THE SENATE HEALTH COMMITTEE
ASSEMBLY HEALTH COMMITTEE.
ON INCREASING ACCESS TO
TREATMENT AND SERVICES IN
RESPONSE TO THE OPIOID CRISIS OF
A WELCOME EVERYONE HERE.
AND THAT'S WHAT I THINK --
CHAIR WOULD HAVE.
FOR BEING HERE AS WELL I JUST
WANTED -- IF
YOU SAY THAT YOU WERE HOLDING
THESE HEARINGS BECAUSE THE
OPIOID EPIDEMIC CONTINUES THE
FACT THIS NATION IN CALIFORNIA
AND WHILE CERTAINLY THE OVERALL
RATE OF OPIATE RELATED DEATHS.
OVERDOSE DEATHS IS LOWERED IN
CALIFORNIA AND OTHER PARTS OF
THE COUNTRY.
THERE ARE AREAS WITHIN OUR STATE
WHERE RATES ARE FIVE TIMES
HIGHEST THE STATE AVERAGE AND
PEOPLE ARE DYING FROM THIS --
THESE HIGH RATES ARE EVEN MORE
CONCERNING BECAUSE THE STATE THE
STATS ARE HAPPENING IN REGIONS
OF THE STATE THAT OFTEN LACK
ACCESS TO HEALTH CARE VERTICALLY
SPECIALLY SERVICES.
AND OF THIS YOU SERVICES.
SO THERE'S NO DOUBT THAT WELL
ALL STE AREAS OF THE STATE ARE
AFFECTED EVEN LARGE URBAN AREAS
THAT TRADITIONALLY MORE ACCESS
TO HEALTH CARE.
AND SOCIAL SERVICES AS WELL.
AND I WOULD ALSO POINT OUT THAT --
THE SURGEON GENERAL DR DRUM
ADAMS WAS MADE --
THE OPIOID CRISIS CERTAINLY A
PRIORITY --
AT THE FEDERAL LEVEL --
AS WELL AND WE WE NEED TO THINK
TO PROTECT CALIFORNIANS.
OUT HERE IN THIS STATE WE'VE
TAKEN ON TWO PROJECTS THE DRUG
MEDI CAL ORGANIZED DELIVERY
SYSTEM IN THE CALIFORNIA HUB AND
SPOKE SYSTEM.
AND WE'LL BE HEARING MORE ABOUT
THOSE AND THEY'RE HELPING TO
IMPROVE SERVICE COORDINATION
INTEGRATION.
AND HOPEFULLY ALSO INCREASE
SERVICES AND A ROLL REGIONS BUT
CERTAINLY THERE ARE CHALLENGES
AS I MENTIONED THE ROLE THE
FEDERAL GOVERNMENT AND SOME OF
THESE PROJECTS TO RELY ON GRANTS
FOR THE FEDERAL GOVERNMENT
WAIVERS FROM THE FEDERAL
GOVERNMENT.
AND THAT WE NEED TO HAVE THE
FEDERAL GOVERNMENT AS PARTNERS
WITH US.
AND AND SOLVING THIS CRISIS SO
WE MUST EXPLORE ALL THESE
PROJECTS AND DISCUSS WHAT WE CAN
DO THE STATE AND THROUGH
PARTNERSHIPS WITH MANY OF THE
FACT THAT THESE STAKEHOLDERS.
FISHER WE SUSTAIN THESE
IMPORTANT LIFESAVING SERVICES
AND BE SURE THAT THEY REACHED
THROUGHOUT OUR STATE.
SO -- YEAH
I'M LOOKING VERY MUCH LOOKING
FORWARD TO HEARING FROM OUR OUR
SPEAKERS TODAY AGAIN SHARE THEIR
INSIGHTS AND THEIR EXPERTISE
WITH US.
WE THINK ABOUT OUR POLICIES THAT
WE CAN MOVE FORWARD --
I KNOW THAT A LOT OF TIMES WE
HAVE A LOT OF PILOTS IN THE
STATE -- BUT
THIS CRISIS SUCH IT'S TIME TO
MOVE FROM PILOT STAGE TO SCALE
SO AGAIN I WANT THANK YOU FOR
BEING HERE AND I AND I WANT
INVITES US --
ASSEMBLY MEMBER CHAIR --
DOCTOR WOULD CHAIR OF THE CELL.
GOOD MORNING AND THANK YOU VERY
MUCH DOCTOR PAN --
FOR PUTTING THIS TOGETHER AND
NOT ALLOWING US TO WORK WITH YOU
ON THIS --
ALSO THANK YOU TO OUR PANELISTS
FOR BEING HERE TODAY FOR YOUR
TESTIMONY THAT WILL HELP SHAPE
THE FUTURE THIS ISSUE THROUGHOUT
THE STATE.
AS MANY YOU KNOW I'M PASSIONATE
ABOUT THIS ISSUE BEEN WORKING ON
THIS SINCE THE DAY I GOT HERE.
I REPRESENT A DISTRICT THAT HAS
BEEN HARD HIT BY THE OPIOID
CRISIS --
SOME EVEN MIGHT SAY
DISPROPORTIONATELY.
THE MOSTLY RURAL AREA I
REPRESENT --
HAS MANY NATIVE AMERICAN TRIBES
AND I WAS ASTOUNDED TO RECENTLY
LEARNED THAT THE OPIATE OVERDOSE
RATE AMONG NATIVE AMERICANS IS
MORE THAN TWICE THE DEATH RATE
AND MORE THAN THREE TIMES --
THE FOR FOR FOR WHITES AND MORE
THAN THREE TIMES OUT OF
CALIFORNIANS IN GENERAL.
THE PAST THREE YEARS WE'VE BEEN
WORKING HARD ON THIS ISSUE WE
HAVE SOME SCENES A MAJOR
PROGRESS PRESCRIPTIONS YOU
ISSUES IN AT THE IN CALIFORNIA
THE END OF TWO TWO THOUSAND
FIFTEEN NUMBER ABOUT TWENTY FOUR
POINT FOUR MILLION.
THE MOST RECENT NUMBERS FOR
TWENTY EIGHTEEN IS NINETEEN
POINT NINE MILLION FOUR AND A
HALF MILLION LOWER THAN WHAT
WE'VE SEEN IN THE PAST --
IN THE LAST PAST THREE YEARS
EMERGENCY THREE HUNDRED AND
FIFTY VISITS AN OVERDOSE
RECOVERY DRUGS ARE BEING
PRESCRIBED INDUSTRY DISTRIBUTED
AT EVER INCREASING RATES.
THE COLLECTIVE EFFORT TO DO TO
ADDRESS THIS CRISIS HAS BEEN
REMARKABLE STILL.
WE HAVE THE NUMBER OF DEATHS IN
TWO THOUSAND SEVENTEEN THAT WENT
OUT.
MOST ALARMING TO ME IS THAT THE
DEATHS RELATED TO FENTON NOW
INCREASED BY 81% IN ONE YEAR.
AN UNFORTUNATE SUSPECT WE'VE NOT
SEEN THE END OF THE RISE IN
DEATHS RELATED TO VOTE NO.
SO WHAT THE EFFORT HAS BEEN
FOCUSED WE'RE SEEING MUCH
PROGRESS MUCH REMAINS TO BE DONE.
TODAY TODAY WE WILL BE LEARNING
ABOUT THE EFFORTS UNDER WAY
THROUGHOUT THE DAY THE STATE AS
WELL EXAMINE.
HOW WE CAN INCREASE ACCESS TO
OPIOID USE DISORDER TREATMENT?
AND SERVICES FOR OUR RESIDENTS
AND HOW THOSE SERVICES CAN BE
IMPROVED X. EXPANDED AND
ENHANCED THANK YOU VERY MUCH
LOOK FORWARD TO OUR AGENDA TODAY.
THANK YOU TO RELAX SO WHAT NOW
WHAT THANK YOU AND RECOGNIZE
YOUR LEADERSHIP IN THIS ISSUE IS --
WE'VE MADE THE PROGRESS THAT YOU
CITED BUT AS YOU'VE ALSO NOTED
THAT NUMBER THAT'S CONTINUES TO
RISE.
SO LET'S BEGIN WITH OUR FIRST
PANEL AT WHICH IN OUR VIEW THE
PILOT PROJECTS AND EVALUATIONS
AND HOPEFULLY WHEN WE TALK ABOUT
PILOT PROJECTS IN VALUATIONS
WERE MOVING FROM PILOTS TO SCALE --
WE HAVE KENDALL --
DAR FLEUR --
PROJECT DIRECTOR AT THE UCLA
INTEGRATED SUB HAVEN'T SPOKE
SYSTEM AND IT'S THE TWENTY
EIGHTEEN VALUATION REPORT AND
DOCTOR DERREN ARATTA A RESEARCH
PSYCHOLOGIST AT UCLA INTEGRATES
SUBSTANCE ABUSE PROGRAMS IS
GONNA OF REVIEW THE STATE'S DRUG
MEDI CAL ORGANIZES THE RE SYSTEM
WAIVER AND THE TWENTY EIGHTEEN
EVALUATION AS WELL.
WELCOME AND THANK YOU VERY MUCH
FOR BEING HERE.
HI HI -- I'M
GOVERNOR OUT OF AS A DARK PANTS
AT ALL I AM --
THAT'S A PLEASURE AND AN HONOR
TO TO ADDRESS PANEL --
TO ADDRESSES BETTY --
THANK YOU FOR FOR YOUR
INVITATION.
DUE TO TIME CONSTRAINTS ALL I'LL
KEEP MY OF COMMENTS BRIEF.
ODDS BY NORMAL OF DISCLAIMER ON
BALD ANYTHING I SAID IT IS MY
OPINION AND NOBODY ELSE IS TO
BLAME -- I'M
HERE TO TALK ABOUT THE DRUG MEDI
CAL ORGANIZE WILL RE SYSTEM --
DEMONSTRATION JUSTICE IF YOU
SLICE. FOR ANYBODY WHO --
MIGHT NOT BE PUT --
COMPLETELY --
FAMILIAR THE ONE SENTENCE THAT
IT PROVIDES ACCESS TO TREATMENT
SERVICES NOT PREVIOUSLY COVERED
BY DRUG MEDI CAL AS PART OF AN
ORGANIZED FULL CONTINUUM OF CARE
DOESN'T DO FULL JUSTICE TO IT
BUT IT'S WHERE I CITIES SEATED --
WORKING INTO THIS.
THIS HEARING ON APPEAL ITS FIFTH
SPECIFICALLY.
IT DOES INCLUDE OPIOID TREATMENT
IT DOES IT'S NOT LIMITED TO THAT --
A PARTICIPATING COUNTIES ARE
REQUIRED TO HAVE --
AT ACCESS TO TO PROVIDE ACCESS
TO A TO A TREATMENT PROGRAMS AND
THOSE PROGRAMS ARE ARE ARE
REQUIRED TO PROVIDE ALL FDA
APPROVED MEDICATIONS FOR
SUBSTANCES DISORDERS --
SAID BUT DIEM SERIOUS GOES A
GOES BEYOND OPIOIDS OF COURSE
AND I THINK THAT'S IMPORTANT TO
PLACE IT AND INTO CONTEXT
BECAUSE WE KNOW THAT THINGS LIKE
METHAMPHETAMINES.
EVEN WHEN I'M HERE TO TALK ABOUT
THAT TODAY THEY THEY ARE IN A
INCREASING --
USE OF THAT IS INCREASING AND WE
KNOW THAT.
IT IF WE JUST TEND TO ATTACK ONE
DRUG IT TENDS TO MANIFEST AGAIN
IN IN IN IN OTHER PLACES WE'VE
SEEN THAT WITH OPIOIDS WHEN WE
ADDRESS PRESCRIPTION DRUGS AND
THE OF THE THE OVERDOSE DEATHS
FOR ABSURD PRESCRIPTION DRUGS
HAVE LEVELED OFF BUT THEN WE SEE
INCREASES IN HEROIN.
AND AND FEDERAL DEATH SO --
DMCA ODS --
I SEE AS SORT OF A BACKSTOP
ADDRESSING ALL DRUGS --
SO WHERE ARE WE IN
IMPLEMENTATION FORTY COUNTIES OF
IT --
SUBMITTED IMPLEMENTATION PLANS
WOULD COVER ABOUT 97% OF OF THE
STATE'S POPULATION BUT IT'S BEEN
A HEAVY LEFT AND SO IT'S BEEN A
A PROCESS TO GET ALL THE
COUNTIES --
GOING THERE ARE STILL GOING LIFE
AS AS WE AS WE SPEAK IN.
TWO THOUSAND NINETEEN SO JUST
VERY BRIEFLY --
THE THE RESULTS THATWE'RE
SEEING SO FAR IS THAT WE ARE
SEEING INCREASING NUMBERS OF
PEOPLE COMING INTO TREATMENT --
ABOUT 7%.
IN THE INITIAL SEVEN COUNTIES
BUT THE MIX OF TREATMENT IS
CHANGING SO MORE RESIDENTIAL --
THE THAN THAN THE PREVIOUSLY OF
THESE CHANGES AND PLACEMENT
APPEAR TO BE APPROPRIATE BASED
ON ASSESSMENTS THAT WE'VE SEEN --
IN 93% OF THE PATIENTS WERE COME
COMING INTO TREATMENT AND RATE
THEIR TREATMENT POSITIVELY WHICH
IS AT THE I THINK IS REMARKABLE --
AND COUNTY ADMINISTRATORS
OVERWHELMING OVERWHELMINGLY
REPORT THAT THE WAIVER HAS HAD A
POSITIVE IMPACT ON ON THERE ARE.
A NUMBER OF DIFFERENT.
SO IN SUMMARY JUSTICE --
WHO WAS SO FAR FROM WHAT WE'VE
SEEN A VERY --
PROMISING INITIAL SIGNS THERE
ARE THERE ARE CHALLENGES --
A IT'S IT'S NOT PERFECT IT'S A
HEAVY LIFT AS YOU CAN SEE WE ARE
STILL GETTING COUNTIES ON BOARD --
BECAUSE OF THAT AND WITH THE
WAIVER ENDING IN TWENTY TWENTY I
THINK IT IT MAKES SENSE --
TO I CAN'T SPEAK FOR THE
DEPARTMENT BUT I THINK IT WOULD
MAKE SENSE TO EXTEND ANOTHER
CENTRIST.
SINCE WE'RE JUST GETTING THE
SYSTEM AND AND A PLACE AS IT WAS
INTENDED --
WITH THAT I THINK IT THE THEY'RE
ALL ALSO CHALLENGES PENETRATION
RATES GETTING ENOUGH TREATMENT
OUT THERE ONE OF THE MAIN
REASONS THAT PEOPLE DON'T.
OF GET INTO TREATMENT AS THEY
THEY DON'T THINK THAT THEY HAVE
A LOT OF TREATMENT I'VE I'VE
I'VE MODIFIED THE SLIDES I'M
SORRY I I KEPT A FIDDLING WITH
IT -- SO ONE
OF THE WAYS I THINK WE NEED TO
GET PEOPLE INTO TREATMENT IS TO
ENGAGE WITH THE REST OF THE
HEALTHCARE SYSTEM AND KINDLED
ARE FULLER IT WILL TALK ABOUT
THE UP IN SMOKE SYSTEM WHICH
TALKS WHICH IS.
RELEVANT TO THAT --
THANK YOU ALL VERY MUCH AGAIN --
FOR HAVING US AND FOR YOUR
SUPPORT TOWARDS THESE EFFORTS TO
INCREASE ACCESS TO TREATMENT FOR
OPIATE USE DISORDERS --
AGAIN I'M CANDLES ARE FULLER AND
THE PROJECT DIRECTOR FOR UCLA'S
EVALUATION OF THE CALIFORNIA HUB
AND SPOKE PROGRAM.
THE HAVEN'T SPOKE PROGRAM IS
BASED ON AN INNOVATIVE MODEL OUT
OF VERMONT TO EXPAND ACCESS TO
MEDICATIONS FOR OPIOID USE
DISORDERS WHICH INCLUDE
METHADONE.
BUPRENORPHINE AND THAT THE TRIAL --
BUT THE FOCUS OF THIS APPROACH
IS REALLY ON BUPRENORPHINE --
BECAUSE IS DARREN WAS MENTIONING --
THE MODEL IS DESIGNED TO REACH
THINGS WHO MAY NOT HAVE A LOCAL
METHADONE OPIATE TREATMENT
PROGRAM NEARBY --
LIKE THOSE IN RURAL AREAS OR
OTHER UNDERSERVED COMMUNITIES --
EVEN WORKING CAN BE PRESCRIBED
IN OFFICE SPACE TREATMENT
SETTINGS LIKE PRIMARY CARE
OFFICES.
BY PRACTITIONERS HAVE GOTTEN A
SAM'S A WAIVER TO PRESCRIBE IT --
SO IN THE MODEL SPECIALTY OPIOID
TREATMENT PROGRAMS OR HUBS
CONNECT WITH --
OFFICE SPACE SETTINGS FOLKS TO
OFFER GUIDANCE IN TREATING
OPIOID USE DISORDERS AND TO
SERVE AS REFERRAL SITES FOR
PATIENTS WHO NEED A MORE
INTENSIVE LEVEL OF CARE --
THIS ALL REQUIRES BUILDING NEW
AFFILIATIONS AND CARE COR
NATION'S BETWEEN OTP AN OFFICE
SPACE SETTINGS --
AND CALIFORNIA HAS REALLY BEEN
LEADING THE WAY IN IMPLEMENTING
THIS HUB AND SPOKE MODEL --
SO JUST TO GIVE YOU AN IDEA OF
WHAT THE NETWORK LOOKS LIKE AND
HOW IS IT HOW IT'S GROWN OVER
TIME --
WE'VE GOT A COUPLE OF MAPS THE
FIRST SHOWS THE NETWORK WHEN THE
PROGRAM IMPLEMENTATION STARTED
IN HUBS AND SPOKES AND AUGUST.
TWENTY SEVENTEEN AT THE TIME
THERE WERE FIFTY SEVEN FOLKS
AMONG THE EIGHTEEN HAVEN'T SPOKE
NETWORKS.
AND BY JANUARY TWENTY NINETEEN
THERE WERE OVER TWO HUNDRED
SPOKE TREATMENT LOCATIONS --
A MAJORITY OF WHICH WERE LOCATED
UP IN THOSE RURAL NORTHERN
COUNTIES --
WHICH HAVE EXPERIENCED AGAIN
THOSE HIGHEST OVERDOSE DEATH
RATES -- SO
IN THE NEXT FEW SLIDES WE HAVE
SOME PRELIMINARY DATA ON THE
NUMBERS OF PATIENTS AND
PROVIDERS IN THE HUB AND SPOKE
NETWORK.
SO HERE YOU'LL SEE DATA THAT
UCLA --
COLLECTED FROM ALL HUBS AND
SPOKES ON THE NUMBERS OF NEW
PATIENTS STARTING ALL THREE
MEDICATIONS EACH MONTH DATING
BACK TO SEVEN MONTHS PRIOR TO
IMPLEMENTATION.
SO OVER THAT BASELINE PERIOD
BEFORE THE DOTTED LINE THERE --
WE'VE SEEN GROWTH BOTH IN THE
OVER OF PATIENTS STARTING
TREATMENT --
BUT ALSO WHAT'S REALLY GREAT
HERE -- IS
THERE'S BEEN A BIG UPTURN IN THE
NUMBER OF PATIENTS RECEIVING
BUPRENORPHINE WHICH IS THAT DARK
BLUE LINE THERE --
JUMPING UP EVEN HIGHER THAN
METHADONE --
SO THAT DATA REALLY SPEAKS TO
THE GROWTH IN THOSE SPOKE OFFICE
BASED TREATMENT SETTINGS --
WHICH IS DUE IN PART TO AN
INCREASE IN THE NUMBER OF
PROVIDERS --
WEAVER TO PRESCRIBE ME PRINT ARE
FEEDING.
SO THIS IS SLIGHTLY OLDER DATA
DATA FROM OCTOBER --
BUT AGAIN WE'VE SEEN GROWTH IN
THE OVERALL NUMBERS OF PROVIDERS --
BUT WHAT YOU'LL ALSO SEE IS THAT
THERE'S ACTUALLY A GAP --
AMONG THE SPOKE PROVIDERS WHO
GET WAVERED AND THEN THOSE WHO
ACTUALLY START PRESCRIBING SO
THE NUMBER WHO GET LEVERAGES
ALONG THE TOP PLAN THERE AND THE
PERCENTAGES THOSE WHO ARE
ACTIVELY PRESCRIBING DEEPER
MORPHINE --
SO WHEN WE SURVEYED HAVEN'T
SPOKE PROVIDERS ABOUT THEIR
PRESCRIBING PRACTICES.
THOSE WHO WERE WAVERED BUT HAD
NEVER PRESCRIBE PEOPLE ARE BEING
WERE LESS LIKELY THAN THOSE
ACTIVE PRESCRIBERS TO FEEL THAT
THEY HAD THE MENTORSHIP THEY
NEEDED TO PRESCRIBE.
OTHER BARRIERS THAT CAME UP IN
THE SURVEYS AND IN OTHER
CONVERSATIONS WITH PROVIDERS
HAVE INCLUDED PROVIDER KNOWLEDGE
IN ATTITUDES ABOUT MEDICATIONS.
STIGMA TOWARDS OPIOID USE
DISORDERS.
ACCESS ACCESS TO COUNSELING
SERVICES AND PHARMACIES FOR
PRIMARY CARE PATIENTS AND FEARS
ABOUT THE POTENTIAL LEGAL
CONSEQUENCES OF PRESCRIBING --
TO ADDRESS THE GAP IN
PRESCRIBING UCLA HAS WORKED WITH
A GROUP AT STANFORD TO DEVELOP
THE HUB AND SPOKE PROVIDER
FACILITATOR PROGRAM WHICH AIMS
TO CONNECT --
CHAMPION PHYSICIAN PRACTITIONERS
WITH THOSE SPOKE PROVIDERS TO
HELP THEM WITH ANY CHALLENGES
THEY MAY BE HAVING IN
IMPLEMENTING MEDICATION ASSISTED
TREATMENT --
AND SO FAR THERE ARE TWENTY
FACILITATOR CHAMPIONS WORKING
ACROSS THE EIGHTEEN HAVEN'T
SPOKE NETWORKS --
SO AGAIN WE DO WANT TO
ACKNOWLEDGE THAT WE'VE SEEN
REALLY REALLY PROMISING GROWTH
IN THE VERY SHORT TIME THAT THIS
PROGRAM HAS BEEN RUNNING --
THE BARRIERS DO REMAIN --
AND CONTINUING TO EXPAND ACCESS
REDUCE DISORDERS WILL REQUIREBY
AND FROM STAKEHOLDERS AT MANY
LEVELS --
AND WE REALLY THANK YOU FOR YOUR
SUPPORT AND THIS WORK SO FAR.
THANK YOU SO VERY MUCH I WANT --
TO WELCOME AT CENTER RUBIO AND
SOME MEMBER RAMOS THANKS VERY
MUCH --
QUESTIONS FROM COMMITTEE MEMBERS.
A WHITE ACTUALLY HAVE SOME
QUESTIONS OKAY YEAH THE THE
SUMNERS LEISURE WHAT
[inaudible]
THANK YOU.
POPULATION IS NOW GOD COVERED
ANDERS THE M. C. O. D. S. OUT
WELL OR OR OR IS. 97% OF
CALIFORNIANS ARE.
WELL ELAINE THAT YEAH THANK YOU
THANK YOU --
SO.
OF THE FORTY COUNTIES OUT OF THE
SUBMITTED IMPLEMENTATION PLANS
NOT ALL OF THEM GONE LIFE I
THINK FOR AROUND TWENTY TWO OF
OF HAVE SAID ACTUALLY STARTED
WITH SERVICES --
SO THAT LEAVES ANOTHER EIGHTEEN
OR SO THAT.
HAVE NOT STARTED YET BUT IF IF
IF THEY DO SUCCESSFULLY ALL
BEGAN THEN.
THAT WOULD ADD UP 297% OF OF THE
POPULATION LIVING IN THOSE
COUNTIES IT'S THERE'S OF THERE'S
A FEW THAT ARE --
WELL.
THE DEPARTMENT OF PUBLIC SPEAK
TO THIS BETTER THAN THAN I CAN I
I'M NOT SURE EXACTLY IF ALL
FORTY OUT OF FORTY WILL WILL GO
LIVE IN A OKAY.
AND SO THERE SO HE SAID THEY'RE
CURRENTLY EIGHTEEN EIGHTEEN
COUNTIES --
BUT THE MOST IT MY IMPRESSION IS
THAT MOSTLY THE ONES THAT HAVE
ADOPTED IN A RURAL COUNTIES
RIGHT WELL THAT YEAH YEAH THE
SMALL COUNTIES.
YEAH SO.
HOW DO WE HOW DO WE CHANGE THAT
YEAH THAT'S? FOR FOR VERY SMALL
COUNTIES HONESTLY I I'M NOT SURE.
WELL ONE OF THE EFFORT THAT'S
GOING ON RIGHT NOW IS TO DO
REGIONAL MODEL SO --
SEVERAL SMALL COUNTIES ARE
WORKING WITH PARTNERSHIP HEALTH
PLAN -- TO
HE TRIED TRY TO WORK OUT
SOMETHING WHERE THEY DON'T
NECESSARILY HAVE TO ALL HAVE TO
HAVE THE FULL CONTINUUM OF CARE
BUT THEY CAN REFER TO ANOTHER
PEOPLE TO ANOTHER COUNTY.
SO THAT'S PROMISING --
IT THE THERE'VE BEEN
DIFFICULTIES AS A IT HASN'T
STARTED YET BUT I'M NOT.
I'M NOT DEEPLY INVOLVED EXACTLY
KNOWING WHY I KNOW IT'S A
COMPLICATED THING TO SET UP THE
HOPEFULLY THEY WILL BE ABLE TO
GET THAT RUNNING AND THAT COULD
SERVE AS A MODEL FOR THE SMALL
COUNTIES.
THERE MAY HONESTLY BE SOME --
THE IF YOU'RE ALPINE COUNTY OF
POPULATION OF ELEVEN HUNDRED AND
YOU HAVE A MINIMUM BASE
ALLOCATION OF THE MONEY THAT'S
COMING TO FOR TREATMENT THROUGH
OTHERS DAVIS OF THE OTHER OTHER
FUNDING SOURCES.
AND YOU'VE GOT ONE OR TWO PEOPLE
MAYBE THAT'LL PRESENT FOR
TREATMENTEACH MONTH I'M NOT
SURE HOW THAT'S WORDS WITH --
YOU KNOW EVER BEING ABLE TO
REACH ALL THE GMC ODS --
REQUIREMENTS.
OF WHETHER THAT WOULD MAKE SENSE
IN TERMS OF JUST THE TIME AND
EFFORT I I DO THINK YOU KNOW
THEY COULD BENEFIT FROM IT BUT
IT'S IT'S IT'S GONNA BE I MEAN
THEY WOULD GET INCREASED RATES
IN.
THE BILL THE BILL FOR THINGS --
THAT THEY OTHERWISE COULDN'T BE
BUT IF IF THEY JUST DON'T FEEL
THAT THEY THEY NEED IT BECAUSE
OF THE THE NUMBER OF PEOPLE THAT
THEY HAVE.
IT THAT THERE MIGHT BE A A A A A
POINT WHERE.
THOSE KINDS COUNTIES MIGHT NOT
PARTICIPATE I DON'T KNOW.
SO IT ARE YOU FIND ARE WE NOT
DONE WANTED OVER GENERALIZED
REFINING AND SOME OF THE SOME OF
THOSE SMALLER COUNTIES AT THEIR
THERE IS A DENIAL OF MAYBE
THERE'S A PROBLEM OR OR THERE'S
A RELUCTANCE BECAUSE FOR FOR
WHATEVER REASON TO ENGAGE IN
THIS -- I
REPRESENT THREE COUNTIES THAT
HAVE BEEN REALLY REALLY HARD YET.
AND I SEE UP THERE THAT YOU KNOW
ONE OF THEM HAS A I SPOKE I SAW
ON THE ON THE BORDER BETWEEN
TRINITY AND MENACING OR TRAINING
HUMBLE --
BUT WE YOU KNOW.
I CAN YEP RIGHT THERE YEAH
THAT'S RIGHT THERE IN THE IN
THAT MENDOCINO HUMBLE REST
ACTUALLY HUMBLE TRINITY AREA.
AND WE HAVE SOME I HAVE A HUGE
CHALLENGES AND AND AND HUMBOLDT
COUNTY AS WELL SO.
SO -- IS IT
IS IT IS IT THE PAPER WORK IS IT
IS IT.
IS IT THE IS IT THE THE
ACCEPTANCE THAT THERE'S A
PROBLEM.
I'M I'M TRYING TO GET TO THE
ROOT YEAH AND AND SO WHEN YOU
SAY YOU WERE GOING TO GET 27097%.
WHAT'S THE 3% THE WON'T BE
COVERED IS THAT GONNA BE IS THAT
GONNA BE RURAL COUNTIES BECAUSE
PROBABLY WHERE WE HAVE A PROBLEM.
SO HOW DO WE AS A WHEN I THINK
OF THAT WHEN I HEAR 97% PERCENT
I THINK OF HIS BROADBAND.
OKAY THE RACES BROADBAND WE HAVE
97% COVERED WILL GUESS WHERE
THAT 3% DOES HAVE COVERAGES.
IN MY COUNTIES.
ON EXCEPT 7% WHERE IS THE 3% IS
IT IS IT ALL IN RURAL COUNTIES
AND IF IT IS HOW DO WE GET THE
PENETRATION TO MAKE TO MAKE THIS
WORK.
RIGHT --
WELL IT IT'S IT'S IT PROBABLY IS
THE RURAL COUNTIES AND TO SOME
EXTENT IT MIGHT BE.
ON ON TO SPECULATE BEYOND THE
DATA THAT PERHAPS BUT TO SET UP
A A RESIDENTIAL PROGRAM OR AND
NARCOTIC TREATMENT PROGRAM YOU
NEED CERTAIN NUMBER OF PEOPLE TO
BE ABLE TO PUT IN THERE TO MAKE
IT.
ECONOMICALLY FEASIBLE.
OF THE SET UP COUNTY PROGRAM --
BUT YOU KNOW IT'S IT IT THEN IT
BECOMES A MATTER OF RESOURCES --
THINGS LIKE HUB AND SPOKE I
THINK.
MIGHT BE PROMISING AND THAT YOU
DON'T HAVE TO SET UP A SPECIALTY
CARE PROGRAM --
BILLS COUNTIES.
HAVE.
YOU KNOW MAXIS PRIMARY CARE IF
YOU HAVE A FEDERALLY QUALIFIED
HEALTH CENTER OR SOMETHING LIKE
THAT AND CAN CAN --
INTEGRATE BEEPING OFF --
INTO THAT THAT MIGHT BE.
I I ACTUALLY THINK --
THAT'S A GOOD SOLUTION
EVERYWHERE BUT ESPECIALLY AND
AND OF WORLD --
COUNTIES. 90% 995% OF PEOPLE WHO --
DON'T GET TREATMENT THEY DON'T
GET IT A PROBLEM SO BUT 85% OF
AMERICANS HAVE SOME INTERACTION
WITH THE HEALTHCARE SYSTEM EVERY
YEAR SO.
THAT'S WHERE THEY'RE GOING LET'S
LET'S LET'S ENGAGE IN THERE I
THINK AND I THINK THEIR WAYS TO
DO THAT.
SO I YOU KNOW OBVIOUSLY HELP
PARTNERSHIP IS A BIG --
A BIG PART OF MY DISTRICT --
AND AND SO THERE ARE
OPPORTUNITIES FOR PARTNERSHIP TO
ENGAGE MORE AYE AYE WELCOME I
WELCOME THAT.
SO I DO WONDER SO WHEN YOU TALK
ABOUT THE THE PROVIDERS NOW THAT
HAVE -- HAVE
THE TRAINING TO BE ABLE TO
PRESCRIBE ANY OF 69% UPTAKE.
SO THE 31%.
WHERE ARE THEY ARE THOSE ARE
THOSE ALSO RURAL --
DO THEY NOT FEEL THEY HAVE A
SUPPORTER OF THE OR THE OR THE
OR THE BACKGROUND.
ARE THOSE ARE THOSE --
FOLKS THAT --
MAYBE OUR PROVIDERS IN IN OUR
TRIBAL COMMUNITIES WHERE WE HAVE
THREE TIMES THE THE OVERDOSE
RATE -- SO
SO WHERE IS THAT 31% THAT'S NOT
UTILIZING THE TRAINING THEY HAVE
TO HELP WITH THE SITUATION.
THAT'S A GREAT QUESTION --
I DON'T HAVE THAT DATA WITH ME
NOW -- MY
SENSE IT'S IT'S IT'S PRETTY
WIDESPREAD BUT YOU COULD BE
CORRECT THAT IT IS IN THOSE --
COMMUNITIES THAT ARE HARDEST WE
DO HAVE THE PRACTICE
FACILITATORS WORKING IN ALL OF
THE REGIONS OF THE HUB AND SPOKE
NETWORK --
BUT AGAIN YOU COULD BE CORRECT.
WOULD IT BE POSSIBLE THE TO
FOLLOW UP ON THAT THAT THAT BACK
TO US BECAUSE I'D LIKE TO KNOW
BECAUSE SOME OF THE COMMUNITIES
THAT ARE HARD TO SEE.
AND WHILE THE NUMBERS MAY NOT BE
A BIG NUMBER COMPARED TO SOME
LARGER COMMUNITIES
PROPORTIONALLY RATHER HIGH.
ESPECIALLY IN OUR MORE ISOLATED
COMMUNITIES IN OUR TRIBAL
COMMUNITIES AND AND SO SO.
I WANT TO BE THIS UP BUT I GO
BACK TO I THINK SOME F OUR
HARDEST HIT AREAS WERE THE ONES
THAT ARE.
THAT ARE NOT SEEN THE
PENETRATION OF WOULD LIKE TO SEE.
AND THAT'S THAT'S WHAT THAT'S
WHAT I'M PUSHING FOR THANK YOU.
CENTER RUBIO THANK YOU --
MY QUESTION GOOD MORNING THANK
YOU FOR BEING HERE MY QUESTION
AND YOU KNOW MISTER WOULD SORT
OF GOT AHEAD OF WHAT I WAS
THINKING.
WHEN I WAS READING THE RESEARCH
THAT WAS PROVIDED IT DOES TALK
ABOUT NATIVE AMERICANS BEING
TWICE?
I EXPENSIVE TWICE THE NUMBER OF
DEATHS AS COMPARED TO WHITES AND
I KNOW THAT WE NEED NO PEOPLE OF
COLOR USUALLY TEND TO HAVE
HIGHER NUMBERS BUT THAT TO ME
WAS PARTICULARLY --
WELL AS WHAT I FOCUSED ON IN
TERMS OF AND SAYS HOW CAN WE
IMPROVE IT BUT I GUESS YOU KIND
AROUND YOU ASKED THE SAME
QUESTION.
HIS THAT'S SOMETHING THAT REALLY
STRIKES ME AS HOW DO WE GET
SERVICES TO THESE FOLKS AND EVEN
AS COMPARED TO LATINOS AND
OTHERS.
NATIVE AMERICANS TEND TO HAVE
THE HIGHEST DEATH SO I JUST KIND
OF ALSO WANTED TO MAKE SURE THAT
WE LOOK INTO THAT AND SEE IF YOU
CAN PROVIDE SOME INFORMATION AS
HOW WE CAN MAKE A BETTER.
YOU'RE ABSOLUTELY RIGHT NOW --
WE'RE WORKING WITH THE%
UNIVERSITY OF SOUTHERN
CALIFORNIA UCLA AND USC DO
SOMETIMES WORK TOGETHER --
THEY THEY ARE CONDUCTING A
TRAVEL NEEDS ASSESSMENT ON ON
THE ENTIRE.
SYSTEM AND THERE.
THEIR REPORT SHOULD BE DO SO --
THERE'S IT SHOULD BE COMPLETE
SOMETIME AROUND THE SUMMER --
BUT THEY'VE BEEN.
THE SAME WHAT YOU'RE SAYING AND
WE'VE BEEN SAYING SAYS THE SAME
THINGS PARTICULARLY BUT
FUNCTIONAL DEATHS AND AND
THEY'VE BEEN TALKING ABOUT HOW.
WHEN THEY GO OUT --
THE PERSON WORKING WITH SHE'S
BEEN DOING THIS KIND OF RESEARCH.
FOR FOR YEARS AND YEARS AND SAYS
THIS IS THE FIRST TIME WHERE
PEOPLE FROM THESE COMMUNITIES
ARE ACTUALLY CONTACTING HER AND
SAYING CAN YOU DO A FOCUS GROUP
IN OUR IN IN IN.
IN OUR AREA BECAUSE WE REALLY
WANT TO TALK ABOUT THIS AND
HOPEFULLY WE'LL HAVESOME SOME
MORE RECOMMENDATIONS LATER THIS
SUMMER.
THANK YOU FOR THAT SO WHEN YOU
DO THAT --
THE THE NEEDS ASSESSMENT MAKE
SURE TO SHARE THAT INFORMATION
WITH US I WOULD LOVE TO SEE IT
THANK YOU.
THANK YOU [inaudible]
SUMMARY MUST [inaudible]
THANK YOU.
I LIKE A POPULATION.
THIS REPORT AND AT 17% --
PER ONE THOUSAND A HUNDRED
THOUSAND RESIDENTS IS FAR MORE
HIGHER THAN SOME OF THE OTHER --
SUB CATEGORIES THAT ARE THERE.
NOW THE DIFFERENCE IN IN THE
NATIVE AMERICAN COMMUNITY WE'RE
TALKING URBAN --
NATIVE AMERICANS AND THOSE THAT
ARE LIVING ON INDIAN
RESERVATIONS THE OUTRAGE IN
FOCUS GROUPS IS GOING THERE YOU
MENTIONED THAT --
THERE'S BEEN SOME OUT REACH AS
FAR AS TRYING TO DEAL WITH THIS
EPIDEMIC THAT'S FACING
CALIFORNIA AND PARTICULARLY WE
SEE -- THE
THE HIGHEST RATE.
SO WE START TO TALK ABOUT --
AREAS LATER ON IN THE AGENDA AS
FAR AS HOW WE'RE GOING TO DO
SOME INTERVENTION SOME IDEAS OF
THOSE THINGS.
HOW ARE WE REACHING OUT TO THE
NATIVE AMERICAN POPULATION
KNOWING THAT CALIFORNIA HAS THE
HIGHEST NATIVE AMERICAN
POPULATION ANY OTHER STATE IN
THE NATION?
AND DEALING AGAIN WITH URBAN
URBAN --
INDIANS THAT LIVE IN THE CITIES
AND THOSE THAT ARE ACTUALLY ON
FEDERAL INDIAN RESERVATIONS I
THINK WE WE OWE T TO BRING THE
STATISTICS.
Là MUCH LOWER --
EVEN IF WE BROUGHT IT TO WHERE
OTHERS ARE AT BUT YET THERE HAS
TO BE A HEIGHTENED AWARENESS TO
IT EVEN IN THE DIFFERENT REPORTS
THAT ARE.
COMING FORWARD SO HOW DO WE DEAL
WITH THAT KNOWING THAT THERE'S
SOME CONSTRAINTS THAT ARE THERE
IS -- WAYS
THAT WE CAN GET INVOLVED --
TO BE ABLE TO OPEN UP SOME OF
THOSE DIALOGUES WITH SOME OF THE
TRIBAL COMMUNITIES TO MAKE SURE
THAT.
THE RESOURCES THAT WE'RE TALKING
ABOUT IN THE STATE OF CALIFORNIA
OUR RESOURCES ARE AVAILABLE TO
THE NATIVE AMERICAN COMMUNITY AS
A WHOLE ALSO.
SO HOW DO WE GET TO THAT POINT
SO THAT WHEN WE GET ANOTHER
REPORT.
THAT WE SEE THE STATISTICS ARE
ISJUST WITH THE THE
PRESENTATION HERE TODAY BUT MY
COLLEAGUES KNOW THAT OTHER AREAS
TO NATIVE AMERICAN --
STATISTICS ARE HIGHER THREE
TIMES HIGHER FIVE TIMES HIGHER
IN OTHER CATEGORIES THAT ARE
THERE TOO SO THIS IS SOMETHING
THAT'S REALLY GOT THE ATTENTION
OF MYSELF IN THE COLLEAGUES THAT
ARE BRING IT UP ALSO.
SO HOW DO WE START TO DEAL WITH
THAT AND HOW DO WE START --
TO BUILT ON THAT COLLABORATION
AND COMMUNICATION THAT'S OUT
THERE.
QUESTION SO --
IN TERMS OF THE WORLD WE HAVE
THE WEEK I GUESS IT STARTS WITH
A NEEDS ASSESSMENT.
THAT'S GOING ON THROUGH UFC
UNDER NOT DOCTOR CLEARED IN A
SUBTLE WHICH IS WORKING WITH A
NUMBER OF GROUPS LIKE --
CRIB IN --
SICKLY OTHER THE TICKET GATE --
URBAN AND RURAL AND PUT.
THEIR ALSO PROJECTS ARE BEING
STARTED --
THROUGH RECENT SO ARE FINISHED A
BUT FAILED.
RESPONSE --
GRANTS. FOR BETTER TARGETED
SPECIFICALLY AT AT THE TRIBAL
COMMUNITY --
DHS CAN PROBABLY TALK A BETTER --
MORE IN MORE DETAIL ABOUT THOSE
THERE'S THERE'S TELEHEALTH
THERE'S A LEAVING OUT A WHOLE
BUNCH OF THINGS WITH IT THAT
THEY DO HAVE SOME THINGS GOING
ON AND HOPEFULLY AFTER WE GET
THE NEEDS ASSESSMENT.
WILL HAVE BETTER DIRECTION ON
WHERE TO GO NEXT [inaudible]
THANK YOU.
REALLY IS MAKING SURE THAT
RESOURCES ARE NO LONGER
AVAILABLE GET TO THOSE THAT THE
THOSE RESOURCES IN THE SO THANK
YOU [inaudible]
THANK.
SO I HAVE A FEW QUESTIONS AS
WELL AND I WANNA THANK YOU FOR
YOUR PRESENTATIONS AND I WOULD
MAKE NO WE WERE --
ALSO HAVE A PANEL ON THE PLANS
FOR EXPANDING THE PILOTS
INSISTING SERVICES SO I HOPE FOR
ALL THE PEOPLE ON THAT PANEL OR
SOME OTHER QUESTIONS --
BECAUSE WE ARE HOPING TO GET
SOME ANSWERS FROM YOU AS WELL
ABOUT THIS --
THIS.
YOU GUYS ARE THE EVALUATORS SO I
HAVE A QUESTION ABOUT --
SO THE THE ORGANIZER EVERY
SYSTEM WAIVER WAS ABOUT. FOUR
YEARS OLD NOW THREE FOUR YEARS
OLD IT WAS APPROVED IN TWO
THOUSAND FIFTEEN FIFTEEN YEAH
AND BY TAKES A LITTLE TIME OKAY --
SO AFTER THAT YOU KNOW I
APPRECIATE YOUR PRESENTATION --
YOU KNOW THE RESULTS FROM THE
SEVEN COUNTIES IF THIS THAT.
THE STATE IN MY MIND A LITTLE
SPARSE ARE YOU GETTING THE KIND
OF DATA YOU NEED TO DO A MORE
DETAILED EVALUATION THAN WE'VE
BEEN ABLE TO GET HERE OR IS IT
JUST THAT TIMING WISE YOU JUST
DON'T HAVE.
THAT I MEAN ARE YOU HAVING THE
DATA DO YOU NEED TO BE ABLE TO
DO MUCH MORE DETAILED EVALUATION
THEY'RE ABLE TO PRESENT YOUR DAY.
OF THE YES WERE WERE --%
THERE'S ALWAYS DELAYS AND ENDED
REPORTING --
WE WE ARE GETTING A NEW BATCH OF
OF DATA RIGHT RIGHT NOW THAT
WILL BE USING FOR REPORT THEY'LL
COME OUT IN.
A FEW MONTHS IN JULY AND THAT
WILL INCLUDE MUCH MORE THAN THE
SEVEN COUNTIES.
SO THAT YEAH.
THE THE UNFORTUNATELY THE ONLY
DID I HAD FOR YOU TODAY WAS FROM
THE REPORT WHICH EARNED IN LAST
YEAR WHICH WAS BASED ON THE
SEVEN COUNTIES AND THAT WAS
BASED ON DATA THAT WE GOT IN
AROUND MAY OF TWENTY EIGHTEEN SO.
IT'S IT'S IT'S BAD TIME BUT
HOPEFULLY WE'LL HAVE MORE SOON
AND I RECOGNIZE THIS.
HAVING DONE RESEARCH MYSELF
EVALUATION THAT THERE'S OF THAT
BUT I JUST WONDERED AT THE DATA
WILL BE COMING FOR YOU TO DO
MUCH MORE DETAILED EVALUATION.
AND AND ARE YOU GOING TO HAVE
THE KIND OF DATA AND ACTUALLY
PRICE FOR BOTH OF YOU TO DO THAT
BREAK OUTS THAT.
THE COMMITTEE HAS BEEN ASKING
ABOUT BEING ABLE TO DO ZERO IN
ON EXACTLY ALSO.
ON LIKE OKAY WELL WHERE ARE THE
COMMUNITIES THAT ARE ARE ARE
FALLING THROUGH THE CRACKS WERE
AWARE --
POPULATIONS THAT ARE ADVERSELY
AFFECTED BECAUSE I THINK I
SHARED CONCERN OF THOUGHT --
OF DOCTOR WOULD THAT --
YOU KNOW IS A 97% SOUNDS REALLY
GOOD BUT THE 3% IF WE DON'T IF
WE DON'T HAVE THE KIND OF DATA
THAT LET US DRILL IN DRILL DOWN
ON THE 3% ON THE NATIVE AMERICAN --
YOU KNOW PART OF THE APPLICATION
ON OTHER FIVE AFFECTED
POPULATIONS THEN WHY AM IS AND
WE SORT OF GO ALL LOOK OVERALL
IT'S PRETTY GOOD BUT ACTUALLY
WERE FEELING AND AND PARTICULAR
AT ME AND WE CAN DO WE HAVE ARE
YOU COLLECTING THE KIND OF DATA
THAT CAN DRILL.
DOWN INTO THAT.
YEAH I THINK WE'LL HAVE THAT --
WELL WHAT WAS REALLY OF THE
TRIBAL NEEDS ASSESSMENT AND THEN
WILL HAVE --
ANOTHER THE NEXT REPORT FOR HUB
AND SPOKE IS.
SCHEDULED FOR WELL WE'RE TURNING
SAN IN SOMETHING IN APRIL BUT
THEN SEPTEMBER THAT BUT I GUESS
IT'S AN IDEA I APPRECIATE YOU
HAVE A REPORT COMING UP I AM
SAYING IS THAT IS A TRULY ARE
YOU HAVE THE RESOURCES TO
COLLECT THE KIND OF DATA THAT
WHEN WE ASK.
YOU THE QUESTIONS WHEN THAT
REPORT COMES OUT YOU'RE GOING TO
BE ABLE TO ANSWER THE QUESTIONS
NOT TURN AROUND TO US AND SAY
WELL WE DIDN'T HAVE THAT KIND OF
DATA SO WE CAN'T ANSWER THAT
QUESTION.
THAT'S WHY ONE DOES ARE YOU
GETTING THE ARE YOU
PARTICIPATING GETTING THE DATA
YOU NEED ANSWERED KIND OF
QUESTIONS WE GOT WERE ASKING.
YES OKAY THE WIND HAS BEEN THANK
YOU FOR ASKING --
AND THEN I GUESS THE OTHER THING
IS YOU SAID YOU MENTIONED THAT
YOU KNOW CERTAINLY I APPRECIATE
THAT NUMBER OF PEOPLE RECEIVING
TREATMENT ROSE 7%.
BUT I LIKE TO KNOW LIKE WHAT IS
THE DENOMINATOR SO --
SO AND I REALIZED MAYBE A LITTLE
BIT SAVE ONLY SERVING 1% OF
PEOPLE AND WE INCREASED BY 7%
I'D GO.
THAT'S STILL FAILURE RIGHT ARE
WE SERVING 20% WE HAVE A SEVEN
FRIEND SENT ENTRIES BECAUSE
THERE'S A HUGE NUMBER OF PEOPLE
WHO ARE.
SO DO WE KNOW WHAT THE
DENOMINATOR IS ANOTHER WORDS
OKAY GREAT RECESSION RIGHT YEAH
SO WHAT PROPORTION OF THEM OF
THE I GUESS THE MAN ARE WE
ACTUALLY SERVING EVEN WITH THE
7% INCREASE AND WE ARE WE
GETTING CLOSE TO A 100% ARE WE
STILL LIKE BELOW 50%.
WERE FORMULA FAR BELOW OKAY SO
7% OBVIOUSLY BETTER THAN NO
INCREASE OF CERTAINLY BETTER
DECREASE BUT NO WHERE NEAR THE
KIND OF PROGRESS WE NEED TO MAKE.
NOW IT'S WAR PROBABLY AROUND FOR
A LITTLE OVER 4% --
THAT'S THE PERCENT OF A
PERCENTAGE OF THE NEED THAT'S
OUT THERE NOW AS I SAID 95% OR
SO OF OF THE PEOPLE WHO.
WE THINK NEED TREATMENT DON'T
THINK THEY NAY TREATMENTS ALL I
UNDERSTAND IT'LL LEAVE.
SO FORGET FOR A 44% OF THE
REMAINING 5% I GUESS THAT'S IN
INCENSE GOOD BUT THAT'S WHY WE
WE NEED WE DO NEED TO GET DRILL
INTO THAT 95% GET THEM.
INTO TREATMENT YEAH SITES I JUST
WEIGHING KNOWLEDGE I MEAN.
I'M NOT SAYING PEOPLE ARE
WORKING REALLY HARD BUT WE'RE A
LONG WAY FROM SOLVING THE
PROBLEM.
YES AND THEN I APPRECIATE YOU
SAID 93% OF THE PATIENTS
RESEARCH EVEN POSITIVELY BUT
GIVEN THE FACT YEAH USUALLY THE
PEOPLE WHO DON'T RATE A POSITIVE
AREN'T THE ONES ARE STICKING
AROUND FOR THE SURVEY RIGHT SO I
MEAN IT'S OF THOSE YEAH NO THAT
93% OF THE RIGHT.
WHAT SO WHAT WE DO IS WE HAVE
THEM -- AS
GREAT POINT I COULD I COULD TELL
YOU ARE RESEARCH I I LIKE THAT --
WOULD SERVE THE THESE ARE NOT A
SURVEYS ARE GIVEN OUT DURING
THAT CERTAIN WEEK IN IN --
SO IF IF THAT WAS OUR FIRST DAY
THEY WOULD STILL GET IT.
NOW THE PEOPLE THAT WE DON'T GET
OF OUR YOU KNOW PEOPLE NEVER
MADE INTO TREATMENT AND I GUESS
IF THEY DROP OUT OF TREATMENT
AND THEY ARE MORE LIKELY TO MISS
THAT WEEK I GUESS SO.
THERE ARE LIMITATIONS FOR SURE
SOAND I REALIZE YOU'RE TO
EVALUATOR YOU'RE NOT FOR SOME
WRITING PROGRAM I THINK SOME OF
THE QUESTIONS WE NEED TO ASK
THEN IS HOW DO YOU REACH THE
OTHER PEOPLE I REALIZE IT'S
DIFFICULT BUT THE A WORD WORD.
WE HAVE A LONG WAY TO GO OKAY.
AND IN TERMS OF THE HUB AND
SPOKE PROGRAM CERTAINLY
APPRECIATE.
ARE THERE SOME IN TERMS OF THE
LEVEL OF ACCESS FOR THE SPOKES
SO -- I
UNDERSTAND PARTICULARLY IN MORE
RURAL COMMUNITIES.
SO WE HAVE HUB AND WE HAVE SPOKE
MAYBE WE CAN GET INTO THIS MORE
WHAT THE PEOPLE WANT TO TALK
ABOUT THIS EXPERIENCE THE
PROGRAM BUT TO WHAT DEGREE HE
DOES A SPOKE DEPENDING WHERE IT
IS.
MAY NEED TO BE A LOT MORE HELP
LIKE BECAUSE THE HUB IS SO FAR
AWAY ARE HARD TO ACCESS SO CAN
CAN YOU MAY BE SPEAK TO IN YOUR
VALUATION --
WHAT YOU'VE SEEN IT IN TERMS OF --
WHETHER THE SPOKES ARE --
ABLE TO DO ENOUGH TO SERVE THEIR
COMMUNITIES WITH THIS MODEL.
YEAH SO THERE ARE CERTAINLY MANY
SPOKES THAT HAVE TO SORT OF
FUNCTION AS HUBS ESPECIALLY IN
THE RURAL NORTH --
THOSE --
SPOKES ARE LOCATED MUCH MUCH
FURTHER FROM THEIR HUBS AND
YOU'LL ACTUALLY SEE IN THE
HUMBOLDT AREA THERE ISN'T THE
HELP LOCATION --
SO WE'VE SORT OF BEEN CALLING
THOSE SUPER SPOKES --
AND THEY'RE ESSENTIALLY
FUNCTIONING TO TAKE ON PATIENTS
WITH -- MORE
COMPLEX OPIATE USE DISORDERS AND
THE ONLY THING THAT THEY REALLY
DON'T HAVE IS METHADONE --
BUT WE CERTAINLY ARE SEEING A
LOT OF THAT.
THANK YOU AND I THINK YOU KNOW.
WE ARE INTERESTED IN SIR DRAWING
DOWN ON THOSE PROVIDERS WHO GOT
TRAINING AND YET STILL ARE NOT
COMFORTABLE AND WHAT WE CAN TRY
TO DO TO KNOCK DOWN THOSE
BARRIERS BECAUSE CLEARLY WE'VE
INVESTED IN THEM.
BUT DATE FOR SOME REASON --
FEELING COMFORTABLE ENOUGH TO
DELIVER --
WILL -- AND
SO.
HOPEFULLY WE CAN GET THAT RATE
MUCH HIRED ARE YOU ABLE TO
ASSESS THAT EVALUATION DATA THAT
YOU'RE GETTING YEAH OKAY SO WE
LOOK FORWARD TO YOUR NEXT REPORT
AND HAVING THAT QUESTION
HOPEFULLY --
GIVE US SOME INSIGHTS AND
ANSWERS.
OKAY ANY ANY OTHER QUESTIONS.
THIS PANEL OKAY SO WE ARE RIGHT
AND I WANNA AGAIN RECOGNIZE AND
WILL COME --
CENTER DRAWS THOUGH AND SO
NUMBER MCCARTY THANK YOU SO MUCH
FOR BEING HERE AS WELL SO WE'LL
MOVE ON TO OUR NEXT.
PANEL THANK YOU SO VERY MUCH FOR
BEING HERE AND SHARING WITH US
THE VALUATIONS I LOOK FORWARD TO
GETTING YOUR FUTURE REPORTS.
OKAY SO WE HAVE THE STAKEHOLDER
EXPERIENCES PILOT PROJECTS AND I
WANT TO WELCOME DR SIERRA ECHO
WASHER.
HUB AND SPOKE GREAT MANAGER
FRIDGES TREATMENT CENTERS --
I WILLIAM HERIS THIS IS A
REGIONAL MANNER RIVERSIDE
UNIVERSITY HEALTH SYSTEM
BEHAVIORAL HEALTH SUBSTANCE
ABUSE PREVENTION TREATMENT
PROGRAM.
IS GONNA BE SPEAKING ABOUT SO --
ABOUT THE HAVEN'T SPOKEN HUMBLE
COUNTY AND THE POSTER HARRIS IS
GONNA SPEAK ABOUT --
THE IMPLEMENTING THE DMC --
PROGRAM AND AND AND HIS COUNTY
AND THEN WE ALSO HAVE ALBERTS
AND NELLA PRESENT CEO OF
TERRAINS A TREATMENT CENTERS TO
PROVIDE PROVIDERS PERSPECTIVE
THE TUB AND SPOKE END.
THE THE M. C. L. E. S. AS WELL
SO -- WHEN
WE GO AHEAD AND START WITH --
DOCTOR KALASHA AND WELCOME ALL
OF YOU [inaudible]
THE KEYS.
GOOD MORNING.
IT'S A PLEASURE TO BE HERE TODAY
IN FRONT OF YOU SENATORS AND
OTHER COMMITTEE MEMBERS AND
THANK YOU DOCTOR PAN A DOCTOR
WHAT FOR YOUR SUPPORT WITH OUR
EUREKA CLINIC.
I'M I'M HERE TO SPEAK ABOUT ARE
YOU JUST HAVE BEEN SPOKE SYSTEM.
I OVERSEE THE JUST HAVEN'T SPOKE
SYSTEM IN OUR ROLE NORTH PART OF
CALIFORNIA.
AND I WOULD LIKE TO SHARE WITH
YOU SOME OF OUR UPDATES IN
PROGRESS IN ALL SIX OF OUR GRANT
REGIONS.
AND THEN FOCUS SPECIFICALLY ON
OUR HOME.
HERE THE AREAS I'D LIKE TO COVER
TODAY.
THROUGH THE HAVEN'T SPOKE GRANT
T. JUST COVERS SIX REGIONS
HUMBOLDT REDDING CHICO ROSEVILLE
MARYSVILLE AND MANTECA.
THE MAP ON THE LEFT OF YOU AS
OUR PROJECTION OF ABOUT TWENTY
SPOKESMAN WE INITIALLY STARTED
IN JUNE OF TWENTY SEVENTEEN THE
MAP ON THE RIGHT OF YOU IS OUR
CURRENT HUB AND SPOKE SYSTEM
WHICH HAS SIXTY ONE ACTIVE
SPOKES.
IN TWENTY COUNTIES SERVING
NEARLY TWO THOUSAND SPOKE
PATIENTS AND THREE HUNDRED HAVE
PATIENCE.
OVER 50% OF OUR SPOKES DID NOT
HAVE MEDICATION ASSISTED
TREATMENT PRIOR TO THIS GRANT.
A LARGE PORTION OF OUR WORK WITH
THEM IS IMPLEMENTING THESE
SERVICES AND GETTING THEM ON THE
GROUND RUNNING.
ADDITIONALLY OUR GOAL WAS TO
TARGET AS MANY OF THE TOP TEN
OVER DOES COUNTIES AS WE COULD
BUT OUR GRANT TERRITORY.
AND WE WERE ABLE TO TACKLE SEVEN
OF THOSE COUNTIES THOSE COUNTIES
BEING HUMBOLDT DEL NORD SISKIYOU
PLUMAS LAKE.
MENDOCINO AND TWELVE ANY COUNTY
IF.
HERE IS AN OVERALL PATIENT
GROWTH CHART OF OUR PATIENTS UP
TODAY AS OF FEBRUARY TWENTY
EIGHTH.
LAST MONTH TWO THOUSAND TWO
HUNDRED AND THIRTY FIVE PATIENTS
IN OUR HUB AND SPOKE SYSTEM FOR
THE RURAL NORTH PART OF
CALIFORNIA.
HERE'S A SIDE BY SIDE PATIENT
GROWTH CHART TO SHOW YOU WHAT
THOSE PATIENTS ARE MADE UP.
ON THE LEFT IS OUR HOW PATIENTS
THREE HUNDRED ON THE RIGHT ARE
SPOKE PATIENTS ONE THOUSAND NINE
HUNDRED AND THIRTY FIVE PATIENTS.
YOU CAN SEE THAT WE HAVE ABOUT
SEVEN TIMES MORE SPOKE PATIENTS
THAN WE DO AT OUR HUBS BEING
SERVED THROUGH THIS FEDERAL
GRANT.
AND THAT IS BECAUSE ONE OF OUR
GOALS IS TO GET TREATMENT INTO
THOSE COMMUNITIES THAT OUR WORLD
THOSE COMMUNITIES THAT HAD NO
TREATMENT PRIOR OR HAD VERY
LIMITED TREATMENT.
AND SO ARE ANTI PEAS ARE HUBS
PLAY.
THESE NEXT FEW SLIDESHOW ARE
SPOKE GROWTH TREND BY REGION AND
HAVE SOME HIGHLIGHTS FOR YOU I
PASSED OUT THOSE HANDOUTS FOR
YOU TO REFER --
FOR THE SECOND TIME I WILL BE
GOING THROUGH THE FLIGHTS.
YOU'LL NOTICE THAT WE HAVE A
STEADY GROWTH IN EACH REGION.
HERE IS A LIST OF THE HUB AND
SPOKE SERVICES THAT WE OFFER TO
ALL OF OUR SPOKE AND COALITION
PARTNERS AS APPLICABLE.
I WOULD LIKE TO MENTION THAT OUR
OUR DRAWDOWNS ARE FOCUSED ON
MATT PERSONNEL SALARIES MATT
MEDICATION THE LOCKS OWN
TRAININGS AND EDUCATION AN
OPIOID COALITIONS.
WE HAVE THIRTY SPOKE PARTNERS
THAT MAKE UP THE SIXTY ONE
ACTIVE SPOKE LOCATIONS IN THESE
PARTNERS ARE LISTED HERE ON THE
SLIDE.
WE ALSO HAVE TWENTY COALITION
PARTNERS THROUGHOUT THE REGION
AND THEY ARE LISTED ON THE SLIDE
AS WELL WE PARTICIPATE AND FUND
THEM FINANCIALLY THROUGH THE
FEDERAL GRANT.
THESE ARE THIS IS A BREAKDOWN OF
THE NALOXONE KIDS THAT WE
DISTRIBUTED THROUGHOUT OUR HUB
AND SPOKE COMMUNITIES. TO DATE
WE'VE DISTRIBUTED SIX THOUSAND
FOUR HUNDRED AND TWENTY SIX KIDS
TO THE AREAS OF NEED.
THESE KIDS GO TO LAW ENFORCEMENT.
PUBLIC HEALTH BEHAVIORAL HEALTH
COALITIONS UNIVERSITIES AND
COMMUNITY EVENTS.
NOW LET'S TAKE A CLOSER LOOK AT
HUMBOLDT.
ON THE RIGHT WE HAVE OUR HUB AND
SPOKE ABOUT FOR HUMBOLDT REGION.
WE HAVE BUT STARS NEXT TO OUR
SPOKE LOCATIONS AND OUR PHARMACY
LOCATIONS THAT ARE HELPING US
PROVIDE MEDICATION TO THE
POPULATION AND TREATMENT.
WE HAVE ELEVEN SPOKES TO DATE TO
PHARMACIES IN THREE LOCATIONS
THAT ARE WORKING WITH US AND
THREE OPIOID COALITIONS.
I'M A FEW HIGHLIGHTS THAT I WANT
TO MENTION FAR HUMBLE TERRITORY
AS THAT WE'VE BEEN WORKING WITH
WATER FRONT RECOVERY SERVICES
WHICH IS ONE OF OUR SPOKE. TO
PROVIDE A RESIDENTIAL MEDICATION
ASSISTED TREATMENT PILOT PROGRAM.
THIS TREATMENT PROGRAM OFFERS
MEDICATION TO PATIENTS THAT ARE
THERE FOR RESIDENTIAL STAY
PATIENCE THAT ARE THERE FOR
THIRTY DAY DETOX OR NINETY DAY
LONGER TERM RESIDENTIAL STAY.
WE'RE ALSO PROVIDING A
MEDICATION ASSISTED TREATMENT
AFTER CARE PROGRAM WORKING WITH
RECOVERY A LOT OF FRONT RECOVERY
SERVICES.
AND WHAT WE'RE DOING AND NOT
PROGRAM IS PROVIDING A
TRANSITION FOR OUR PATIENTS THAT
ARE GOING FROM MATT RESIDENTIAL
CARE TO MATT PRIMARY CARE.
AT TIMES THERE IS A WAIT LIST
AND SO SINCE ARE ABLE TO NOT
HAVE A BREAK IN TREATMENTS WHILE
THEY'RE ABLE TO TRANSITION TO
MATT PRIMARY CARE.
WITH EDIE BRIDGE COLLABORATION
THIS IS ANOTHER GREAT HIGHLIGHT
THAT WE HAVE WE COLLABORATED
WITH SAINT JOE'S HOSPITAL AND
THE CALIFORNIA ET BRIDGE TEAM.
TO BRING BE FOR MORPHINE INTO
THEIR EMERGENCY DEPARTMENT
PATIENTS ARE ABLE TO GET INDUCED
TO THE EMERGENCY DEPARTMENT AND
THEN TRANSFER TO SPOKE PROVIDERS
IN THE COMMUNITY --
TO CONTINUE LONG TERM CARE.
AND IN HUMBOLDT SPECIFICALLY WE
DISTRIBUTED FIVE HUNDRED AND
SIXTEEN KIDS TO LAW ENFORCEMENT
PUBLIC HEALTH IN COALITIONS AND
COMMUNITY EVENTS.
AND AS OF FRIDAY OUR NUMBER OF
REPORTS IS TWO HUNDRED AND TO
REPORT IN THE WALK SOME
REVERSALS FROM THE COMMUNITIES
THAT ARE TRACKING.
FIRM THERE MAY BE MORE.
THESE ARE THE THREE COALITIONS
THAT WE ARE ACTIVELY
PARTICIPATING AND FUNDING
THROUGH THE HUMBOLDT GRANTS ARE
X. SAFE HUMBOLDT --
BUT COMMUNITY COALITION ARE X.
SAFE DEL NORTE HUMBLE IS ONE
AREA WHERE WE ARE WORKING WITH
THE TRIBAL MAP PROGRAM WE HAVE
FIVE TOTAL IN OUR REGION.
WHAT ARE CHALLENGES AND HUMBLE?
THERE THERE ARE FEW THAT I'VE
LISTED HERE --
WHEN WE STARTED WORKING ON THE
GROUNDS OPEN DOOR COMMUNITY
HEALTH CENTER WAS THE MAIN
SOURCE FOR MEDICATION ASSISTED
TREATMENT THROUGHOUT HUMBLE?
THEY HAD APPROXIMATELY SEVEN
HUNDRED PATIENTS BEING
PRESCRIBED SUBOXONE AND
APPROXIMATELY FIVE HUNDRED OF
THOSE PATIENTS WERE --
YOU DE RELATED.
THERE BEN C. L. HERMAN'S
BACHELOR HAD A VISION TO TREAT
ALL MEDICAL CONDITIONS INCLUDING
SUBSTANCE ABUSE BY INTEGRATING
IT INTO PRIMARY CARE --
HOWEVER BEYOND OPEN DOOR HUMBLE
EXPERIENCES LIMITED PRESCRIBER
AND MATT PATIENT CAPACITY --
IN HUMBLE COUNTY 7% OF
PRESCRIBERS HAVE A DATA TWO
THOUSAND WEAVER HOWEVER MANY OF
THOSE PRESCRIBERS ARE NOT
UTILIZING THEIR WAIVER AND THOSE
THAT ARE ARE NOT UTILIZING IT TO
THEIR CAPACITY. FOR EVEN WHEN
THE APPROXIMATELY FIVE HUNDRED
PATIENTS BEING TREATED THEIR
OPEN DOOR.
IN TWENTY SIXTEEN THE URBAN
INSTITUTE ESTIMATED THAT AN
ADDITIONAL EIGHT HUNDRED PEOPLE
WITH -- YOU
DE IN THE COUNTY WERE NOT ABLE
TO ACCESS LOCAL TREATMENT.
WAIT LISTS ARE A BERRIER IN
HUMBOLDT --
AS WELL AS THROUGHOUT OUR REGION
AS WELL --
PATIENTS THAT WOULD LIKE FINALLY
ABLE TO RECEIVE TREATMENT MIGHT
HAVE TO WAIT WEEKS OR MONTHS TO
GET INTO TREATMENT.
MATT STAFF RECRUITING IT'S VERY
LIMITED IN ALL OF OUR RURAL
AREAS AN EXPRESSION IN HUMBOLDT
WHERE WE HAVE THE FUNDING TO
MAYBE PROVIDE THAT RECRUITMENT
AND PAY THOSE SALARIES WERE NOT
ABLE TO FIND THOSE PROVIDERS.
OR THOSE NURSES OR THOSE
CLINICIANS.
TRANSPORTATION AND HUMBLE
ESPECIALLY IN THE WINTER TIME
CAN BE VERY LIMITING TO BE ABLE
TO GET TO AND FROM TREATMENT WE
ARE WORKING WITH THE SOME OF OUR
SPOKES FOR TELEMEDICINE.
I BY EVEN IN OUR RURAL AREAS
THAT CAN BE A BARRIER.
AND THEN THE LACK OF PHYSICAL
SPACE WITH BUSY A PRIVATE
PRACTICES A BUSY HOSPITALS ONCE
WE GET SOMEBODY ON BOARD TO
pTREATMENT MODEL WE'RE TRYING TO
BE CREATIVE WITH SPACE.
AND IT'S VERY HARD TO FIND OUT
WHERE TO HOUSE THOSE PROGRAMS
ONE DAY THE PROGRAM CAN BE A MAP
PROGRAM IN THE NEXT DAY IT MIGHT
BE A GROUP.
SO WHAT WE'RE BEING CREATIVE BUT
THAT.
AND THAT BRINGS ME TO MY LAST
FLIGHT [inaudible]
QUESTION.
AND AT THE END OF THE PANEL THAT --
I'M SURE PEOPLE HAVE QUESTIONS
IS YES.
OKAY SO MISTER HARRIS OKAY.
I THANK YOU AND GOOD MORNING I
WANT TO TALK A LITTLE BIT ABOUT
THE EXPERIENCE WITH RIVERSIDE
COUNTY WITH THE OUR TEAM SIRIUS
WAIVER.
OUR FIRST OFF IT'S OF THE WAIVER
HAS BEEN THE GREATEST
OPPORTUNITY FOR COUNTIES IN MANY
YEARS -- TO
DESIGN AND IMPLEMENT A SUBSTANCE
USE DISORDER SYSTEM OF CARE --
THAT HAS THE FINANCIAL AND
CLINICAL RESOURCES.
I TO MORE FULLY ADDRESS THE
COMPLEX WITH SUBSTANCE USE
DISORDERS.
ARE THE WAIVER HAS ALLOWED
RIVERSIDE COUNTY TO OFFER A MUCH
WIDER CONTINUE WHAT OF SERVICES.
THAT WAS NOT POSSIBLE UNDER THE
PREVIOUS STATE PLAN MODEL.
I RIVERSIDE COUNTY WAS ONE OF
THE FIRST TO COUNTIES TO ROLL
OUT THE WAIVER --
WE ROLLED IT OUT ON FEBRUARY
FIRST OF TWENTY SEVENTEEN AND
SOME OF THE CHANGES THAT WERE
MADE POSSIBLE THROUGH THE WAIVER
ROLL OUT INCLUDED THE FOLLOWING
ITEMS --
FIRST THE DMC WAIVER ALLOWED
RIVERSIDE COUNTY TO ALMOST
DOUBLE THE NUMBER OF INDIVIDUALS
WE PROVIDED RESIDENTIAL
TREATMENT --
TO IN FEBRUARY OF TWENTY
SEVENTEEN THAT MONTH WE PROVIDED
RESIDENTIAL TREATMENT TO THREE
HUNDRED AND SIXTY SEVEN
INDIVIDUALS.
AND IN AUGUST OF TWENTY EIGHTEEN
THAT NUMBER HAD GROWN TO SIX
HUNDRED AND SEVENTY TWO PHIL
OVER AN 80% INCREASE IN
RESIDENTIAL --
CAPACITY THERE.
I SECONDLY ARE THE WAIVER
ALLOWED US TO REDUCE OUR WAIT
TIMES FOR A WITHDRAWAL
MANAGEMENT OR DETOX SERVICES AND
RESIDENTIAL.
UP BEFORE THE WAIVER TO WAIT
TIMES FOR ANYWHERE FROM TWO
MONTHS TO SIX MONTHS TO GET INTO
TREATMENT.
AND NOW WE'RE ABLE TO USUALLY
PLACE PEOPLE WITH AND SOMETIMES
STATE DAY THEY CALL OR WITHIN
SEVEN DAYS --
THIRTEEN WE WERE ABLE TO
INCREASE THE AVAILABILITY OF
MEDICATION ASSISTED TREATMENT --
FOR INDIVIDUALS WITH ALCOHOL USE
DISORDERS AND OPIOID USE
DISORDERS A LIKE YOU'VE HEARD OF
FROM THE TESTIMONY FROM THE
OTHERS.
ON THE WAIVER ALSO WHEN WE WERE
DESIGNING IT ALLOWED US TO
ENGAGE OUR TREATMENT PROVIDERS.
IN THE PLANNING DESIGN AND A
ROLL OUT FOR A COMPLETE
CONTINUUM OF CARE.
ALSO WITH THE WAIVER WE WERE
FINALLY ALLOWED TO PROVIDE
INTENSIVE CASE MANAGEMENT FAMILY
COUNSELING INDIVIDUAL THERAPY.
ALL OF WHICH WERE NOT COVERED
UNDER THE PREVIOUS STATE PLAN
AND AMENDMENT.
AND GAVE EQUAL AND REMEMBER TO
EVERYONE.
I FINALLY THE WAIVER ULTIMATELY
PROVIDED AN INCREASE IN THE
AMOUNT OF FUNDING. FOR TREATMENT
SERVICES IN RIVERSIDE COUNTY
HELLO PRIOR TO THE WAIVER WE ARE
ANNUAL OPERATING BUDGET WAS
SOMEWHERE AROUND TWENTY MILLION
DOLLARS AND NOW WE'RE OVER
EIGHTY MILLION DOLLARS A YEAR
THAT WE HAVE TO COVER SERVICES.
ARE THERE HAVE BEEN CHALLENGES
IN THE ROLL OUT PROCESS. ONE OF
THE MOST SIGNIFICANT ONES WAS
THE INABILITY TO KEEP UP WITH
THE INCREASED LEVELS OF STAFFING
NEEDED TO OUR PROVIDE SERVICES
WITH ALL THE NEW SERVICES
REQUIRED.
NEW STAFFING AND AN RIVERSIDE
HAD A HIRING FREEZE AND SO I
MADE A LITTLE BIT CHALLENGING
BUT WE GOT THERE --
ALSO THERE IS EXTENSIVE TRAINING
THAT WAS REQUIRED TO MEET THE
OPERATING UNDER THE A SAM I
REQUIREMENTS AND IN THE USE OF
EVIDENCE BASED PRACTICES.
A REALLY BIG CHALLENGE WAS THE
SET UP OF THE TWENTY FOUR HOUR.
HELPLINE WE HAD NO.
INKLING OF HOW BUSY IT WAS GONNA
BE -- AN
AVERAGE OF TWO HUNDRED CALLS A
MONTH IN --
JANUARY OF TWENTY SEVENTEEN TO
OVER FOUR THOUSAND CALLS IN
FEBRUARY SO IT KINDA HIT IS.
REALLY HARD.
I'M.
PROBABLY ONE OF THE MOST
CHALLENGING ISSUES --
TO DATE IS THAT IN THE CURRENT
REGULATIONS CLIENTS ARE
PERMITTED ONLY TO RESIDENTIAL I
TREATMENT EPISODES OF UP TO
NINETY DAYS NO ONE CALENDAR YEAR
PERIOD.
I'M IF AN INDIVIDUAL COMES IN
AND USES FIVE DAYS AND THEN
LEAVES AND THEN COMES BACK IN
AND USES FIVE DAYS AND THEN
LEAVE STATE.
USED UP THERE AND TARA QUOTA FOR
THE YEAR.
UNDER THE THINGS THAT WE WOULD
LIKE TO SEE CHANGE IS THAT --
DEREGULATION CHANGE SO THAT AN
INDIVIDUAL WOULD GET A HUNDRED
AND EIGHTY DAYS TOTAL --
FOR THE CALENDAR YEAR.
REGARDLESS OF THE NUMBER OF
EPISODES THAT IT TAKES --
IN SUMMARY I WANT TO SAY THAT
THE FAMILY TESTIMONY OF THE LIFE
CHANGING SERVICES IS REALLY ON
ENDING.
I NEVER GET TIRED OF HEARING A
CLIENT'S LOVED ONES COME AND
TELL US THANK YOU FOR GIVING ME
MY SON BACK THANK YOU FOR GIVING
ME MY DAUGHTER BACK --
THE WAIVER IS CAUSING POSITIVE
RIPPLE EFFECTS ACROSS THE SYSTEM
OF CARE.
AND INTEGRATING PHYSICAL.
MENTAL AND SUBSTANCE USE HEALTH
CARE AT A RATE THAT IS
BREATHTAKING THANK YOU.
VERY MUCH MISTER SANADA.
THANK YOU YES SIR I ALSO KNOW
WHAT PRESIDENT AND CEO OF
TARZANA TREATMENT CENTERS A
LARGE PROVIDER OF SERVICES
REPRESENTING.
ALL OF THE SERVICES UNDER THE
ORGANIZED DELIVERY SYSTEM.
BUT I'M ALSO THE PRESIDENT OF
THE CALIFORNIA ASSOCIATION OF
ALCOHOL AND DRUG PROGRAM
EXECUTIVES AND WITH THAT
REPRESENT A LARGE NUMBER OF
PROVIDERS ALL WORKING IN THE
FIELD.
SO I APOLOGIZE THAT MIGHT
WRITTEN COMMENTS HAD MADE IT TO
YOU -- BY
THIS MORNING BUT THEY WILL GET
TO YOU SHORTLY --
I'M GONNA A JUST WALK THROUGH
VERY QUICKLY --
SOME BULLET POINTS THAT ARE IN
THOSE COMMENTS --
THEN WE'LL GO FROM THERE SO AND
THESE ARE NOT IN ANY PARTICULAR
PRIORITY ORDER WAS.
SHOW UP PAYMENT REFORM --
WE ARE HOPING TO BEGIN A SERIOUS
CONVERSATION AROUND PAYMENT
REFORM -- IF
IT DOESN'T START NOW THE OF
PLANNING FOR A WAIVER RENEWAL.
THE CURRENT COST BASED THE
SYSTEM THAT WE HAVE.
I DON'T THINK TAKES US INTO THE
FUTURE WELL WE HAVE TO LOOK AT
SOME OTHER MODELS.
THE THE THE SERVICES AND
WORKFORCE CAPACITY AREA THAN BY
THE WAY I WAS ASKED TO COMMENT
ON THINGS THAT.
WE THINK MIGHT BE PROBLEMATIC OR
NEED FIXING IN THE NEW WAY FOR
IN.
OTHER RELATED ITEMS LIKE THAT SO
THAT'S WHAT I'M DOING --
THE ORGANIZED DELIVERY SYSTEM
AND THE HUB AND SPOKE THE OPIATE
DOLLARS THAT HAVE COME IN THE
CALIFORNIA.
BAR WITH OUT A DOUBT THE SINGLE
GREATEST EXPANSION OF SUBSTANCE
USE SERVICES I THANK THE STATE
HAS EVER SEEN IS FANTASTIC.
THE BREADTH OF THE CONTINUING IS
FANTASTIC.
HAVING SAID THAT WE HAVEN'T
SOLVED THE ACCESS PROBLEM YET.
SOME OF THE EARLIER DISCUSSIONS
WERE POINTING OUT 97% COVERAGE
OF THE MEDI CAL POPULATION DOES
NOT MEAN 967% ACCESS OF THOSE
WHO NEED ASH JUDY GET S. U. D.
SERVICES --
RESIDENTIAL SERVICES --
WHILE THERE'S BEEN TREMENDOUS
GROWTH WE NEED A THIRD ROW THAT --
CAPACITY --
AND THAT'S NOT AN EASY TASK TO
DO SPECIALLY UNDER THE COST
BASED REIMBURSEMENT SYSTEM
THERE'S NO WAY.
TO HAVE A SURPLUS TO REINVEST IN
THAT KIND OF EXPANSION --
SO WE WE NEED TO LOOK AT THAT A
FURTHER --
UP ONE OF THE GREATEST --
ITEMS THAT HAMSTRING OUR ABILITY
TO INCREASE ACCESS IS WORK FORCE
YOU FOR TO TOUCH LONG --
WE WE ARE IN A SORT OF A CRISIS
STATE WITH THE WORK FORCE RESCUE
DO SERVICES.
THAT USED TO BE THAT THE ONLY
FOLKS THAT WANTED AN ISSUE THE
OF SOMEONE WORKING IN THE ISSUE
THE FIELD THAT WAS CERTIFIED.
WAS THE ISSUE THE PROVIDER --
TODAY EVERYBODY WANTS THEM
HEALTH PLANS WANT THEM HOSPITALS
WANT THEM --
SCHOOLS WANT THEM --
AND OF COURSE A MENTAL HEALTH
WANTS THEM AND OF COURSE WE NEED
THEM IN THE SUBSTANCE USE REAL --
THIS SO IT IT IS IN A CRISIS
STATE OR WE BELIEVE WE NEED A
SINGLE STATE AGENCY TO HANDLE
CERTIFICATION.
I AM PERHAPS LICENSURE OF NG
THAT ON TO THE PRIVATE SECTOR
HAS NOT BEEN A VERY POSITIVE
THING OVERALL WE HAD TEN
INITIALLY CERTIFYING
ORGANIZATIONS.
UP UNTIL YESTERDAY WE WERE DOWN
TO TWO OF THE DEPARTMENT
FORTUNATELY APPROVED THE
REINSTATEMENT OF A THIRD SO
WE'RE BACK UP --
TO THREE BUT IT'S IT'S JUST IT'S
NOT ADEQUATE IT'S GOT ALL KINDS
OF PROBLEMS WE THINK CAN BE
FIXED THROUGH A SINGLE STATE
AGENCY OVERSIGHT.
AND HOPE TO WORK WITH SOME A FEW
OF GOING FORWARD TO TRY TO
ADDRESS THE RECOVERY SUPPORT
SERVICES WHICH ARE A BENEFIT
UNDER THE NEW ODS SYSTEM.
A VERY IMPORTANT BENEFIT --
WE THINK NEEDS FURTHER --
DEFINITION AND SOME FURHER
SUPPORT TO USE A WORK FORCE THAT
HAS LIVED EXPERIENCE.
NOT CERTIFIED OR LICENSED KIND
OF EXPERIENCE.
THERE IS A PROCESS FOR THAT TO
HAPPEN BUT IT REQUIRES COUNTIES
IN THEIR PLANS TO IDENTIFY UP.
A TRAINING PROGRAM --
FOR WORK FORCE --
AND MANY COUNTIES DON'T HAVE THE
BAND WITH THE DO THAT SO THEY
FALL BACK ON WE CAN DELIVER
RECOVERY SUPPORT SERVICES SO
LONG SINCE OF REGISTERED OR
CERTIFIED COUNSELOR OR A
LICENSED PRACTITIONER THE
HEALING ARTS.
WHILE THAT PULLS WORK FORCE AWAY
FROM THE COURT TREATMENT TO DO
RECOVERY SUPPORT SERVICES
FURTHER AGGRAVATING THAT PROBLEM
AND WE THINK THAT.
LIVED EXPERIENCE NEEDS TO BE
RECOGNIZED AS PART OF RECOVERY
SUPPORT AND HOPE TO HAVE MORE
DIALOGUE ABOUT THAT.
THERE ARE SOME SERIOUS.
ADMINISTRATIVE.
BURDENS AS PART OF THE ORGANIZED
DELIVERY SYSTEM.
WE CAN'T GET AWAY FROM THEM ALL
SOME OF THEM ARE EXTREMELY
IMPORTANT BUT SOME OF THEM WE
CAN BE SMARTER ABOUT --
DOCUMENTATION REQUIREMENTS
AROUND MEDICAL NECESSITY AND
ASSESSMENT THE REST OF THAT.
WITH MUCH MORE STANDARDIZATION
AT THE STATE LEVEL.
SO THAT EACH AND EVERY COUNTY
DOESN'T DO SOMETHING DIFFERENT
OR PILE ON TOP OF WE CAN GET
SMARTER ABOUT THAT MINIMIZE THAT
BURDEN ON THE PROVIDER COMMUNITY.
SO THAT WORK FORCE CAN BE USE
FOR WHAT IT'S THERE --
FOR SOARING THE POPULATION.
SO WE HOPE TO HAVE MORE
DISCUSSION ABOUT WITH COUNTIES
ON THE DEPARTMENT.
THERE ARE THINGS LIKE YOU MUST
CREDENTIAL STAFF SO THE PROVIDER
STAFF HAVE TO BE CREDENTIALED BY
THE QUOTE ON QUOTE HEALTH PLAN
THAT'S THE COUNTY.
WILL OF ONE COUNTY CREDENTIALS
MY WORK FORCE.
THAT SHOULD BE ACCEPTABLE FOR
ANY OTHER COUNTY I MIGHT DO
BUSINESS WITH.
EACH COUNTY SHOULDN'T HAVE TO GO
THROUGH THAT PROCESS ALL OVER
AGAIN FOR THE SAME SET OF STAFF
IT'S JUST.
IT'S AN ENORMOUS BURDEN AND SO
THE BURDEN ON THE COUNTY ON THE
PROVIDERS AND THE WORK FORCE --
THAT WE THINK WE CAN DO THINGS
SMARTER ABOUT --
A IT JUST ONE EXAMPLE TRAINING
REQUIREMENTS THERE IS MANDATORY
TRAINING REQUIREMENTS IF MY
STAFF GET THAT MANDATORY
TRAINING AND COUNTY HEY. FOR A
SAM ASSESSMENTS OR WHATEVER IT
HAPPENS TO BE.
THAT SHOULD BE.
ABLE TO BE CARRIED OVER TO THE
NEXT COUNTY.
GROUP SIZE THE GROUP SIZE IN THE
TERMS AND CONDITIONS --
IN MY READ IS SPELLED OUT AT TWO
TO FOURTEEN FOR CLINICAL GROUP --
BUT IN PRACTICE IT BECAUSE I
THINK IT'S AN STATE RAGS IT'S
TWO TO TWELVE BUT WE'D LIKE TO
SEE THAT TO TO FOURTEEN THAT'S
IN TERMS AND CONDITIONS AND
BRACED.
IMMEDIATELY --
I'VE BEEN TOLD THAT WAS AMENDED
BUT I CAN FIND NO AMENDED
VERSION --
THAT IT WAS AMENDED TO TO TO
TWELVE IN THE TERMS AND
CONDITIONS WE IN FACT WOULD
RECOMMEND IN THE RENEWAL THAT
THAT GET MOVED.
TO TO TO SIXTEEN HERE AGAIN FROM
AN ACCESS STANDPOINT THE MORE
LIMITED WE ARE ON THE SIZE OF
THAT GROUP.
THE MORE WE LIMIT ACCESS AND I
DON'T THINK IN MOST OF THE FOLKS
I SPEAK WITH DON'T THINK WE LOSE
ANYTHING AND THE QUALITY OF
THOSE GROUPS.
BECAUSE IT GOES UP BY A COUPLE
FOLKS IN FACT MANY OF THEM TO BE
YOU YOU CAN'T GO OVER WHEN YOU
BOOK IT. TO TWELVE AND HALF THE
TIME YOU'RE RUNNING GROUPS WITH
TWO TO TEN BECAUSE OF NO SHOWS
AND STUFF LIKE THAT.
WE THINK THERE'S ROOM THERE --
THE OF THE JUST KEEP GOING HERE
OF WITHDRAWAL MANAGEMENT.
THERE WAS A LOT OF EXPANSION
WITHDRAWAL MANAGEMENT ONE OF THE
PLACES THERE'S BEEN VERY LITTLE.
THE EXPANSION BUT A TREMENDOUS
MADE.
ISN'T THREE POINT SEVEN AND FOUR
POINT ALL.
HIGHER ACUITY WITHDRAWAL
MANAGEMENT POPULATION --
IT'S HOSPITAL BASED --
WITHDRAWAL MANAGEMENT --
THERE IS NEXT TO NO CAPACITY.
ALL THE COUNTIES RECOGNIZE THAT
SO WE THINK WE NEED TO FOCUS
MORE ON THE BUT WE THINK THAT WE
NEED TO LEVERAGE THE E. P. STT
BENEFIT MUCH BETTER THAN WE DO
TODAY IS PART OF ALL.
OF INTEGRATING THAT WITH THE
ORGANIZED DELIVERY SYSTEM IT'S
PARTICULARLY CRUCIAL --
FOR YOU SERVICES.
THERE ARE SERVICES IN THE TERMS
AND CONDITIONS AS PAT OF THE
CONTINUING THAT HAVE BEEN
SPELLED OUT.
THAT ARE NOT IMPLEMENTED ACROSS
THE BOARD COUNTY BY COUNTY.
AN EXAMPLE OF THAT IN MY NOTES
THAT YOU'LL GET IS TELEHEALTH --
IT IS NOT.
BEEN BRACED BY EVERY COUNTY --
TELEHEALTH WAS PUT IN THERE
AGAIN.
TO BOB HELP WITH ACCESS. TO CARE
AND IF IT'S NOT.
UTILIZE WE CAN'T MAKE THAT
HEADLINE. ONE OF THE GREATEST
BURDENS FOR PROVIDERS EHR SYSTEM.
IF YOU DO BUSINESS WITH --
ONE COUNTY IT'S ONE THING IF YOU
DO BUSINESS WITH MULTIPLE
COUNTIES AND UNDER THE ORGANIZED
DELIVERY SYSTEM AND BECAUSE OF
COUNTY OF RESIDENCE FOR SERVICE.
THERE'S AN ABSOLUTE REQUIREMENT
TO DO BUSINESS WITH MORE THAN
ONE COUNTY.
EACH COUNTY HAS AN EXPECTATION
THAT YOU EMBRACE THEIR EHR
SYSTEM.
REGARDLESS OF YOUR OWN EHR
SYSTEM.
AND MUCH OF THE TIME TAKE NO
STEPS TO DEVELOPING THE PROPER
INTERFACES BETWEEN ONE H. R.
SYSTEM ANDTHE OTHER SO DATA CAN
BE PROPERLY EXCHANGED.
AND THE COST AND THE DOUBLE
TRIPLE DATA ENTRY ASSOCIATED
WITH THAT AGAIN.
SOMETHING WE CAN DO SOMETHING
ABOUT WE JUST NEED TO FOCUS ON
DOING IT.
IT REALLY DETRACTS FROM THE
PRIMARY PURPOSES --
THAT POINT ON A RESIDENTIAL CARE
IS ALSO IN MY NOTES WE NEED TO
GET AWAY FROM THIS.
OF CURRENT STRUCTURE ON
RESIDENTIAL AND PROVIDE THAT
BENEFIT.
THE FULL OF SPAN OF DAYS TIED
FOR MEDICAL NECESSITY AND NOT
THIS TO BUY THE APPLE APPROACH
THAT WE HAVE TODAY AND THERE --
IT'S CONSTRAINING SO I MENTIONED
THE COUNTY OF RESIDENCE AND
COUNTY OF SERVICE ISSUE.
THE DEPARTMENT HAS BEEN OF A
HUGE ADVOCATE HELPING.
RESOLVE A LOT OF ISSUES WITH
COUNTIES ARE STILL TREMENDOUS
PROBLEMS WITH IT.
EVEN IF YOU GET MULTIPLE COUNTY
CONTRACTS YOU'VE GOT SOMEBODY IN
A RESIDENTIAL BED FROM.
OF COUNTY A IN YOUR SERVANT
COUNTY BE.
IF THEY NEED GENERAL HEALTH CARE.
YOU CAN'T PROVIDE IN THAT COUNTY
YOU'VE GOT TO GO BACK TO THE
COUNTY OF ORIGIN.
IF THEY NEED A PRESCRIPTION YOU
GOT TO GO BACK TO THE COUNTY OF
ORIGIN -- WE
HAVE TO REVISIT THIS A LITTLE
BIT MORE I THINK STILL.
AND LASTLY THE HUB AND SPOKE --
BUT MY COMMENT ON THAT IS VERY
STRAIGHTFORWARD YOU'VE HAD A LOT
OF DISCUSSION ABOUT IT.
WE ALL HOPE AND PRAY THAT THE
FEDERAL GOVERNMENT CONTINUES TO
SUPPORT FOR THE HUB AND SPOKE
PROJECTS ARE OPIATE EXPANSION IN
THE STATE.
BUT IF IN FACT THEY DON'T.
WELL WE ALL PRAY THAT THE
LEGISLATURE IN THE
ADMINISTRATION.
STEP UP AND THE FIGURE OUT A FIX
FOR THAT THANK YOU.
THANK YOU THANK YOU OFFER THANK
YOU SO VERY MUCH.
QUESTIONS FROM THE COMMITTEE
MEMBERS.
YES SOME MEMBER RAMOS.
THANK YOU MISTER CHAIR AND I DO
HAVE TO RUN TO ANOTHER --
HEARING BUT I DO WANT TO BRING
UP -- YOU
MENTIONED YOU WORKING WITH A
TRAVEL COMMUNITIES --
OUT IN YOUR AREA HUMBOLDT COUNTY
AND I SING SOME IN THERE AS FAR
AS LAKE COUNTY.
AND YOU MENTIONED --
FIVE DIFFERENT TRIBAL GROUPS I
THINK THAT YOU'RE WORKING WITH
YOU SHARE A LITTLE BIT ABOUT
WHAT'S BEEN SUCCESSFUL AND AND
SOME OF THE THE THE ROAD BLOCKS
AND MAYBE YOU HAVE SEEN IN IN
TRYING TO BRING AWARENESS TO
THAT COMMUNITY.
YEAH I'M IN THE BEGINNING WE
REACHED OUT TO THE TRIBAL
COMMUNITIES IN ALL SIX OF OUR
REGIONS TO SHARE THE GRANT AND
SHOW WHAT RESOURCES WE CAN BRING
WHAT I NOTICED WAS HELPFUL WAS
BRINGING IN A LOCAL FROM THEIR
COMMUNITY THAT NEW THEM THAT WAS
ABLE TO EXPLAIN THE GRANT --
AND WAS ABLE TO PROVIDE SOME
MORE SUPPORT BECAUSE BEING AN
OUTSIDER --
IT'S VERY HARD TO DO THAT SO WE
DID BRING A FEW EXPERTS IN FROM
THE COMMUNITIES THAT WE WERE
ABLE TO CONNECT WITH THROUGH
OPIOID COALITIONS THROUGH
PROVIDER MEETINGS THAT WERE
WILLING AND VERY INTERESTED IN
HELPING US.
ONCE WE WERE ABLE TO DO THAT --
THE NUMBER OF PATIENTS ARE NOW
GROWING IN EACH ONE OF THOSE
MATT PROGRAMS AND MORE AND MORE
PATIENTS ARE COMING IN FROM THE
NATIVE COMMUNITY --
BARRIERS ARE STILL STIGMA
BARRIERS ARE STILL --
ACCESS BUT WE ARE TRYING TO
ADDRESS THAT WITH TRAINING AND
COMMUNICATION REUSING TRIBAL
LIAISONS --
TO DELIVER THAT INFORMATION ONCE
WE TRAIN THEM AS WELL.
THANK YOU THANK YOU FOR THAN I
DO APOLOGIZE TO BOTH CHAIRS --
HAVING TO RUN OUT BUT AS WE GET
TO THE NEXT TOPIC AS FAR AS
PLANNING --
FURTHER OUT REACH IF WE COULD
TAKE SOME OF THAT INTO
CONSIDERATION AS WE START TO
MOVE FORWARD AND I RESPECTFULLY
ON THANK YOU BYE THANK YOU WHEN
WE KNOW PEOPLE TO GO IN THE
HOUSE OF THE US AND RUBIO.
IT WAS A GOOD MORNING WHILE
THERE'S A LOT TO UNPACK HERE.
IN PARTICULAR I BELIEVE IT WAS --
MISTER HARRIS YOU DISCUSS STUFF
ONE OF THE BIGGEST CHALLENGES
TWENTY FOUR HOUR HTLINE --
I BELIEVE YOU STATED THAT THERE
IS TWO HUNDRED CALLS THAT YOU
WENT TO FOUR THOUSAND CALLS HE
GIVE ME A SENSE OF HOW MANY OF
THOSE CALLS INTO SERVICE AND HOW
MANY DID YOU NOT AND IF PEOPLE
CALL FOR ASSISTANCE WERE YOU
ABLE TO REFORM IF YOU CAN HANDLE.
THEM YOURSELF --
YES WE WILL WE HAD NO IDEA WHAT
WE WERE GETTING INTO.
WHEN WE OPEN THE LINE UP AND
WENT LIFE?
AND SO MANY OF THOSE CALLS THAT
COME IN --
OR INFORMATIONAL CALLS THEY'RE
LOOKING --
FOR ALL KIND OF DIFFERENT THINGS
AND WILL WILL PROVIDE THE
INFORMATION WILL PROVIDE LOCAL
RESOURCES A EXCEPT TRUCK --
WE AT FIRST WERE LOSING.
ABOUT 8% OF THE CALLS BECAUSE
THEY WERE ON HOLD FOR SO LONG
AND AND I THINK WE'VE GOTTEN OUR
A LOS CALL PERCENTAGE DOWN TO
ABOUT TWO OR 3% RIGHT NOW.
WHICH IS IS INITIALLY STARTED
WITH --
THREE INDIVIDUALS THAT WERE
ANSWERING CALLS AND TO ETS THAT
WERE SCREENING THE CALLS AND
WE'VE SINCE HAD TO GO TO I
BELIEVE TEN I INDIVIDUALS THAT
ARE ANSWERING THE CALLS AND FOR
A SET OF OUR OFFICE ASSISTANCE
THAT SCREEN THE CALLS COMING IN --
FORCE IT'S STILL NOT PERFECT BUT
WE'RE WE'RE GETTING THERE WE
BOUGHT IT A A NEW --
CALL SYSTEM TO HELP WITH THAT
PROCESS --
IS SO.
AND AGAIN WE STILL GET A LOT OF
QUESTIONS LIKE --
WORSE THE CLOSEST PIZZA PARLOR
DECK KIND OF STUFF AND WE'LL TRY
TO DO THE BEST WE CAN BUT IT'S
HARD WHEN YOU GET STUFF LIKE
THAT COMING AND SO.
THANK YOU --
I MISTER SAID NOW I HOPE I'M
SAYING YOUR NAME CORRECTLY I
HAVE A QUESTION FOR YOU AS WELL
YOU DISCUSS THE CHALLENGE IN
TERMS OF CREDENTIALING.
GOING FROM ONE COUNTY TO ANOTHER
COUNTY CAN YOU GIVE ME A SENSE
OF WHAT THE CREDENTIALING
PROCESS IS HOW MANY MINDS WHAT
IT'S REQUIRED.
CAN YOU TALK FURTHER ON THAT
SHOW TO DO THIS WITH A STAFF
THAT THEY NEED --
TO VERIFY EDUCATION LICENSURE
BACKGROUND --
SO IT'S THAT KIND OF INFORMATION
YOU HAVE TO GO THROUGH REPEATED
TIMES THAT.
WE THINK IT'S PRETTY
STANDARDIZED IN THAT.
IF IT'S DONE IN ONE PLACE.
AND APPROVED IT SHOULD BE USABLE
ELSEWHERE.
SO TO THAT QUESTION IS THERE ARE
YOU DO NOT HAVE A CENTRALIZED
SYSTEM THAT TRACKS EVERYONE.
BY WAY OF EXAMPLE MY TEACHER SO
IF I GO FROM SCHOOL TO SCHOOL
DISTRICT RIGHT THREE BUT A LOOK
TO SEE IN THE SYSTEM THAT I'M.
AT A CREDENTIALED TEACHER DO YOU
GUYS HAVE A CENTRALIZED THERE IS
THERE ARE NO SUCH CENTRALIZED
SYSTEM IN THE PUBLIC SECTOR THAT
I AM WARE OF CERTAINLY NOT
UNDER THE O. D. S..
THERE IS SUCH A CENTRALIZED
SYSTEM IN THE PRIVATE SECTOR --
BUT EVEN IN THE PRIVATE SECTOR
NOT ALL HEALTH PLANS UTILIZED.
SOME DO SOME DON'T.
THANK YOU FOR THAT AND LAST
QUESTION FOR YOU I'M SORRY IT'S
A LOT OF INFORMATION.
ARE YOU WERE DISCUSSING I DON'T
UNDERSTAND THE NEXT SALON
DISTRIBUTION I THINK YOU TALKED
ABOUT IT.
THANK YOU AND ARE YOU ALSO SAID
IT WAS TWO HUNDRED AND TWO
REPORTED REVERSALS CAN YOU
EXPLAIN. TO THAT WHAT IT IS AND
WHAT IS THE RIVER SO PROCESS
ANALOG SON IS AT LIFESAVING
MEDICATION AT PROVIDES A
REVERSAL FROM AN OPIATE OVERDOSE.
AND SO FOR HUMBOLDT COUNTY
SPECIFICALLY WE PROVIDED IT TO
LAW ENFORCEMENT COALITION
MEMBERS PROVIDERS FOR COMMUNITY
EVENTS AND FOR COMMUNITY ACCESS --
LAW ENFORCEMENT CARRIES THAT ON
HAND WITH THEM OUT IN THE FIELD --
THE TWO HUNDRED INTO REVERSALS
WERE POOR HATCHER WHICH IS A
COMMUNITY I'M RESOURCE CENTER
AND THOSE REVERSALS WERE
REPORTED FROM OVERDOSES AND
ACTION WORD THAN OUR CAN WITH
UTILIZED.
SO LET ME ASK YOU ABOUT THAT IN
PARTICULAR YOU SAID LAW
ENFORCEMENT IS THERE ANY BODY
ELSE THAT'S QUALIFY. TO TO HAVE
IT OR DO YOU HAVE TO HAVE SOME
KIND OF CREDENTIAL TO HOLD THAT
KIND OF MEDICATION YOU DO NOT
HAVE TO HAVE A CREDENTIAL TO
HOLD THAT MEDICATION IF YOU ARE
ASKING FOR THE NALOXONE.
THROUGH THIS FEDERAL GRANT WE
WILL BE ABLE TO PROVIDE IT TO
YOU -- BUT
WE GO INTO THE COMMUNITY BE
PROVIDE THE TRAINING --
AND HAND OUT AS MANY AS WE CAN
PROVIDE.
OKAY THANK YOU THANK YOU.
TO PERSONAL THANK YOU TO ALL
THREE OF YOU FOR THIS
INFORMATION IT'S IT'S REAL I
THINK IT'S REALLY REALLY
VALUABLE AND I THINK IT
HIGHLIGHTS SOME SOME REAL
SERIOUS CHALLENGES WE HAVE --
AND DELIVERY OF THESE SERVICES
SO -- BACK
TO THE CHALLENGES HUMBLE HUMBLE
COUNTY I KNOW WELL --
AND YOU MENTIONED THAT YOU SEE
SAID IN YOUR SLIDE YOU HAD --
7% PRESCRIBERS HAVE DATED HAVE
HAVE THE WAIVER [inaudible]
YET.
AMONG THOSE 7%.
HOW MANY DID YOU SAY ARE
ACTUALLY USING THAT WAY?
FOR WE KNOW THAT NOT ALL 7% ARE
USING NOT --
THE MOST RECENT DATA THAT WE
HAVE IS AN UPDATED BUT ALL
PROVIDERS IN THE SYSTEM HOWEVER
WE'RE GETTING THAT DATA FROM THE
URBAN INSTITUTE I'M OUT OF
TWENTY SIXTEEN THE ALL PROVIDERS
HAVE NOT BEEN USING THEIR
WAIVERS TO MAXIMUM CAPACITY OR
SOME OF THEM ARE.
CLOSETED PROVIDERS WHERE THEY'RE
NOT UTILIZING THE WAIVERS AT ALL.
IS SO WHAT IS THE WHAT IS THE
IMPEDIMENT IS THAT WHAT WE HEARD
FROM OUR OUR RESEARCHER BEFORE.
THAT THEY'RE NOT CONFIDENT OR
OTHER DATA FEELING HAVE THE
MENTORSHIP OR THEY'RE THEY'RE
WORRIED ABOUT LIABILITY I MEAN
WHAT DO YOU SEEN AND AND I'VE
ASKED SOME OF THESE PROVIDERS
MYSELF AND I'M GETTING A A FEW
THEMES.
ARE SOME OF THE THEMES THAT I'VE
HEARD ARE YOU KNOW BEING I'M
HAVING THE FLOODGATES OPEN AND
NOT KNOWING WHAT TO DO WITH THIS
BEING A NEW SPECIALTY --
JUST THAT GENERAL FEAR OF
STARTING MEDICATION ASSISTED
TREATMENT SOME PROVIDERS HAVE
THE LICENSE BUT THAT'S NOT WHAT
THEIR PRIMARY SPECIALTY IS AND
SO JUMPING ON BOARD HAS BEEN
REALLY HARD HOW WE'VE BEEN
TACKLING THAT.
IS THROUGH OUR EXPERT
FACILITATORS AND HUMBLE WE'RE
WORKING WITH DOCTOR COUNTY
STOCKTON AND SHE OFFER SUPPORT
TO THE NEW PROVIDERS IN THOSE
ORGANIZATIONS AND WALK THEM
THROUGH IT SHE'S BEEN DOING
MEDICATION ASSISTED TREATMENT
FOR TEN YEARS AND IT'S VERY
COMFORTABLE.
THROUGH HER HELP AND SUPPORT
SPEAKING FROM ONE PROVIDER TO
ANOTHER PROVIDER WITHIN THEIR
LANGUAGE WE'VE BEEN GAVE GETTING
SOME MORE AND MORE ON BOARD --
BUT IT IS A PROCESS.
SO YOU ALSO MENTIONED YOU HAVE
BUT EIGHT HUNDRED PEOPLE THAT
COULD UTILIZE HERS BUT I CAN'T
BECAUSE THERE'S NO ACCESS SO.
SO -- IS
THAT ARE YOU SEEING THAT IN
OTHER COUNTIES AS WELL OR IS
THIS OR IS THIS A HIGHER.
PERCENTAGE IN HUMBLE COUNTY THAN
THROUGHOUT SOME OF THE OTHER
COUNTY SITUATION WHERE I AM
SEEING THAT THROUGHOUT ALL SIX
OF OUR GRANT REGIONS --
HUMBLE IS A HIGH PERCENTAGE
GIVEN HOW ROLE SO MANY OF THE
AREAS ARE AND SOME OF THOSE
BARRIERS WITH TRANSPORTATION AND
ASSISTANCE.
YOU ARE ALSO AND I NOTED THAT --
ON ONE OF THE EARLIER SLIDES IN
THE FIRST OUR FIRST PRESENTATION
THERE WAS NO SPOKE TO DOWN OR
COUNTY.
BUT THERE IS WITH YOU SOMEONE IN
THE MUST BE A LAG IN THE DATA OR
SOMETHING BECAUSE THAT WAS
JANUARY NINETEEN REPORT AND YOU
HAVE A SPOKE BUT IT WHAT DIDN'T
SHOW UP IN THE OTHER DATA S
HUMBOLDT ACTUALLY ARE ONLY
TERRITORY WHERE WE DON'T.
HAVE A PHYSICAL HUB AT THIS
MOMENT --
ALL OF OUR OTHER GRANTS HAVE A
PHYSICAL HUB WE ARE OPENING UP A
CLINIC IN YOUR RICA EITHER LATER
THIS YEAR OR EARLY NEXT YEAR
WHICH WILL OPERATE AS THE HUB TO
HUMBLE.
BUT AT THIS POINT WE'VE
CONNECTED ALL OF OUR SPOKES TO
EXPERT FACILITATORS AND WE'RE
CREATING A MEDICAL NEIGHBORHOOD.
EVEN THOUGH WE DO NOT HAVE A
PHYSICAL HALBERSTAM.
SO WHAT IS THE IMPEDIMENT TO A
HUB IN HUMBLE COUNTY.
I'M AT THIS POINT WE THE HOPE IS
TO OPEN -- I
HAVE BEEN HUMBOLDT COUNTY
QUESTION.
BUT SO I'M CURIOUS WHERE WHERE
IS THE REASON AND I AYE AND
PHYSICAL I UNDERSTAND WHAT
YOU'RE DOING.
BUT WHAT WHAT MAKES IT SO
CHALLENGING TO CREATE A HUB IN
HUMBOLDT COUNTY.
WHAT ARE THE FACTORS OUT THERE --
LEADING TO ABOUT I THINK THE
CHALLENGE --
LIES WITHIN THE SAME CHARGES
THAT I'VE BEEN SPEAKING TO WITH
THE STIGMA --
AND THE BARRIERS FOR CHANGE AND
EXCEPTION I'LL OF KNOWING THAT
THIS TREATMENT IS NEEDED --
OPEN DOORS BEEN THERE FOR YEARS
AND YEARS AND YEARS AND BEEN
PROVIDING THIS MEDICATION AND
THIS I TREATMENT TO THE
COMMUNITY ABOUT HAVING ANOTHER --
ORGANIZATION COMMAND HAS BEEN --
A LITTLE BIT DIFFICULT AND SO WE
ARE ADDRESSING NOT WITH THE
COMMUNITY AND WE'VE NOW BEEN
WELCOMED.
AND SO THE HOPE IS TO BE ABLE TO
IT ADDRESS THAT IMPEDIMENT
WITHOUT OPENING.
IN MY FINAL QUESTIONS ACTUALLY
TO ALL OF YOUR LIKE YOU TO TOUCH
ON THIS.
TREATMENT OF YOUTH [inaudible]
PERCENTAGE EFFECTIVENESS --
I THINK YOU KNOW A LOT OF THE
OVERDOSES HAPPEN WITH PEOPLE IN
OLD THAT ARE OLDER --
NOT ALL OBVIOUSLY SO BUT OVER
DOES THIS HAPPEN WITH YOUNG
PEOPLE --
WHO MAY NOT BE ADDICTED OR OR
DEPENDENT AT THAT POINT SO TELL
ME ABOUT HOW YOUR EXPERIENCES
WITH USE AND HOW THESE PROGRAMS
WORKING WITH THE YOUTH AND I
LOOKED FOR ALL THE BILL TOUCH ON
THAT?
SO WHAT I CAN SPEAK TO IT I I AM --
OF A USE OF PROVIDER.
BOTH RESIDENTIAL OUTPATIENT
SERVICES FOR YOU.
WE ARE BARELY SCRATCHING THE
SURFACE ON NEED --
AND OF THERE IS TREMENDOUS THE
NILE.
OF HIM FAMILIES.
WELL WITH PARENTS LOVED ONES.
SCHOOL SYSTEMS WELFARE SYSTEMS
FOSTER CARE SYSTEMS.
AROUND THE NEED FOR SUBSTANCE
USE SERVICES WITH YOU --
THEY WOULD RATHER TALK ABOUT
THEIR ACADEMIC ISSUES SOME OTHER
BEHAVIORAL ISSUES EVEN MENTAL
HEALTH.
THEY DON'T WANT TO HAVE A
DIALOGUE ABOUT SUBSTANCE USE
DISORDERS --
SO IS IT IT IS PERVASIVE IN SOME
OF THOSE SYSTEMS.
BUT IT'S VERY DIFFICULT TO
ENGAGE THEM AND GET THEM. TO
HELP IDENTIFY SERVICES. TO THE
EXTENT THAT YOU CAN GET INTO
SCHOOLS.
BECAUSE I DON'T ALWAYS OPEN
THEIR ARMS TO LET YOU IN --
YEAH YOU CAN HAVE MORE DIRECT
CONTACT --
IN TERMS OF THAT IDENTIFICATION --
AND AND MAKE SOME GOOD HEADWAY
BUT IT'S EXTREMELY DIFFICULT WE
DO NOT HAVE A GOOD SYSTEM OF
CARE IN THE STATE OF FOR
ADOLESCENTS SERVICES --
IT PROP SIXTY FOUR RESPONSE TO
GENERATE REVENUE SOONER OR LATER
THAT -- GETS
EARMARKED --
FOR A TREATMENT AND PREVENTION
SERVICES MORE HOPING THAT.
SOME OF THOSE RESOURCES WILL
HELP BUILD.
A YOUTH --
CONTINUE ON BUT JUST AS WE HOPE
THAT THE ORGAN E. P. STT WILL
HELP WITH THAT EFFORT.
AND BOTH OF THEM ARE HELPING
WITH THAT BUT I THINK WE'VE GOT
QUITE A WAYS TO GO.
YEAH -- AS
FAR AS RIVERSIDE COUNTY GOES ON
UP UNTIL LAST YEAR WE DID NOT
HAVE A A FACILITY WITHIN THE
COUNTY THAT WOULD TREAT --
PRESIDENTIAL ADOLESCENTS WE
WOULD SEND HIM. TO TO TARZANA
AND WE DID HAVE ONE PROVIDER DAT.
OPENED UP A RESERVE A
RESIDENTIAL FACILITY LAST YEAR --
FOR SIX BOYS SIX GIRLS OUT IN
THE COULD SHALLOW VALLEY.
THAT WAS A LITTLE BIT
CHALLENGING BECAUSE OF THE
COMMUNITY CARE --
LICENSING REQUIREMENTS AND IT
WAS KIND OF A A LITTLE BIT MORE
OF A DIFFICULT PROCESS TO GET
THEM UP UP AND RUNNING BUT WE DO
HAVE THAT NOW.
WE HAVE A LOT OF OUTPATIENT.
TREATMENT FACILITIES --
FOR FOR USE UNDER UNDER THE AGE
OF EIGHTEEN WE ALSO ARE WORKING.
WITH OUR IN OUR PREVENTION
PROGRAM TO TREAT HIGH RISK --
INDIVIDUALS AND SO WE HAVE A
COUNTY BASED.
INDIVIDUAL PREVENTION SERVICES
PROGRAM THAT WORK WITH THE YOUNG
PEOPLE WHO HAVE STARTED TO HAVE
SOME NEGATIVE EXPERIENCES WITH
DRUGS OR ALCOHOL BUT HAVEN'T
REACHED LEVEL TO WEAR A
DIAGNOSIS IS WARRANTED.
AND THAT SERVICE IS AVAILABLE AT
ALL TEN OF OUR COUNTY OPERATED A
SUBSTANCE ABUSE CLINICS --
IT'S A HOME GROWN A PROGRAM THAT --
WE'VE RECEIVED NATIONAL
RECOGNITION FOR AN ADDENDUM
VALUATION PROCESS WHAT IT.
AND CURRENTLY --
WITH THE ADVENT OF THE ODS
WAIVER WE RUN A PILOT PROJECT
WHERE WE'RE TRYING TO EXPAND
THAT SERVICES DIRECTLY INTO SOME
OF THE SCHOOL SYSTEMS.
WE'RE ACTIVE AND FIVE OF OUR TO
WHERE WE WILL PLACE A SUBSTANCE
ABUSE COUNSELOR INTO --
THE DISTRICT.
TO PROVIDE TO EITHER TO
PREVENTION INTERVENTION OR THE
TREATMENT INTERVENTIONS SO WE'RE
TRYING O BE AS ACTIVE AS WE CAN --
WITH THIS STUFF.
BIGGEST PROBLEM THAT WERE SEEN
WITH THE HOUSTON ARE COUNTY IS
AROUND MARIJUANA --
AS FAR AS OPIATES GO IT'S NOT
PRESENTED ITSELF IS A HUGE
PROBLEM YET ON THE UNDER
SEVENTEEN POPULATION HOWEVER DE.
THE EIGHTEEN THROUGH TWENTY FOUR
OUR POPULATION IS WHERE WE'RE
SEEING.
SOME OF THE BIGGEST GROWTH THERE.
THROUGH THE HAVEN'T SPOKE WE'RE
WORKING WITH OUR COALITIONS TO
ADDRESS YOUTH EDUCATION IN THE
SCHOOLS AND DURING COMMUNITY
EVENTS --
WE'VE NOTICED IN SOME OF OUR
ROLE COMMUNITIES THAT --
OPIOIDS ARE TO THE CONCERNED IT
IS MARIJUANA AND SOME OTHER
ILLICIT SUBSTANCES HOWEVER --
THROUGHOUT THE REGIONS THAT WE
ARE WORKING AND MEANT FOR YOUTH
ISN'T VERY COMMON EITHER SO I DO
AGREE THAT ADOLESCENT --
CARE IN THIS SYSTEM IS LACKING.
I HAVE A QUESTION.
I'M THANK YOU FOR THAT
INFORMATION.
IT'S TO GOING INTO THE SCHOOLS
TO PROVIDE SERVICES --
CAN YOU GIVE ME A SENSE OUR
SCHOOL DISTRICTS BEING RECEPTIVE
OR EIGHT GETTING IN.
SOME KIND OF RESISTANCE INTO
GOING INTO THE SITES I'M JUST
CURIOUS ABOUT THE BOAT.
OKAY -- I'M
SORRY I COULDN'T GO TO WHOEVER
OKAY.
I AM SIXTY WE HAVE BOTH WE HAVE
DISTRICTS THAT ARE BEGGING FOR
THE SERVICE AND THEN WE HAVE
DISTRICTS THAT WANT NOTHING.
TO DO WITH US SO ONE OF THE WAYS
AROUND IT IS WE HAD AN ANIMAL
YOU WITH OUR SELF Là GRAHAM --
AND ANY DISTRICTS THAT ARE
COVERED THROUGH DAM.
WE OFFER THE SERVICES AND THAT
AND WHAT YOU COVERS AT A TO SO.
I THINK YEAH.
HEALTH AND I WANNA THANK.
THANK YOU ALL FOR BEING HERE
PREFIGURE TESTIMONY HAD FEW
QUESTIONS AS WELL --
SO FIRST OF ALL --
DR -- KHWAJA
YOU HAD MADE REFERENCE TO OF
COURSE THE WORK FORCE CHALLENGES
WE KNOW HUMBLED HAS A WORK FOR
SHORTAGE BUT IN ADDITION TO THE
EXISTING WORK FOR SHUTTERS
GEORGE NUMBER PROVIDERS YOU ALSO
MENTIONED THAT.
YOU HAVE PROVIDERS.
TO THE WHO WELL WE WE TALKED
ABOUT PEOPLE BEING TRAINED AND
NOT ACTUALLY DELIVERING --
I CAN YOU AN AND ACTUALLY I
THINK -- THE
THE EVALUATORS HAD MENTIONED ONE
OF THE REASONS MAY HAVE BEEN
ALSO --
PEOPLE ARE AFRAID THAT IF THEY
STARTED PRESCRIBING THE MIGHT
FACE SOME PENALTY OR SOMETHING
LIKE THAT --
HE SPEAK TO THE BARRIERS WE
MIGHT DO IS A LEGISLATURE SO FOR
EXAMPLES OR SOMETHING THE
MEDICAL BOARD NEEDS TO DO TO
TELL PEOPLE THAT IF YOU
PRESCRIBE AN AFRO AND YOU'RE NOT
GONNA LOSE YOUR LICENSE IS THAT
AN ISSUE OUT THERE.
CAN YOU JUST SPEAK TO SOME OF
THOSE THINGS THAT --
KEEP PEOPLE FROM WHO SAY OKAY I
WANT TO HEALTH AND I DO THE
TRAINING --%
I DO THE TRAINING BUT THEN AND
UP NOT ACTUALLY --
YOU MENTIONED THAT PEOPLE KNOW
EITHER THEY DO A LITTLE MORE
THAT WAS A WHAT OF THINGS THAT
WE CAN TRY TO DO TO HELP THEM
THEY'RE THINK SPEAKING UP AS A
MEDICAL BOARDTO LET THESE
PROVIDERS NOT ALL THAT THIS IS
AYE AYE NECESSITY TO INTEGRATE
THIS INTO PRIMARY.
CARE IS WHAT WE NEED HERE --
IN CALIFORNIA WOULD BE VERY
HELPFUL I HAVE HEARD --
SECONDHAND FROM PROVIDERS THAT
THEY HAVE HEARD THAT YOU KNOW D.
A. HAS COME IN AND DONE YOU KNOW
THIS OR THAT AND BUT THEY'RE
THEY'RE SCARED OF LOSING THEIR
LICENSE BUT I DON'T KNOW OTHER
PROVIDER SPECIFICALLY IN THE SIX
REGIONS I'M WORKING WITH --
BUT IT IS A COMMON FEAR EVEN
THOUGH IT'S HEARSAY AMONGST THEM
AND BEING THE ONLY ONE IN THE
COMMUNITY YOU'RE YOU'RE GONNA BE
THE ONE THAT'S TARGETED IS WHAT
THAT THE THOUGHT IS.
OKAY SO SOUNDS LIKE WE HAVE SOME
WORK TO DO.
WITH OBVIOUS DA'S FEDERAL BUT WE
HAVE FRIENDS IN OUR FEDERAL THAT
SO WE NEED TO WORK WITH PEOPLE
AND UPS COURSE THE MEDICAL YOU
KNOW THAT MEDICAL ASSOCIATIONS
AS WELL ABOUT SENDING THE
MESSAGE THAT.
YOU CAN DO THIS YOU CAN DO THIS
SAFELY YOU'RE NOT GOING TO LOSE
YOUR LICENSE AND PERHAPS WE NEED
A REGULATORY AGENCIES TO MAKE
FIRMER STATEMENTS ABOUT --
FOR THAT FOR PROVIDERS WHO ARE
WHO ARE ENGAGING IN AND
TREATMENT THAT WOULD BE HELPFUL.
THE MORE MORE WE TALK ABOUT IT
THE MORE AND MORE WE SEE
PROVIDERS COMING ON BOARD THAT
WEREN'T THERE A YEAR AGO OR TWO
YEARS AGO AND SO THE
CONVERSATION IS NECESSARY. FOR
THAT THAT'S A VERY HELPFUL --
I HEARD YOU SING THE PRAISES OF
OF THE THE OF YOU KNOW.
THOUGH YES SAID THE IN THE THE
NEED FOR A PROCESS --
BUT WE ALSO HEARD AND I'M NOT
SAYING THAT I THINK IT IS FROM
WHAT YOU'RE TELLING ME ABOUT
HEARING THIS IS BETTER THAN WHAT
WE WERE DOING BEFORE SO WITH SO --
BUT WE ALSO HEARD THAT WE'RE
ONLY REACHING A FRY A FRACTION
OF THE PEOPLE WHO ARE OUT THERE
I REALIZE IS A CHALLENGING
POPULATION --
WHAT DO YOU SEE SO YOU I YOU
MENTIONED THAT YOU ACTUALLY
INCREASE TREATMENT BY 80% NUMBER
OF PEOPLE SO ACTUALLY US OF THAT
SO I'M NOT SURE WHAT THE AT THE
AVERAGE 7%?
BECAUSE YOU'RE AT 80% I REALLY
OUT THE WAY EVERYONE ELSE WAS AT
SO -- SUIT
CLEARLY VERY SUCCESSFUL
RIVERSIDE.
COUNTY BUT WHAT'S THE NEXT STEP --
FURS SO WILL THE WAIVERS GONNA
COME UP WHAT HE SEES THE NEXT
STEP SO WE CAN REACH EVEN MORE
PEOPLE -- I
IS YOU CAN TELL ME WHEN
RIVERSIDE YOU GOT IT ALL TAKEN
CARE OF OR JUST A LONG WAY TO GO.
AND WHAT TO WHICH WE BE DOING TO
HELP YOUR COUNTY AND OTHER
COUNTIES THAT TO YOUR COLLEAGUES
TO TRY TO TO STEP IT UP AND GET
YOUR PEOPLE.
THERE IS STILL A LOT MORE TO DO --
TREATMENT IS WE WERE FINALLY
PAYING THE RESIDENTIAL PROVIDERS
WHAT THEY WERE WORSE.
PREVIOUSLY WE WERE ONLY.
ABLE TO PAY THEM SOMETHING LIKE
EIGHTY DOLLARS A DAY.
AND THE PROVIDERS WEREN'T
WILLING TO GIVE THE COUNTY OF
MORE THAN JUST A FEW BADS NOW
WE'RE ACTUALLY ABLE.
TO PAY THEM A REASONABLE --
DAILY RATE AND SO TO THE
PROVIDERS WERE DâN MORE THAN
WILLING TO OPEN MORE BEDS FOR
THE COUNTY TO USE AND SO THAT.
MUCH ATTRIBUTED FOR THAT
SIGNIFICANT GROWTH THERE --
I THINK AS LONG AS WE ARE ABLE.
TO CONTINUE TO PAY OUR PROVIDERS --
WHAT THEY'RE WORTH AND --
IF WE CAN EXPAND THE NETWORK OF
PROVIDERS THAT'S GOING TO BE
REALLY CRITICAL --
MANY OF THE PRIVATE PROVIDERS
DON'T WANNA PLAY WITH THE THEY
CAN GET MORE FROM --
SOME OF THE INSURANCE COMPANIES
THAT THEY WORK WITH SO --
I I THINK.
THERE'S A LOT OF WAYS THAT WE
CAN IMPACT US BUT WE'RE
CERTAINLY NOWHERE NEAR --
TO THE POINT WHERE WE CAN REST
ON OUR LAURELS YET.
AND LESS THAN LA KNOW THAT --
LOOKING FOR TO GET A COPY OF
YOUR WRITTEN TESTIMONY YOU TOUCH
ON MANY DIFFERENT TOPICS --
GET THROUGH ALL OF THEM BY BY
THE KNOWLEDGE THAT THERE A LOT
OF DIFFERENT THINGS THAT YOU
MENTIONED THAT WE SHOULD BE
LOOKING AT ONE OF THE THINGS I
WAS INTERESTED THOSE YOU
MENTIONED TERMS OF RESIDENTIAL
CAPACITY AND NOW WE DO COST
BASED.
REIMBURSEMENT RATES AND YOU THAT
MAKE REMARKS THAT WELL OF COURSE
THAT MEANS THAT IF WE DO COST
BASE TO COVER THE COSTS BUT
THERE'S NO CAPITAL FOR FURTHER.
EXPANSION RIGHT --
NOW I THINK IT MAY BE A
CHALLENGE TO SAY WHICH IS GOOD
NOW I HAVE TO DEAL INCREASE
RATES SO THAT YOU CAN ACCUMULATE
THAT CAPITAL RIGHT AT THE THAT
ARE THERE OTHER ALTERNATIVES FOR
EXAMPLE IS LIKE A REVOLVING
CAPITAL FUND THAT ALLOWS PEOPLE
TO BUILD SO THAT THEY CAN --
EXPAND OUR OF A IT IS SOME
THOUGHTS.
BEYOND JUST INCREASING I MEAN WE
WANT TO PAY AN APPROPRIATE RATE
NIGHT WE JUST HEARD ABOUT THAT --
BUT IT IN TERMS OF TRYING TO
BUILD THAT CAPACITY WHERE THE
BARRIERS TO BUILDING THAT
RESIDENTIAL CAPACITY TALKED
ABOUT.
CHAU --
BEYOND THE ISSUES WITH OF
FINDING APPROPRIATE FOR OLD
FACILITIES IF YOU CAN FIND THE
LAND.
OR EXPAND EXISTING ONES IF
YOU'VE GOT THE ABILITY TO EXPAND
BY ADDING BEDS --
THE THERE THERE IS A REAL A REAL
PROBLEM WITH.
HERE'S A A REASONABLE RATE FOR
THE BED DAY I'M BUYING FROM YOU.
BUT AT THE END OF THE DAY IF
THAT HUNDRED DOLLAR BED DAY I'M
BUYING FROM YOU.
YOU OPERATE VERY EFFICIENTLY AND
COME IN AT NINETY DOLLARS YOU
MUST GIVE ME THE TEN DOLLARS
BACK.
AND IF YOU END UP OF THE AT THE
END OF THE YEAR.
SPENDING A HUNDRED AND TEN
DOLLARS.
WELL THANK YOU FOR YOUR DONATION
NO ONE'S REIMBURSING YOU FOR
THAT TEN DOLLARS --
WE COULD DESIGN --
COST BASED SYSTEM THAT ARE LEFT
A MARGIN IF YOU.
RAN EFFICIENT WAY AND THERE WAS
A 10% OF 5% OR WHATEVER A
SURPLUS THAT YOU'RE ABLE TO
RETAIN IT.
SO LONG AS IT'S REINVESTED IN
THAT MISSION THAT FURTHER
INFRASTRUCTURE AND GROWTH KIND
OF THING.
THAT'S A DISCUSSION THAT COULD
BE HAVE AND WE CAN LOOK AT OTHER
PAYMENT REFORM MODELS --
TO TO A MORE TRADITIONAL FEE FOR
SERVICE --
IF IT'S A FAIR AND REASONABLE --
DOES A LOT OF STRAIGHT FORWARD
FEE FOR SERVICE IF IT'S A
REASONABLE RATE FOR FOR THAT
SERVICE DRIVEN.
FROM COST DATA TO SORT OF GET
THERE THAT --
IT'S STRAIGHT FEE FOR SERVICES
AND APPROACH WE CAN MARKET CASE
RATES AND OTHER --
INCENTIVE OUTCOME BASED MODELS
WHERE YOU YOU HAVE A LITTLE BIT
A REST GET YOUR BASE RATE BUT
YOU HAVE THE ABILITY TO EARN
MORE BY.
OF BY -- AN
INCENTIVE BASED PLAN THAT IS
DRIVEN BY OUTCOMES THAT YOU'RE
ACHIEVING CERTAIN DELIVERABLES
AS PART OF THAT --
AND THAT'S THE KIND OF SERIOUS
DISCUSSION THAT I THINK WE NEED
TO HAVE A AS WE GO FORWARD WITH
THIS.
SOME PROVIDERS ARE CAPABLE OF
GOING OUT AND FINDING FINANCING --
IN TAKING THAT VERY BIG PLUNGE
THAT RISK --
TO TO ADD BEDS --
BUT ALL IN ALL MANY ARE JUST NOT
THERE THEY'RE NOT ABLE TO DO
THAT THEY'RE SMALLER.
OPERATORS NOT CAPABLE OKAY THANK
YOU AND APPRECIATE THAT YOU GIVE
US SEVERAL SUGGESTIONS FOR
TRYING TO IMPROVE EFFICIENCY
ACROSS THE MULTIPLE GOVERNMENT
ENTITIESAND SO FORTH WE SHOULD.
WAIT WHAT MIGHT FOLLOW UP WITH
SOME QUESTIONS WITH PANEL ABOUT
THAT THANK YOU.
THE REBELLION I HAVE ONE MORE
QUESTION I'M SORRY FOR THE LATE
QUESTION BUT YOU KNOW JUST GOING
BACK TO SARAH --
YOUR TEA SET OUT.
A LOT OF THE PATIENTS ARE A
COMMAND GET TREATMENT AND THEN
THEY THEY FALL THROUGH THE
CRACKS BECAUSE THEY DON'T HAVE
TRANSPORTATION IT'S NOT
CONSISTENT AND AND I CAN ONLY
ASSUME THAT IN ORDER TO GET
BETTER YOU HAVE TO HAVE
CONSISTENT TREATMENT --
IS THERE ANYTHING THAT YOU GUYS
ARE DOING IN TERMS OF TRYING TO
PROVIDE.
THOUGHT TRANSPORTATION ANY
PARTNERSHIPS ANY.
WAY OF MAYBE UTILIZING FUNDING
TO PARTNER WITH TRANSPORTATION
COMPANIES TO MAKE SURE THAT WE
GET PATIENTS THERE I'M JUST
THINKING OF THAT RESOURCES
WASTED IN TERMS OF AGAIN IF YOU
GET TREATMENT AND YOU TO
CONSISTENTLY SHOW UP IT'S A
WASTE OF A RESOURCE IS BECAUSE
YOU'RE NOT GONNA GET.
ANY BETTER SO CAN YOU SURE ABOUT
ANY PARTNERSHIP OR ANYTHING THAT
YOU GUYS ARE TRYING TO DO. ONE
OF THE ALLOWABLE EXPENSES
THROUGH THE HUB AND SPOKE GRANT
IS FOR TRANSPORTATION SO WE ARE
ABLE TO PROVIDE GAS CARDS --
AND LIFT VOUCHERS UBER VOUCHERS
TO PATIENTS BUS PASSES TO GET TO
AND FROM TREATMENT WE KNOW SOME
OF OUR SPOKE THEY'VE BEEN GONE
AS FAR AS TO HIRING AYE DRIVER
TO TO GO AND GET THE PATIENTS
AND BRING THEM TO TREATMENT.
ASIDE FROM THIS GRANT AS WELL
AND SO WE ARE TRYING TO BE
CREATIVE --
MAYBE EVEN SCHEDULING DAYS MET --
THAT ONE MONDAY OR THAT ONE
TUESDAY SO THE FAN IS TAKING ALL
OF THEM AND SO FORTH.
THANK YOU FOR SHARING THANK YOU.
OFFER YOUR PRESENTATIONS IT'S
BEEN -- VERY
INSIGHTFUL AND THANK YOU SO MUCH
FOR BEING HERE TAKE YOUR TIME
SHARE WITH US THANK YOU.
RIGHT WE'RE GONNA THE NEXT PANEL
IS ON PLANS FOR EXPANDING PILOTS
SINCE THE SERVICES NOW --
BECAUSE WE S. THE ONLY PEOPLE
POWER YOUR BREAK IT UP INTO TWO
PIECES.
SO WE'RE FIRST GOING TO BRING UP
A DOCTOR LEAST LOOK FROM THE
CALIFORNIA SOCIETY THE DICTION
MEDICINE.
IS GONNA BE TALKING ABOUT THE
SALES EXPERIENCE IN TRAINING
PHYSICIANS AND AND MEDICATIONS
AS TREATMENT --
WE HAVE DOCTOR JOHN CONNALLY
DIVISION DIRECTOR OF SUBSTANCE
ABUSE PREVENTION CONTROL LA
COUNTY DEPARTMENT PUBLIC HEALTH
AND IS ALSO A MEMBER OF THE
COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATIONS WE TALK
ABOUT COUNTIES EXPERIENCES. FOR
CONTRACTING AND WE HAVE A FOR AS
HIS -- OF
SUBSTANCE SE DISORDER
COMPLIANCE BOTH OF THE PART OF
HEALTH CARE SERVICES SO WELCOME
AND THEN THE WE WILL BRING UP
THE NEXT THREE SPEAKERS AND US.
AND THE SEPARATE PANEL ON THE
SAME TOPIC AS WELL SO FOR THOSE
OF YOU WHO ARE WAITING FOR THAT
ONE THAT WILL --
WILL BRING YOU UP --
NEXT SO.
WE'LL START WITH THE DOCTORS
KNOW COCA.
THANK YOU OF MY NAME IS LEASE
NEWARK.
I AM A PAIN PHYSICIAN IN PRIVATE
PRACTICE --
YOU'RE IN SACRAMENTO DO PAIN
MEDICINE.
MANAGEMENT ADDICTION TREATMENT --
ALSO PRIVILEGE TO SERVE AS THE
SPEAKER FOR THE CALIFORNIA
MEDICAL ASSOCIATION.
HOWEVER TODAY I AM HERE
REPRESENTING THE CALIFORNIA
SOCIETY OF ADDICTION MEDICINE.
COMPOSED OVER SIX HUNDRED
CALIFORNIA PHYSICIANS AND
ASSOCIATED PROFESSIONALS.
IN THE FIELD OF ADDICTION
MEDICINE. ONE OF SEE SAM'S GOALS
IS TO INCREASE THE NUMBER OF
PROVIDERS WHO PRESCRIBING MANAGE
BUPRENORPHINE TO TREAT OPIOID
ADDICTION.
SUCH PROVIDERS MISS FIRST OBTAIN
A FEDERAL WAIVER INCOMPLETE
EIGHT HOURS OF ONLINE TRAINING.
WHILE THE NUMBER OF PROVIDERS IN
CALIFORNIA OBTAINING A FEDERAL
WAIVER HAS INCREASED.
IN SUFFICIENT NUMBERS OF
PROVIDERS REMAIN A BARRIER TO
ACCESS FOR THIS LIFESAVING
MEDICATION.
ADDITION TREATMENT IS NOT.
TRADITIONALLY BEEN PART OF
PRIMARY CARE.
HOWEVER IT IS ESSENTIAL.
THAT MANAGEMENT OF ADDICTIVE
DISORDERS BECOME PART OF PRIMARY
CARE.
AS A PARTNER WITH THE DEPARTMENT
OF HEALTH CARE SERVICES SEE SAM
HAS BEEN PROVIDING TRAINING AND
MENTORING TO PHYSICIANS AND
OTHER PROVIDERS.
IN THE M. A. T. EXPANSION
PROJECT.
MEDICATION ASSISTED TREATMENT OR
MATT.
IS A PROVEN AND EFFECTIVE
TREATMENT FOR OPIOID USE
DISORDERS.
WE SIMPLY NEED MORE PHYSICIANS
PROVIDING THIS TREATMENT.
THROUGH THIS PROJECT SEE SAM IS
REACHING PRIMARY CARE PROVIDERS
IN RURAL AREAS WHERE THE NEED IS
GREAT.
SELECTING A PROVIDER IN EACH
CLINIC TO BECOME A CHAMPION
ENCOURAGING OTHERS TO TREAT
OPIOID DEPENDENT PATIENTS.
AND A NORMALIZES TREATMENT AND
TRAIN MORE PRIMARY CARE
PHYSICIANS.
WE ARE WORKING TO REDUCE
BARRIERS TO PRESCRIBING DEPEND
ARCANE. TO REDUCE THE FEAR THE
COMES WITH EXTRA D. E. A.
OVERSIGHT. TO ADDRESS THE
BARRIERS FOR DRUG TESTING.
AND TO UNDERSTAND THE ROLE OF
PHARMACY AS A PARTNER.
HELP WITH THE ACCESS.
HELP WITH ACCESS TO LOCAL
ADDICTION MEDICINE RESOURCES.
AND TO NAVIGATE THE SYSTEM OF
PRIOR AUTHORIZATIONS ALL TOO
OFTEN REQUIRED BY INSURANCE
CARRIERS.
UNDER THE MA T. EXPANSION
PROJECT.
CCM RECEIVED FUNDING TO SUPPORT
FORTY EIGHT PRIMARY CARE
PROVIDERS THROUGH MENTORED
LEARNING EXPERIENCE SCHOLARSHIPS.
THAT PROVIDED.
TUITION TO ATTEND THE C. SAM
ADDICTION MEDICINE STATE OF THE
ART CONFERENCE VERY WELL
ATTENDED AND AN OUTSTANDING
CONFERENCE.
DURING THIS THREE DAY CONFERENCE
THEY LEARN MORE ABOUT MATC
MOTIVATIONAL INTERVIEWING DRUGS
OF ABUSE OPIOID DEPENDENCE PAIN
AND ADDICTION.
THE ENVIRONMENT OF ADDICTION
INCLUDING CO OCCURRING DISORDERS
POLY SUB DISAPPEARS AND HOW TO
REDUCE THE BARRIERS FOR PATIENTS
TO GAIN ACCESS TO TREATMENT.
BASED ON THEIR FEEDBACK THE
OBJECTIONS OF THIS PROJECT ARE
BEING ACCOMPLISHED.
SHE SAM IS RECEIVING FUNDING
FROM DH CS TO CONTINUE THIS
PROJECT FOR TWO MORE YEARS.
MENTORED LEARNING EXPERIENCE
CALLER SHIPS WILL BE OFFERED IN
SOUTHERN CALIFORNIA REGIONS IN
TWO THOUSAND NINETEEN AND TWO
THOUSAND TWENTY SHE SAM WILL
CONTINUE THIS MISSION TO RICH
OWN PROGRAM OF OFFERING
MENTORING AND SCHOLARSHIPS.
HOWEVER SSTAINED FUNDING IS
ESSENTIAL TO MAINTAIN AND EXPAND
THE EXPAND THIS AFFECTED PROGRAM.
WE ARE CONTINUE TO BE IN THE
THROES OF AN OPIOID IN SUBSTANCE
ABUSE EPIDEMIC.
WE KNOW WHAT NEEDS TO BE DONE
AND WE ASK FOR FUNDING RESOURCES
TO HELP FIGHT THE SCOURGE.
THANKS FOR THIS OPPORTUNITY TO
SPEAK BEFORE THE PANEL.
MUCH SECTORS THE CUT BACK TO
CALI WELCOME.
THANK YOU TO THE CHAIRS IN THE
COMMITTEE FOR HAVING THE
ASSOCIATION HERE TODAY I'M HERE
REPRESENTING THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION.
AND WANTED TO ORGANIZE MY
COMMENTS AROUND.
THE DRUG MEDI CAL ORGANIZED
DELIVERY SYSTEMS AND SPOKE
SYSTEM GRANT AND I THINK THAT WE
AS AN ASSOCIATION REALLY SEE
BOTH OF THESE BUT PARTICULARLY
THE DRUG MEDI CAL ORGANIZED
DELIVERY SYSTEM.
AS AN OPPORTUNITY TO EXPAND TO
ORGANIZE AN ADVANCE --
AND INTEGRATE SUBSTANCE USE
DISORDER TREATMENT INTO THE
BROADER HEALTH CARE SYSTEM WE'D
LIKE TO SEE THIS IMPLEMENTED IN
AS MANY COUNTIES AS POSSIBLE
THOSE YOU'VE HEARD FROM OTHER
FOLKS WHO HAVE.
TESTIFIED TODAY AND EXPERTS THAT
THERE ARE CHALLENGES INVOLVED IN
THAT THAT INVOLVED --
AND INVESTMENT OF RESOURCES AND
INFRASTRUCTURE.
I THINK --
FIRST OF ALL ALL FOCUS.
WITHIN THAT REALM ON NETWORK
ADEQUACY AND CERTAINLY WE SEE
AMONG THE COUNTIES A GROWTH IN
ALL LEVELS OF CARE WE'VE HEARD
ABOUT PARTICULARLY WITHDRAWAL
MANAGEMENT AND RESIDENTIAL
TREATMENT BEDS AS A NEED.
CERTAINLY AS AS BUILT --
FACILITIES EITHER EXPANDING --
RENOVATING OR BUILDING NEW
FACILITIES REQUIRES INVESTMENT
IN THAT SOMETHING WE WOULD
ENCOURAGE PERHAPS THROUGH SOME
SORT OF CAPITAL INVESTMENT AT
THE STATE LEVEL.
WE ALSO APPRECIATE THE
DEPARTMENTS EFFORTS IN THE AREA
OF STREAMLINING DRUG MEDICAL
CERTIFICATION SO WE CAN RECRUIT
NEW PROVIDERS IN TO OUR NETWORKS.
WE ALSO --
WE ALSO OF OF THE IN TERMS OF
THE STIGMA USE TREATMENT TO MAKE
AS THERAPEUTIC COMMUNITIES NOT --
NOT FACILITIES THAT PROVOKE UP
POSITION.
IN ADDITION YOU'VE HEARD QUITE A
BIT ABOUT THE WORK FORCE.
I THINK ONE OF THE TREMENDOUS
STRENGTHENED LEGACIES OF
SUBSTANCE USE TREATMENT
PROVIDERS IS THAT WE RELY ON A
GREAT DEAL OF OF PEER EXPERIENCE
LIVED EXPERIENCE.
THAT IS IN MANY CASES AND
COUNSELING AND GROUP SESSIONS
VERY VALUABLE.
AT THE SAME TIME I THINK WE
STRUGGLE TO RECRUIT ENOUGH OF
THOSE PROFESSIONALS WHO ARE
CLINICIANS EITHER REGISTERED OR
CERTIFIED --
COUNSELORS BUT ALSO LICENSED
PROFESSIONALS THAT WE ALSO NEED
TO DO THE PRESCRIBING WE'VE
SPOKEN ABOUT AND TO DETERMINE
MEDICAL NECESSITY.
EITHER IF THEY'RE LICENSED
CLINICAL SOCIAL WORKER OR A
LICENSED MARRIAGE AND FAMILY
THERAPIST --
IN ADDITION TO THAT THE WORK
FORCE OFTEN STRUGGLES WITH
DOCUMENTATION WHICH IS JUST A
REQUIREMENT OF NOT ONLY MEDI CAL
BUT MODERN HEALTH CARE.
AND WE SO WE STRUGGLE TO MAKE
SURE THAT WE'RE TRAINING OUR OUR
CLINICIANS TO TO MEET THOSE
STANDARDS THAT ARE REQUIREMENT.
OF F OUR SYSTEMS.
IN ADDITION WE NEED TO MAKE SURE
THAT WERE THAT WE NEED TO SERVE
AND THE LANGUAGES THAT THEY
SPEAK BUT ALSO WITH CULTURAL
SPECIFICITY WE SPOKE ABOUT THAT
SOME ALREADY TODAY --
AND SO REFLECTING OR HAVING A A
WORKFORCE THAT REFLECTS THAT
NEEDED THAT SERVES THE
COMMUNITIES AND UNDERSTANDS THE
COMMUNITIES THAT WE MUST --
WORK IN --
IS VERY IMPORTANT AND AND
SOMETHING WE NEED TO CONTINUE TO
WORK ON YOU'VE HEARD QUITE A BIT
ALSO ABOUT THE YOUTH SYSTEM OF
CARE -- AND
IT'S VERY IMPORTANT I THINK TO
TOO MANY COUNTIES TO HIGHLIGHT
THAT -- ALL
OF THE ISSUES I MENTIONED SO FAR
WHEN IT COMES TO INFRASTRUCTURE
AND TO WORK FORCE THERE EVEN
MORE EXTREME IN THE YOUTH --
AND THE YOU SYSTEMS OF CARE TO
RECRUIT PROFESSIONALS WHO HAVE
THE THE ABILITY TO DELIVER
DEVELOPMENTALLY APPROPRIATE
SERVICES.
AND IN MOST SETTINGS THAT WOULD
REQUIRE NOT ALWAYS BUT OFTEN A
LICENSED PROFESSIONAL TO SERVE
SOMEONE --
WITH THE THE LEVEL OF EXPERTISE
AND TRAINING TO TO SERVE AT RISK
YOUTH.
I THINK IN ADDITION YOU'VE HEARD
ABOUT THE EARLY PERIODIC
SCREENING DIAGNOSTIC AND
TREATMENT BENEFIT THAT IS A
MANDATE UNDER MEDICAID AND THE
pMEDICARE PROGRAM.
WE IT'S HARD TO UNDERSTATE HOW
IMPORTANT THE IMPLEMENTATION OF
ODS IS TO REALIZING THAT.
THEY'RE ALL THE TOOLS IN OUR
TOOLBOX THIS WAIVER PILOT TO
MAKE THAT REAL AND AVAILABLE
ACROSS THE STATE.
AND WE SHOULD DO EVERYTHING WE
CAN I THINK TO MAKE SURE THAT
ALL COUNTIES HAVE WHAT THEY NEED
TO TO MAKE SURE THAT.
YOU GET THE THE BENEFITS THAT
THEY ARE ELIGIBLE FOR AN
ENTITLED TO ONE OF THE PROGRAM.
AND ALSO WITH AS I SAID THE THE
DEVELOPMENTAL SPECIFICITY OF THE
DATE THAT THEY NEED --
I THINK IN ADDITION. ONE OF THE
OTHER AREAS THAT WE AS AN
ASSOCIATION ARE FOCUSED ON IS
THE WAY FOR RENEWAL IN TWENTY
TWENTY THERE ARE MULTIPLE
WAIVERS COMING UP FOR FOR
RENEWAL --
NEXT YEAR AND I THINK THERE ARE
THREE BROAD GOALS THAT WE WOULD
EMPHASIZE IN THAT AND ARE
ANXIOUS TO WORK WITH THE
DEPARTMENT ON DEVELOPING --
THE THE TERMS AND CONDITIONS OF
OF A RENEWAL WAIVER I THINK ONE
IS TO INTEGRATE BEHAVIORAL
HEALTH SERVICES BOTH MENTAL
HEALTH PLAN SERVICES AND
SUBSTANCE USE DISORDER SERVICES.
AND ALSO TO INTEGRATE THOSE
SERVICES WITH THE BROADER MEDI
CAL AND HEALTH CARE SYSTEMS.
SO -- WE
WOULD ALSO LIKE TO SPEAK VERY
EXPLICITLY TO THOSE GOALS AND
THE RENEWAL OF THE WAIVER I
THINK THE THIRD THING THAT ALSO
IS VERY IMPORTANT AND A PRIORITY
OF THE ASSOCIATION AND OF OF
COUNTIES.
IS TO MAKE SURE THAT THERE'S
FLEXIBILITY TO HAVE A FRAMEWORK
THAT WORKS NOT ONLY IN LOS
ANGELES OR SAN DIEGO COUNTY BUT
ALSO HUMBLED.
MONO SIERRA LAKE OTHER COUNTIES
THAT ARE ARE RURAL AND HAVE VERY
DIFFERENT --
NEEDS AND PROFILES OF PEOPLE
THAT THEY HAVE --
THAT'S I THINK AN IMPORTANT
FEATURE THAT WOULD ALSO LIKE TO
HIGHLIGHT.
I'LL ECHO THE COMMENTS MADE
EARLIER ABOUT THE TO NINETY DAY
STAYS I THINK WE WOULD WE WOULD
ADVOCATE EITHER FOR A CAP ON THE
NUMBER OF DAYS IN A YEAR THAT
YOU CAN STAY IN RESIDENTIAL.
THE ALTERNATIVE WOULD BE TO
SHORTEN PERHAPS THE
AUTHORIZATION PERIODS WITHOUT A
CAP A STRICT CAPS IN A SHORTER
AUTHORIZATION PERIOD WOULD
ENSURE THAT THERE'S ONGOING
MEDICAL NECESSITY FOR THAT
HIGHER MORE EXPENSIVE LEVEL OF
CARE.
WITHOUT AGAIN DISTRICT CAP AND
WE THINK THAT'S A A SOLID MOVE
TOWARD PARITY WITH MENTAL HEALTH
AND AND OTHER HEALTH CARE
SERVICES --
I'LL WRAP UP MY COMMENTS ON THE
HUB AND SPOKE SYSTEM WE THINK
THIS IS BEEN A TREMENDOUS
OPPORTUNITY --
I'LL SPEAK SPECIFICALLY ABOUT
THE LOS ANGELES COUNTY
EXPERIENCE WE HAVE TWO LARGE
SKILLED PROVIDERS THAT ARE
SERVING AS HUBS RECRUITING
SPOKES BOTH IN THE PRIMARY CARE
AND MENTAL HEALTH --
NETWORKS IN OUR COUNTY WE THINK
THAT THEY'RE STEADILY INCREASING
THE NUMBER OF PRESCRIBERS AND
CLINICS THAT OFFER THAT SERVICE.
AGAIN OUR OUR CONCERN AS YOU
HEARD BEFORE SUSTAINABILITY
WE'RE DOING WHAT WE CAN TO
RECRUIT PROVIDERS TO EITHER
BECOME OPA TREATMENT PROGRAMS
WITH DNC CERTIFICATION OR BECOME.
A A AN S. U. D. TREATMENT
PROVIDER WITH THE MC
CERTIFICATION AT THE OUTPATIENT
LEVEL AND THEN LEVERAGE THE THE
OTHER MEDI CAL BENEFITS TO
PROVIDE THE MEDICATIONS.
SO WITH THAT I'LL OF FINISHING
JUST SAY THIS IS A AN INCREDIBLE
GENERATION OPPORTUNITY THAT I
WOULD ENCOURAGE ALL TO SUPPORT
AND MAXIMIZE.
THANK YOU THANK YOU DOCTOR
KENTON.
GREAT SO GOOD MORNING JENNIFER
CAN WITH THE DEPARTMENT OF
HEALTH CARE SERVICES --
I WOULD SAY YOU KNOW A COUPLE
THINGS ABOUT THE WAIVER AND THE
WEAVER WAS.
IMPLEMENTED IN AUGUST OF TWENTY
FIFTEEN AND IMMEDIATELY --
THAN JUST RENEWED WHEN WE WERE
NEW THE WAIVER IN DECEMBER AND
SOMETIMES.
OUT OF GREAT CHALLENGES COME
GREAT OPPORTUNITIES AND THAT IS
EXACTLY HOW THE ODIOUS WE'VE
ACTUALLY CAME TO BE IS THAT WE
HAD A SIGNIFICANT PROGRAM
INTEGRITY ISSUE IN THE DRUG
MEDICAL PROGRAM WITH.
FRAUDULENT PROVIDERS AND BECAUSE
OF THAT.
WE SAT AMONGST OURSELVES IN THIS
WAS ACTUALLY PRIOR TO ME.
BEING AT THE DEPARTMENT BUT
MERRILEES CAN CERTAINLY CHIME IN
HERE -- WE
SAT AROUND AND SAID WHAT CAN WE
DO.
TO IMPROVE THE SYSTEM BUT ALSO
YOU KNOW RETURN SOME OF THE
PROGRAM INTEGRITY TO THIS AND SO
THE WAIVER THAT WE HAVE BEEN
WORKING SO HARD ON IS THIS FIRST
IN THE NATION.
SO WE'RE INCREDIBLY PROUD OF
WHAT WE HAVE PUT INTO PLACE WE
ARE INCREDIBLY PROUD OF THE FACT
THAT THESE BENEFITS.
ARE AVAILABLE TO MEDI CAL
RECIPIENTS --
IN A MEANINGFUL WAY ACROSS A
BROAD SPECTRUM OF NEED.
AND SO I THINK THAT --
WHAT YOU WILL HEAR FROM US IS
NOT JUST FIVE YEAR DEMONSTRATION
BASIS BUT ALWAYS WANTING --
TO HIGHLIGHT THE BENEFITS THAT
COME FROM THIS AS WELL AS OUR
CONTINUED INTEREST IN HAVING
THIS RENEWED WITH THE FEDERAL
GOVERNMENT --
WHEN THE WAIVER EXPIRES IN
DECEMBER OF --
TWENTY TWENTY I THINK THAT YOU
KNOW TWO OF THE COUNTIES THAT WE
ARE MOST PROUD OF ARE HERE --
AND YOU HEARD FROM THEM ALREADY --
RIVERSIDE IN LA HAVE DONE AN
EXCEPTIONAL JOB IN NOT ONLY
IMPLEMENTING BUT REALLY EMBRACE
SCENE AND LEANING AND TO THE TO
THE WORK THAT --
IS REQUIRED TO BUILD UP THIS
INFRASTRUCTURE AND CERTAINLY ALL
OF THE CHALLENGES THAT THEY
ACKNOWLEDGE ARE ALL CERTAINLY
TRUE BUT I THINK YOU KNOW WE
HAVE BEEN MOST --
PROUD TO SEE THE RESPONSE --
WHEN YOU TALK ABOUT THE
RIVERSIDE CALL VOLUME I THINK WE
WERE CERTAINLY TAKEN ABACK --
WHEN WE SAW AND WE FELT REALLY
SORRY FOR THEM BECAUSE THAT WAS
THEIR CALL VOLUME AND NOT OURS --
BUT I THINK IT HAS ALSO BEEN A
REALLY GREAT AND POSITIVE
PARTNERSHIP WITH THE FEDERAL
GOVERNMENT --
BUT BECAUSE WE WERE THE FIRST --
IN THE NATION WE WERE PROCESS
WITH THE FEDERAL GOVERNMENT AND
I'M SAYING THAT WITH SOME WHAT
OF A NICE WAY BUT IT WAS A
EXERCISE WILL PROCESS --
TO GET THE CONTRACTS APPROVED
THEY HAD TO GO NOT ONLY THROUGH
US AND GO THROUGH THE COUNTIES
AND BE APPROVED BY THE COUNTY
BOARD OF SUPERVISORS BUT THEN
THEY HAD TO GO BACK TO SEE EN
MASSE AFTER ALL OF THAT FOR
REVIEW AND APPROVAL --
SO AGAIN WANTING TO MAKE SURE
THAT IT'S RIGHT WANTING TO MAKE
SURE THAT IT IS SUCCESSFUL YOU
KNOW THERE HAS BEEN PARTNERSHIP
WITH THE FEDERAL GOVERNMENT IN
MAKING THAT HAPPEN --
I WOULD ALSO BE REMISS IF I
DIDN'T TALK ABOUT THE
PARTNERSHIP THAT WE HAVE WITH
OUTSIDE --
INTO T. SUCH AS THE CALIFORNIA
HEALTHCARE FOUNDATION THEY HAVE
BEEN EXCEPTIONAL PARTNERS AND
HELPING US DO THE THINGS THAT WE
NEEDED TO DO WITH THE COUNTIES
IN ORDER TO PROVIDE TECHNICAL
ASSISTANCE TO PROVIDE TRAINING.
TO PROVIDE RESOURCES AND
LEARNING COLLABORATIVE AND SO --
THIS HAS NOT BEEN IN AN ISOLATED --
VACUUM IN TERMS OF THE STATE AND
THE COUNTIES JUST OFF DOING
THEIR OWN THING IT HAS BEEN
PROVIDERS AS YOU HAVE HEARD IT
HAS BEEN COUNTIES IT HAS BEEN
THE CALIFORNIA HEALTHCARE
FOUNDATION --
IN YOUR PREVIOUS QUESTIONS
AROUND PREVALENCE --
I WOULD DRAW YOUR ATTENTION TO A
CH C. F. REPORT THAT WAS
ACTUALLY ISSUED LAST FALL AROUND
SUBSTANCE USE PROBABLY REDDING
CALIFORNIA AROUND PREVALENCE
STATISTICS.
I THINK WHAT I WOULD ALSO LIKE
TO HIGHLIGHT --
BECAUSE I THINK WE ACKNOWLEDGE
IT BUT IT'S IT GETS LOST IN THE
YOU KNOW CURRENT --
OPIOID DISCUSSIONS IS THAT.
THE SUBSTANCE THAT IS MOST ABUSE
IN ALL POPULATIONS AND SO YOU
KNOW WHERE WE CAN WE TRY VERY
HARD TO BUILD CAPACITY THAT IS
NOT --
SUBSTANCE SPECIFIC RIGHT SO YOU
KNOW WHAT YOU WILL HEAR FROM OUR
LEASE LATER ON IS THE THINGS
THAT WE'RE DOING WITH THE SO ARE
AND THE S. T. R. GRANT FUNDS --
ARE OBVIOUSLY HAVING TO BE
FOCUSED ON OPIATES BECAUSE
THAT'S WHAT THE FEDERAL GRANT
REQUIRES IT IS ALSO OUR
INTENTION IN DOING THIS THAT WE
ARE BUILDING CAPACITY.
FOR SUBSTANCE USE DISORDER
TREATMENT SERVICES PROBABLY READ --
THE ONLY OTHER THING --
THAT I WOULD WILL US LEAVE YOU
WITH IS NONE OF THIS WOULD HAVE
BEEN --
POSSIBLE WITHOUT THE STATE'S
WILLINGNESS AND ABILITY TO
IMPLEMENT THE AFFORDABLE CARE
ACT.
SO THE ENHANCE MATCH AROUND THE
MEDICAID EXPANSION POPULATION
FOR SINGLE CHILDLESS ADULTS THE
1100% AT THE START AND THEN
OBVIOUSLY WE HAVE BEEN FACING
DOWN AND IT WILL BE PERMANENTLY
DOWN TO A NINETY TEN MATCH --
MAKES THIS POSSIBLE FOR THE
COUNTIES THE STATE PAYS FOR THAT
10% -- OR
WHAT IS THE YOU KNOW 8% NOW OUR
WHATEVER FEES THAT WERE IN THE
COUNTIES AREN'T PAYING FOR ANY
OF THE OTIONAL EXPANSION NOR
ARE THEY PAYING FOR THE
RESIDENTIAL.
PORTION OF THE BENEFIT BECAUSE
THOSE COMPOST REALIGNMENT SO
AGAIN WE AS A STATE HAVE
PARTNERED WITH THE COUNTIES TO
MAKE THIS A SUCCESSFUL --
YOU KNOW ONGOING SERVICE
DELIVERY MECHANISM AND SO WE AS
A STATE HAVE BEEN OBVIOUSLY
COMMITTED TO WORKING CLOSELY TO
MAKE THAT --
A REALITY AND THEN LASTLY I
THINK -- TO
YOUR COMMENT DOCTOR WOULD NOT
INDICATED THAT THEY WANT TO BE A
PART OF THE WAIVER I'M IT IS
VOLUNTARY NATURE --
SO WE WE CAN'T FORCE THE COUNTY
TO PARTICIPATE ALTHOUGH WE HAVE
THINK WE HAVE ALSO AS A
DEPARTMENT REACHED OUT --
TO LIKE THE COUNTY MEDICAL
SERVICES PROGRAM BOARD I WENT IN
THE FALL AND DID APRESENTATION
TO THEM TO SAVE YOU KNOW SIMILAR
TO HOW YOU HAVE OPERATED THE
COUNTIES. SEVENTY NOT SEVENTEEN
THOUSAND OBLIGATIONS AS IT
PERTAINS TO HEALTH SERVICES FOR
THOSE THAT ARE NOT MEDICALLY.
I MEDI CAL ELIGIBLE.
I WOULD ENCOURAGE THEM TO THINK
IN A WAY THAT WOULD ALLOW THEM
TO OPERATE THE DRUG MEDI CAL
BENEFIT EITHER STATE PLAN OR
WAIVER IDEALLY WAIVER OBVIOUSLY
BUT STATE PLAN TO HELP THOSE
COUNTIES THAT DON'T HAVE THE
COMPLIANCE INFRASTRUCTURE --
TO EVEN MEET THEIR CURRENT --
OBLIGATIONS RIGHT ALPINE
STRUGGLES --
SOME OF THOSE OTHERS COUNTY
STRUGGLE AND HAVING --
A SINGLE ENTITY THAT IS FAMILIAR
TO THE COUNTIES TO HELP
ADMINISTER THAT BENEFIT WE THINK
WOULD BE A REALLY POSITIVE.
STEP FORWARD FOR HELPING THEM
NOT ONLY COMPLY WITH THE FEDERAL
REQUIREMENTS IN THE STATE
REQUIREMENTS AROUND PROVISION OF
SERVICES BUT ALSO MAKING SURE
THAT RESIDENTS IN THOSE COUNTIES
ACTUALLY ARE RECEIVING SOMETHING
AND SO.
YOU KNOW.
CERTAINLY INTERESTED IN
CONTINUING THE CONVERSATION WITH
THEM BUT I WILL --
I WILL CERTAINLY DIFFER TO
MARLEY SO LITTLE BIT MORE ON THE
DETAILS AROUND THE HUB AND SPOKE
AND OTHER.
AS HERE AND SO ARE GRANT SO
THANK YOU.
THANK YOU SO MUCH I THINK DOCTOR
PANAS HEARD ME SPEAK BEFORE JUST
KP THAT SHORT TIME.
SO -- I DO
WANT TO CALL YOUR ATTENTION TO
OUR HANDOUT THAT WE PROVIDED
ADJUSTED THERE'S BEEN A LOT OF
PROJECTS TODAY THAT HAVE NOT
BEEN MENTIONED BUT ON THE LAST
PAGE IS A LIST OF ABOUT THIRTY
PROJECTS THAT.
THE DEPARTMENT IS OVERSEEING
WITH OUR FEDERAL OP AWAY DOLLARS
AND I WANT TO HIGHLIGHT JUST A
FEW THAT HAVE COME UP TODAY SO
YOU'RE AWARE OF THAT THERE ARE A
LOT OF EFFORTS.
AROUND SPECIAL POPULATIONS AND
AND OTHER SPECIFIC AREAS I'M SO
I DON'T WANT YOU TO LEAVE TODAY
THINKING THAT THERE ISN'T WORK%
BEING DONE --
SO I'M GOING TO QUICKLY
HIGHLIGHT OUR TRIBAL ENMITY
PROJECTS I KNOW THAT HAS COME UP
QUITE A BIT TODAY --
SO WE'VE BEEN VERY FORTUNATE IN
WORKING NOT ONLY WITH THE TRIBES
TO THE URBAN AND THROUGH TRIBAL
COMMUNITIES WITH OUR WAIVER AS
WE'RE STILL WORKING ON REALLY
DESIGNING WHAT THAT LOOKS LIKE
FOR THAT POPULATION.
BUT ALSO AROUND OPIOIDS SO WE
HAVE QUITE A FEW PROJECTS I
WORKED WITH OUR TRIBAL COMMUNITY
I JUST WANT TO TALK ABOUT
QUICKLY I'M WITH SOME M. A. T.
CHAMPIONS THAT GO OUT IN ON TO
TRIBAL RESERVATIONS BUT ALSO
WITH THE URBAN CLINICS.
ARE WE HAVE A NATIVE PROJECT
ECHO WHICH IS A GREAT WAY TO
TEACH DOCTORS AND PHYSICIANS
ABOUT PRESCRIBING VIEW BUT WE
WANTED IT TO BE CULTURALLY
SENSITIVE SO IT'S BEING
DEVELOPED SPECIFICALLY. FOR THE
SO HOW ARE FUNDING SOME LOCAL
OPIOID COALITIONS WHERE OUR
TRIBES URBAN CLINICS CAN BE A
PART OF THE COUNTY.
I COALITION ORSTART THEIR OWN
AND THEY ACTUALLY KICKING OFF
THEIR FIRST NATIVE COALITION
THAT STATEWIDE --
THAT'S COMING UP NEXT MONTH THAT
WE'RE REALLY EXCITED ABOUT --
WERE ALSO DOING SOME VERY
SPECIFIC WORK BECAUSE DOCTORS
TALK WELL TO DOCTORS NURSES TALK
WILDER NURSES AND WE HAVE A
PHENOMENAL NURSE KATIE BELL THAT
GOES OUT. TO TRIBAL CLINICS AND
ACTUALLY HELP THEM SET UP AN
EIGHTY PROGRAMS AND WE HAVE SOME
UP IN HUMBLE INYO AND SOME OF
OUR OTHER.
AREAS SO THAT'S BEEN REALLY
SUCCESSFUL AS WELL I'M SO
THERE'S BEEN A LOT OF WORK AND
WITH OUR TRIBAL COMMUNITIES AND
THERE'S A TON MORE PROJECTS LIKE
IT'S SPEAK ABOUT WITH THEM BUT I
JUST WANT TO HIGHLIGHT THE
SPECIFIC WORK IS BEING DONE WITH
THEM.
NUMBER ALSO WITH THIS GRANT
FUNDING WHAT'S REALLY GREAT
ABOUT IT IS WE'RE ABLE TO TAKE
OUR WORK WITH OUR MEDICAL SYSTEM
AND GO BEYOND THAT --
SO THESE FUNDS CAN REACH INTO
JAILS SO WE HAVE A JAIL PROJECT
BECAUSE OUR FOLKS MOVE IN AND
OUT OF THE JUSTICE SYSTEM
SOMETIMES I'M SO WE'RE HELPING
JAILS WE HAVE TWENTY THREE
COUNTIES RIGHT NOW AND ANOTHER.
COHORT THAT STARTING WITH THE
JAIL PROJECT UNFORTUNATELY A LOT
OF OUR JAILS DO NOT PROVIDE
MEDICATION ASSISTED TREATMENT
THE REALLY HELPING THEM OVERCOME
THEIR BARRIERS --
THEY ARE LEARNING TRAINING
THEY'RE LEARNING FROM OTHER
JAILS BUT THEY'RE ALSO RECEIVING
SOME FUNDING TO ACTUALLY MAKE
THAT HAPPEN TO AT LEAST START.
ABOUT PROCESS WE ARE ALSO
WORKING WITH OUR HOSPITALS WE
HAVE A REALLY GREAT PROGRAM HERE
IN CALIFORNIA.
THE CALIFORNIA BRIDGE THAT'S
ACTUALLY RECEIVING NATIONAL
ATTENTION WHERE IT'S REALLY
HELPING EDIE AND HOSPITAL
SETTINGS ONCE AGAIN.
WHEN SOMEONE COMES INTO THOSE
SETTINGS NOT JUST LET HIM LEAVE
LINKING THEM INTO THE COMMUNITY
IN YOUR HEARD?
SPEAK ABOUT THAT EARLIER WITH
OUR HUB AND SPOKE SYSTEM SO WERE
ALSO -- WANT
TO TOUCH ON REALLY QUICK --
TO WERE JUST KICKING OFF A
RESIDENCY PROGRAM BECAUSE WHAT
WE HEAR TIME AND TIME AGAIN IS
UNFORTUNATELY A LOT OF OUR
PHYSICIANS LEAVE THE RESIDENCY
PROGRAM AND MAYBE A FOUR HOURS
OF TRAINING WITH SUBSTANCE USE
DISORDERS.
AND NUMBER EXPECTING THEM TO YOU
KNOW STAND UP AND AND GET A
WAIVER EIGHT OUR WAIVER TRAINING
SO MAYBE THEY'VE HAD A TOTAL OF
TWELVE HOURS OF TRAINING --
SO WE DON'T FEEL THAT THAT'S
ACCEPTABLE AND SO WE'RE REALLY
WORKING I'M GOING TO BE WORKING
WITH SOME RESIDENCY PROGRAMS TO
HELP.
UP THOSE HOURS AROUND SUBSTANCE
USE TO REALLY TRAIN OUR
WORKFORCE BETTER --
AND THEN THERE'S A TON OF
MENTORING PROJECTS TALKED ABOUT
THE C. SAM PROJECT --
BUT WHAT WE'VE HEARD TIME AND
TIME FROM POSITIONS WHY THEY'RE
NOT PRESCRIBING.
THEY DON'T HAVE THE TRAINING AND
THEY'RE THEY'RE SCARED THEY
DON'T KNOW HOW TO DO AN
INDUCTION THEY DON'T HOW TO WORK
WITH THE PATIENT.
SO REALLY WORKING ON MULTIPLE
LEVELS -- OF
DIFFERENT MENTORING PROGRAMS --
AND WITH THAT I'M JUST GOING TO
WRAP UP.
AND GET THE I..
THANK YOU VERY MUCH SO THAT
START WITH --
CHAIR WAS YOU SEE AND IT HAS TO
STEP OF OUT BRIEFLY A LITTLE THE
SHORTLY [inaudible]
WELL THANK.
QUESTION FOR YOU --
SOME OF THE MANPOWER SHORTAGES
IN ISSUES WERE TALKING ABOUT
TRAINING --
I'M GOING TO GUESS THAT IT'S I'M
SORRY THAT YOU'RE GONNA GUESS
THAT IT'S MORE DIFFICULT FOR
TREATING YOUTH THE YOUTH.
OF WILL IT IS BUT YOU KNOW KEEP
KEEP IN MIND THAT THESE
SPECIALLY REJECTION MEDICINE IS
RELATIVELY NEW SPECIALTY --
WE HAVE BEEN DOING THIS A LONG
TIME.
AND I'D I DIDN'T START OUT IN
ADDICTION MEDICINE NICER AND
INTERNAL MEDICINE ANESTHESIA DID
PAIN MEDICINE WHICH DIDN'T HAVE
A RESIDENCY TO SPEAK OF EITHER.
AND THEN RECOGNIZE THE
IMPORTANCE OF HAVING A SKILL SET
AN ADDICTION MEDICINE.
BECAUSE OF THOSE COMORBID
CONDITIONS --
THAT OVERLAP O TO TO A HIGH
DEGREE --
CHRONIC PAIN MANAGEMENT SERVER
AVAILABLE TO US AT THE TIME.
AND SUBSTANCE USE DISORDER.
AND AS A CONSEQUENCE OF THAT I
WON OFTEN GOT MEDICAL REVIEW
OFFICER TRAINING AND TRY TO GET
UP ON UP TO SPEED ON ON
BIOLOGICAL FLUID ANALYSIS
BECAUSE IT'S STILL AN EVOLVING
ART.
AND WHEN YOU START DOING THAT
POINT OF SERVICE --
DRUG TESTING YOU FIND OUT
THERE'S ALL KINDS OF STUFF GOING
ON THAT YOU'RE NOT GOING TO
CATCH ON A ROUTINE HISTORY AND
PHYSICAL EXAMINATION.
SO YOU HAVE TO DO THAT KIND OF
THING AND THEN AND THEN THE
COMPLEXITY OF THE MANAGEMENT
BECOMES GREATER.
WHO IS NOT AS SIMPLE AS JUST
PRESCRIBING A MEDICATION?
AND I THINK THE THE
INFORMATIONAL PACKET TO THE ALL
PROVIDED TO THE TION OF THE H.
SAM MULTI TIERED A CONTINUUM OF
CARE IS CRITICAL.
IS VERY IMPORTANT RECOGNIZE IT --
SUBS USES ORDERS A BRAIN DISEASE
AND LIKE ANY ANY DISEASE IT
REQUIRES MONITORING MANAGEMENT
CARE OVER THE OVER THE LIFE OF
THAT INDIVIDUAL TO COLLECTED
WHATEVER DISEASE ENTITY THAT MAY
BE.
IT REQUIRE THAT SKILL SET.
SO WHAT WE'RE TRYING TO DO IS
GET AS MANY PEOPLE AS POSSIBLE.
A INTERESTED IN AS TO THE WILL
HAVE TO LEARN OUTSIDE OF THE
STANDARD CURRICULUM MINUTES AT
THE VERY LEAST YOU WANNA RAISE
IT AS AN ISSUE WE ARE WHY YOUR
TRAINING IN IN ANY IN ANY
SPECIALTY.
IT DOESN'T MATTER --
WHETHER IT'S JANICE'S INTERNAL
MEDICINE FAMILY PRACTICE
PEDIATRICS IT DOESN'T MATTER.
IT IS A LIFE LONG --
DISEASE THAT AFFECTS PRETTY MUCH
EVERYBODY IN SOME WAY SHAPE OR
FORM SO IT IS SOMETHING THAT WE
NEED TO ENTER A SKILL SET.
AND I THINK SEIZE HIM IT'S BEEN
PARTICULARLY EFFECTIVE AT
DEVELOPING EVIDENCE BASED --
INFORMATION TO HELP --
IT WORK WITH OUR COALITION
PARTNERS AND EVERYBODY INVOLVED
WITH THIS PROCESS. TO TO MOVE
THE BALL AND SPOKE IS A
BRILLIANT IT'S REALLY GREAT THE
HUBS ARE --
LIKE FEDERALLY LICENSED IN A
MOST OF US AFTER PRACTICE LAN
ORANGE IN A FEDERALLY LICENSED
FACILITY.
WE'RE CERTAINLY HAPPY TO HAVE
THAT LEVEL OF EXPERTISE IN
ACCOUNTABILITY THAT WE CAN REFER
TO HE'S A REALLY REQUIRES A
NETWORK IT DOES REQUIRE VILLAGE
IN THIS IN THIS.
WE WERE WE REQUIRE IT AND
NETWORK OF FOLKS THAT WE CAN
WORK WITH. TO MANAGE THE
COMPLEXITY OF THIS ISSUE
[inaudible]
THANK YOU --
DIRECTOR CAN --
DO YOU JUST THE ACS ENVISION
THIS THESE SERVICES.
BEING A CARVED OUT ALWAYS BEING
CARVED OUT OR IS THIS SOMETHING
THAT.
WELL I THINK --
BASED ON THE TWO THOUSAND AND
ELEVEN REALIGNMENT --
THAT WAS DONE OBVIOUSLY BETWEEN
THE LEGISLATURE THE
ADMINISTRATION AND THE VOTERS --
THERE ARE CONSTITUTIONAL ISSUES --
THAT.
WOULD HAVE TO BE.
AS DISCUSSED --
IN TERMS OF TAKING.
YOU KNOW I KNOW THAT A LOT OF
PEOPLE TALK ABOUT THE CARVE OUT
ON THE MENTAL HEALTH SIDE BUT
OBVIOUSLY SUBSTANCE USE IS ALSO
CARVED OUT TO THE COUNTIES IN
TERMS OF RESPONSIBILITY AND I
KNOW THAT.
THERE'S BEEN A LOT OF INTEREST
AND INTEGRATING AND AND TAKING
THE BEHAVIORAL HEALTH ISSUES AND
PUTTING THEM IN WITH --
LARGER KIND OF PHYSICAL HEALTH
PROGRAM --
THE FUNDING IS A COMPLICATING
FACTOR FROM THE STANDPOINT THAT
THERE HAD THERE IS A
CONSTITUTIONAL --
THE VERSION OF FUNDING TO THE
COUNTIES FOR THESE SPECIFIC
ISSUES WHICH IS WHY THE ODS
WAIVERS VOLUNTARY --
SUCH THAT THE COUNTIES CAN OFTEN
I'M AND THEN THEY'RE USING THEIR
REALIGNMENT DOLLARS AND OTHER
FUN SOURCES --
TO DRIVE DOWN THE FEDERAL SHARE
IN ADDITION TO OBVIOUSLY
BLENDING IT WITH.
STATE GENERAL FUND FOR BENEFITS
THAT ARE OUR RESPONSIBILITY SO I
THINK.
THE WAY I APPROACH IT IS --
THE PATIENT SHOULDN'T SEE
THEMSELVES HATED AND THEY
SHOULDN'T SEE THEMSELVES AS
BEING IN A CARVE OUT BENEFIT AND
IT'S REALLY UP TO US AS A STATE
AND COUNTIES AND MANAGED CARE
PLANS AND PROVIDERS. TO FIGURE
OUT THE BACK AND INTEGRATION
ISSUES AND NOT MAKE THE
BENEFICIARY BE RIVER --
COGNIZANT OF THAT --
ESPECIALLY BECAUSE OF THE
CONSTITUTIONAL ISSUES AROUND
REALIGNMENT AND SOME OF THE
OTHER YOU KNOW KIND OF
HISTORICAL --
WAYS THAT WE HAVE HANDLED THE
DIVISION OF SERVICES BETWEEN
STATE AND COUNTIES [inaudible]
SO --
RECOGNIZE A PARTNERSHIP IS IS
TRYING TO ADMINISTER THE ODS
BENEFIT AND SEVERAL COUNTIES
HOW'S THAT GOING AND HOW DO YOU
SEE THAT GOING FORWARD.
SO OBVIOUSLY REPRESENTS THEY
THEY WORK WITH SMALL SOME OF THE
SMALL COUNTIES WHERE WE'RE
SEEING SOME OF THE TRACKS SOME
OF THESE CHALLENGES SO HOW DO
YOU SEE THIS GOING FORWARD SO I
PARTNERSHIP IS BEEN WORKING WITH.
EIGHT COUNTIES OF THEIR FOURTEEN
COUNTIES IN THEIR SERVICE AREA --
IT HAS BEEN CHALLENGING I THINK
WE HAVE SPENT A LOT OF TIME AND
THEY HAVE SPENT A LOT OF TIME --
TRYING TO WORK THROUGH RATE
ISSUES SO THAT HAS BEEN THE REAL --
CHALLENGE BECAUSE EACH COUNTY
HAS TO FUNDS.
THE OF THE PART OF THE RATE THAT
GOES TO PARTNERSHIP AND HOW DO
THEY SET THAT RAY AND THEN WE
HAVE TO LOOK AT THE RATE AND
MAKE SURE THAT IT'S APPROPRIATE
BEFORE IT GOES TO THE FEDERAL
GOVERNMENT FOR REVIEW.
AND THERE HAS JUST BEEN A LOT A
LOT OF COMPLEXITY AROUND THAT.
FUND SOURCE AND WHO'S PAYING FOR
WHAT AND AND IS IT IN THE RATE
AND HOW DID YOU KNOW IT HAS BEEN
A WORK IN PROGRESS --
I THINK THAT WE HAVE MADE SOME
GOOD --
HEADWAY --
FROM THE LAST I HEARD WE THINK
WE MAY GO WITH THEM --
I THINK THAT THE OTHER
ALTERNATIVE IS THE ONE THAT I
MENTIONED EARLIER CMS P. WOULD
ALSO IN CAPSULE LATE THOSE
COUNTIES IF THE FOR WHATEVER
REASON THE PARTNERSHIP --
PROCESS DOESN'T PLAY OUT PLUS
THE CMS P. HAS A BROADER NETWORK
OF COUNTIES THAT ARE NOT IN CAP
SLATED IN THAT PARTNERSHIP
ARRANGEMENT BUT I THINK WE'RE
TRYING AS MUCH AS POSSIBLE. TO
EITHER PUSH FOR REGIONAL
APPROACHES OR TO PUSH FOR A MORE
INTEGRATED WEIGH EVEN --
AS YOU KNOW AS I SAID TRYING TO
DO THE BACKEND INTEGRATION WITH
EACH OTHER RATHER THAN MAKING
THE BENEFICIARY BE PART OF A
BIFURCATED SYSTEM.
GOOD SO WHAT HAPPENS IF THE
FUNDING RUNS OUT [inaudible]
WHO?
I HAD A ONE ANSWER THAT QUESTION
[inaudible]
OKAY.
I PREFER TO LIVE IN THE REALITY
THAT WE HAVE TODAY WHICH IS WE
HAVE FEDERAL FUNDS WE HAVE STATE
FUNDS WE HAVE LOTS OF RESOURCES
AND WE ARE MAKING PROGRESS AND
AND TO THE EXTENT THAT THAT
CHANGES IN ANY WAY --
I WILL.
DEFER TO YOUR WISDOM
[inaudible]
OKAY.
I I WOULD.
I WILL ASK ONE REALLY REFRESHING
YOU MENTIONED A LOT OF
COLLABORATION CHS HAVE.
YOU DIDN'T MENTION THE PH SO WAS
THAT WAS AT ASSUME THERE'S
CORPORATION WITH PEOPLE
ABSOLUTELY NO I WAS TALKING JUST
AS IT PERTAINS TO LIKE ODS
WAIVER.
THERE HAS BEEN A LOT OF WORK
ACROSS THE STATE DEPARTMENTS OF
OTHERS AS IT PERTAINS TO THE
OPIOID COALITION WE HAVE BEEN
WORKING WITH THE PH ON SOME OF
THE USE OF THE S. T. R. AND SO
ARE GRANTS.
THAT HELP THEM DO SURVEILLANCE
AND MONITORING --
I THINK WE'RE VERY PROUD AND WE
USE IT -- A
LOT IN TERMS OF THE DASHBOARD
THAT THEY HAVE CREATED IN TERMS
OF ALL OF THOSE --
REALLY HELPFUL WAYS FOR HOW WE
SO A LOT OF THE THINGS THAT ARE
LEASES DONE IN TERMS OF THE VERY
TARGETED PROJECTS.
HAVE BEEN DRIVEN BY THE FACT
THAT WE CAN LOOK AT THE DATA
THAT THE DEPARTMENT OF PUBLIC
HEALTH IS PUT UP ON THEIR OPA
DASHBOARD TO SAY WHERE ARE
HIGHEST.
RISK COUNTIES AND YOU KNOW
OBVIOUSLY AS YOU KNOW THERE UP
IN THE UPPER NORTH BUT I THINK A
LOT OF WORK IS GONE IN WITH THEM.
AROUND --
ACADEMIC DETAILING AND THERE'S
SOME OTHER PROJECTS THAT WE HAVE
BEEN COLLABORATING WITH THEM ON
AND THEN OBVIOUSLY WE'VE BEEN IN
CONVERSATIONS WITH THEM AROUND.
PROP SIXTY FOUR AND YOU KNOW WE
HAVE COLLABORATION THAT IS BEING
BUILT THERE AS WELL.
AND I MENTIONED THAT --
THE P. H. WAS THERE BECOMING UP
LATER -- AS
WELL SO LOOKING FORTY HEARING
FROM THEM ALSO APPRECIATE --
BUT BOTH SWISS AND DISCOUNT THE
PREVIOUS PANEL THAT ALTHOUGH OUR
FOCUS IS OFTEN OPIOIDS IT REALLY
IS ABOUT SUBSTANCE USE.
TREATMENT RIGHT --
ITSELF.
OKAY CERTAINLY ONE BUT WE'VE
ALSO HERE DOES A SHIFT FROM
OPIOIDS TOWARD.
THAT AS WERE CLAMPING DOWN
OPIOIDS TOWARD MATH AND
SEPTEMBER.
MCCARTY.
I WANTED TO FOLLOW UP ON DOCTOR
WOULD QUESTION ABOUT FUNDING BUT
I JUST WANTED TO ASK ABOUT YOU
AND THE AND THAT THE WORK FORCE
AND THEN THE PROVIDERS I KNOW WE
HAVE A GRAY CAT HE INTEREST
RIGHT HERE AND AND JUST TO JUST
LEFT THE ROOM SO DON'T.
ALWAYS IN A POINT AT THEIR
PROFESSIONALS BY --
BUT AS FAR AS YOU KNOW THEN
BEING ABLE. TO TO FOCUS ON THE
TREATMENT SIDE THE X. WAIVERS
NOT ALWAYS --
READILY AVAILABLE AND NOR TO
PEOPLE IN THE PROFESSION.
HAVE THAT TRICK TRAINING IF YOU
ASK PEOPLE IN ON THE STREET
ABOUT THIS ISSUE THOUGH FIVE
SCRATCH THEIR HEAD RELATED SO
EASY FOR SOMEONE TO PRESCRIBE.
BY COULD IN OXYCONTIN SO FORTH
BUT SO DIFFICULT FOR THEM TO
PRESCRIBE.
THE MEDICATION TO GET OFF OF
THEIR ADDICTION SO --
HAVE WE SEEN ANY ANY CHANGE TO
THAT I KNOW WE WE WORK TO
LEGISLATION LAST YEAR AND SENATE
HEALTH CLAIM ASSEMBLY HEALTH
COMMITTEE HELPS GET ACROSS THE
FINISH LINE TO ADDRESS THAT.
SO IS THERE ANY.
ANY REASON TO BE OPTIMISTIC THAT
WE'RE SEEING MORE PEOPLE IN THE
WORK FORCE.
READY TO STEP UP FROM THE STREET
INSIDE.
YEAH SO YOU BROUGHT UP SOME
EXCELLENT POINTS AND JUST TO BE
CLEAR FOR THOSE THAT AREN'T
AWARE OF THE X. WAVERED AS A
FEDERAL REQUIREMENT --
AND SOME OF THOSE DISCUSSIONS
HAVE BEEN BROUGHT FORWARD BY
VARIOUS STATES QUESTIONING WHY
CAN ANY DOCTOR PRESCRIBED AN
OPIOID THAT'S HIGHLY ADDICTIVE
BUT YOU HAVE TO GO THROUGH
SPECIALIZED TRAINING TO PROVIDE
THE SOLUTION --
SO I KNOW THERE'S BEEN A LOT OF
TALKS ON THAT IS A FEDERAL ISSUE --
THAT BEING SAID WE'RE WORKING
WITHIN THOSE PRE THE OTHER
PROJECTS I HAVEN'T MENTIONED
THAT WE'RE DOING SOME.
LARGE MIT WORK FOR SUMMITS --
THIS SUMMER THAT ARE FREE OF
CHARGE CAN GET SEE USE SOME
FOLKS CAN COME IN AND LEARN
ABOUT HOW TO PRESCRIBE MATC --
THE TRAINING FOR PEOPLE MORPHINE
IS NOW YOU CAN ACTUALLY GET IT
ONLINE FOR FREE SO WE'RE MAKING
SYSTEMS AWARE OF THAT --
WE'VE EEN DOING A LOT OF WORK
WITH PRIMARY CARE PROVIDERS
HELPING THEM INCREASE THE NUMBER
OF PRESCRIBERS --
BUT WHAT WE'RE FINDING AND OTHER
STATES HAVE FOUND IS IT'S ONE
THING TO GET AN AXE WAIVER
THAT'S GREAT THAT DOESN'T THAT
REALLY ISN'T A SOLUTION IT'S
PART OF IT.
IT'S PROVIDING THAT MENTORING
AND TRAINING AROUND SO THAT
FOLKS ARE FEELING COMFORTABLE --
TO PRESCRIBE SO WE HAVE TONS OF
DIFFERENT PROGRAMS AROUND THAT
EVEN I'M HAVING DOCTORS GO OUT
PHYSICALLY ON SITE TO NEW
PRESCRIBER AND HELPING THEM
WE'RE ALSO GOING TO BE DOING A
BIG SURVEY OF ALL THE X. WAVERED
PROVIDERS IN CALIFORNIA.
WHY ARE YOU NOT PRESCRIBING WHAT
YOUR BARRIERS WHAT DO YOU NEED
HELP WITH I'M SORRY TAKING A
MULTI PRONGED APPROACH --
AND PUBLIC HEALTH IS GOING TO
TALK ABOUT IT AND THEY'RE GOING
TO HIGHLIGHT THE COLLABORATION
OF VARIOUS STATE DEPARTMENTS AND
CALIFORNIA THAT THE WORKING
TOGETHER.
ON A DIFFERENT EFFORTS --
SO LET THEM I WANT TO STEAL
THEIR THUNDER --
BUT WE HAVE BEEN WORKING WITH
BROAD DIFFERENT SECTORS OF STATE
DEPARTMENTS IN THIS AREAS AS
WELL OF HOW CAN WE GET MORE
FOLKS -- TO
STEP UP AND I DO JUST WANT TO
QUICKLY RELEASE THIRTY SIX
THOUSAND FOLKS INTO THE
COMMUNITY EVERY YEAR I'M WORKING
ON HOW TO LINK THEM TO OUR WAY.
FOR BUT THEY'RE ALSO TAKING A
VERY BROAD STEP FORWARD AND IF
ANNOUNCED THAT --
IN THE FALL OF LAST YEAR HOW
THEIR GO RE DESIGNING THEIR
WHOLE STD SYSTEM BUT THEY'RE
LOOKING TO WHAT WE'VE DONE IN
THE WAIVER THEY'RE GONNA REQUIRE
A STAMP BUT REALLY GETTING A
COORDINATED SYSTEM OF CARE. FOR
INDIVIDUALS IN CALIFORNIA
REGARDLESS OF PAYMENT SOURCE IF
THEY HAVE A SUBSTANCE USE
DISORDER.
OKAY THANK YOU ENOUGH FOR
DIRECTOR CAN'T BACK TO DOCTOR
WOODS QUESTION ON THE FUNDING
AND YOU'RE SAYING WE'RE VERY
HOPEFUL THAT WE WON'T HAVE TO
LOOK FOR IT EITHER.
A SOURCE AND YOU KNOW STATE
FUNDING IN IN THE IN THE BUDGET
OF COURSE IS MORE TIGHT THIS
YEAR BUT EVEN IF IT WAS LAST
YEAR THERE ARE STILL SO MANY
OTHER PRIORITIES THAT.
THAT WE KNOW WHAT THE TO FOCUS
ON AS WELL.
SO SO THAT BEING SAID IN THIS.
IN THIS --
IS THIS YOUR YET OUR POINT
YEAH SURE YES YES IT IS THAT
THERE'S THERE'S TWO POTS OF
MONEY HERE ONE IS THAT THE
TARGET A RESPONSE.
HE SAID ONCE THE THANK THE
GRANTED CELL ONCE NINETY MILLION
OVER TWO YEARS AND ONCE ONE
FORTY OVER TWO YEARS AND SO --
THAT THE WORK THAT WE HEARD ON
THE PRIOR PANELS ESSENTIALLY IS
AS PART OF THIS YES --
FUNDING STREAMS OUT IF IF THIS
WENT AWAY ALL OF THAT --
POTENTIALLY WOULD BE A
SIGNIFICANT AMOUNT OF THE WORK
HAT MARLEY SPOKE TO IN TERMS OF
ALL THE PROJECTS AND HUB AND
SPOKE AND THE NALOXONE
DISTRIBUTION.
THAT IS ALL BEEN FUNDED BY THOSE
TWO FEDERAL GRAY BUDGET THAT WAS --
ANNOUNCED EARLIER THIS WEEK THAT
WAS ONE OF THE POSITIVE THINGS
IN THE BUDGET --
IS IN USE IT IN THE SENATE IT
EXTENDS FUNDING FOR MULTIPLE
YEARS IT HAS A VARIETY OF
OPTIONS FOR STATES TO USE AROUND --
WOMEN WITH OPIOID DISORDER SO I
THINK WE'RE STILL KIND OF
UNPACKING THE THE DOCUMENT TO
SOMEHOW DETAIL AND SOME DIDN'T
BUT WE HAD BEEN --
ADVISE THROUGH OUR CONTACTS OF
THE FEDERAL GOVERNMENT THAT THEY
WERE LIKELY TO EXTEND THE GRANT
FUNDING --
FOR MULTIPLE YEARS AND SO THAT
JUST MEANS THAT --
OUR LEASE HAS TO THINK OF MORE
PROJECTS --
TO FUND IN THE STATE SO IT'S A
CRITICAL RESOURCE IT WILL COME
TO AN END AT SOME POINT BUT FOR
NOW THERE'S MULTIPLE YEARS OF
GRANT FUNDING.
AND SOMETIMES WHEN STATES DON'T
SPEND THEIR ALLOCATION THEY WILL
GO BACK TO OTHER STATES AND SAY
DO YOU WANT ANOTHER YOU KNOW DO
YOU NEED US AND SO THERE'S
OFTENTIMES REALLOCATION OF UNDER
SPENT FUNDS AND THEN.
THE FUNDING AROUND MEDICAID
OBVIOUSLY IS SO CRITICAL BECAUSE
IT'S AN ENTITLEMENT PROGRAM AND
FOR EVERY DOLLAR THAT WE PUT IN
AS A STATE --
WE GET A DOLLAR FROM THE FEDERAL
GOVERNMENT FOR WHATEVER THOSE
SERVICES NEED TO BEAND SO
THAT'S KIND OF MORE OF MY THAT'S
THE PART THAT IS MUCH HARDER TO
MAKE UP OBVIOUSLY IF THERE'S A
FEDERAL CHANGE OF THAT KIND OF
FUNDING.
SO BESIDES POTENTIALLY LOSING IT
RIVERSIDE.
AND THE OTHER.
ONE LOS ANGELES THE IDEA THAT
PEOPLE SLIPPING THROUGH THE
CRACKS.
THAT THERE IS --
A LOT OF PEOPLE THAT ARE
BENEFITING BUT A LOT OF NEED OUT
THERE SO IS THERE ANY --
QUANTIFIABLE INFORMATION AT THAT
TALKS ABOUT HOW MUCH MORE.
IS IS NEEDED TO TO BASICALLY --
AT WRAP UP THE PROGRAMS THAT WE
ALREADY YEAH SO I HAVE.
I HAVE SOME OLD DATA --
THAT HASN'T BEEN UPDATED SINCE
LAST TIME I PULLED IT BUT JUST
FROM A MAGNIFICATION OF FUNDS --
I'LL USE RIVERSIDE LOS ANGELES
OBVIOUSLY BECAUSE THEY TESTIFIED
SO BASED ON WHEN WE RAN CLAIMS
AND DOLLARS --
FOR RIVERSIDE THEY PUT IN TWO
POINT ONE MILLION OF THEIR OWN
MONEY -- THE
STATE PUT IN FOUR POINT.
FIVE AND THEY DREW DOWN TWENTY
SIX MILLION AND FEDERAL FUNDS
AND DELIVERED THIRTY THREE
MILLION DOLLARS FOR THE SERVICES.
SO FOR TWO POINT ONE MILLION
THAT RIVERSIDE PUT IN THEY GOT
THIRTY THREE MILLION DOLLARS
WORTH OF SERVICES THE
MAGNIFICATION.
OF THOSE DOLLARS IS WHAT HAS
BEEN SO CRITICAL AND I THINK
THAT THAT CERTAINLY WHAT THE
COUNTY IS REFERRING TO IS IS.
THE CREATION OF THIS DELIVERY
SYSTEM ALLOWS THEM THE CAPACITY
TO BE ABLE TO TAKE PEOPLE WHEN
THEY COME AND SAY I NEED HELP.
THAT IT USED TO BE WELL I DON'T
HAVE YOU KNOW I HAVE A SUBSTANCE
ABUSE BLOCK GRANT AND IT'S ONLY.
YOU KNOW EIGHT HER THOUSAND
DOLLARS A YEAR AND I CAN'T FIND
ANYTHING ELSE AFTER THAT.
THIS BASICALLY SAYS FOR EVERY
PERSON THAT COMES TO THE COUNTY
AND SAYS I'M A MEDICARE
RECIPIENT I MEET MEDICAL
NECESSITY CRITERIA THE COUNTY
HAS A PLACE FOR THEM AND THEY
HAVE A FUN SOURCE THAT GOES TO
TOWARDS THAT I MEAN LOS ANGELES --
ON THE STATE AND THEY PUT IN TEN
MILLION OF THEIR OWN MONEY.
EIGHT POINT FOUR MILLION IN
STATE GENERAL FUND SIXTY MILLION
AND FEDERAL FUNDS SO FOR TEN
MILLION INVESTMENT BY THE COUNTY
THEY GOT EIGHTY MILLION DOLLARS
WITH THE SERVICES --
AND SO THAT HAS BEEN --
THAT CANNOT BE --
UNDERSTATED IN TERMS OF HOW
IMPORTANT IT IS TO HELP YOU MEET
THE NEED AND AGAIN YOU HAVE TO
GET PEOPLE IN THE DOOR AND THEY
HAVE TO KNOWLEDGE THAT THEY HAVE
A PROBLEM AND I THINK THAT WAS
CERTAINLY PART OF THE TESTIMONY
FROM THE PREVIOUS PANELISTS
THERE'S A SIGNIFICANT.
PART OF THE POPULATION THAT
DOESN'T FEEL THAT PUT ALL THE
MECHANICS AND PLACE THAT WHEN
THEY DO COME TO THAT REALIZATION
EITHER THEIR FAMILY OR THEY YOU
KNOW WE HAVE TWENTY FOUR THEIR
REQUIRED TO HAVE TWENTY FOUR
HOUR CALL LINES THEY'RE SUPPOSED
TO HAVE.
YOU KNOW ALL YOUKNOW THE
APPEALS AND GRIEVANCES AND YOU
KNOW ALL THE DIFFERENT PROCESSES
OF A MANAGED CARE PLAN THE
COUNTIES HAVE BEEN FORCED TO
REALLY.
UP THERE ADMINISTRATIVE
INFRASTRUCTURE TO DEAL WITH BOTH
THE NEEDS OF THE POPULATION BUT
ALSO TO MAKE SURE THAT WE'RE
GETTING THE RIGHT DATA AND THAT
THE RIGHT NETWORK IS IN PLACE TO
BE ABLE TO SERVE ALL THE THE
NEED WITHIN THAT WAIVER SYSTEM
[inaudible]
THANK YOU.
THANK YOU AND FEW QUESTIONS AS
WELL -- SO --
DUTCH SNUCK --
WE HEARD A LITTLE BIT ABOUT SO.
YOU'RE DOING TRAININGS WERE
FRIGHTENING MENTORSHIP --
WE STILL HAVE PHYSICIANS WHO ARE
NERVOUS RIGHT NOW AND AND
HOPEFULLY YOU KNOW WITH THE
MENTORSHIP AND THE TRAINING AND
MAYBE WE NEED A LOT MORE
TRAINING AND ATTENDING CCM
CLASSES.
HOW HOW BIG OF A PROBLEM IS THIS --
THE FDA OVERSIGHT ME CLEARLY
FDA'S FEDERAL BUT IS DEL THE FDA
THE MEDICAL BOARD AND RAISES THE
FIVE WITH.
A PRE IN THE PREVIOUS QUESTION
BUT HOW HOW BIG OF A OF AN ISSUE
IS.
PROVIDE --
MATT I MEAN IS IS THIS.
THERE'S MORE WE NEED TO DO TO
TRY TO REASSURE THEM THAT.
THEY'RE DOING YOU KNOW I'LL TELL
YOU AS A PROVIDER THAT THEY
RECKON FORSMAN AGENCY IS ON
WATER AVENUE AND I'M ON BELL
STREET.
AND I DID HAVING COME KNOCK ON
THE DOOR AND ASKED ME SOME
QUESTIONS --
BECAUSE A NET IN NEXT
DESIGNATION.
AS A GREAT PAIN SPECIALS ARE
PREDOMINATELY PRESCRIBE.
OPIATES FOR PAIN MANAGEMENT AND
SO MY USE OF BUPRENORPHINE
PREDOMINATELY IS FOR PAIN
MEDICINE NOT SO MUCH FOR
ADDICTION TREATMENT.
ALTHOUGH A I AM INVOLVED WITH
ADDICTION TREATMENT IN A VARIETY
OF OTHER VENUES --
THEY'RE NOT NECESSARILY THE SAME
DISEASE.
BUT IN IN MINE --
PRACTICE OF PAIN MEDICINE --
THROUGH A VARIETY OF THINGS YOU
SEE GUIDELINES OF WRITING THINGS --
THERE'S BEEN A MOVEMENT TO
REDUCE MORPHINE EQUIVALENT OF CG
AND CO PRESCRIBE MEDICATIONS IS
SO THE THE SUBSTITUTE DRUG DO
JURY IS.
AN ORPHAN.
AND THE BARRIER TO ACCESS TO
THAT IS THE COST --
AND ACCESSIBILITY --
AND THE OTHER THING IS TO BE
OPEN OR FOR MY CALL THE
CONTROLLED SUBSTANCES ARE ARE ON
THE DATABASE SNEAKERS DATABASES
HOUSING DEPARTMENT OF JUSTICE.
AND AS YOU KNOW IS BEING --
MIND BY --
FORSMAN.
AND THE MEDICAL BOARD OF
CALIFORNIA THERE'S A CORNERS
PROJECT IT'S ON GOING TO TO READ
CORRECTIVE ASSESSMENT OF YOUR
STATUS [inaudible]
SO.
MOST PEOPLE WOULD WANT TO BE A
LITTLE ADVERSE TO RISK.
AND THERE'S CERTAINLY RISK
INVOLVED WITH PRESCRIBING A
CONTROLLED SUBSTANCE RECALL WAY
BACK IN THE DAY WHEN.
BEFORE WEHAD TRIPLICATE
PRESCRIPTIONS SO FAR BACK CARGO.
IN ONLY A THIRD OF THE ELIGIBLE
PRESCRIBING PHYSICIANS IN
CALIFORNIA EVEN EVEN HAVE THEM
LET ALONE USE THEM SO IS A
CONVENIENT EXCUSE NOT TO
PRESCRIBE AT ALL.
CHAU.
IT IS AN ISSUE IN A AND I THINK
VIRTUES AND MORE IMPORTANTLY A
NETWORK THAT IS MORE OR LESS IN
AGREEMENT WITH HOW WE MANAGE
THESE PATIENTS ARE BE MORE
COMFORT.
WHAT YOU DON'T WANT IT WOULD
WHAT HAPPENS ALL TOO OFTEN I IN
OF ALWAYS BEEN KIND OF A
TERTIARY CARE?
PROVIDER BECAUSE I'M KIND OF THE
LAST QUARTER RESORT FOR PATIENTS
WITH PAIN DISORDERS.
WHAT HAPPENS YOU GET VERY LONELY
ISSUE IS YOUR PRACTICE DEVELOPS
AND COMPLEXITY?
WHICH I WHAT I LIKE THAT BUT
IT'S NICE TO HAVE REFERRAL
SOURCES AND BE DIMINISH FOR HELP.
IN THIS PARTICULAR ISSUE
SUBSTANCE USE DISORDER WHICH
ISSUED WE'RE TALKING BOUT
OPIOIDS BUT AS I JUST STATED.
WHEN I TO YOUR DRUG SCREENING
INTO QUANTITATIVE ANALYSIS I
FIND ALL KINDS OF A CALLED
ALCOHOLISM MORE THAN ANYTHING
ELSE?
AND I FIND A LOT OF WELL YOU
KNOW CHICHI POSITIVITY BUT I
ALSO FIND A LOT OF
METHAMPHETAMINE.
DOES NOT DOES NOT EXPECTED
OWNERS OFTEN FIND HER WHEN OR
FAT NO THAT TYPE STUFF BUT IT
TELLS ME THAT THE THE SUBS ABUSE
COMMUNITY IS MUCH BROADER THAN
WHAT WE'RE ADDRESSING AND THAT'S
GOING TO REQUIRE MORE OF THIS.
TO TO WAKE UP TO THAT REALITY
INCORPORATE THAT INTO OUR
PRACTICES.
SHOW I THINK I THINK THE DRUG
ENFORCEMENT AGENCY WE'RE ON THE
SAME SIDE WE DON'T WANT TO LIST
YOUR SOME MEDICATIONS BUT WE DO
WANT PEOPLE. TO HAVE --
BE ENCOURAGED TO HAVE AND THE
TREATMENT FOR THOSE THAT ARE
CAPABLE OF DOING SO REDUCE THE
STIGMA AS MUCH AS POSSIBLE ONCE
WE ESTABLISH THAT THIS IS A
DISEASE.
AN H. B. MANAGERS SUCH A
REQUIRES LONG TERM CARE AND
MULTIFACETED APPROACH AND THAT'S
WHY I WANTED ONE OF THE BARRIERS --
FOR PRIMARY CARE PROVIDERS IS
THE HOW CAN OVER FOR THIS
PATIENT ON HOW CAN I I DON'T
WANT TO BE THAT YOU KNOW THAT
THE DRUG TREATMENT SPECIALIST BY
MYSELF I WANT TO HAVE A A TEAM.
THE COMMITTEE A GROUP OF PEOPLE.
OF THE CALL USE THAT SWITCH HATS
SINCE YOUR LEADER IN CMA SO WHAT
IS THE MEDICAL COMMUNITY WHAT'S
CMA DOING TO TRY.
TO WELL SUITED ONLY TO HELP THE
MEDICAL COMMUNITY I SHOULD BE
ACT WORKED DISAPPEAR THE
CALIFORNIA MEDICAL ASSOCIATION
IS FORTY FIVE THOUSAND
PHYSICIANS UP AND DOWN THE STATE
OF CALIFORNIA AND WE AS SPEAKER
OF THE HOUSE --
YOU KNOW WE'RE INVOLVED WITH THE
ANNUAL HOUSE OF DELEGATES TO THE
DISCUSSES MAJOR ISSUES.
A MAJOR ISSUES HAVE INVOLVED
THESE VERY TOPICS OPIOIDS --
AND THAT SORT OF THING HAVE BEEN
MAJOR ISSUES CALIFORNIA MEDICAL
ASSOCIATION HAS BEEN OF FORWARD
WITH THE DEVELOPMENT OF THE OP
TREATMENT GUIDELINES FOR THE
MEDICAL BOARD OF CALIFORNIA
WHICH I WOULD LIKE TO EMPHASIZE.
TAKES INTO ACCOUNT SPECIFIC
POPULATIONS OF INDIVIDUALS AND
BRACING THE CONCEPT THAT ONE
SIZE DOES NOT FIT ALL.
THE BEST MEDICAL MANAGEMENT IS
ONE PATIENT AT A TIME
INDIVIDUATED CARE FOR THAT
PATIENT.
THAT'S THE UNDERLYING THEME OF
HOW WE APPROACH THINGS I WOULD
NOTE THAT THE CDC GUIDELINES OR
DIRECTED AT THAT A AND A MORE
GENERAL PRIMARY WHAT WE WHAT
WE'RE DOING IS DOING EVERYTHING
WE CAN. TO BRING THIS
INFORMATION FORWARD --
AND ONE OF THE REASONS I'M HERE
TODAY IS IS --
MY PARTNERSHIP AS AS A LEADER IN
CALIFORNIA MEDICAL ASSOCIATION
WITH.
A IN CALIFORNIA CITED ADDICTION
MEDICINE AND THE LARGER ENTITY
AMERICAN SOCIETY OF ADDICTION
MEDICINE.
AND ALL THE VARIOUS PLAYERS AND
FALL THE PAIN MANAGEMENT
COMMUNITY INTERVENTIONAL PAIN
MANAGEMENT COMMUNITY. TO BRING
US TOGETHER SO WE'RE KIND OF
TALKING ON THE SAME PAGE AND AND
NOT.
KNOW THAT OLD ADAGE ABOUT YOU
KNOW WHAT PART OF THE ANIMAL ARE
YOU YOU'RE TRYING TO DESCRIBE.
IT'S IMPORTANT WE HAVE A
CONVERSATION IS SOMEWHAT UNIFIED
THEY WERE IN AGREEMENT WITH AS
WE MOVE FORWARD IF WE'RE GOING
TO GET TO WHERE WE NEED TO GET.
THAT'S WHAT CALIFORNIA MEDICAL
ASSOCIATION BRINGS EVERYBODY
TOGETHER UNDER ONE ROOF SO WE
CAN HAVE THESE DISCUSSIONS.
AND THE DOCTOR CONNELLY --
THE YEAH WE'VE HEARD FROM DIRECT
CAN'T ALL RIGHT THE THAT'S THE
ANY SAMPLES WERE THE ONES HERE
RIGHT RIVERSIDE LA YOUR LA.
BUT THEN WHAT ABOUT ALL THE
OTHER COUNTY SO YOU'RE HERE ALSO
REPRESENT BEHAVIOR HEALTH
DIRECTORS ASSOCIATION YOU'RE ON
THE GOVERNING BOARD --
WE WE ALSO HEARD ABOUT --
AT LEAST FROM.
NOW THIS IS THE NOW --
ABOUT --
SOME ISSUES ABOUT.
WELL YOU KNOW YOU THROUGH
CERTIFICATION FOR DIFFERENT
COUNTIES AND SO TYPICALLY VOEPEL
IS A REALLY BIG COUNTY.
THE PRIDE JUST THAT CLUB THAT
YOU KNOW WHEN YOU'RE ON THE ROAD
WE PROBABLY HAVE A NETWORK FOR
YOU INVOLVE MULTIPLE COUNTIES
RATE AND SO FORTH AND SO AWARE
TO THINGS THAT.
COUNTIES ARE LOOKING AT IN TERMS
OF TRYING TO WELL WE HEARD
STANDARDIZED MEDICAL NECESSITY
ACROSS COUNTIES AND THAT MAY BE
A QUESTION FOR DOCTOR CAN ALSO
AS WELL --
TRYING.
TO THE STANDARDIZED
CERTIFICATION SO THAT YOU CAN
ACTUALLY OPERATE MULTIPLE
COUNTIES IS THAT HAVING.
TO RECERTIFY OVER AND OVER AGAIN
FOR DIFFERENT COUNTIES --
AND ALSO WHAT HOW DO WE MOVE SO
DO YOU HAVE THAT PIECE OF IT AND
THEN ALSO WE WE HEARD RIVERSIDE
SO WE ARE THE AVERAGE OF 7%
ACCORDING TO EVALUATORS
RIVERSIDE CLAIMED 80% INCREASE I
DON'T KNOW LA WAS BUT HOW WE GET
EVERYONE UP TO THAT.
EIGHTY FOR THIS IS THE 7% THAT
WE HAVE STATEWIDE AND WHAT CAN
WE DO.
TO TAKE WHAT YOU'RE DOING AND LA
LAW DOING RIVERSIDE AND GET
OTHER COUNTIES TO DO THE SAME
THING SO THERE'S A LOT.
OF SEVERAL QUESTIONS ABOUT THE
OTHER -- SO
I'LL SPEAK TO THEM IN ORDER I
THINK WITH REGARD TO MEDICAL
NECESSITY ODS REALLY DOES
PROVIDE A SOLUTION TO THAT BY
REQUIRING.
THE AMERICAN SOCIETY OF
ADDICTION MEDICINE CRITERIA TO
BE INCORPORATED IN THE
ASSESSMENT SO THAT IS ONE ROUTE
TO TAKE --
AND I THINK ONE WAY FOR COUNTIES
TO REALLY STANDARDIZE THE WAY
THAT THEY'RE APPROACHING A
PLACEMENT ACROSS THE CONTINUUM
OF CARE IN A SPECIFIC LEVEL OF
CARE WITH REGARD TO
CERTIFICATION. FOR FACILITIES
THAT ALSO WAS HANDLED AT THE
STATE LEVEL THROUGH PROVIDER
ENROLLMENT AT DH CS.
THOUGH I THINK MISTER SIN ELLA
ONE OF THE ISSUES THAT HE'S
TALKING ABOUT IS THAT.
WHEN WHEN OUR CONTRACT?
THE PROGRAM AUDITOR'S FROM FROM
THE COUNTY GO IN AND LOOK AT ALL
OF THE DIFFERENT STAFF IN THOSE
FACILITIES WE MAKE SURE THAT
THEY'VE RECEIVED TRAINING ON THE
SAME CRITERIA.
THEY RECEIVED ALL OF THE
DIFFERENT REQUIRED --
EDUCATIONAL MODULES THAT THAT WE
WOULD REQUIRE IN THE STATE WOULD
REQUIRE UNDER CONTRACT.
SO THAT'S I THINK THAT'S MORE
WHAT -- WHAT
HE SPEAKING TO WITH REGARD
RIDLEY I THINK THERE COULD
EVENTUALLY BE THE POSSIBILITY OF
HAVING A MORE STANDARDIZED
REPOSITORY FOR THAT INFORMATION
BUT IT WOULD REQUIRE INVESTMENT?
SO THAT WOULD THAT WOULD REQUIRE
SOME INFORMATION SYSTEMS BUT
IT'S SOMETHING THAT'S IT'S IN
THE ART OF THE POSSIBLE I WOULD
SAY -- IN
ADDITION IT WITH REGARD TO THE
INCREASE IN AND UTILIZATION WHAT
WE SAW IN LOS ANGELES COUNTY WAS
SOMEWHAT SIMILAR.
WE SAW A 60% INCREASE ROUGHLY
AND RESIDENTIAL ADMISSIONS WHICH
WAS HUGE ABOVE AND BEYOND WHAT
WE HAD BEFORE.
AND TO PUT A LITTLE MORE CONTEXT
ON TOP OF WHAT DIRECTOR KENNETH
SAID.
BECAUSE OF THE FEDERAL MATCHING
DOLLARS AVAILABLE THROUGH MEDI
CAL WHEN A LOT OF OUR TREATMENT
WAS FUNDED THROUGH OTHER SOURCES
LIKE AB ONE OH NINE PREVIOUSLY
THE CAL WORKS PROGRAM ETCETERA.
THOSE WERE STRICTLY CAP DOLLARS
SO NOW THAT W HAVE A VARIETY OF
DIFFERENT FUNDING SOURCES
INCLUDING REALIGNMENT WE CAN
APPLY TO THE MEDICARE PROGRAM.
IT OPENS UP MANY MANY MORE BEDS --
IN OUR CONTRACTED FACILITIES SO
AS LONG AS WE HAVE THOSE
PROVIDERS UNDER CONTRACT WE CAN
BUY EVERY SINGLE BUT IN THAT
FACILITY IF WE HAVE THE
RESOURCES OR NOT STRICTLY.
CAPPED ANYMORE --
AS WE WERE PREVIOUSLY WITH
FEDERAL BLOCK GRANT DOLLARS OR
AB ONE OH NINE DOLLAR.
SO THAT THAT I THINK THAT COVERS
MANY OF DID THE ISSUES YOU
RAISED THAT I MISS ANYTHING.
BUT I IT'S GREAT TO HEAR LA
COUNTY SIXTY FOR SAID I HERE
WHICH IS THE BIGGEST COUNTY IN
OUR STATE --
HERE NEVER SIDE --
PERCENT SO WHERE WAS THE OVERALL
STATE ONLY 7% HEARD SOME OF THE
FOR THE EASTER COUNTIES OF US BE
LAGGING BEHIND AND SAID WE HAVE
THESE.
LEAD AND WE WE PLAY OUT THE 3%
THAT WERE COVERED BY ODS BUT WAS
A 97% OF POPULATION --
SAID BUT SO WHAT WHERE WE GO IT
IS SO WHAT ARE SOME THE THINGS
THAT WE CAN DO TO WHAT ABOUT THE
OTHER COUNTIES RIGHT --
YOU KNOW EIGHTY TWO SIXTY THE
HOUSE 7% AVERAGE LIKE WHAT
WHAT'S HOLDING THE OTHER SOME OF
THE OTHER COUNTIES BACK.
I THINK I WOULD IDENTIFY THREE
THINGS PRINCIPALLY NUMBER ONE IS
PROBABLY. FOR A LOT OF ROLLER
SMALLER COUNTIES WITH PERHAPS
LESS INFRASTRUCTURE IT'S REALLY
A LIMIT IN TERMS OF WHAT
FACILITIES THEY HAVE.
SO THAT'S THAT'S PROBABLY THE
FIRST LIMITATION THE SECOND
REALLY IS WORKFORCE EDUCATION
AND TRAINING SO THERE'S BEEN
INVESTMENT IN THE PAST IN THE
MENTAL HEALTH SPACE AND THAT
MADE IN THAT REGARD.
I THINK THAT WOULD BE INCREDIBLY
VALUABLE --
IN THE SUBSTANCE USE TREATMENT
FIELD AS WELL WE JUST WE WE ARE
SORELY LACKING THE WORK FORCE TO
SERVE.
ALL OF THE NEED DID LA IN
RIVERSIDE HIGHER EVERYONE ELSE
PEOPLE.
I DON'T I DON'T THINK SO BECAUSE
WE STILL NEED MORE.
WELL I HAVE A I GUESS THERE IS A
BAND THAT AND AGREED.
I'M NOT DISAGREE WITH THE
STATEMENT THAT WE NEED TO DO
WORK WORK FORCE RIGHT WITH THE
WORKFORCE IS INSUFFICIENT BUT
ALSO.
I WOULD ALSO RECOGNIZE AND THAT.
RIVERSIDE DR 80% YOU JUST TALK
60% WITH YOUR EXIST I SOON WITH
YOUR EXISTING WORK FORCE THE
BEADED SUCK UP ALL THE WORK
FORCE BUT ALL THE OTHER PEOLE
THEY ALL MOVED TO THIS TO
COUNTIES AND THAT'S WHY THE
OTHER COUNTIES COULD DO IT RIGHT
I'M SORRY.
I IS I'M NOT SAYING THAT
WORKFORCE IS AN ISSUE BUT I'M
ALSO SAYING THAT WELL YOU SAID
YOU GOT 60% INCREASE IN LA LA
YOU KNOW AT SO.
WHAT ELSE IS HOLDING PEOPLE BACK
SO LOOK AT THAT AND SEE WHAT WE
CAN TRY TO DO?
BUT WHAT ELSE IS HAPPENING AS
WELL BECAUSE AT LEAST THAT
WASN'T THERE WITH THE STATE THAT
MADE THAT IF MAYBE RATE LIVING
STAT BUT IT DIDN'T HOLD YOU BACK
FROM DOING 60% LA COUNTY.
SO YEAH I THINK THE OTHER PIECE
THE THAT ALSO ARE COLLEAGUES
FROM DH CS SPOKE TO HAS TO DO
WITH THE ADMINISTRATIVE
CAPABILITY OF INDIVIDUAL
COUNTIES SO WE ARE.
A LARGE COUNTY WE HAVE HUNDREDS
OF EMPLOYEES WITHIN OUR DIVISION
WE HAVE BROUGHT ON A LOT OF
STAFF TO HANDLE AUTHORIZATIONS
AND QUALITY IMPROVEMENT
UTILIZATION MANAGEMENT --
MANY OF THEM ARE CLINICIANS
LICENSED PROFESSIONALS SOCIAL
WORKERS PHYSICIANS NURSES WHO
HANDLE THAT WORK WE'VE GOT A A
STRATEGIC PLANNING STAFF A
MARKETING AND BENEFITS YOUR
ENGAGEMENT STAFF.
WHICH ARE.
YOU KNOW THE WHICH ARE FUNCTIONS
THAT I DON'T EXIST I DON'T THINK
EXIST IN A LOT OF OTHER COUNTY
SO PART OF IT REALLY IS I THINK
THE ABILITY OF THE COUNTY TO
SHOULDER --
AND TO TAKE ON A LOT OF THE
REQUIREMENTS OF OF THE WAIVER I
I WOULD SAY MANY OF MY
COLLEAGUES WOULD WOULD RAISE
THAT IS AN IMMEDIATE LIMITATION --
THANKS THE CROWD THANK YOU YOU
KNOW.
MODOC COUNTY IS ONE OF THE
HIGHEST RATES IN THE STATE.
THERE'S NO WAY YOU CAN GET FROM
ALL TERRORIST READING WHICH IS A
HUB CLOSE AS YOU CAN GET TO IS
SUSANVILLE.
IN MOST PEOPLE IN MODOC COUNTY
GET THEIR HEALTH CARE EITHER IN
OREGON OR IN IN RENO.
SO. ONE OF THE ONE OF THE THINGS
THAT WE NEED TO DO IS LEVERAGE
AND EXTEND THE REACH OF THE
PROVIDERS DEBTS TELEHEALTH IN A
DROP OF ELECTRONIC MEDICAL
RECORDS TO TO WHICH WE DON'T
HAVE AN ABUNDANCE.
YOU KNOW I I'VE WORKED FOR YEARS
TO TRY TO BUILD TO DO THAT
THERE'S A VARIETY OF
ENCUMBRANCES WITH HIP AND THAT
pSORT OF THING.
BUT WE COULD EXTEND THE REACH OF
THE EXISTING PROVIDERS NOW IF WE
COULD JUST ADDRESS THOSE
SITUATIONS.
BUT I THINK CERTAINLY WILL --
YOU KNOW WE NEED MORE PEOPLE BUT
I ALSO WANT THAT WE WON'T PEOPLE
LOOK AT WORKFORCE ISSUES --
AND THIS IS BEYOND JUST
SUBSTANCE USE BUT YOU KNOW WE WE
FOR A BURDEN MANY PROVIDERS WITH
ADMINISTRATIVE WORK SO FOR
EXAMPLE AND THIS IS NOT THE TWO
SUBS USE BUT THE RESEARCH STUDY
DONE.
PRIMARY CARE DOCTORS ONLY
SPENDING 26% OF TIME DOING
CLINICAL WORK.
IF YOU WANT W. WORKFORCE CUT THE
ADMINISTRATIVE WORK DOWN THE 50%.
YOU CAN STILL SPEND 50% AND YOU
BASICALLY AND LET DO 50%
CLINICAL ARCHITECT TO DOUBLE
YOUR PRIMARY CARE WORK FORCE.
SO I DON'T KNOW WHAT IT IS IN
THE SUBSTANCE USE AREA BUT YOU
KNOW THAT'S THERE'S A COST TO
THE WORK FORCE WHEN PEOPLE ARE
OVER BURDENED WITH.
WITH -- WITH
OVER A BASICALLY OF WORK AND I
REALIZE THAT YOU KNOW CMS
KANAREK CHOIR CERTAINLY OF
DOCUMENTATION WE HAVE TO SET HER
UP BUT WE HAVE TO THINK ABOUT.
WHAT THE BALANCE AND HAVE THAT
KIND OF CONVERSATION NOW IN THE
STATE BUT NATIONALLY AS WELL --
BUT I GUESS THE QUESTION I HAVE
THEN IS IS THAT --
IN TERMS OF THE BEHAVIOR HEALTH
DIRECTORS ASSOCIATION.
I MEA.
I KNOW THAT EACH COUNTY HAS
CERTAINLY HAS THE AS PRIDE IN
ITSELF AND EVERYONE WANTS TO DO
THEIR OWN THING AND WE HAVE
SMALL COUNTY IS A LARGE ACCOUNT
USING YOUR RIGHT YOU KNOW FIGURE
COUNTIES LIKE LA.
HAVE MORE SUPPORT HELP OTHER
SUPPORT FOLKS YOU CAN DO IF
MARKETS ADDRESS BUT I MEAN IS IS
THERE SOME EFFORT TO THINK ABOUT
WELL HOW CAN.
WE E. REGION LIES ARE BUYING THE
THE TO COLLABORATE MULTIPLE
COUNTIES COMING TOGETHER TO DO
SOME OF THESE FUNCTIONS --
IS THERE SOME MECHANISM TO TO DO
THAT I REALIZE EVERY COUNTY HAS
THEIR OWN BUDGET THEY GET THEIR
OWN I MEAN I'VE HEARD BUT
SUBCOMMITTEE TO GET DOWN A
LITTLE.
BUT YEAH THERE TO DEFUSE THE
FUNDING STREAM BUT AT SOME POINT
TO BUILD THAT KIND OF
INFRASTRUCTURE.
RIGHT -- IT
IN SUCH A SMALL ONES MAYBE THAN
EVEN THE MEDIUM ONES ARE MEETING
WAS CAN HELP SMALL ONES THAT WE
TALK ABOUT HUB AND SPOKE.
WHAT ABOUT A HUB AND SPOKE FOR
COUNTIES RIGHT WHAT ABOUT
PROBABLY AS WELL AS TERMS OF OUT
REACH NOT COUNTY SPECIFIC WHEN
MARK?
BUT I'M JUST THINKING LIKE IS
BECAUSE WE AGES SERVE HERE THIS
I GO OKAY WELL.
YOU KNOW BUT IT'S GOOD I
APPRECIATE HAVING LA HERE APRIL
RIVERSIDE HIGH PERFORMING ONCE
WEBER THE LOW PERFORMING ONE
SAKE TELL ME WHAT THE PRICE YEAH
WHAT'S WHAT'S KEEPING YOU FROM
BEING AN LA RIVER SIDE RIGHT AND
WHAT DO WE NEED TO GET.
TO WHERE TYPES OF THINGS THAT WE
CAN LEVERAGE TO TRY TO GET YOUR
PERFORMANCE UP TO THAT --
THAT LEVEL YEAH I THINK YOUR
YOUR COMMENTS A LINE VERY
CLOSELY WITH THE FEELINGS OF THE
ASSOCIATION AND IT REGIONAL
APPROACHES I THINK FOR MANY WILL
BE A WAY TO PULL RSOURCES
PARTICULARLY IN AREAS WHERE THEY
HAVE MORE ADMINISTRATIVE
CHALLENGES SO THAT.
THAT ABSOLUTELY A LINES I THINK
WITH THE GOALS OF OF THE THE
ASSOCIATION AND THE VARIOUS
COUNTY BEHAVIORAL HEALTH
DIRECTORS WE WE UNDERSTAND THAT
OBVIOUSLY NEEDS AN
INFRASTRUCTURE VERY DIFFERENT
CROSS THE STATE AND SO.
I WOULD BE INTERESTED IN A
FRAMEWORK THAT LOOKS AT IN
CERTAIN AREAS WERE THAT MAKES A
LOT OF SENSE PERHAPS EVEN AMONG
MEDIUM SIZE COUNTIES THAT THAT
WOULD BE AN OPTION THAT THEY
COULD PURSUE TO MAKE SURE THAT
WERE.
LEVERAGING EVERYBODY'S RESOURCES
IN A PARTICULAR REGION --
AND I THINK --
YOU KNOW THE THE RELATIONSHIP OF
THE COUNTIES TO THE MANAGED CARE
PLANS IS ANOTHER QUESTION THERE
THERE IS.
A PROVISION IN THE DMC ODS
WAIVER THAT ALLOWS OBVIOUSLY
COUNTIES AS PARTNERSHIP IS DOING
WITH NORTHERN RURAL COUNTIES.
TO TO YOU KNOW ENGAGE IN
PARTNERSHIPS AND TO WORK WITH
MANAGED CARE PLANS TO USE THEIR
INFRASTRUCTURE TO OPERATIONALIZE
THE BENEFIT AS WELL.
SO I THINK THE THE WAYS THAT
COUNTIES MAY APPROACH THEIR
THEIR MANAGED CARE PLANS TO MAKE --
BENEFITS MORE ROBUST WILL VARY
ACROSS THE COUNTIES BUT
CERTAINLY I THINK THERE ARE LOTS
OF DIFFERENT IDEAS AND AND
THERE'S OPENNESS TO ELABORATE
ACROSS DIFFERENT PARTNERS SO I I
APPRECIATE WHEN YOU SAY OPENNESS
AND ONE KNOW WHEN SOMETHING'S
GOING TO HAPPEN --
AND BECAUSE OF THIS WE STARTED
OFF IN THE BEGINNING YOU KNOW
PEOPLE ARE DYING SO I MEAN I I
APPRECIATE THE IMPROVEMENTS AND
I THINK THINGS ARE BETTER NOW
BUT AT THE SAME TIME WE STARTED
OFF BY SAYING --
YES -- WE
HAVE LOWER PRESCRIPTION RATES --
FOR FEW AIDS WE HAVE YOU KNOW
THAT WE THAT I THINK EVERY
PEOPLE SAY THAT THE CERTAINLY
THE OR DOING NOW IS BETTER THAN
WHAT WE HAD BEFORE BUT OUR DEATH
RATES ARE GOING UP.
RIGHT MORE PEOPLE STILL DIE SO
WE'LL GET MORE PEOPLE IN
TREATMENT AT THAT BUT THE DEATH
RATE STILL IT IS STILL.
INCREASING.
SO.
OPEN THIS IS GREAT AND I
APPRECIATE YOU SAYING THAT I'M
LOOKING FOR TO HEAR HEALTH
DIRECTOR SAYING OKAY HERE'S OUR
PLAN THIS IS AND THIS IS WHAT WE
NEED TO MAKE THIS HAPPEN AND NOT
THREE YEARS FROM NOW NOT NEXT
YEAR -- I
CARE BUDGET SUBCOMMITTEE --
WILL BE HEARING THIS ISSUE MAYBE
I'D LIKE TO HEAR SOMETHING WHEN
WE HAVE THAT COMMITTEE MEETING.
OVERSIGHT DATING.
SO I I THINK THAT WHAT WE'RE
LOOKING FORWARD TO TWENTY TWENTY
IN THE WAIVER RENEWAL IS AN
OPPORTUNITY TO REALLY DIVE AND
VERY MEANINGFULLY WITH CONCRETE
PROPOSALS OKAY SO YOU NINETEEN
AND WE WOULD NEED THE SUBMIT THE
WAIVER BY A WHAT TIME.
IN THE LATE SUMMER EARLY FALL
FOR THE ELEVEN FIFTEEN RIGHT
THIS THIS SUMMER EIGHT YEAH SO
SO WE NEED THE IDEAS ALREADY
RIGHT SO THAT WE CAN PUT INTO
THEIR SO THAT THAT THAT'S OUR
TIMELINE RIGHT.
YEAH I I APPRECIATE OF SO I MEAN
I THINK I THINK THERE'S AN
URGENCY THE I AND I AND AND THE
TAKING OVER YOUR WORDS WE SAID
OPEN I APPRECIATE THE OPENNESS
BUT I'D LIKE OKAY Là HOW DO WE
MOVE THINGS ALONG --
SO THAT WE CAN TRY TO YEAH WE
WANT AND WE HAVE A FAIRLY NARROW
WINDOWS A TIME A SAID THERE IS
YOUNG PEOPLE ARE DYING SO AS WE
WAIT.
OTHER PERSON DIES ANOTHER PERSON
DIES.
RIGHT.
SO WE NEED TO MOVE.
YES YEAH I AGREE WE WE NEED
ACTION AND WE LIKE THE PLAN TO
ACT RIGHT NOT THANK YOU THANK
YOU -- AND
SO EXT SO IN TERMS OF SO I KNOW
YOU'RE WORKING AREA WE TALKED
ABOUT THE LIGHT FLAVOR --
EIGHT SO WHAT KIND OF CHANGES DO
YOU ANTICIPATE BAIT GIVEN THE
LESSONS WE'VE LEARNED THAT DAY
LOOKING FORWARD --
THIS THIS COMING WAIVER SO IF
WE'VE HEARD A LOT OF STUFF WE
HAVE AN EVALUATION WE'RE LOOKING
FOR FUTURE REPORTS --
ETCETERA --
WHERE WHERE DOES THAT WHAT WOULD
YOU LOOK LIKE WE'RE GOING WITH --
I MEAN I THAT AROUND SUBSTANCE
USE I THINK THAT --
WE HAVE IN THE CONVERSATIONS
WITH PROVIDERS IN THE COUNTIES
YOU KNOW SOME OF THE ISSUES THAT
WERE RAISED BY MISTER CINELLI
TODAY HAVE CERTAINLY BEEN.
RACE WITH US IN PRIOR
CONVERSATIONS OVER THE MONTHS
AND YEARS SINCE THAT WAIVER WAS
APPROVED --
WE'VE ESSENTIALLY TOLD PEOPLE
KEEP A RUNNING LIST --
BECAUSE WHEN WE GET TO A POINT
WHERE WE WERE READY AS A AS A
DEPARTMENT TO KIND OF ENGAGE IN
COLDER DISCUSSIONS WITH BOTH
STAKEHOLDERS IN THE LEGISLATURE --
TO KIND OF CRYSTALLIZE OUR
PROPOSAL TO THE FEDERAL
GOVERNMENT --
THERE'S PLACES WHERE WE'RE GONNA
BE LOOKING FOR INPUT AND WE'RE
GONNA BE MAKING CHANGES SO I
THINK THAT --
SOME OF THE THINGS THAT HE
MENTIONED AROUND THE LENGTH OF
STAY.
THAT CAPS --
DAYS -- HAS
CERTAINLY BEEN SOMETHING THAT
THEY HAVE HIGHLIGHTED FROM THE
BEGINNING --
I WILL SAY THAT THAT WAS A
FEDERAL ISSUE --
SO.
YOU KNOW IT AT A CERTAIN POINT
AND WE DO HAVE A NEGOTIATING
PARTNER THAT WE HAVE.
TO ALSO WORK WITH AT THE FEDERAL
LEVEL AND SO SOME OF THESE
THINGS WERE SPECIFIC TO THEM AND
AND REALLY ADDRESS THEIR
CONCERNS ABOUT A NEW BENEFIT
BEING.
ROLLED OUT IN A WAY THAT THEY
WANTED TO UNDERSTAND HOW IT WAS
GOING TO BE UTILIZED.
I THINK --
THE WAIVER PRISON --
COUNTY SIR REGIONAL LIES --
AND FOR US TO LOOK AT DIFFERENT
FUNDING AND FINANCING MECHANISMS
I KNOW THAT --
CERTAINLY COST BASED
REIMBURSEMENT HAS BEEN --
REYES NOT ONLY IN THIS ISSUE BUT
IN THE MENTAL HEALTH --
WAIVER IN THE NINETEEN FIFTEEN
WAIVER AS WELL AND SO I THINK.
YOU KNOW WE HAVE A WE HAVE OUR
UNLESS WITHIN THE DEPARTMENT
THAT WILL BE WORKING TO KIND OF
CRYSTALLIZED AROUND THINKING
AROUND WHAT WOULD BE APPROPRIATE
TO RECOMMEND --
AS MAYBE A DRAFT PROPOSAL AND
THEN HAVE STAKEHOLDERS RESPOND
TO THAT SO IT IT'LL BE AN
ITERATIVE PROCESS.
YOUR GUIDE TO ENGAGE THE
LEGISLATURE IN THIS COURSE.
THANK YOU --
AND BECAUSE THE OTHER QUESTION I
HAVE IS -- I
I UNDERSTAND --
THAT IS VOLUNTARY YOU'VE SORT OF
TOUCHED ON SOME OF THE REASONS
WHY --
CONCERNS ABOUT.
DISPARITIES IN ACCESS TO
SERVICES BETWEEN.
RESIDENTS IN THE OPT IN COUNTIES
VERSUS THE OPT OUT COUNTIES IS
THAT SOMETHING.
HOW WE CAN DEAL WITH THAT --
I MEAN I THINK THAT GOES TO THE
DISCUSSION THAT --
WE HAD EARLIER AROUND THE THE
THE VERY FEW COUNTIES THAT HAVE
NOT.
PUT IN IMPLEMENTATION PLANS ARE
VERY SMALL AND MOSTLY UPPER
RURAL NORTH --
I THINK THAT WAS IN SOME CASES
MY EFFORT TO REACH OUT TO SEE
MUST BE TO HAVE A DISCUSSION --
TO TRY TO ADDRESS THAT AND
NARROW THAT --
BUT WE CANNOT REQUIRE COUNTIES
TO PARTICIPATE I THINK THAT --
EVEN IN SPITE OF THAT THE
COUNTIES WE WOULD WANT TO HELP
THEM BE SUCCESSFUL IN PROVIDING
THE REQUIRED MANDATED STATE PLAN
SERVICES.
THAT ARE THE LOWER LEVEL OF
SERVICES THAT HAVE ALWAYS BEEN
REQUIRED --
IN TERMS OF METHADONE --
OUTPATIENT DRUG FREE COUNSELING
PERINATAL RESIDENTIAL INTENSIVE
OUTPATIENT THERAPY --
THOSE ARE ALREADY REQUIRED OF
THE COUNTIES REGARDLESS OF
WHETHER THEY ARE.
IN THE PROCESS OF GOING INTO THE
WAIVER OR NOT AND SO WE'VE BEEN
WORKING WITH THE COUNTY STEVEN
BRING THEM UP TO COMPLIANCE IN
THOSE AREAS AND AGAIN THAT'S
THAT'S AN ONGOING EFFORT BY OUR
DEPARTMENT.
AND NO QUESTION IS AND MAYBE
IT'S A QUESTION FOR BOTH --
NO CHIEF PRESENT ALSO --
DOCTOR CONNELLY THAT HAPPENS
FOLK BECAUSE SYSTEM AND CORRECT
ME OF A ROCK.
I MEAN.
SO COUNTIES DON'T GET GRANTS FOR
THAT RIGHT SO THAT'S KIND OF
LIKE --
ANNALS OVERLAYS RIGHT WORDS SO
IT'S IT'S SO YOU HAVE.
THIS OPERATES TOGETHER.
SO.
YES PROVIDERS RIGHT SO SO SO I
GUESS IN TERMS OF HOW ARE WE
BRINGING THOSE TWO PIECES
TOGETHER WE HAVE THE HAVE THE
SCOPE SPOKE HERE WITH WHAT WE'RE
DOING WITH THE IDEA SO HOW HOW
DO YOU SEE THAT COMING TOGETHER
AND THE EVOLUTION OF THAT.
BECAUSE AS WE TALK ABOUT THE
NEXT WEAVER PROBABLY WANT TO
THINK ABOUT HOW THESE TWO
INTERFACE.
SO YES WHEN WE DEVELOP THE HUB
AND SPOKE --
FIRST OF ALL ALL HUGS AND ANY
SPOKES HAVE TO OFFER MEDICAL AS
WELL I'M AND WE DID THAT FOR
SUSTAINABILITY BECAUSE WE WANTED
TO ENSURE FOR GOING TO INVEST IN
TRAIN PHYSICIANS AND PROVIDE THE
SERVICES --
THAT THEY WOULD HAVE THAT BUT
WHAT'S CAN REACH BEYOND.
THE MEDICAL PATIENTS SO WE CAN
SERVE ANY INDIVIDUAL THAT WALKS
THROUGH THE DOOR --
BUT SO IT REALLY HAS BEEN AND
AND YOU'RE RIGHT IT GOES RIGHT
THE FUNDING GOES RIGHT TO THE
PROVIDERS --
BUT THEN OBVIOUSLY THE COUNTIES
CAN ACCESS THOSE INCREASE
SERVICES THAT ARE AVAILABLE NOW
IN THAT THERE'S MORE M. A. T.
AVAILABLE THAT THEY CAN UTILIZE --
FOR THE DRUG MEDI CAL WAIVER
VINEY THE FEDERAL MONEY THAT
LIKE HOW IT'S AT A FIXED AMOUNT
OF MONEY OR IS IT OKAY SO IT'S
IT'S JUST NINETY MILLION THAT IS
JUST A YES JUST NINETY MILLION
SO.
AND OKAY.
SO WE WILL TALK ABOUT WHAT
HAPPENS AND YOU SELL HOPING THAT
THE PRESIDENT'S BUDGET THERE'S
AN EXTENSION OF THAT AND SO YES
FROM THE COUNTY PERSPECTIVE HOW.
THE INTERFACE WITH HAVE BEEN
SPOKEN THE FUNDING THAT GOES
THERE SURE SO THE THE FUNDING
DOES GO DIRECTLY FROM FROM THE
DEPARTMENT TO THE PROVIDERS THAT
THEY CONTRACT WITH BUT BECAUSE
THEY ARE ALL IN OUR NETWORKS.
WE MAKE SURE THAT WE DO
COORDINATE VERY INTENTIONALLY
WITH THEM TO MAKE SURE OF THAT --
WERE WORKING ON ON CONVENING
SPOKES POSSIBLY FOR THEM IN THE
RECRUITMENT EFFORTS THAT THEY
ARE STANDARDIZING THEIR
APPROACHES WE HAVE TWO DIFFERENT
HUBS FOR EXAMPLE IN LOS ANGELES
COUNTY WE'RE TRYING TO ALIGN
MARKETING MATERIALS WE HAVE
REGULAR MEETINGS WITH THEM --
TO TO ALSO UNDERSTAND THE
UNIVERSE OF POTENTIAL SPOKES IN
THE COUNTY BECAUSE WE HAVE I
THINK INFORMATION THAT IS IS
HELPFUL TO THEM IN THEIR EFFORTS
TO PROVIDE TECHNICAL ASSISTANCE
AND TO INCREASE THE REACH OF MIT
SO THAT IS DEFINITELY I THINK
SOMETHING THAT.
COUNTIES ARE MINDFUL OF AND WANT
TO MAKE SURE THAT IT'S NOT.
DUPLICATIVE OR UNCOORDINATED BUT
RATHER SOMETHING THAT ADDS TO
WHAT WE'RE ALREADY DOING IS
PARTLY SAID.
AND MAYBE THIS IS A QUESTION.
FOR ON THE PRIOR SPLIT --
ALICE BUT IS THERE CHALLENGES
RECRUITING SPOKES.
pSO YEAH IF CHALLENGES IN
RECRUITING SPOKE OTHERS ACTUALLY
IF IF MORE PEOPLE SIGN UP THE
SPOKES WE COULD WE HAVE THE
CAPACITY TAKE THE MONARCHY WILL
FIX GRANT IT CETERA AND SO I'M
JUST.
JUST SAY CELL IS RATE LET ME
STEP THE NUMBER PEOPLE WILLING
TO BE SPOKES ARE THE NUMBERS
FOLKS WERE ABLE TO HANDLE.
YEAH SO THERE IS A CHALLENGING
RECRUITING SPOKES --
BUT A LOT THE HUBS OF DONE AND
THERE SPOKE A LOT ABOUT IT THEY
WERE VERY AGGRESSIVE AND CAN'T
AND AND REACHING AND AND WORKING
WITH THE COUNTY PARTNERS THE
MANAGED CARE PLANS WHOEVER'S IN
THE AREA. TO GET MORE SPOKES ON
BOARD --
THERE'S BEEN EFFORTS NOW TO HAVE
JAIL SO SPOKES --
TRIBAL HEALTH CLINICS OTHER
ENTITIES IT SEEMS LIKE MORE
FOLKS ARE RAISING THEIR HANDS --
AT SOME POINT THOUGH IT DOES
BECOME AN ISSUE A CAPACITY FOR
THE HUB AS WELL I'M BECAUSE
THAT'S A LOT OF SPOKE TO SOLVE.
THE HOW THE DO WE NEED MORE HUBS
TO YEAH SO THAT THAT BECOMES A
CHALLENGE OF YOU KNOW AND IT'S
BEEN A VERY QUICK RAMP UP AS YOU
SEE THAT'S ONLY BEEN.
IN EXISTENCE FOR A FEW YEARS --
BUT THERE HAS BEEN A LOT MORE
INTEREST IN IT [inaudible]
SO.
THE KEYS WERE HUBS EIGHT AND WE
ALSO TALKED ABOUT SUPER SPOKES
BECAUSE AND MAY THE COMMUNITIES.
IN TERMS OF DISTANCE OR OTHER
THINGS THAT IT'S SO WE NEED
PEOPLE TO BE SUPER SPOKES
[inaudible]
TO OKAY --
MAYBE I'LL JUST LIKE JUST LIKE
IS THERE SOMETHING THAT THE
MEDICAL COMMUNITY TO DO TO GET
MORE PEOPLE TO BE.
WILLING TO STAND UP AND BE
SPOKES ARE SUPER SPOKES.
WELL YES I THINK I THINK HAVING
[inaudible]
HAVING -- A
A GENERAL --
CONSCIOUSNESS RAISING IF YOU
WILL.
THAT THIS IS A TOPIC THAT SHOULD
BE BROUGHT ON BROAD YEARS
WHATEVER SORT OF MEETING THERE
ISN'T SUBS TO BE USE.
APPROACH TO SUBSEA PEWS AND AND
SUCCESSFUL MODELS LIKE LIKE WHAT
WE'RE JUST TALKING ABOUT YOUR
THE OPENS FOCUS.
I THINK UNQUESTIONABLY A
SUCCESSFUL MODEL TO REACH OUT
AND TRY TO ADDRESS THIS ISSUE.
UGH GIVEN ALL THE VARIOUS THINGS
OUT OF IT THEN TALKED ABOUT --
YOU KNOW WE WE WE EVEN INC A
COVER SIDE OF ADDICTION MEDICINE
OR TO PARTICULAR ENTHUSIASM FOR
PEOPLE ARE INVOLVED WITH THIS.
VERY ENTHUSIASTIC GO OUT AND
INNOVATE IN IN TREAT INTO ALL
THESE KIND OF THINGS --
THE GENERAL POPULATION DOCTORS
AT LARGE OR OR PERHAPS NOT SO
EAGERTO TAKE ON ANOTHER
SUBSPECIALTY X. EXPERIENCE.
YOU KNOW PARTICULAR ONE THE
STOKERS A STIGMA AND WE ALL TALK
ABOUT TRYING TO REDUCE THE
STIGMA AND AND THAT'S JUST
SOMETHING IT'S GOING TO TAKE
TIME THE ORGAN AFTER PARTICIPATE
AND AND ENCOURAGE THE WORK --
I'M VERY OPTIMISTIC.
A GIVEN FROM WHAT I'VE SEEN
CERTAINLY IN IN THE LARGER
ORGANIZATION IN CALIFORNIA SITE
EVERY DAY.
OF COVERAGE OF ELECTION AS BUT
ALSO THE CALIFORNIA MEDICAL
ASSOCIATION.
RESIDENTS.
MEDICAL STUDENTS FELLOWS ARE
INCREASINGLY OPEN AND WILLING TO
ENGAGE.
THESE COME.
SO I THINK GOING FORWARD IT IS
ROLE WORTH OUR WHILE TO INVEST
NOW.
AND CONTINUE INVESTING NO I I
THINK IT'S BEEN POINTED OUT HERE
WE'RE SCRATCHING THE SURFACE.
IN TREATMENT AND IDENTIFYING IN
MANAGING THIS PROBLEM AND AND I
THINK I THINK WE'RE DOING A GOOD
JOB OF IT.
THERE'S MUCH MORE WORK TO DO.
IT IS VALLEY --
SORRY MY BUDGET HAD ON TO THE
NINETY MILLION THAT WE GET I
MEAN ARE WE EXPANDING IT ALL OF
THE THAT THAT.
OKAY I I GET IT I LIKE TO SAY
THAT MY RELEASED WORKS AND WITH
MONEY FALLING OUT OF HER POCKET.
AND I GUESS THE QUESTION IS IS
THAT WE GO WE PROGRESSIVELY TRY
TO GET MORE PEOPLE TO BE HUBS
AND SPOKES AND SO FORTH AND WERE
SUCCESSFUL AND THEY ACTUALLY.
THANK YOU SO MUCH FOR WRAPPING
THIS UP SO QUICKLY --
DOES IS SOME POINT WE'RE GOING
TO HIT WHERE --
WE NEED MORE MONEY THAN THAT NOW
WE'RE GOING TO GET FROM THE
FEDERAL GOVERNMENT RIGHT.
WE KNOW THE DEMAND IS VERY GREAT
SO I'M JUST WONDERING WHERE WE
ARE WITH THAT ARE WE GONNA HAVE
A SITUATION YEAH.
I GUESS THAT'S A GOOD PROBLEM TO
HAVE A ONE LEVEL PERHAPS BUT
BECAUSE IT'S A FIXED AMOUNT I
MEAN THE TERMS OF HOW THE MONEY
FLOWS IS THAT GOING TO BE AN
ISSUE OR NOT --
THAT WE ARE POTENTIALLY RUN INTO
SOME POINT ARE WE JUST FAR AWAY
FROM THAT POINT YEAH SO GREAT
QUESTION SO THE NINETY MILLION.
I WAS ONLY FOR TWO YEARS A
TECHNICALLY ENDS --
THIS APRIL BUT SINCE AS YOU CAN
IMAGINE IT TOOK AWHILE FIRST TO
RAMP UP --
TO GET THE SYSTEMS IN PLACE AND
WE DO HAVE SOME CARRYOVER INTO A
THIRD YEAR --
BUT THEN THOSE FUNDS WILL BE EXT
THE OTHER GRANT IS ALREADY --
OBLIGATED TO OTHER PROJECTS SO
YES THERE IS --
YOU KNOW DEPENDING ON THE LEVEL
OF FUNDING FROM THE FEDERAL
GOVERNMENT AND I I WILL SAY.
AND WERE YOU KNOW THANKFUL FOR
THAT MONEY BUT IT COMES VERY
QUICKLY AND HAS TO BE SPENT VERY
QUICKLY I MEAN THERE'S REALLY
LITTLE NOTICE SO AT THIS POINT
THE HUB AND SPOKE SYSTEM IS
FUNDED.
UP UNTIL ABOUT APRIL OF NEXT
YEAR.
AND THAT'S AS FAR AS WE AT THIS
POINT -- NO
THAT'LL BE FUNDED AND THAT'S
FUNDED JUST AT THE THE LEVEL OF%
THE SYSTEM WE HAVE NOW THERE
ISN'T ANY ROOM FOR EXPANDING NOT
CURRENTLY.
OKAY SO WE ACTUALLY.
TRY TO EXPAND THEIR SNOW WITH
THEIR ART FEDERAL DOLLARS FOR
THAT OKAY AND HOPEFULLY.
KNOCK ON WOOD THERE.
CONGRESS AND PRESIDENT CAN AGREE
ON SOMETHING THAT WOULD ALLOW
EXTENSION OF THAT CONTINUE --
ACTUALLY DIGITAL WELL EXTENSION
THE FUNDING NEEDED DIGITAL
FUNDING RIGHT --
OVERTIME.
OKAY ALL RIGHT ON THE IT WILL
THANK YOU SO VERY MUCH THANK YOU
SO MUCH FOR YOUR PRESENTATIONS
AND QUESTIONS --
NOW I WANT TO BRING UP --
FROM DEPARTMENTPUBLIC HEALTH --
WE HAVE --
STC ALAMO A CHIEF OF EACH --
WE HAVE --
JULIE AND I GUESS PSYCHO DEFEAT
DIRECTOR OF THE OFFICE IF YOU
TAKE DEVELOPMENT EXTERNAL
RELATIONS AND DR JAMES GREEN
DEPUTY DIRECTOR CENTER FOR
HEALTH.
INFORMATICS ALL FROM THE
DEPARTMENT OF PUBLIC HEALTH.
AND WE ARE TALKING ABOUT --
SOME FEDERAL GRANTS WE HAVE
NALOXONE DISTRIBUTION PROGRAM
MULTI AGENCY EFFORT TO ADDRESS
THE OPIOID CRISIS DATA
COLLECTION EFFORTS.
AND SO WELCOME --%
A AND I THINK YOU'RE HER A YEAR
HER DEPARTMENT CALLED OUT
EARLIER RIGHT ABOUT PARTNERSHIP
SO NOW YOU'RE HERE YOU CAN SPEAK
FOR YOURSELF.
HOW'S THE HOW'S IT GOING AND AS
EVERYONE ELSE HELPING YEAH IS
COOPERATING WITH YOU HELLO
WELCOME.
THANK YOU SO MUCH FOR INVITING
THE CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH TO COME SHARE WITH
YOU WHAT WE'RE DOING AROUND --
OPIATE OVERDOSE PREVENTION AND
WE ARE A PROUD PARTNER OF THE
CALIFORNIA DEPARTMENT OF OF
HEALTH SERVICES SO THANK YOU
FROM UP FOR THAT --
AGAIN MY NAME IS STACY ALUM A
MIX AND AYE SIR COMMUNITIES
FRENCH I'M GONNA START US OFF BY
GIVING YOU A VERY BRIEF UPDATE
ON THE LOCKS ON GRANT PROGRAM --
SO AS YOU KNOW IN TWENTY SIXTEEN
SENATE BILL EIGHT THIRTY THREE
ESTABLISHED A NEW NALOXONE GRANT
PROGRAM WITHIN THE CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH.
WITH THE GOAL OF REDUCING THE
NUMBER OF FATAL OVER OVERDOSES
IN CALIFORNIA FROM OPIOID DRUGS
BY INCREASING ACCESS TO NALOXONE
IN OUR COMMUNITIES.
A TOTAL OF THREE MILLION DOLLARS
OF GENERAL FUND WAS ALLOCATED ON
A ONE TIME BASIS TO SUPPORT THE
PROGRAM THROUGH JUNE THIRTIETH.
TWENTY NINETEEN CITY PH OFFERED
NON COMPETITIVE GRANTS OF THE
LOCKS ON PRODUCT AND FUNDING TO
ALL LOCAL HEALTH DEPARTMENTS TO
CONDUCT NALOXONE DISTRIBUTION
PROJECTS AND THEIR JURISDICTIONS.
LOCAL DEPARTMENT GRANT
RECIPIENTS CONDUCTED OUTREACH.
AND THEY SELECTED LOCAL PROGRAMS
AGENCIES A COMMUNITY BASED
ORGANIZATIONS WITHIN THEIR
JURISDICTIONS THAT SERVE
POPULATIONS AT RISK FOR OPIOID
OVERDOSE TO RECEIVE ALLOCATIONS
OF NALOXONE.
THROUGH THESE GRANT SIXTY LOCAL
HEALTH DEPARTMENTS RECEIVE
690-008-0030 DOSES OF DARK HAND
NASAL SPRAY.
FROM CITY PH.
AND ACCORDING TO THEIR
DISTRIBUTION PLANS WHICH ARE THE
REQUIRED TO SUBMIT PRIOR TO
THEIR ACTIVITIES --
THE LOCAL HEALTH DEPARTMENTS ARE
DISTRIBUTING THE LOCKS OWN TO
ENTITIES SUCH AS SYRINGE
EXCHANGE PROGRAMS SUBSTANCE USE
DISORDER TREATMENT SERVICES
HOMELESS PROGRAMS LAW
ENFORCEMENT AGENCIES JAILS.
FIRE SERVICE AGENCIES EMERGENCY
MEDICAL SERVICES AGENCIES AND
OTHER ENTITIES INCLUDING OTHER
PUBLIC HEALTH PROGRAMS AND
SCHOOLS.
LOCAL HEALTH DEPARTMENTS WILL
SUBMIT A FINAL REPORT TO CITY PH
BY APRIL FIRST TWENTY NINETEEN
TO FURTHER PROVIDE INFORMATION
ON THE TYPES OF ENTITIES.
THAT RECEIVE NALOXONE FROM THEM
THE TARGET POPULATION IN THE
NUMBER OF INDIVIDUALS THAT
RECEIVE NO LOCKS OWN FROM THE
LOCAL ENTITIES.
AND IF POSSIBLE THE NUMBER OF
OVERDOSE REVERSALS THAT CAN BE
ATTRIBUTED TO THIS PROGRAM.
SEE THE PAGE WILL SUMMARIZE THAT
INFORMATION IN A FINAL REPORT
DUE TO YOU ON JUNE.
TWENTY NINETEEN I'M AT THIS
POINT CITY PH DOES NOT HAVE
FUNDING AVAILABLE TO PURCHASE
ADDITIONAL NALOXONE HOWEVER
LOCAL HEALTH DEPARTMENTS AND
OTHERS ARE NOW ABLE TO ACCESS
THE LOCKS ON THROUGH THE
CALIFORNIA DEPARTMENT OF HEALTH
CARE SERVICES.
ONGOING NALOXONE DISTRIBUTION --
IN ENTITIES APPLYING FOR THAT --
NALOXONE THROUGH THAT PROGRAM
ARE STILL ABLE TO UTILIZE OUR
STATEWIDE STANDING ORDER FOR
NALOXONE AS WELL AS THE NALOXONE
ADMINISTRATION TRAINING THAT WE
PRODUCER HAVE AVAILABLE ON OUR
WEBSITE. TO BE HAPPY TO ANSWER
ANY QUESTIONS AFTER THE PANEL.
THANK YOU.
JULY AND AUGUST TACO AND THE
DEPUTY DIRECTOR OF THE OFFICE OF
STRATEGIC DEVELOPMENT EXTRA
RELATIONS WILL EXPAND ON WHAT
STACEY DESCRIBED --
IN PARTICULAR ADDRESSING THE
STATE RIGHT OKAY SIXTY WORK
GROUP AND OUR CURRENT FEDERAL
GRANT FUNDS.
C. PH WORKING IN COLLABORATION
WITH MANY PARTNERS HAS TAKEN A
COMPREHENSIVE COLLECTIVE ACTION
APPROACH TO ADDRESS THE CHANGING
DYNAMICS OF THE OPIOID EPIDEMIC.
SINCE TWO THOUSAND FOURTEEN THE
CITY PH DIRCTOR AND STATE
PUBLIC HEALTH OFFICER HAS
CONVENE THE STATE WIDE OPIATES
SAFETY WORKGROUP OR SOS WORK
GROUP WHICH PROVIDES A FORUM FOR
COLLABORATION ACROSS VARIOUS
STATE SECTORS TO ALIGN
ACTIVITIES AND MESSAGES.
I'M IN ADDRESSING THE EPIDEMIC.
THE S. WAS WORK GROUP BRINGS
TOGETHER OVER FORTY STATE AND
NON GOVERNMENTAL STAKEHOLDER
ORGANIZATIONS TO IMPROVE
COORDINATION AND EXPAND JOINT
EFFORTS --
ADJUSTING APPEARED MISUSE
ADDICTION AN OVERDOSE DEATH.
CITY PH HAS RECEIVED MULTIPLE
FEDERAL GRANTS BEGINNING IN
TWENTY FIFTEEN TO SUPPORT A WIDE
RANGE OF OPIATE OVERDOSE
PREVENTION ACTIVITIES INCLUDING
THE SOS WORKER.
THERE'S BEEN CONTINUOUS
FLUCTUATION IN FEDERAL FUNDING
LEVELS AND AT THIS TIME THERE IS
CONTINUED FUNDING FOR ON GOING
COORDINATION OF THE SOS
WORKGROUP.
IN ADDITION TO SUPPORTING THE
WORK GROUP THESE FUNDING SOURCES
HAVE SUPPORTED A RANGE OF
ACTIVITIES INCLUDING. TO PROMOTE
SAFE PRESCRIBING PRACTICES AND
POLICIES WITH PROVIDERS AND
HEALTH PLANS. TO WORK IN
PARTNERSHIP WITH THE CALIFORNIA
DEPARTMENT OF JUSTICE TO
INCREASE THE EFFECTIVENESS AND
UTILIZATION OF THE CURE'S
PRESCRIPTION DRUG MONITORING
PROGRAM. TO IMPROVE DATA
SURVEILLANCE CAPACITY THROUGH
THE DEVELOPMENT OF THE
CALIFORNIA OPIATES SURVEILLANCE
DASHBOARD.
COLLABORATION WITH CORONERS AND
MEDICAL EXAMINERS AND EFFORTS TO
IMPROVE DATA SYSTEM INTEGRATION
AND INTRACTABILITY.
WE ALSO PROVIDE SUPPORT TO BUILD
AND STRENGTHEN LOCAL COMMUNITY
COALITIONS. TO PROMOTE ACCESS TO
MEDICATION ASSISTED TREATMENT
AND THE LOCKS OWN.
AND TO DEVELOP COMMUNICATION AND
AWARENESS RESOURCES TO HELP --
ADDRESS THE RISKS OF OPIOID USE
AS WELL.
AROUND ADDICTION AND TREATMENT.
ON AND SO THAT'S A QUICK SUMMARY
OF OUR CURRENT ACTIVITIES AND
AFTER THAT THE PANELISTS BE
HAPPY TO ANSWER QUESTIONS
[inaudible] THREE DATA
COLLECTION OPPORTUNITIES.
THE NATIONAL INTEROPERABLE A
COLLABORATIVE HAS RECENTLY
PUBLISHED A FIFTY TWO PAGE
COMPREHENSIVE OPIOID RESPONSE
THAT OF GARDENS ACROSS MULTIPLE
STATE.
EXPERIENCES ENTITLED THE OPIOID
USE DISORDER PREVENTION PLAYBOOK.
A KEY SUCCESS INDICATOR
IDENTIFIED IN REITERATED
THROUGHOUT THE DOCUMENT.
IS THE NEED FOR A ROBUST DATA
SHARING AMONG STAKEHOLDERS TO
EFFECTIVELY RESPOND TO ALL
FACETS OF THE OPIOID CRISIS.
IN CALIFORNIA WHILE THE HEALTH
AND HUMAN SERVICES AGENCY HAS
ESTABLISHED INFORMATION SYSTEMS
INTER OPERABILITY AND ATTENDED
DATA SHARING AS A PRIORITY.
AND WHAT CALIFORNIA DEPARTMENT
OF PUBLIC HEALTH IS TAKING A
LEADERSHIP ROLE.
IN CONVENE STATE.
SPEC WIDE STAKEHOLDERS TO
ADDRESS THE OPIOID CRISIS NOW.
VIA THE STATEWIDE OPIOID SAFETY
WORKGROUP.
SUPPORT FOR A WIDER AND STRONGER
INTRA AND INTER GOVERNMENTAL
CULTURE DATA SHARING IS SEEN BY
SUBJECT MATTER EXPERTS IN THIS
AREA.
AS NECESSARY TO OPTIMIZE
CALIFORNIA'S EFFECTIVE
GOVERNMENTAL RESPONSE. TO THE
OPIOID CRISIS IN ORDER TO AVERT
OPIOID DEATH.
AND NEAR DEATH ADVANCE AND ALL
THE NEGATIVES QUALITY.
OF OPIOID USE DISORDER IMPACTING
CALIFORNIANS.
THANK YOU --
QUESTIONS.
I THINK YOU'RE WITH THANK YOU --
JUST A COUPLE QUESTIONS AND THIS
IS REGARDING THE WORK GROUP --
TO MENTION YOU'VE GOT A LOT OF
STATE AGENCIES AND NGOS --
I KNOW I VISITED --
BACK AND I TWO THOUSAND FIFTEEN
AND ACTUALLY ASKED IS THERE MORE
COULD BE MORE COLLABORATION WITH
THE PRIVATE SECTOR [inaudible]
AND GROUPS OUT THERE IS SO THAT
THE NGOS WHAT YOU'RE CONSIDERING
THE PRIVATE THE THE PRIVATE
SECTOR AT THIS POINT.
ALSO THAT THE SO THE AT THE WORK
GROUP LEVEL ONE OF OUR PRIMARY
FOCUS IS HAS BEEN INTO TO PART
MEDICAL COLLABORATION ACROSS
STATE GOVERNMENT AGENCIES WE
HAVE SUPPORTING TASK FORCES THAT
FOCUS ON SPECIFIC AREAS LIKE
DATA COMMUNICATIONS.
MATERNAL NEONATAL OPIOID
EXPOSURE AND THOSE ARE OPEN TO
ANY EXTERNAL STICK WITH
ORGANIZATIONS THAT WOULD LIKE TO
PARTICIPATE SO THIS CAN BE
PROVIDER ORGANIZATIONS THAT CAN
BE NGOS THAT CAN BE TREATMENT
PROVIDERS --
THE CAN BE HEALTH PLANS.
AND HOW HOW ARE YOU HOW IS THE
OUT REACHING GETTING THEM THAT
INFORMATION TO BE ABLE TO
PARTICIPATE.
YES I THINK THERE'S OBSERVE A BI
DIRECTIONAL APPROACH THAT WE
TAKE ONE IS TO TRY --
TO THAT WE'VE RECEIVED MANY
INCREASE ABOUT THIS WORK AND
REQUESTS TO PARTICIPATE AND SO
THAT'S PART OF OUR ROLE AS THE
PUBLIC HEALTH ENTITIES TO HELP
FACILITATE THOSE.
EXPLAIN WHAT'S AVAILABLE AND
CONNECT THEM TO THE AREA OF
FOCUS THAT MOST ALIGNS WITH
THEIR NEEDS THE OTHER IS THAT WE
PARTICIPATE IN VENUES WHERE
THOSE STAKEHOLDERS ARE GATHERED
THERE'S THAT.
MARK KERR CALIFORNIA --
VENUE WHICH IS ORT OF MANY
STATE PLANS AS WELL AS MANY
HEALTH SYSTEMS IN PROVIDERS WERE
PRESENT IN THOSE SPACES TO BE
ABLE TO HEAR WHAT THOSE CONCERNS
ARE AND MAKE THEM AWARE OF THE
OPPORTUNITY TO PARTICIPATE AND
WORKER TASK THE DEPARTMENT OF
PUBLIC HEALTH.
OUR FORTY MEMBER ORGANIZATIONS --
ACROSS THE DIFFERENT STATE
BRANCHES ALSO DO THAT WITH THEIR
STAKEHOLDER --
NETWORKS THAT THEY HAVE
AVAILABLE SO THAT'S THE PROCESS
THAT WE USE AT THIS TIME.
A YOU MENTION A COLLABORATION
WITH CORNERS MEDICAL EXAMINERS
CAN DESCRIBE A LITTLE BIT YES
THAT'S TO HELP INCREASE THE
DEPTH AND THE CONTEXT AROUND THE
DATA WE HAVE AROUND --
**** OPIATE OVERDOSE EVENTS FROM
A PUBLIC HEALTH PERSPECTIVE ONE
OF THE MAIN THINGS WERE TRYING
TO DO IS BETTER UNDERSTAND.
THE RISK PATHWAYS THAT ARE
LEADING TO OVERDOSE WE CAN GET
RID BECAUSE AND TARGET
INTERVENTIONS MORE EFFECTIVELY.
AND AS YOU'VE SEEN FROM THE DATA
THERE ARE MANY DIFFERENT
DYNAMICS AT PLAY AT THE SAME
TIME WITH OPIATES WE'VE GOT
DIFFERENT THINGS THAT ARE
AFFECTING SORT OF YOUNGER ADULTS
VERSUS MIDDLE AGE WE'VE GOT THE
SYNTHETIC AN ILLICIT OPIATES
VERSUS PRESCRIPTION.
SO WHEN WE WORK WITH CORNERS THE
MEDICAL EXAMINER'S ITS SHOULD
HAVE THEM CAPTURE ADDITIONAL
CONTEXTUAL INFORMATION AROUND
THE CIRCUMSTANCES OF AN OVERDOSE
SO THAT WE CAN BEGIN TO USE THAT
IN OUR UNDERSTANDING OF THOSE
RISK PATHWAYS.
ARM AND I GUESS JUST OF FINE
FINALLY AND I THINK THIS IS
SOMETHING THAT I HAVE.
KIND OF REPEATEDLY ASKED YOU
KNOW.
WE IS THE LEGISLATURE IN
OBVIOUSLY YOU'RE WORKING BEHIND
THE SCENES OUT THERE.
IS THERE WHAT CAN THE
LEGISLATURE DUE TO HELP MOVE
SOME OF THESE THINGS FORWARD
BECAUSE I I'VE [inaudible]
FEEL.
WHILE THERE IS PROGRESS.
LOOK IN MY RURAL COUNTIES WE
CAN'T WE CAN'T GET WE CAN'T GET
PROVIDERS TO ACTUALLY. TO WORK
IN THE SPACE --
WE CAN'T GET ACCESS TO PEOPLE --
WE HAVE A WORK FORCE SHORES SO
WHAT WHAT DO WE NEED TO DO AND
THAT'S THE KIND OF GUIDANCE THAT
I'M PERSONALLY LOOKING.
FOR HELP US WITH DIED AND YOU IF
YOU'RE IN YOUR SIX YEAR OF THIS
TASK FORCE NOW.
WHEN CAN WE EXPECT?
SOMETHING THAT CAN HELP AS A
GUIDE FOR FURTHER ACTIVITY THEY
WORK A DOZEN BILLS LAST YEAR
RELATED TO OPIOIDS OUT THERE --
AND YOU'RE DOING ALL THIS WORK
BUT IS THERE SOMETHING WE CAN BE
DOING THAT WE'RE NOT DOING.
THAT BASED ON ALL THE STUDY AND
ALL THE WORK.
THAT WE'RE MISSING HERE --
AND WHAT IS KIND OF WE'RE NOT
THE I'M NOT THE EXPERT I'M NOT
OF I'M NOT A PUBLIC HEALTH
EXPERT.
BUT I AM.
KIND OF WAITING.
AND AND I'M I DON'T HOW LONG AM
I GONNA BE WAITING OR IS OR WAS
THERE EVER GONNA BE
RECOMMENDATIONS THAT COME OUT OF
THIS WORK.
THIS GROUP FOR SOMETHING WE CAN
BE DOING AT THE LEGISLATIVE
LEVEL TO HELP MOVE THIS ALONG.
THANK YOU FOR THAT QUESTION AND
THAT IS SOMETHING I THINK JUST
EVEN HEARING THAT IS SOMETHING
THAT.
IS OBVIOUSLY VERY ENCOURAGING TO
THE MANY THE MANY DIFFERENT
SECTORS THAT ARE WORKING IN THIS
AND KNOWING THAT THE LEGISLATURE
WANTS TO BE A KEY PARTNER IN
THAT AND HAS FOR FOR QUITE SOME
TIME.
I THINK I'VE ASKED THIS BEFORE
THIS IS NOT CERTAINLY NO NOT AT
ALL BUT I APPRECIATE YOU
REITERATING THAT.
I THINK THAT --
THESE VENUES WHEN WE'RE TRYING
TO PROVIDE WHEN YOU REQUESTED
THESE UPDATES FOR US TO BE ABLE
TO SHARE.
THE STATUS AND TO DO AGAIN ON
THE BARRIERS I THINK THAT THAT'S
SOMETHING THAT IS VERY HELPFUL
CERTAINLY I THINK ANYTHING THAT
IS HELPING US ELEVATE THE
SALIENCE OF THE ISSUE AND THE
ISSUE IT GREATER PENETRATION
INTO THE AREAS WHERE WE'RE STILL
SEEING GAPS.
I THINK THAT'S AN EXTREMELY
IMPORTANT ROLE --
THAT YOU ALL ARE CURRENTLY
PLAYING AND CAN CONTINUE TO PLAY
I THINK THAT THERE WE'VE ALSO
HEARD SOME OF THE QUESTIONS
AROUND WHAT ARE THE SORT OF
POLICY BARRIERS THAT WE MIGHT BE
ABLE TO COLLECTIVELY ADDRESS AND
I THINK THAT SOMETHING THAT WE
CAN.
DIVING DEEPER TOGETHER ON IN
SPECIFIC AREAS OF FOCUS --
BUT I THINK THAT THOSE ARE VERY
HELPFUL I THINK THAT --
BE HAPPY TO ALSO GO BACK AND GET
FURTHER INFORMATION TO PUT THEM
IN TERMS OF SPECIFICS THAT YOU'D
LIKE TO KNOW MORE ABOUT.
IN THOSE MORE TANGIBLE
OPPORTUNITIES FOR THE
RECOMMENDATIONS COMING OUT OF
THE WORK GROUP.
I'D ALSO SAY THAT ONE OF THE THE
STRUCTURE OF THE WORK GROUP AT
PRESENT IS LARGELY AROUND HOW DO
WE AMPLIFY THE EXISTING
ACTIVITIES THAT ARE HAPPENING.
IN EACH ORGANIZATION ONE OF THE
KEY GAPS THAT WE TRY TO ADDRESS
IS TO BRIDGE THE SILOS ACROSS
THE FUNDING THAT'S GOING OUT.
AND TO HELP LINK UNDERSTANDING
ACROSS SECTORS AND BETWEEN THE
STATE AND LOCAL LEVEL SO.
THAT VENUE IS PREDOMINATELY --
AND THAT THE ALSO COME THROUGH
THOSE RESPECTIVE DEPARTMENTS AND
THOSE PROGRAMS --
AND SO THAT'S ONE OF THE WAYS
THAT WE'RE TRYING TO TO NARROW
IN ON THAT.
SO HOW'S THAT GOING.
I THINK IT'S GOING VERY WELL I
MEAN I THINK THAT THE THE WORK
THAT YOU'VE HEARD ABOUT TODAY.
EACH ONE OF THOSE ACTIVITIES IS
SUPPORTED --
AND EXTENDED THROUGH THE
COLLABORATION WE HAVE ACROSS OUR
SECTORS THE DATA THAT WE'RE
USING IN OUR DISCUSSION TODAY.
AND THAT WE'VE ACCESS TO THE
DATA DASHBOARD COMES FROM A
PARTNERSHIP THAT IN IT WAS
INITIATED WHEN THE CALIFORNIA
DEPARTMENT OF JUSTICE SAID WE
THINK THAT THIS.
INFORMATION ABOUT PRESCRIBING
COULD BE USED FOR PREVENTION BUT
WE UNDERSTAND WE'RE NOT THE MOST
EFFECTIVE MESSENGER FOR THAT.
WHO CAN PARTNER WITH US TO MAKE
THAT AVAILABLE SO IT'S A SORT OF
CROSS DEPARTMENTAL?
LINKAGES TO BE ABLE TO FIND HOW
WE CAN USE OUR RESPECTIVE
STRENGTHS --
AND ADDRESS GAPS THAT I THINK
ARE THE RESULT IN THE FOCUS OF
THE WORK GROUP AND THAT'S WHY I
THINK THERE'S BEEN TREMENDOUS
PROGRESS.
SO I GUESS I WOULD GO BUT AND OF
I GUESS WE'LL TWO FIVE TWO
QUESTIONS AND I'LL I'LL MOVE ON
ONE IS --
WITH REGARDS TO QUARTERS AND
MEDICAL EXAMINERS ARE IS THERE
ANY PUSH TO ENCOURAGE --
REAL DATA SO WE ACTUALLY KNOW I
MEAN ARE THEY DOING TOXICOLOGY
SCANS ON ALL CASES THAT THEY
SUSPECT MIGHT BE RELATED TO AN
OVERDOSE.
OUR AND IS THAT DATA AVAILABLE
BECAUSE I DO WONDER ABOUT UNDER
REPORTING QUITE FRANKLY.
AND SO IS THE BAG TO THE THE
PROBLEM BIGGER OR SMALLER OR DO
WE ACTUALLY KNOW --
IF IF IF THEIR ACTUAL ECOLOGY ON
ON THESE CASES OR DO WE KNOW
THAT.
I THINK THE INTENT OF THAT WORK
IS TO EXPAND THE DEPTH AND THE
EFFECTIVENESS OF THAT DATA AND
TO EXPAND --
WHAT'S BEING COLLECTED THERE SO
I THINK THAT THAT'S SOMETHING
THAT WE'VE BEEN INCREASING
LEASING HAPPEN --
AND THAT THERE ARE RESOURCES
AVAILABLE THAT ARE HELPING
CORNERS THE MEDICAL EXAMINER'S
TO DO THAT BUT THAT OUT REACH
HAS TO DO WITH HELPING THEM
pUNDERSTAND.
THAT NECESSITY AND TRY TO FIND.
EXACTLY THE ANSWER TO THE
QUESTION THAT YOU'RE ASKING IS
HOW MUCH DO WE ACTUALLY --
HOW WIDELY ARE WE ACTUALLY
CAPTURING THAT DATA?
SO I GUESS IN MY FINAL QUESTION
COME BACK TO YOU.
I GUESS YOU KNOW AFTER FOUR
YEARS I'M STILL KIND OF WAITING
FOR THOSE.
THIS COULD BE REALLY HELPFUL.
COULD WE DO IS THERE SOME THE DO
YOU UNDERSTAND WHERE I'M COMING
FROM.
THIS COULD BE REALLY HELPFUL
WE'RE WILLING TO TAKE THAT RISK.
I UNDERSTAND THAT MAY BE THE
DEPARTMENT IS NOT.
BUT I AS A EGISLATOR I'M SEEING
PEOPLE DIE IN MY DISTRICT I AM
WILLING TO TAKE A RISK ON MOVING
A POLICY FORWARD THAT MIGHT BE
CONTROVERSIAL.
THAT MIGHT BE DIFFICULT FOR
PEOPLE TO ACCEPT IN THE IN THE
IN THE GOAL OF TRYING TO SAVE
PEOPLE'S LIVES.
AND AND SO [inaudible]
I GUESS.
I'M HOPING FOR MORE THAN.
I KNOW YOU GUYS ARE ALL WORKING
TOGETHER AND I THINK THAT'S
GREAT AND THE AND AND UP BUT I
ALSO RECOGNIZE THAT GOVERNMENT
HAS SILOS AND THAT FRUSTRATES ME.
HUGE AMOUNT --
AND I WISH WE COULD NOT COME ALL
DOWN WHICH ON A ROOM TO MAKE IT
ALL WORK TOGETHER --
AND COLLABORATE ON THESE THINGS
BUT I WILL GO BACK THAT I'M
STILL WAITING FOR THOSE THESE
ARE THINGS THAT WE THINK COULD
WORK ON A MUCH LARGER SCALE.
AND HELP US TO HELP BECAUSE THIS
PROBLEM WHILE IT IS IS THE IS
NOT GOING AWAY.
AN AND LIKE I SAID WE'RE FIVE
YEARS INTO THE YEAR IN THE SIX
YEAR OF THIS TASK FORCE NOW.
AND I BY AND OVER. FOUR YEARS
AGO I'VE I I'VE ASKED THE SAME
QUESTION.
AND CONTINUE TO BRING IT UP AND
I I HOPE THAT.
I HOPE SOME IS LISTENING
[inaudible]
CLEARLY.
WE'LL MAKE SURE WE ELEVATE THAT
QUESTION WITHIN THE WORKGROUP.
THAT'S GREAT.
THANK YOU.
THANK YOU --
AND THANK YOU SO MUCH FOR BEING
HERE I AM I AM GOING.
TO FOLLOW UP.
ON A DOCTOR WAS QUESTIONS AND
YOU YOU HEARD BY QUESTIONS TOO I
THINK YOU'RE IN THE AUDIENCE TO
THE BEHAVIOR HEALTH DIRECTORS.
AND I THINK SAY REITERATE THEN
IS THAT EVEN THOUGH WE WERE
MAKING PROGRESS AND FORTY DEATHS
ARE GOING UP.
AND PEOPLE ARE DYING.
AND SO -- SO
I GUESS. ONE QUESTION IS IS THAT
I APPRECIATE THAT NOW THE
WORKGROUP BRING TOGETHER AND I
HEAR A LOT OF ELEVATION AND SO
FORTH CITING SO WHAT.
WHAT IS WHAT HAVE YOU DONE?
I GUESS IS THE QUITE THINK
THAT'S THE FRUSTRATION OR
HEARING A LITTLE BIT LIKE OKAY
SO WHAT ARE THE CORNERS DOING
DIFFERENTLY NOW YOU'VE BEEN
MEDIA THE CORNERS WHY THEY
DECIDED TO WHAT'S DIFFERENT NOW
THAN. FOUR YEARS AGO WE STARTED
WORK GROUP HAVE THEY CHANGED ANY
WITH THE WAYS THEY DO AND I HAVE
THE CHANCE AND THEY AGREED TO TO
CHANGE THE WAY.
YOU KNOW HOW OFTEN THEY DO THAT
HOW OFTEN THEY TEST.
I GUESS NOBODY'S AFTER AND SEES
FOR SUBSTANCE IS THE THAT THE
TRAFFIC UP MAYBE MISSED CASES
RIGHT -- ARE
WE CHANGING AND WE CHANGED OR
HOW AND ACTUALLY THE DATA PART
YOU KNOW WHAT KIND OF DATA WE
COLLECT THE I ASKED THE THE
VALUE.
IS ABOUT --
DENOMINATOR EIGHT SO YOU KNOW WE
HAVE CURES THE END OF CAPTIONS
WE HAVE THAT THE THE WHOLE WEEK
ARE WE I MEAN THIS IS.
I HAVE A MASTERS IN PUBLIC
HEALTH SO HE'S LIKE OKAY IT OUT --
BUT WE DO AIR BASIC PUBLIC
HEALTH.
WORK ABOUT GETTING THE DATA
GATHERING THE DATA TOGETHER AND
SAYING WHAT A MISSING ELEMENT
ACID EVALUATORS I'LL ASK YOU TO
IS LIKE WHAT OTHER DATA ELEMENTS
DO YOU SEE NOW YOU'VE BEEN
LOOKING AT THIS THAT YOU.
ARE MISSING THAT YOU NEED WE
HAVE MORE RESOURCES TO COLLECT
WHAT ARE WE DOING THAT IN THE
LAST.
WHAT ARE WE DOING DIFFERENTLY IN
THERE'S A REASON WE'RE HAVING
THIS HEARING?
RIGHT I MEAN SELF TALK ABOUT
ELEVATION WE'RE HAVING A HEARING
TODAY ABOUT THIS RAY CRISIS WE
PLAN TO TAKE THE INFORMATION
FROM THIS HEARING AND THEN MOVE
FORWARD WITH ACTIVITY ON THE
LEGISLATURE.
WE ALSO YOU KNOW I APPRECIATE
THAT YOUR BRAIN AND WE NEED TO
HAVE PEOPLE WORKING TOGETHER.
BUT WORKING TOGETHER IS NOT JUST
BEATING.
YOU KNOW AND MEETING IN MEDIAN
MEETING ANDERSON UTILITIES A
MEETING BUT THEN AT THE THAT
CONVERSATION LEADS TO CHANGE.
LEADS TO DIFFERENT KINDS
ACTIVITIES SO YES ALL PUBLIC
HEALTH STANDPOINT --
WHAT IS IT THAT WE NEED TO DO
NEXT SOME MAY NOT REQUIRED
LEGISLATION THAT'S FINE --
BUT I WE CAN RE COLLECTING THE
KIND OF DATA WE'RE DOING A WE
DOING THE KIND OF SURVEILLANCE
THAT'S NECESSARY TO TO GET AN
ACCURATE.
ESTIMATE OF WHAT'S GOING ON SO
WE HAVE THAT WE HAVE PEOPLE WHO
ARE NOW --
WHO'S YOUR ADDICTED.
YOU HAVE THE OTHER TYPES SO A
READ WE DO WE HAVE THE KIND OF
INFORMATION ARE YOU WORKING WITH
EVALUATORS WE HAVE JUST HEARD
FROM SOME VALUES THE OPEN UP
THIS HEARING.
ARE YOU WORKING WITH EVALUATORS
THE TO BE SURE THAT WE HAVE THAT
THAT KIND OF DATA APPRECIATE WE
HAVE A WORK GROUP THAT'S A
MEETING FOR HOW MANY YEARS NOW
BUT WHAT HAS CHANGED IN THAT
SENSE THAT WORK GROUP CAME
TOGETHER IN TERMS OF THINGS THAT
WE'RE DOING WHAT.
WE DOING DIFFERENTLY NOW AND AND
THEN OF COURSE GOOD PUBLIC
HEALTH RIGHT AND SO THAT CHANGE
IN BEHAVIOR WHAT KIND OF CHANGE
AND OUTCOMES THAT LEAD.
TO AND WE MEASURING THAT.
SO -- IN
RESPONSE TO THE QUESTION --
THE DEPARTMENT PUBLIC HEALTH IS
CURRENTLY DESIGNING A DIGITAL
INFRASTRUCTURE THAT CONNECTS.
ITS INTERNAL REGISTRIES IS
SURVEILLANCE SYSTEMS AND
BUSINESS SUPPORT SYSTEMS
SPECIFIC. TO THE OPIOID CRISIS.
THE SYSTEM IS BEING DESIGNED TO
MONITOR FATAL AND NONFATAL
OPIOID EVENTS.
DATA COLLECTION FROM DATA
SOURCES INCLUDE VITAL RECORDS
THE FELLA.
OCCUPY PATIENT DISCHARGE AND
EMERGENCY DEPARTMENT ALLAH.
CAL READY LABORATORY DATA
GETTING HERE TOXICOLOGY QUESTION
GERMAN --
EMSA PRE HOSPITAL DOWN.
AND DEPARTMENT OF JUSTICE CURES
PRESCRIPTION DOWN --
THESE DATA SOURCES WILL BE
MONITORED AT THE STATE AND SUB
STATE LEVEL OVER TIME AND ACROSS
DEMOGRAPHIC ATTRIBUTES INCLUDING
GENDER RACE ETHNICITY AGENT
RESIDENTS.
AND CURRENTLY A PREDICTIVE
ANALYTICS SERVICE IS BEING
DEVELOPED A MONITOR OPIOID
RELATED PRESCRIPTION KAREN'S.
AND PROVIDE TREND DATA ON A
REGIONAL BASIS TO STAKEHOLDERS.
THIS STATUS OF THE PROJECT WAS
ANTICIPATED TIME OF WELL
COMPLETION IN TERMS OF AT LEAST
HAVING THOSE CAPABILITIES I
REALIZE THIS IS.
SOMETIMES AN EVOLVING THING AS
WELL BUT WHAT WHERE ARE WE WITH
THIS.
NOW -- JUST
A BRIEF OVERVIEW AND THEN A THE
CARD MONIES FEDERAL MONIES
BECAME AVAILABLE.
I BELIEVE IN LATE SEPTEMBER.
BY A MID DECEMBER OF TWO
THOUSAND EIGHTEEN WE HAD HIRED
THE SIX DEDICATED --
INDIVIDUALS OF SKILL SETS FOR
THIS KIND OF WORK TO THE
ANALYTICS SERVICES UNIT.
ARE WE ON BORDER THEM DURING
JANUARY FEBRUARY AND FOR THE
CONTRACT --
WITH THE SOFTWARE MIDDLEWARE --
VENDOR TO BRING IN THE
TECHNOLOGIC SOLUTION THAT THEY
COULD WORK WITH --
WE ANTICIPATE USING THE OPIOID
USE CASE AS I'VE MENTIONED HERE.
AS OUR FIRST USE CASE AND WE
HOPE TO HAVE A PROOF OF CONCEPT --
DETERMINED BY MID AUGUST OF THIS
YEAR.
HEY AND THEN THEN WE CAN SCALE
BEYOND THAT OF THAT IT IF THAT
IS SUCCESSFUL IT'S ALWAYS A
PROOF OF CONCEPT THAT.
IS THE CELLS AT A THAT'S NOT
WORKING SYSTEM YET RIGHT THAT.
IS AN HONOR WORKING SYSTEM IS A
PROOF OF CONCEPT WHICH BASICALLY
SAYS.
CAN WE IN FACT COLLECT ALL THIS
TO SOME PLACE TO WAY OF THE
COORDINATION PLACE.
WE HAVE A DATA DICTIONARY THAT
CAN TAKE THE DATA FROM DIFFERENT
VOCABULARIES AND INTEGRATED.
CAM WITH THEM PROCESS THAT ON
THE INGESTION SOFTWARE CAN WE
MAKE IT AVAILABLE TO THE
ANALYTICS SOFTWARE WILL GIVE US
THE OUTPUTS THAT WE'RE LOOKING
FOR TO INFORM DECISION MAKING.
SO NOW WOULD YOU SELL ASSUMING
YOUR PROOF OF CONCEPT WORKS OUT
SO THIS IS AUGUST THEN DO YOU
HAVE THE FUNDS TO THAN ACTUALLY
MAKE A WORKING SYSTEM OR IS THAT
HOW MUCH FEDERAL FUNDS YOU HAVE
IS IT JUST THE TO PROVE CONCEPT
IS ACTUALLY ENOUGH.
THANK YOU THROUGH TO
IMPLEMENTATION --
JULIE PERHAPS YOU CAN HELP ME
WITH THIS BUT I BELIEVE THE CDC
COED FUNDS ARE AVAILABLE.
THROUGH THE CURRENT FEDERAL HERE
AND SANSA FUNDS ARE AVAILABLE IN
TWO NEXT YEAR WHICH IT HELPS
SUPPORT THAT BUT THAT DOESN'T
SUPPORT THE SIX POSITIONS
[inaudible]
GOING FORWARD [inaudible]
THAT'S CORRECT.
OKAY SO THOSE WE CAN GET THE
PROOF OF CONCEPT WE'RE NOT SURE
WE CAN GO BEYOND THAT FUNDING
WEISS.
OBVIOUSLY YOU KNOW YOU WANT YOU-APPROVED THE CONCEPT BUT OKAY --
AND I BELIEVE WILL PRY HAVE
FURTHER DISCUSSIONS ABOUT THIS
THAN BUDGET I UNDERSTAND.
OKAY RIGHT BECAUSE I NEED THAT
THAT'S THE CUT RATE WE NEED TO
HAVE THAT KIND OF INFORMATION TO
KNOW WHAT'S GOING ON THAT'S WHAT
PUBLIC HEALTH ABOUT RIGHT SO.
IT WERE A DARK ROOM WE NEED THE
LIGHT SO WE CAN SEE WHICH WAY TO
GO WE CAN FIND A WAY TO SOLVE
THE PROBLEM OTHERWISE WERE.
PLAINLY WINE AROUND --
OKAY [inaudible]
AND SO I I THINK ONE OF THINGS I
I WOULD CERTAINLY APPRECIATE
NINE ON OF WAS IS ACTUALLY --
I DON'T AS THEY RECOVER REPORT
ON THIS SOS I MEAN I REALLY
WOULD LIKE TO HAVE A LIST OF
LIKE OKAY THE THINGS THAT.
THAT ARE TO HELP DIFFERENCE
SINCE WE STARTED.
RIGHT -- I
RELEASE THE FEDERALLY FUNDED SO --
BUT I MEAN IT LIKE TO KNOW LIKE
WHAT WHAT KIND OF CHANGES ARE WE
TALKING ABOUT THAT IS COMING OUT
YEARS OF DISCUSSION.
AND THE PLAN TO EVALUATE THE
IMPACT OF THOSE CHANGES NOW
HOPEFULLY MAYBE WE HAVE THE
SYSTEM WE'RE GOING TO BE ABLE TO
BETTER MEASURE THAT.
RIGHT AND THEN ALSO BILL THIS IS
WE TALK ABOUT COLLABORATION
SAMPLE ARE YOU WORKING WITH THE
BEAVER HEALTH DIRECTORS I JUST
CHALLENGED THEM TO SAY WELL WHAT
WE DO ABOUT THE SMALLER COUNTIES
MEDIUM SMALL COUNTIES WHO DIED
THE INFRASTRUCTURE.
RIGHT SO IT'S GREAT TO HEAR FROM
THE SUCCESSES BUT I WONDER WHY
THE ONES WHO ARE DOING AS WELL.
AND I LET OUT COMPLETELY OUT
THERE DID THAT THE ONE THAT ARE
PERFORMING AT THAT'S GREAT TO
TALK TO THE TOP PERFORMERS BUT
ALSO I WANT NO WORD IN MIDDLES
GOING SO I ARE YOU INVOLVED IN
THAT KIND OF DISCUSSION ARE NOW
IS THAT SEPARATE DISCUSSION.
WITH BEHAVIOR HEALTH DIRECTORS
YES ME SO I BELIEVE THERE ARE
BEHAVIOR HEALTH DIRECTORS THAT
ARE PARTICIPANTS --
THAT CONVERSATION HAPPENING IN
YOUR GROUP RIGHT NOW OR NOT THE
VERY CORE CONVERSATION I JUST
HAD WITH --
THE GENTLEMAN FROM LA IS THAT
EVEN BEEN THE TOPIC OF YOUR
DISCUSSION.
I THINK THAT THE CERTAINLY THE
CHALLENGES IN TERMS OF UPTAKE
AND THE MAKING THE EXPANSION OF
MEDICATION ASSISTED TREATMENT
AVAILABLE IN ALL SETTINGS AND
ALL COUNTIES HAS CERTAINLY BEEN
A PRIORITY SO LET ME JUST ASK
ANOTHER QUESTION AND I
APPRECIATE TALKING ABOUT
CHALLENGES.
IS THE GROUP TALK ABOUT
SOLUTIONS [inaudible]
CERTAINLY OKAY.
AGAIN I WANT TO REITERATE RIGHT
THAT THE THE WAY THAT THE WORK
GROUP FUNCTIONS.
IS TO BE ABLE TO BRING THE
SECTORS TOGETHER RIGHT
UNDERSTAND WHAT ARE THE
ACTIVITIES THAT WE'RE DOING
WITHIN THOSE SILOS THAT YOU
DESCRIBE THIS AND THE FUNDING
THAT COMES DOWN TO SUPPORT THAT
WORK.
IN THE ACTIVITIES OR DESCRIBED%
THROUGHOUT THE DAY AS WELL AS
OTHER ACTIVITIES THAT OCCUR AND
WHAT WE'RE TRYING TO DO IN THAT
VENUE.
IS TO INFORM EACH OTHER'S WORK
WITH THE UNDERSTANDING THAT WE
HAVE FROM EACH OF THOSE SECTORS
AND PERSPECTIVES. FOR EXAMPLE TO
BE ABLE TO DETERMINE WHEN
DEVELOPING THE ROLLOUT OF THAT
HAVE BEEN SPOKE SYSTEM.
PART OF THE SUPPORT THE DH CS
HAS BUILT IN COLLABORATION
PUBLIC HEALTH IS WE NEED TO RAMP
UP LOCAL COMMUNITY COALITIONS
RIGHT SO THAT'S A PRACTICE THAT
WE IDENTIFIED IN PUBLIC HEALTH
AND THEN SHARED THROUGH OUR WORK
GROUP.
WITH THE EXPERIENCE TO TEACH THE
S. AND THE DATE AMPLIFY KLAY THE
INSIGHT THAT YOU'RE LOOKING FOR
WHICH IS WHAT ARE THE BARRIERS
AND A LOCAL COMMUNITY.
THAT ARE COMING UP AND IT'S THIS
COALITION VENUES THAT HELP US TO
IDENTIFY THOSE SO THAT'S AN
EXAMPLE OF THE SORT OF THE
INTERCHANGE THAT OCCURS TO
INFORM.
AND MORE EFFECTIVELY DIRECT THE
RESOURCES AND EFFORTS THAT WE
HAVE IN EACH DEPARTMENT THAT'S
PART OF THE BENEFIT OF THAT.
BUT THE DESTRUCTION THAT WE HAVE
ON THE WORK GROUP IS TO HELP.
MORE EFFECTIVELY INFORM EACH
OTHER'S WORK AND EXTEND THE
IMPACT OF THAT WORK SO NOT ONLY
TO SORT OF CONVENE AND THEN COME
UP WITH WHAT WE THINK THE ISSUES
ARE TO BE ABLE.
TO ACTIVELY INFLUENCE EACH
OTHER'S WORK AS IT'S OCCURRING
RIGHT NOW.
OKAY SO IT'S I THINK IT'S AND IN
THE END OF THE DAY I'M SURE GOOD
STUFF IS COMING OUT OF THIS I
THINK WHAT.
AT LEAST.
I CAN ALMOST BE FOR DOCTOR
WHAT'S BUT I MEAN I THINK WE'RE
A FEELING A LITTLE FRUSTRATION
IN THE SENSE THAT.
WE CERTAINLY SEE VALUE IN THE
GROUP AND I'M SURE YOU'RE DOING
IT BUT I'M NOT HEARING AS MUCH
AND I REALIZE I GIVE YOU A VERY
LIMITED ABOUT TIME TO PRESENT IS.
SOMETHING ABOUT LIKE WHOA OKAY
SO WHAT HAS COME OUT OF THE
GROUP THAT HAS LED TO CHANGE
RIGHT.
OKAY MEANS GREAT FOR PEOPLE TO
TALK TOGETHER AND THAT'S
IMPORTANT IT'S A VERY IMPORTANT
FIRST STEPS TO DOING THIS AND
NOW AND TO BREAK THOSE SILOS BUT
THEN THE THING IS IS THAT OKAY
FINE YOU'RE TALKING BUT WHAT HAS
HAPPENED RATES FOR EXAMPLE.
THEY YOU SAID OKAY FINE BECAUSE
WE MET TOGETHER WE WERE ABLE TO
PROVIDE EXPERTISE DEPART PUBLIC
HEALTH THAT DTS WHEN HAVE HAD
ACCESS TO WIN IT THOUGHT ABOUT
TO DO MORE REACH OUT REACH THAT
ADDRESS THE STIGMA.
AND I DON'T OF THAT REALLY
HAPPENED OR NOT BUT I'M JUST
TRYING FROM RIGHT SO I MEAN THAT
THE DATA HELPFUL TO NOW.
AND ANOTHER EXAMPLE OF
UNINTENDED CONSEQUENCES CONCERN
OR AMBIGUITY AROUND THOSE GETS
ELEVATED THERE THERE'S A FASTER
CAPACITY FOR US TO COLLECTIVELY
RESPOND.
IN A AN EXAMPLE OF THAT WOULD BE
WHEN THERE'S SORT OF THE CURES
MANDATED REGISTRATION THE
MANDATED USE OF EMERGING CONCERN
AROUND THE PROVIDER COMMUNITY
BUT WHAT DO WE DO WHEN WE'RE
WE'RE IDENTIFYING THAT THERE ARE
PATIENTS THAT WE'RE NOT SURE HOW
TO TRANSITION.
WE COLLECTIVELY ARE ABLE TO HELP
PROVIDE RESOURCES AND SUPPORT
FOR THAT AND THEY COME OUT WITH
UNIFIED MESSAGING.
ARE UNINSURED AGENDA OF HOW WE
WANT.
TO HOWARD COLLECTIVELY AGREEING
TO ADDRESS THOSE ISSUES OKAY AND
AGAIN I AM ACTUALLY I I THINK
THAT ONE THE VERY IMPORTANT
ROLES OF THAT THE BAR PUBLIC
HEALTH IS THE DATA
INFRASTRUCTURE TO DO THE
SURVEILLANCE I MEAN THAT'S
THAT'S THAT'S THE BREAD AND
BUTTER OF PUBLIC HEALTH RIGHT.
WHAT'S GOING ON WHERE IT IS SO
I'M HOPING THAT WE CAN FOLLOW UP
ON WHERE WE ARE ON THE STATE
INFRASTRUCTURE AND THAT TOO FOR
CONCEPT AND HOPEFULLY WE CAN GO
FROM PREFER CONCEPT SOMETHING
THAT CAN GIVE US KIND OF TOOLS
WE NEED TO BETTER DIRECT.
RESOURCES WE WANT DIRECTOR TRY
TO SOLVE THE PROBLEM.
I JUST WANT TO MAKE SURE TO THAT
YOU'RE AWARE OF THE OPIOID DATA
DASHBOARD AS WELL THAT THAT WE
RUN SO THAT HAS.
RADIATION ER VISITS AND
PRESCRIBING ALL AT ONCE AND IT'S
A QUERY SYSTEM SO.
WE'RE VERY PROUD OF THE
USEFULNESS OF THAT SO THAT'S
COUNTIES IN COALITIONS CAN GO ON
AND GET.
THE MOST --
EASILY ACCESSIBLE INFORM THEIR
LOCAL EFFORTS AS POSSIBLE AND
THEN WE DO USE THAT TO RUN
SURVEILLANCE AND LOOK OBSERVE
AND TRACK EXCELLENT WELL THANK
YOU THANK YOU FOR SHARING THAT
AND AGAIN THAT'S ONE OF OUR
PUBLIC.
OKAY EXCELLENT.
JUST A COUPLE OF MINOR THINGS
HERE SO YOU TALKED ABOUT THE
BARRIERS AND AND THEIR
STRATEGIES FOR OVERCOMING AREAS
I ASSUMING THAT YOU THAT THERE'S
A REEVALUATION OF HOW THAT'S
THOSE ARE WORKING.
THAT'S WORKING I THINK THAT'S
CONTINUOUS ABSOLUTELY I THINK
THAT ESPECIALLY WITH THIS ISSUE
WERE SAYING THAT EACH STEP WE
IDENTIFY THAT THERE ARE NEW
CHALLENGES THAT COME WITH.
WHAT'S THE SUPPORT THAT'S NEEDED
TO SUSTAIN THAT STEP.
SO I THINK THAT THAT'S SOMETHING
THAT ABSOLUTELY IS CONTINUOUSLY
BEING RE EVALUATED AND AND THOSE
INFORMATION CHANNELS COMMUNITY
COALITIONS ARE MULTI SECTOR
WORKERS ARE VENUES WHERE THOSE
ISSUES ARE SURFACED AS WELL AS
WITHIN OUR RESPECTIVE PROGRAMS.
THE ONE OF THE THINGS WE HEARD
FROM FROM THE GENTLEMAN FROM
TARZANA TODAY WAS.
THAT THAT SYSTEMS DON'T
COMMUNICATE AND AND SO ARE THOSE
THE KINDS OF THINGS THAT YOU
THAT YOU'RE THAT YOU'RE
EVALUATING AND MAKING
RECOMMENDATIONS ON SIMPLIFYING
THE PROCESS OF THE PROVIDERS CAN
ACTUALLY.
PROVIDE RATHER THAN HAVE TO
SPEND THEIR TIME DOCUMENTING A I
MEAN I'M JUST TRYING TO
UNDERSTAND.
THE BREASTS OF THE WORKGROUP
CENTER WITH WITHIN THE
DEPARTMENT WE HAVE AN INTER
OPERABILITY INITIATIVE.
THAT WE BRANDIS SPEAKER SYSTEM
OF DATA SHARING WHICH IS AN
IMMEDIATE AND LONG TERM PROJECTS
TO IMPROVE INTER OPERABILITY.
BOTH WITHIN THE SYSTEMS WITHIN
THE PUBLIC HEALTH DEPARTMENT AS
WELL AS OUR LOCAL PARTNERS AND
STATE ANOTHER FEDERAL PARTNERS
BEYOND THAT.
AT THE AGENCY LEVEL THERE'S A
TAB THAT A SUB COMMITTEE WHICH
IS THAT WORK.
ON THE HEALTH INFORMATION
EXCHANGE THE STATE AND AS YOU
KNOW THERE ARE SIGNIFICANT
CHALLENGES THERE WITH A HUGE
WHITE SPACE AND SOME OF THE
RURAL AREAS IN REGARDS INNER
OPERABILITY THAT WE'RE
ATTEMPTING TO ADDRESS.
THAT IS PART OF THE PROCESS YES
SIR SOUNDS LIKE IT'S A PRETTY
SIGNIFICANT ISSUE.
I GUESS THE FINAL THING IS AN
VERY THE VERY BEGINNING WE
TALKED ABOUT.
HOW THE TRIBAL COMMUNITIES?
AND IS THAT SOMETHING THAT'S
PART OF THE DISCUSSION AND SO
WHAT SO.
THAT SEEMS TO CONTINUE TO BE A
GLARING PROBLEM SO ARE THERE
STRATEGIES THAT ARE BEING
EMPLOYED TO HELP WITHOUT REACH
THE TRAVEL COMMUNITIES AND THOSE
ARE CONTINUING TO BE REEVALUATED.
YES SO THERE I FIND OUT
INFORMATION ABOUT THAT.
MY FOR MY COMMUNITY THE
CALIFORNIA RURAL INDIAN HEALTH
BOARD.
AS A RECENTLY --
REACHED OUT TO THE CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH AND
THEY HAVE JOINED.
THE STATE WIDE OPIOID --
SIXTY WORKGROUP PAN ARE PRESENT
AND ENGAGE IN A PROCESS AND
THEY'RE HELPING US REACH OUT
FURTHER OR TO OTHER
ORGANIZATIONS AND SUBSETS WITHIN
THE TRAVEL COMMUNITIES
THROUGHOUT CALIFORNIA.
PRIOR TO THAT THEY WERE TO PART
OF THIS PROCESS THAT'S A
SIGNIFICANT AT THEIR YEAH.
THE I'M JUST TRYING TO THEY WERE
NOT A PART OF THIS UNTIL JUST
RECENTLY.
THEY RECENTLY JOINED THE WORKERS
THAT'S WHAT THEY WERE NOT A PART
OF THE PROCESS.
THEY MAY HAVE BEEN A PART OF THE
PROCESS AT THE LOCAL LEVEL THEY
HAD NOT BEEN PARTICIPATING AS A
STATEWIDE ENTITY.
THEY ALSO RECENTLY RECEIVED SOME
FUNDING TO INCREASE THEIR OWN
CAPACITY WHICH IS ALLOWED THEM
TO PUT INCREASED FOCUS.
ON THIS ISSUE AND THEIR
PARTICIPATION THERE.
WE'VE ALSO BEEN PROVIDING
TECHNICAL ASSISTANCE TO THEM ON
THE DATA FRONT BECAUSE THEY'VE
BEEN TRYING TO BETTER UNDERSTAND.
THE NATURE OF THE BURDEN --
ON TRIBAL COMMUNITIES AND THERE
ARE SOME QUESTIONS THAT THEY HAD
ABOUT DATA AND THAT'S SOMETHING
THAT WE'VE BEEN WORKING TOGETHER
WITH THEM ON WHAT I'M GLAD THERE
THAT THE KIND.
THIS IS A NUMBER THIS IS THIS
ISN'T NOT I KNOWN THAT THEY BEEN
THIS IS BEEN A PROBLEM WITH THIS
WITH THESE.
WITH THESE COMMUNITIES FOR A
LONG TIME I'M JUST SURPRISED
IT'S TAKEN SO LONG. FOR THEM TO
BE A PART OF THE WORKGROUP.
WELL OKAY I'M JUST I GUESS I'LL
JUST LEAVE IT AT THAT --
SOME OF THE CHALLENGES YOU TALK
ABOUT TECHNICAL CHALLENGES ARE
PROBLEMS ARE JUST THINGS LIKE
THAT SOME OF THESE.
HAVE HAVE INTERNET ISSUES A A
LOT OF A RIDE A HUGE HUGE HUGE
CHALLENGES AND THESE.
I WOULD JUST ENCOURAGE IN
GENERAL HEALTH THAT WE ENGAGE
WITH OUR TRAVEL COMMUNITIES MORE.
THEY OFTEN FEEL LEFT OUT OF
THESE CONVERSATIONS WEATHER'S
OPIOIDS OR ALCOHOL OR OR JUST IN
GENERAL --
IT'S A IT'S A HUGE HUGE
CHALLENGE --
FOR PEOPLE AND WHEN WITH WITH
GUARDS OPIOIDS WHEN THEY'RE DIED
AT THREE TIMES THE RATE OF OF OF
SOMEONE IS CAUCASIAN --
I I JUST.
I JUST WONDER WHY THEY WERE AT
THE TABLE CENTER BUT THAT'S YOU
KNOW THAT'S THAT'S ANOTHER
THAT'S ANOTHER DISCUSSION.
THANK YOU FOR BEING HERE AND YOU
KNOW WE WANT TO BE SURE PUBLIC
HEALTH AS PART OF THIS HEARING --
I KNOW IT.
DOESN'T ALWAYS SEEM LIKE FUND.
BUT BECAUSE YOU'RE SO IMPORTANT
TO THIS AND WE NEED YEAH WE NEED
THE INFORMATION THAT YOU'RE
DOING I APPRECIATE THAT YOU'RE
YOU KNOW CONVENING PEOPLE AND
HAVING THOSE CONVERSATIONS BUT
ALSO WE WANT TO BE SURE THAT
WERE.
WERE MOVING THINGS AHEAD I THINK
IS -- BOTH --
SELLER WOULD NIGHT SAYING THAT.
WE HAVE PEOPLE DOING PILOTS WE
HAVE.
OTHER THINGS BUT PEOPLE ARE
DYING AND WE NEED TO ACT MORE
QUICKLY RIGHT SO IT'S GREAT FOR
PEOPLE TO COME AND TALK AND
THAT'S REALLY IMPORTANT AND SO
FORTH AND ETCETERA BUT WE'RE
ALSO.
PARTISAN RANTINGS HEARINGS TO
PUSH FOR ACTION NIGHT OKAY FINE
WE'VE TALKED ABOUT THIS.
WHERE WE CAN DO RIGHT I'M GLAD
YOU'RE OPEN TO DIFFERENT IDEAS
BUT OPEN DOESN'T MEAN YOU'RE
DOING SOMETHING I SO WHAT'S THE
NEXT STEP OKAY NOW YOU'RE OPEN
LET'S GET TO THE NEXT UP AND DO
SOMETHING?
RIGHT AND I'M NOT SAYING PEOPLE
ARE DOING THINGS IN FACT WE JUST
HEARD A LOT OF GOOD THINGS
PEOPLE ARE DOING BUT WE THIS IS
A MAJOR PROBLEM AND AND WE WILL
WE WILL WANT TO SEE.
ADDRESS AND THERE'S BEEN A LOT
OF LEGISLATIVE ACTIVITY MORE
FOCUSED ON THE PRESCRIPTION SIDE
OF THINGS BUT NOW I'M AND I AM
CERTAINLY NOT GONNA GO AND RIGHT
OFF THE PEOPLE READY ARE
SUFFERING RIGHT NOW FROM SOME SO
WE DON'T LIKE MORE PEOPLE.
ENTERING THE PIPELINE INTO
SUBSTANCE USE BUT WE ALSO CAN'T
ABANDON THE PEOPLE WHO ARE
SUFFERING AND THEIR FAMILIES WHO
HAVE SUFFERED FROM SUBSTANCE USE
AND THAT MEANS THAT'S ACCESS TO
TREATMENT.
THAT'S ALSO.
YOU KNOW THE FUTURE OF THE OF
THE SPORTS THAT WE HAVE THE DATA
TO SHOW IT'S SET IT TO KNOW WHAT
THEY WERE MAKING PROGRESS ON
THAT AS WELL AND I APPRECIATE
THE WORK THAT THAT.
PUBLIC HEALTH IS DOING THE WE'D
LIKE TO HEAR A LITTLE MORE FROM
YOU ABOUT.
THE THINGS AND I'M LOOKING FOR
TO THE DATA INFRASTRUCTURE TO
YOU PROVIDE IT'S IMPORTANT FOR
US TO KNOW WITH.
BREAKING PROGRESS AND OKAY THANK
YOU THANK YOU SO MUCH FOR BEING
HERE.
OKAY SO WE'RE PUBLIC COMMENT --
SO PEOPLE CAN LINE UP THE
MICROPHONE KEEP YOUR COMMENTS TO
TWO MINUTES OR LESS.
BUSES ACCEPTABLE --
WE'VE HAD A LONG HEARING BUT
ALSO WE DO WANT TO HEAR FROM YOU
AND IT AND SO I APPRECIATE SO
PLEASE STATE YOUR NAME THE
ORGANIZATION WITH IF YOU'RE A
WITH AN ORGANIZATION AND LOVE.
AND LOVE TO HEAR WHAT YOU HIGH
YOUR SILENCE I'M HERE YOU DAILY
WITH CALIFORNIA CONSORTIUM OF
ADDICTION PROGRAMS AND
PROFESSIONALS AND I REALIZE I'M
PLAYING TO A DWINDLING HOUSE AND
A HUNGRY CROWD.
SO KEEP IT SHORT I BASIC FELT
COMPELLED TO OME UP --
FOR CHAIRMAN WOULD.
AB QUESTIONS HE KEEPS SAYING
WIRE PEOPLE AND MY DISTRICT
DYING AT HIGHER RATES THAN OTHER
DISTRICTS.
AND THEN THE FOLLOW UP IS WHAT
THE HECK CAN BE DONE AND I DON'T
FEEL LIKE YOU GOT ANSWERS TO
EITHER OF THOSE QUESTIONS TODAY.
SO I WANTED TO TALK ABOUT HUB
AND SPOKE IS WONDERFUL IT'S
GREAT IT'S LOVELY.
IT'S BASICALLY A MEDICATION
DELIVERY SYSTEM.
AND I WOULD BE.
NOT TO SAY THAT IF YOU HAD
MEDICATION FRICTION.
AVAILABLE FREE AT EVERY CDS IN
YOUR DISTRICT I DON'T KNOW THAT
MAKE THAT MUCH IMPACT IN THE
RURAL AREAS.
WHAT'S MISSING IS --
PEOPLE ARE DYING BECAUSE THEY
LIKE SEVERAL SPEAKER SAID ARE
NOT AWARE THEY HAVE ADDICTION OR
THEY'RE NOT AWARE HOW TO GET IT
TREATED.
SO THEY'RE NOT GOING TO GO TO A
POINT TO THE OTHER GROUP OF
PEOPLE WHO WERE RELAPSE.
SO THESE ARE PEOPLE WHO HAVE
CHANNELS TO GET ILLEGAL DRUGS
THE MOST DANGEROUS OF WHICH IS
SPENT ON I'M THEY HAVE AN
ABILITY TO KNOW HOW TO USE THEM.
AND THEY HAVE A VERY LOW
TOLERANCE --
RELAPSING FROM HER ONE IS
BASICALLY DEADLY IN MANY CASES.
SO WHAT'S MISSING IN YOUR AREA
IN MANY AREAS IN THE STATE IS
THE COUNSELING THAT GOES ALONG
WITH THE MEDICATION ASSISTED
TREATMENT.
AND THERE'S A STRUCTURAL REASON
WHY IT DOESN'T EXIST IN THE ROLE
COUNTY.
AN OUTPATIENT TREATMENT CENTER
AND THAT IS THE LICENSE TO GET
REIMBURSEMENT PROVIDE SERVICES.
IS A MULTI THOUSAND DOLLAR
APPLICATION.
IT'S NOT SUITABLE TO A ONE OR
TWO PERSON ENTITY.
PRIVATE PRACTICE.
SO YOU REALLY CAN'T PROVIDE
SERVICES TO PEOPLE IN THE DRUG
MEDI CAL SYSTEM.
WITHOUT A LICENSE.
NOBODY PAYS YOU.
ALSO NO ONE PAYS YOU AS THE
NEWSPAPER PRACTITIONERS THROUGH
INSURANCE UNLESS YOUR LICENSE IN
CALIFORNIA DOESN'T HAVE A
LICENSE.
PREDICTION COUNSELORS.
SO WE COULD KEEP POURING MONEY
INTO PROVIDING MEDICATION.
BUT IT'S THE COUNSELORSWHO.
MEET WITH THE PARENTS.
WITH THE CLIENT MOTIVATE THEM
MAKE THEM REALIZE HEY I'VE GOT A
PROBLEM AND HERE ARE THE WAYS
YOU CAN ADDRESS THE PROBLEM.
THEY'RE ALSO CRITICALLY
NECESSARY TO THE FOLLOW UP TO
KEEP PEOPLE FROM RELAPSING SO
OUR MODEL NOW IS.
GET SO SICK.
THAT YOU HAVE TO BE
INSTITUTIONALIZED FOR THIRTY
DAYS FOUR HOURS FROM YOUR HOME
AND ANOTHER COUNTY.
GET OUT OF BEING
INSTITUTIONALIZED HAVE NO FOLLOW
UP OR MAYBE SOME MEDICATION YOU
MIGHT BE MOTIVATED TO USE.
AND WE EXPECT THAT TO WORK WE
DON'T DO THIS WITH ANY OTHER
DISEASE.
IN CALIFORNIA SO WE'RE WAIT I'M
THAT WE NEED TO LOOK AT I SMALL
OUTPATIENT PROGRAMS.
THAT COULD BE DONE.
IMMEDIATELY IMMEDIATELY THE
DEPARTMENT COULD ISSUE SMALL
OPPOSITION LICENSES. TO
INDIVIDUAL PRACTITIONERS WHO
HAVE A BACKGROUND CHECK WHO ARE
ALREADY CERTIFIED TO WORK AND
LARGER PROGRAMS.
AND ALLOW THEM TO DO THIS WORK
WHERE THE PEOPLE ARE THAT COULD
HAPPEN.
AT THE END OF THE SESSION WE CAN
GET THOSE SMALL OUTPATIENT
LICENSES GOING IN LIEU OF
WAITING FOR THE LEGISLATURE.
WHICH HAS ALREADY PASSED A
LICENSABLE TWICE FOR THIS
PROFESSION TO FINISH THAT NEEDED
WORK SO THAT NOT ONLY PEOPLE ON
MEDICAL BUT ALL PETITIONS COULD
ACCESS CARE LOOK LIKE.
THANK YOU AND ACTUALLY IF YOU
HAVE SOME MATERIAL OR SOMETHING
IN THAT REGARDS --
PLEASE SHARE WITH US I WILL
CERTAINLY THANKS VERY MUCH
[inaudible]
WELCOME.
GOOD AFTERNOON MISTER CHAIR AND
MEMBERS I'M FOR MCDADE TING ON
BEHALF OF THE CALIFORNIA STATE
ASSOCIATION OF COUNTIES SEE SACK
REPRESENTING THE COUNTY
SUPERVISORS IN THE FIFTY EIGHT
COUNTIES.
IT'S A GREAT AND VERY THOROUGH
HEARING WERE SPECIALLY HARDENED
TO SEE PUBLIC HEALTH THE PUBLIC
HEALTH ANGLE BECAUSE THE HARM
REDUCTION ANGLE IS REALLY
IMPORTANT.
AND EVEN IN COUNTY LAND PUBLIC
HEALTH AND BEHAVIOR HEALTH ARE
LEARNING TO WORK TOGETHER ON
THIS ISSUE SOME OF THE GREAT
LESSONS LEARNED FROM PUBLIC
HEALTH CAN BE ACT APPLICABLE TO
ADDICTION TREATMENT --
I DO WANT TO SAY THAT THE OF THE
DRUG MEDICAL PROGRAM AND THE
DRUG MEDI CAL WAIVER IS A
DEMONSTRATE THAT HAVE SO MANY
COUNTIES JOIN IN --
DUE TO THE GREAT WORK I THINK DH
CS AND MS PRESENT OTHERS HAVE
WORKED REALLY HARD TO GET AS
MANY COUNTIES AS POSSIBLE IN THE
PROGRAM AND I WANT TO COMMEND
THEM FOR THAT.
AS WELL AS OUR PER COMMUNITY
PROVIDERS WHO ARE PARTNERING
WITH COUNTIES TO OFFER THE
SERVICES --
AND WE HEAR THE NEED FOR NEW
IDEAS YOU HEARD A FEW --
I'VE TALKED WITH A DIRECTOR
CAN'T AND OTHERS ABOUT CMS P. --
POTENTIALLY DOING DRUG MEDICAL
THEY'RE ALREADY IN THE COMMUNITY
THEY'RE GREAT JPA THEY DO A
REALLY GOOD JOB ALREADY SO
THEY'RE A GOOD VEHICLE FOR THAT --
ALSO PAYMENT REFORM YOU'VE HEARD
SEVERAL IDEAS FOR THAT SO WHERE
IT WILL BE CONTINUE TO WORK ON
THIS ISSUE AND MAKE SURE THAT
THE SERVICES ARE GETTING.
IN ALL AREAS THE NEED TO GET IN
AND WITH THE NEXT WAVE --
HOPEFULLY WE CAN HAVE IT WILL BE
A DEMONSTRATION ANYMORE THAT THE
HUB AND SPOKE MODEL IN THE
WAIVER WILL BE WHAT BECOME
STATEWIDE.
THANK YOU [inaudible]
WELCOME.
DOCTOR PAN DOCTOR WOULD
ACKNOWLEDGING THEM THE SECOND TO
LAST PERSON KEEPING YOU FROM
YOUR NEXT MEETING YOUR LUNCH
I'LL KEEP MY COMMENTS VERY BRIEF --
I'LL HUDDLED ON WITH THE WHITE
MAN GROUP HERE ON BEHALF OF CAL
CLARA TODAY WE GREATLY
APPRECIATE THE CONTINUE TO FOCUS
AT THIS COMEDIAN YOU TO HAVE
BEEN.
I'M GIVING A SHINING A LIGHT
STILL ON THIS ON THIS OPIOID
WHICH CONTINUES THE CRISIS WHICH
OF COURSE IS AN EPIDEMIC AND WE
WANNA FIND SOLUTIONS TO IT --
WE WANT TO ASK THAT BOTH
COMMITTEES ALSO DEDICATE THE
SAME OF TIME AND ATTENTION TO
PREVENTION.
TREATMENT ARE --
WE DEFINITELY THINK THAT IN THE
LONG RUN IN THE WAY THAT WE'RE
GOING TO ACTUALLY KERR OF THIS
OPIOID CRISIS.
IS BY INTEGRATING NON
PHARMACOLOGICAL TREATMENTS --
OF COURSE CHIROPRACTIC CARE
PHYSICAL THERAPY MENTAL HEALTH
SERVICES THEY'RE ALL I AM NUMBER
MONOCLE TREATMENT OPTIONS IN THE
CHIROPRACTORS I CAN SPEAK FOR
OUR MEMBERSHIP THAT THEY'RE MORE
THAN WILLING. TO PARTNER UP AND
TO YOUR POINT DR WOULD OF
DEPARTMENTS WORKING IN SILOS I
THINK ALL OF THAT A LOT OF THE
PROVIDERS AND ALL THESE
PROFESSIONS ARE WILLING TO WORK
TOGETHER.
AND WE REALLY HOPE THAT A WE
HAVE A CHANCE TO REALLY TALK
ABOUT PREVENTION.
THANK YOU [inaudible]
WELCOME.
THANK YOU ROBERT HARRIS ON
BEHALF LCI KIT CALIFORNIA
[inaudible]
STANDARDS ENFORCEABLE STANDARDS
WHO PROVIDES TREATMENT.
AND WHO DOESN'T THERE IS NO
LICENSE YOU KNOW THE MOST
CRITICAL PART OF CARE IS THAT
AFTER CARE OUTPATIENT.
VOLUNTARY CERTIFICATION IN
CALIFORNIA.
IF YOU HAD A LICENSE AND AND
SOMETHING YOU CAN ACTUALLY
ENFORCE AGAINST PEOPLE YOU GET
RID OF ALL THE PROBLEMS YOU HAVE
AN ORANGE COUNTY.
IS IT ISN'T A SOBER LIVING HOMES
OF THE PEOPLE TAKING THE MONEY
AND GIVING ITS THE SOBER LIVING
HOMES WITH NO STANDARD.
YOU GET RID OF THE WHOLE THING
WHERE DIANA DULY GOT CHASED
AROUND BIKE ANDERSON COOPER FOR
LA COUNTY PROVIDING THANK
SERVICES.
SO THAT'S PART OF IT IN IN THE
STANDARD SUITE WE HAVE A SIMPLE
BILL LAST YEAR THAT PASSED IN
THE GOVERNOR VETOED.
WE AT THE HE HAS SOME SOMEONE
WHO WORKS FOR THE ADMINISTRATION.
IT SETS STANDARDS JUST FOR KIDS
IS FOR KIDS TREATMENT.
CAN'T WE AT LEAST DO THAT SO I
THINK I THINK THAT'S PART OF IT
WE NEED TO ENFORCEABLE STANDARDS.
WE NEED THE STATE GOVERNMENT AND
THE RESPONSIBLE DEPARTMENTS TO
STOP ABDICATING RESPONSIBILITY.
IT'S PARTLY WHAT WHAT T. C. A.
P. P. JUST TOLD YOU ABOUT ABOUT.
INDIVIDUALS PROVIDING SERVICES
SHOULD BE LICENSE AND EVERYONE
SHOULD HAVE STANDARDS THEY HAVE
TO MEET AND TELL YOU DO THAT.
SOME LETTER TO ANYBODY DOESN'T
DIDN'T DO ANYTHING AND IT'S NOT
ENFORCEABLE AND THEY DON'T WANT
AND FORCES.
SO I THINK THAT'S THE BASIC
THING WE WERE SCIENCE.
ON BEHALF OF SEE SAM WAS ALSO MY
CLIENT.
THE REASON DOCTOR CON COULDN'T
BE HERE TODAY TO TESTIFY AND
DOCTOR STUCK TOOK HIS PLACE
BECAUSE HE WAS JUST BECAUSE I
KNOW THE SERVING ON A HEARING
YOU WERE TALKING ABOUT
PARTNERSHIP HEALTH PLAN.
AND HE WAS DOING A PRESENTATION
TO PARTNERSHIP SO SO WE'RE WE'RE
ON THAT WE REALIZE SITE.
NEED HELP AND WE'RE WORKING
THANK YOU MUCH.
I SEE NO ONE ELSE AT THE
MICROPHONE I WANT TO THANK
EVERYONE FOR PARTICIPATING THIS
HEARING WHAT THANK ALL OF OUR
SPEAKERS AND APPRECIATE WE HAD A
LOT OF QUESTIONS --
BUT I THINK IS EXTREMELY
IMPORTANT TOPIC THANK YOU CHAIR
WOODS -- FOR
FOR YOUR LEADERSHIP AND THE
STATE ASSEMBLY AND LOOKING
FORWARD TO WORKING WITH --
YOUR COMMITTEE --
TO DRESS THIS EXTREMELY
IMPORTANT ISSUE AND SO WITH THAT --
THIS --
INFORMATIONAL HEARING OF THE I
JOIN ASSEMBLY AND SENATE HEALTH
COMMITTEES IS NOW ADJOURNED
THANK YOU