absolutely supported as well. And sorry, last question here in terms of like just data privacy and you're talking about cyber and I'm sure you're thinking about this a lot, but given that this is going to be a major stakeholder concern, there's already a lot of eyes on 988 and its potential for getting caller information, especially given concerns about privacy and anonymity. Can you say more about what the capabilities of this new platform are going to be in terms of caller ID and like even if somebody has a number blocked still being able to have visibility into their phone number and sort of other privacy concerns? Yeah. So I think the phrase we heard most frequently was confidential yet maybe not anonymous and those are two different things. So however, anyone who's accessing any date, any data in the system has to be credentialed to read that data and that could be something as simple as the permissions you're given locally in your center to access whatever data is in your local system and an agreement on what data is shared from one system to the next as to who has the authority to see that data. And it's probably more important to think about that in terms of data coming from 901 into 988 or in the 901 space, location is known, assumed, provided part of normal day to day business. What do we do with that location when it comes into 988? It's an interesting question. Part of what we have to solve as a board is really figuring that out. And the same thing, once a call comes into 988 needs to interface with 901, the system will allow the sharing of information, but what information from a policy perspective is appropriate to share? What do we need to push down to the local level in terms of the decision? What are some things that need to be gathered at a state level just to answer things like statistics and data metrics and other things that are being required by SAMHSA and others and obviously at the state level? So that's a long way and kind of a political way to dance around your question, but yes, the data is critical and who views the data will depend on who that person is that's in the system. And we the state never want the data. So don't think that OES ever wants it. The only thing I need is what's required to manage the contract and make sure that the that the vendor is complying with the contract. The rest of the data is all local. You own it, you manage it, you give permissions to it, and we'll determine some of the policies on how you move that data around the system kind of as a board and we'll start those conversations today really. Thank you. Okay, other questions from the board? I have a question. Jennifer Kenton, Campbell Police, kind of piggybacking off of the question that was just asked about the technology portion. I'm curious with going with NGA, moving into that next gen call handling solution, is has NGA talked about a way that they'll be able to maybe again policy driven, I understand, but if they have to mask that location to the 988 center, will they be able to unmask that location when it is transferred to 911? And then a follow up question to that. I'm curious with going with the next gen solution and the capabilities for location it has, will this change the way that 988 calls are routed in the state? Is it going to be routed based on location now? So those are some pretty heavy questions. So I'll take the first question. I'll take the second one first with regard to how calls are routed in the state, sort of. And I say it like that because how calls are delivered to us, we cannot change. That's an FCC ruling, they're delivered based on area code. They'll be routed to us. Where we meet that call could potentially change and we've started to have those conversations. I'll cover that in the later update, but rather than meeting that call at each center individually, we see an opportunity potentially meet that call at the source. In other words, we're vibrant is routing that to us. We can do sort of a cloud to cloud connection and eliminate some of that down to a center back up to the cloud stuff and improve our reliability. So the routing of calls and how they are received by us, we can't influence. Once the call gets to us and is in our system, yes, the way it's moved around will absolutely change because we've already built geospatial boundaries for all the 13 centers. We already have geospatial boundaries for all of the 911 centers. So when a call is moved from place to place, we can route it to the exact center provided we know the location. Now, that's a whole big caveat. And that's part of the first part of the question. The way we get location today with a 98 call is nonexistent. It doesn't come in. So we built into the solution a way to push a notification to a caller that they click on in return and location would be known. That would be sort of like a consented location. There are tools available to us to do a look up to get an address for just any number that comes in. And we even have the ability, if we decide per policy, to be able to go out for landlines and voice over IP to hit our database that we have to pull in location. And that would be a little bit dicey, right? Because now we're getting the exact location. Still anonymous, we don't know who the person is, we just know where they are. So we have those capabilities. Are we going to use them? Don't know. The push, link, return location, that's there. And then obviously the other way to get location is just ask the help seeker. And that would discover it. This conversation is going to become much more critical when you're tying this to a mobile response. Very difficult to do a mobile response if you have no idea where the person is. I don't know who can solve that problem, but good on you if you can. So I think that's part of it. So location will come either voluntarily provided by the help seeker. We push them a link, they click on it, it comes back. We use publicly available data sources to ping the location and bring that location in. Or we could potentially ping the 911 database for fixed locations. Doesn't help you with the mobile device, but for fixed locations we could. So those are sort of some of the ways we can get location. I think for this group, it's probably important to understand under what circumstances would that be done? Do we need to make a decision here? Is that a local decision? Those are kind of things I think we have to talk through as a group. But that's kind of where we are right now. So I don't know, Jennifer, that answered all of your two questions. Did I miss anything? No, I think you got it. Thank you. I appreciate it. Okay. All right. Any other questions on this sort of first slide of what we've been doing so far? Jeff, favorite with a comment? Yeah, go ahead. So just to that point on that topic, I know from the PSAP perspective, and I think this would be just obviously not something that has to be discussed right now. But I think for everyone that doesn't work in a 911 environment, I believe it's critical that we do whatever we can to provide whatever data behind a phone call could come from a 988 call transferred into a PSAP to 911. Because I would assume the theory is it's being transferred to 911 because there's a necessity for law enforcement, fire, medical response, and having that information going to be critical. So I think for our discussion, I think it's important to remember that while I know confidentiality is key, the purpose of transferring a 988 call to 911 would be for an emergency services response. And having whatever data we can along with that call, including location, it would be critical. Yeah. And Jeff, I think your point is well taken. And then for this group to think beyond that, location is sort of basic in terms of the information that could be shared. What other information should be shared? Because this customer relationship management software is going to have a lot more history and data available, some of which could be really critical to the emergency response. So are there some data fields there that we should identify and then say, look, upon this transfer to 911, this set of data should also go with it and that would be fine. But this other data over here, no, this probably is not appropriate to share. And it's up for this group to really think that through and come up with a standard because we can support either in the technology. We're doing it based on standards and data conveyance and everything. But what you put in that data payload is a policy decision. The data will be available to be shared. Policy determines what gets loaded into there and what gets shared. And it could differ, right? Some centers could say this based on the relationship with their county or there's other supporting agencies and others may have something else. So it's going to be an interesting conversation. If I could just respond to that really quickly as well. I think that just to give a little more sort of view into the potential flip side. What you're fundamentally saying is what can be shared versus what should be shared. And yes, I think there's a temptation more data sharing, more information about location opens more possibilities. You can provide better mobile crisis response. I run a mobile crisis program. I understand we want to know where people are so we can find them and help them. That's fundamentally important in this conversation. There is an important flip side though, which I just want to give a little voice to, which is the national suicide prevention lifeline as was previously conceived before it became the 988 crisis and suicide hotline or lifeline has a whole evidence base for preventing people from killing themselves. And it is able to perform that function because people trust it and people are willing to call it because they're not scared that somebody is going to come and bust down their door, right? And that trust in the system as it has existed is held dearly and is a major concern among people who have used the lifeline and among advocates that undermining that trust could interfere with people's utilizing a life-saving service. So we want to think about this from a safety perspective. Absolutely. And safety might mean I need to know where your location is so I can send my mobile team to come and meet you where you're at and try to help you in an in-person way. But safety might also mean being really judicious and really focusing on transparency and really being potentially humble about the ways that we should use the information that we could have access to in order to preserve that trust and the integrity of the lifeline as a suicide hotline. Thanks. So I think if I'm hearing that correctly and I think it's probably important to put on the record, no data is being shared today and nothing we're rolling out changes anything that's happening in any center today. And prior to any change, we need to really carefully consider the messaging so that we can help people understand this is what's happening. This is not what's happening. And right now nothing's happening other than some surveys. So I think that's going to be really important to maintain this trust because we have installed nothing as of yet. We want to be very clear on the messaging and I think that's probably a challenge for us state agencies and how do we get timely messaging out? We can do messaging. Timely messaging is usually another thing for us. So we may leverage the partnerships of the board to help us be more timely. I do want to mention, A, I'm going to give a pretty in detailed presentation shortly and that will kind of talk about some of these issues. But currently Health and Human Services does have a web page dedicated to this issue, does have some fact sheets, does talk about the fact that people today can feel confident that they can call 988 and not get a police or mobile crisis response. And so we certainly are getting a lot of questions from stakeholders about when we're going to start communicating that. But more broadly, other than just a fact sheet, but we have been making sure that stakeholders know that that's something that hasn't been put in place yet because I do think there's maybe a misconception that that right now people would call 988 and would get a law enforcement response. And I don't that's my understanding is that that's not happening anywhere. But you guys can tell me if that's incorrect. But but I think there's a misconception amongst some of our public stakeholders that that's something that's currently already in place. Yeah, I think that I think that's important. I don't know of one that has that implemented. We certainly have not enabled any technology to facilitate that. So if it's happening, it's a local decision, local policy, nothing that we're doing has changed any of that. Where that has maybe happened, sorry, this is Matt Goldman, where that's maybe happened is if a 98 call center manually transfers a call to 911, which is local policy and can be facilitated and is done in accordance with standards that are set out by an SPL accreditors, right? Like they have to have a high risk protocol. So when there is a need for active rescue, there is a process to connect in 911 manually. And so I think a lot of what we're talking about here is ideally creating a technology solution that more readily facilitates a process that is already happening locally in many sides. Yeah, I think that's a great way to put it. And that's really what this board is tasked with is to document those processes at a state level, providing enough flexibility at the local level to meet that need for things that are already happening. And so that we're going to start that conversation today and hopefully get to the point where we stand up a working group to go solve that problem and tell us their great ideas that we will then adopt. So that's sort of the plan for that. All right. So the next steps of where we are headed, just so you get a sense of overall timing, you know, this first quarter, we're focused on sort of the kickoff and the surveys and the deployment plan and what we're doing. And we're on track to finish all those things. The next step for us is to sort of validate this interface between 911 and 98 from a technology perspective. And initially, it's just going to be, you know, audio and location are the only two things that would ever move between the two systems and location may end up being just the default location of the center that took the call might be the only thing we have. And just based on today's technology. And then we'll begin in the second quarters, some installs at the first centers. We will come back at the next board meeting and give you a list of who they are and timelines and all that. And we'll be pushing some updates out as well because we don't meet again until May and we'll be making a lot of progress before them. And then we'll go into the second group of centers toward the end of 2023 and beginning of 2024 to finish out the process. And depending on workflow analysis and what we see on the surveys at some of the centers, we know one center is moving already. Those are the kind of things that could sort of impact these timelines, but we're not expecting anything to really push this too far. Yeah, likely the technology will be ahead of the policy, but we'll see. So any questions on that agenda item? All right. Any other questions or comments from the public on that? All right. Seeing, hearing none. We'll move on. This is really the one I think that's going to be, we already started this conversation sort of, but obviously the technology planning is underway. I think we should probably add to this slide the messaging piece is going to be huge and key to how we deliver the message on what is and is not happening. But I wanted to point out that there's a number of examples out there. And this is not an exhaustive list. I could come up with 50 to put on here. I just put a few. States of Minnesota, Maine, Virginia, they're all doing active stuff. State of Washington is doing some pretty interesting things as well. I've read them all, all these plans. I think the one that's closest to what we're trying to do is probably Virginia. They did a pretty good job with their plan. And it's probably something worth looking at. And I actually have a couple of other discussions, but I wanted to just kind of show you this graphic. And this is from Virginia. Not saying this is what we're going to do. Not saying this is the end all be all solution. Little hard to read on there, but basically they came up with these levels. And each level correlates to some actions. And then the document describes in a lot of detail what each level is, what every word on this slide means, how you move from level one to level two, level two to level three, level three to level four, and the subsequent actions that happen. Something like this is probably what we will need to do in terms of policy, where there's certain things on this chart that are just built into the platform handled locally. This is just what's done to handle a 98 call. But when you get into the urgent and emergent columns, some workflows could be impacted. So maybe in the urgent level, that's the mobile crisis, perhaps. And maybe in the emergent column, that's the 911 emergency service interface, where you've got to get someone there because there's some circumstance. So I think our work as a group focuses in on looking at the documentation that's out there. No sense to reinvent the wheel. There was a tremendous group of folks in Virginia that worked on this, did a marvelous job crafting this document gives us a great starting point. We pull in some of the lessons that we have in our state of great resources that are available, counties and centers that are doing some cool stuff like D.D. Hirsch and others. We pull in those and we develop something that we think is supportable as a state. And we probably do that at the working group level. They draft something, send it to us in advance of a meeting, we read it, and we start a dialogue back and forth to modify and approve. That's probably the cycle that we're on. And we're at step one, kind of talking about the concept. So from a conceptual perspective, I want to see if you all are thinking that that is a logical path to take as a group. Okay, I'm seeing some heads nod. All right, so kind of an informal, we're kind of headed in the right direction, which is what we want. Not a voting item, it wasn't on the agenda, but it kind of helps us understand. And then they also did this workflow diagram, which is really hard to read on the slide. The slides are posted online already. So those of you with your laptops, caloes.ca.gov, bottom right hand corner, click 988. The slides are there. You can check them out right now and zoom in and do whatever you got to do. So this type of flow, we may need for certain use cases or workflows or something. And then to the points that have already been discussed this morning, specifically by Dr. Goldman, probably what data is appropriate to share in each of these would be a subsequent chart that we would want. You know, this is the type of information and the type of people, individuals, credentialed trained folks that would have access to the data. That's what we're thinking in terms of kind of the work of this group. Admittedly, there's some crossover from what Health and Human Services is required to do in AB 98. But we knew that. And this is specifically to the 988 interface. So I want to kind of tee that up and see if you guys had any thoughts or further conversation before we sort of get to the work. And the work would be done in a working group that we have the ability to establish today based on the agenda. I think I've got that establishing working groups is agenda item number eight. I just have a quick question that I don't recall. Isn't there a particular date and statute of which we're supposed to have this in place? So, yes, but the definition in statute is unclear. Fuzzy. In other words, it's broad. The basic 91 to 98 interface was supposed to be in place 14 days before the statute was signed into law. So that was the first step. Which we did do and we were working on. And then the next date was 2024. So we basically have until July of 2024. I think we'll be well ahead of that timeline. Depending again on center moves, facility availability, and some of these other crazy, if we go into another pandemic or something, having been through a major deployment during a pandemic that it tends to impact timelines. So, so, but yes, that's the basic timeline. So I think we're in good shape for this to be able to form their working group and come back and get the policy aligned with the technology to move this forward. All right. Has anyone read through the Virginia plan on the board? Anybody else? Do you have a little bit? Any comments or thoughts on it? No, I mean, I think it's great that you've looked at a lot of them. We in San Francisco have undertaken a process in close partnership with our local 901 to do a whole thing around triage of behavioral health calls that come into 901, which calls would be appropriate for transferred to various resources. So, you know, we've, I wouldn't say reinvented the wheel, but we've had a process of adapting the wheel to our local context based on local resources. I would just say, I think that's going to be the challenge for doing it at a state level is the local resources are so variable, PSAP by PSAP. Yeah, that that'll be a challenge, but I think having a general framework is good. And I agree. I think Virginia's strong, but I'm sure we will have some adjustments that we would want to make for California. Absolutely. And I don't know, Erica, if you have any comments, I know you've done a bunch of work at DD Hirsch with the same kind of process. So we're going to be leveraging this local expertise we have to kind of, you know, help formulate this plan. I mean, I think I just have to echo Dr. Goldman that it really varies. And I think one of the interesting pieces, at least for the DD Hirsch 911 988, like, like pilot that we did with LA, that involved warm transfer. So those types of, you know, how do we carry the caller experience, the counselor at our center stayed on the line the entire time since they are the ones that established rapport. These are things we're going to need to think about if we are indeed creating these statewide protocols because our center, you know, is well staffed and equipped. We take about 40% of the California 988 calls, but that may not be the case across the state where agents have that type of resource to do those warm transfers, for example. Yeah, so you can imagine a workflow where, you know, this is the 911 center. You have a relationship and you want to transfer the call to what if they're handling some impactful event and they just simply don't have anybody available. Whereas the call goes in, that's part of the policy. Vice versa. This is the 988 center that I always deal with. What if they don't have any counselors available because there's something particularly impactful happening in that center? So that's kind of an upstream decision matrix that happens. And then, but that drives policy, right? Because if you end up in an alternate location, your access to resources could change. So that all has to be in the workflow where you provide that flexibility. You sort of have this perfect world where this is what I want to do most of the time. And this is how it works. When that's not available, then what do we do? Who backs up whom? What happens in those circumstances? So, Erica, that's a great point. And then locally, these things are different. There may be the desire to do a warm transfer. In some cases and in other cases, let's just take a busy 911 center. You're impacted by some significant event. You get this call that really should be 988. Your policy has had love to go with that caller to preserve the experience and stay on the call and facilitate the exchange. But I've got 30 calls in queue. There's a massive fire raging through my area. And I have to save somebody's life. So, and this one is as I've deemed can go over here to have a more purposeful conversation to meet their immediate need. But I've got lives at risk here. So maybe that hand off is going to look different. So it's all that kind of stuff that you have to allow the flexibility for in the policy. And I think we all understand that. So we're probably going to have some nice to haves that are sort of, yes, we'd love it to happen that way. And maybe some need to have this is the stuff that you really have to make sure happens. And the policy will probably need to be done like that. And then we'll learn that we didn't get exactly right. And we'll come back and probably have to fix it up a little bit to clean in those areas that that we got off a little bit. So that's probably all this is going to work. And then at some point, we have to train everybody to that level. So yeah, training, training, training. All right. So any other comments or anything you want to have sort of on the stable one to 988 interface conversation, any other thoughts, because we're going to kind of shift gears. Okay, any comments from the public on that? Or online? Nothing? Okay. So next slide is on the surcharge. This is the exact same slide I presented at the last meeting. So I don't have any updates here. But you all have had time to potentially review the current budget that's out and to maybe think through this process. So I want to see if the board members have any comments or or feedback on this. I think the big thing to understand here is if it's not authorized in the budget for a state agency to do, they cannot do it, even if the law allows them to do it. The law sort of sets the here's what you can do. The budget says, here's the authority of the money you have relative to what's approved in the in the statute is sort of a two step process. So just make sure we all understand that. Okay. And then this is just our calculations. I kept that slide up there just so that if you have for quick reference, if you're wondering what, you know, eight cents is predicted to bring in in terms of revenue in 2023, that's that bottom number. And that's how we calculate it. But I did just want to this number's a little different from what was in some policy analysis, like during the initial AB 988 process, I think they estimated like 56 million for an eight cents or charge. I was just curious if there was any understanding of maybe there are different numbers of lines that were being estimated, I don't know. That number right there is the variable number, which is the estimated number of access lines, 46,121,214. That is calculated each year and is submitted to us by all the carriers. Okay. But it's calculated in December and delivered to me in August. Okay, so there's a lag, there's a lag. And then the revenue starts to get collected the next January of the number that gave me the previous December, if that's all tracking to everybody. So what actually gets deposited in terms of revenue could be a little different than what we predict. And generally we're seeing about a one to two percent increase in the number of access lines. So the revenue we bring in might be a little bit more than that. But this is a pretty good bound of what's available in the fund. Thank you. Yeah. And then just by way of understanding process, like I said, we at the state we can't spend any of the money till we have authority to spend it, we have no authority to spend right now. So the money is being deposited into the count is protected. It can only be used for what it's supposed to be used for. But we have no access to it. We will when the budget is approved and in July and by then the fund will have built up and you will see that we will carry that previous year balance in here as we set the fee each year. Next year, it's already set at eight cents. It won't change. But that just kind of starts to see how this is going to move forward in terms of a budgeting process. Yeah. And it's all layers upon layers. Okay. Any questions from the public on the set in a surcharge calculation? Anything you see online over there guys? No. All right. Okay. So the last thing I'm going to update on and then I'm going to turn it over to Stephanie is maybe 98 milestones. I'll go through these quick. We were required to have a 98 system director. And we've done that. I'm appointed into that. And we will we've asked for an additional position in our budget proposal, which is working this way through the legislature. And if approved, I would actually hire someone that can help facilitate this. I will probably still keep chairing this, but they would be the one giving this update kind of a thing. So sort of somebody do all the work that I don't have time to do. The basic 98 to 91 interfaces have been validated. And then like I said, that July 2024 deadline's coming. We're on track to do that. 98 advisory board's been established. We've already met twice, which is unbelievable. But good for you guys. And then BCPs or budget change proposals have been submitted by Health and Human Services, DHCS and Cal OES, and they're all on the Department of Finance website. So if you want to go look at what those are in detail, all that's available. All subject to change. This is a proposal that has to be approved through the legislature and signed by the governor before it's final. But there's budget hearings and processes and questions and all kinds of things that will happen between now and June. All right. I think that's it on AB 98 milestones that I have for updates. Any questions from the board? All right. Any questions from the public? Okay. So if you guys want to change over the slides, we've asked Stephanie to give us an update from CHHS. And so she's going to give us that update and then we'll transition back. So give us a moment as we're navigating through the slides and switch over. Okay. So thanks, everyone. Today, that's great. I can use it. These are the three items we're going to go through. I probably have more slides and more detail in my slides than I have time to talk through with you all. So I am hoping that you can post these on the website and then also just make sure that the members have access to them so that they can read some of the detail because it's kind of some of it's a little bit complex. It seems to be a running theme in this particular board. But I'll go over an overview of a project that we were actually assigned prior to the signature of AB 988, but it was very relative to the work that our Health and Human Services Agency and our departments will be doing and try to kind of quickly go over what our agency is required to do as part of AB 988 and then try to identify some of the things that we did in that plan that can help us kind of jump off and jump off quicker to meet some of the requirements that we have under AB 988. So I wanted to kind of ground people in our approach at Health and Human Services. We are an agency with 12 departments and five offices. Our approach to this particular issue is really across the entire behavioral continuum. You can see right there that the part that we're going to talk about today is the crisis systems, but you'll notice in my presentation that our philosophy behind crisis care is that we really want to focus on preventing crisis. We really want to focus on stabilizing crisis and transitioning people to ongoing care so that the need for crisis services actually reduces and that people are getting the care that they need so that we're not creating a robust crisis system and instead we're creating a robust outpatient behavioral healthcare system. So this is a really a lot of detail on this slide and I apologize that I developed a lot of these slides in late fall and there were some changes that happened that haven't been updated on these slides, but I think really the story here is that we've been doing crisis prevention work and in particular suicide prevention work in the state and have led in this space on a national level for over 50 years and so there's a long set of steps that have been taken to build out this system and 988 offers us an opportunity to take it even further and you can look at some of that detail on your own. So we were given an assignment from the administration. This actually took place in 2021 and really we were posed at agency the question of well does the state have a comprehensive crisis care continuum plan? Like what should the crisis care continuum system look like in California? Certainly there were a couple things happening in the background that led to this questioning. First and foremost was that at the federal level there was the designation of the three digit 988 number and then also we were in the midst of a pandemic and quite frankly our rates of suicide were spiking and there were more people who were needing crisis services and so we were really getting a lot of questions saying you know what is the state doing on a state level to ensure that we're meeting the crisis care needs of Californians and so we decided that you know you're right we don't really have a comprehensive statewide strategic plan in this space and we should really work on one prior to diving into some of the details that we've talked about in this committee around really being able to implement this transition to 988 and the vision behind 988 which as we know is much bigger than just people calling into a number to get help but also to potentially get access to critical crisis care services in a new way and so it's a little bit of the background so we decided that we were going to embark on putting together this project. So the crisis care continuum plan has these elements in it it'll be published fairly soon hopefully actually within the next couple of weeks and I can share it with all of you so it is it does identify a statewide vision for a full set of services that that all Californians and that's really critical when I say all Californians have access to crisis care. We have put forth some recommendations on what should be statewide essential crisis services so services that you should be able to receive no matter where you live and we provide a high level overview of the cost of developing this system and also identify how current investments in our behavioral health system of care which are quite significant in the last few years can help contribute to building out this system. We outline a very basic governance model that has a lot more work to do as we will do our work associated with AB 988 and we identify a roadmap towards the end of this decade so through 2029 of major milestones and goals that we should be trying to achieve as we build out the system. So this was quite a process we've been doing it for over a year this is just some examples of the organizations that we worked with to solicit their input in designing this. I also want to lift up that at Health and Human Services we have something called a behavioral health task force we have about 50 different representatives on that task force who actively also engaged in this everything from commercial health plans to probation chiefs it's a very diverse group of people as behavioral health is a very diverse issue and people had very different opinions about what our crisis care continuum should look like. So at a high level this slide summarizes some of the things that we found when doing this project and the rest of the presentation really is to dive into a little bit more detail. So the good news is is that one of the things that we did document is that well we do believe that we are in a good place in terms of meeting 988 readiness as you will see in the presentation while there still remains a lot of geographic variation as been highlighted in our conversation just now with our counties in Los Angeles and San Francisco we do think that we have the ability and we've shown the that we have the ability to actually answer the calls with quality at their higher volume and so we do feel confident in that there's a lot of other work to do that I'll talk about. The plan is really organized with three strategic pillars which I would just call strategic goals and today we're really going to focus on the one that I've highlighted building towards consistent access statewide and this is really important because one of the things of course we found is that there wasn't consistency statewide where you live in many cases did determine the kinds of crisis care that you would get and then also how do we build out because it will be a process and it will be a challenge frankly high quality and equitable crisis care services for all Californians so that would be regardless of payer and so the plan as I mentioned really identifies short term medium and long term goals over the next five years or through actually that's incorrect it's really through 2029 and I'll also identify where we've made investments to date and some of the things that we found around changes that need to be made or or focuses that we need to have in order to ensure that we're being inclusive and that we're advancing equity so what did we learn first and foremost we kind of organized what we learned into three buckets this is kind of making it a little bit more accessible a pretty complex model which is called the crisis now model and this was really important to us because in a lot of the the ways in which crisis services have been approached even designed there isn't really a recognition of the importance of preventing crisis and so we felt it was essential to develop a plan that really lifted up strategies that prevent crisis in the first place rather than just designing a system that was more focused on quality response to crisis and so we have the bucket of preventing crisis and preventing crisis is really the best way to prevent crisis I say it all the time is having a healthy well funded behavioral health system of care adds everything from digital self-help recovery groups harm reduction models outpatient care we'll talk about it in detail but we will never be successful with building out the vision of AB 988 unless we focus on investing in our behavioral health care system and making it accessible and culturally responsive to Californians so responding to crisis that's what we're talking about here right the calls that come into our 988 centers the calls that come into also our there's a lot of other hotlines that exist out there that are not 988 that we'll talk about that that really contribute critically to addressing people's crises and then also building out that mobile crisis response and having the appropriate co-response models that we know that we will have to use in various different places and and throughout the state and then lastly stabilizing crisis I probably because I am the behavioral health person here at this table I guess there's other people here who also really focus on mental health delivery but probably won't go to a ton of detail with this group but this will be a very important part of the planning process that agency leads to to really fulfill the vision of 988 which you know it's only you can be in crisis but if you have nowhere to go then we haven't really done our job and if you have nowhere to receive ongoing care after we've stabilized your crisis you are just going to get in the queue to have another crisis so it's really critical to build out that system as well. So what did we find when we were trying to look at this readiness I know there's a lot of detail on this slide but basically the kind of one of the takeaways is is that at a national level there are a variety of different warm lines and and helplines as well we're going to focus more on the statewide and county boxes in this particular slide and I think we've created here in California a statewide peer support warm line through Cal Hope. Cal Hope also has the ability I hope you've heard of it. Cal Hope also has the ability to offer crisis counseling and also interim actual in-person crisis counseling in language and this was all in some ways done as part of the pandemic response and we've really found it to be incredibly effective and we're trying to really think about what is the next iteration of Cal Hope as we build out our 988 centers. We also have a variety of other state hotlines that are focused on certain populations including foster care youth and older adults and then what I think it's where we get a little bit more complex is we have a lot of county operated lines with over 75 different county local crisis lines and kind of teasing through this and we'll talk about it in a second how this is going to work with some of the other 988 centers is what we really will be focusing on at the Cal HSS 988 advisory committee. So this is just a quick snapshot of some of the really excellent performance our existing 13 California lifeline centers who are now 988 centers have been able to excuse me have been able to accomplish in the last six months. I'm not going to go through all the detail on that slide but our counties are I'm sorry our crisis lines have really built their capacity to take this additional volume and I think probably Dee Dee Hirsch and I don't know if Lee Lee San is here but our crisis lines have been working incredibly diligently to build build their own internal capacity to meet this increased demand and we really felt and also directed state resources because we felt that in terms of in terms of developmentally it made sense for for us to really invest in making sure that our crisis lines had capacity first and foremost as we think about what was what's going to be probably a decade plus process to build out this vision of AB 988 and so most of our investments to date have really focused on building up that capacity so 20 million from our Department of Healthcare Services in a previous budget money is also coming in from SAMHSA to support this growth. So part of what the plan does is that it assesses where we are in the process and then offers some direction of what work can we do in the future and where we should be doing future work as a soon-to-be-formed committee of the 988 Policy Advisory Board. I can't remember what our policy bar is called but so one of the things that we can do to really that we really recognize is that obviously what I just shared with you is that there's a lot of different lines and and prior to 988 there may have been people in local communities who are calling local crisis lines. Should they still continue to call those local crisis lines how is that all going to work and we don't know the answers to many of those things yet but we know that one of the things that we really should consider is making sure that we are facilitating resources and that we're sharing best practices across these crisis lines. So here are just some examples of things that we could do in the future to really facilitate creating high quality response to crisis with the lines that we have in that are in addition to our 988 call lines so creating common standards standards for operation that are common, finding ways to support the sharing of resources and databases so that people have information about what's available in terms of services and support and also pooled workforce strategies. We do have a workforce crisis in behavioral health that trickles down to this particular capacity as well and so part of what we'll be doing in the future with our plan is really looking at maybe what other states have done as well to make sure that they are coming up with creative solutions for having just the workforce capacity to answer the increased volume in calls. So we also looked at the availability of mobile crisis as well as crisis stabilization. This is pretty preliminary. This assessment was done a couple years ago and published by our Department of Health Care Services and we really did this behavioral health needs assessment for the purpose of rolling out a behavioral health infrastructure program and our mobile crisis benefit efforts that we have underway but what you can really see in this map is a lot of variants but certainly we are in the process of ongoing building out mobile crisis teams. Honestly, this presentation could take all day and be its own conference so I'm going to go as fast as possible but we have been and with the support of SAMHSA and other opportunities at the federal level been able to really invest in building out mobile crisis teams at the county level. This is really focused on MediCal and our MediCal beneficiaries and the delivery system that exists within our county behavioral health system but you can see there that the dark blue shows areas where there's probably the most capacity and no surprise, those are in some of the larger counties and the areas as it gets lighter are the areas that maybe either don't have capacity or have limited capacity. So mobile crisis teams were probably doing the best at. We've got of the counties who responded to our survey that was only 44 counties out of the 58. The majority of them do feel like they have sufficient intervention capacity but they certainly don't have the enough capacity to meet the demand. When we move to something called crisis stabilization units, it's a long conversation about the value of crisis stabilization units but you can also see there that again a significant drop in capacity. Certain counties have more capacity than others. These are units where people can be brought to other than a traditional hospital where they can get some initial services and hopefully be triaged to ongoing care. Again, not all communities have the capacity to meet the current demand and then lastly the area where we have the most significant work to do is really more like crisis residential or longer-term crisis care and when I say longer-term crisis care we're still talking about 14 to 30 days so not a real long time but a lot of people need as you can imagine if they're experiencing a psychiatric crisis more than just 23 hours of care. So things that we could do to make sure that we have increased mobile crisis and crisis receiving and stabilization capacity. So first and foremost we want to make sure that in the near term we are investing in our workforce and our infrastructure. We'll talk about that in a second but some of the things we can do is really analyze data to inform our staffing decisions, explore how we can better use telehealth to do some of this work, to both increase access as well as quality. I'm gonna skip a little bit over these and some examples of how to do this increase in access so standardizing processes and protocols, analyzing data to inform staffing and oh I'm just repeating myself I'm sorry but these this slide shows what we looked at in other states and lifted up as things that we should explore more as we move forward with our AB AB 988 at some point I feel like we should rename these advisory committees are our 988 advisory policy committee when we're thinking about ways in which California can move forward. So thinking that or knowing that we have preventing crisis, stabilizing or responding to crisis and stabilizing crisis this slide just really kind of summarizes some of the things that we could do to move forward in improving our system. So in crisis I can barely see this in crisis prevention hotlines you know again established standards and protocols we've kind of been talking a little bit about that making sure that we're providing adequate training. We think about our hotlines that will then be transitioning people to mobile crisis response what are standards for protocols and those processes that we just were speaking about. Can we provide incentives for both formal and informal relationships and of course the importance of this group how do we best use technology to create that that transition and I can't go through all of those in fact honestly I can't see them. So I can't read them for you but part of the purpose of this this presentation really is to outline for you guys that while we haven't necessarily established our advisory committee yet we have been doing some work in the background that we are very excited that we'll be able to lift off of. So what are the probably biggest pieces of work that is in the plan that was really heavily vetted with our stakeholders was developing what we're calling essential crisis services and these will definitely be achieved over time. We feel very committed and I think this is true in many many different policy areas under this administration that your zip code should not determine your health care your zip code should not determine a variety of your access to high quality education whatever it is your zip code should not determine whether or not you're going to get access to high quality crisis care. So while it will take time to achieve these things we do think it's possible and so we worked with all of those stakeholders I mentioned before to really develop this list and so what you see here is that in the in the near term is the blue these are things that we feel like by the end of next fiscal year we can really make available for all Californians. We in many ways already made this available for all Californians we're being a little bit I think cautious in this but this would be to make sure that all Californians would have access to a peer-based warmline and all Californians would have access to a 24-7 365 days of the year hotline where they could get crisis supports. What we do think is also achievable in the medium term or in by the close of fiscal year 26-27 which I guess is about three years away would be the significant investments that we've been making in community-based behavioral health services. I'm sure that you guys are aware that there are a lot of significant investments that we've made under this administration that we're in the middle of implementing. We have a peer support benefit, MediCal, we are using and expanding Medicaid assisted treatment. These are things that we want to figure out how to make accessible for all Californians and having and using digital platforms is one way that we can help address services that may not be available in in all communities and then I can't go through all of these but I'll move to the very end of the decade which would be the kind of peach color and these are really in our minds where we want to go. These are innovative practices things like peer respite, things like in-home crisis stabilization. Imagine if you're having a crisis and you would be able to have counselors come to your house to assist you. Things like sobering centers so that people don't have to be taken to jails or hospitals when they just need to calm down and have a transition to transition away from having substances in their body so that they can focus on their recovery. We are also really interested in post-crisis step-down services, parcel hospitalization, supportive housing. These are things that need to be in our environment so that we can make sure that people who experience a crisis don't experience one right after they've been stabilized. I'm not going to go through these but the plan does identify metrics that we can use and how we could measure them to ensure that we're making progress in our investments in this space. And lastly I or lastly for the plan and we'll get to a few other things but we did look at some different communities around the state and where they are in the process. As we've talked about in this group often we know that we're going to have to have localized models based on the needs of the communities, the capacities of the communities. Just here and I don't have in front of me, I know we have lots of different communities represented at this table. Some are further along than others since we do have San Francisco at the end. I think our team that worked on this plan really felt that San Francisco was one of those areas that really had a highly coordinated care continuum across the crisis spectrum. But that doesn't mean that we can't have success with other models and so what the plan does is really outline four different models that counties could look at and do some local planning and I cannot underscore enough how important it is to do local planning. I think part of what we will encourage people to do in our advisory committee is to first we're going to model what that planning process could look like at the state level and hopefully it'll be replicated at the local level making sure that all the right players are at the table to think through how to create a strong healthy system. Just wanted to lift up some of the things that we heard from some of our departments about what we should make sure that we consider as we move forward with developing this plan. I just highlighted a few. You can go back and read all the details from our Department of Developmental Services. They were particularly concerned and wanted to make sure that there was attention paid to protocols that were appropriate and training protocols for individuals who are living with intellectual and developmental disabilities. I think I would also say since I'm also sitting here next to my partner here from EMS that EMS, our EMS partners thought that the planning process could be a tremendous process to identify and support strengthening relationships between EMS and our county behavioral health partners. Our Department of Aging really wanted to lift up that there are unique needs for people who are older adults and that we particularly need to look at in-home support care and crisis services for our aging and older adult population. I'm not going to go through this, but I did want to lift up that part of what the plan does is we actually hosted listening sessions for community members, people who had lived experience with a behavioral health crisis, either personally or a family member. I think what I would just say here is that people really underscored the need for crisis response to be humanized for us to really recognize that based on who you are, your race, ethnicity, your disability status, where you live, it was how you experienced crisis. We really need to figure out how to create crisis systems that were sensitive to the diversity of California. And so this really just highlights some of the areas that some of the populations that we will be identifying as having special needs and special considerations, older adults, LGBTQ, youth and especially system impacted youth, veterans, tribes and native populations, these are things that we'll address in our plan. I'm going as fast as I can. This slide just really summarizes some of the resources I was talking about before, so over $1.6 billion has been put into the crisis system in the last few years. Obviously, it takes us time to build things, which is why we have to be patient in creating the system that I've been talking about, but we have been blessed to have significant resources to contribute to this process. That being said, the plan also kind of assesses how much it would cost if we really were to implement all of those essential services that I just mentioned. And there's a lot of data around how we came up with this numbers. It'll be in the plan that you can review, but generally speaking, it cost about $2.5 billion annually to have the system I've just described based on California's current population. We do think a vast majority of that is potentially reimbursable under our service delivery systems, which I'll talk about in a second, whether it be MediCal or commercial insurance, but not all of it. And I think what this slide shows, if you can't read the slide in detail, is that it really is those preventing crisis services. The ones I talked about is being so important that we really don't have sustainable or ongoing funding for. So the plan also talks about continuity of care and strategies to address it. And I'm just going to real quickly talk about one of the things that we'll be looking at, which will be gaps in insurance coverage and ways to enhance reimbursement. Too much information on this slide for us to go in detail, but I think the most important thing that really is something we want to lift up here is that you see that, I think that says 54% at commercial health plans. So the vast, not the vast majority, but the majority of Californians are in commercial health plans. You all pay on an average $600 a month, whether it's through your employer or personally, to have commercial health coverage. And we want to, and as you can see that in terms of who's actually utilizing our crisis services, it is most people in commercial plans. So we really want to make sure that we're working with our commercial health plan partners for one to prevent crisis, right? That's a pretty expensive cost. But also to make sure that we're getting coverage for those people in commercial plans who are getting access to crisis services. And luckily for California, we have a very low rate of uninsured in the state. I don't have a lot of time to go through this, but this just really identifies a part of the plan actually gives us some next steps on how to meet each of our three large strategic priorities. So for example, when we think about building towards consistent access statewide, we really are going to focus on four areas of investment. How do we make things available? How do we make things affordable, right? If we want commercial plans to cover more crisis care services, they have to perform well and they have to be affordable. Of course, things have to be appropriate. We have a very diverse state. And probably really critical is really creating awareness. How do we educate communities? How do we make sure that people reach out for help before they're in crisis and have access to services and know what to do when they are in crisis and navigate the system as well? So this slide and the next couple of slides, which I'm not going to go over in detail, but I'll explain what they are so that you can read them on your own. We have about 15 specific things that we have to do as part of the Health and Human Services 988 Policy Advisory Group. We also have a very short timeline in which we can do them. And what these next two slides identify are those 15 things, and I'm not going to read them all. For example, I'm going to pick number four to identify a state governance structure to support the implementation administration of crisis services that are accessed through 988 so that someone who may call 988 might end up getting a mobile response and from that mobile response might be taken to one of those crisis stabilization units or a sobering center or whatever, some of the other things that I've talked about. And then what the second part or what would be the right side of the screen identifies is what is in the current plan that we've been working on that we can review to help us answer the question that is identified in number four. I picked number four because we have identified some best practices from a few other states on how they've designed who's responsible for what at the state level in order to have a strong and healthy crisis care system. And I can't go through them all, but you can read them on your own. It's pretty significant. I would think some of the overlap with this particular body would be things like compliance with state technology requirements and or guidelines for operating 988. Seems like there's a lot of overlap. I'm looking at budge. And so I think that we want to really identify those areas and work together closely. As I mentioned, there are quite a few. I'll just end with the bottom one there, number 14. We need to identify strategies to support the behavioral health crisis system and make sure that it's adequately funded. And I am including mechanisms for reimbursement. So as I mentioned, this plan at least did start to look at and try to get a sense of ways in which how much things cost and ways in which we can partner with our commercial plans to ensure that people with commercial insurance have access to robust crisis services. And then the last two slides here also identified for us lifting off on the plan where we should start based on what we know from our crisis care continuum plan. So for example, number seven, if you can notice, I can actually best see the slides that the best see the things that are on the bottom of the slide. Number seven says resources and policy changes to address statewide and regional population needs for behavioral health crisis services. We have done some landscape analysis of current statewide and regional policies regarding coverage. And so we can lift off from that. I think one of the areas that I think is probably going to be the biggest hardest lift in this big long list of things that we have to do is to have a really comprehensive assessment of what our crisis services currently are in the state. I know I lifted up an assessment that we did a couple years ago at the Department of Health Care Services. That was an incredibly difficult task. And it will take primary research and data collection, and it'll be difficult to really see what that landscape is, especially since it's changing moment by moment, because we made all those investments in behavioral health care. We've got counties that are bringing on new mobile crisis teams every few months, and we don't have a way to necessarily capture that data. So I think it'll really be a challenge and it'll be a critical thing to get done right as part of this process. Oh, okay. So I'm going to just wrap up here and let people know that we do plan on publishing the plan. I guess it's still early in 2023. I'm really hopeful actually be in the next couple of weeks. We're just going through a variety of different approvals right now. We intend, as Budge had mentioned, we don't have any budget authority and we don't have any budget to start this process. We have put forward a budget change proposal that we're eagerly going to be going through the legislative process. Obviously, both the Department of Health Care Services and the Department of Managed Health can. Department of Health Care Services being over all of our Medi-Cal enrollees are 14 million plus people who are in Medi-Cal and the Department of Health Care Services who manages all those other folks who are in commercially insured plan have a lot of work to do as well. So they need resources and staff to fulfill their obligations. We have a joint BCP for all three of us that you can find on the Department of Websites, the Department of Finance's website. As I mentioned, we will be leveraging our existing plan so that we can move quickly in doing and meeting some of the obligations that are outlined in the 14 points that we have to accomplish in our policy work group. We are going to continue to participate in this similar to Budge ongoing. I may not be the person who is here representing CalHSS, but we certainly plan to be very active and really want to coordinate closely and we coordinate very closely outside of these meetings. And then we have some cleanup trailer bill language that will be made available to the public fairly shortly but is not yet available. And that's it. All right. Well, thank you, Stephanie. And I will say that very rarely does somebody else's work assigned under legislation look more difficult than mine, but you win. So I want to see that was a lot of information. We will make this available. It'll either be late this week, early next week, it'll be up on our website. We got to go through ADA compliance and stuff. So it will be linked at the same place as where you see the information for this meeting. So stand by it. It's a process for us, but we'll get it up there as soon as we can. We'll have access to this. But I want to see if the board has any questions. I mean, there's been a tremendous amount of work that's been done and analysis. And this is basically the platform from which everything else will grow out of. So any questions from the board on this? Go ahead, Tracy. Stephanie, that was great. Thanks. That was a lot of good information. Do you feel that or maybe not from everything is still happening with this is, you know, all still happening as far as collecting data for it, but from data in the past, or just what you know, that it's all connected correlated to homelessness as well, is that I didn't see that up there as part as part of the population. But all those types of people can be in that population. Is that kind of a recurring right at the top thing? It is. And I think if I have more time, I probably would have gone over, you know, some of the other areas of our work. I think you make a really good point. We intend to involve our interagency council on homelessness as part of our advisory body. As you know, my secretary is the co-chair of that body. And the whole purpose of that body is really to make sure that we are having a health and human services approach to homelessness. So I don't know if that's specifically, we certainly are thinking about it. I know that we're also thinking about the data that we could share with the initiatives that are being led in that space and need to share data. But I think absolutely people who are unhoused and people who are living in unstable housing are really at high risk of experiencing behavioral health crisis, whether it be a mental health crisis or a psychiatric crisis or a crisis of substance use, but also physical crisis, right? Like I think that all three of those things often are happening at the same time as crisis. So that's why it's so important for us to have partnerships with EMS, fire, law enforcement. And I know that that, you know, for some is, I don't want to say concerning, but people really want us to get to a kind of a fully behavioral health response to care. But the reality is, these are individuals who are interfacing with those entities on a daily basis. And so how do we work together to make sure that, as you were saying earlier, that, and this is probably too simple in my mind, that the fireman goes to the fire and that, when that's needed. And if there's someone who can respond and support the person medically or psychiatrically with help, that that is that help is available. But I think what really underscores what you're saying, Tracy, is that the crisis services aren't there, right? They're not, if someone does respond, there's no, there really isn't a ton of capacity of where to take them, where they can have access to crisis stabilization. And so, you know, we've invested significantly at the state level. And I didn't talk about it today, but we have our behavioral health infrastructure program, which is a $2.2 billion program to build behavioral health facilities. Many of those facilities will be focused on providing crisis services and actual crisis brick and mortar buildings. And I don't know if any of the other counties who are here, people who are doing services at the local level would have any additional comments. But certainly the number of people who are unhoused in California and as it grows, stresses our crisis system more. And we have to take that into consideration as we're trying to build out the system. Right. Yeah, you obviously understood my point just from the local level. That's what we're dealing with. And the big part of the population that we see every day that are in, you know, unfortunately, the whole process that you spoke of, and which is a great thing is that it's proactive, but we're obviously already in the reactive stage by the time they get to 911. So that opportunity is gone at that point. But you know, and we do have a lot of local programs that I know even directly in my own town that we can get people into and are proactive with the homelessness crisis in our own communities and things like that. But I'm sure there's a large part that are being missed. So I appreciate that. Thank you. Speaks volume to why I was saying that assessment is going to be really challenging to do. But because on a daily monthly basis, it changes what's available changes or the number of people who need help changes. And so I think we would want to err on the side of more rather than less. Unfortunately. Okay, thank you. Any other questions from the board for Stephanie? So go ahead. Yeah, again, lot to digest lots of information, but a couple things sort of stood out to me. One actually has to do with the mental health parity. You mentioned about that as critical and I totally absolutely agree with that because, you know, it's after stabilization, after crisis response, where do we really refer? And I think one of the statistics is very telling, which is your commercial coverage of, you know, over 50%. So I'm just curious, you know, with HHS, what's your effort that you can share with us about how do we really working with the commercial plans to to establish or to bring up that that continuum? Because as a county services, we definitely see a disparity between actually Medi-Cal, actually covered services versus what actually can accessible in a commercial side. Two things that I think we'll look at. First, what you saw on that slide is that clearly people who have a commercial insurance are having crises and those are costly. So like if somebody is has a crisis and then they have to be admitted into a hospital, that costs that commercial plan. And so it's in, we want to make the case that it's really in their benefit to really try to, like with physical illnesses, manage something outside of what could be a far more costly hospitalization or etc. And then secondly, and this doesn't sound super boring, but like part of what we have to do is make sure that we create all these billing codes so that people can get reimbursed for for all the different things that that we want people to be able to be reimbursed for. So I think we're making some progress. There's lots of national conversations about how there really could be a strong benefit financially, but also for individuals for commercial plans to not just, you know, do crisis, but also more importantly, as I've been talking about, really prevent their enrollees from experiencing a major crisis that could end up in a hospitalization or a long term hospitalization. And they will be very much at the table when we have our advisory committee and very eager to look forward to partnering with them. Okay. Any other questions from the board? Okay, I have two. One will will is sort of a terminology question that I'm interested in. The term warm line is used frequently to access certain services. Is there a difference in the services available from someone who's accessing them via warm line or via 988? Or are they essentially the same? I almost want to turn to my 988 folks to see if they're willing to answer that. I'm interested because the term is used a lot. We probably should understand if there is a difference. If it's a transitional difference, if it's just the terminology difference, I don't anybody want to step out there, not binding no binding response. We'll just look. If you want to speak for Dee Dee Hirsch, go for it. Okay. I'm going to bow out this one. I mean, they're fuzzy. It's a great area. There's not clear consensus definitions for these things. I think in general, warm lines are perceived as lower acuity, almost universally peer run support. I think that there's not an expectation of any subsequent step after contacting a warm line. It's like you call the warm line for support, and you kind of know that's what you're going to get. You're not having any illusion that there's going to be a connection to care request for additional service. I think probably the way that the national suicide prevention lifeline pre-988 was conceived, overlapped with that more. I think now that there's been this recast in of the national suicide prevention lifeline as the 988 crisis and suicide lifeline, it's shifted and expanded its focus a little more to encompass crisis services with this vision of connecting to mobile crisis and linkage to crisis facilities. I think they're distinguishing themselves a little more increasingly, but there's definitely still overlap. A lot of 98 call centers are still staffed by peers and volunteers and offering warm line like services as well as their core functions. This is Erica from DD Hirsch. Just to be transparent, I haven't had personal experience with warm lines, so I can't speak to how they define themselves. I do know that at DD Hirsch, the type of extended training that all the counselors are provided, maybe it's updated. The last time I was trained in 2014, it was about 80 hours, like 10 weekends of a Saturday. Part of the screening to establish the suicide risk of a person is asking those levels to assess level of intent. And if we do find that we're speaking with someone who may be in a type of crisis, but it's not necessarily suicidal, we inform that person, okay, this is a suicide crisis line. I do hear, you do require some type of assistance. I have 10 minutes or 15 minutes, whatever the protocol is and let's talk, but because this is a suicide crisis prevention service, we do also need to keep the lines open for those who are in a suicidal crisis. At least for our line, the last time I was trained in the protocols, there is a clear distinction between that acuity. I think that's important from a messaging perspective, because one of the things we talk about and we will probably have to discuss the message is who do you call when? And that's a common question that we get frequently. So when do you call a warm line versus when do you call 98 versus when do you call 911? Now we know people will get it wrong and make deliberate choices based on perception anyway, but at least the messaging would be consistent and then you have to facilitate in the system the ability to move the folks around based on the choice they've made, which is outside of your control. So I think it's just something for us to consider with regard to the warm line. And the other question I have is, as you guys have done this work, it's a substantial body of work. Are you seeing any barriers in state statute that would prevent the implementation of some of these initiatives? Okay, I figured there was. So something simple that I've heard, I don't know if it's true, but I've heard that an ambulance can only transport people to a hospital. I don't know if that's true or false, if that's a state statute, if that's a local policy, but you know, if that is in fact a law, a statute, then that would be something that you could potentially have a large source of resources that could be used for something else in mobile crisis that would be prevented by some statute. And again, I don't know if that's true or false, could be urban myth. I don't know. Does anybody know if that is in fact a law? Yeah, go ahead. Not to put you on spot. No, it's not a problem. So the answer is very complicated. But by and large, yeah, yeah, of course. But by and large, you are correct. For the most part, an ambulance is only going to go to a local acute care hospital. Now there are some exceptions where you can have direct transports to a mental health center, one that comes to mind. It's just one example. But like in Alameda County, those local 911 units for a patient who has no medical complaint and requires a behavioral health evaluation can go to John George Pavilion, which is in San Leandro. Those are generally the exceptions, not the rule. And for the most part, ambulances go to hospitals and we're pretty much bound in statute to do that. Yeah, a lot of this will fall, Stephanie, to the work you're doing, not this body, but knowing resources available have to tie into technology. And so there is a linkage there to this technology group in terms of what is and is not available, what services are available, where, how is that indicated, you know, through the technology platform as to what's accessible. All those become really important questions. And if there's limitations, then this group would have to work together to sort of remove or modify or clarify them. So I should look, I mean, but I do actually literally think one of the things that our policy advisory group is tasked with doing is to really look at those things and maybe lift them up. But one of the things that you and I can talk about strategy-wise is how we can, once we have our work group up and running this summer, that we can work on bringing agenda items to this group to deliberate on issues that come up in the other work group and vice versa to talk through together. And maybe that's a separate working group. I know we're going to get to that discussion shortly, but I see that happening a lot. Yeah, I do as well. All right. So if you guys want to switch the slides over, I'll pull the board and the public any other comments and agenda item number six, which, I'm sorry, agenda item number five, health and human services update. Okay. Seeing, hearing none. All right, we'll move on. Now we're probably going to run a little over. So if you I'll move as quick as I can on the next item. SAMHSA, FCC and vibrant updates. This was a requested agenda item that was added at the last meeting. We've got it in here. I'm going to go quickly. We have met with SAMHSA. They've appointed a technology director. Her name is Stephanie, which was very handy for me. So I didn't need to learn a new name. So, and we have met once and it was a very, very good meeting. We've got a follow-up meeting scheduled on the 24th. She wants to talk through an overview between us and vibrant of the unified platform we're developing. So that's all very favorable, very positive. We're working in a good direction there. The FCC rules to is promoting rules to report, promote reliable access to 98 and lifeline. So this is triggered based on the two day outage that occurred to the 98 system. If you're not aware of that, that happened, I don't know, December. Is that right? Yeah, I think it was insane. So there are FCC proposed rules. If you've never commented on them, there's a very complex process that you have to go through to make comment. Oftentimes, the timelines are so truncated that we as a state have a difficult time even getting through that process. But some of you as an agency may be able to look at them and respond. If you need some extra expertise and help navigating the rules, navigating how to respond, just reach out to me. We have been through that process and we can help you with that. But essentially, they are looking at the reliability and resiliency of 98. I do have a meeting with the FCC in two weeks. 98 will be on the agenda topics that I'm talking to them on. And that's as I'm wearing my National Association of State 911 Administrators hat. I'm the president of that group. Every state has a 911 administrator and we all get together. So we'll be meeting with the FCC and talking through talking with them. So if you have anything you want me to ask, let me know. I do have an audience with them and really looking forward to that. I have a link here to the proposed rules that the FCC is working on. The last point on this slide, we are beginning discussions with Vibrant. I kind of alluded to this earlier about where to meet the traffic and how do we do those integrations with them to bring the information into California and integrate into our platform. We're at the initial stages of those discussions that have gone very favorably. We're really excited about that. And then we're certainly working to make sure the cybersecurity requirements are addressed within our solution. That's something super important. And that kind of encompasses the larger umbrella of data protection and HIPAA and all those other things that we have to be mindful of. They're all built into the platform. So that's a very quick update of what we've been doing here. Is there any questions or comments from the board on these items on agenda item number six? One very quick question. So here you're explaining that NG9911 has to figure out with Vibrant how to get calls from Vibrant to NG9911 as the vendor and then to the call centers. Is there also anything in the contract with NG9911 that requires them to have alignment or interface with Vibrant's data collection and reporting and sort of jiving with their unified platforms that we're still interfacing with that sort of responsibility for Vibrant? Yes, there is. And we've also looked at any requirements and reporting requirements that the state wants to have and local reporting requirements. We realize there are three different levels there. There's some federal data that they want at the federal level. There's some state data that folks are requesting at the state level. And there's some local data that's needed to support just operation and what you do at the local level. All of those are part of our discovery process. So that workflow analysis we're doing. And we want to automate all that. And we want to make all the data based on relational databases so that we can generate those reports with you out having to do anything. So we don't want you to, you know, a lot of folks are asking for the raw data, which is great. But if you get the raw data, then you've got work to do to produce the report you want. If we can just produce the report you want, tell us. We'll produce it. But there's a level of comfort there and integration. We'll do either. But that's certainly part of what we're focused on. Yeah, absolutely. Thank you. Yep. Okay, any questions from the, any further questions from the board or from the public on agenda item number six? Okay. Moving on to agenda item number seven. This was a request we got to add this to the agenda. And, Stephanie, I saw this was actually in your plan that you went over as well. Just this idea of making sure that we have equal access. And so for me, the question I have about equal access, and you can see it on the slide here of what is being said, you know, but obviously the facts about it and the fact that it's accessible. Is this concern mainly focused on the messaging around how you get services? Or is there a concern that the technology itself is limiting access? Or is it the policy? Or something like that? So I want to get your sense as a board of what you're hearing in terms of is this perception or is there really a limitation in technology? Or is this a policy or what are you guys hearing? So open it up to the board. Go ahead, Kristen. Just to clarify, you're talking about access to 988 from the community, right? From the community. Okay. Equal access to all. In other words, regardless of the group you're accessing from, you have equal access. This could be everything from rural to special groups that have particular needs or perceptions or whatever is, is there in fact a barrier that you're seeing that's technology rated, the related policy related or perception? Or maybe a little in Riverside County. There isn't a local 988 center there. And so our calls are probably going to D.D. Hirsch. And the perception is they won't be as familiar with the resources. Okay. Yeah. Okay. So that's fair enough. And I think that falls into the larger plan that is in development that we recognize based on the graphic that was shown in the very services that are available in each county. That's probably fair. That's probably a fair perception. There is a difference in what's available in each county. Okay. Fudge, I think that I think it's perception mostly as far as just people even still knowing that it even is there or an option for them. Because when we talk to people who really truly meet that, and we've been thrown it out here and there more and just talking with people in general and different groups that I deal with there, it's as much as we all see the commercials and know about it in our capacity. I think it's still just more of an unknown that it's there and what it can do for them at all the different levels of what it's going to offer for them. Okay. I don't think it's a technology really because they seem to not have any problem reaching other 9-1-1 and everything else. Right. So it's probably not so much a technology piece. I think that's what I'm hearing and seeing, which is good news. But there is a perception. There is a messaging. There is a gap there. So go ahead. I think a few of us wanted to say something. Do you want to go? Okay. I also want to just, I think I was maybe one of the folks who brought this up and to add a little more to what specifically I was suggesting that we talk about here as well is also thinking about disparities in access to 9-1-1 and to mental health services, including by ethno-racial groups. So, you know, black and brown populations, there's been public surveys by Pew and others showing that there is a large degree of mistrust in calling 9-1-1, like especially communities that are primarily people of color who have been largely impacted by things like police violence and not wanting to even pick up the phone to call 9-1-1, even if there's a crime happening, right? And so the idea in, I think this is very much reflected in Stephanie what your plan was getting at is, you know, having that in mind while doing this kind of planning, it is a perception thing, except this goes back to the can versus should share. Trust is so fractured and mistrust runs so deep in some communities in California that even if we're saying as transparently as possible, here's what we're actually doing with the data. If there's even the possibility that something could be done with data, people won't trust us. And so I think acknowledging that there are those, you know, histories of, you know, trauma in communities, especially communities of color, acknowledging that there's also the challenge of like communities of color not necessarily wanting to engage with 988 even because it's a mental health resource and there's a lot of stigma and disparities around accessing a mental health specialty resource. So that's like, also how do we help with accessing 9-1-1 or 988 or, you know, the framing of all of this, it's complicated. And so, you know, I will also acknowledge as a white man, I'm not speaking from personal experience here, but my purpose for wanting to elevate this to the agenda was to make sure that there is an active process as part of this work group to engage stakeholders who can speak on behalf of communities of color who do have, I think, important points to make here and make sure that as technical requirements are being specified, that it really takes these ideas into consideration. And that hadn't really come up in our first meeting, so I just wanted to make sure that there was space as part of this process and that that wasn't just relying on a relatively so far quiet public comment process but rather was proactively engaging groups and representatives and stakeholders to really participate in that process. Yeah, thank you. And I think just so we appreciate how difficult this will be, I challenge you to poll 10 of your acquaintances and ask them if they've ever heard of 988. So maybe, well, yeah, yeah, Stephanie, you might be in another category. I have done that and there are some like, what's that? And so if just the awareness of the number itself being available is not propagated out, you can imagine the perceptions that are out there of what what services are and are not available, how data is and is not shared. So the messaging got a very valid point. I think we need to be very proactive with this. So Erin, I think you had a comment as well. I just think for some people it's very confusing because their agencies were wanting to get ahead of some of this and created their own mental health teams initially. And so I think there's some in the public that are thinking if they call 988, they are still getting some type of a police response, there's confusion with that and then other agencies involve fire right away and there's just confusion as to what you're getting when you call 988 and as some have already spoken, whether it's associated with 911 and it's just each agency even within a certain county has their own policy of how they're already doing things. And I know at the sheriff's office we have a MET team and but that's separate from 988. And so there's a whole lot of different teams and I don't want to say policies but already groups handling some of this but none of us are really on the same page as of yet. So I just think in general law enforcement is slightly confused along with some of county health and fire mixed in and it's just everyone's trying to do the right thing but I don't know that we have a single message yet. So if it's confusing for us then it has to be confusing for the public. Yeah and I think that's a valid point. So I you know if there's no objections I think we'll just keep this as a standing item to keep in here. So go ahead Eric I'm sorry I missed you. So as we were discussing this earlier you asked what laws are preventing you from doing your work. Something that came to mind that speaks to the diversity and what type of mental health teams are available. And I'm speaking as a layperson getting 5150ed. I know that there are implications for if a police officer takes a person to a mental health center that may be an involuntary hold versus a voluntary hold. I don't know the law well but I know that you like a licensed mental health professional can make that determination and I think as we're hoping to reach people and stabilize them with resources appropriate to their acuity level we want to be very mindful that folks are not afraid to call our number because they think there's going to be risk they're going to be placed in an involuntary hold which I'm sure many of us who work in this field have some type of experience with loved ones it can be extremely destabilizing. Yeah I think that's a valid point sorry go ahead Stephanie. I am very valid points. I know this will be very much front and center in our policy work group but actually I do have a question so say I am physically disabled I'm blind I'm hard of hearing I don't speak English like what are what are some of the current tools at our disposal and maybe that's not technology but I think it is I mean I actually it is I'm actually more concerned about that making sure I don't know do you guys can you can any of you who run a current crisis line talk about like how would how would somebody who is who is deaf or hard of hearing utilize 988 I mean I know we have chat and we have text. So we do have a and I'm going to butcher the acronym there's like a TTY like services available for the visually impaired I I don't know about resources for that specifically but I think this is going to be a conversation that continues to evolve especially as I saw like you mentioned in one of your slides telehealth services maybe options for video etc but there are some resources that do exist for accessibility. Yeah and we do have some requirements on the technical side in the contract to address that but building them out depending on how they are accessing the system is limited on the carrier side in other words if you dial 988 from your phone as an audio call as an access and functional needs person you may have restricted the ability for us to take advantage of technology versus get some echo here so what happened you're good let's just see if I was paying attention I am so versus if you you were to say come in through a chat or some texting options so those are things that we the technology will help but I think there is some gaps here for sure we have a relationship with the access and functional needs community through Cal OES we have a assistant director overseas that and also we on the 911 side work very closely with them so I think we should really begin to have those conversations yeah okay other conversation on that any comments from the public on that agenda item I think it's super important okay the last one is some work we have to do and I put it last for a reason because I wanted us to have the context of the conversation that we've just had for the past two hours which it has been two hours by the way what do we need in terms of working groups to help us go off and do some work and come back with some recommendations to the board as a whole because you can see meeting once a quarter as a formal board is going to be tough to get certain things done we will accomplish some tasks but it's not a good way to produce work products in a fast manner so I'll thank you for advancing the slide you got me over there it's good so that's really what I agenda item number eight is about so I want to see if any of you have recommendations on working groups that we can form and the way it would go you make your recommendation we can vote on it and establish it today based on the unanimous for our majority vote because it's an agenda item and we've agendized it that way so I'll solicit input from any board members on a working group that needs to be formed board's open well we had talked about one last time right about the the idea of like a triage clinical best practices how to identify calls I think especially from 9-1-1 to 9-8-8 directionality like how to determine from a 9-1-1 perspective which calls are appropriate for potential transfer to 9-8-8 in lieu of dispatch of a you know police fire EMS type service right that's when I was thinking of the sort of this 9-1-1 to 9-8-8 policy and vice versa I don't know the title gets a little wonky depending on which direction you put first but essentially under what conditions do we make a decision to move a call either directions and what data should sort of go from the point A to point B I think that would be critical I don't know what we call that committee or working group maybe it's just 9-1-1 and 9-8-8 policy working group or something I don't know maybe we protocols yeah policy all right protocols I like that better because you're the one with policy thank you very much yeah there's something specific I think about like triage on like trigger points yeah okay the triage or call criteria like yeah like what at what point do you so maybe it is pretty close how about 9-1-1 9-8-8 triage process so that we aren't because the term protocol has in the 9-1-1 space has the same correlation as rule you must do got it and it sort starts to make that community get a little bit what about I mean operational like 9-8-8 9-1-1 and 9-8-8 operational working group or interface something I mean because it's an it's an operational piece that we need to figure out I like interface workflow or guidance 9-1 and 9-8-8 interface working group and out of that you will develop many things can I ask a question is part of what the working groups could do is could we bring more people in to have technical expertise yes and that's the idea thank you that's exactly how this would work so that we can form the working group and go get the expertise needed to develop something and then come back and present it to this board they wouldn't have the ability to determine anything they just recommend things so it's a good way to get work done in a way that doesn't require this setup sorry to throw a wrench in it I will just say this is I think stemming from the statute defining what this group is supposed to do we're talking about 0.3 here which does say the creation of standards and protocols for 1-9-8-8 centers will transfer 9-8-8 calls into 9-1-1 piece apps and vice versa so they refer to standards and protocols right this body has that authority the working group is not okay got it yeah so we that's the distinction there and so we would be it would be harder to get members to sign up for something where you're developing a protocol they'd be like no no thank you but if you're just an interface working group they can make recommendations then it's up to us to do the hard work to develop the policy or the protocol yeah okay so that's one um and so um I should we probably vote on that one now probably the way to do that right before we do another discussion in terms of or do them all at once all right okay so we'll just any other suggestions I have one other one I thought of but I'll wait and see if you guys come up with anything oh I wanted to have one based on the topic we already talked about accessibility and I don't know if that's the right I mean that's I'm worried about both accessibility as well as approaching things with a lens of addressing disparities which might be more in the wheelhouse of our policy might the agency's policy committee but I know that in the process of doing the plan that I just talked to you guys about the passion and concern amongst primarily the disability community that this is going to be something that's accessible to them and I don't understand the technology you all do um but I think that was something that was really important as well as in language capacity it was very important and I don't again know if that has a technology component to it or not but those I just want to express um from what we heard from constituents that that was really important and should be considered so maybe it warrants a working group so accessibility and equal access working group yeah and does that also get what you were getting at okay yeah and yes it is technology and yes it is sort of roles based in a lot of the practices we're seeing at the centers are if you're from a particular community where someone who's familiar with the unique needs of that community they're typically best served to meet your need because they can identify with what your unique needs are or somebody else might not so and there are you know they're like we saw on the on the graphic you produce there's a number of hotlines out there and warm lines out there that are specifically developed for certain groups and and types of of people that's what this group could also take a look at as well okay concrete example for the group if it's helpful um I know that you can press is it for guys and get the veterans hotline so it's not just and then there was a discussion about whether or not we should we create like a press two and you could get somebody who answers who would be able to be sensitive to issues around Native Americans or tribes um or I don't I mean I don't know where it could go and then that could be maybe we have a press number for everybody and that would be a bad idea so in terms of a platform technology wise so that's kind of what I was thinking about in the state of Washington I believe it is has implemented the tribal access via a push on the interface so that's a good example of a state that's actually done that so okay Tracy um I was thinking of a group that can be able to find all these other grassroots efforts that are occurring to really cue the rest of the state and the counties at whatever is granular granularity as we can go because I feel there's a lot of those things happening that so we've got to find them and kind of I don't know embrace them a little bit more or at least forgot what they're doing and again that one message type of thing right sort of an information gathering working group where you're going out there information and best practices or something like that okay we're gonna need a lot of people to volunteer by the way so it's gonna be up to you guys to go and get the folks because the next step will be to see if any one of you want to chair any of these so yeah I know I'm out too Stephanie I'm ducking on that one but um so okay so there's three and the only other one I had thought of was this whole statutory review of things that in statute might be preventing forward progress I think if we're not deliberate in doing that and Reggie left the room at just exact right time when I mentioned the legislative work yeah it was planned um but I think someone to do like a legislative review of some of the statute that's out there that potentially would need to be updated now this group has no power to update them and we're on shaky ground to even venture into those waters but I think just identifying the barrier would be the purpose of that just to kind of get make a list is is my thought sorry Tracy go ahead were you I was gonna ask Stephanie a question about that kind of does your group like when like say that Senate bill 402 does your agency go and is there a piece of yours that goes off to kind of reach over to those groups of people to be like okay well you know this is kind of opposite of what we're trying to accomplish or is that just completely that's all political and hands off or just curious yes and no right I mean we provide technical assistance on legislation um and uh that's um yes we have an entire shop all of our departments have legislative offices um and certainly we provide technical assistance on legislation um I don't know how to answer I mean I I'm not as familiar with what your authorities are here to be honest with you but I do think um paying attention to it I mean obviously this is a we've talked we've talked about so many different topics today you could see why I mean there could potentially be 50 bills that are introduced this year that touch this subject but we do have capacity within our departments and I can't speak for Cal OES like everyone's tracking these like if someone wanted to have a work group that was just making sure that we're looking at them I just I can't speak on behalf of whether or not we officially as an agency or our departments would do that because there's just a lot out there um and I'm specifically talking about existing statute that's much more of a safe space that that that needs to be reviewed legislative policy pending legislation that's a whole other group we want to stay far away from but if it's existing yeah then and we identify it as a challenge it's up to there's a it's a very complex process to update it and who would do it is in question but just identifying that a plan is implemented that hasn't a statute that is potentially in conflict with what you're trying to do um is what I'm thinking of and if that's a bad idea then I'll clear around the fact that it's it's impeding on your goals to meet the technology that needs to be in place for us to reach our goals yeah I think that I'm gonna strike that one so I won't even suggest it but maybe I'll talk to Reggie to see how we do that so so we have three I guess lastly just related to statutory review even though you're striking it and that might be fine for now might revisit I would also ask if that were to be considered would regulatory review also oh yeah it would have to yeah okay so it would just be to the statute itself like right like a classic for example like a lot lives on regs for a classic regulatory limitation today is the fact that all calls are routed by area code as defined by the FCC it's that's a that's something that we all know is out there so all right maybe we'll revisit that so the three on that that we've discussed are the 91 and 98 interface working group it's number one number two the accessibility and equal access working group number three information gathering working group is that the name we want to go with or you suggest that Tracy give a better name no I don't have a better name unless somebody else does but um I'm just yeah okay any others besides those three well I had a question Tracy um about the type of information gathering that you were envisioning yeah and as I said that I just thought of like yeah because information is obviously very broad and the reason I even brought it up was that um I was involved in an EMSA meeting for dispatch centers within LA County and someone from I believe it was from D. Hersh was actually in on the call and she was talking about efforts and programs and things moving forward in LA County specifically and I was like you know so I made a comment about how I'm on the 98 group and that these were great ideas and that would be good to get but you know it's not just polarized to that county and I'm sure there's and I know there's other efforts even within very granularly within dispatch centers themselves where they have triage nurses and mental health pieces within the dispatch center specifically and so kind of like all of that specific information so it's being done for us and it'd be great for us to really know that and understand it as much as possible again so not the word information or at least specifically to what information which is what I was thinking as far as um similar programs or no help me out here somebody what are the words it's kind of like local implementation discovery work group like how how is 988 implemented at the local levels that we can draw from their experience as we're thinking about what the statewide experience looks like yeah local county efforts that are doing great things that we can uh wrap our heads around that was a really long title Erica so uh county and local implementation gathering working group so we're going to probably need to anyway I'm going to have to come up with a name of that anybody good at on the spot come on Mr Mr Troxel what do you got for us yeah is that good good enough good enough for government work so I don't know that's the words I was thinking the best practices are innovation yeah probably best practices because I don't know what the connotations of the word policy is but there are a lot of pilot groups and a lot of discovery like yeah experimentation that's happening I think we'll take off locals maybe just best practices working group because there could be county there could be state there could be okay so maybe best practices working group we like that better okay all right very broad it is the only risk is does that does that get confused with the 988911 interface because there's a lot of best practices there too that very true and it might but I think they may gather information that feeds over to the other group that's figuring that out so yeah but I think that would free that group up to focus more on that specific thing because there's a lot of other information that has to be fed back into the system that are just specific to 98 so yeah all right um so from here and Meg I hate to spring this on you but we can vote on establishing these today but how do we is there anything that would that governs sort of the tasks we assign to them and how we appoint a structure for them do you mean how do we vote about that no like if I we establish these groups today how do we get members on them and how do we assign tests to them how do we define what they're doing I see yeah we we could and do we do that do we have to do that and then vote on the charter and then they get to work because then in which case they won't get to work until May the way that it was agendized we're establishing the working groups so that would include their task and the membership okay we don't have to know all the people that are going to be on the working groups but I think that that falls broadly under this agenda item okay so with that said um the the um I want to see if there's any comments from the public before we take any motions as a board yeah so what we did in our task force is we identified areas that we knew as a state we really couldn't manage from a board perspective because of the timing and frequency that we were doing this so we formed these working groups we developed a basic set of here's what we're going to do um and then they went out and got formed and now they report back into the 911 advisory board it's a structure that works really well um we can do that today by establishing these groups and then we will start to form them and then at the next meeting we can just report out the progress they've made what the group is and what they're focused on and give the board an opportunity to tweak adjust a line with what we really want them to do and that would be the motion so the motion would be to establish these three working groups best practices working group 911 and 98 interface working group accessibility and equal access working group and charge them with establishing their members and developing um tasks that they will then begin to execute on and report out to the 98 advisory board at the main meeting um and give us an opportunity to adjust that they have no ability to set policy or procedure or any of that they're just simply making recommendations and gathering information back up for us so that would be we have to point a chair today yes right all right and we need a chair for each of these so there's three of them we need three volunteers yeah one by one 98 and 91 and 98 interface working group any takers but so a question first can you define the responsibilities of the chair and then form form the group establish the tasks and report back out to the advisory board but just are any limitations as far as members of the group or any that or that can all just be set by the chair and all those things are kind of open for yeah all set by the chair um a question go ahead how um was it bagley keens the name of the act yes how does it interface with meetings of the working group members we we at bagley keen does not apply and public meeting notice wouldn't apply to those you know they're not setting policy they're not they're not doing anything other than gathering information so that's how we've established them before it's good we're doing it right so because that's what we're doing and and that's a great question erica thank you and then just to also just say it out loud really the only limitation we have for membership on the working group is that it should not be a majority of this meeting which would informally create a very good point you cannot have seven or more nine eight advisory board members on those working groups that that would then establish a quorum in another meeting that would violate the meeting rules for this yes that's correct you could have two or three though that would be completely fine no restrictions again or four even um I guess even five right because we have 13 members on this board is that right by my count so we'd be fine to go up to that many yes okay other questions are the working group meetings governed under bag leaking no I mean um I'm not going to volunteer as chair but I can definitely volunteer there's a lot of expertise in our departments that I'm sure that there are people who might be interested in being on a working group yeah we do need the chair to come from this board though so there's a continuity there so I think that membership is fine but we want them to be chaired here so again anybody up for the 91 and 98 interface working group but just as Jeff a barrel I'll I'll be willing to chair that Jeff you are a hero all right thank you sir you're welcome okay so there's one accessibility and equal access working group I should not share given uncertainty about my continued ability to participate so yeah unfortunately I know eyes are on me but I have to defer okay all right that one may get formed later which is fine we can approve its existence and form it later I think that would be fine and then the best practice is working group I volunteer to chair all right so that's Tracy okay so this question do we have staff support in chairing these work groups yes yeah there there will be a volunteer for the accessibility work group okay you already are in trouble because you just did in public so have a really big staff and board for that yeah do you want to do that you want to co-chair it put you and Matthew together and then uh if Matthew you have to there you go that works that's that's good yeah that way we can get that done in this meeting we don't have to wait a whole another cycle okay yes and we will provide the support we have hi Anita can you wave your hand can you say hi I'm working group manager that's and we have additional staff we can help too because we've done this before so okay this would be an extremely complicated motion for somebody to make but if somebody wants to give it a shot so the the proposal is we would need a motion for somebody to make a motion to establish the three working groups the best practice is working group chaired by Tracy the 988 and 901 interface working group chaired by Jeff a bear from San Diego county the accessibility and equal access working group co-chaired by Stephanie and Matthew and these chairs would be charged with forming the group establishing the goals and reporting back to the advisory board at the main meeting so do we have a motion to do said things no I motion to establish the best practices working group as chaired by Tracy I also motion to establish the 98911 interface working group as chaired by Jeff and I also motion to establish the accessibility and equal access working group as co-chaired by both Stephanie and Dr. Goldman I second the motion nice job Aaron okay so I'm going to do a roll call vote here um so uh Stephanie Welch yes all right Dr. Goldman yes all right deputy chief deputy director Brian a alo yes all right Lizanne's not here Erica yes all right Dr. Poon yes Krista Miller yes well says not present Jeff a bear yes Tracy Gonzalez yes Jennifer Kenton yes all right thank you Jennifer Aaron rally yes and Jennifer Dwyer yes all right so I'm really excited that those that were appointed as chairs also said yes and the motion carries okay any other further public comment on that item okay moving on to the next agenda item uh agenda items for future meetings um one I know to put on there is the working group report out so I certainly will add that on anything else that needs to be added on to the agenda for next time oh let me switch the slides here budge can we keep a placeholder for an update from Stephanie on the HHS technical yes yeah we'll keep the play is you good with that okay we will yeah so essentially what we're thinking Jennifer is that the current agenda items would all stay unless one of you wants one of them removed we could talk about that but essentially the same agenda we went through today would would remain with the exception of the working group establishment would be working group reports that's essentially the agenda we would come into the next meeting with is there anything as far as uh wordage wording as far as uh when the working groups will be fully established no there was just can we full full speed ahead Tracy just get her down you are empowered to yeah your deadline is have a report by may but that's that's a good question okay any other any other conversation on that about future agenda items any comments from the public on that or online okay yeah yeah and that's one of the the updates that we have in our 98 report out for a branch yeah okay so that finishes up agenda item number eight I think we're on the agenda item that we all love uh public comment any comments from the board for members that weren't for anything that wasn't on the agenda okay any comments from the public anything online you see anything in the chat or anything okay anybody in the room all right seeing hearing none item number 10 adjourn do we have a motion to adjourn a favor motions to adjourn okay there's six motions to adjourn so that might be saying something it's we're a half hour all right so we'll say Dr. Goldman as the motion Erin as the second because I think you clicked yours too all right I was going to actually ask you do you think that we should be allotting more time for these meetings we can two hours the long meeting I really was trying to keep it to that but we can certainly block out two and a half hours so we can do that that's easily there's nothing preventing us from doing that yeah I don't have a comment on that it was more can we get the agenda emailed to us yes we can we will have it ready at least 10 days prior and the last been because I'm not that great about we follow my email on time but um that would be super helpful yeah just in terms of process what we'll do is is about a month before the meeting we will send you the agenda see if you have any additional items to add give you about a week to comment back on whether you have additional items to add and then we will add those in and that did happen this time Stephanie we did that but and then we will then follow up when we post on the website let's just make a note from a policy perspective just send it to the members because sometimes the web they're not checking the website and that way you'll you'll actually have the agenda too yeah yeah and I think that's one step we don't do now but we will add in yeah that's great that's great one additional question um as we're going through the work group report outs if there are like supplemental slides or documentation information or something for the board to review are those always distributed with the agenda like I just want no they are not um what we typically do because this is a very fluid environment the agenda set can't be modified um but if you have anything to present just get us to us a couple of days prior and then once we present it we'll ADA compliance it and put it on the website to make it publicly accessible because if it's presented here it has to be public material so that's how we'll do it does that make sense in other words one or two days before get us what you want to present or worst case day of we'll make it happen and then once it's presented we will take on the responsibility of making an ADA compliant and posting it on our website because that's required from our side okay all right okay so we are in the middle of a motion and a second to adjourn any other comments before we adjourn anyone opposed to us adjourning all right so we stand adjourned my time is 12 29 thank you everybody