 All right, and start the meeting Dwayne. Good evening, everyone. Welcome for the May 11th version of Durham's Community Safety Wellness Task Force Meeting, this is our monthly meeting. We're so glad that you are all here and glad that those who are visiting with us through our streaming device are also with us as well, that we're here in community. Now we'll turn this to, I am Xavier Case, one of the co-chairs. Now I'll turn this over to my co-chair Marsha Owen The values? Okay, good evening. It's good to be together. So good to be together that the value that I offer to you all this evening is belonging. Xavier, you mentioned immediately community and the qualities of belonging and presence seem to be essential for repair and care. So do we all agree that those two belonging and presence will be the two values that will hold the center of our time together? Sound good? All right, thank you. Thank you, thank you, thank you. Xavier, back to you. Okay, just by way of announcements, members of the task force and also round table members who are not on the task force but are participating with us, helping doing the work, I should have gotten an invitation from Dwayne and Dr. Campbell about a one year appreciation during that we're having on June 10th at 6 p.m. It's going to be at the mutual building. You mean June 15th? June 15th, thank you. June 10th is another announcement. So thank you, I have both takes there. So it'll be on Wednesday, June 15th at 6 p.m. Thank you, I'm looking right at it and reading the wrong one. So that's, again, just a way to just kind of come together and just be in the same space together. No shop talk, just enjoying human communication and camaraderie. The second announcement is on the fact that we are, because we're at the end of the year, we have our fourth quarter report due. And so we have until Friday, June 10th for the round tables to put that together. And we'll give you more information about what we're looking for and hopefully it'll be kind of easy. We'll be alerted. We know that there have been some events happening in this quarter, but not as many as normal. So we want to make sure we take note of that and give you a writing assignment that makes sense for the quarter. So that's it for announcements from what Marcia and I are aware of. Are there any announcements from the floor, from task force members that need to be noted? I'll just share briefly while we're on record. The SRO round table has been able to host one listening session for parents and caregivers and families. We have a second one that we've just confirmed this week for May 25th at 6 p.m. via Zoom. If folks want that information, I'm not entirely sure the best way to get that to them because we are partnering with Village of Wisdom to really center black parents and caregivers through their networks. So they've invited folks and there are a couple of other black parent organizations that we're working with. So if you are a black parent, family member, caregiver of a DPS student, you are welcome to attend. And if folks reach out to anyone here, point them my way and I'll get you the Zoom link for the 25th at 6 p.m. Thank you, Jesse. Any other announcements? Oh, yes, mind you saying in chat that there was an email sent out today from Village of Wisdom. So that can be forwarded to the listener as a great suggestion. Thank you. If there are no other announcements, turn back over to Marsha to introduce our presenters for tonight. Thanks, Xavier. Yes, it is really a pleasure to welcome four researchers from Duke. Nicole Sramsapata is the lead researcher. They will be presenting on mental health and the criminal justice system in Durham. And she is joined by Maria Tackett from Dr. Maria Tackett from Arts and Sciences. Michelle Easter from School of Medicine and Isabella Larson or Bella who is a double major undergrad at Duke. All of them have joined together with the Duke Bass Connections Program that is an interdisciplinary program that puts, as we can see, lots of people from lots of places together to tackle really difficult problems. And I would certainly say that mental health and the criminal legal system is one of those problems. So thank you so much. I won't spill the beans. I'll just turn it over to you, Nicole, but with great gratitude and welcome. Well, thank you so much, Marsha and Xavier for inviting me. And so the three of us had a really exciting conversation and they helped me to choose what we're talking about tonight. So I am super excited to bring a subset of all the work that this amazing team has done to you guys tonight and hope this is the start of a really deep and interesting conversation. So I'm gonna start by sharing my screen. Oh, can I have permission to screen share? So yeah, I'll just say this is all the work is funded by the Bass Connections Program and also the Data Plus program. So those are two programs that get students involved at Duke, students like Bella and many more who I'll share a list briefly with you in a while to get students involved in research that is interdisciplinary, societally relevant. And that's given me the pleasure of working with Maria and Michelle to faculty collaborators. Maria and I co-lead the team and Michelle's been a collaborator for a long time. See if I can share screen yet. Yes, I can share screen now. Okay, could do. All right, full screen, okay. All right, so we call our Bass Connections team Mental Health and the Justice System in Durham County. And as I said, these are our funding sources and so two sources, the Bass Connections and Data Plus support the students. And then we got a small grant from the Office of Durham and Community Affairs which allowed Michelle and me to go on a listening tour and talk to providers who work with those with mental illness in that are maybe just as involved but are generally high need patients around our community. So when we have a bit of context around the numbers that we've been analyzing it, a lot of times comes from those sources. So Maria, Michelle and Bella are the people that are here tonight, they're in red and you can see the names of all the other collaborators from the past few years. And these are just the past two years actually. And Bella is one of our longest standing team members and she's going into her third year with us next year. So all of this work has been done in partnership with these organizations around Durham. And what I will say about all of them is that they've got a long standing history of trying to do right by people with mental illness involved in the justice system on just boots on the ground, really, really practical trying things, seeing what works. And then we came in just a few years ago with the power of Duke students who were interested and wanted to learn and just time to analyze data and ask questions that are important to these groups. And this is an ongoing project, as I said earlier. So we wanna hear what questions, if any questions come up from you guys that could continue and support our next steps, we've got the data and we'll just keep analyzing it and see what we find. So the data that we have are merged from the Durham County Detention Facility and Duke Health. This would not be possible without the services of Duke's ACE Analytics Center of Excellence, which has the mission of making health data accessible for analysis. So what they do is they merge the data set and then anonymize it. So we can follow an individual who's going in and out of the detention facility in and out of the health system, but we never know their name. So there's no risk of a data breach. And that's been a really important thing for us to build trust in the community and be able to do this work. So the big takeaways that I'll show you tonight, so I'll give you the punchline now and then we can dig into some of these as we go. Durham City and County have done a lot over the past several years to care about those with mental illness who are involved in the justice system. When they're not in detention, many are using Duke Health and very often the emergency department. And I'll show you a deep dive that Michelle has done into those patterns of use in the ED. Like largely probably with credit to point number one is that what we're seeing now is that those who are the most difficult to treat, those with serious mental illness and co-occurring substance use disorders remain the ones that are most likely to be re-arrested. So in some ways we've gotten the low hanging fruit and now the really difficult cases are the ones that are still struggling, of course. Maria and her part of the team did a deep dive, deep longitudinal analysis that I'll show at the end, suggests that a visit to the Duke Emergency Department seems to be a warning sign of arrest in the near future, that we'll dive into what we think is going on there. And then I'll show you our cash bail analysis that brings us to kind of a dilemma between medical ethics and legal ethics and we'll go there and see what you guys think for that and see how we can begin to resolve it. So I'll start with a little bit of background about just what was known in the literature when we started about mental health and criminal justice. Mental illness and addiction are overrepresented in the incarcerated population. There's a lot more research from prisons than from county jails. So prisons are where people go when they're convicted and serving their sentence. Jailists, people that are held before trial, serving short sentences, or those are the two main things. So in jail, people are innocent until proven guilty or they're serving a really short sentence. So it's a different population in many ways. The one definition that I wanna take forward is this term serious mental illness. And in the research literature and in the way that we have defined it, that is a diagnosis of schizophrenia, bipolar disorder, or major depressive disorder, or any two or all three of those. So when I say serious mental illness, I'm specifically talking about those diagnoses they tend to need different kinds of care while they're in an incarcerated setting. They're unable to comply with orders, unable to engage into the typical ways in the general prison or jail population. And so they have been a focus over the past several years of research. Those with serious mental illness are not more likely to commit crimes in the general population, but if they ever get arrested, they're more likely to get stuck in the system. So definitely, and I'll show some data on this, definitely do not want to bring on any stigma of mental illness and crime. It's not that they're more likely to commit crimes, but it's just the getting trapped in the system. So the way that we know that Durham has done a lot over the past several years is that they've paid attention to the sequential intercept model. And the way to think about the sequential intercept model, I'm gonna go ahead and put it all up there. So if you think about all the places where one could interact with the criminal justice system, you've got the officer on the street who can choose to make an arrest or not. And at that phase, we in Durham have over 50% of our police officers and a similar percentage of sheriff and the Duke police, Durham Tech police, Intercentral Police, significant percentages are trained in crisis response. And if a person is not committing a serious crime or it's clearly, if it's clear to the officer that they need mental health rather than incarceration, they can be diverted to the crisis center, which is on Crutchfield Street, kind of up behind Duke Regional Hospital on the north side of town. If someone does need to be arrested, if they have committed a crime that merits serious enough to be arrested, in jail, there are many education programs, treatment, we've had mental health services provider, psychiatric medications have been provided in the jail for many, many years. And so those things are done in the jail and done fairly well. And then we've had a mental health court and a drug court in Durham for a long time. And I don't know the details, but the county has just received a grant to do some expansion and some additional work in the drug courts. And then in the probation and parole end of things, the criminal justice resource center. And so the courts in the probation for all criminal justice resource center have the ability to mandate that people engage with counselors and continue on the progress of their treatment. So all along these points, Durham has done a ton of work and it's happened over a fairly long timeline starting back to 2006. And I'm not gonna go into the whole timeline of what emerged at each stage of this, but suffice it to say that Durham's done a lot and there hasn't been a lot of fly-by-night things that went away. A lot of things have really stuck and stayed because people have been caring about this for a long time. And we are now analyzing data between 2014 and 2021. So the last bit of this timeframe. So all right, we have the data from 2014 to 2021 and the match with Duke health records. So what we have from the detention facility is the date the person was incarcerated and released. Then we can do the math and figure out how long they stayed, what they were charged with, some general demographic information, race, ethnicity, sex, gender, and then their release reason that could be, they made bail, time was served, they were convicted to move to prison, all those things. And then from Duke health, we have their appointment dates, which clinic they visited, did they go to the ED inpatient, outpatient? We also have data from Lincoln Community Clinic. We have both their current and historical diagnoses, any prescriptions they were given and their insurance payer. And most recently, we've gotten the census tract of their most recent home address from Duke health. So we haven't done much with that information yet, but we're planning to use it both as a proxy for socioeconomic status and also to do some mapping around Durham County. So Durham is not too different from what we knew in the literature is that people with mental illness are overrepresented in the incarcerated population. So only about 32% of those who were ever incarcerated, this is in the past seven years, were unknown or unmatched to Duke, so they had never had a Duke appointment. But then among the remaining, 16% had a serious mental illness and that's schizophrenia, bipolar, or major depressive disorder. Another 25% had not a serious mental illness diagnosis, but some other mental illness diagnosis. And in this group, we've got drug addiction, post-traumatic stress disorder, depression, anxiety, intellectual developmental delays, dementia. So this is more of a catch-all of mental health diagnoses. And only 27% of those who had, 27% of the whole population had been to Duke but still had no mental health diagnosis. And we can assume that the percentage that have some sort of mental health diagnosis is probably higher than this because it's probably present in those unmatched as well. So when they're splitting, oops, sorry, splitting along those who first column, no diagnosis, second column, serious mental illness, and, oh, serious, sorry, second column, the mental health, but not serious. And then the third column, serious mental illness. This just shows where they go in the Duke system. So look along at the yes row for each one. And the numbers are going to add up to more than the total in each group because someone can go to multiple clinics. Someone could go to the emergency department and an inpatient clinic in Lincoln all across that time. But what strikes us about this is that Lincoln community clinic is used less than I thought it would be. The Duke ED is used fairly heavily and inpatient and outpatient clinics are also used fairly heavily. So people are coming to Duke and Duke has a lot of experience with them. So getting into the question of what kinds of crime are people with serious mental illness committing? We wanted to ask the question, are they arrested for different crimes? Are the patterns different? And the short answer is really no. If you split the group, here's the first column is no diagnosis, serious mental illness only, substance use disorder only, and then co-occurring serious mental illness and substance use. If you just blur your eyes, the shapes are pretty similar. The bottom pink here is violent crimes. The middle is property crimes. The orange is drug crimes and the green is other sort of a catch-all. Maybe a little bit more property crime in those with mental illness and substance use disorder. Actually not more drug crime even though the substance use diagnosis is in both of these categories. So the crime types are not that different among these different populations. So then how does this population interact with the Duke emergency department? This is the deep dive that Michelle has done into doing a familiar face analysis. So this analysis, we define a familiar face at the ED across a five year period as those who have been seen 20 or more times across a five year period in the ED. And that could be 20 times in one year and nothing in the next four years, but that is not typically how it goes. These are generally people who are chronically coming in to the Duke ED for their healthcare. Those with multiple incarcerations are overrepresented in that ED familiar faces group compared to those with fewer incarcerations. There were in this particular time period, 585 formerly incarcerated people who were also ED familiar faces and they accounted for 21,000 visits to the ED. 8300 of those visits were uninsured and that cost 11.7 million to Duke and their incarcerations cost three and a half million to the county, to the detention facility. So if you're not the kind of person that goes for the human reason to take care of these people then there's a pretty strong financial incentive to take care of these people in a different way. So asking when they come to the ED, why are they coming? And one point I wanna make before I go down that road is that these particular 585 people are kind of a small proportion of the whole population that's seen in the Duke ED that's almost 300,000 but they're a really significant percentage. They're 21% of the ED familiar faces. So when we break apart familiar, frequent ED users are familiar faces from those who just come in at least once. This first column shows you the general sample so that almost 300,000 people who came to the Duke ED in most, like in most of our department circulatory. So most people come into the ED for a heart attack. Muscular skeletal, so injuries are the second most common. And then mental disorders are also pretty high up there for why people in a general health care sample come to the ED. When you compare that instead to the jail sample the reasons for coming in are slightly different. Those who come to the ED just once or twice most often if they're in a jail sample they're younger they're not having heart attacks but they're coming in for injuries and poisoning. This is overdose, car wrecks, gunshot wounds and really any other kind of injury. The musculoskeletal reasons are still there mental disorders are still there. But when you look at the combination of people who are in the jail sample and also frequent ED users those mental disorders jump right to the top of the list. That is their number one reason for coming in to the emergency department. We're still seeing the aches and pains and the injuries and poisonings but those mental disorders are right at the top of the list. Are there any questions there? I'll pause there because we're going to shift gears a little bit but just about general health care uses if there are any questions now. I have a quick question. I thought that I just clarified maybe I missed the slide. At what point does a person receive a mental health diagnosis? Oh good question, yeah. So we took the data from Duke Health and this was across all of their visits. Did they ever get a diagnosis that met the ICD-9 and ICD-10 codes for all the different categories of mental disorders? So it wasn't like we were tying that to their jail time. It was just across any of the times they came to Duke Health did they ever get a mental illness diagnosis? So the hospital does the diagnosis? Yeah. Okay, got it. Thank you. Yeah and it could have been, they came to a psychiatrist saying I'm having mental issues or they came to the emergency room and the attending physician went, this seems like more than just a broken arm. Kind of thing. Yeah, maybe just one more follow. So it's not that the mental health professionals in the jail are offering the diagnosis. It's done in the hospital. Yeah and we have looked at the data both ways. So the diagnoses can happen in the jail if something is active and happening and really relevant to their stay in the jail. People can also come into the jail and say I have this mental illness diagnosis and I need to stay on my medication. And if they self-present to the providers they will get their medications in the jail. And a couple of years ago we did a deep dive analysis of those that were recognized by the jail versus those that had been diagnosed at Duke Health. And there's a pretty good overlap. I think it seems like it was 50 or 60% are recognized in both places but then there are some that are only known to the jail and some that were only known to Duke Health. So, but this data is specifically from Duke Health. Thank you so much. Nicole, that's a standard part of jail intake because it's not part of the health screen is a mental health screening which designates whether that detainee is put in the mental health pod or connected with CGRC mental health staff. But you didn't use that as a point of identification of particular detainee. Right, it is now and it wasn't for the whole time that we were. Oh, so you didn't, since it wasn't for the length of your study, you didn't want to include that. Okay. Right, right, exactly. Yeah, and we, that data is from another colleague of ours is doing analysis with that and it was harder to get that data. So we just took what we had. Okay, so moving on, we're gonna ask now how does mental health relate to re-arrest? And the short answer is this is where I was going earlier in the big summary is that those with co-occurring serious mental illness and substance use disorders are the most likely to be re-arrested. And so the y-axis here is the percentage of people with each diagnosis and each of the blocks here is one year since their first arrest. This was starting in 2014, 2015. Those with no mental health diagnosis. So the light green bars here, about 40% of them are re-arrested in their first year. And then the next set of numbers are cumulative. So almost 50 are re-arrested by their second year, 54, 56% by their end of their fourth year. Those with serious mental illness are re-arrested at a slightly lower rate. And but their re-arrests continue to go up across the years. Those with a substance use disorder, that's the light blue, about 50% of them are re-arrested in the first year. And that goes up to over 70% by the fourth year. But those with co-occurring substance use disorder and serious mental illness are the most likely to be re-arrested. And they're not different from those with just a substance use disorder. And so they are re-arrested again over 70% by the fourth year. So again, the most serious patients are the ones that are most often re-arrested. And similar to the graph I showed you before, they're not more often arrested for drug crimes. So we wondered if it was this, the substance use disorder presence in their diagnoses that was leading to the re-arrest and drug arrests are not a dominant reason for their arrest. So it's other things, they're decompensating, getting arrested. So I'm gonna dive in now to the longitudinal analysis to look at how the patterns of usage of Duke Health and is related to re-arrest. And so we've done a longitudinal analysis to assess that risk of re-arrest after a visit to Duke Health. And this is the summary plot of that, sort of boiling a lot of work down into one graph. So if you'll hang with me and walk through it, the X-axis here is the period since the most recent arrest and the periods are months, the periods are 30 days, but we can't call them months because it's not like January, February, March, it's like 30 days from here to here, the next 30 days. So roughly it's months on the X-axis. The Y-axis is the odds of re-arrest of people in each of these categories here. And I'll go through the categories in a moment. But when you're thinking about odds in any analysis, what odds to be below one, so odds below one, this dotted line here, if it's below one, that means the person is less likely to be re-arrested. If it's above one, it's more and more and even greater that the highest amount, more likely to be re-arrested. So if you start down here at the bottom dotted yellow line, this is a person who has no mental health diagnosis. And in yellow, they have not been to the emergency department in the past month. And if that person is out in the community for about five months, their odds of re-arrests go down significantly, they're below one at that point and they continue to go down pretty rapidly over the four year period, the 48 month period here. Compare that to a person here, the blue dotted line also has no mental illness diagnosis but has been to the emergency department. So we take this longer time to get their odds below one as a sign that things are not going well for that person. They had some reason to visit the emergency department, things were not going well and it took them a little bit longer to stay out in the community before their odds of re-arrest went down. Then we wanna look at the solid lines here. The solid yellow line is someone who has the most serious co-occurring serious mental illness and substance use disorder diagnosis. If they have not been to the emergency department, it takes them about eight months for the odds of re-arrests to go below one. But if they have a visit to the emergency department, it takes them almost 10 months to have their odds of re-arrests go below one. So what we take that to mean is that their experience out in the community has, something has happened that they are not adjusting well back to life in the community and things are going wrong and that visit to the emergency department is a sign that things are not going well for that person. The other thing that we take from this graph is the really steep slope of all of these lines. If people can string together anywhere from six months to a year, then their odds of re-arrests go down really significantly. So this gives us a hint at when the intensive effort probably should be given to people with both serious mental illness and even no mental illness. I'll pause there before we go into cash bail. Are there any questions there with that group? Yeah, Marcia. Thanks. So if you've got, do we know how many people were diverted to the crisis center? I love the familiar faces. So if they're familiar faces in the ED, they're probably familiar faces to law enforcement. Do we have any? That data is out there, but I don't have it. So the crisis center has been collecting that data for years ever since they came into existence. But if they are diverted to the crisis center, then they're not booked into the jail, which is a good thing. And they're also not going to the Duke ED or Duke at all in that moment of crisis. So we don't have access to their data. One of the things that we're planning to work on this summer, we've kind of got to figure out on a deeper level how to do it is over the timeline that diversion has grown more and more in usage has our level of arrests gone down, has our level of business to the ED gone down. We haven't done that analysis yet. It's pretty complicated to do, but the data are out there, but we don't have it to put it all together. Thanks. And I think it's on Mike's sister's hand too. Yeah, thanks, Nicole. I got kind of a, so now what kind of question, getting out of the weeds of what the data says of what currently is, but what should be. I think from hearing the version of this that you presented to the Stepping Up Initiative and certainly sitting out in those meetings, would you say it's fair to say that your research and the Stepping Up Initiative, which is kind of A principle, if not B principle recipient of this, there is no presupposition that someone with mental illness needs to enter into the system of care only by means of a crisis response. And if so, certainly not only by means of a crisis response at law enforcement. So that not if, but when we can build up a system of community safety department, that can and would be a preferable way for people to encounter the system before they're even justice involved at all. And also that there was no presupposition that the principal venue for receiving mental health care needs to be or should be in the jail. The jail is currently one of the main providers of it, but I take that as an indictment of the system, not a point of pride. And I think it's the more we can do, and this data would seem to suggest, the more we can do to people from mental illness ending up in the jail in the first place, and the quicker we can get them diverted post-arrest into mental health court and whatnot and not relying on the CGRC mental health staff, good as they are to provide this, the better, right? That doesn't mean we don't need improved mental health support inside the jail, but it should by no means be the default place where people encounter it. Would that be a fair? Yeah, yeah, I would agree with that 100%. And part of, I won't speak for my collaborators here, but part of where I tend to go with this is, holy cow, the county's done a lot, Duke needs to do more. And that we have a shortage of mental health providers in the whole world, which leads us to, okay, do we do more community-based? Do we do more group therapy? We don't have enough for one-on-one therapy. So yeah, we can go there, but let's save that for the end and let me finish off the cash bail part. But yeah, short answer is I totally agree with Mike. Okay, so we're gonna show now the analysis of cash bail reform. As many of you are aware, one thing that's been, it's been in conversation around the country recently is eliminating cash bail. And so the main arguments against cash bail are that requiring someone to pay to get out of jail when they're innocent until proving guilty is really unfair because it ends up disadvantages those who can't afford to pay bail. That leads to major disruption in livelihood and families for what are very often minor crimes. It leads very often to people who will plead guilty just to go home. So it leads to greater guilty pleas, even if people are not actually guilty because they've already spent time in jail and just wanna go home. On the other side, there's the belief that letting people out of jail will lead them to fail to appear and because we need that bail to entice them to come back and get their money back, will lead to increased crime. And then the argument in Durham is that I have heard is that people with serious mental illness, especially those who are unsheltered don't have a lot of resources to put them back on the street where they are at risk. They couldn't get mental health care. As I said, we have an understaffed mental health system even at Duke all over the world. So it puts them back on the street when they're at more risk rather than in jail where they have at least a shelter and services. So in that background, but in 2019, DA DeBarry was elected on the platform of cash bail and around the same time the 14 district court judges both changed their policies, both moved policies in the direction of reducing cash bail. So the DA's policy was really explicitly to recommend release on their own recognizance for nonviolent low level offenses. But of course the DA can only make recommendations and the judges make the ultimate decision. So the DA's could say, let this person go and the judge could say no. But what the judges did at the same time have a very specific schedule for all the different levels of offenses. And on those lower level nonviolent offenses, they made recommendations for much lower bail amounts even including zero. So around the same time, the DA was going much more aggressively toward it but the judges were also inching in the same direction to have lower bail amounts and even down to zero. So what we wanted to do was compare rearrests for new crimes after release for initial low level offenses. So we wanted to specifically look at these people that were likely to be released or should be released under these policies. First offense, very low level crime. And then we asked if they were rearrested in that arrest period or in that period after the release for a new crime. So did crime go up? We compared timeline before versus after the policy change. So here's our timeline. Between February and May of 2019 is when this new policy was rolled out and ramped up. So we sort of bracketed that timeframe and we said, let's call June, the first six months, June to December of 2019 after this new policy is totally ramped up, we're gonna call that after the new policies are in place. So if someone was arrested between June and December 2019 and that was their first arrest in the after period. And then we gave them through the end of March, 2020 to ask if they were rearrested. And of course, we all know what happened in March of 2020 and the data after March of 2020 are kind of not comparable to anything before that. So we had a six month period in which their first arrest could happen and then we allowed them, we gave the time through the end of March, 2020 to see if that person was rather quickly rearrested. And then to have a parallel period before the new policy, we looked at June to December of 2018 up through March of 2019 to look through rearrest. So these are our before periods and our after period. And as I said, the judges were kind of inching in this direction and the DA was going more aggressively but behavior did change. So people were released differently after versus before the policy. So the orange ones that are moving toward the left are things that were reduced after the policy compared to before. So there were about 5% fewer people who were charged a bond to get out of jail. And there was a comparable amount of increase of people who were released on a written promise or a custody release. So as I said, the judges were inching in this direction, doing less secured bond and doing more release on their own reconnaissance. And then when we do the analysis comparing before versus after, the short answer which is good when a negative result is the interesting one, there was no change in rearrests for new crimes before versus after the policy change. So that policy itself did not increase crime in this particular population or first offender low level. So that hypothesis that people are gonna go back out and commit crimes was not supported by our data in this low level group. But once again, we see the thing that we always see is that those with co-occurring substance use and serious mental illness and those with even substance use disorders alone were still at a higher risk of rearrest. One thing that's common throughout this literature is that women are less likely to be rearrested. And we also observed that whether or not the person was released on their own reconnaissance or whether they had a secured bond, those groups were both less likely to be rearrested than other release reasons in the data set like time served or charges dismissed. So it looks like releasing someone for whatever reason is not a bad thing. But what we've heard from our collaborators at the jail and a lot of folks who are interacting with these patients on a day-to-day basis, they shared a lot of anecdotes from collaborators about people who were intentionally attempting to get rearrested to get that food and shelter and mental health care. We heard stories of people going to the Duke Emergency Department after they were released from jail and then getting rearrested for refusing, for trespassing, for refusing to leave the emergency department. And these are certainly anecdotes and they're not enough to trip the statistics in the opposite direction but they're highly salient to the people that are working with him on the street and it tends working with them in the jail and in the criminal justice system. And it tends to be the patients with the fewest resources. So those who don't have a place to go don't have a family to take care of them. And this is where we bring in, I would say the medical versus legal dilemma that these people are not getting care and they're unable to be stabilized and perhaps back in danger if they're on the street again. So there's the dilemma and I would love to continue the conversation that Mike started a few minutes ago. So ideally we wouldn't wait till a crisis of either emergency department or law enforcement level. We'd want to intervene before a crisis. We want a community that knows people and isn't afraid of someone who's just having a bad day or a mental health crisis. We want people who want our whole community to know that these people aren't dangerous. We want those mental health services before a crisis. And yeah, so then the question becomes how do we do that? How do we do that as a community? And I'm just thrilled that you guys are thinking about that on a really deep level and coming up with ideas for our whole community. So the next few steps for our team, this summer we're gonna do mapping of neighborhoods within Durham to look at the need and these diagnoses and the arrest areas, the addresses of the arrested people and whether Duke Health Services are in those areas, whether Lincoln is in those areas, we're gonna continue with longitudinal analyses of policy changes and then continuing to gather information about what services are there. And long-term future goal is to explore system level approaches because as Mike said, this is a system level problem. It's not any one person's problem. And just so many people are trying to do the right thing, but yet where is the right place to put all those right efforts? So I will stop there and stop the share and let me ask my collaborators first, is there anything blaring that I missed that you wanna put out there before we open it up for the conversation? All right, go ahead with the... Any questions from you guys? What else can I share with you? What other questions should we ask of the data? I think one request I've seen in the chat is that can we get this PowerPoint? I think so much, I think we all probably have a lot of questions, but it's so much information which is fabulous, but at least for me, it's really helpful to have that and to have time to sort it and discern it and see because it does, it's really valuable and touches so many of our mission, so many points of our mission. So is that possible? You could send it to Dwayne and... Yes, yeah, I can share the PowerPoint. I'm seeing in the question, someone asked if we can share the raw data and the short answer to that is no because health data is protected by HIPAA and we have a very strict data use agreement with the detention facility, so I cannot share the raw data, but any questions you guys wanna ask, we're not doing this just for academic interest, we really want our work to be relevant to the community, so any questions you wanna ask of the data, we're happy to try to do it. And Nicole, I mean, there's a whole lot of raw data you gathered on the jail population that isn't just related to mental health, so we've talked before, if any of us have questions related to anything about the jail population over the last year, if we can submit it to you almost like a research query and you can help us find the answer to that without us starting over. Doesn't have to have anything to do with mental health, which has to be related to the jail population over the past year, right? Yep, and I'm seeing your comment now, Mike. Let's see, the bail research is not limited to just about with mental health, exactly. Is all those arrested detained and then released on bail bond? Yes, so yeah, even to those, the results we got apply across the board, crime did not increase in any population, but yeah, it's a deep issue. Let's see, Manju says, would your team be able to share the raw data? Okay, yeah, no. All right, able to- Huh? I'm sorry, yeah, I feel like Manju, I was going to say that, but she was sort of uplifting something that she had said earlier, if you want to respond to that. Okay, let's see. Are we able to see the data absent of identifying information? Just the analyzed data, the analyses that we've done. And yeah, so we have multiple reports. I'm happy to share these slides. We have a big stakeholder report from last year that was really describing the patterns of use in Duke Health. Short answers, yes, all the reports we've done, I'm happy to share. Thank you. So you'll send the reports when you send the slides? Yes, yeah. Thank you. So I have a comment and then a question. So just being transparent, I work at the Duke's Office of Durham and Community Affairs. I'm in a different unit, but I'm very familiar with Bath Connections and the work that you all do. I know our office has been shifting in some ways and we have an Associate Vice President of Community Health that reports jointly to the VP on the university side, Stephanie, and then someone on the medical side. And in a recent conversation that I'm recalling, there was a lot of talk around sort of like the social determinants that impact health. I'm just curious or curious not to leave name that like, I wonder, cause you mentioned earlier that like Duke should be doing more. And I'm just wondering if that might be one particular relevant avenue to explore just given the way that Bath Connection sits within that office. It's just something to consider. Yeah, I would love an introduction. I've met Stelfany years ago, but who's the AVP that you were talking about? Her name is Deborah Clark Jones. Okay. So that's just someone who may be a helpful resource, just in terms of understanding like what can the university do, particularly like on the health side or in a sort of cooperative way that considers both the university and the health system. Given like your roles, your collective role as faculty and students and just thinking about that, just based on my understanding of how Duke operates. So that's just something I'm throwing out there. The other thing, and I think it gets at what you sort of ended with, which was like, how do we intervene before crisis? I think some of what it feels almost like off-putting, but just kind of like a rub is like, when you know a system is both helpful and harmful and the report shares all the ways in which it's helping, but doesn't offer more transparently honestly how it may also be harming or is harmful. So it's like, I think that's a bit, it's almost like a sort of not to use this term. It gets used a lot, but gaslighting, it's like, if I know you've hurt me and then you say, but I love you, it's like, that's not the issue. Like I know it can be helpful. The issue is that some of it is not working, right? Or it's working in a certain way that it's harmful. So I think my question is like, in your research, has there been any way to like name with better specificity? Like what are the things that like could be doing, what could these systems be doing differently or doing better? Cause I feel like there's the conversation of like, how did we intervene before? But we recognize that like, there are going to be crises and things will happen after that point. And that's where there's tension because after the crisis happens, sometimes there's additional harm happening once they're in that system. And like, I didn't hear much that spoke to those instances because I feel like that's what people point to to say, like, oh, we need to defund or oh, this is the issue. So I'd be curious to hear based on the research you've done, less about like, oh, yes, they have shelter, they have food, they have care, they come back, so on and so forth. But like, where are there sort of points of improvement to reduce harm after crisis within the system based on your assessment thus far? Yeah, I really appreciate that perspective and that sort of unveiling of the biases. Because like I said, our collaborators have been the people of the system, in and of the system who are trying to do the right thing, but you're right, may intentionally be causing harm, unintentionally, certainly causing harm, can't deny that. So to answer the question, I would have to think harder, maybe Bella, Maria, Michelle would have some ideas, I'd have to think harder about what is in our data that are markers of those harms. The obvious extreme thing is, are they getting, you know, disciplined, harshly disciplined by the guards in the jail? We have no record of any discipline within the jail. We don't have that. Tell me other things that I might look for and we're happy to do the analysis. Like a length of exposure to the jail, I mean, how long you're there could be one. That's a good one, yeah. If we can control for how long people are in there and is that a fact? Yeah, I think we've pretty well seen, haven't we, Michelle, that the longer, people who spend a longer time in jail have worse health outcomes? Yeah, so that feels like somewhat in conflict with this idea that like, oh, people who get re-arrested, even if it's anecdotally are going back in order to receive those services, when it's like, well, couldn't they be redirected to something else? What are those things? Yes. Or having heard stories, again, anecdotally, where it's like, okay, people are in that system and like they actually weren't receiving their meds or like they weren't receiving the care that like, so and like, yeah, I'm just sort of sitting, trying to sit in that tension and Isaac, I see your hand, if it's related to this, feel free to interject. I'm just sort of trying to create space for a more nuanced conversation. Oh yeah, I'm so grateful for what you're bringing up. We'd have to think harder about where the data is and where we would get that. And probably it comes down to talking to the people, talking to, yeah, I've been talking to providers, we need to talk to incarcerated people. But yeah, we haven't done that yet. Yeah. Isaac, did you want to chime in? Yeah, thank you. Yeah, Jesse, thank you for your initial question there, and that made me clarify some questions that I was having the whole time that I didn't realize until after you put it the way you did. Okay, so my question is, if I'm understanding correctly, the data for your project is based on the initial diagnosis you get from Duke Health, correct? Yes. Okay, so then how do you negotiate the possibility that incarceration was the triggering event for the mental health crisis that then produces or that triggers the diagnosis? I like where you go with that. We, Maria, we could look at those timelines, can we like see if the diagnosis predated or post-dated the incarceration? Well, that's what I'm saying. If the diagnosis is made at Duke Health after the person is passed from the jail to health, your sample is only people who've been first incarcerated before the diagnosis. We have the full data set from 2014 to 2021. So if they didn't get arrested until 2018 and they had four years before that to have a diagnosis, go ahead, Maria, what were you gonna say? Oh, I was just gonna say, I think we could try to code the data so that we get the first instance of a diagnosis and track that compared to the index arrests in our data set. But that is, I guess, just to kind of add to the conversation more broadly, that is one big limitation to our data, I think, where I think there's a separation between what the data are showing and then sort of the anecdotal evidence. And so with the data, since we only have bookings data, all those biases and things that have been brought up, that's gonna get baked just automatically into our data set because we can only see people who've been actually booked. And so we miss a lot of the process and the decision-making just given our data are kind of tracking these really specific points of times that have a lot of context that led up to those points. So I just wanna kind of separate a little bit with the conclusions we can draw specifically from the data and the models versus people's stories. Yeah, I know we're letting, I guess, I didn't feel like my question got answered, so that's okay. But I at least want to offer, it feels very important that in the process of asking the questions or looking for these different sort of observations or data that's relevant, words are hard, it's been a long day, it just feels important that you all are courageous in asking questions that don't necessarily point out, oh, this is what we're doing well. And as someone that is both an alum and an employee of Duke, I know Duke loves to like pat itself on the back and like self-congratulate and say, look at how we're doing well. And like they say all the right words and like I think that can sort of be, it's easy to sort of fall into that trend and it feels really important, especially considering how important this topic is that like there be a serious curiosity and interest in figuring out within the systems, like what can we do better? Like where are we actually falling short? Because this actually is a matter of life and death. And like it's not worth it to only come out and be like, oh yeah, we're all doing a great job. This is like, and it's not about like, do people care or are they trying? But just like how, like you said systems level issues, like how is the system itself setting people up to fail, setting up people to die for lack of a better phrase. So I just feel like I didn't get any of that in the presentation and that is not necessarily anyone's fault per se, but just as an observation that I'm making that like, are we even looking for that? So I'm just lifting that up. Yeah, yeah, I think it's absolutely fair to say that was not in the presentation because it's not in our data. But I love the fact that there's so many more questions to ask. Yes, yes. And I think the place is like you said, this is coming from the perspective of people who are trying to do the right thing and want to know, is it working? But they don't want to know, is it not working? Is it failing? And so we have to hear those stories from different places. So yeah, I would love for this group to help us frame those questions, figure out where to get the data from, figure out how to talk to, to get that data. Absolutely. Sounds great. And this might be more a conversation that we can have offline. I know we have our agenda and wanna hold space for everything that's coming up. But like again, I'll just say as a last point, happy to connect offline. And if Deborah Clark-Jones is the best point of contact or someone else that she knows that might translate well or transfer well in terms of like the connections you're already making within the Duke systems given vast connections sort of placement within the organization. Yeah, thank you. That would be absolutely wonderful. I'll reach out, I've got her down your name. Great. And I think having the information that you provided and having an opportunity for us to think about it and talk some more task force, that this is just the beginning of a conversation. And thank you for your hospitality here, your desire to let us in and get involved and participate in this inquiry and figure this out because it is extremely important. And we're running out of time. But so we'll hopefully see you again. This should be the beginning of a conversation and an inquiry. So thank you. Thank you all for this great work. And it will lead us hopefully to better care and a safer community. Thank you so much. And I will turn it over to Xavier. And again, to Nicole and your team, thank you for the great presentation, the information and the great discussion from task force members, the deep thoughts that were expressed in conversation as well as those that have been placed in the chat. We do want to give the crisis response around table a few minutes to just kind of talk about the wonderful town hall we had. We were co-sponsoring a town hall with the community safety department to give the community a chance to have some input in a town hall format for some crisis response pilots. Those pilots were designed to look at in particular behavior health crises in response to those crises that come in through the 911 call center. And the whole spectrum from the call to the response and in follow-up. So there's one pilot that's gonna start in July crisis call diversion where a mental health professional is embedded into the 911 call center to help mitigate the right response to the right calls. For the in-person, there are two pilots on community or community responder team and a co-response team. And then for the follow-up, there are care navigators who are designated to follow up after those calls have been made. So the whole spectrum, we had about about a hundred people at any given time throughout the town hall. There was a lot of great information given. I wanted to make sure that I talk about some of the questions that were brought up. What types of training will people have? Most of the questions and energy was around the actual response part. Not so much the call or the follow-up, but there's a lot of energy around response. Our community cares about how response happens in their community. That was one of the big takeaways for me. And so that's kind of the background and the framework of what the town hall was about. We have other members of the round table, Manju, Shanice, Isaki's here, Jennifer's not here. If you want to add on to that, I believe Manju was gonna prepare something. That was a great summary. I would just add that, yes, about a hundred at a time were present. 72 of those folks availed themselves of the stipend for participation, which suggests that we had a higher percentage of lower income participants than in some of our previous opportunities to speak. A large percentage of the participants were black or brown, and there were participants who availed themselves of Spanish interpretation services. It broke out into four discussion groups. One on trading and evaluation, one on personnel and approach, one on supplies and appearance, one on call types, transport and follow-up. And this was our first time taking what we've been doing as in-person listening sessions with directly impacted community members into an online setting. And the purpose was to be able to go much bigger across many Durham neighborhoods at once, and to be able to allow Durham residents to see a popular version of the presentation that the Community Safety Department did for city council and be able to really engage with these pilots and give detailed feedback. And we'll share more in our, in our room. Mind you. Anything anybody want else on the round table want to add? Okay, if not, move on to our next agenda item. We have three items that are coming from, well, one is the, first one is a template for recommendations. I believe you discussed that last month, I was absent last month, but I believe you discussed that and, but did not come out with a vote on whether to adopt the actual document. Mike, I had sent you a message about, did you want to do screen sharing on this? I can do that. And we can be pretty hopefully expeditious since we've got this and the second reading of the prescriptions of repair and the first reading on the Office of Survivor Care. So can everybody see this? This is the template. There are two things that are new to it since everybody looked at it. It was in the Google doc. Both things suggested by others, one of our local elected liaisons and then another one that I think, maybe Marsha and Xavier and Dwayne, it's suggested. So I've highlighted those in yellow and you saw that in the PDF I sent out. How the proposal aligns with strategic plan or plans of governing bodies to implement and those are already noted above in which entities would be implementing this. And then the second one is, is there any potential for conflict of interest presently or in the future based on any task force members, personal or professional interests or relationships? If so, explain that has been included in other city task force. I think the recovery one is in their template for recommendations that was included in there. So I guess just to open it up for additional questions and then since it's, I think, comes from a standing committee, as they say, there's no need for a motion to accept so that it can just be to vote. And I guess particularly if there are questions or comments on whether or not we want to add these two additional items. Obviously that align with strategic plan, you could just put NA presumably, like with any of these things just because there's an item in the template where it doesn't mean you have to enter it. I have a question, can you hear me? Yes. Can you define conflict of interest? Do you mean financial or do you mean like any interest? I will defer to those who suggested that the inclusion of that item, because not that I disagree with it, but I didn't come up with that. So they'd be better place to suggest what they mean by that. In this case, we mean any relationship whatsoever. It doesn't have to be financial. And to have a conflict of interest does not mean it would not be approved either. It's just a matter of putting upfront any potential biases or relationships just so everybody's aware. I still don't feel completely clear on what would be expected to be disclosed in that area. Could you give me an example, maybe of what you're looking to do? Sure, and this came up from our department and the discussion that happened, I'll give an example. If Xavier owns a company and Xavier is recommending for a particular service that the city offers to residents, but Xavier and Marsha has a relationship and Xavier is going to refer residents to Marsha's LLC. Should Xavier make clear that he has a friendship with Marsha or a professional relationship with Marsha? That's one example. Or another example is if I am making a recommendation for any particular service and that service, incidentally, I have my own company and I'm recommending that my company be given some money, because you mentioned finances too, to provide this service, that I disclose that. So those are two examples. Okay, thank you. Yeah, the financial conflict of interest, I feel very clear about. Any other sort of conflict of interest or any other potential interest feels, it just feels really expansive to me and I don't want, I don't want people to put people into a situation where there might be some, they might have some connection to some person or some organization that may or may not be connected to the work and that if they don't disclose it, that it would be problematic for them on the back end. The city has a really specific definition of conflict of interest around financial interest of like yourself and your immediate family. I feel like once you get beyond that, it just gets to the sort of nebulous zone of like, everyone knows everyone or like, everyone is connected to everyone. We've all focused on this task force, I've been doing this kind of work for a long time. Like, are people expected to disclose, yeah, like a friendship with someone who might benefit feels a little bit, you know, what is a friendship? Like, have I, you know, just do, how close does it have to be? If I met the person once, does it count? I don't know, I think that I would feel more comfortable with a little bit more clarification, but, you know, of course it's up to you. Jillian, can I suggest a potential solution so that Duane and you or the city manager's office could consult and just adopt the whatever language is an existing recommendation from the city, a city task force that uses the language on financial conflict and interest. And if we know that that is going to be the change, then perhaps we could be able to vote on the template, knowing that that kind of friendly amendment additionally made later, that if others find that acceptable. So we don't have to, you know, delay the adoption of this recommendation by yet another month for that wording to be adjusted. Mike, I agree with you and Council Member Jillian. I like the point that you make. And I do think we could just adopt what the city has because the city does speak specifically to nepotism regarding family members, as well as the financial conflict of interest. So I think that's a good place that we could both start and end for the purpose of this template, Mike. Sounds great, thanks, Yal. Yeah, I might also add that since all of us were appointed and signed such a document, a concerning conflict of interest, it's already covered in anything coming from us. We've already been held to task and we've signed off on the Code of Ethics. So it's embedded in anything that we do. So it could, in my opinion, just be taken back out. I'm not sure if that complicates things at all. I think we should still keep it Xavier only because since starting the task force, members could have gotten a conflict of interest, essentially. So conditions or context might have changed. But I do like Mike's suggestion and for us to use specifically the city's language or own conflict of interest. Manju and then Jesse. Is assessment system referred to method of evaluation or something else? That for assessing the, you know, the outcomes of the whatever the proposal is. Like how will... Like, for instance, you saw... This roundtable recommend that the effectiveness is assessed? Yeah, at least. And again, you saw it with the prescriptions for repair example and you'll see with the Office of Survivor Care that I don't think we would want to be too prescriptive and getting ahead of ourselves and suggesting an assessment system for a program that would need to be built by whatever entity organization. But just we are noting that there will certainly be one and these are potential elements of it, likely elements of it. If the proposed entity, project, whatever pilot isn't even built yet, you can't say this is exactly what the assessment system for it would be but just to be clear that there will be one and this is... I think what some of its elements would include. So we're not going to be suggesting the expenditure of public funding without any expectation on the front end that there will be accountability for the outcomes produced by that publicly funded endeavor. And then obviously the city and the county and the school board when they receive these proposals could accept that outline of an assessment system as is or they could kick it back to us and say, we want more before we approve it. Same thing as a task force, we could say we want a little more detail before we approved it. Jesse? My comment was just regarding the competitive interest sort of clarity. Is it simple enough to just say like is there any potential for financial conflict of interest? Like does that help clarify what is meant? Is that in line with how the sort of current powers that be refer to conflict of interest or is that unhelpful? That's the understanding I got. But I thought I was saying just in the interest of time that we don't try to wordsmith it too much and we let Dwayne work that out with the city manager's office using the language that's already in city recommendations which is focused on financial. So I guess I was under the, and maybe I'm just, I guess it's been a long day. So if that's the case, we won't be able to vote on it tonight. Well, I think if you accept that friendly amendment with the trust that that language will be clarified to be financial conflict of interest, if you're comfortable not seeing the exact final wording, we could approve it with the understanding that that change will be made before it's actually any of us start actually using it. If you're okay with that, or if you want to delay until June, you know, then that's what we'd have to do to read it again. No, I hear you. I mean. So, so Mike, could you put it in the form of a motion please? All right. Well, it's, it's with. So any other questions or comments is particularly on that other addition about the alignment with strategic plan or plans plural. This part this other new addition. Didn't hear any comment on that or so. All right. Hearing none then that's with the understanding that this last part will be amended that Dwayne will amend that to make it clear that it's financial conflict of interest. Then I would move that we adopt this template. Obviously, once, you know, Dwayne finalizes it, he'll share it with us. It'll be someplace where we can all then start using it. The round table can start using it. Mike, do you mind sharing more about why the, the question how the proposal aligns with the strategic plan? I wasn't my idea. So I can't really explain the justification for it. Our local government liaison has suggested it and can explain. I mean, I can understand that. I think. Like I'm mindful of something that I'm still sitting with, but would certainly align with like what I know, school board members and other sort of school professionals have said is important and things that they're working on, particularly as it relates to like social emotional learning. So like, I think I would highlight that in that particular section to sort of substantiate the ideas that we have and how it aligns with what like folks are already doing. So that's sort of what I'm seeing. It was your idea. Yeah, that was, that was my idea. And yeah, the, the reasoning behind it was that whenever we do proposals, like when we do council budget requests or when departments do budget requests, one of the, one of the key questions is always how does this align with the city's strategic plan? And so I thought it would be helpful for making the argument to elected bodies to have that in your proposal template so that you have, you know, so, so that you can argue that this is part of that, that you have looked into and can argue that this is compliant with your strategic plan or advanced strategic plan. And here's how it's, it's mostly to, to make it appealing to elected officials by acknowledging that you've aligned with their priorities. And may, Jillian, may we turn to Dwayne and he may, may he in turn turn to the city manager, the county manager for assistance in helping us so we don't all have to try to read hundreds pages of strategic plans for the city and the county and the school board so we can go and find the wording we want with some guidance so we don't all have to start to scratch. Yeah, I mean the reasonable for us to ask. Definitely. I know I have not read the county strategic plan. I know the city and the school districts are both pretty simple. You can get into, you know, really detailed, like, you know, descriptions of all the initiatives, but there's like a two pager on the website. Okay, that's not so bad. Yeah. Yeah. Okay, that's not so bad. Yeah, you can certainly read the whole million page thing, but you don't have to to get the, to get the just to get enough to answer that question. Good to know. Good to know. Thank you. Okay, so any other, there are no other questions on the motion. Can we vote? And I guess Dwayne, what do you want to say? I can second the motion that Mike made after Manjoo. Yeah. Yeah, sorry, Manjoo. Thank you. Manjoo, are you good? Well, just that it feels really important on a task force that we've really intentionally lifted up expertise from community. That there not be some threshold that someone has to be really like, that someone has to have read that million page strategic plan. So it felt helpful to hear that there are kind of one pager, two pager versions of each of the three strategic plans. I really want the process of creating a recommendation to be something that anyone at any education level in our city feels like they can do based on what they're hearing in community. And what their lived experience is and basically that we keep the threshold of creating a proposal as accessible as possible. But I also heard you say stuff in our email chain about this, Mike about just letting folks create proposals and not be too wedded to whether each of these sections is filled out to a T and that we can support each other to strengthen our proposal. So that all of that put together feels like enough for me to feel great about this. Thank you. So how do we vote Dwayne or Xavier or more? Yeah, thumbs up on the screen. They all I have to call it out and name my name so I can make sure we have the right. Hopefully we can run a little beyond 730 because we at least want a second reading on a vote on the prescription to repair at least. Yes, sir. I was going to get to that. We are at 729. So go ahead start calling it. We're going to definitely run over. It's ambitious to kind of what we're doing an hour and a half. Most of these meetings do last longer. So we will be running over tonight. This is a, this is not a recommendation. So a simple majority will do there are 11 of us present tonight. Let's call your name and a simple yes and no yay name, whatever you like, Alec. Yay. Isaac. Yes. Yeah. Yes. Jesse. Yes. Mind you. Yes. Marsha. Yes. I'm sorry. I was looking looking muffin. Yes. Samuel. Denise. Yes. I have this alphabetically, but I vote yes as well. I'm at the bottom as I'm used to being. So the past unanimously, we thank you for that because it's very important that we want our document to be the document that we want because from here on out, all recommendations will follow this format. That being said, we do have a second reading and vote on one recommendation and then a first reading on another recommendation. Still coming from the same round table. So we'll go back to Mike. I will just, I will reiterate the, the contents of the prescription for repair. I will say that we addressed all of the, most of the good suggestions that you all had the last meeting, tried to include some more specificity and, you know, consulted with our various partners and others, including the community safety department who will house this pilot. And their, their take is that we've struck the right balance with enough guidance in the proposal to let them know how to proceed without getting too far ahead in, in putting too much detail on the, before the pilot is, is created. So things like, and Jennifer had raised the point about what you need a memorandum of understanding or contracts or what not with the various potential service providers. You know, we don't know who those are yet and we consulted with city and others who said, no, that, that, that is not needed in this kind of a proposal. Those are the details that the, the community safety department and the hired coordinator of this pilot will work out in the planning period as stated in the proposal. And since it's proposal that approved will commence, commence life once the city can approve it while the task is still going on. We'll be getting monthly updates from the, from the department, from the community safety department and this coordinator on this prescription for repair proposal. So we'll be able to know how it is evolving and developing before, and then as it has begun before we're all done next April. Could you possibly score down to the section that talks about proposals goals? I think that's the best space for someone who may have not had a chance to work over this. Thank you. Thank you. Thank you. And then Jesse, you got a, you have a question. Yeah, I think. And I wish I had gotten, I only got to review this earlier today. I think the only thing that sort of made me like take a step was the timeline. Sort of. Included. The timeline. I think it's a good question. Sort of included the timeline. Goes past our work together as a task force. If I understood that correctly. And it does say like other stakeholders. But in my mind, I felt like, unless we plan to like extend our work, I wasn't under the impression that we would still be gathering formally, you know, into spring of next year. So that was my only sort of question in terms of like, does it make sense to name, or my misunderstanding what CWTF? Cause now I'm like, oh, that's not safety wellness task force. Maybe. Well, I mean, no, I mean, any, I would assume that like the opposite survivor care, there would be proposals as task force will propose that will long outlive the life of the task force. We're just setting, they start, they don't, they can't begin and end in the, in the lifetime of the, of the task force. This particular proposal, since it's a year long, can mostly, you know, coincide with a portion of the task force lifespan, but it will continue beyond that. And, you know, perhaps if, if depending on its outcome, it may live on even beyond that, but not, we would not be responsible. Obviously it's good. It will live in the community safety department that once approved. Yeah. That's the part that made sense. Yeah. I just wondered if some kind of caveat of like, wow, the task force is still, but if that feels that that doesn't feel necessary again, because I know we're not like, and it can't start until the city technically approves it. And who knows how quickly they will review it. So, you know, our timeline is a hopeful one, assuming expeditious city approval, but who knows how long it will take. So we've, you know, obviously that task, that timeline would have to be adjusted. It can't begin by definition until the city approves it. Right. So Jillian, hope we can be, we can, we can not have to wait around until the fall to get this approved. You know, assuming the task force approved. I'm going to say that's unfortunately likely that it will have to wait through the fall, just because of the way our agenda schedule works. I don't know if it could get onto an agenda before our break in July. We only have, I think, three more cycles. So we'll see. But yeah, I can't, can't guarantee that. Sorry. And this one, obviously we're conscious of the art partnership with the partnership with Duke and their, you know, their, their clock is ticking as well. So, but that's all something that community safety department, but definition will have to work out with them and the other partners knowing what the potential timeline will be. I don't know. I don't have Ryan's on the call, but it's possible to get it on as like a subreddit bin determined. So we can, we can look into it. Any other questions or comments? So it's a, it's a proposal from a standing committee. So I don't believe it needs a motion or a second. At least that standard Robert's rules procedures. So. Can we, if there's no more questions or discussion, then we can vote and save you. You can call the names. But if I'm wrong about that, if that's not how you guys want to proceed with all task force business, then you know, don't, that's, you know, we don't, you don't have to stick to Robert's rules. If you want a motion and a second, you can have one. No, we're fine. As long as there's no other questions. And this is a second reading and this is our opportunity to go. Okay. All right. Let's go with Esau. Yes. Yes. Okay. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Nothing. Thank you. Thank you. Samuel. Samuel. I vote yes as well. This one also passes unanimously. Thank you very much. We will. Move on to our first reading now. Of another proposal from. The criminal legal system. Drown table. And this one is connected if I'm not mistaken. Correct. Yep. Okay. I think we've received it. If the, if you all are willing to stick around and have brief discussion on it, we can or this can count as first, you know, presentation and reading and we can adjourn and then have. You know, discussion in the interim and then discussion and vote in June. I'll leave that up to. To the body. Since we're at 738. Yeah. I would prefer for the second of public to have some discussion if they're pressing. Sure. Issue that people. Came ready to talk about. I don't know. I don't know. Exactly. All right. So I will be very brief and, um, and then muffin and and or Toyota may wish and, and Marsha may wish to share a little bit. I will say I think in, in context, I think this proposal is a good hopeful model in that. Um, We emphasized, uh, first. As with the other one, you know, building on what, um, survivors told us. What their experiences and what their needs are. We emphasized bill collaborating and collab and coordinating and improving existing services rather than creating brand new ones, but also trying to house lift up survivor care to a centerpiece in the community's response to harm and having it live in the community safety department rather than in disparate places and not having it connected to law enforcement or the criminal legal system, which it currently is. Uh, the proposal itself is to create a three year pilot office of survivor care within the community safety department who is enthusiastic. I don't think it's an overstatement to say in taking on this project as well as the other one to house it to staff it to begin to develop it. Um, so too or other important community partners. Uh, and they're, they're too numerous to list, but they're, they're in there as well. Um, this, um, proposal is somewhat intentionally short on the details of what this office would do because we don't presume to know what all the needs of survivors are until we can hear from them and the prescriptions for repair proposal helps with that. The, our listening sessions with the 16 family members of homicide victims helps with that. The information from Dukes, um, intervention, a gun violence intervention program helps with that. Uh, and then we'll be able to gather, uh, other sources as well. We were not limiting ourselves in terms of who is a survivor. Um, just as the prescriptions repair with Monju's very good suggestion and clarification that clearly those who are victims of police and law enforcement violence would be included in this office's care as well as the prescription for repair. People who are justice involved, but who are also survivors are absolutely, you know, in need of care and would be part of this. There would be no kind of exclusions of that. Um, the, the main part of the, of the first year, which is the, why the budget for that first year is more limited is just the staff, this office up and get it up and running. So the coordinator and the two staff persons can collaborate and work with community partners to figure out the structure and to glean what survivors needs are and the best ways to address them with additional resources as a single point of referral and perhaps some in-house trauma care and other things provided. The main function that the office would provide to survivors in its second and third year would be guiding them through the process of, of survivors of violent crime, applying to the up to $30,000 they can get from the state and, but only assisting them in that process and making it hopefully a little less onerous than it is, but also upfront covering the up to $5,000 for funeral and burial expenses for family members of homicide victims and then working to get reimbursed from the state for that so that, so that individuals or family members of homicide victims don't have to go through the dehumanizing very difficult process that we have plenty of evidence. Yes, that's the case of applying to the state for that rather called through some. That's just what the pilot will do in its three years. Obviously this, if successful, it would live beyond and hopefully continue to grow and the, you know, the amount that the opposite survivor care could provide could be greater and it might not be limited to funeral and burial, you know, and all those kind of things that could grow beyond that. The other thing I will say is that we've intentionally tried to build in a permanent structure for the pilot as well as for its permanent iteration, a structure of a community input and accountability and advisory circle and made up of community members and others that will advise the pilot and would continue to advise the office beyond that so that it's not something that would live in the community safety department out of the public eye without without regular public input and accountability. Thank you. I see a hand for Jesse. Oh, I thought I just wanted to be in the queue. I wasn't sure. So, right. Muffin, Toya, Marsha, if there's anything you would like to add and then we'll go to Jesse. I would just like to add that these proposals, the details are about mitigating the harm of systemic harm. Right now survivors of care are being denied support or completely ignored. And this also just aligns so beautifully touches in so many ways. The same concerns, the same care needs, the same intentions as the crisis response. How do we respond to children who have been harmed and families? It's looking, it's that it really is embodying that belonging that we talked about in the beginning. So I just want you to know that this is, the details are really addressing harm. I was just going to say, I would agree with you, Marsha. I think the thing that resonated most with me would be that the office of survivor care would be available as part of the initial crisis crisis response by law enforcement. I think that's very crucial when people are dealing with something that's traumatic. And when it's especially when it's like an unfamiliar process as far as like what to do and how to do it. So having that there from experience, I think dealing with anything that's involved with the criminal justice system is pretty important. And I felt like that hit home with me. Muffin? Muffin signed off. Or she's still there. She signed off. Okay. I would only say that, yeah, one of the, and by all means, if you think the proposal could use a little more detail and how we build up the referred, the kind of referral system and how people get connected to the office, that's certainly something we can continue to work on. And we've talked with Ryan that the community safety department and crisis and the crisis response would be a pretty obvious potential in entree into it. So too might be the DA's office. You know, we don't, by definition, this is people who are survivors of violent crime. So a crime will, you know, some active violence will have happened, crisis response, uniformed law enforcement or not will have responded. There may or may not be an arrest in a trial. So there will be many potential points to connect people to this office. And obviously it's going to have, need to have a very clear public face and a lot of, you know, awareness building about what it's, who it's there for. But that's something that we'll kind of lead to the office to develop in the planning phase unless you all think that we could do more to suggest ways that the public will know of it and interact with it. Jesse and then lunch. I just, I wanted to say two things when I'm, I was really encouraged reading this. I, I love the, like lifting up a survivor. And just appreciated that and wanted to save that on record. So thank y'all for this work. I think one thing that I only say worried or concerned about, but at least wondered about is there a strong sense that city council through CSD or other units are like in a position to fund it for those additional years? Like, do we know that? I think I'd be, I think that's where, if, if I'm concerned, it's wondering like, okay, I don't want people to feel like, oh, okay, we spent the 220. And then there wasn't additional funds to make it continue. And then that's sort of a reason to show that like, oh, like it's sort of set up to fail. And people are like, oh, it didn't work. And I was like, well, no, the funding ran out. And so I'm just curious if there's any sort of certainty or confidence that, that those additional funds would be granted? Or is that sort of up in the air and could be the major game changer or deal breaker if city council just doesn't approve it? Well, yeah, obviously, if there wasn't a commitment for it, for the city to fund it through its three years, then it wouldn't, it wouldn't happen. You can't, you can't start a pilot and not finish it. You certainly can't start a pilot without the confidence that when it, not if, when it is proven to be successful, that there is commitment to continue it. The community safety department absolutely is supportive of it in the long term as our community partners, religious coalition and others. But you raise an excellent point. And I don't know what else we can do. And that'll be the case with probably many of our proposals with all three of the governing bodies. So we're all going to need to figure out how do we successfully put that, apply that pressure to make sure these aren't yet another pilot that comes and goes. These need to be long term. And the city and the county and the school board if they're approving them have to commit to that. But, you know, they all have to advise us our liaisons on how to approach that. I would think. Yeah, I feel like, I know we've talked about this. Yeah. I think you have a great mind at thinking about how to shift structure. And I'm always thinking about culture as well. You guys are going to be in a very similar situation, right? You'll have great proposals with the school board. Yeah, yeah, yeah. What confidence that they'll commit to them over the long term. Yeah, absolutely. I think my point, though, is that like if. A part of the challenge there is that like moving. Structure. Without moving culture to. Is a part of like if the culture is there, then city council would be like, yeah. We want it. It is. Certainly there in this. Yeah. So like you, you don't need to convince me. And like, I don't need to convince y'all. I'm just wondering like, do you feel like. The culture is there. So it may be Jillian or half year. Yeah. In the community safety department and the religious coalition and others. Yes. But I think. Yeah. So you're raising it really excellent. I'm really excellent point that we all want to be mindful of it. All our proposals going forward. Maju and then we'll let. Jillian respond. Maybe we could receive the direct response from. Council member Johnson first. Sure. Yeah. Jillian. Hey, y'all. So I would say, but I am not entirely confident. That the city council is. Going to be excited about funding. I mean, I don't know, I don't know. I don't know. I don't know. A lot of proposals from the task force, but I am not worried about this one. I don't, I think that this one is probably like, like, my concern would be, you know, with, with the new majority on council that. There is less excitement around. Shifting resources from law enforcement into alternative. Into alternative safety work. So I don't, I don't really see this. As, as particularly as challenging in the same way that some of the. Other proposals that y'all have presented or that, you know, expect you to present in the past and the future has. Have been. So I don't, I don't really see this. This is as a potential space for controversy. I'm sure that there will be many, but this one feels pretty. Yeah. Yeah. Yeah. Yeah. I don't think there's any consensus. Driven to me. Like, I don't think you're going to have a problem with city council. Wanting to fund this. I think there will be problems with wanting to fund other things, but this isn't a particularly like status quo challenging. Proposal. I don't think there's going to be anybody who's like, no, let's not help crime victims. So I wouldn't worry too much about this one. Yeah. I think I just wanted at least. Like, you know, where that is. So thank you for speaking up. That was really. I was just, that was, that's like, it wasn't like a worry. It was just like an observation and something to sit with so that like, we're not wasting time if we know, like. The culture. Yeah, I mean, I would, I would worry if you recommend to like, you know, replace all the SROs with, you know, trained on our safety officers, right? Like that, that's going to, that's going to be like a much more, a much bigger challenge to the way things are currently done. And, you know, and yeah, the way the political winds are blowing right now, I do think, you know, these kinds of considerations are important. Although I just only speak with myself, I'm still going to dream big and have a radical vision, whether it gets rejected or not. I don't want to just presuppose. We should only go moderate because we get exactly, but anyway, I think you should absolutely go big. And then if, you know, if things get voted down, then people will have to justify that, right? Because this task force and this department are important pieces of the work of the city. They are in our strategic plan. Like all of it. So yeah, I think that, that it's important that these, that this work is happening. and that yeah, you should go big and you should be challenging and yeah, we should fight for this to move forward. And I would just say, right, Jillian, I would say this in some ways, this proposal is very status quo challenging because it centers survivor care and says it needs as much consideration as dealing with those who have caused harm and that is not the way the status quo function. So this is in fact, pretty transformative. It has the potential to be as quiet as it may seem. Sometimes transformative isn't controversial, right? Right, right. Javier? Yeah, I just, I have to hop off here. I have to go pick up a kid, but I just wanted to say that I don't foresee a lot of challenge, at least political challenge, maybe there'll be financial challenges but not a political challenge to it. Partly because we have said around, there have been lots of conversations around especially violent crime victims and the lack of support and care for them. So that's been very, very much acknowledged. And I think it helps us build a transformative space where folks causing harm and folks who have been harmed, we get to a place where there's actual dialogue. And we've done and we'll continue to do our homework and engaging the stakeholders and getting their commitment, including those who are, where those elements of survivor care live disparately, they're in on this. The DA's office in support of this idea, at least the staff who are the two police victims' advocates are supportive of this. City, community safety department all in, religious coalition all in. So to Jesse's point, we've got the culture building or built. Thank you, I'm sorry. I need to hop off. Yeah, we need to ramp up as well. And I will just say for the... After we'll put the alignment strategic plan in there and we'll note N.A. for conflict of interest for that one. And when you get the second reading on this officer survivor care, we'll have also plugged in those two elements of the now improved template. We're no longer at quorum, so we have to end the meeting. Yep. Can Maju get her comment in, since it'll let us know what we should be working on in the... I just shared it.