GOOD AFTERNOON. THIS IS THE
ASSEMBLY BUDGET SUBCOMMITTEE
NUMBER ONE ON HEALTH AND HUMAN
SERVICES. TODAY'S HEARING WILL
BE FOCUSED ON BEHAVIORAL HEALTH.
GIVEN THE LENGTH OF TODAY'S
AGENDA. I WOULD LIKE TO REQUEST
THAT ALL OF OUR SPEAKERS BE AS
BRIEF AS POSSIBLE. WHILE WE WILL
BE WANTING TO HEAR WHAT YOU HAVE
TO SAY. WE ALSO WANT TO HEAR
FROM THE PUBLIC WHO HAVE TO WAIT
UNTIL THE END OF THE HEARING. WE
WILL HAVE PANEL PRESENTATIONS ON
THE 1ST 29 ISSUES IN TODAY'S
AGENDA, WHILE THE REMAINING 19
ARE NON PRESENTATION ITEMS.
MEMBERS ARE WELCOME TO ASK
QUESTIONS ON ALL ISSUES OF THE
AGENDA, INCLUDING ON NON
PRESENTATION ITEMS, AND WE
WELCOME PUBLIC COMMENT ON THEM
AT THE END OF THE HEARING,
SHOULD THERE BE ANY I WANT TO
REMIND EVERYONE THAT PUBLIC
COMMENT ON ALL ISSUES OF THE
AGENDA. WILL BE TAKEN AT THE END
OF THE HEARING AFTER THE LAST
ISSUE HAS BEEN PRESENTED. WE
WILL FIRST TAKE PUBLIC COMMENT
FROM THOSE WHO ARE HERE IN THE
ROOM, AND THEN WE WILL BE GOING
TO OUR PHONE LINES. WITH THAT.
LET US BEGIN WITH ISSUE ONE. OUR
FIRST ISSUE IS AN OVERVIEW OF
THE MENTAL HEALTH SERVICES
OVERSIGHT AND ACCOUNTABILITY
COMMISSION AND ITS PROPOSED
BUDGET. WE WILL HAVE DR TOBY
EWING, THE COMMISSION'S
EXECUTIVE DIRECTOR, TO PRESENT
THIS ISSUE. WELCOME AND PLEASE
BEGIN. THANK YOU VERY MUCH, MR.
CHAIR AND MEMBERS APPRECIATE THE
CHANCE TO JOIN YOU TODAY. WE DID
PROVIDE SOME MATERIALS IN THE
FORM OF A HANDOUT WILL REFERENCE
THAT IN MY, UM BRIEF COMMENTS TO
MY BEST TO BE BRIEF, UM IN THE
RIGHT UP. THE STAFF IDENTIFIED A
COUPLE OF QUESTIONS HERE. WHAT
ARE THE HIGHLIGHT THE
COMMISSION'S MOST SIGNIFICANT
WORK AND ACHIEVEMENTS. AND IT
ASKED THIS QUESTION AROUND THE,
UM KIND OF THE COMMISSION'S
PORTFOLIO AND WHETHER OR NOT IT
EXCEEDS THE ORIGINAL INTENT OF
THE IMAGE, THE STATUTE AS IT WAS
DRAFTED. IN TERMS OF OUR MOST
SIGNIFICANT WORK, UM AND WE
TRIED TO DO IN THIS HAND OVER TO
GIVE YOU THAT PORTFOLIO. MOVE
THE MIC A LITTLE BIT CLOSER. YOU
BET. APOLOGIES SO IN THE PORT IN
THE HANDOUT WE PROVIDED WE
PROVIDE, UM. UH ABOUT 20 OR SO
KEY INITIATIVES AND WE TRIED TO
GIVE YOU A STATEMENT ABOUT WHAT
EACH OF THOSE INITIATIVES ARE
COVERING THE ACCOMPLISHMENTS
THAT WE HAVE ACHIEVED TO DATE
AND WHAT THE OPPORTUNITY
REPRESENTS, AND I WANT TO
HIGHLIGHT A COUPLE OF THE
GRAPHICS IN THERE. THE FIRST IS
THIS LIFESPAN GRAPHIC AND WHAT
WE'RE REALLY TRYING TO DO WITH
THIS LIFESPAN. GRAPHIC IS TO PUT
THAT PORTFOLIO IN THE CONTEXT OF
THE PUBLIC THAT WE SERVE. IT'S
REALLY AN EFFORT TO, UM,
IDENTIFY THE WORK THAT WE'RE
DOING. BUT MORE IMPORTANTLY, THE
WORK THAT ISN'T BEING DONE IN
TERMS OF THE COMMISSION'S OWN
PORTFOLIO, AND WHEN WE FIRST DID
THIS, WE RECOGNIZE THAT WE HAD
SOME SIGNIFICANT DEFICITS IN
EARLY CHILD EDUCATION AND IN
OLDER ADULTS AND SUBSEQUENT TO
THAT WE'VE BEEN WORKING TO
DEVELOP A PARTNERSHIP WITH THE
DEPARTMENT OF AGING TO REALLY
STRENGTHEN OUR WORK ON OLDER
ADULTS, AND WE'VE BEEN ABLE TO
MAKE SOME INVESTMENTS IN THAT
AREA. AND WE'RE WORKING TO MAKE
SOME SIMILAR INVESTMENTS. IN
EARLY CHILDHOOD EDUCATION. IN
TERMS OF, UM I'M GONNA GET TO
THE GRAPHIC AT THE END OF THIS
DOCUMENT. IT WON'T GO THROUGH
ALL THE INITIATIVES IN REFERENCE
TO YOUR COMMENT ABOUT BEING
BRIEF. UM BUT IN TERMS OF OUR
MOST SIGNIFICANT WORK AND
ACHIEVEMENTS, I WANT TO
HIGHLIGHT THE COMMISSION WAS
REALLY FORMED TO ELEVATE MENTAL
HEALTH IN TERMS OF PUBLIC POLICY
AND PRACTICE GOING BACK TO THE
ORIGINS. OF THE MENTAL HEALTH
SERVICES ACT, THE EARLY WORK 20
PLUS YEARS AGO, DONE BY THE
STATE'S LITTLE HOOVER COMMISSION
REALLY RECOGNIZED THAT IT WAS
IMPORTANT TO HAVE AN ENTITY
WHOSE JOB IT WAS TO REALLY DRIVE
TRANSFORMATIONAL CHANGE TO ASK
TOUGH QUESTIONS AND TO PROVIDE
ADVICE AND GUIDANCE TO THE
LEGISLATURE AND THE GOVERNOR,
AND THAT IS ONE OF OUR MOST
SIGNIFICANT ACCOMPLISHMENTS TO
DATE. WE HAVE NOT DONE THIS
ALONE. IT HAS BEEN DONE IN
PARTNERSHIP WITH THE DEPARTMENT
OF HEALTH CARE SERVICES,
COMMUNITY ORGANIZATIONS,
COMMUNITY PARTNERS BHD. A
COUNTIES. OTHERS UM WE REALLY
SEE OURSELVES AS SHAPING AND
INFORMING OPPORTUNITIES SERVING
AS A CATALYST AND SOME OF THE
WORK THAT'S MENTIONED HERE. SOME
OF THE WORK THAT YOU'RE WELL
AWARE OF IN SCHOOL, MENTAL
HEALTH, OUR RECENT WORK AND
WORKPLACE MENTAL HEALTH OUR WORK
AROUND DIGITAL STRATEGIES AND
DELIVERING CARE. AS EXEMPLIFIED
BY THE WORK THAT THE DEPARTMENT
HEALTHCARE SERVICES IS DONE MOST
RECENTLY WITH CAL HOPE ARE AREAS
WHERE THE COMMISSION HAS
ELEVATED AN OPPORTUNITY THAT
OTHERWISE WAS NOT BEING PURSUED
AT AT A POINT IN TIME. ON OUR
PROGRAMMATIC WORK, AS MENTIONED
IS MENTIONED IN THE AGENDA.
SUICIDE PREVENTION, EARLY
PSYCHOSIS WORK ARE ALL COVID
DROP IN FORTIFYING F SPS
ENHANCING UNDERSTANDING OF THE
MENTAL HEALTH SYSTEM AND
ENHANCING TRANSPARENCY AROUND
FUNDING SERVICES AND OUTCOMES.
THESE ARE ALL AMONG WHAT I WOULD
CALL THE MOST SIGNIFICANT
ACCOMPLISHMENTS AND ACHIEVEMENTS
OF COMMISSION. WE'VE BEEN
ELEVATING INNOVATION. WE HAVE
BEEN REALLY WORKING TO IDENTIFY
LEADERSHIP OPPORTUNITIES AT THE
COMMUNITY LEVEL. WE ELEVATE THE
VOICE OF COMMUNITY MEMBERS OF
YOUTH IN PARTICULAR AROUND YOUTH
AND SCHOOL, MENTAL HEALTH. AND
SO I WOULD SAY WHAT MAKES THE
WHAT'S THE COMMISSION STANDS
APART BECAUSE WE DO NOT HAVE THE
SIGNIFICANT SIGNIFICANT
PORTFOLIO. THAT OTHER
DEPARTMENTS DEPARTMENTS MUCH
LARGER THAN WE HAVE THAT THEN WE
ARE HAVE THAT ALLOWS US TO
ACTUALLY BE DYNAMIC THAT ALLOWS
US TO IDENTIFY OPPORTUNITIES
THAT ARE NOT BEING PURSUED,
WHICH IS PART OF WHAT THIS
ANALYSIS IS. UM LAST, I WOULD
DRAW YOUR ATTENTION TO THE TO
THE SECOND TO THE LAST PAGE IN
THIS DOCUMENT THAT WE HAVE
PROVIDED TO YOU. FOCUSING ON
UPSTREAM EFFORTS AND WHAT WE
REALLY TRIED TO DO HERE. IS WE
START WITH THIS UNDERSTANDING
THAT WE CANNOT STATE OF
CALIFORNIA CANNOT AFFORD TO PAY
ITS WAY OUT OF THE CHALLENGES WE
HAVE IN MENTAL HEALTH CARE TODAY
. UM WE MUST INVEST IN UPSTREAM
OPPORTUNITIES AROUND PREVENTION
, EARLY INTERVENTION THAT IS
BUILT INTO THE MENTAL HEALTH
SERVICES ACT. UM PREVENTION AS A
MANDATE, ONE OF THE ONLY AREAS
WHERE IT ACTUALLY IS A MANDATE.
AND THE ACT REALLY DEFINES
PREVENTION AND VERY BROADWAY'S
LOOKING AT THE FACTORS THAT
ACTUALLY CONTRIBUTE TO MENTAL
HEALTH NEEDS, SUCH AS UNSTABLE
HOUSING, UNEMPLOYMENT, LACK OF
HOPE, RIGHT. IT'S CREATING WORK
IS ABOUT HOPE AND OPPORTUNITY.
AND SO, UM, THE COMMISSION'S
WORK THE MENTAL HEALTH SERVICES
ACT WORK IS REALLY ABOUT
ELEVATING UPSTREAM OPPORTUNITIES
TO SUPPORT PEOPLE BEFORE NEEDS
DEVELOP AND THE DESIGN SYSTEMS
THAT ARE RESPONSIVE IN AND
INTERVENE EARLY TO PREVENT THE
ESCALATION OF NEEDS OVER TIME.
AND SO, IN THIS GRAPHIC, WE'VE
TRIED TO REPRESENT THE SCHOOL
MENTAL HEALTH WORK, WHICH IS
REALLY ABOUT A BROAD POPULATION
BASED STRATEGY TO ENGAGE YOUNG
PEOPLE. WE HAVE NOT PUT OUR
WORKPLACE MENTAL HEALTH EFFORT
ON THIS DOCUMENT YET BECAUSE
IT'S JUST EMERGING BUT
COMPARABLE TO SCHOOL BASED
MENTAL HEALTH WORKPLACE MENTAL
HEALTH IS ABOUT ENGAGING ADULTS
ARE RISKS ARE RESILIENCY, THE
OPPORTUNITIES THAT WE HAVE QUITE
DON'T COME FROM WORK ALONE BUT
CAN BE INFLUENCED AND IMPACTED
BY WORK. AND FOR THOSE OF US WHO
RECEIVE HEALTH COVERAGE THROUGH
OUR EMPLOYERS. WORK IS A PLACE
WHERE WE RECEIVE ACCESS TO HIGH
QUALITY, EFFECTIVE MENTAL HEALTH
CARE OR NOT, DEPENDING ON THE
QUALITY OF THAT COVERAGE AND THE
TYPES OF SERVICES THAT ARE
AVAILABLE, BUT OUR SCHOOL MENTAL
HEALTH WORK ARE ALL OF YOUTH
DROP IN WORK IS REALLY ABOUT
CREATING TRUST AND CREATING VERY
ACCESSIBLE, EASY PATHWAYS TO
CARE FOR YOUNG PEOPLE WHO ARE
WHO OFTEN STRUGGLE BECAUSE OF
ISSUES OF TRUST. OR THE
RESPONSIVENESS OF THE SYSTEM TO
THEIR NEEDS. INTO OUR EARLY
PSYCHOSIS WORK, WHICH YOU'LL
HEAR A LITTLE BIT MORE ABOUT
LATER TODAY, WHICH IS THAT UP
THAT EARLY PSYCHOSIS WORK IS SO
IMPORTANT IN TERMS OF ENGAGING
EARLY IN THE EVOLUTION OF
SOMEONE'S DISORDER THAT IS
LIKELY TO LEAD TO THE MOST
DEVASTATING IMPACTS THAT WE SEE
IN OUR COMMUNITIES. HOMELESSNESS
INCARCERATION, HOSPITALIZATION
AND DEATH. AND SO EARLY
PSYCHOSIS WORK IS REALLY THAT
MOST IMPORTANT EARLY
INTERVENTION AND THEN OUR FULL
SERVICE PARTNERSHIP WORK AND
THIS ARRAY OF UPSTREAM
STRATEGIES ARE REALLY DESIGNED
TO ADDRESS SOME OF THE MOST
PRESSING SOME OF THE MOST
EXPENSIVE SOME OF THE MOST
DEVASTATING IMPACTS ON
INDIVIDUALS, FAMILIES AND
COMMUNITIES, NAMELY IN THE THREE
UM. MAROON CIRCLES AT THE BOTTOM
HOMELESSNESS. INCARCERATION AND
HOSPITALIZATION. SO I THINK YOU
KNOW, I WANT TO MENTION THIS
BECAUSE IT'S THIS FRAMEWORK THAT
WE ARE VERY PROUD OF, AND WE
THINK IS VERY, UM, SIGNIFICANT
IN TERMS OF THE OPPORTUNITY
ACCOMPLISHMENT OF THE
COMMISSION'S I DON'T WANT TO SAY
THAT THAT'S WHAT WE HAVE
ACCOMPLISHED. BUT WHAT WE'RE
PROMOTING IS AN UPSTREAM
STRATEGY THAT TIES TOGETHER A
BROAD ARRAY OF PROGRAMS AND
OPPORTUNITIES DESIGNED TO REDUCE
PUBLIC SECTOR COSTS REDUCED THE
KINDS OF SUFFERING THE TRAUMA,
THE IMPACTS THAT WE SEE ON
INDIVIDUALS AND FAMILIES AND DO
IT IN A WAY THAT IDEALLY NEVER
REQUIRES THE ENGAGEMENT WITH THE
MENTAL HEALTH SYSTEM BECAUSE WE
HAVE DESIGNED INTERVENTION SO
EARLY IN THE SYSTEM THAT WE'RE
SUPPORTING PEOPLE SO THEY DON'T
END UP NEEDING MENTAL HEALTH
CARE. THANK YOU FOR THE CHANCE.
I KNOW THAT WAS QUICK. WE TRY TO
GIVE IT TO YOU IN WRITING SO
THAT WE COULD GET TO ANY
QUESTIONS YOU MIGHT HAVE, UM
APPRECIATE THE CHANCE TO BE
HERE. THANK YOU. THANK YOU.
DEPARTMENT OF FINANCE. GOOD
AFTERNOON CHAIR REMEMBERS. MY
NAME IS ELENA RAMOS DEPARTMENT
OF FINANCE. WE WERE ASKED TO
COMMENT ON WHY THERE IS A
NEGATIVE FUND BALANCE AND THE
MENTAL HEALTH SERVICES FUND.
JUST NOTE THAT AS OF THE 2023
GOVERNOR'S BUDGET, THERE IS NO
NEGATIVE FUND BALANCE. HOWEVER,
THE STATE RECEIVES 5. OF THE
ANNUAL MENTAL HEALTH SERVICES
FUNDS REVENUES FOR STATE
DIRECTED PURPOSES AND IN RECENT
YEARS, THE STATE DIRECTOR
EXPENDITURES HAVE BEEN HIRED
THAN THE REVENUES AND THAT'S
ACHIEVABLE. GIVEN THAT THEY ARE
CARRYOVER FUNDINGS FROM PRIOR
YEARS. WE WERE ALSO ASKED TO
COMMENT ON WHETHER THE TERM
EXPENDITURES REFERS TO THE
FUNDING BEING DISTRIBUTED TO
COUNTIES OR ACTUAL EXPENDITURES
BY COUNTIES. SO WITH REGARDS TO
THE 95% OF ANNUAL MENTAL HEALTH
SERVICES FUND REVENUES, THE FUN
CONDITIONS STATEMENT REFLECTS
THE AMOUNT ALLOCATED TWO
COUNTIES AS OPPOSED TO ACTUAL
SPENDING. BY THE COUNTIES. AND
LASTLY, WE WERE ALSO ASKED. TO
COMMENT ON THE FACT THAT THE
STATE REPORTED 5.8 BILLION
MENTAL HEALTH SERVICES FUND FOR
PAST YEAR AND THE STATE
COMPTROLLER'S OFFICE REPORTED A
DIFFERENT NUMBER. SO IN THE
SPIRIT OF BEING BRIEFED THE
PRIMARY DIFFERENCE BETWEEN THE
$2 IS THAT THE ADMINISTRATION'S
AMOUNT INCLUDES A CRUEL AMOUNT
SO MONEY THAT IS DOING THE
FUTURE ATTRIBUTABLE TO THE PAST
YEAR. ELIO. YES WELL, LOANS
THAT, LEO, UM AS THIS IS A KIND
OF AN OVERVIEW ITEM WERE DON'T
HAVE ANYTHING TO COMMENT OR
AVAILABLE FOR QUESTIONS. BRING
IT UP TO THE DIOCESE FOR ANY
QUESTIONS. DR JACKSON, CAN YOU
DESCRIBE, UM ANYTHING THAT'S IN
THE WORKS AND TO MAKING SURE UH
, THAT WE ARE FOLLOWING THE BEST
PRACTICE OF UNIVERSAL SCREENINGS
FOR MENTAL HEALTH. UM THAT'S A
GOOD QUESTION. UM SO YOU KNOW?
WE HAVE NOT LOOKED AT THAT ISSUE
SPECIFICALLY, BUT THERE'S NOT
CONSENSUS. ON WHAT THAT MEANS
BEST PRACTICE IN TERMS OF
UNIVERSAL SCREENING FOR MENTAL
HEALTH. AND, UM. THE COMMISSION
HAS A POSITION. EVERYBODY WHO
NEEDS CARE SHOULD GET CARE AND
THROUGH OUR PREVENTION
INTERVENTION WORK. UM WORKING TO
PROMOTE THAT STRATEGY. BUT WHEN
WE ENGAGE SUBJECT MATTER,
EXPERTS THERE ARE DISAGREEMENTS
ON WHAT IT WOULD MEAN TO ADOPT
THAT GOAL. AND WHAT WE MEAN TO
OPERATIONALIZE THAT AND SO I
THINK THERE'S A HANDFUL OF
ISSUES HERE. ONE IS, UM
ESTABLISHING THAT AS AN AGREED
UPON GOAL. I BEING CLEAR ABOUT
WHAT WE'RE SCREENING FOR? THE
KINDS OF INSTRUMENTS THAT WE
WOULD USE WHERE THAT SCREENING
WOULD GET DONE. AND UM, AND WHAT
THE RESPONSE WOULD BE. WHEN
SCREENS REVEAL SOMETHING THAT IS
NEEDED. WE HAVE WE'RE MAKING
PROGRESS ON SUICIDE SCREENING.
WE'RE MAKING PROGRESS ON
SCREENING IN SCHOOLS. UM BUT I
THINK WE'RE NOT YET TO THE POINT
WHERE THE STATEMENT YOU MADE IS
SOMETHING THAT'S BEING
OPERATIONALIZED STATEWIDE.
DEFINITELY NO, IT'S NOT BEING
OPERATIONALIZED. I MEAN, YOU
LOOK AT THE U. S. SURGEON
GENERAL'S RECOMMENDATIONS. UM,
IN REGARDS TO YOUTH MENTAL
HEALTH CRISIS. ONE OF HIS
RECOMMENDATIONS ACTUALLY IS
UNIVERSAL SCHOOL MENTAL HEALTH
SCREENINGS. OUR FIRST SURGEON
GENERAL OF CALIFORNIA, ALSO SAID
THAT WE NEED TO BE DOING
UNIVERSAL SCREENINGS. CAN YOU
THINK OF ANYTHING ELSE WE CAN DO
THAT'S BETTER THAN UNIVERSAL
SCREENINGS BECAUSE AT THIS POINT
WHAT WE'RE LOOKING AT IS WE'RE
WAITING FOR THINGS TO MANIFEST
ITSELF. BY THAT TIME, IT COULD
BE A SUICIDE. BY THAT TIME, IT
COULD BE SOME TYPE OF MANIC
ISSUE. BUT IF WE TALK ABOUT
PREVENTION AND EARLY
INTERVENTION I CAN'T SEE. ANY
TYPE OF TOOL. OR ANYTHING WE CAN
DO. THAT'S BETTER THAN UNIVERSAL
SCREENING, SO I'M NOT SURE UM,
WHO IS IN DISAGREEMENT WITH THAT
NOW? OPERATIONALIZE NG IT. IS AN
ISSUE NOT BECAUSE WE CAN'T DO
IT. BUT BECAUSE PEOPLE ARE
TRYING TO HOLD ONTO THEIR OWN
SYSTEMS OF POWER, THIS IS AN
ADULT ISSUE. THAT WE ARE LOOKING
AT. AND SO I WOULD JUST SAY THAT
IF WE CAN LOOK MORE INTO THAT
AND PROVIDE A BETTER WAY FORWARD
SO THAT WE CAN DO WHAT WE KNOW
WORKS. PH. QUÊ. RIGHT, EVEN IF
YOU LOOK AT THE P H. Q FOR UM BY
THE WAY. PH. HE WAS AN
ASSESSMENT TOOL FOR DEPRESSION.
WHEN YOU EVEN LOOK AT THOSE KEY
QUESTIONS. YOU CAN TELL RIGHT.
THAT'S SOMETHING IS GOING ON.
WHETHER SOMEONE HAS LOST THEIR
APPETITE. WHETHER SOMEONE CAN NO
LONGER SLEEP VERY WELL. WHETHER
SOMEONE IS LOSING HOPE, RIGHT?
THESE ARE KEY QUESTIONS AND PH
QUÊ THERE EVEN IF WE DID THAT.
THINK ABOUT HOW MANY YOUNG
PEOPLE WE COULD HAVE ON OUR
RADAR SCREEN. TO BE ABLE TO
INTERACT WITH THEM MORE SO THAT
WE CAN PREVENT GREATER MENTAL
HEALTH THINGS GOING ON. I MUST
ADMIT, I'M VERY FRUSTRATED ABOUT
THIS. IF YOU CAN'T TELL BECAUSE
. YOU KNOW, WE TALK ABOUT YOUTH
BEING IN A NATIONAL MENTAL
HEALTH CRISIS. SUICIDES BEING
THE SECOND MOST THE, UH, MOST
CAUSE OF DEATH. AND ADULTS CAN'T
GET THEIR ACT TOGETHER. TO DO
SOMETHING THAT CAN LITERALLY
SAVE LIVES. YOU HAVE NOTHING IN
YOUR PURVIEW THAT IS RESPONSIBLE
FOR THAT. YOU'RE JUST HERE AND
I'M SORRY. YOU'RE NOW THE MY
FOCUS. AH ANYONE ELSE WANT TO
TAKE THE SEAT? RIGHT BUT THE
IDEA IS THIS. I REALLY UH UM.
WE'RE STILL NOT ACTING AS IF
THIS IS A CRISIS. WE ARE DOING A
GREAT JOB OF BEGINNING TO LOOK
AT THE WHOLE MENTAL HEALTH
INFRASTRUCTURE PIPELINE.
DIRECTING MORE MONEY TOWARDS
FACILITIES. WE NEED MORE
INPATIENT OUTPATIENT FACILITIES
. WE NEED MORE BEDS FOR PEOPLE
TO HOUSING FOR THOSE WITH MENTAL
HEALTH ISSUES. WE'RE DEALING
WITH IT ON THE HOMELESSNESS
FRIGHT. WE'RE DEALING WITH
WORKFORCE DOLLARS, BUT WE'RE
TRYING TO SAVE WORKFORCE DOLLARS
FOR THESE THINGS, RIGHT, BUT
WE'RE NOT DOING ANYTHING RIGHT
NOW OF SIGNIFICANCE. TO
STABILIZE THE CURRENT
POPULATION. RIGHT? AND UH, WE'RE
SEEING SOME GOOD PRACTICES FROM
TIME TO TIME, BUT WE'RE NOT
DOING IT STATEWIDE. AND IF I
HEAR SOMEONE TELL ME ABOUT LOCAL
CONTROL ONE MORE TIME BEFORE WE
HAVE TO DO INSTEAD OF FOCUSING
ON SAVING LIVES, RIGHT, UH I
MIGHT NEED AN EVALUATION. UH SO
I THINK THE IDEA IS WE'VE GOT TO
BE MORE AGGRESSIVE. I CAN'T TELL
YOU. I CAN'T THINK OF A TIME
THAT WE'RE RIGHT NOW THAT WE
SHOULD NOT BE MORE AGGRESSIVE.
AND SO I WOULD URGE YOU TO EVEN
BE MORE AGGRESSIVE WITH YOUR
RECOMMENDATIONS. LET'S REALLY
DIG IN THERE BECAUSE WE ARE IN A
CRISIS. AND UH, I'M JUST
DUMBFOUNDED. BYE. UM. SYSTEM
LEADERS BEING MORE CONCERNED
WITH THE SYSTEM THAN THE PEOPLE
THAT THE SYSTEM IS SUPPOSED TO
SERVE. SO I WOULD JUST URGE THAT
WE DO MORE. THANK YOU. THANK
YOU. UM DR EWING. I'M GOING TO
FOCUS IF I CAN ON THE
COMMISSION'S WORK, WHICH ARE
HIGHLIGHTED PREDOMINANTLY ON
PAGES. 30 31 32. LIKE IF I CAN
FOR YOU TO SPEAK ABOUT THE
MENTAL HEALTH STUDENT SERVICES
ACT IMPLEMENTATION AND SEE IF
YOU CAN PAINT A PICTURE FOR US
ON HOW WE'RE BRINGING MENTAL
HEALTH SERVICES TO OUR SCHOOLS.
THANK YOU, DOCTOR. AMBULANCE FOR
THAT QUESTION, AND I WILL SORT
OF WEAVE IN SOME RESPONSES TO
MEMBER JACKSON ALONG THE WAY, I
MAY SAY SO, UM YOU KNOW, JUST
RECALL THAT THE COMMISSION'S
WORK ON THE MENTAL HEALTH
STUDENT SERVICES ACT REALLY WAS
DESIGNED TO INCENTIVIZE
PARTNERSHIPS BETWEEN SCHOOL
DISTRICTS, LOCAL EDUCATION
AGENCIES AND BEHAVIOR. HEALTH
DEPARTMENTS, WHERE WE HAD
EXAMPLES OF STRONG PARTNERSHIPS
YOU KNOW, HAPPENING ACROSS THE
STATE, BUT TO DR JACKSON'S POINT
, YOU KNOW ONE OFFICER EXAMPLES
. WE WERE NOT SEEING SCALE. WE
WERE NOT ACTUALLY SEEING
STRATEGIES. THAT WE'RE LEARNING
FROM, YOU KNOW, ONE PARTICULAR
PROGRAM AND EXTENDING THAT INTO
THESE OTHER PROGRAMS THAT THAT
CAPACITY TO LEARN AND TO AND TO
SCALE TRANSFORMATIONAL CHANGE
WAS MISSING. THE MHS ESA THAT
DESIGN THAT THE COMMISSION
BROUGHT TO THIS WAS NOT TO TRY
TO FIGHT EVERY BATTLE AROUND
LOCAL CONTROL. IT WAS TO SAY WE
WILL INCENTIVIZE A PARTNERSHIP
AND WHAT THAT PARTNERSHIP LOOKS
LIKE NEEDS TO BE TAILORED TO
WHAT'S HAPPENING IN LOS ANGELES
OR DEL NORD OR IMPERIAL TRINITY
, RECOGNIZING THAT THERE'S LOTS
OF DIFFERENCES. AND THERE IN
TERMS OF NEEDS, THE POLITICS THE
RELATIONSHIPS BUT ALSO THEIR
CAPACITY TO DELIVER. AND SO THE
MIDDLE HEALTH STUDENT SERVICES
ACT REALLY WASN'T DESIGNED TO BE
A UNIFIED STATEWIDE PROGRAM. IT
WAS DESIGNED TO BE A STATEWIDE
INCENTIVE TO CREATE STRONG
PARTNERSHIPS THAT COULD BE
TAILORED TO LOCAL NEEDS, AND
THAT IDEALLY, WOULD FLOURISH
THROUGH THE CAPACITY BECAUSE
IT'S SHORT ONE TIME MONEY. A
LIMITED DOLLARS WAS NOT A LOT OF
MONEY. SIX MILLION WAS THE
LARGEST GRANT L. A COUNTY 2.5
MILLION WAS A GRANT TO SMALLER
COUNTIES. AND SO WE NEVER
THOUGHT THAT WHAT WE COULD GET
WITH THAT WAS TO PAY FOR CARE
FOR EVERY STUDENT. WHAT WE KNEW
WE COULD GET WAS COUNTY BEHAVIOR
, HEALTH DEPARTMENTS AND ELIA'S
THAT WERE ALREADY WORKING
TOGETHER TO WORK TOGETHER BETTER
THOSE THAT HAD NOT YET MET EACH
OTHER TO CONNECT IN WAYS THAT
WOULD BE SUPPORTED AT AT OUR
FISCAL REST. LET US PUT THE
MONEY ON THE TABLE. TO GET THEM
TO ENGAGE AND TAKE RISK. THIS
WAS WE SAW THIS AS AN INCENTIVE
AND AN OPPORTUNITY FOR
INNOVATION LOCALLY, UM, WE WENT
DOWN TO IMPERIAL COUNTY A FEW
WEEKS AGO AND HEARD FROM LOCAL
DIRECTORS THERE THAT IT HAS BEEN
PHENOMENAL IN THAT THEIR
EDUCATION, LEADERSHIP AND THEIR
BEHAVIOR, HEALTH LEADERSHIP OR
PARTNERING IN WAYS THAT THEY HAD
NEVER SPOKEN TO EACH OTHER. AND
THEY'RE ENGAGING AND THEY'RE
ENGAGING THEIR JUVENILE JUSTICE
PARTNERS THAT ARE ENGAGING THEIR
FOOD BANKS. THEY'RE ENGAGING,
BROAD COMMUNITY PARTNERS TO
CREATE A PARTNERSHIP. THEY PUT
MORE LOCAL DOLLARS IN, UM, WELL
BEYOND WHAT THE STATE PUT IN TO
CREATE THAT PARTNERSHIP, AND
WE'RE WORKING TO ACTUALLY BRING
SOME YOUNG PEOPLE FROM IMPERIAL
UP TO SACRAMENTO FOR YOUR MAY
HEARING. OKAY. A COUPLE OF
EXAMPLES. UM A YOUNG WOMAN
SHARED THAT SHE WAS GETTING ALL
LAUGHS BECAUSE SCHOOL WAS NOT A
SAFE, COMFORTABLE PLACE FOR HER.
AND BECAUSE HER SCHOOL PROVIDED
HER WITH THE THERAPIST AT SCHOOL
WHO CONNECTED WITH THEIR
TEACHERS. SHE'S PASSING ALL HER
CLASSES. A YOUNG MAN SAID. HE
TALKED ABOUT STRUGGLES AND THIS
THIS IS A LARGELY IMPOVERISHED
COMMUNITY. RIGHT UM, FARMWORKERS
, I THINK THEY SAID 67% NON
ENGLISH SPEAKING IN THE
HOUSEHOLD. UM SOMETHING LIKE 76%
FREE INTRODUCED PRICE LUNCH
ELIGIBILITY ACROSS THEIR ENTIRE
STUDENT POPULATION. AND THIS
THIS YOUNG MAN SAYS SCHOOL WAS
NOT POSITIVE FOR ME, AND I WAS
OUT OF SCHOOL MORE THAN I WAS IN
SCHOOL UNTIL THIS PROGRAM CAME
ALONG, AND I REALIZED THAT IF I
WAS STRUGGLING GOING TO SCHOOL
GOT ME ACCESS TO A THERAPIST.
AND SO NOW I'M ACTUALLY
PARTICIPATING IN SCHOOL AS A
STRATEGY TO ACTUALLY ADDRESS THE
ISSUES THAT HE'S DEALING WITH.
DRIVEN FROM HIS COMMUNITY, HIS
FAMILY, HIS LIFE EXPERIENCES. SO
UM IMPERIAL COUNTY HAS REALLY
TAILORED A STRATEGY THAT MEETS
THEIR NEEDS VERY DIFFERENT IN
VENTURA, WHERE THEY'RE WORKING
TO BUILD OUT WELLNESS CENTERS IN
ALL OF THEIR HIGH SCHOOLS AND
ALL OF THEIR MIDDLE SCHOOLS. UM
SOME SOME PARTNERS ARE REALLY
FOCUSING ON SCREENINGS AND
ASSESSMENTS, SUICIDE SCREENINGS
IN PARTICULAR. SOME ARE WORKING
ON TRAININGS FOR THEIR TEACHERS
SO THEY CAN UNDERSTAND AND
RECOGNIZE THE NEEDS OF MEN
HEALTH NEEDS OF THE STUDENTS
THAT ARE IN THE CLASSROOMS. SO
WE'RE WORKING TO PUT TOGETHER.
UM, SORT OF A, UM UH, PORTFOLIO
OF WHAT THESE PRACTICES LOOK
LIKE OUR ROLE HAS BEEN TO
INCENTIVIZE THESE PARTNERSHIPS
AND THEN TO FACILITATE CROSS
PARTNERSHIP LEARNING, AND SO WE
HOST LEARNING COLLABORATIVE
MEETINGS. WE DON'T HAVE THE
EXPERTISE IN SCHOOL MENTAL
HEALTH. THAT'S NOT WHO OUR STAFF
ARE. WE HAVE SOME, BUT WE'RE
REALLY TRYING TO DO IS TO
CONNECT. LOCAL PARTNERS WITH
EACH OTHER SO THAT THEY CAN
LEARN FROM EACH OTHER AND GET TO
THE POINT WHERE THAT SCALING AND
THAT CONTINUOUS IMPROVEMENT THAT
COLLABORATIVE LEARNING IS
HAPPENING ON THEIR DIME AS PART
OF THEIR NORMAL COURSE OF
BUSINESS. THAT'S THE BEST THAT
WE COULD DO WITH ONE TIME
FUNDING, LIMITED AMOUNT OF MONEY
, AND SO I WOULD BE HAPPY TO
GIVE YOU MORE EXAMPLES, IF YOU'D
LIKE TO SEE THOSE IN TERMS OF
WHAT'S HAPPENING IN YOUR
DISTRICTS OR IN ANY DISTRICTS.
OUR GOAL IS TO REALLY ELEVATE
THOSE SUCCESSFUL PRACTICES SO
THAT THEY SCALE IN WAYS THAT
STILL CAN BE TAILORED. TO THE
CHALLENGES THAT ARE UNIQUE TO
RURAL URBAN, UM, YOU KNOW, HIGH
SCHOOLS, MIDDLE SCHOOLS,
ELEMENTARY SCHOOLS AND ALL OF
THE ABOVE. I'LL USE THAT. THEN
EARLIER, YOU STATED YOUR, UM IN
YOUR TESTIMONY THAT YOU IT'S
YOUR JOB TO ELEVATE INNOVATION.
AND YOU ALSO STATED THAT EARLY
PSYCHOSIS IS THE MOST IMPORTANT
EARLY INTERVENTION THAT I'D LIKE
TO TRY AND UNDERSTAND IF I CAN
YOUR THOUGHTS ON EARLY PSYCHOSIS
ONLY BEING ONLY BEING IN 14
COUNTIES OUT OF 58. SINCE THIS
IS THE MOST IMPORTANT STRATEGY.
HOW DO WE MAKE SURE THAT ALL
COUNTIES ARE AWARE AND ARE
LEARNING FROM YOUR COMMISSION SO
THAT WE CAN INSTITUTE THIS AT
SCALE? SO YOU HAVE IN THE
AUDIENCE HERE TODAY AND WHO I
THINK WILL PRESENT ONE OF THE
FOREMOST NATIONAL EXPERTS ON
THIS ISSUE, AND I'M HESITANT TO
TRY TO SOUND SMART IN FRONT OF
HER. UM OR HER TEAM. BUT UM, SO
WHAT WE DID WAS THIS PROJECT
STARTED WITH HIRING RESEARCHERS
TO GO OUT AND ASK TOUGH
QUESTIONS ABOUT WHAT'S AVAILABLE
TODAY? AND ARE WE DELIVERING
HIGHEST QUALITY OF CARE? AND THE
ANSWER WAS, IT REALLY DEPENDS ON
WHERE YOU LIVE? IT DEPENDS ON
WHAT INSURANCE COVERAGE YOU HAVE
. HOW ASSERTIVE YOU ARE. HOW
AGGRESSIVE YOU ARE, HOW HARD YOU
ARE WILLING TO FIGHT. TO GET
WHAT YOU NEED AND IN RESPONSE TO
THAT, AND YOU KNOW AND
CONSISTENT WITH, REMEMBER
JACKSON'S COMMENTS THAT'S
ABSOLUTELY INAPPROPRIATE, RIGHT
? UM WE USE LIMITED FUNDING ONE
TIME MONEY TO TRY TO INCENTIVIZE
OPPORTUNITIES TO STRENGTHEN
EARLY PSYCHOSIS CARE, UM, THE
FUNDING THAT WE'VE MADE
AVAILABLE FROM THE STATE, BUT IN
PARTNERS WORKING WITH COUNTIES,
WE'VE BEEN ABLE TO LEVERAGE
COUNTY INNOVATION, FUNDING AND
SOME FEDERAL MONEY AND SOME
PHILANTHROPIC DOLLARS. TO
ACTUALLY BUILD OUT A LEARNING
COLLABORATIVE THAT IS DESIGNED
TO BE DATA DRIVEN, DESIGNED TO
PROVIDE TECHNICAL ASSISTANCE AND
SUPPORT AND IT WORKS WITH PEOPLE
WHO WANT TO WORK WITH US AND SO
BECAUSE WE DON'T HAVE THE
FUNDING TO SCALE THIS OVERNIGHT
WHAT WHAT THE COMMISSION DOES IS
CREATE OPPORTUNITIES AND THEN
ASKS, WHO'S INTERESTED WHERE WE
TEND TO FOCUS ON THOSE FOLKS WHO
WANT TO ENGAGE. BECAUSE THEY'RE
EASIEST TO WORK WITH,
PARTICULARLY WHEN THIS WORK IS
HARD, AND THIS WORK IS VERY HARD
FOR LOTS OF REASONS, I'D SAY
THREE IN PARTICULAR WORKFORCE.
AS YOU ALL KNOW, IT HAS BEEN
DISCUSSED. YOU KNOW, MANY OF
THESE HEARINGS SECOND WOULD BE
TECHNICAL ASSISTANCE. IT'S NOT,
YOU KNOW, PEOPLE COMING OUT OF
TRAINING PROGRAMS ARE NOT YOU
KNOW, ON FIRST DAY SKILLED IN
DELIVERING THIS KIND OF CARE,
AND SO THERE'S A LOT OF
TECHNICAL ASSISTANCE TO MOVE
FROM TYPICAL CARE WHAT WE MIGHT
CALL STANDARD CARE TO EFFECTIVE
EVIDENCE BASED PRACTICES. WE
DON'T HAVE THIS PROBLEM IN OTHER
AREAS OF HEALTH CARE. WE HAVE
THIS PROBLEM IN MENTAL HEALTH
CARE. AND THEN THE LAST PIECES
FUNDING OUR FINANCING SYSTEMS
DON'T ACTUALLY PAY FOR THE CARE
THAT THE RESEARCH SHOWS IS
NECESSARY AND MOST EFFECTIVE.
AND SO, UM, YOU KNOW, WE HAVE
BEEN PROMOTING A RANGE OF
STRATEGIES, INCLUDING, UH, DOING
RESEARCH WITH MANAGED CARE
ORGANIZATIONS TO SEE IF WE CAN
DOCUMENT THAT IT'S COST
EFFECTIVE FOR THEM TO PAY FOR,
UM, EVIDENCE BASED CARE AS AWAY.
ALTHOUGH THE MENTAL HEALTH COSTS
GO UP, WE ANTICIPATE THAT THE
OVERALL HEALTH CARE COSTS WOULD
GO DOWN BECAUSE SOMEONE
COMMANDERS TO DIABETES CARE
BETTER RIGHT? THEY'LL AVOID ER
UTILIZATION FOR THOSE REASONS.
THE WORK WE'RE DOING. THERE IS
PROBABLY NOT GOING TO PAY OFF
BECAUSE THERE'S ENOUGH TIME AND
THE AND THE SUBJECT BASE ISN'T
BIG ENOUGH TO REALLY MAKE THE
CASE FOR INSURANCE COMPANIES TO
VOLUNTARILY JUMP IN, BUT THE
COMMISSION HAS PROMOTING A
STRATEGY THROUGH SOME OF OUR
WORKPLACE EFFORTS TO ENCOURAGE
THE STATE TO LEVERAGE THE PUBLIC
SECTOR PURCHASING POWER. OF
HEALTH CARE BENEFITS TO OUR
PENSION PLANS TO ACTUALLY CREATE
A MARKETPLACE WHERE ACCESS TO
CARE MET, UH MENTAL HEALTH
FUNDING MATCHES. EXPECTATIONS
FOR CARE. WE DON'T HAVE THIS
PROBLEM IN OTHER AREAS OF HEALTH
CARE. WE HAVE THIS PROBLEM THAT
THERE'S A MISMATCH BETWEEN WHAT
WE NEED TO DO AND WHAT WE'RE
WILLING TO PAY FOR. CAN YOU SAY
A LITTLE BIT MORE ABOUT YOUR THE
INNOVATION SUMMIT THAT'S AT THE
TOP OF PAGE 32. WHEN AND WHERE
WAS IT? WHO WAS THERE AND WHAT
WAS DISCUSSED. SO UM, IN 2018 WE
IN PARTNERSHIP WITH, UH, COUNTY
BEHAVIOR, HEALTH DIRECTORS WITH
SOME PHILANTHROPY WITH BARELY
HEALTH, WHICH IS A HEALTH CARE
DIVISION OF GOOGLE AT THE TIME
HOSTED AN INNOVATION SUMMIT. AT
THIS POINT IN TIME, ALTHOUGH THE
MENTAL HEALTH SERVICES ACT
REQUIRES 5% SET ASIDE FOR
INNOVATION, AND THE LAW SAYS,
USE THE MONEY TO RETURN IT. THE
COMMISSION FOUND THAT COUNTIES
WERE NOT INVESTING IN INNOVATION
. AND SO, YOU KNOW, ULTIMATELY,
THE AUDITOR AND ELIO I'VE
FORGOTTEN WHO ACTUALLY DID THE
WORK FOUND ABOUT OUR DAY HCS
FOUND ABOUT $350 MILLION AN
UNSPENT FUNDS AND IN THE
SIGNIFICANT PORTION OF THAT WAS
INNOVATION. THERE WAS HESITATION
AND FRUSTRATION ON THE PART OF
COUNTIES ABOUT YOU KNOW. WHAT
DOES THIS LOOK LIKE? WHAT DOES
THIS MEAN? WE DID NOT HAVE
STREAMLINED SYSTEMS FOR
COMMISSION APPROVAL OR FOR
COUNTY APPROVAL, AND SO THE
INNOVATION SUMMIT WAS DESIGNED
TO KICK START. UM WE WANTED TO
DO WAS TO CREATE, UM, A
PARTNERSHIP BETWEEN THE MENTAL
HEALTH COMMUNITY IN CALIFORNIA
AND THE INNOVATION COMMUNITY IN
CALIFORNIA, WHICH IS WHY WE
TURNED TO VERILY HEALTH. RIGHT
AND AT THAT TIME THERE WAS A LOT
OF FRUSTRATION AND PUSH BACK IN
COMMUNITIES AND COUNTIES. WE HAD
COUNTIES THAT INVESTED IN A IN A
COMMUNITY GARDEN IN FRESNO, YORK
COUNTY, INVESTED IN A COMMUNITY
GARDEN AS A STRATEGY TO ENGAGE
AND AMONG IMMIGRANT COMMUNITY
AND THERE WERE EDITORIAL SAYING
THIS WAS A COMPLETE WASTE OF
MONEY. WE WANTED TO CREATE THIS
PARTNERSHIP SO THAT WHEN
COUNTIES WERE TRYING NEW THINGS
, AND EVEN IF THOSE NEW THINGS
DIDN'T WORK OUT, AND SOMEONE
WROTE AND AGGRESSIVE NEGATIVE
RESPONSE THAT THE BUSINESS
COMMUNITY WOULD STEP UP AND SAY,
I'D RATHER LIVE IN A STATE
THAT'S TRYING TO DO BETTER THAN
IN THE STATE THAT'S GIVEN UP.
AND SO WE TURN TO THE BEST
INNOVATORS IN THE WORLD. TO TRY
TO BRING THAT CULTURE THAT
PERSPECTIVE AND ATTITUDE AND TO
CREATE, UM STRONGER FREEDOM AND
WILLINGNESS ON THE PART OF OUR
COUNTY PARTNERS TO TAKE RISKS
AND SUBSEQUENT TO THAT SUMMIT.
IT WAS INCREDIBLY SUCCESSFUL AND
IT WAS REALLY DIFFICULT AND
CHALLENGING ALL THE SAME TIME,
BUT IN SUBSEQUENT YEARS WE'VE
SEEN AN EXPLOSION OF COUNTIES
INTEREST IN INNOVATION. AND
WE'VE SEEN A MUCH GREATER
WILLINGNESS TO TRY CREATIVE
THINGS. MUCH OF THE INNOVATION
THAT THE COMMISSION REVIEWS AND
APPROVES IS MORE ABOUT
CONTINUOUS IMPROVEMENT, KINDS OF
THINGS. IT'S NOT, YOU KNOW,
COLONIZED MARS KINDS OF
INNOVATION. IT'S HOW DO WE GET
BETTER? AND SO, UM, SO WE'RE
ACTUALLY WORKING TO WE'RE
TALKING. THE COMMISSION IS
EXPLORING THE IDEA OF HOSTING A
SUBSEQUENT MENTAL HEALTH SUMMIT,
POSSIBLY NEXT YEAR. TO REALLY
ACHIEVE ACHIEVE THREE THINGS.
THE FIRST IS TO JUST CELEBRATE
THE FACT THAT COUNTIES ARE
INNOVATING. AND HOW IMPORTANT
THAT IS. IT'S 5% OF THE MHS SAY
, BUT IT'S LESS THAN 1% OF
OVERALL PUBLIC MENTAL HEALTH
SPENDING. AND SO IT'S A IT'S A
TINY INVESTMENT THAT HAS
OUTSIZED POTENTIAL FOR IMPACT.
AND SO WE WANT TO CELEBRATE THAT
BECAUSE COUNTIES ARE TAKING
RISKS. THEY ARE DOING THINGS
THAT ARE HARD THEY'RE DOING
THINGS THAT MAY BE BUCKING
TRADITIONS OR CULTURES AND SO WE
WANT TO RECOGNIZE AND REWARD
THEM. SECOND WE WANT TO IDENTIFY
CORE PRIORITIES THAT SHOULD BE
ON THE TABLE FOR INNOVATION.
RIGHT SO WHAT ARE THE BIG
CHALLENGES AS SOME MEMBER
JACKSON POINT OUT, POINTS OUT
AROUND SCREEN LIKE, WHAT SHOULD
WE BE INNOVATING IN RIGHT? WHERE
MIGHT WE IDENTIFY? HOW MIGHT WE
IDENTIFY CORE ISSUES? THAT
SHOULD BE THE FOCUS OF THIS
INVESTMENT FROM A STATEWIDE
PERSPECTIVE? BUT STILL
RESPECTING LOCAL DECISION MAKING
, AND THE THIRD ISSUE WOULD BE
AS WE IDENTIFY THOSE CORE
CHALLENGES. MIGHT WE IDENTIFY
PARTNERS? WHO HAVE EXPERTISE.
WHO COULD LEAN IN COHEN VEST AND
SUPPORT SUCCESS, PARTICULARLY
WHERE WE'RE ASKING THE
BEHAVIORAL HEALTH SYSTEM TO
TACKLE CHALLENGES THAT ARE
OUTSIDE OF ITS COMFORT ZONE OR
LEVEL OF EXPERTISE. CALIFORNIA
HAS THE ACADEMIC RESEARCH
POTENTIAL AND CAPACITY THAT IS
UNRIVALED IN THE WORLD. WE HAVE
AN INNOVATION SECTOR THAT IS
UNRIVALED IN TECH IN
COMMUNICATIONS. WE THINK THAT
THERE IS NO PROBLEM THAT WE
CANNOT SOLVE. IF WE CAN MARSHAL
, THE POLITICAL CAPITAL, THE
IDEAS THE RESOURCE IS THE
EXPERTISE AND POINT THAT ALL OF
THOSE RESOURCES AND ENERGIES
TOWARDS THOSE CHALLENGES. AND SO
THAT THIRD ISSUE IS ABOUT HOW DO
WE BRING TOGETHER THE SUPPORT
THAT IS NECESSARY FOR THIS LESS
THAN 1% INVESTMENT TO ACTUALLY
TRIGGER THE KIND OF
TRANSFORMATIONAL CHANGE IS
NECESSARY THAT WE DON'T HAVE TO
HAVE A CONVERSATION ABOUT HIS
SCREENING APPROPRIATE. BECAUSE
WE DON'T HAVE TO HAVE THAT
CONVERSATION IN OTHER AREAS OF
HEALTH CARE. THANK YOU, DR EWING
. I WILL THANKS VERY MUCH THIS
ENTIRE PANEL AND WE WILL MOVE ON
TO ISSUE TOO. THE FOCUS OF THE
NEXT THREE ISSUES IS ON THE
CHILDREN AND YOUTH. AND THE
FIRST OF THESE IS AN OVERSIGHT
ISSUE. WE WILL BEGIN WITH FIONA
LOU YOUTH ADVOCATE WITH CHEN UP.
WILL YOU PLEASE BEGIN WHEN YOU
ARE READY? YES, PLEASE.
GOOD AFTERNOON CHAIR AND MEMBERS
. MY NAME IS FIONA LOU AND I'M
CURRENTLY A HIGH SCHOOL SENIOR
AT NORTHWOOD HIGH SCHOOL IN
ORANGE COUNTY, CALIFORNIA I'M
ALSO YOUTH ADVOCATE WITH JENNA,
A YOUTH LED ORGANIZATION THAT
CHAMPIONS EDUCATIONAL EQUITY
THROUGH STATE POLICY AND
GRASSROOTS ORGANIZING. IT'S AN
HONOR FOR ME TO BE HERE TODAY TO
TALK ABOUT YOUTH, BEHAVIORAL
HEALTH, AND I DEEPLY APPRECIATE
THE STATE OF CALIFORNIA FOR
PRIORITIZING YOUTH VOICES IN
THESE SPACES. IT'S KNOWN THAT
EVERY GENERATIONAL COHORT WHEN
THIS IS AN EVENT SO CRITICAL IN
THEIR LIFETIME, THAT IT TO FIND
A BONDING EXPERIENCE FOR MOST
PEOPLE IN THAT AGE GROUP. AMONG
OTHER THINGS, THE PANDEMIC WAS
UNDOUBTEDLY A MAJOR LIFE
ALTERATION FOR GEN. Z I'VE EVEN
HEARD PEOPLE MAKE JOKES THAT WE
CAN PINPOINT THE EXACT MOMENT.
ALL OF US WERE THRILLED TO BE
OFF SCHOOL FOR TWO WEEKS,
THINKING THAT IT WOULD JUST BE A
SMALL INTERRUPTION IN OUR LIVES.
THIS WAS OBVIOUSLY NOT THE CASE.
THE REALITY IS THAT THE EFFECTS
OF THE PANDEMIC ARE STILL
ONGOING AND INSIDIOUS FOR YOUTH
MENTAL HEALTH. IF YOU HAD ASKED
ANYONE WHO KNEW ME BOTH BEFORE
AND AFTER THE PANDEMIC THEY
WOULD DESCRIBE BEFORE ME AS
OUTGOING, EXTROVERTED AND
FRANKLY ANNOYING, AND AFTER ME
AS MORE COLD, RESERVED AND
INTROVERTED. AND THERE'S NOTHING
WRONG WITH BEING INTROVERTED.
BUT THE TRUTH IS THAT MIGHT
CHANGE IN CHARACTER WAS DUE TO
MY SKYROCKETING SOCIAL ANXIETY
FROM THE ISOLATION OF THE
PANDEMIC. THIS WAS COUPLED WITH
THE TRADITION AND LONELINESS. I
ALREADY FELT IN MY FRESHMAN YEAR
BECAUSE I HAVE BEEN SEPARATED AT
MY NEW SCHOOL FROM MY FRIEND AND
MY SUPPORT SYSTEM BECAUSE OF
REZONING IN MY DISTRICT BEING
TRAPPED IN MY ZOOM FOR DAYS IN
MY ROOM FOR DAYS ON END ON ZOOM
FOR DAYS ON END CAUSED MY
INCREASED ANXIETY, FEELINGS OF
SADNESS, CHRONIC EXHAUSTION AND
LEARNING LOSS, A LOT OF WHICH I
STILL SUFFER FROM TODAY. THIS
TESTIMONY WOULDN'T BE A FULL AND
ACCURATE TESTAMENT TO MY MENTAL
HEALTH JOURNEY IF I DIDN'T SPEAK
ABOUT THE OVERARCHING PROBLEM
THAT PREVENTS YOUTH LIKE ME FROM
SEEKING HELP THE STIGMA LIKE
MANY OTHER YOUTH IN CALIFORNIA
FROM DIVERSE FAMILIES, I GREW UP
IN A HOUSEHOLD WHERE I NOT ONLY
FELT LIKE MENTAL HEALTH WAS NOT
DISCUSSED BUT WHERE I ALSO FELT
LIKE MY FAMILY HADN'T HAD THE
OPPORTUNITY IN LIFE TO EVEN
ADDRESS THEIR OWN MENTAL HEALTH.
TAKE MY SINGLE MOTHER, FOR
EXAMPLE WHO JUGGLES WORK ON TOP
OF TAKING CARE OF ME, MY BROTHER
AND MY GRANDMA. AND RUNNING
ERRANDS TO KEEP OUR FAMILY
FUNCTIONING, LEAVING HER WITH NO
TIME FOR SELF HEALING AND
SEEKING HELP. THIS IS WHY I
EVERY DOCTOR'S VISIT WITH HER
PEERING OVER MY SHOULDER AT THE
TEENS ONLY SURVEY THEY GAVE ME I
WOULD RELUCTANTLY CHOOSE NEVER
FOR ALL THE QUESTIONS THAT ASKED
ME WHETHER I HAD EXPERIENCED ANY
MENTAL HEALTH STRUGGLES. I HOPE
THAT MORE RESOURCES ARE CATERED
TOWARDS PARENTS WHO ARE LIKE MY
MOM WHO IS AN IMMIGRANT AND THE
CHINESE NATIVE SPEAKER AND WHO
IS ALSO FOREIGN TO WHAT MENTAL
HEALTH AWARENESS LOOKS LIKE IN
THE US WITH A CULTURE THAT IS
VASTLY DIFFERENT FROM HER
HOMELAND. THIS WILL HELP THEM
BETTER UNDERSTAND WHAT THEIR
CHILDREN ARE GOING THROUGH AND
HOW THEY CAN HELP SUPPORT THEM
IN NAVIGATING THEIR PROCESS.
ANOTHER CRITICAL ACCESS POINTS
ARE SCHOOLS AS STUDENTS IN THE K
TO 12 PUBLIC EDUCATION SYSTEM.
WE SPENT A VAST AMOUNT OF OUR
TIME IN THE SCHOOL SETTING AND
EVEN AFTER SCHOOL BEING
INTEGRATED IN THAT SAME SETTING
THE INTERACTIONS WE HAVE DAILY
WITH OUR PEERS, TEACHERS AND
SCHOOL ADMINISTRATORS ALL
CONTRIBUTE TO WHAT TYPE OF
ENVIRONMENT WE FOSTER FOR
OURSELVES AND OUR SCHOOLS AND
WHERE THE ENVIRONMENT IS SAFER,
DISCOURAGING. AS A STUDENT WHO
ATTENDS A SCHOOL THAT IS
ACADEMICALLY RIGOROUS AND PUT AN
EMPHASIS ON GRADES AND
MAXIMIZING OUR TIME EFFICIENCY.
MY MENTAL HEALTH IS ALSO ONE
THAT IS GROUNDED ON BURNOUT.
EVEN THOUGH MY SCHOOL SAYS THEY
PRIORITIZE STUDENT MENTAL HEALTH
, THAT IS NOT THE WAY THAT IS
VASTLY RECEIVED BY MANY OF MY
PEERS. OUR TEACHERS STILL
EMPHASIZE GRADES OVER LEARNING,
AND OUR COUNSELORS AND
ADMINISTRATION ARE COMPLACENT.
RECENTLY MY SCHOOL IMPLEMENTED A
PUNITIVE, TARDY POLICY THAT LOGS
STUDENTS OUT OF CLASS EVEN IF
THEY ARE A MINUTE LATE, WHICH
CAUSES THEM TO GET TO CLASS EVEN
LATER, SOMETIMES 10 OR 15
MINUTES. THIS IS A DISRUPTION TO
THEIR LEARNING, OTHER PEERS AND
FOR THE TEACHER DURING THIS
TARDY SWEEP, THEY HAD ALSO EVEN
PLAYED MUSIC THAT SOUNDED LIKE
PURGE MUSIC. ON THE SCHOOL
SPEAKER, WHICH MADE STUDENTS
FEEL MOCKED IN THE SHAMED
EDUCATORS NEED TO RECEIVE
ADEQUATE AND MEANINGFUL
TRAININGS THAT ARE STUDENT
CENTERED TO LEARN HOW EXCESSIVE
SCHOOLS DISCIPLINES SUCH AS
THESE, WHICH KEEPS STUDENTS AWAY
FROM CLASS RATHER THAN
INCENTIVIZES THEM TO HAVE A GOOD
RELATIONSHIP WITH SCHOOLS ARE
DANGEROUS AND AFFECT THE MOST
VULNERABLE GROUPS. AS SOMEONE
WHO HAD TROUBLE WAKING UP FROM
FOUR SCHOOL IN MY FRESHMAN YEAR
BECAUSE OF CHRONIC TIREDNESS. I
HAD NO DOUBT THAT THIS POLICY
WOULD HAVE DRIVEN ME AWAY FROM
FEELING SAFE AT SCHOOL EVEN
MORE. CALIFORNIA IS LEADING
STATE WITH THE MENTAL HEALTH
RESOURCES THAT WE PROVIDE FOR
OUR YOUTH FAMILIES AND SCHOOLS
AND MANY OTHER COMMUNITIES. AND
EVEN THOUGH THIS IS THE CASE, WE
STILL RECOGNIZE THAT WE HAVE A
LONG WAY TO GO IN SUPPORTING OUR
MOST IMPACTED COMMUNITIES. AND
WITH THAT, THANK YOU FOR
ALLOWING ME TO SHARE MY
EXPERIENCE TODAY. THANK YOU. OUR
NEXT SPEAKER IS CASSIE POLES,
WHO IS A YOUTH MENTAL HEALTH
ADVOCATE AND A MEMBER OF THE
CHILDREN AND YOUTH BEHAVIORAL
HEALTH INITIATIVE ADVISORY
BOARD. BEGIN WHEN YOU ARE READY.
HI HOW ARE YOU GUYS DOING TODAY?
HI MY NAME IS CASSIE AND I'M THE
YOUTH ADVOCATE. WE ARE AT A
RECORD HIGH FOR THE AMOUNT OF
PEOPLE SEEKING MENTAL HEALTH
SERVICES. MENTAL ILLNESS IS THE
MOST COMMON HEALTH CONDITIONS
FACED BY CALIFORNIANS, NEARLY
ONE IN SEVEN CALIFORNIA ADULTS
EXPERIENCE AND MENTAL ILLNESS.
ONE IN 26 EXPERIENCE, A SERIOUS
MENTAL ILLNESS AND ONE IN 14
CHILDREN HAVE EMOTIONAL
DISTURBANCES. CURRENTLY 5.7,
WHICH IS ABOUT 3.5 MILLION
PEOPLE HAVE UNMET MENTAL HEALTH
NEEDS. 36% OF THOSE PEOPLE COULD
NOT AFFORD TO GET THE HELP THEY
NEEDED. BUT 67% COULD I HAVE
BEEN A RECEIVER OF MENTAL HEALTH
SERVICES FOR MORE THAN HALF OF
MY LIFE, AND I CAN PERSONALLY
VOUCH FOR THIS AND THE
DIFFICULTY IN FINDING SERVICES
THAT ARE TIMELY AND ALIGNED WITH
WHO I AM AND WHAT I NEED. BEFORE
THE PANDEMIC. OUR MENTAL HEALTH
CARE SYSTEM WAS ALREADY IN A
CRISIS SITUATION WITH THE SECOND
OPIATE WAVE CONTINUES STIGMA
AROUND MENTIONING MENTAL HEALTH
CONTINUED LACK OF RESOURCES AND
EDUCATION ALL OVER THE STATE AND
THE MENTALITY OF PUNISHMENT OVER
REHABILITATION WAS ALREADY
WEARING DOWN THE SYSTEM. WHEN
COVID CAME, THE SYSTEM CAME
TUMBLING DOWN WITH IT AFTER
HAVING MY THERAPIST OF 10 YEARS
QUIT. I WENT TWO YEARS WITHOUT
ACTIVE MENTAL HEALTH TREATMENT
DESPITE GIVING OUTSIDE REFERRALS
, BUT YET NO PROVIDERS RETURNING
MY CALLS. THIS LED ME TO A
CRISIS POINT IN WHICH I AM STILL
RECOVERING FROM. I WAS TOLD BY
FOUR KAISER HOSPITALS THAT I WAS
NOT SICK ENOUGH FOR THEIR
INTENSIVE OUTPATIENT PROGRAM.
DESPITE HAVING SEVERE DEPRESSION
, NEARLY HAVING A MAN EPISODE
AND OVER MANY AND SELF
MEDICATING THE BEST THEY CAN DO
WITH THREE CRISIS COUNSELING
SESSIONS IN WHICH I HAD TO WAIT
TWO WEEKS BEFORE MY FIRST
APPOINTMENT. I NEVER WANT ANYONE
TO GO THROUGH THE EXPERIENCE OF
FEELING LIKE THEY NEED TO HARM
THEMSELVES TO GET HELP. AND
THESE UNPRECEDENTED TIMES WE ARE
BEING HANDLED HANDED THE GOLDEN
TICKET TO COLLABORATE AND CREATE
A FUNCTIONAL SYSTEM THAT WOULD
BE ABLE TO HOLD ITS OWN FOR
DECADES. IN AN ARTICLE WRITTEN
BY CAL MATTERS, CHRISTINE DON'T
STONER, MERTZ WAS QUOTED SAYING
THE QUESTION THE QUESTION IN OUR
MINDS IS WHAT IS THE APPROACH
AND PROCESS TO SOLVING SOME OF
THESE PROBLEMS. WE WOULD WELCOME
GREATER PARTNERSHIP AROUND THAT,
AND THIS IS WHERE I COME IN. I'M
HERE TODAY AS BOTH A RECEIVER OF
MENTAL HEALTH CARE SERVICES AND
AS AN ADVOCATE TO TELL YOU WHAT
THE SOLUTIONS CAN BE, AND IT'S
PRETTY SIMPLE YOUTH INVOLVEMENT
, ENGAGEMENT AND CONTINUOUS
EDUCATION AND MORE ACCESS TO
SUBSTANCE ABUSE RESOURCES, BUT
ABOVE ALL ELSE, LOVE AND
COMPASSION. EARLIER THIS YEAR,
CALIFORNIA HEALTH AND HUMAN
SERVICES AS PART OF THE C Y B H
I AN INITIATIVE. PUBLISHED A
REPORT CALLED COW CALLED YOUTH
AT THE CENTER. IT GIVES US 12
ACTION CALL THE ACTIONS TO
REIMAGINE THE SYSTEM, BUT AS
EVIDENT TODAY WE ARE MISSING ONE
VERY HUGE AND IMPORTANT ASPECT
OF THIS YOUTH. WE MUST HAVE
YOUTH BEING INVOLVED, AND THEY
MUST HAVE A SEAT AT THE TABLE.
WE WANT TO BE INVOLVED, AND WE
WANT TO BE ACTIVELY
PARTICIPATING. I DON'T THINK YOU
GET ENOUGH CREDIT FOR WHAT
THEY'RE CAPABLE OF BRINGING TO
THE TABLE. AND IF THE ADULTS IN
THE ROOM CANNOT WORK IN
PARTNERSHIP WITH EACH OTHER AND
OFFER YOU THE SUPPORT THEY NEED,
NOTHING WILL CHANGE. SENATE BILL
2 TO 4, WHICH WAS SIGNED INTO
LAW IN 2021 REQUIRES THAT
SCHOOLS WITH HEALTH CLASSES NOW
HAVE TO EXPAND THE CURRICULUM BY
THE DEPARTMENT. BUT BY THE
CURRICULUM SET BY THE DEPARTMENT
OF EDUCATION TO INCLUDE MENTAL
HEALTH. HOWEVER THE SCOPE OF
THIS BILL WAS LIMITED TO ONLY
THOSE SCHOOLS THAT OFFER HEALTH
SERVICE THAT OFFER HEALTH
CLASSES AND GIVES NO EXTRA
FUNDING TO DO SO. IF WE CAN
BARELY GIVE AN EQUAL EDUCATIONAL
OPPORTUNITY TO ALL WALKS OF LIFE
IN THE STATE, HOW CAN WE EXPECT
THERE TO BE CULTURALLY SENSITIVE
, DIVERSE AND EFFECTIVE
EDUCATION ABOUT MENTAL HEALTH?
WHEN I WAS IN ELEMENTARY SCHOOL
, WE HAD A THING CALLED OCEAN
WEEK, WHICH WAS A WEEK DEDICATED
TO LEARNING ABOUT DIFFERENT
ASPECTS OF THE OCEAN. SO I THINK
THERE SHOULD PROBABLY BE A THING
CALLED MENTAL HEALTH WEEK WHERE
EVERY YEAR FROM K THROUGH 12
STUDENTS LEARN AND DISCUSS
MENTAL HEALTH THROUGH EVIDENCE
BASED PRACTICES. THIS CAN BE
DONE BY PARTNERING WITH OUTSIDE
NONPROFITS AND EDUCATIONAL
PROGRAMS. STUDIES HAVE SHOWN
THAT THIS LEADS TO AN INCREASE
IN SUICIDE PREVENTION AWARENESS
, A DECREASE IN DEPRESSION AND
SUICIDE ATTEMPTS AS WELL AS
CREATING SOLIDARITY AND BETTER
PEER SUPPORT AMONG THE SCHOOL
COMMUNITY. IT ALSO PROVIDES
ACCESS FOR ALL I'M HOPEFUL ABOUT
A BILL MOVING THROUGH
LEGISLATION THIS YEAR SP FIVE
OH, NINE THAT AIMS TO MANDATE
MENTAL HEALTH INSTRUCTION AT ALL
SCHOOLS. 24 COUNTIES IN
CALIFORNIA HAVE NO DETOX, ORMAT
TREATMENT OPTIONS OR HARM
REDUCTION PROGRAMS LIKE NEEDLE
EXCHANGES, SAFE INJECTIONS,
CENTERS AND LACK OF NALOXONE,
WHICH, AS A RESULT, THESE
COUNTIES HAVE MUCH HIGHER RATES
OF OVERDOSE. EVERY COUNTY SHOULD
HAVE TO SUSTAIN A SET NUMBER OF
RECOVERY RESOURCES PER CAPITA
AND THOSE RESOURCES NEED TO BE
PLACED WITHIN MARGINALIZED
COMMUNITIES AND RECEIVE ADEQUATE
FUNDING BY THE STATE. WE ALSO
NEED TO CHANGE THE PERCEPTION OF
THESE WORDS. NEEDLE EXCHANGES DO
NOT CREATE MORE DRUG ADDICTS. IT
SIMPLY ALLOWS FOR THOSE WHO
ALREADY USED THE ABILITY TO GET
CLEAN. SUPPLIES WHICH LETS SENDS
THE BURDEN ON THE SYSTEM FROM
OVERDOSES, HIV HEPATITIS AND
OTHER ILLNESSES. IT CAN ALSO
LEAD A PERSON TO GETTING HELP IN
A WAY THAT'S NONJUDGMENTAL AND
IN A SAFE ENVIRONMENT AS A
FORMER HEROIN AND METH ADDICT,
SUBSTANCE USE FELT VERY LIMITED
. WHEN I ENTER TREATMENT AT 20,
IT FELT VERY ISOLATING. I HAVE
ALWAYS HAD THE VIEWPOINT THAT WE
NEED MORE HARM REDUCTION AND
THAT IT NEEDS TO BE MORE
ACCEPTABLE IN ADDICTION
MEDICINE, ESPECIALLY AS YOUNG
PEOPLE ARE BEING MORE AND MORE
INVOLVED IN CHOOSING THEIR
TREATMENT PLANS. YOU SHOULDN'T
HAVE TO BE READY TO ENTIRELY
QUIT USING BEFORE YOU'RE ABLE TO
GET HELP. IT ALLOWS YOU TO GO AT
YOUR OWN PACE AND DO WHAT SETS
YOU UP FOR SUCCESS. WE NEED TO
STOP HAVING THE ONE SIZE THAT'S
ALL APPROACH FOR SOME ABSTINENCE
WORK, BUT IT CREATES A WALL OF
SHAME AND EMBARRASSMENT. YOU
ALSO SHOULDN'T HAVE TO LIVE IN
FEAR OF BEING PUNISHED FOR
HAVING MENTAL HEALTH ISSUES. THE
FORMULA IS PRETTY SIMPLE YOUTH
INVOLVEMENT, ENGAGEMENT AND
CONTINUE WITH EDUCATION AS WELL
AS MORE ACCESS TO SUBSTANCE
ABUSE RESOURCES AND LOVING ONE
ANOTHER. WHAT ARE YOU GUYS GOING
TO DO TO MAKE THIS HAPPEN? ANY
QUESTIONS? I GOT A TON AND WE'LL
ASK THEM AT THE END, BUT I'M
JUST GOING TO TAKE A MOMENT AND
APPRECIATE BOTH CALC AND FIONA
FOR GROUNDING US. IN THE
PERSPECTIVE OF OUR YOUTH. IT'S
VERY IMPORTANT FOR US, AND IT
WAS INTENTIONAL. AS WELL TO MAKE
SURE THAT WE BOTH CREATED THE
SPACE BUT LOOK FORWARD TO BEING
ABLE TO ENGAGE IN CONVERSATIONS
AS SOON AS WE FINISH THIS PEN.
THANK YOU. NEXT WE WILL HEAR
FROM DIRECTOR MELISSA STAFFORD
JONES, WHO'S THE DIRECTOR OF THE
CHILDREN'S AND YOUTH BEHAVIORAL
HEALTH INITIATIVE. GOOD
AFTERNOON, DR ARAMBULA AND
MEMBERS OF THE COMMITTEE AGAIN.
MELISSA STAFFORD JONES, DIRECTOR
OF THE CHILDREN YOUTH BEHAVIORAL
HEALTH INITIATIVE AT THE
CALIFORNIA HEALTH AND HUMAN
SERVICES AGENCY. THANK YOU FOR
INVITING CALLEJA JUST TODAY AND
FOR THE OPPORTUNITY TO PROVIDE
AN OVERVIEW AND A STATUS UPDATE
OF THE WORK UNDER WAY ON THE C Y
B H I BEHAVIORAL HEALTH
CONTINUES TO BE A TOP PRIORITY
FOR THIS ADMINISTRATION. WE ARE
FULLY COMMITTED TO ACCOMPLISHING
OUR TRANSFORMATIONAL GOALS TO
IMPROVE THE MENTAL HEALTH. WELL
BEING SERVICES AND ONGOING
SUPPORTS FOR ALL CALIFORNIANS,
INCLUDING OUR CHILDREN AND YOUTH
, WHO WE KNOW ARE STRUGGLING,
AND THIS IS A COMMITMENT WE KNOW
WE SHARE WITH ALL OF YOU AND
APPRECIATE THE LEADERSHIP OF THE
LEGISLATURE ON THE CRITICAL
ISSUE OF CHILDREN'S MENTAL WELL
BEING. AS YOU KNOW, THE C Y B H
I IS A FIVE YEAR $4.7 BILLION
INITIATIVE, WORKING TO REIMAGINE
AND TRANSFORM THE SYSTEM
SUPPORTING BEHAVIORAL HEALTH AND
WELL BEING FOR CHILDREN AND
YOUTH INTO A MORE COORDINATED
YOUTH CENTERED, EQUITABLE AND
PREVENTION ORIENTED ECOSYSTEM OF
SERVICES AND SUPPORTS IT'S A
CORE ELEMENT OF THE GOVERNOR'S
MASTER PLAN FOR KIDS. MENTAL
HEALTH, WHICH TAKES AN ALL OF
THE ABOVE CROSS SECTOR SYSTEMS
CHANGE APPROACH TO IMPROVE KIDS
WELL BEING AND ACCESS TO
SERVICES. AND WE KNOW THE NEED
CONTINUES TO BE SIGNIFICANT AND
URGENT. WITH CHILDREN AND YOUTH
CONTINUING TO STRUGGLE AS THEY
HAVE OVER THE LAST DECADE WITH
INCREASING MENTAL HEALTH
CHALLENGES. AND WE ALSO KNOW
THAT ALTHOUGH THESE CHALLENGES
FOR YOUTH HAVE GROWN OVERALL AND
CAN AFFECT ALL YOUTH, SOME
GROUPS OF YOUTH ARE
DISPROPORTIONATELY IMPACTED,
INCLUDING OUR BIPAC, YOUTH AND
FAMILIES. LGBT Q. PLUS YOUTH
YOUTH FROM LOW INCOME AND
UNDERSERVED COMMUNITIES, AND
THESE GROUPS FACE MORE SYSTEMIC
BARRIERS TO ACCESSING SERVICES
AND SUPPORTS AND BUILDING A MORE
EQUITABLE ECOSYSTEM IS CORE TO
THE WORK OF THE C Y B H. I. AND
THE LEGISLATURES AND GOVERNORS,
RECENT BUDGET INVESTMENTS AND
ACTIONS UNDERSCORE THE
COMMITMENT TO SOLUTIONS TO
ADDRESSING THESE ISSUES. WE HAVE
HEARD LOUD AND CLEAR FROM OUR
PARTNERS WORKING ON THE C Y B H
I OVER THE 1ST 18 MONTHS OF
IMPLEMENTING THE INITIATIVE THAT
SIMPLY DOING MORE OF HOW SYSTEMS
AND SERVICES WORK TODAY IS NOT
GOOD ENOUGH. AND WILL NOT BE
EFFECTIVE IN BUILDING THE
SYSTEMS AND SERVICES, YOUTH AND
FAMILIES NEED FOR MENTAL HEALTH
AND WELL BEING. AND I THINK WE
JUST HEARD THAT FROM OUR TWO
YEARS TO YOUTH AS WELL. PARTNERS
EMPHASIZED THE NEED FOR
FUNDAMENTAL TRANSFORMATIONAL
CHANGE. AND WE RECOGNIZE THAT
THE SYSTEMIC CHANGE IS NEEDED,
BREAKING DOWN SILOS COORDINATING
ACROSS SYSTEMS AS
ASSEMBLYMEMBER'S JACKSON TALKED
ABOUT IN WAYS THAT ACTUALLY SENT
HER KIDS AND HELP THEM ACCESS
THE PORTS SUPPORTS AND SERVICES
THEY NEED AS EARLY AS POSSIBLE,
REDUCING STIGMA AND
DISCRIMINATION CANNOT BE
ADDRESSED OVERNIGHT. BUT THE
NEED FOR THIS WORK IS
ACKNOWLEDGED UNIVERSALLY AT THE
LEGISLATURE AND AMONG OUR
PARTNERS. WE HAVE PARTICULARLY
HEARD THIS FROM YOUTH AS YOU
HEARD ALREADY TODAY WHO HAVE
CHALLENGED US TO REDEFINE
TREATMENT TO INCLUDE NOT ONLY
CLINICAL SERVICES BUT ALSO
THINGS LIKE ARTS ACTIVITIES.
MINDFULNESS ACCESS TO SAFE PARKS
AND GREEN SPACE ACCESS TO PEER
SERVICES. AND AS YOU HEARD SO
POWERFULLY FROM MS POLLS ABOUT
LOVE AND COMPASSION,
RELATIONSHIPS WITH CARING
ADULTS. THAT CULTURE AND
CULTURALLY RELEVANT PRACTICES
MUST BE PART OF HEALING YOUTH OF
EMPHASIZED YOUTH HAVE TOLD US
THEY NEED SYSTEMS TO STOP
WAITING UNTIL THEY ARE IN CRISIS
TO SUPPORT THEM. THAT THEY WANT
AND NEED A BEHAVIORAL HEALTH
WORKFORCE THAT LOOKS LIKE THEM
SPEAKS. THEIR LANGUAGE COMES
FROM THEIR COMMUNITIES AND
UNDERSTANDS THEIR EXPERIENCE.
YOUTH HAVE ALSO TOLD US AS WE
HEARD FROM THE YOUTH WHO
PRESENTED ABOUT THE IMPORTANCE
OF ENSURING THAT THEIR PARENTS
AND THEIR FAMILIES HAVE THE CARE
AND SUPPORT THEY NEED BECAUSE
OUR YOUNG PEOPLE KNOW THAT
AFFECTS THEIR WELL BEING. AND
YOU HAVE ALSO TOLD US THAT THE
HARM SYSTEMS HAVE CAUSED TO THE
MENTAL HEALTH AND WELL BEING OF
SOME YOUTH, FAMILIES AND
COMMUNITIES IN THE PAST MUST BE
RECOGNIZED FOR THEM TO TRUST
THAT THE IMPROVED SYSTEMS WE ARE
ALL WORKING ON WILL TRULY
SUPPORT THEM. WHAT YOUTH AND
FAMILIES WANT AND NEED TO
IMPROVE. BEHAVIORAL HEALTH IS
SUMMARIZED IN THE RECENT REPORT
THAT WAS MENTIONED YOUTH AT THE
CENTER. AND ITS FINDINGS ARE
REALLY GROUNDING AND GUIDING THE
WORK OF THE CHILDREN AND YOUTH
BEHAVIORAL HEALTH INITIATIVE.
ALL OF THE WORK STREAMS AND THE
CHILDREN AND THE YOUTH
BEHAVIORAL HEALTH INITIATIVE ARE
CONTINUING TO ENGAGE YOUTH AND
FAMILIES. THE INITIATIVE OVERALL
IS ALSO IN THE PROCESS OF
FORMING A CHILDREN, YOUTH AND
FAMILY ENGAGEMENT NETWORK THAT
WILL CONTINUE TO STRENGTHEN AND
BUILD OUR CAPACITY FOR ONGOING
YOUTH ENGAGEMENT IN THE C Y B H
I, INCLUDING THE FORMATION OF AN
EVALUATION ADVISORY GROUP TO THE
C Y B H I THAT WILL INCLUDE
YOUTH AND FAMILIES, AND I'M
PLEASED THAT MS POLLS IS
ACTUALLY AGREED TO BE A MEMBER
OF THAT GROUP. WE ARE ALSO IN
THE PROCESS OF WORKING TO HIRE A
YOUTH FELLOW TO BE PART OF OUR C
Y B H I TEAM AT KELLY HHS. C Y B
H I HAS BEEN PROGRESSING WITH
RESEARCH, PLANNING AND DESIGN.
WE ARE NOW ACTIVELY MOVING INTO
THE IMPLEMENTATION PHASE WITH
MANY OF THE C Y B H I S 20
COMPONENT WORK STREAMS. THROUGH
THE END OF 2022. WE HAD ENGAGED
OVER 1000 ORGANIZATIONS AND OUR
EFFORTS ACROSS MULTIPLE SECTORS
OF HEALTH, EDUCATION, COMMUNITY,
FAMILIES AND YOUTH. CONDUCTED
ALMOST 400 LISTENING SESSIONS
AND EXPERT AND STAKEHOLDER
INTERVIEWS AND HELD OVER 75
ROUNDTABLES AND FOCUS GROUP
DISCUSSIONS WERE HELD ALMOST 50
EVENTS DIRECTLY ENGAGING YOUTH
AND FAMILIES. AND CROSS SECTOR
COLLABORATION AND CENTERING WHAT
YOUTH AND FAMILIES WANT AND NEED
IS CENTRAL. IN THE WORK, THE
INPUT THE INSIGHTS THE EXPERTISE
FROM BOTH LIVED AND PROFESSIONAL
EXPERIENCE FROM OUR ENGAGEMENT
WITH OUR PARTNERS IS SHAPING THE
PLANS AND WORK UNDERWAY THROUGH
THE C Y B H I AND MEETING KIDS
WHERE THEY ARE AT IS CRITICAL TO
INCREASING ACCESS TO BEHAVIORAL
HEALTH SERVICES AND SUPPORTS AND
WE KNOW THAT SCHOOLS ARE WHERE
MANY KIDS ARE. HEALTH SCHOOL
PARTNERSHIP IS CORE TO THE WORK
OF THE C Y B H I AND INCLUDES
MULTIPLE EFFORTS TO SUPPORT
INCREASED ACCESS TO SCHOOLING,
BEHAVIORAL HEALTH SUPPORTS AND
SERVICES FOR STUDENTS. WHICH YOU
WILL BE HEARING MORE ABOUT FROM
MY COLLEAGUE, AUTUMN BOYLAN, AS
WELL AS OTHER PRESENTERS TODAY.
C Y B H. I ALSO RELEASED A
WORKING PAPER EARLIER THIS YEAR
ON THIS ISSUE ABOUT HOW DO WE
PUT INTO PRACTICE MORE
COORDINATED EFFORTS ACROSS
EDUCATION AND HEALTH SYSTEMS,
FOR EXAMPLE, CAL HHS AND THE
CALIFORNIA DEPARTMENT OF
EDUCATION ARE IN DISCUSSIONS
AROUND HOW WE CAN SUPPORT
COORDINATED IMPLEMENTATION OF
COMMUNITY SCHOOLS AND THE C Y B
H I BOTH THE STATE AND LOCAL
LEVEL. THE OVERALL WORK OF THE C
Y B H. I HAS FOUR MAIN FOCUS
AREAS, BUILDING THE BEHAVIORAL
HEALTH WORKFORCE BUILDING
INFRASTRUCTURE WE NEED ACROSS
THE ECOSYSTEM FOR THAT MORE
COORDINATED, INTEGRATED APPROACH
COVERAGE AND ALL PAYER FINANCING
AND INCREASING PUBLIC AWARENESS
AND REDUCING STIGMA, AS WE HEARD
FROM OUR YOUTH IS SO INCREDIBLY
IMPORTANT. THE WORK IN EACH OF
THESE FOCUS AREAS IS LED BY AND
COORDINATED ACROSS MULTIPLE
DEPARTMENTS WITHIN CALAIS CHECKS
AND YOU WILL BE HEARING FROM
THOSE DEPARTMENTS ABOUT THEIR
SPECIFIC WORK STREAMS NEXT FROM
THE DEPARTMENT OF HEALTH CARE
SERVICES AND LATER IN THE AGENDA
FROM THE CALIFORNIA DEPARTMENT
OF HEALTH. PUBLIC HEALTH AND THE
HEALTH CARE ACCESS AND
INFORMATION DEPARTMENT ABOUT THE
CONCRETE ACTIVITIES AND PROGRESS
UNDERWAY IN EACH OF THE WORK
STREAMS THAT THEIR DEPARTMENTS
ARE LEADING. IN JANUARY OF THIS
YEAR, WE ALSO PUBLISHED A C Y B
H I PROGRESS REPORT, WHICH IS
AVAILABLE ON OUR WEBSITE TO
PROVIDE UPDATES ON THE
ACTIVITIES AND ACCOMPLISHMENTS
OF EACH COMPONENT. SPENDING
PLANS OF OVER $2.3 BILLION FOR
WORK UNDERWAY ACROSS THE C Y B H
I OR IN PLACE FOR YEARS. 21 22
22 23 COMBINED WITH AN
ADDITIONAL ESTIMATED $750
MILLION PLANNED SPENDING IN 23
24. ADDITIONAL FUNDS WILL BE
SPENT AS THEY BECOME AVAILABLE
IN THE OUT YEARS OF THE
INITIATIVE, AND LASTLY FOR THE
INITIATIVE. OVERALL CAL HHS HAS
SELECTED MATHEMATICA AS OUR
EVALUATION PARTNER FOR THE C Y B
H I AND GROUND WORK IS UNDERWAY
FOR THE EVALUATION, INCLUDING AS
I MENTIONED FORMATION OF AN
EVALUATION ADVISORY GROUP,
FINALIZATION OF OUR OUTCOMES,
GOALS AND ONGOING WORK TO MAKE
THE EVALUATION A LEARNING
PROCESS ALONG THE WAY, AND NOT
ONLY A REPORT THAT COMES OUT AT
THE VERY END, BUT HOPEFULLY AN
OPPORTUNITY TO BE LEARNING ALONG
THE WAY. BEFORE TURNING IT OVER
TO MY COLLEAGUE. AUTUMN BOYLAN
FROM D. H C S TO REPORT ON THE
SPECIFIC WORK THAT D HCS IS
LEADING. I WAS ASKED TO PROVIDE
A BRIEF REPORT ON THE TWO C Y B
H I COMPONENTS UNDERWAY THROUGH
THE OFFICE OF THE SURGEON
GENERAL. THE FIRST OF THOSE IS
THAT THE OFFICE OF THE SURGEON
GENERAL WAS FUNDED $1 MILLION
UNDER THE C Y B H I TO DEVELOP A
TRAUMA, INFORMED TRAINING FOR
EARLY CARE AND EDUCATION
PERSONNEL. TO HELP BUILD AN
OVERALL MORE TRAUMA, INFORMED
SYSTEM OF SERVICES AND SUPPORTS
SINCE WE KNOW THAT STRESS AND
TRAUMA CAN HAVE A SIGNIFICANT
IMPACT ON A CHILD'S HEALTH
DEVELOPMENT AND THEIR ABILITY TO
LEARN THE TRAINING IS DESIGNED
TO PROVIDE FOUNDATIONAL
KNOWLEDGE AND THE OFFSET. THE
SURGEON GENERAL HAS WORKED WITH
AN EXPERT WORKING GROUP AS WELL
AS MANY STAKEHOLDERS OVER THE
LAST YEAR TO INFORM ITS
DEVELOPMENT. BETA TESTING BY 200
PLUS PRACTITIONERS IN THE FIELD
WAS RECENTLY COMPLETED. AND THE
TRAINING WILL BE PUBLICLY ONLINE
FOR FREE TO EDUCATORS AND OTHER
CHILD SERVING STAFF THIS SUMMER.
IT INCLUDES SPECIFIC MODULES FOR
THREE AGE GROUPS, 0255 TO 11 AND
12 TO 18 AND HIS COMPUTER
SMARTPHONE AND TABLET
COMPATIBLE. THE TRAINING IS
DESIGNED TO ENGAGE THE LEARNER
WITH EXAMPLES, STRATEGIES AND
PRACTICES THAT VARY ACCORDING TO
DEVELOPMENTAL STAGE SERVED AND
INCLUDES TOPICS SUCH AS
IDENTIFYING ACTIVATED STRESS
RESPONSES. SELF REGULATION FOR
CHILDREN AND ADULTS AND LOOKING
AT PRACTICES AND CONDITIONS THAT
REALLY SUPPORT US SAFE AND
SUPPORTIVE RELATIONSHIPS AND
ENVIRONMENTS IN SCHOOLS. AND I
THINK WE HEARD FROM MS POLLS
ABOUT THE IMPORTANCE OF THAT
WORK. THE O. S G WILL BE WORKING
IN THE COMING MONTHS TO DEPLOY
THE TRAINING AND HELP MAKE SURE
IT REACHES ITS TARGET AUDIENCES
AND TO HEAR ONGOING FEEDBACK ON
THE TRAINING THE SECOND WORK
STREAM UNDER THE OFFICE OF THE
SURGEON GENERAL IS PART OF C Y B
H I S FOURTH BUCKET OF WORK TO
INCREASE PUBLIC AWARENESS
AWARENESS AND HELP KIDS GET
CONNECTED TO NEEDED SERVICES AND
SUPPORTS AND AS PART OF THAT OS
G IS IMPLEMENTING AN ACES AND
TOXIC STRESS PUBLIC AWARENESS
CAMPAIGN THAT WAS CREATED IN THE
C Y B H I THE CAMPAIGN AIMS TO
PROVIDE AWARENESS SUPPORT AND
HEALING STRATEGIES FOR
INDIVIDUALS AND COMMUNITIES BY
INCREASING AWARENESS OF THE
IMPACT OF TRAUMA AND A CHILD'S
HEALTH AND DEVELOPMENT,
PROVIDING SUPPORT TO PARENTS AND
CAREGIVERS IN RAISING RESILIENT
CHILDREN AND CREATING POSITIVE
EXPERIENCES FOR THEM WILL ALSO
SUPPORTING OLDER YOUTH WITH THE
TOOLS TO ENHANCE SELF CARE AND
REDUCE STRESS. THE CAMPAIGN WILL
HIGHLIGHT AND ENGAGE COMMUNITIES
AND PRACTICAL STRATEGIES THAT
PARENTS, CAREGIVERS AND YOUNG
PEOPLE CAN BUILD UPON. THE
CAMPAIGN WILL PRIMARILY FOCUS ON
ENGAGING ECONOMICALLY
DISADVANTAGED. L G B T Q. PLUS
AND RURAL COMMUNITIES,
COMMUNITIES OF COLOR IMMIGRANTS
, REFUGEES, JUSTICE AND WELFARE
INVOLVED YOUTH AND YOUNG PEOPLE
AGES 18 TO 24, A CAMPAIGN VENDOR
CONTRACT WAS RECENTLY AWARDED
AND THE CAMPAIGN IS ANTICIPATED
TO LAUNCH IN THE FALL OF THIS
YEAR. THANK YOU FOR THE
OPPORTUNITY TO PRESENT TODAY AND
I LOOK FORWARD TO ANSWERING YOUR
QUESTIONS. THANK YOU. OUR NEXT
SPEAKER IS AUTUMN BOYLAN, DEPUTY
DIRECTOR OF OFFICE OF STRATEGIC
PARTNERSHIPS WITH THE DEPARTMENT
OF HEALTH CARE SERVICES. GOOD
AFTERNOON AND THANK YOU FOR
HAVING US HERE TODAY CHAIR
ARAMBULA AND MEMBERS. UM AND
THANK YOU TO MISS POLES AND MISS
LOU FOR THEIR TESTIMONY THIS
AFTERNOON. UM WE HAVE HAD THE
PLEASURE OF WORKING WITH MISS
POLLS IN THE WORK THAT WE'VE
DONE AT THE DEPARTMENT OF HEALTH
CARE SERVICES AND SOME OF HER
COLLEAGUES AND REALLY APPRECIATE
HAVING THEIR VOICE AND THEIR
BRAVERY COMING HERE BEFORE THIS,
UM THE THIS AUDIENCE TODAY. UH
THE DEPARTMENT HAS MADE
SIGNIFICANT PROGRESS AND TAKEN
IMPORTANT STEPS TO IMPLEMENT
THAT KEY PROVISIONS OF THE
CHILDREN IN YOUTH BEHAVIORAL
HEALTH INITIATIVE THAT WE
OVERSEE, INCLUDING IMPROVING
ACCESS TO CRITICAL BEHAVIORAL
HEALTH SERVICES AND SUPPORTS FOR
CHILDREN, YOUTH AND FAMILIES
ACROSS THE STATE. OVER THE PAST
18 MONTHS, OUR DEPARTMENT HAS
ENGAGED EXTENSIVELY WITH OVER
1000 UNIQUE AND DIVERSE
STAKEHOLDERS FROM ACROSS THE
STATE AS WELL AS KEY
IMPLEMENTATION PARTNERS FOR THE
WORK THAT WE ARE LEADING. MOST
IMPORTANTLY, WE'VE WORKED TO
INCLUDE VOICES FROM YOUTH AND
FAMILIES AS WELL AS CAREGIVERS.
IN THIS WORK. WE HAVE ALSO
ENGAGED WITH OUR LOCAL EDUCATION
AGENCY PARTNERS, EDUCATORS,
HEALTHCARE PROVIDERS AND PEARS,
BEHAVIORAL HEALTH EXPERTS AND
COMMUNITY BASED ORGANIZATIONS,
AMONG OTHERS. WE HAVE DONE THIS
THROUGH KEY INFORMANT INTERVIEWS
, TOWN HALL SESSIONS,
ROUNDTABLES SURVEYS WORKGROUPS
TO EXPERT PANEL THINK TANKS AND
MONTHLY WEBINARS WHERE WE'VE
SHARED INFORMATION PUBLICLY ON
ALL OF THE STATUS OF OUR WORK
STREAMS. WE HAVE IN ALL OF THIS
WORK, PRIORITIZED HEARING FROM
CHILDREN, YOUTH AND FAMILIES AND
NOT JUST HEARING FROM BUT
ACTIVELY ENGAGING AS PARTNERS IN
THE WORK THAT WE'VE BEEN DOING.
WE HAVE CONVENED WITH A YOUTH
ADVISORY PANEL WHO HAS
EXPLICITLY INFORMED THE WORK
THAT WE'VE DONE AROUND THE
VIRTUAL SERVICES, PLATFORM AND
SCHOOL BASED SERVICES. AND IT
AND HAVE PARTNERED WITH MS POLES
AND OTHERS TO HELP FACILITATE
FOCUS GROUPS WITH OTHER YOUTH
THROUGHOUT THE STATE. WE'VE
ENGAGED IN TOTAL WITH OVER 300
CHILDREN IN YOUTH, AND REALLY,
UM, WE DO NOT HAVE A IF WE BUILD
IT, THEY WILL COME APPROACH TO
THIS WORK. WE KNOW THAT IT NEEDS
TO BE DESIGNED BY AND FOR YOUTH
AND WITH THEIR VOICES IN MIND.
THROUGHOUT THIS ENGAGEMENT. WE
HAVE ALSO SOUGHT TO ENGAGE
DIVERSE POPULATIONS, REGIONS AND
AGE GROUPS MAKING SURE THAT
WE'RE INCLUSIVE OF INDIVIDUALS
FROM BLACK, LATIN X ASIAN
AMERICAN LGBT Q. PLUS
COMMUNITIES AS WELL AS OTHER
HISTORICALLY UNDERSERVED
POPULATIONS, SUCH AS RURAL
COMMUNITIES, FAMILIES
EXPERIENCING HOMELESSNESS,
JUSTICE INVOLVED IN FOSTER YOUTH
WE HAVE ALSO CONVENED OVER 200
LEADING EXPERTS IN THINK TANKS
IN VARIOUS WORKGROUPS AND WILL
CONTINUE TO PARTNER THROUGHOUT
OUR WORK. WE HAVE TO EXCUSE ME
AT THE DEPARTMENT. WE EVER SEE
12 DIFFERENT WORK STREAMS. I'M
GONNA GIVE YOU A BRIEF UPDATE ON
SOME OF THOSE WORK STREAMS
TODAY. IN JANUARY OF 2023. SO
IT'S JUST THIS YEAR, THE
DEPARTMENT IMPLEMENTED THE MY
MEDICAL DIETETIC SERVICES AND
DIETETIC CAREGIVER SERVICES
BENEFITS, DIETETIC SERVICES,
INTEGRATE PHYSICAL AND
BEHAVIORAL HOUSE SCREENING AND
SERVICES FOR THE WHOLE FAMILY
DURING A CHILD'S WELL VISIT AND
NOT JUST THE CHILD WHO IS THE
IDENTIFIED PATIENT. ADDING
DIETETIC SERVICES AS A MEDICAL
BENEFIT OFFERS SUSTAINABLE
FUNDING TO CREATE AND MAINTAIN
THIS INFRASTRUCTURE FOR
INTEGRATED CARE FOR CHILDREN,
CREATING SEAMLESS ACCESS TO
BEHAVIORAL HEALTH ASSESSMENTS
AND CONNECTION TO OTHER LOCALLY
AVAILABLE SERVICES AS NEEDED.
THE UH WE ARE ALSO LEADING
EFFORTS AROUND THE BEHAVIORAL
HEALTH VIRTUAL SERVICES
PLATFORM, WHICH WILL LAUNCH IN
JANUARY OF 2024. UH THEY
BEHAVIOR HEALTH VIRTUAL SERVICES
PLATFORM IS A TECHNOLOGY DRIVEN
SOLUTION FOR ALL CHILDREN, YOUTH
AND FAMILIES IN CALIFORNIA THAT
WILL IMPROVE ACCESS BY OFFERING
YOUTH PARENTS AND CAREGIVERS A
NEW WAY TO ACCESS BEHAVIORAL
HEALTH SERVICES AND SUPPORTS THE
PLATFORM WILL PROVIDE SUPPORT
AND RESOURCES. SUCH AS
INTERACTIVE DIGITAL EDUCATION
TOOLS, SELF MONITORING TOOLS, AT
LEAST SCHEMES, MINDFULNESS
EXERCISES AND ACCESS TO FREE ON
DEMAND. 1 TO 1 COACHING AND
COUNSELING SUPPORTS IT WILL ALSO
INCLUDE THE OPPORTUNITY FOR
YOUNG PEOPLE AND PARENTS AND
CAREGIVERS TO ENGAGE IN
SCREENING AND ASSESSMENT TO
BETTER UNDERSTAND THE BEHAVIORAL
HEALTH NEEDS OF OUR YOUTH. WE
CONDUCTED AN EXTENSIVE MARKET
SCAN TO REVIEW DIGITAL
BEHAVIORAL HEALTH PLATFORMS THAT
EXIST IN THE WORLD TODAY, SO NOT
JUST IN CALIFORNIA BUT ACROSS
THE GLOBE. CONDUCTED OR REQUEST
FOR INFORMATION AND NUMEROUS
VENDOR DEMONSTRATIONS TO GET TO
THE RIGHT ANSWER FOR
CALIFORNIA'S DIGITAL BEHAVIORAL
HEALTH SOLUTION. WE RECENTLY
ANNOUNCED THAT WE HAVE SELECTED
A PRIMARY VENDOR PARTNER, CðC
AND IS A PIONEER IN YOUTH
FOCUSED DIGITAL BEHAVIORAL
HEALTH WITH A PLATFORM THAT IS
TODAY ACCESSIBLE TO OVER EIGHT
MILLION TEENS AND YOUNG ADULTS.
IN PARTNERSHIP WITH TRUTH AND
OTHERS SELECTED VENDORS. WE WILL
CONTINUE TO CONDUCT EXTENSIVE
USER TESTING TO OBTAIN INPUT
FROM YOUTH AND FAMILIES AS KEY
PARTNERS IN THE DESIGN. CONTENT
CREATION AND FUNCTIONALITY OF
THE PLATFORM TO MAKE SURE THAT
IT NEEDS MEETS THE NEEDS OF OUR
YOUTH. THESE ACTIVITIES WILL
CONTINUE BOTH PRIOR TO AND AFTER
THE GO LIVE IN JANUARY. WE ARE
ALSO WORKING WITH LEADING
VENDORS TO PROVIDE A STATEWIDE E
CONSULT SOLUTION FOR PEDIATRIC
AND PRIMARY CARE PROVIDERS TO BE
ABLE TO CONNECT WITH AND GET
CONSULTATION FROM LICENSED
BEHAVIORAL HEALTH PROVIDERS IN
THE STATE. TO DATE, WE HAVE
ENGAGED EXTENSIVELY WITH LEADING
EXPERTS ON THE CONSULT SERVICES
AND RECENTLY LAUNCHED A
WORKGROUP REPRESENTING PRIMARY
CARE PROVIDERS. PEDIATRICIANS.
BEHAVIORAL HEALTH EXPERTS AND
OTHERS TO HELP INFORM THE DESIGN
OF THE STATEWIDE SOLUTION, WHICH
WILL LAUNCH IN JANUARY OF 2024.
WE HAVE ALSO WORKED WITH
STAKEHOLDERS CLOSELY TO IDENTIFY
AND SCALE EVIDENCE BASED IN
COMMUNITY TO FIND EVIDENCE
PRACTICES THROUGH A GRANTING
INITIATIVE THAT IS SCALING THESE
PRACTICES THROUGHOUT THE STATE
BASED ON ROBUST EVIDENCE FOR
EFFECTIVENESS AND THE IMPACT
THAT THE PRACTICES HAVE IN TERMS
OF RACIAL EQUITY AND
SUSTAINABILITY. WE PUBLISHED A
GRAND STRATEGY DOCUMENT
OUTLINING OUR APPROACH TO
SCALING THESE EVIDENCE BASED AND
COMMUNITY TO FIND EVIDENCE
PRACTICES ACROSS SIX DISTINCT
ROUNDS OF FUNDING, WITH EACH
HAVING A DISTINCT PRIORITY.
FOCUS FOR THE FUNDING. UM AND
TODAY WE HAVE RELEASED THE
FUNDING APPLICATIONS FOR TWO OUT
OF SIX OF THE ROUNDS OF FUNDING
AND ARE GETTING PREPARED TO
RELEASE THE OTHER ROUNDS OF
FUNDING. THE SIX ROUNDS OF
FUNDING FOCUS ON PARENT
CAREGIVER SUPPORT AND TRAINING
PROGRAMS, PARTICULARLY FOCUSED
ON SUPPORT FOR YOUNG CHILDREN
AGES 0 TO 12, INCLUDING
PRACTICES SUCH AS TRIPLE P
INCREDIBLE YEARS AND HEALTHY
STEPS, WHICH IS THE FOUNDATION
OF THE MEDICAL DATA SERVICES
BENEFIT. WE ARE ALSO SCALING
TRAUMA, INFORMED PRACTICES AND
PROGRAMS SUCH AS TRAUMA FOCUSED
CBT COGNITIVE BEHAVIORAL
INTERVENTION FOR TRAUMA IN
SCHOOLS, MULTI SYSTEMIC THERAPY
AND OTHERS. EARLY CHILDHOOD
WRAPAROUND PROGRAMS, INCLUDING
HOME VISITING MODELS AND INFANT
AND EARLY CHILDHOOD MENTAL
HEALTH, CONSULTATION, YOUTH
DRIVEN PROGRAMS IN PARTNERSHIP
WITH THE MENTAL HEALTH SERVICES
OVERSEEING ACCOUNTABILITY
COMMISSION, INCLUDING THE ALCOVE
MODEL. EARLY INTERVENTION
PROGRAMS PARTICULARLY FOCUSED ON
EARLY PSYCHOSIS, WHICH WE KNOW
IS OF PARTICULAR INTEREST TO
THIS PANEL TODAY AND PARTNERING
WITH THE CALIFORNIA DEPARTMENT
OF PUBLIC HEALTH TO IDENTIFY
STRATEGY TO SCALE COMMUNITY TO
FIND EVIDENCE PRACTICES AND
MANAGED CARE ENVIRONMENT. AH AS
I MENTIONED WE'RE WORKING
CLOSELY WITH THEM AND ALL
SERVICES OVER SENT
ACCOUNTABILITY COMMISSION WHO
WILL LEAD THEM IN CONSULTATION
WITH THE HDS, THE GRANT
ADMINISTRATION ACTIVITIES AND
PROVIDE TECHNICAL ASSISTANCE TO
GRANTEES FOR THE ALCOVE PROGRAM
AND COORDINATED SPECIALTY CARE.
WE ALSO ARE LEADING AS PART OF
THE MASTER PLAN AND THE C Y B H
I A NUMBER OF INITIATIVES TO
EXPAND ACCESS TO MENTAL HEALTH
AND SUBSTANCE USE DISORDER
SERVICES AND SUPPORTS FOR
CHILDREN AND YOUTH THROUGH
SCHOOLS. THIS IS BUILDING OFF OF
AND LEVERAGING THE WORK THAT HAS
ALREADY BEEN DONE AROUND THE
MIDDLE HEALTH STUDENT SERVICES
ACT, WHICH YOU HEARD DIRECTOR.
YOU AIN'T TALKED ABOUT EARLIER
TODAY, AS WELL AS THE COMMUNITY
SCHOOLS INITIATIVE AS MELISSA
STAFFORD JONES MENTIONED IN HER
OPENING COMMENTS. IN
COLLABORATION WITH THE
CALIFORNIA DEPARTMENT OF MANAGED
HEALTH CARE. WE ARE WORKING TO
DEVELOP AND MAINTAIN A SCHOOLING
STATEWIDE, ALL PIERRE FEE
SCHEDULE THAT WILL REIMBURSE
SCHOOL BASED AND SCHOOL LINKED
PROVIDERS FOR DELIVERY OF
OUTPATIENT MENTAL HEALTH AND
SUBSTANCE USE DISORDER SERVICES
. THIS INCLUDES PSYCHO EDUCATION
SERVICES SCREENINGS FOR SCHOOL
AGED CHILDREN FOR BOTH MENTAL
HEALTH AND SUBSTANCE USE
DISORDER SERVICES. TREATMENT
CASE. CONSULTATION UM, AND MANY
SERVICES WITHIN THOSE CATEGORIES
SCHEDULED LAUNCH BEGINNING IN
JANUARY OF 2024 WILL BE
IMPLEMENTED ACROSS THE STATE IN
A PHASED APPROACH TO ENSURE
SUCCESSFUL PARTICIPATION BY ALL
PUBLICLY FUNDED CAME THROUGH 12
SCHOOLS AND DISTRICTS AS WELL AS
THE CALIFORNIA COMMUNITY
COLLEGES. CALIFORNIA STATE
UNIVERSITIES AND UNIVERSITY OF
CALIFORNIA SYSTEMS FOR ALL
STUDENTS UNDER THE AGE OF 26.
THE GOAL OF THE FEE SCHEDULE IS
TO SIMPLIFY REIMBURSEMENT
PROCESSES AND ADMINISTRATIVE
BURDENS FOR SCHOOLS, A SCHOOL
DISTRICTS AND THEIR PARTNER
ORGANIZATIONS, INCLUDING
COMMUNITY BASED ORGANIZATIONS
CAN BE EVERY HEALTH DEPARTMENTS
AND BEHAVIORAL HEALTH PROVIDERS
TO OBTAIN REIMBURSEMENT FROM ALL
PAIRS. SO THAT'S WHAT MAKES THE
C Y B H I SO UNIQUE. IT'S NOT
JUST THE MEDICAL HEALTH PROGRAM.
OR COMMERCIAL HEALTH PLANS, BUT
REALLY THINKING ABOUT THAT
UNIVERSAL APPROACH TO MAKING
SURE THAT CHILDREN IN OUR
SCHOOLS HAVE ACCESS TO THE
NECESSARY BEHAVIORAL SERVICES
AND SUPPORTS. THIS INCLUDES
SERVICES PROVIDED AT SCHOOL OR
NEAR SCHOOL THROUGH PARTNERSHIPS
BETWEEN SCHOOLS AND COMMUNITIES.
D H. C S AND THE DEPARTMENT OF
MANAGED HEALTHCARE COLLABORATED
TO LAUNCH A STATEWIDE CROSS
SECTOR WORK GROUP CONSISTING OF
OVER 60 MEMBERS REPRESENTING
LOCAL EDUCATION AGENCIES,
EDUCATION SECTOR ASSOCIATIONS
AND UNION REPRESENTATIVES.
COUNTY OFFICES OF EDUCATION CAN
BE BEHAVIORAL HEALTH DEPARTMENTS
, HEALTH PLANS, BOTH COMMERCIAL
AND MEDICAL, AMONG OTHERS. AND
WE ACKNOWLEDGE THAT THIS IS A
COMPLICATED AND COMPLEX
INITIATIVE. THERE ARE STILL MANY
OUTSTANDING POLICY AND
OPERATIONAL QUESTIONS ABOUT THE
FEE SCHEDULE IMPLEMENTATION THAT
WE ARE WORKING WITH OUR
COLLEAGUES AND IMPLEMENTATION
PARTNERS TO ADDRESS WE ARE
CAREFULLY CONSIDERING INPUT FROM
OUR IMPLEMENTATION PARTNERS
AROUND POLICY DECISIONS IN
COLLABORATION WITH OUR SCHOOLS
AND HEALTH PLAN PARTNERS AS WELL
AS THE COUNTIES. AND THE INTENT
OF THE WORK GROUP IS TO HELP
INFORM THESE COMPLEX POLICY AND
OPERATIONAL DECISIONS AND THE
WORK GROUP WILL CONTINUE TO MEET
THROUGHOUT. 2022 EXCUSE ME, 2023
BEYOND AS NECESSARY TO INFORM
THIS WORK. WE ALSO MEET
SEPARATELY AND REGULARLY WITH
KENNY BEHAVIORAL HEALTH PLANS
AND ASSOCIATIONS, THE HEALTH
PLANS AND ASSOCIATIONS AND LOCAL
EDUCATION AGENCIES AND A LARGE
COALITION OF EDUCATION LEADERS.
WE ARE WORKING CLOSELY WITH THE
L E, A AND, UM INSTITUTIONS OF
HIGHER EDUCATION PARTNERS TO
ALSO IN CONJUNCTION WITH THIS
SCHEDULE EFFORT TO DESIGN THE
GRANTING INITIATIVE FOR THE
SCHOOLING, PARTNERSHIP AND
CAPACITY GRANTS, WHICH WILL BE
USED TO SUPPORT OPERATIONAL
READINESS AND HELPS SCHOOLS BE
POSITIONED TO BE ABLE TO DELIVER
A WIDER ARRAY OF SERVICES TO UH
, TWO STUDENTS ON SCHOOL
CAMPUSES. WE ARE FINALIZING THE
GRANT DESIGN ADMINISTRATION
STRATEGY AND ANTICIPATE ISSUING
THE GRANTS BEGINNING IN JUNE OF
THIS YEAR. AND UM WE ALSO, UM AS
PART OF THE STUDENT BEHAVIORAL
HEALTH INCENTIVE PROGRAM. HAVE
UM, UH, LAUNCHED IN 2022 THE
INCENTIVE PROGRAM TO ENCOURAGE
MANAGED CARE PLANS TO PARTNER
AND BUILD SUSTAINABLE
RELATIONSHIPS AND INFRASTRUCTURE
BETWEEN THE MEDICAL MANAGED CARE
PLANS AND LOCAL EDUCATION
AGENCIES. WELL WHICH WILL ALSO
LAY A FOUNDATION FOR THE WORK WE
ARE DOING WITH THE FEE SCHEDULE
AS WELL. THE STUDENT BEHAVIORAL
OF INCENTIVE PROGRAM IMPROVES
COORDINATION OF STUDENT
BEHAVIORAL HEALTH SERVICES,
INCREASE ACCESS TO PREVENTATIVE
AND EARLY INTERVENTION,
BEHAVIORAL HEALTH SERVICES. FOR
TRANSITIONAL KINDERGARTEN
THROUGH 12TH GRADE INCREASES
MENTAL HEALTH SERVICES ON OR
NEAR SCHOOL CAMPUSES AND
INCREASES ACCESS TO BEHAVIORAL
SERVICES THROUGH SCHOOL
AFFILIATED BEHAVIORAL HEALTH
PROVIDERS. FURTHERMORE THROUGH
THE CAL HOPE STUDENTS SUPPORT
INITIATIVE PHDS AND ITS PARTNERS
HAVE ESTABLISHED A STATEWIDE
SOCIAL AND EMOTIONAL LEARNING
COMMUNITY OF PRACTICE, WHICH
AIMS TO PROVIDE RESOURCES
TRAINING AND SUPPORT TO LOCAL
EDUCATION AGENCIES FOR
IMPLEMENTING SOCIAL AND
EMOTIONAL LEARNING PROGRAMMING
IN SCHOOLS, INCLUDING SOME OF
THOSE THAT WERE MENTIONED BY OUR
YOUTH SPEAKERS, SUCH AS
PARTNERING WITH NONPROFITS TO BE
ABLE TO PROVIDE SCL PROGRAMMING
IN SCHOOLS. D. H C. S ALSO
LAUNCHED WITH PARTNERS THAT TELL
HOPE SCHOOLS .ORG WEBSITE THAT
ENSURES THAT THESE RESOURCES ARE
AVAILABLE STATEWIDE THROUGH OUR
CAL HOPE PROGRAM. AS WE ROLL OUT
ALL OF THESE SCHOOL BASED
INITIATIVES, DHC S AND GMHC ARE
ALSO DEVELOPING OVERSIGHT
STRATEGIES TO ENSURE SUCCESSFUL
IMPLEMENTATION AND COORDINATION
OF THESE PROGRAMS AT THE LOCAL
LEVEL. WORKING WITH OUR
COLLEAGUES AT THE DEPARTMENT OF
EDUCATION AND STATE BOARD OF
EDUCATION TO COORDINATE AND
ALIGN IMPLEMENTATION STRATEGIES
FOR THE C Y B H I. COMMUNITY
SCHOOLS AND OTHER PROGRAMS WERE
ALSO ENGAGING REGULARLY WITH THE
LOCAL EDUCATION AGENCIES, HEALTH
AND PARTNERS IN COUNTIES AS WE
AS WE ADDRESS OPERATIONAL
CONSIDERATIONS, SUCH AS QUALITY
OVERSIGHT AND MONITORING, WHICH
WE KNOW IS AT THE FOREFRONT OF
THEIR MINDS AS WELL. AND
FURTHERMORE, ALL MEDICAL MANAGED
CARE PLANS WILL BE REQUIRED TO
ENTER INTO A MEMORANDUM OF
UNDERSTANDING WITH THE LOCAL
EDUCATION AGENCIES AND THEIR
SERVICE AREAS. BEGINNING IN 2025
. THIS MOU REQUIREMENT WILL
INCLUDE THE PROVISION RELATED TO
COORDINATING VARIOUS SCHOOL
BASED SERVICES AND PROGRAMS AND
EFFORTS BETWEEN THE MANAGED CARE
PLANS AND THE LOCAL EDUCATION
AGENCIES. THANK YOU. OUR NEXT
SPEAKER IS DR TOBY EWING. THANK
YOU VERY MUCH. MR CHAIRMAN
MEMBERS, TOBY EWING ON BEHALF OF
THE HEALTH COMMISSION. YOU KNOW
THE AGENDA REALLY HIGHLIGHTS A
COUPLE OF QUESTIONS HERE FOR THE
COMMISSION. DO WE SEE GAPS IN
THE STATE'S EFFORTS TO MEET THE
BEHAVIORAL NEEDS? CHILDREN IN
YOUTH IN OUR COUNTY IS MAKING
GOOD USE OF THE FUNDS THAT ARE
AVAILABLE AT THE IMAGES, A AND
YOU KNOW, I DON'T WE DON'T HAVE
TO LOOK FARTHER THAN THE
ADMINISTRATION'S HANDOUT THAT
IDENTIFIES SOME OF THE
STATISTICS AROUND SUICIDE RISK.
UM JUST PROFOUND SENSE OF
HOPELESSNESS AMONG YOUNG PEOPLE
WHO SHOULD BE AT THEIR MOST SORT
OF JOYOUS AND HOPEFUL TIMES IN
OUR IN THEIR LIVES, AND SO, UM,
YOU KNOW, THE DATA REALLY
SUGGEST PROFOUND IMPACTS. UM I
WANT TO HIGHLIGHT THAT THAT
WE'RE SEEING TREMENDOUS WORK
HAPPENING ACROSS THE STATE, AS
EVIDENCED BY THE TESTIMONY THAT
YOU JUST HEARD ON SCHOOL MENTAL
HEALTH AND PREVENTION, IMPROVED
ACCESS TO CARE, YOUTH
EMPOWERMENT. UM YOU KNOW THAT
THE YOUNG PEOPLE PRESENTING
BEFORE YOU TODAY IS PHENOMENAL,
SOMETHING THAT WE'RE SEEING MORE
AND MORE IN THE LEGISLATURE. UM
EXCEEDINGLY RARE TWO YEARS AGO.
AND SO THE STATE IS MAKING
PROFOUND PROGRESS IN TERMS OF
TACKLING THE ISSUES. WE'RE
ASKING THE QUESTIONS ABOUT
UNIVERSAL SCREENING THAT WE
WEREN'T ASKING BEFORE. BUT WE'RE
NOT AT THE POINT WHERE WE DON'T
NEED TO ASK THOSE QUESTIONS,
RIGHT? WE'RE NOT AT THE POINT
WHERE WE CAN SAY THAT. YOU KNOW,
WE SHOULD PAT OURSELVES ON THE
BACK AND THAT WERE DONE. UM IT
IS STILL TOO HARD TO ACCESS CARE
SERVICES AND SUPPORTS ARE OFTEN
UNAVAILABLE IN WAYS THAT ARE
TAILORED TO WHO THESE
INDIVIDUALS ARE WHERE THEY LIVE
, WORK, PLAY LOVE AND SPEND
THEIR TIME. WE HAVE TREMENDOUS
BARRIERS TO CARE. ITEM ONE ON
THIS AGENDA REFERENCES SOME
REAUTHORIZATION FUNDING THAT
WE'RE SEEKING, IN PART BECAUSE
WE'VE GIVEN FUNDS OUT TO
COUNTIES AND THEY'VE GIVEN IT
BACK ALL USE THE YOUTH, THE
ALCOVE FINDING IN PARTICULAR.
ALL COVANTA PAPER IS A VERY
ELEGANT, SIMPLE, TAILORED
STRATEGY. OPEN THE DOOR, LIKE
YOUNG PEOPLE WALK IN AND MEET
THEIR NEEDS. PHYSICAL HEALTH
PRIMARY HEALTH CARE. MENTAL
HEALTH SUPPORTS NO QUESTIONS
ASKED ALL PAYER STRATEGY
CONSISTENT WITH C I B. H I, UM
WE'VE HAD COUNTY PARTNERS TURNED
DOWN THE MONEY BECAUSE IT'S
HARDER TO IMPLEMENT THAN IT
SHOULD BE. DO YOU PROVIDERS DO
THE LEVEL OF INTEGRATED PRIMARY
HEALTH CARE AND MENTAL HEALTH
CARE THAT YOUNG PEOPLE ARE
SEEKING, AND WE KNOW IF THEY
COME IN FOR THE PRIMARY HEALTH
CARE, AND WE NEED TO SEND THEM
DOWN THE STREET AROUND THE
CORNER IN THE NEXT TOWN, OR WAIT
A MONTH TO GET ACCESS TO THE
MENTAL HEALTH CARE. THEY WON'T
FOLLOW UP. INTERNATIONAL
RESEARCH SHOWS IF YOU INTEGRATE
THIS SERVICES IF YOU OPEN THE
DOOR IF YOU DESIGN THE SERVICE
WITH YOUTH IN SANTA CLARA
COUNTY, WHERE WE HELP SUPPORT
THE FIRST ALCOVE, THEY ASKED
YOUNG PEOPLE TO INTERVIEW THE
STAFF WHO WERE BEING CONSIDERED
FOR HIRING. THEY WERE GOING TO
HIRE A VERY QUALIFIED NURSE
PRACTITIONER AND YOUNG PEOPLE
SAID. THE VIBE ISN'T THERE? THEY
DIDN'T HIRE THAT PERSON. BECAUSE
THEY PUT YOUNG PEOPLE FIRST IN
FRONT IN THE DESIGN IN THE
DELIVERY, EVEN IN THE STAFFING
OF SERVICES, WHO IS GOING TO BE
MOST APPROPRIATE. WORKING WITH
THE YOUNG PEOPLE ARE GOING TO
WALK IN THE DOOR. IT'S VERY
DIFFICULT ON PAPER. IT LOOKS
EASY, BUT IN PRACTICE BECAUSE OF
FUNDING AND LICENSING AND THE
HIRING AND TRAINING WE'VE
DESIGNED THIS SYSTEM TO LOOK
VERY DIFFERENT, UM. I WAS
THINKING ABOUT THIS AND YOU KNOW
IF WE WANT PROVIDERS IF WE WANT
TO SERVE WHOEVER WALKS IN THE
DOOR WE REALLY READ NEED TO
RETHINK THE DESIGN OF THE SYSTEM
CONSISTENT WITH WHAT C Y B H I
IS DOING RIGHT? ALL PAYERS ALL
COMERS. UM, YOU KNOW, NOT
SEPARATING OUT BASED ON WHO IS
WHO THE INSURER IS WHAT THE
DIAGNOSIS IS, BUT REALLY
STREAMLINING CARE. UM SO WE'RE
MAKING TREMENDOUS PROGRESS, BUT
THERE'S A LOT OF WORK TO BE
DONE. OUR COUNTIES USING THE
FUNDS TO SERVE CHILDREN WITH
EFFECTIVELY, ABSOLUTELY. PICK A
COUNTY. WE CAN SHOW YOU A
PHENOMENAL PROGRAM IN EVERY
COUNTY. BUT WE STILL HAVE THE
ISSUE THAT DR JACKSON HAS
POINTED OUT THAT BECAUSE IT
EXISTS IN A COUNTY DOESN'T MEAN
IT'S STATEWIDE. WHAT WE'RE
TRYING TO DO WITH YOUTH ALCOVE
IS TO CREATE A CONSISTENT, YOUTH
DRIVEN BRANDED MODEL THAT IS
AVAILABLE STATEWIDE THAT IF A
YOUNG PERSON PARTICIPATES IN THE
ALCOVE PROGRAM IN SANTA CLARE,
AND THEY HAPPEN TO BE IN SAN
DIEGO, THEY KNOW WHAT THEY'RE
GOING TO GET WHEN THEY KNOCK ON
THAT DOOR. WE'RE TRYING TO
ACTUALLY RECOGNIZE THE LOCAL
CONTROL AND ACHIEVE STATEWIDE
NOUS AT THE SAME TIME, AND THAT
GETS VERY DIFFICULT TO DO. THIS
IS A REALLY TOUGH QUESTION TO
ANSWER BECAUSE IT'S WRITTEN IN
THE SPIRIT OF, YOU KNOW, DO WE
HAVE ACCESS TO EFFECTIVE
SERVICES EVERYWHERE? WE DON'T
HAVE A UNIFIED MENTAL HEALTH
SYSTEM. WE HAVE THIS MOSAIC. OF
THOUSANDS OF PROGRAMS THAT ARE
ALL DIFFERENT IN THEIR DIFFERENT
FOR DIFFERENT INDIVIDUALS IN
DIFFERENT COMMUNITIES, AND THAT
IS BOTH A STRENGTH AND IT'S
INCREDIBLE LIMITATION IN TERMS
OF ASKING THE KIND OF STATEWIDE
OVERARCHING QUESTIONS THAT
YOU'RE TRYING TO GET AT IS, ARE
WE SERVING CALIFORNIANS TO THE
BEST OF OUR ABILITY? ONE OF THE
THINGS I WAS, I WAS THINKING
ABOUT THIS QUESTION, AND, UM YOU
KNOW TOO MANY CHILDREN, YOUTH
AND FAMILIES FIRST. WE DON'T
RECOGNIZE THE MENTAL HEALTH
NEEDS THAT WE HAVE. WHEN WE DO
RECOGNIZE MENTAL HEALTH NEEDS.
IT'S VERY DIFFICULT TO KNOW HOW
TO GET WHAT YOU NEED. RIGHT AND
THEN IF YOU'RE IF YOU HAVE A
STRONG SENSE OF WHAT YOU'RE
LOOKING FOR ITS THEN OR WHAT YOU
NEED. IT'S THEN DIFFICULT TO GET
ACCESS USING THE EARLY PSYCHOSIS
EXAMPLE. UM, YOU KNOW, AS AS AN
AREA WHERE WE'RE HOPING TO
CREATE IMPROVEMENTS RIGHT? SO SO
WE DON'T NECESSARILY HAVE THAT
HIGH LEVEL AWARENESS OF WHAT
MENTAL HEALTH IS AND WHAT IT
MEANS TO BE HEALTHY WHEN ILLNESS
REQUIRES SOME SORT OF RESPONSE.
HOW TO GET YOU KNOW HOW TO SEEK
CARE. AND THEN WHETHER OR NOT
THE CARE WE'RE GETTING AS A CARE
WE NEED WE DON'T DO THIS IN
HEALTHCARE. RIGHT. IMAGINE IF
THE MAJORITY OF CALIFORNIANS
STARTED THEIR HEALTHCARE JOURNEY
ONLY WHEN THEY GET SICK OR FELT
PAIN. AND THE FIRST STOP WASN'T
GOING TO GOOGLE STOMACHACHE. AND
THEN I'M GOING TO START LOOKING
AROUND AND SAYING WELL, WHO
COULD ACTUALLY PAY FOR LIKE, WHO
DO I TURN TO WHEN MY STOMACH
HURTS? AND WHO'S GOING TO PAY
FOR THAT AND WHAT SERVICES AND
WHAT'S THE WEIGHT? AND IS IT AND
AM I GOING TO GO TO THE
PODIATRIST FOR THIS? YOU KNOW,
STOMACHACHE BECAUSE OF THAT
MISMATCH BETWEEN THE SERVICES
THAT I NEED AND WHAT MAY BE
AVAILABLE. WE HAVE TO RETHINK
THIS SYSTEM THROUGH THIS MUCH
MORE UPSTREAM STRATEGY
CONSISTENT WITH THE COMMENTS ARE
THEY ABOUT SCREENING ABOUT
AWARENESS? UM TODAY. MY KIDS ARE
HOSTING CONVENING AT MCCLATCHY
HIGH SCHOOL FOR 150 YOUNG PEOPLE
TO TALK TEENS, TWO TEENS TALKING
ABOUT MENTAL HEALTH. UM THIS
REALLY IS ABOUT EMPOWERING YOUNG
PEOPLE. TO BE, UM. VOCAL ABOUT
WHAT THEIR NEEDS ARE WHAT'S
WORKING AND WHAT'S NOT WORKING,
AND IT REALLY IS ABOUT OUR
ABILITY TO LISTEN TO THEM AND TO
PUT IN PLACE STRATEGY THAT WILL
BE HELPFUL. SO YOU KNOW, IN THE
SHORT ANSWER IS COUNTIES ARE
DOING SOME PHENOMENAL THINGS.
THE REAL ANSWER IS WE'RE FALLING
WAY SHORT OF WHERE WE NEED TO
BE. AND WE HAVE TO DO A BETTER
JOB OF MAKING IT EASIER FOR OUR
LOCAL PARTNERS TO BE SUCCESSFUL
AND HARDER FOR THEM TO MAKE IT
LESS LIKELY FOR THEM TO STRUGGLE
IN DOING WHAT THEY WANT TO DO.
WHAT THEY KNOW IS RIGHT AND WHAT
THEY HAVE THE POTENTIAL TO DO IN
TERMS OF MEETING THOSE NEEDS.
HAPPY TO ANSWER ANY QUESTIONS
YOU MIGHT HAVE. THANK YOU. NEXT
WE WILL HEAR FROM MICHELLE
CABRERA, EXECUTIVE DIRECTOR OF
THE COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION. YEAH.
GOOD AFTERNOON CHAIR AND MEMBERS
MICHELE CABARET AROUND WITH THE
COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION. UM I WAS
ASKED TO SPEAK TODAY TO THE
CHALLENGES THAT COUNTY
BEHAVIORAL HEALTH AGENCIES ARE
EXPERIENCING IN IMPLEMENTING
SERVICES FOR CHILDREN AND YOUTH.
IN THIS MOMENT, POST PANDEMIC
AND FIRST I WANT TO, UM,
READING, REITERATE AND AFFIRM
WHAT DR EWING JUST SAID, WHICH
IS THAT COUNTIES ARE DOING SOME
AMAZING WORK. UH IN SERVING
CHILDREN AND YOUTH AND ONE OF
THE MAIN CHALLENGES THAT THEY
FACE DOES GO TO SOME OF THESE
STRUCTURAL ISSUES AROUND, UM,
FUNDING, WHICH GOES BACK TO
INSURANCE COVERAGE, RIGHT? WE
ARE ABLE TO DO SO MUCH OF THE
AMAZING WORK THAT WE DO THAT IS
PREVENTION ORIENTED. THAT IS
UPSTREAM OF ILLNESS. THAT IS, UM
ENGAGING CHILDREN AND YOUTH IN
CONNECTION IN CULTURALLY AND
LINGUISTICALLY MEANINGFUL WAYS.
IN LARGE PART BECAUSE OF THE
ESSAY AND SPECIFICALLY
PREVENTION AND EARLY
INTERVENTION FUNDS WITHIN THE
NHS, A UM, THERE ARE SIGNIFICANT
GAPS IN COVERAGE, THERE ARE
SIGNIFICANT SHORTAGES IN THE
WORKFORCE. AND THOSE THINGS I
THINK ARE CONNECTED, RIGHT IF
YOU DON'T HAVE ENOUGH INSURANCE
PAYERS OUT IN THE WORLD TO
PROVIDE REIMBURSEMENT TO THE
WORKFORCE THAT YOU NEED, YOU'RE
GOING TO HAVE A VERY INADEQUATE
AND LOPSIDED WORKFORCE, AND
THAT'S PART OF WHAT WE SEE.
TODAY WE SEE SPECIALISTS AND
THESE REALLY VIBRANT PROGRAMS IN
POCKETS AND PATCHWORK.
THROUGHOUT THE STATE THAT ARE
FUNDED WITH THESE, UM, UNIQUE
SOURCES OF FUNDING UNDER COUNTY
BEHAVIORAL HEALTH, BUT WE DON'T
SEE THE SAFETY NET SUPPORTED AND
BOLSTERED THROUGH LONG TERM,
SUSTAINABLE AND BURIED PAYERS IN
THIS SYSTEM, RIGHT, SO I THINK
IT'S IMPORTANT TO SORT OF
HIGHLIGHT AND LIFT UP SOME OF
THOSE STRUCTURAL AND SYSTEMIC
CHALLENGES BECAUSE WE TALK ABOUT
FUNDING AND SYSTEMS. IT'S NOT
BECAUSE WE CARE ABOUT OUR OWN
NEEDS. IT'S BECAUSE WE SEE
WHAT'S POSSIBLE. BUT WE'RE ONLY
. LIKE OUT ON THAT LITTLE
ISTHMUS, RIGHT? WE NEED TO BUILD
A WHOLE LANDSCAPE THAT IS
SUPPORTED IN THOSE WAYS. UM. I
WANT TO SAY A LITTLE BIT, TOO
ABOUT WHAT COUNTIES HAVE DONE.
WE SURVEYED OUR MEMBERS AND WE
FOUND THAT 85% OF COUNTY
BEHAVIORAL HEALTH AGENCIES
ALREADY HAD SOME FORM OF SCHOOL
BASED SERVICES, OBVIOUSLY NOT
ENTIRELY TO SCALE. BUT OUR
PERSPECTIVE IS REALLY UNIQUE
BECAUSE MOST COUNTIES ALREADY
ARE IN SCHOOLS, AND THAT'S BEEN
GROWING WITH INVESTMENTS LIKE
THE MHS S A, UM I ASKED COUNTIES
WHY THEY HAD INVESTED SO IN
SIGNIFICANTLY IN SCHOOL BASED
SERVICES, AND THEY SAID, WE'RE
LOOKING FOR OUR KIDS. WE NEED TO
GO WHERE THEY ARE AT RIGHT AND
MOST KIDS AFTER A CERTAIN AGE,
THEY'RE NOT HANGING OUT IN
PRIMARY CARE. UH LUCKILY, UM,
HISTORICALLY, THE CHALLENGES
THAT WE'VE HAD IN BUILDING OUT
THE SCHOOL BASED SERVICES HAVE
COME DOWN TO YOU. YOU HAVE TO
BUILD PARTNERSHIPS ACROSS
SYSTEMS. RIGHT SO YOU HAVE TO
ENGAGE WITH YOUR LAWN. YOUR
EDUCATION PARTNERS WHO ARE WERE
BUSY WITH THEIR OWN BUSINESS OF
TRYING TO RUN A SCHOOL AND
EDUCATE KIDS, RIGHT? SO YOU'RE
TRYING TO GET IN THE DOOR TO SAY
HEY, PARTNER WITH ME. WE WANT
TO. WE WANT TO HELP. AND THEN
THE OTHER PIECES. SPACE LIKE
LITERALLY SPACE, RIGHT? WE'VE
HAD CLINICIANS WHO ARE
DELIVERING SCHOOL BASED SERVICES
OUT OF JANITOR'S CLOSETS QUITE
LITERALLY BECAUSE THERE'S NO
OTHER PLACE FOR THEM TO DO
CONFIDENTIAL SERVICES, SO REALLY
PRACTICAL THINGS LIKE THAT. THE
LAST THING I WANT TO HIGHLIGHT
IS THAT GAP IN COVERAGE ISSUE
AND FOR A LONG TIME, UM, MEDICAL
WAS ACTUALLY A VERY INADEQUATE
PAIR OF SCHOOL BASED SERVICES
BECAUSE WE HAD TO ESTABLISH THAT
A KID MET THE VERY HIGH MY BAR
OF NEEDING SPECIALTY SERVICES,
MEANING THEY HAD SOME. OF
MEDICAL HEALTH SERVICES. SO WE
WERE JUST PAYING WITH M H S A TO
COVER BOTH MEDICAL KIDS WHO
WEREN'T AT THAT LEVEL OF
SEVERITY AND KIDS WITH PRIVATE
INSURANCE. AND SO WE'VE BEEN
KIND OF HOLDING UP A WHOLE LOT
IN SCHOOLS DON'T GET TO TURN
KIDS AWAY BASED ON THEIR
INSURANCE STATUS, RIGHT SCHOOLS
SERVE EVERYBODY AND SO THEY VERY
RIGHTFULLY SAID IF YOU COME ONTO
OUR CAMPUS WE WANT TO KNOW THAT
EVERYBODY GETS SERVED RIGHT?
THAT'S AN THAT'S AN APPROPRIATE
REQUEST. UM I THINK YOU KNOW,
UNDER THE C Y B H I THIS IS
GONNA TOTALLY, YOU KNOW, TAKE
THE CHESSBOARD IN SORT OF FLIP
IT ON ITS HEAD AND REARRANGE ALL
OF THE DIFFERENT PIECES. AND SO
I THINK IT'S IMPORTANT FOR US TO
UNDERSTAND WHAT THE IMPACTS OF
THAT WILL BE AND HOW IT'S GOING
TO WORK OUT. UM WE THINK IT WILL
BE MOST EFFECTIVE IF WE ARE
LOOKING AT HAVING ALL THE
CLINICIANS WORKING AT THE TOP OF
THEIR LICENSE. AND FOR THOSE
SERVICES TO BE SUSTAINABLY
FUNDED AND SUPPORTED. UM THERE
IS A DIFFERENCE IN TERMS OF THE
YOU KNOW THE WAY THAT THE FEE
SCHEDULE IS BEING CONCEPTUALIZED
TODAY. IT'S THOUGHT OF AS BUDGET
NEUTRAL SO YOU DON'T HAVE A LINE
ITEM IN THE BUDGET TO FUND THE
FEE SCHEDULE. WHY IS THAT
BECAUSE IT IS ASSUMED THAT
EXISTING INSURANCE PAYERS
ALREADY HAVE RESPONSIBILITY TO
SERVE CHILDREN AND YOUTH.
HOWEVER THE REALITY IS MOST
LIKELY PRIVATE PLANS ARE GOING
TO INCREASE PREMIUMS TO COVER
THE COSTS OF THE FEE SCHEDULE.
MOST LIKELY MEDICAL MANAGED CARE
PLANS WILL GET THEIR CAPITATED
RATES ADJUSTED COUNTY BEHAVIORAL
HEALTH PLANS. WE GET WHAT WE GET
RIGHT? IT'S NOT TIED TO
POPULATION. IT'S NOT TIED TO
THOSE SORTS OF THINGS. WHAT WE
DO ARGUE IS THAT THE STATE DOES
OS REIMBURSEMENT FOR NEW
SERVICES OVER WHAT WE ALREADY
PROVIDE. TO COVER THE COST OF
THE FEE SCHEDULE. OTHERWISE WE
WILL BE ROBBING PETER TO PAY
PAUL. WE'RE GOING TO BE TAKING
OUT OF ONE AREA OF OUR SERVICES
TO COVER THE FEE SCHEDULE
SERVICES RIGHT NOW, THE FEE
SCHEDULE IS CONTEMPLATED TO BE
SUBSTANCE USE DISORDER SERVICES
FOR US AND TO THE COMMENTS OF
THE EARLIER SPEAKER. WE
ABSOLUTELY AGREED. THAT WE NEED
TO DO SO MUCH MORE WITH YOUTH,
SUD TREATMENT AND ACCESS TO
THOSE SERVICES. SCHOOLS CAN BE A
LITTLE TRICKY IN TERMS OF SUD
SERVICES BECAUSE THEY'RE NOT ALL
FRIENDLY PLACES TO KIDS COMING
OUT AND SAYING I'M USING ALCOHOL
OR I'M USING DRUGS RIGHT THAT
CAN GET A CHILD. SUSPENDED FROM
SCHOOL OR EVEN EXPELLED OR WORSE
, THEY COULD FACE CRIMINAL
CHARGES BECAUSE IT'S ALL ILLEGAL
, AND SO THERE ARE A LOT OF
DIFFERENT SERIOUS CONSIDERATIONS
THAT COME INTO PLAY WHEN YOU'RE
TALKING ABOUT CITING SUD
SERVICES AT SCHOOL, AND WE AS
COUNTING BEHAVIORAL HEALTH HAVE
EXPERIENCE IN THIS AND WE HAVE A
REALLY, UM BIG STAKE IN MAKING
SURE THAT WE'RE ULTIMATELY
PROTECTING KIDS AND DOING IT IN
A WAY THAT IS QUALITY AND THAT
AGAIN KEEPS THEM SAFE. UM BUT
YES TO ALL THE COMMENTS ABOUT
HARM REDUCTION. BROADLY SPEAKING
, WE DEFINITELY SEE THAT AND
SUPPORT IT. UM IN ORDER TO BRING
THIS TO SCALE, WE ALSO NEED TO
UNDERSTAND AGAIN. THE UNDERLYING
WORKFORCE CONSIDERATIONS AND I
WILL SAY NOTHING ABOUT BRINGING
SCHOOL BASED SERVICES TO SCALE
LOOKS FREE. FROM WHERE WE SIT.
OUR WORKFORCE IS TOO SCARCE.
DEMAND FOR THEIR SERVICES IS TOO
HIGH. AND FRANKLY, AT THIS
MOMENT IN TIME, THEY ARE BURNED
OUT. OUR WORKERS DESERVE A
LIVING WAGE AND THE SYSTEM
FUNDING TO SUPPORT THAT DOES
NEED TO GO ALONG WITH IT
OTHERWISE WHERE CONSUMERS WILL
BE LEFT WHETHER THERE ARE
MEDICAL, WHETHER THEY'RE
PRIVATELY INSURED, WHOMEVER IS
IN THE SAME FRUSTRATING POSITION
THAT PEOPLE ARE IN TODAY.
GETTING GHOST LISTS FROM HEALTH
PLANS TO CALL PROVIDERS WHO
DON'T RETURN THEIR PHONE CALLS
AND ONE THING WE DON'T WANT TO
SEE WITH THE IMPLEMENTATION OF
THE C Y B H. I IS MORE OF THE
SAME AS WE HEARD BEFORE. UM I'M
HAPPY TO ANSWER ANY QUESTIONS,
BUT THANK YOU SO MUCH FOR THE
OPPORTUNITY TO SPEAK WITH YOU
TODAY. DEPARTMENT OF FINANCE.
NATE WILLIAMS WITH DEPARTMENT OF
FINANCE NOTHING FURTHER AT BUT
AVAILABLE FOR QUESTIONS. ELIO
RYAN MILLER, ELIO NOTHING TO ADD
, BUT AVAILABLE FOR QUESTIONS
THANKS TO THE DIOCESE FOR ANY
MEMBERS. QUESTIONS DR JACKSON.
BUT NOT FOR THE DEPARTMENT OF
FINANCE. YEAH. YEAH. AH UM MISS
JONES AND BOYFRIEND. AND IF I
CAN INVITE THE YOUTH TO COME
FORWARD AS WELL, I JUST WANT TO
MAKE SURE YOU HAVE A SEAT AT THE
TABLE.
AND FOR YOUNG PEOPLE, AND SO
SORRY, MISS YOUR PRESENTATION,
BUT GOOD JOB ANYWAY. AH! I WALK
ON THE SCHOOL CAMPUS IN THE 2024
2025 SCHOOL YEAR. UM AND I'M A
YOUNG PERSON. WHAT SHOULD I SEE?
DIFFERENT UM THEN THEN I SEE
TODAY. SURE UM, THANK YOU FOR
YOUR QUESTION. AH IN 24 25 WHEN
WE START TO PHASE IN THE FEE
SCHEDULE, SCHOOLS WILL HAVE THE
OPTION TO PARTICIPATE, AND WE
WOULD EXPECT THERE TO BE SOME
RAMP UP IN TERMS OF THE
IMPLEMENTATION OF THE FEE
SCHEDULE. WE'RE WORKING WITH OUR
L. A PARTNERS CLOSELY TO MAKE
SURE THAT THEY ARE READY TO
IMPLEMENT THE FEE SCHEDULE
ACROSS THE STATE. UM BUT I WOULD
EXPECT THAT YOU WOULD SEE MORE
PROGRAMMING IN SCHOOLS ACROSS
THE STATE. I THINK THE NEEDS OF
VARIOUS SCHOOL SIZES AND
DISTRICTS WILL VARY. DIFFERENT
SCHOOLS HAVE DIFFERENT MODELS
FOR HOW THEY DELIVER HEALTHCARE
SERVICES, INCLUDING BEHAVIORAL
HEALTH SERVICES. UM SOME HAVE
WELLNESS CENTERS AND PROGRAMS
THAT THEY ARE OPERATING ON THEIR
SCHOOL CAMPUS. SOME PARTNER WITH
COUNTY BEAVER HEALTH
DEPARTMENTS, AS YOU JUST HEARD.
FROM MICHELLE CABRERA. OTHERS
HAVE PARTNERSHIPS WITH COMMUNITY
BASED ORGANIZATIONS AND
BEHAVIORAL PROVIDERS IN THE
COMMUNITY, SO IT VARIES ACROSS
THE STATE, BUT THERE WILL BE A
MORE SUSTAINABLE ACCESS TO
RESOURCES PROVIDED AND
REIMBURSED THROUGH THE
COMMERCIAL HEALTH PLANS AND THE
MEDICAL MANAGED CARE PLANS SO
THAT SCHOOLS HAVE A SUSTAINABLE
FOR THE SOURCE OF FUNDING TO
SUPPORT STUDENTS. BEHAVIORAL
HEALTH NEEDS. ON CAMPUS AND
THROUGH OFF CAMPUS PARTNERSHIPS
WITH COMMUNITY BASED
ORGANIZATIONS. WHAT MEASUREMENTS
ARE WE USING TO ENSURE THAT IF
THEY ACCESS THOSE FINES THAT IS
BASED UPON BEST BEST PRACTICE?
OR BASED UPON WHAT THE ACTUAL
NEEDS IN INSTEAD OF JUST
CHECKING A BOX. SO THERE'S A
VARIETY OF SERVICES THAT WILL BE
INCLUDED ON THE FEE SCHEDULE,
INCLUDING EVIDENCE BASED
INTERVENTIONS AND SERVICES THAT
WILL BE AVAILABLE IN SCHOOLS
ACROSS THE STATE. THERE ARE WE
ARE ALSO LOOKING TO AS PART OF
THE EVALUATION, IDENTIFY
SPECIFIC MEASURES. THAT WILL BE,
UM. THAT WE WILL BE REVIEWING AS
PART OF THE EVALUATION TO
DETERMINE THE EFFECTIVENESS OF
THESE PROGRAMS ACROSS THE STATE
, LOOKING AT THINGS LIKE REDUCED
UTILIZATION OF EMERGENCY
DEPARTMENT SERVICES, REDUCED
HOSPITALIZATIONS, REDUCED
ABSENTEEISM AND OTHER MARKERS OF
STUDENT SUCCESS AND YOUTH
SUCCESS IN OUR STATE. SO MANY
THINGS THAT WE'RE LOOKING AT,
AND I THINK I'M MELISSA STEPPER.
JONES COULD SPEAK TO THE
EVALUATION. THANKS AUTUMN. YES
WE ARE CERTAINLY LOOKING IN
TERMS OF OUR OUTCOME. SCHOOLS AT
BOTH FOR THE FEE SCHEDULE
ITSELF, SORT OF HOW IT'S BEING
UTILIZED THE TAKE UP RATE WHAT
THAT MEANS IN TERMS OF
ACCESSIBLE SERVICES, BUT ALSO
OVERALL, ARE WE DECREASING
BARRIERS AND INCREASING ACCESS
TO SUPPORTS AND SERVICES AND YOU
? IS THAT THE PERCEPTION OF
YOUTH AND FAMILIES THAT THEY
KNOW HOW TO GET TO THE POINT
THAT WAS MADE EARLIER. THAT THEY
FEEL LIKE THEY HAVE MORE ROUTES,
AND THEY KNOW HOW TO GET TO THE
SUPPORTS AND SERVICES THAT THEY
NEED, AND THEY ACTUALLY FEEL
LIKE THEIR WELL BEING IS
IMPROVED, OR CERTAINLY PART OF
THE OUTCOME SCHOOLS. I'D ALSO
NOTE THAT IN THE 24 25 SCHOOL
YEAR, WE WOULD HOPE THAT THERE
ARE MORE EDUCATION PROFESSIONALS
WHO HAVE HAD THE OPPORTUNITY TO
ENGAGE IN THE TRAUMA INFORMED
TRAINING THAT I DESCRIBED
EARLIER. WE KNOW THAT MANY
SCHOOLS ALREADY DO THAT KIND OF
TRAINING, BUT WE'VE ALSO HEARD
FROM OUR PARTNERS THAT NOT ALL
DO THEY DON'T ALL HAVE THAT. AND
THIS WILL BE FREE, PUBLICLY
AVAILABLE TRAINING AND INCLUDING
AN EARLY CARE AND LEARNING
SETTINGS, AS WELL AS FOR K
THROUGH 12, SO WE WOULD HOPE TO
SEE THAT THERE ARE MORE
EDUCATION PROFESSIONALS AND
OTHER SCHOOLS SERVING STAFF,
WHETHER THAT'S THE BUS DRIVER OR
THE SCHOOL CUSTODIAN WHO HAS HAD
AN OPPORTUNITY TO HAVE THAT
TRAINING AND WE WILL ALSO START
TO SEE IN THE 24 25 SCHOOL YEAR
. THE ADDITION OF WELLNESS
COACHES, WHICH WILL BE HEARING
AN UPDATE ABOUT EARLIER BUT
REALLY BUILDING OUT THAT TEAM.
OF SUPPORTS AND WELLNESS COACHES
, IN MANY WAYS WILL BE ABLE TO
FUNCTION LIKE A NEAR PEER
SERVICES, PROVIDING NON CLINICAL
SUPPORTS AND COACHING TO OUR
YOUNG PEOPLE. UM WE'VE CERTAINLY
HEARD FROM YOUTH WEEK THAT WE
HAVE ENGAGED WITHIN THIS WORK
THAT, UM, THE FIRST PERSON THEY
WANT TO SEE WHEN THEY WALK IN
THE DOOR OF A WELLNESS CENTER ON
A SCHOOL SITE. TO BE HONEST, IS
NOT SOMEBODY WHO LOOKS LIKE ME,
MIDDLE AGED WHITE WOMAN THAT'S
NOT WHO THEY WANT TO SEE. THEY
WANT TO SEE SOMEBODY WHO COMES
FROM THEIR COMMUNITY. WHO
UNDERSTANDS THEIR EXPERIENCE AND
A WELLNESS COACHES ARE REALLY
IMPORTANT WAY FOR US TO BOTH ADD
TO AND DIVERSIFY AND CREATE A
MORE REPRESENTATIVE WORKFORCE.
AND THEN YOU ALSO HEARD EARLIER
FROM MY COLLEAGUE, MISS BOYLAN
ABOUT SOME OF THE OTHER WORK
THAT HCS IS DOING IN TERMS OF
STRENGTHENING SOCIAL EMOTIONAL
LEARNING PROGRAMS ACROSS THE
STATE, SO I WOULD HOPE TO SEE
THAT WE WOULD HAVE MORE
EFFECTIVE AND MORE LEARNING FROM
EACH OTHER SOCIAL EMOTIONAL
LEARNING PROGRAMS ACROSS THE
STATE. AND THAT THE NEW VIRTUAL
SERVICES PLATFORM IS ALSO
ANOTHER TOOL FOR BOTH EDUCATORS
AND YOUTH TO BE CONNECTED TO
OBVIOUSLY OUTSIDE OF THEIR
SCHOOL HOURS, BUT THAT IT'S A
CHANCE FOR THEM TO INCREASE
THEIR AWARENESS OF THE TOOLS
THAT ARE AVAILABLE TO THEM
ACROSS THE SYSTEM. IS IT
POSSIBLE THAT A SCHOOL DISTRICT
OR SCHOOL JUST MADE MHM CHOOSE
NOT TO DO ANYTHING. UH YES, IT
IS POSSIBLE THAT THE DISTRICTS
AND THE SCHOOL SITES ON THE
INDIVIDUAL CASE BY CASE BASIS,
OPT NOT TO PARTICIPATE. UM THERE
ARE THERE'S NOT A STATUTORY
REQUIREMENT FOR THE SCHOOLS TO
PARTICIPATE IN THE C Y B HIV
SCHEDULE. HOWEVER WE ARE WORKING
VERY CLOSELY WITH ALL 58
COUNTING OFFICERS OF EDUCATION.
DISTRICT PARTNERS TO MAKE SURE
THAT THE SCHOOLS AND THE
DISTRICTS ARE SUPPORTED IN DOING
THIS WORK THAT THEY'RE
APPROPRIATELY RESOURCED TO DO
THIS WORK AND THAT THEY HAVE THE
PARTNERSHIPS WITH THE MEDICAL
MANAGED CARE PLANS, COMMERCIAL
HEALTH PLANS AND COUNTY BE ABLE
TO HELP DEPARTMENTS IN ORDER TO
BE ABLE TO SUSTAIN AND IMPLEMENT
THIS STRUCTURE, SO IT'S NOT A
MANDATE. BUT IT IS SOMETHING
THAT OUR LOCAL EDUCATION AGENCY
PARTNERS, AS WELL AS OUR COLLEGE
AND UNIVERSITY PARTNERS ARE KEEN
TO MAKE SURE THAT THEY HAVE
RESOURCES AVAILABLE TO BE ABLE
TO SUPPORT THE SERVICE NEEDS OF
THEIR STUDENTS. SO WE'RE ALL IN
IT TOGETHER IN TERMS OF WHY
WE'RE SHOWING UP AND THE WORK
THAT WE'RE DOING, AND SO I THINK
IT'S REALLY JUST ABOUT MAKING
SURE THAT THE SCHOOLS ARE
APPROPRIATELY RESOURCED AND
SUPPORTED, UM, THAT WE'RE
THINKING ABOUT THE
IMPLEMENTATION STRATEGY THAT
WE'RE PARTNERING WITH THEM TO DO
IT IN THE RIGHT WAY, AND THAT'S
WHY WE ARE TAKING OUR TIME TO
PHASE IN THE APPROACH WORK WITH
OUR LOCAL EDUCATION AGENCIES.
MAKE SURE THAT WE ARE, UM,
IMPLEMENTING IT IN THE RIGHT WAY
SO THAT THEY HAVE THE TOOLS AND
RESOURCES THAT THEY NEED IN
ORDER TO BE ABLE TO OPT IN FOR
THIS PROGRAM. I WOULD ADD TO
THAT. THAT UM, AS YOU HEARD,
MISS BOYLAN DESCRIBED EARLIER.
IT'S NOT A FIXED, INFLEXIBLE
MODEL. I THINK SOMETHING WE'VE
REALLY HEARD FROM. OUR PARTNERS
IS THE WAY IN WHICH THEY WANT TO
PERHAPS INCREASE OR EXPAND
BEHAVIORAL HEALTH SERVICES AND
SUPPORTS VARIES IN SOME OF THEM
. THEY MIGHT WANT TO HIRE MORE
STAFF DIRECTLY THROUGH THE
SCHOOL'S SOMEWHAT TO DO MORE OF
THAT, BECAUSE THEY HAVE A REALLY
ROBUST SET OF COMMUNITY BASED
ORGANIZATION PARTNERS TO HELP
DELIVER THE SERVICES SO IT
DOESN'T HAVE TO BE SORT OF ONLY
ONE WAY IN WHICH THEY CAN DO
THAT RAMP UP THE WAY THE FEE
SCHEDULE WILL BE STRUCTURED. IT
WILL REALLY SUPPORT SCHOOLS
DEVELOPING THAT SUITE OF
SERVICES THAT REALLY MAKES SENSE
FOR THEIR AND TITI FOR THEIR
STUDENTS FOR THEIR COMMUNITY AND
FOR THEIR PARTNERSHIP, SORT OF
THE ECOSYSTEM OF THEIR THEIR
COMMUNITY. UM AND THEN THE OTHER
THING I WOULD MENTION IS THAT A
LOT OF OUR DISCUSSION WITH
THINKING ABOUT HOW DO WE, UM,
CREATE A MORE COORDINATED
APPROACH THEY ACROSS EDUCATION
INITIATIVES AND C Y B H I IS
THAT WE'VE CERTAINLY HEARD FROM
PARTNERS AT THE LOCAL LEVEL IN
THE FIELD IS VERY CHALLENGING TO
SIMULTANEOUSLY IMPLEMENT ISLANDS
OF INITIATIVES. THERE'S C Y B H
I. THERE'S CALLIE. THERE'S
COMMUNITY SCHOOLS. THERE'S
EXPANDED LEARNING THERE'S
UNIVERSAL PRE KINDERGARTEN. AND
SO PART OF THE WORK THAT WE ARE
TRYING TO DO RIGHT NOW, WITH THE
STATE BOARD OF EDUCATION IN
CALIFORNIA DEPARTMENT OF
EDUCATION AND OUR PARTNERS IN
THE FIELD IN BOTH EDUCATION AND
HEALTH IS HOW DO WE SUPPORT A
MORE COORDINATED APPROACH? THE
RATHER THAN FIGURES FEELING LIKE
YOU'RE IMPLEMENTING COMPLETELY
SEPARATE INITIATIVES? WHERE DO
THEY ACTUALLY COME TOGETHER?
BECAUSE THEY DO HAVE A UNIFYING
VISION AND APPROACH OF A WHOLE
CHILD APPROACH. A VERY STRONG
FOCUS ON EQUITY AND MAKING SURE
THAT WE ARE REALLY ADDRESSING
THE NEEDS OF THE MOST
UNDERSERVED KIDS AND THAT OUR
GOAL IS FOR OUR KIDS TO THRIVE
FOR THEM TO BE WELL FROM A
HEALTH PERSPECTIVE AND BE ABLE
TO LEARN. SO HOW DO WE BRING
THAT TOGETHER MORE? AND I THINK
WE'RE REALLY TRYING TO THINK
ABOUT WHAT DOES THE KIND OF
IMPLEMENTATION SUPPORTS LOOK
LIKE THAT WILL DO THAT WHICH
WILL HOPEFULLY HELP SCHOOLS TAP
INTO THE WORK OF THE C Y B AND
TRY BECAUSE IT WILL FEEL
CONNECTED TO THE WORK THEY ARE
TRYING TO DO AS A SCHOOL AND AN
L. A IN THE FIRST PLACE. YOUNG
PEOPLE. DO YOU HAVE ANY WELLNESS
CENTERS ON YOUR CAMPUS? I DON'T
FEEL AS QUALIFIED TO TALK ABOUT
THIS JUST BECAUSE I WENT TO
PRIVATE SCHOOL, BUT NO, THERE
WAS NOT A WELLNESS CENTER, BUT
WE HAD THE COUNSELING CENTER
THAT WE COULD GO TO IF WE WERE
IN A CRISIS SITUATION OR WHATNOT
. LIKE I KNOW WHEN I HAD MY
EATING DISORDER. MY THERAPIST
WAS VERY OR MY COUNSELOR WAS
VERY SUPPORTIVE ON SIGNING OFF
AND MAKING SURE THAT I ATE MY
LUNCH AND THINGS LIKE THAT. SO
WE DID HAVE SOMETHING OH, UM,
ALONG THE LINES OF THAT, BUT NOT
NECESSARILY A WELLNESS CENTER
LIKE WE'RE TRYING TO DEFINE
TODAY. YEAH UM, I'M STILL HIGH
SCHOOL SENIORS, SO I GO TO
PUBLIC SCHOOL IN IRVINE UNIFIED
, AND WE DO, UM, LUCKILY, HAVE
THE PRIVILEGE OF HAVING WELLNESS
CENTERS, BUT I THINK A BIG ISSUE
IN MY SCHOOL IS THE CULTURE
BETWEEN, UM EDUCATORS,
ESPECIALLY ADMINISTRATION AND
STUDENTS. A LOT OF TIMES LIKE
THERE'S A LOT OF MISTRUST
BETWEEN, UM JUST THE ADULTS IN
SCHOOL AND STUDENTS BECAUSE OF
LIKE I MENTIONED BEFORE SOME
SCHOOL DISCIPLINE POLICIES THAT
HAVE COME UP LATELY, AND, UM,
SINCE MY SCHOOL IS VERY LIKE
HIGH PERFORMING VERY MERITED,
KIDS, WE OBVIOUSLY THEY EXPECT
US TO ABIDE TO A LOT OF THOSE
THINGS WITHOUT REALIZING THAT WE
ALSO HAVE MENTAL HEALTH
CONCERNS. JUST, UM ONES THAT WE
DON'T VOICE AS MUCH. UM, BUT I
THINK BECAUSE OF THAT A LOT OF
STUDENTS DON'T TURN TO OUR
SCHOOL TO ADDRESS OUR MENTAL
HEALTH NEEDS AND WE MORE SO JUST
SUPPRESS IT OURSELVES. WHAT DO
YOU NEED TO DO? DECAYING ACCESS
TO THE WELLNESS CENTER. UM WE
MOST OF THE TIME WE CAN JUST
WALK IN, BUT I KNOW FOR A
COUNSELORS. THEY HAVE A LOT MORE
ON THEIR PLATE. IF WE ACTUALLY
WANT TO TALK TO SOMEONE, UM, BUT
OUR WELLNESS CENTER JUST HAS A
LOT OF LIKE DISTRESSING ACTIVITY
, STRESS BALLS AND SAND AND
THINGS LIKE THAT. BUT IF WE
WANT, LIKE SOME KIND OF SESSION
WITH OUR COUNSELORS THAT WOULD
HAVE TO BE PRE SCHEDULED. I'VE
GONE TO, UM, SOME CAMPUSES WHERE
YOU HAVE TO EARN POINTS TO GET
TO A WELLNESS CENTER. RIGHT
WE'RE STILL USING THAT THERE'S
SOME UP TO PLACES WHERE YOU KNOW
, IN ORDER TO HAVE WELLNESS
ACCESS TO WELLNESS CENTER F. IT
IS EVEN STAFFED. FULL TIME.
WHICH IN MOST CASES IT'S JUST
NOT THE CASE, RIGHT? AH BUT
YOU'RE EITHER SENT THERE BECAUSE
YOU HAVE SOME TYPE OF BEHAVIOR
ISSUE AND THEY'RE GOING TO SEND
YOU THERE TO GET SOME SUPPORT.
OR THERE'S CERTAIN TIMES WHERE
YOU JUST CAN'T HAVE ACCESS TO
IT. YEAH, MY WHOLE YOU WANT TO
SAY SOMETHING BEFORE I GO ON MY
TIRADE COMMUNITY COLLEGE LIKE
THE ONLY WAY YOU CAN GET ACCESS
TO LIKE THE WELLNESS CENTER IS
BY A ANOTHER PERSON, WHETHER
IT'S A FRIEND OR A TEACHER OR
SOMEONE ELSE HAVING TO REFER YOU
OVER, HMM. SO THIS IS MY THING.
I I'M NOT, UM, TOTAL FAN OF
WELLNESS CENTERS. WHY IS IF YOU
GO THERE, YOU MOST LIKELY WILL
NOT GET A PROFESSIONAL TO HELP
YOU AT THIS CURRENT STATE TIME
RIGHT NOW. UM OR LIKE I SAID, IT
IS MORE, UM MERIT BASED FOR LACK
OF A BETTER TERM. MY WHOLE POINT
IS THIS. IS THAT WE ARE NOT
TREATING THE MENTAL HEALTH
CRISIS LIKE WE TREATED COVID 19.
AND THAT'S JUST A FACT. OH THERE
WAS NO SUCH THING AS SILOS
ANYMORE. THERE WAS NO SUCH
THINGS AS THIS IS THE WAY WE DO
THINGS ANYMORE. WE TOUR
ABSOLUTELY EVERYTHING DOWN TO
MEET THE CURRENT NEED TO GET
PEOPLE VACCINATED. WE SHUT DOWN
SCHOOLS. WE HAD ALL KINDS OF
THINGS. BUT WE'RE STILL. WE'RE
STILL TRYING TO FIT MENTAL
HEALTH INTO CURRENT SYSTEMS.
INSTEAD OF TRANSFORMING THE
SYSTEMS ITSELF. AND. IF WE KNOW
THIS IS A CRISIS. BUT YET IT IS
STILL VOLUNTARY TO PROVIDE IT.
HOW ARE WE CALLING THIS A
CRISIS? WE'RE NOT REALLY CALLING
IT A CRISIS. WE'RE IGNORING THE
NEED AND YOU KNOW, AT THE END OF
THE DAY, IT'S ADDING MORE BURDEN
ON THE PUBLIC HEALTH CARE SYSTEM
ON TAXPAYER DOLLARS. UH UM, YOU
KNOW, IN ONE KAISER SYSTEM I'VE
SEEN 40 PEOPLE LEAVE IN THE LAST
REALLY YEAR AND A HALF BECAUSE
OF THE BURDEN ONTO THE SYSTEM.
YOU BETTER STOP PREACHING GIRL.
MY WHOLE POINT IS THAT HMM. AT
THE QUESTION IS, ARE WE SERVING
YOUTH? THE BEST THAT WE CAN THE
ANSWER IS NO. BECAUSE WE ARE
STILL PRESERVING. OR STILL
TRYING TO STEP OVER LAND MINES
INSTEAD OF SAVE LIVES. AND THIS
IS JUST THE WAY WE'RE TRYING TO
ACCOMPLISH THIS. RIGHT? AND SO I
WILL CONTINUE TO CHALLENGE
ANYONE AND EVERYONE WHO WILL
LISTEN, BECAUSE AS YOU KNOW, I'M
NOT A I'M PRONE TO REPEAT MYSELF
OVER AND OVER AGAIN. UH, THAT.
WE STILL GOT TO DO BETTER. WE
HAVE GOT TO PUT OUR FOOT DOWN.
AND SAY THIS IS A CRISIS. THIS
IS WHAT OUR YOUNG PEOPLE NEED.
THEREFORE EVERYONE GET OUT THE
WAY SO THAT WE CAN SERVE THEM
THE WAY WE KNOW WE SHOULD BE
SERVING THEM. AND EVEN IF IT'S
FROM A LOCAL PERSPECTIVE. AND
MAKING SURE THAT THERE'S
FLEXIBILITY BECAUSE YOU'RE
RIGHT. DIFFERENT CULTURES,
DIFFERENT THINGS LIKE THAT THEY
NEED A LEVEL OF FLEXIBILITY. SO
IT FITS THERE. AREAS RURAL AREAS
, YOU KNOW, MOUNTAINOUS AREAS. I
MEAN THERE, THERE'S SOME LEVEL
OF FLEXIBILITY THAT NEEDS TO
OCCUR. UH BUT THE WAY WE'RE
DOING IT, WE'RE STILL SAYING
WE'LL GIVE YOU SOME MONEY.
PLEASE DO THIS. AS OPPOSED TO
SAYING WE NEED TO DO IT. SUBMIT
YOUR PLAN. RIGHT SO THAT WE CAN
HELP YOU TO ACCOMPLISH THAT.
WE'RE STILL NOT AT THE FULL
LEVEL YET. AND WHEN WE HAVE
ANOTHER HEARING NEXT YEAR NEXT
BUDGET YEAR I CAN ALMOST
GUARANTEE YOU. THAT I'LL HAVE TO
SAY THIS EXACT SAME THING. IF WE
KEEP GOING DOWN THE ROAD, WE'RE
GOING RIGHT NOW. AND IT HURTS ME
TO HAVE TO SAY THAT. BUT BEFORE
I GOT HERE TO SACRAMENTO UM. I
RAN A NONPROFIT THAT DID
RESTORATIVE JUSTICE PRACTICE
RESTORATIVE PRACTICES. AND I
MYSELF CONDUCTED CIRCLES. AND
THE WORST THING YOU WANT. IS TO
HAVE CONDUCTED CIRCLES. AND THEN
A YEAR OR SO LATER. YOU ARE
TOLD. THAT WAS SOMEONE THAT WAS
IN YOUR CIRCLE. COMMITTED
SUICIDE. A YOUNG PERSON. I
WOULDN'T WISH THAT ON ANYBODY.
BUT I GUARANTEE YOU, WE MIGHT
HAVE COUNT IT. IF I HAD THE
KNOWLEDGE AT THE TIME TO DO SOME
TYPE OF UNIVERSAL SCREENINGS OR
SOMETHING. SO THE IDEA IS. AND
I'M IMPLORING EVERYBODY PUSH THE
ENVELOPE LIKE WE DID. COVID 19.
BECAUSE ALL OF A SUDDEN WE FOUND
MONEY ALL OF A SUDDEN, THERE
WERE NO SACRED COWS. AND ALL WE
DID WAS PEOPLE COMPLAIN, BUT
HEY, WE ALL TOOK IT. BECAUSE IT
WAS ABOUT SAVING LIVES, BUT WE
CONTINUE TO NOT BECAUSE THAT'S A
THAT WAS A PHYSICAL AILMENT. BUT
BECAUSE THIS IS A BEHAVIOR
HEALTH AILMENT, WE DON'T TAKE IT
AS SERIOUSLY. OR WE DON'T ACT AS
AGGRESSIVELY SO AGAIN. I ASK
EVERYONE, PLEASE. WE'VE GOT TO
DO MORE. WE'VE GOT TO DO MORE.
GO AHEAD. YOU KNOW, YOU KIND OF
MISSED A PRETTY POWERFUL SPEECH
EARLIER, BUT I MEANT THIS THE
FORMULA FOR THAT. YOU KNOW WHAT?
WATCH THE RECORDING LATER. WATCH
THE RECORDING. OKAY FORMULA.
WATCH IT. ONE WORD IN EVERY
STATEMENT THAT YOU HAVE SAID
THAT YOU HAVE MISSED AND ITS
YOUTH YOUTH NEED TO BE INVOLVED
IN AT THE TABLE. THEY'RE
WILLING, READY AND ABLE TO IT'S
WEEK IF YOU AS THE ADULTS CANNOT
HELP US AND LISTEN TO US, THEN
YES, YOU'RE RIGHT. WE'RE GOING
TO BE HERE NEXT YEAR, AND IT'S
GOING TO BE THE SAME. BE AS LIKE
IT IS TODAY, SO IF WE DON'T GET
MORE YOUTH INVOLVED BECAUSE IT'S
GOING TO AFFECT US, IT'S GOING
TO AFFECT OUR KIDS. THE OLD
ARCHAIC SYSTEM DIDN'T WORK, AND
IF WE'RE GOING TO DO THE SAME
THING THAT IT'S GOING TO
CONTINUE TO NOT WORK. SO WE
REALLY NEED TO PUT YOUTH AT THE
FOREFRONT IN EVERY DECISION
THAT'S MADE INVOLVING THIS.
AMEN. I CAN'T WAIT TO SEE YOU IN
ONE OF THESE SEATS ONE DAY. MY
FIRST QUESTION IS GOING TO BE
FOR YOU MISS POLLS IF I CAN JUST
OFF OF WHAT YOU WERE STATING, WE
HEARD THAT YOU WERE CO
FACILITATING FOCUS GROUPS
REGARDING THE VIRTUAL SERVICES
PLATFORMS THAT I'D LOVE TO HEAR
FROM YOU. WHAT RESPONSES YOU
WERE HEARING SO SINCE I'M A
LITTLE BIT OLDER IN THIS SPACE,
I'M 24. I WAS CO FACILITATING
FOR BOTH THE ADULT AND THE
YOUTH. KIND OF, YOU KNOW, PRIOR
TO PROVIDING A MIDDLE GROUND AND
SO FROM YOUTH, A BIG PROBLEM
WITH COVID HAS BEEN THE LACK OF
CONNECTION BUT ALSO FEELING LIKE
, YOU KNOW IF THEIR PARENTS
AREN'T INFORMED ABOUT MENTAL
HEALTH, AND THE PARENTS ARE
REALLY WILLING AND WANT TO BE
INVOLVED IN EVEN IF THEIR KID
DOESN'T HAVE MENTAL HEALTH
ISSUES, JUST LEARNING ABOUT
STUFF. AND SO I THINK A LOT OF
IT HAS TO DO WITH PRIVACY
BECAUSE KIDS ARE WORRIED LIKE
HOW IS THEIR DATA GONNA GET USED
AND WHATNOT, BUT ALSO PARENTS.
IT'S LIKE, WELL, CAN I BE
ALERTED WHEN MY KID SAYS THAT
THEY WANT TO HARM THEMSELVES SO
THAT I CAN HELP GET INVOLVED IN
THE PROCESS? SO IT WAS A VERY
INTERESTING THING, BECAUSE, YOU
KNOW OKAY. AT THE END OF THE
DAY, KIDS WANT TO BE MORE FACE
TO FACE AND HAVE RELATIONSHIPS
LIKE THAT AND NOT JUST TALKING
TO A CHAT BOTS ONLINE. ALONG
THOSE LINES. THERE ARE NO SILVER
BULLETS AND IT IS AND ALL OF THE
ABOVE APPROACH THAT I'D LIKE TO
COME BACK TO THE WELLNESS
CENTERS AND HOW WE ANY
SUGGESTIONS THAT THE YOUTH ARE
MAKING ON HOW WE CAN STRENGTHEN
THEM OR INCREASE ACCESS TO THEM
. I THINK IN INCREASED ACCESS
LIKE I COME FROM VALEO, AND SO
THEY'RE I MEANT ANY ACCESS IS A
BIT SMALL IN THE EDUCATION
SYSTEM IN THE CITY. YOU KNOW,
THERE IS NO SUCH THING. BUT I
THINK LIKE HAVING PROFESSIONALS
AND I THINK WHAT IS REALLY
NEEDED. IS THE PEER TO PEER
SUPPORT BECAUSE KIDS FEEL MORE
COMFORTABLE TALKING TO KIDS AND
SO AND THAT'S HOW A LOT OF THEM
ARE GOING TO GET HELP. AND SO I
DO THINK HAPPY AND THE PEER TO
PEER EDUCATION IS REALLY WHAT'S
GOING TO BE HELPFUL AND WE NEVER
KNOW WHERE THAT'S GOING TO END
UP LEADING IN TERMS OF LIKE,
MAYBE IT MAKES YOUTH WANT TO GET
MORE INVOLVED AND THEN MAYBE
THEN BECOME MENTAL HEALTH
FACILITATORS HIMSELF, BUT I
THINK HAVING PROFESSIONALS THERE
AND HAVING THE RESOURCES TO AT
LEAST GUIDE THEM TO CONTINUED
SERVICES, I THINK IS WHAT'S
NEEDED. CAN WE GET AN UPDATE
FROM THE ADMINISTRATION WE HAD
HEARD ABOUT THE STRENGTH OF
PERIOD APPEAR FROM OUR YOUTH
LAST YEAR THAT I'D LIKE TO
UNDERSTAND HOW WE'RE
INCORPORATING THAT AND MOVING
FORWARD. SURE HAPPY TO PROVIDE
AN UPDATE. SO UM, ONE OF THE
INITIATIVES THAT WAS FUNDED AS
PART OF THE 2022 BUDGET ACT. IS
THE HIGH SCHOOL PERIOD APPEARED
DEMONSTRATION PILOT PROJECT. WE
ARE CONTRACTING WITH THE
CHILDREN'S PARTNERSHIP TO, UM.
YEAH, TO ROLL OUT THE GRANTS FOR
THAT INITIATIVE. THEY'RE
PLANNING TO, UM, CONVENING AN
ADVISORY GROUP OF YOUTH TO HELP
INFORM THE REQUEST FOR PROPOSALS
FROM ALL OF THE HIGH SCHOOLS.
UM, THEY WILL SELECT UP TO EAT
HIGH SCHOOL'S OVER THE COURSE OF
THE NEXT 2 TO 3 YEARS TO PILOT.
THE PERIOD APPEAR PROGRAMS
EVALUATE THE OUTCOMES AND TO
DEVELOP STATEWIDE STANDARDS FOR
HIGH SCHOOL PERIOD PAIR
PROGRAMMING. WE ARE ALSO
BUILDING IN PURE PROGRAMMING AS
PART OF THE VIRTUAL SERVICES
PLATFORM BASED ON WHAT WE HEARD
FROM YOUTH OVER THE COURSE OF
THIS LAST YEAR AROUND THE
VIRTUAL SERVICES ENVIRONMENT,
AND SO THERE WILL BE MODERATED,
SAFE PEER TO PEER FORUMS WHERE
YOUNG PEOPLE CAN SHARE THEIR
STORIES ENCOURAGE EACH OTHER
WITHOUT REPLICATING THE BAD
THINGS ABOUT SOCIAL MEDIA LIKE
LIKES IT JUST LIKES BUT GIVING
YOUTH AN OPPORTUNITY TO LEARN
FROM EACH OTHER AND SHARE FROM
EACH OTHER. AND THAT WILL BE A
PART OF WHAT WE DELIVER THROUGH
THE DIGITAL BEAVER HALL PLATFORM
, WHICH WILL PROVIDE, YOU KNOW,
AND I THINK TO REMEMBER
JACKSON'S POINT EARLIER ABOUT
HOW ARE WE PUSHING THE ENVELOPE
TO DO THINGS A LITTLE BIT
DIFFERENTLY? YOU KNOW, CREATING
THIS OPPORTUNITY FOR A STATE
FUNDED DIGITAL BEHAVIORAL HEALTH
PLATFORM WHERE YOU CAN GET
ACCESS TO 1 TO 1 COACHING SPORTS
WITH THE REAL PERSON ON THEIR
PHONES AT ANY TIME OF THE DAY IS
SOMETHING THAT REALLY DOES PUSH
THAT ENVELOPE FORWARD AND
THROUGH THAT WE'RE ALSO GOING TO
BE MAKING PEER TO PEER
PROGRAMMING AVAILABLE, UM AND AS
WELL AS THROUGH EVIDENCE BASED
PRACTICE GRANTS IN SCHOOL BASED
FEE SCHEDULE THAT WE'RE REALLY
ARE TRYING TO THINK ABOUT. THE
OPPORTUNITIES FOR YOUNG PEOPLE.
TO LEAD AND GUIDE THIS WORK
THROUGH THE PEER TO PEER
PROGRAMMING IN ALL OF THESE
VARIOUS COMPONENTS OF THE C Y B
H, I JUST ADD. I KNOW WHEN YOU
HEAR A LITTLE LATER FROM THE
DEPARTMENT OF HEALTH CARE AND
ACCESS AND INFORMATION ABOUT THE
WORKFORCE PIECES THAT ONE OF THE
COMPONENTS AS YOU KNOW IN THE
MEDICAL PROGRAM IS THE NEW PEER
SUPPORT SPECIALIST BENEFIT AND
WORK AND FOR EXAMPLE, IN SOME OF
THE FUNDING FROM H CHI TO
INCREASE THE TRAINING FOR PEER
SUPPORT SPECIALIST THEY REALLY
PRIORITIZED YOUNG ADULTS. THEY
EVEN ALLOW 16 AND 17 YEAR OLDS
INTO THE PROGRAM SO THAT WHEN
THEY TURN 18 AND CAN ACTUALLY BE
ELIGIBLE TO PROVIDE THE SERVICE
THAT THEY'RE READY. SO THERE WAS
A STRONG FOCUS ON YOUNG ADULTS.
SO EVEN THOUGH IT'S MORE OF A
NEAR PAIR MODEL, BUT THAT IT HAS
THAT ASPECT TO IT AS I MENTIONED
EARLIER, THE WELLNESS COACH
REALLY AS MANY ASPECTS OF THAT
NEAR PAIR MODEL TRYING TO
INCREASE THAT KIND OF SUPPORT
AND AVAILABILITY OF A WORKFORCE
THAT IS MORE REPRESENTATIVE OF
OUR YOUTH AS AN IMPORTANT PART,
AND I DO THINK THE WELLNESS
COACH IS PART OF OUR
TRANSFORMATIONAL EFFORT. IT
REALLY IS MEANT TO SORT OF HELP.
SHIFT THE WORKFORCE TO ADDRESS
WHAT WE ARE HEARING FROM YOUTH
ARE THERE NEEDS IN TERMS OF
BETTER ADDRESSING THOSE, AND I
UM. I THINK WE ALL WORKING ON
THIS AND I DON'T JUST MEAN IN
STATE GOVERNMENT. I MEAN, ALL OF
OUR PARTNERS SHARE THIS SENSE OF
URGENCY AND THE NEED FOR
TRANSFORMATION AND WRESTLE WITH
THE VERY QUESTIONS THAT
ASSEMBLYMEMBER'S JACKSON IS
RAISING EVERY DAY ABOUT IS THERE
ANY STONE WE'VE LEFT UNTURNED?
COULD WE MOVE THINGS FASTER AND
CANDIDLY? AT THE SAME TIME, OUR
PARTNERS ARE ALSO SAYING, DON'T
JUST TAKE THE WELL WORN PATH, SO
BECAUSE THE WELL WORN PATHS ALL
THE STUFF WE ALREADY KNOW HOW TO
DO, AND IF YOU JUST DO MORE OF
THAT, IT'S NOT GOOD ENOUGH. SO
HOW DO WE MOVE QUICKLY, BUT DO
IT DIFFERENTLY AND NOT JUST DO
THE SAME AND ACTUALLY DO
SOMETHING THAT'S
TRANSFORMATIONAL AND YET I CAN
TELL YOU. WE ASK OURSELVES EVERY
DAY. COULD WE DO IT FASTER? CAN
WE DO IT BETTER? COULD WE DO IT
DEEPER, AND SO I APPRECIATE SORT
OF THE COMMENTS AROUND THAT
BECAUSE I THINK WE ARE ALL
WRESTLING AND WORKING TOWARDS
THAT. SO THANK YOU, UM FOR
DIRECTOR STAFFORD JONES. YOU
SAID THAT MATHEMATICAL WAS GOING
TO BE, UM CONVENING AND OUTCOMES
GROUP. HOW CAN WE ENSURE THAT WE
HAVE YOUTH WHO ARE INCLUDED INTO
THOSE GROUPS IN SPACES? THANKS
VERY MUCH. WE'VE ACTUALLY BEEN
WORKING EVEN BEFORE WE SELECTED
MATHEMATICA THROUGH A
COMPETITIVE RFP. WE HAD BEEN
CONDUCTING A SERIES OF FOCUS
GROUPS SPECIFICALLY WITH YOUTH
AROUND THE STATE AS WELL AS
COMMUNITIES, FAMILIES AND OUR
PARTNERS WITH PROFESSIONAL
EXPERIENCE. TO INFORM WHAT
SHOULD BE THE FIVE YEAR OUTCOME.
SCHOOLS FOR THE C B H I SO WE'VE
ACTUALLY GATHERED QUITE A BIT OF
INPUT DIRECTLY FROM YOUTH
ALREADY AND FAMILIES IN TERMS OF
WHAT THOSE OUTCOMES SCHOOLS
SHOULD BE. SO BEFORE WE EVEN
HIRED MATHEMATICAL. WE HAD A
DRAFT SET OF OUTCOMES SCHOOLS
AND THEN WE'RE WORKING WITH THEM
TO REFINE THOSE AND THEY HAVE
BEEN BOTH MEETING WITH. WE HAVE
AN EQUITY WORKING GROUP FOR THE
C Y B H I. THERE'S A DATA
COMMITTEE THEY'VE BEEN MEETING
WITH TO HELP INFORM THAT
PARTICULARLY FROM AN EQUITY
PERSPECTIVE. AND THEN, AS I
MENTIONED, WE'RE FORMING A C Y B
H I EVALUATION ADVISORY GROUP
THAT WILL BE MADE UP OF YOUTH,
PARENTS AND FAMILIES,
RESEARCHERS, FRONTLINE
CLINICIANS AND LOCAL SYSTEMS
LEADERS SO THAT GROUP WILL ALSO
BE HELPING TO INFORM THE
FINALIZATION OF THOSE OUTCOMES
SCHOOLS. I'M GOING TO STICK WITH
THIS THEME IF I CAN YOU HAVE
MENTIONED WORK GROUP ASSOCIATED
WITH COORDINATING UM, MENTAL
HEALTH STUDENT SERVICES ACT AS
WELL AS COMMUNITY SCHOOLS AND
THAT THERE WERE 60 PEOPLE IN THE
WORK GROUP I HEARD ELIA'S K¾T
BHD IS MEDICAL MANAGED CARE
PLANS, BUT AGAIN, I DIDN'T HEAR
YOUTH AND I WANT TO BE
INTENTIONAL TO ASK TO MAKE SURE
OUT OF THOSE 60 PEOPLE THAT WERE
HAVING SPACE FOR THE YOUTH AS
WELL. WE ARE SO THAT THE 60
PERSON WORKGROUP IS THE
IMPLEMENTATION PARTNERS GROUP
FOR THE HIV SCHEDULE.
SPECIFICALLY HOWEVER, WE DID, UM
AND CONTINUE TO ENGAGE WITH
YOUTH IN A VARIETY OF SETTINGS
TO GET INPUT ON THE DESIGN OF
THE FEE SCHEDULE IN TERMS OF
WHAT SERVICES KIDS WANT TO HAVE
ACCESSIBLE ON SCHOOL CAMPUSES.
WE DID, UM, SOME LISTENING
SESSIONS, SESSIONS AND FOCUS
GROUPS. LAST YEAR. WE ALSO
ENGAGED WITH A YOUTH ADVISORY
BOARD. UM THROUGH SOME OF THE
STATEWIDE YOUTH SERVING
ORGANIZATIONS SUCH AS THE
CALIFORNIA COALITION FOR YOUTH
AND THE CALIFORNIA YOUTH ACTION
NETWORK TO BE ABLE TO INFORMS
THIS WORK THAT WE'RE DOING, AND
WE HAVE MEMBERS FROM THOSE
ORGANIZATIONS THAT PARTICIPATE
IN THAT WORKERS AS WELL. SO
WE'RE TRYING TO ENGAGE YOUTH ON
ALL FRONTS ACROSS THE BOARD, UM
AND REALLY HAVE YOU KNOW, SPEND
SOME TIME THINKING ABOUT HOW WE
MAKE SURE THAT WE BUILD YOUTH
ENGAGEMENT NOT ONLY INTO OUR
WORK GROUPS, BUT ALSO INTO OUR
CONTRACTS IN TERMS OF THE
REQUIREMENTS OF OUR PARTNERS AND
VENDORS AS WELL. UM, AND FOR
EXAMPLE, IT'S THERE'S A
REQUIREMENT IN OUR VIRTUAL
SERVICES PLATFORM CONTRACT THAT
THERE'S A YOUTH ADVISORY
COMPONENT TO THAT AS WELL. SO
REALLY TRYING TO BUILD THAT IN
STRUCTURALLY INTO THE WORK THAT
WE'RE DOING. FINAL COMMENT. IF I
CAN ELEVATE, I BELIEVE BOTH
YOUTH SPOKE ABOUT HOW HARD IT
WAS FOR US TO ACCESS CARE, AND
AS WE'RE INCREASING ACCESS
ACROSS THE STATE, WE'RE GOING TO
HAVE MORE AND MORE WORKFORCE
CHALLENGES, AND SO AS THE AGENDA
LATER, WE'LL DISCUSS WORKFORCE
PROPOSALS. I WANT US TO GROUND
OURSELVES IN THE COMMENTS THAT
WE HEARD FROM THE YOUTH ABOUT
MAKING INVESTMENTS INTO THAT
SPACE AS WELL. WITH THAT I WILL
AGAIN APPRECIATE MISS LIU AND
MISS POLES AND THIS ENTIRE PANEL
AND WE WILL NOW MOVE ON TO ISSUE
THREE. THANK YOU. ISSUE THREES
ON THE C Y B H I V APPROPRIATION
INCLUDED IN THE SPRING FINANCE
LETTER, DEPARTMENT OF FINANCE
WILL PRESENT THIS PROPOSAL.
PLEASE BEGIN. DEPARTMENTAL
DEPARTMENT OF FINANCE. NINA HONG
UM HMM. WITHIN THE LARGER C Y B
H I INITIATIVE. KELLY TEACH
AGENCY WAS ALLOCATED 50 MILLION
GENERAL FUND OVER FIVE YEARS IN
21 22 TO SUPPORT CROSS
DEPARTMENTAL COORDINATION,
PROCURE SUBJECT MATTER EXPERTISE
AND ACQUIRE TECHNICAL TOOLS,
ENGAGE STAKEHOLDERS AND LOCAL
IMPLEMENTER AND SUPPORT
INITIATIVE WIDE, COMPREHENSIVE
MULTI YEAR EVALUATION TO
IDENTIFY BEST PRACTICES AND
INFORM FUTURE POLICY AND PROGRAM
WORK. KELLY DHS IS REQUESTING TO
RE APPROPRIATE 8.8 MILLION
GENERAL FUND FROM 21 22
ALLOCATED AMOUNTS TO BE
AVAILABLE TO EXPAND UNTIL JUNE.
30 2025 LEO RYAN MILLER. ELIO.
WE HAVE NOT RAISED CONCERNS WITH
THIS PROPOSAL. BRING IT UP TO
THE DIOCESE. SEE IF THERE'S ANY
MEMBERS QUESTIONS SEEING NONE. I
WILL THANK THIS PANEL AND WE
WILL MOVE ON TO ISSUE FOR. ISSUE
FOR US ON THE CHILDREN'S
PSYCHIATRIC RESIDENTIAL
TREATMENT FACILITIES. A B 23 17
TRAILER BILL, WE HAVE THE HCS
DIRECTOR MICHELLE BOSS TO
PRESENT THIS ISSUE WELCOME AND
PLEASE BEGIN. GOOD AFTERNOON, MR
CHAIR MEMBERS, UH, MICHELLE BOSS
, DIRECTOR OF THE DEPARTMENT OF
HEALTH CARE SERVICES, A B 23 17
WAS PASSED IN 2022 ESTABLISHES
THE PSYCHIATRIC RESIDENTIAL
TREATMENT FACILITIES AS A NEW
CATEGORY OF HEALTH FACILITIES
LICENSED BY THE DEPARTMENT.
PSYCHIATRIC RESIDENTIAL
TREATMENT FACILITIES, DEFINED AS
A LICENSED HEALTH FACILITY
OPERATED BY A PUBLIC AGENCY OR
PRIVATE ORGANIZATION WITH A
PROVIDER AGREEMENT WITH A STATE
MEDICAID AGENCY. A B 23 17 ALSO
REQUIRES THE DEPARTMENT IN
COLLABORATION WITH STAKEHOLDERS
TO ESTABLISH REGULATIONS AND
CERTIFICATIONS CONSISTENT WITH
MEDICARE AND MEDICAID
REGULATIONS TO MAXIMIZE FEDERAL
PARTICIPATION. THE TRAILER BILL
IS THE PROPOSED TRAILER BUILD
LANGUAGE IS MEANT TO CLEAN UP
STATUTE GOVERNING THE
PSYCHIATRIC RESIDENTIAL
TREATMENT FACILITIES TO ALIGN
WITH FEDERAL LAW AND MAKE OTHER
TECHNICAL CHANGES. THE CURRENT
LANGUAGE IS IN CONFLICT WITH
FEDERAL REQUIREMENTS AND PUTS
THE DEPARTMENT AT RISK OF LOSING
FEDERAL MEDICAID DOLLARS DUE TO
NONCOMPLIANCE. ADDITIONALLY THE
TRAILER BILL LANGUAGE PROPOSES
TO ALIGN THE COMPOSITION AND
CREDENTIALS OF THE
INTERDISCIPLINARY TEAM MEMBERS
WITH FEDERAL REGULATIONS AND CMS
REQUIREMENTS. SPECIFICALLY THE
CURRENT LANGUAGE ALLOWS FOR A
REGISTERED NURSE OR A LICENSED
VOCATIONAL NURSE TO SERVE ON THE
INTERDISCIPLINARY TEAM. HOWEVER
A LICENSED VOCATIONAL NURSE DOES
NOT MEET THE SAME EDUCATIONAL
REQUIREMENTS AS AN RN, INCLUDING
, UM, AN L V N IN LIEU OF
UNREGISTERED NURSE WOULD NOT
MEET THE FEDERAL CHOIR MINTS.
ADDITIONALLY FEDERAL
REQUIREMENTS REQUIRE MINIMUM
STAFFING THAT INCLUDES A MASTER
LEVEL PSYCHOLOGIST THAT IS
DISTINCT FROM CALIFORNIA'S
DEFINITION OF THE MENTAL HEALTH
PROFESSIONAL. THE DEPARTMENT
PROVIDED A WALKTHROUGH OF THIS
LANGUAGE WITH US LEGISLATIVE
LEADERSHIP. ASSEMBLYMEMBER'S
RAMOS IS OFFICE AND OTHER
LEGISLATIVE STAFF. OUR NEXT
SPEAKER IS CHRISTINE STONER
MERTZ, CHIEF EXECUTIVE OFFICER
OF THE CALIFORNIA ALLIANCE.
CALIFORNIA ALLIANCE OF CHILD AND
FAMILY SERVICES. THANK YOU GOOD
AFTERNOON CHAIR AMBULANCE
MEMBERS OF THE BUDGET
SUBCOMMITTEE. CHRISTINE STONER
MERTZ, CEO OF THE CALIFORNIA
ALLIANCE, SHELDON FAMILY
SERVICES REPRESENTING 116,
NATIONALLY ACCREDITED COMMUNITY
BASED ORGANIZATIONS, PROVIDING
SERVICES TO CHILDREN, YOUTH AND
FAMILIES IN CALIFORNIA. THE
CALIFORNIA ALLIANCE WAS A PROUD
SPONSOR OF ASSEMBLY BILL 23 17,
AUTHORED BY ASSEMBLYMEMBER'S
RAMOS. WE WERE SEEING THE
IMPACTS OF NOT HAVING THIS LEVEL
OF CARE ALL AROUND US AND
CONTINUE TO SEE THAT MEDICAL
YOUTH BEING UNNECESSARILY
HOSPITALIZED AND THAT RECEIVING
LIFE SAVING ONGOING MENTAL
HEALTH SERVICES ARE PARTNERS OF
THE CALIFORNIA CHILDREN'S
HOSPITALS HAVE ALARMING DATA
ABOUT YOUTH AND THEIR EMERGENCY
ROOMS IN PSYCHIATRIC CRISIS. AND
THESE ARE NOT THE RIGHT PLACES.
FOR MANY OF THESE YOUTH WHO
COULD BE BETTER SERVED IN THEIR
COMMUNITIES AND IN AN
ENVIRONMENT STAFFED WITH MENTAL
HEALTH PROFESSIONALS. MAYBE 23
17 FILLS A LIFESAVING GAP FOR
YOUTH IN CRISIS AND WE ARE
GRATEFUL. EXCUSE ME TO THE END
MINISTRATIONS FOR ALL OF THE
SUPPORT TO GET THIS FAR. WE DO
FEEL THAT IN ORDER TO FULFILL
THE PROMISE OF A B 23 17 AND
ENSURE THAT THERE IS AN
INTERDISCIPLINARY TEAM THAT
REFLECTS THE REALITY OF
CALIFORNIA'S MEDICAL PROGRAM. WE
MUST LOOK AT, UM THE CHANGES
THAT ARE BEING SUGGESTED IN TBL
IN TRAILER BUILD LANGUAGE. WE
MUST CONSIDER WHO'S WORKING
WITHIN OUR CURRENT SPECIALTY
MENTAL HEALTH SYSTEM NOW, WHICH
INCLUDES MASTERS LEVEL
CLINICIANS. WE HAVE SEVERE
WORKFORCE SHORTAGES AND ARE AT A
CRISIS POINT BY DELETING SOME OF
THE PROPOSED TEAM MEMBERS FROM
THE ORIGINAL LANGUAGE, INCLUDING
MASTERS LEVEL THERAPISTS. WE
BELIEVE THAT OUR PROVIDERS WILL
HAVE A VERY DIFFICULT IF NOT
IMPOSSIBLE, TIME STANDING UP
MANY OF THESE PROGRAMS ANY OF
THESE PROGRAMS IN CALIFORNIA WE
BELIEVE THAT WITH SOME MODEST
AMENDMENTS, WE WILL MAINTAIN THE
INTEGRITY OF THESE PROGRAMS,
PROVIDE HIGH QUALITY SERVICES
AND BE ABLE TO STAFF THE
PROGRAMS AND STAND THEM UP IN
CALIFORNIA ARE RECOMMENDATIONS
INCLUDE INCLUSION OF THE OPTION
FOR A MENTAL HEALTH PROFESSIONAL
WHO HAS A MASTER'S OR DOCTORATE
DEGREE IN PSYCHOLOGY, MARRIAGE
AND FAMILY THERAPY, SOCIAL WORK
OR COUNSELING AND WHO HAS BEEN
LICENSED, REGISTERED OR WAIVED
BY THE STATE. INCLUSION OF
LICENSED VOCATIONAL NURSE NURSES
, IN ADDITION TO REGISTERED
NURSES. INCLUDE THE OPTION FOR A
NURSE PRACTITIONER AS ONE OF THE
STAFF, UM AND ENSURE THAT WE'RE
ALIGNED ALIGNING THESE
REGULATIONS AND CAL AIM
DOCUMENTATION REFORM. FOR
EXAMPLE, AROUND THE REQUIREMENT
OF AN INDIVIDUAL PLAN OF CARE.
WE VERY MUCH APPRECIATE THE
SUBCOMMITTEE'S OVERSIGHT OF THIS
ISSUE. WE THINK ASSEMBLYMEMBER'S
RAMOS FOR HIS AUTHORSHIP OF THIS
BILL AND CONTINUED COMMITMENT TO
CHILDREN'S MENTAL HEALTH, AND WE
LOOK FORWARD TO A POSITIVE
OUTCOMES SO THAT WE CAN STAND UP
CRISIS CHILDREN'S CRISIS
RESIDENTIAL PROGRAMS. DEPARTMENT
OF FINANCE. NATE WILLIAMS, THE
DEPARTMENT OF FINANCE JUST WANT
TO AGREE WITH THE DEPARTMENT'S
ASSESSMENT THAT THIS, UM TRAILER
BELLS SHOULD BE, UM, GOING
THROUGH THE TRAILER BILL
PROCESS. IT'S AN APPROPRIATE
AVENUE. UM IN THAT IT, UM IT IS
TIED TO BUDGET CHANGE PROPOSAL
AS WELL AS IT AFFECTS ITS
CHANGING LANGUAGE THAT COULD
AFFECT FEDERAL FUNDING. JULIO,
NO CONCERNS. BRING IT UP TO THE
DIOCESE FOR ANY MEMBERS,
QUESTIONS ASSEMBLYMEMBER'S RAMOS
THANK YOU, MR CHAIR AND GET INTO
SOME OF THE DISCUSSION AND
RECOMMENDATIONS. UM WOULD, UH.
IS THERE AN OPTION OR IS THEIR
WILLINGNESS TO LOOK AT SOME OF
THE AMENDMENTS THAT HAVE BEEN
DISCUSSED HERE TO TRY TO, UM
MAYBE. ADD IN THERE, THE HEALTH
PROFESSIONAL AND THE DIFFERENT
COMPONENTS THAT ARE THERE
WITHOUT JEOPARDIZING FEDERAL
FUNDING. THIS WHOLE BILL WAS SET
TO, UM MAKE SURE THAT
DEFINITIONS UM WERE IN SYNC HERE
AT THE STATE OF CALIFORNIA AND
THE FEDERAL GOVERNMENT SO WE
COULD USE UM, THAT FUNDING FOR
PSYCHIATRIC RESIDENTIAL
TREATMENT CENTERS. AND SO IT WAS
A LONG PROCESS TO GET TO THAT
POINT. UM, WE WORKED WITH THE
ADMINISTRATION ON SEVERAL
AMENDMENTS TO TRY TO, UH, ADAPT
AND TO MAKE SURE THAT IT DID
MEET ALL THOSE, UM, CRITERIA
THAT WAS IN FRONT OF US. WE DID
GET IT THROUGH THE LEGISLATURE.
IT WASN'T EASY, BUT WE GOT IT
THROUGH, UM, WAS SIGNED INTO
LAW. AND NOW UNDERSTANDING THAT
THERE COULD BE SOME COMPONENTS
THAT COULD JEOPARDIZE SOME OF
THE FUNNY BUT IS THERE UM
WILLINGNESS TO LOOK AT SOME OF
THESE DIFFERENT CLASSIFICATIONS
OF THE WORKFORCE BECAUSE OF THE
WORKFORCE IS THAT ARE ACTUALLY
AVAILABLE IN THE STATE OF
CALIFORNIA VERSUS OTHER STATES
IN THE NATION AND WE WOULD BE
WILLING TO WORK WITH YOU ON SOME
OF THAT LANGUAGE TO ENSURE AS
CLOSE AS WE CAN GET TO THAT TO
ENSURE WITHOUT JEOPARDIZING
FUNDING FOR IT, BECAUSE WE DO
KNOW THAT THIS NEEDS TO MOVE
FORWARD. WE DID WORK HARD ON IT
AS IT'S ATTESTED TO THE
ADMINISTRATION TO THE
LEGISLATURE AND THE BODY, BOTH
HOUSES WE GOT IT THROUGH. UM,
BUT I THINK NOW COMING FORWARD
WITHIN THE TRAILER BILL. AND
SETTING OUT THE PARAMETERS. BUT
NOW, I GUESS IS THEIR
WILLINGNESS TO WORK WITH MY
OFFICE AND SOME OF THE
RECOMMENDATIONS TO SEE IF
THERE'S A WAY WE COULD EVEN FIND
TUNE IT A LITTLE BIT BETTER
COURSE WE'RE WILLING TO CONTINUE
TO WORK ON THIS JUST I MEAN, OUR
GUIDE POST REALLY IS MEETING THE
FEDERAL REQUIREMENTS BECAUSE WE
DO NOT WANT TO SEPARATE
JEOPARDIZE THE FEDERAL THE
FEDERAL DOLLARS AND SO ALSO
DOING AN ASSESSMENT OF MAYBE
WITH SOME OF THE OTHER STATES
HOW THEY IMPLEMENT THIS. WE'RE
WILLING TO KIND OF ENGAGE AND
CONTINUE THOSE THOSE
DISCUSSIONS. WE DID FLAG THIS
ISSUE BACK IN AUGUST FOR
LEGISLATIVE STAFF. THAT THERE
WAS SOME CONFLICT HERE THAT BUT
WE AGREED THAT WE WOULD MOVE THE
BILL SO THAT WE CAN CONTINUE TO
WORK ON THIS BECAUSE THERE WAS A
LOT OF EFFORT OVER THE SUMMER
MONTHS IN TERMS OF NEGOTIATING
ON THIS BILL, SO I CONTINUE TO
REMAIN COMMITTED TO ENGAGING ON
THE ON THE KIND OF THE
DEFINITION. BUT DO YOU WANT TO
FLAG THAT OUR GUIDE POST IS TO
ENSURE THAT WE GET F F P AND WE
KNOW THAT WE DO NEED NEED THIS
IN THE STATE OF CARVE. I
REMEMBER RIGHT OFF OF MEMORY.
THERE WAS ONLY TWO COUNTIES THAT
EVEN UM WE'RE ABLE TO HAVE ANY
TYPE OF SERVICES AMOUNT OF 58
COUNTIES IN THE STATE OF
CALIFORNIA. SO I GUESS THAT, UM
HOW? HOW BROAD AND HOW NARROW IS
THAT DEFINITION? I THINK JUST
TAKING OFF ONE OF THE
RECOMMENDATIONS HERE, INCLUSION
OF THE OPTION FOR A MENTAL
HEALTH PROFESSIONAL WHO HAS A
MASTER'S OR DOCTORATE DEGREE IN
PSYCHOLOGY. JUST THAT IS THERE.
IS THERE AN OPPORTUNITY WITHIN
THE FEDERAL GUIDELINES TO BE
ABLE TO ADD SOME OF THAT, OR I'D
BE HAPPY TO READ THE FEDERAL
REGULATIONS. THE TEAM MUST ALSO
INCLUDE ONE OF THE FOLLOWING A
PSYCHIATRIC SOCIAL WORKER ARE
REGISTERED NURSE WITH
SPECIALIZED TRAINING IN ONE
SPECIALIZED TRAINING OR ONE
YEARS EXPERIENCE IN TREATING
MENTALLY ILL INDIVIDUALS AND
OCCUPATIONAL THERAPIST WHO IS
LICENSED IF REQUIRED BY THE
STATE AND WAS SPECIALIZED
TRAINING OR ONE YEAR OF
EXPERIENCE IN TREATING MENTALLY
ILL INDIVIDUALS. A PSYCHOLOGIST
HAS A MASTER'S DEGREE IN
CLINICAL PSYCHOLOGY OR HAS BEEN
CERTIFIED BY THE STATE OR BY THE
STATE PSYCHOLOGICAL ASSOCIATION.
SO THAT'S THE FEDERAL DEFINITION
OF WHAT MUST BE INCLUDED IN
INTERDISCIPLINARY TEAM, AND IT'S
A FEDERAL DEFINITION THAT
BLANKETS ALL THE STATES IN THE
NATION. WHICH SOME OF THE THOSE
IN THE WORKFORCE DON'T GO BUY
SOME OF THOSE CATEGORIES HERE IN
CALIFORNIA. THAT WAS THE WHOLE
PURPOSE OF THE BILL. BUT WE DO
KNOW THAT THINGS HAVE TO MOVE
FORWARD. SO WE WOULD TRY TO, UM
OPEN AS MUCH AS WE CAN TO SOME
OF THESE DIFFERENT COMPONENTS.
ENSURE THAT THAT THERE'S A
WORKFORCE THAT'S PART OF THE
INFRASTRUCTURE THAT COULD MEET
THE CHALLENGE COMING FORWARD
WITHOUT HAVING TO GO BACK. AND
REESTABLISH, UM, DIFFERENT, UH,
DEGREES DIFFERENT, UH, AREAS TO
MOVE FORWARD WITH A NEW
WORKFORCE THAT THEY WOULD DELAY
THE WHOLE IMPLEMENTATION OF IT.
I THINK WE'RE ALL ON THE SAME
PAGE. WE WORKED WITH THE
ADMINISTRATION. WE WORKED WITH
OUR OUR SPONSORS TO ENSURE THAT
THERE IS, UM SOMETHING MOVING
FORWARD WITHIN THE PSYCHO
PSYCHIATRIC RESIDENTIAL
TREATMENT CENTER, AND WE DID DO
A LOT OF AMENDMENTS TO TRY TO
CURB SOME OF THESE THINGS. UM
BUT, UM, IF WE CAN TRY TO SEE IF
THERE IS SOME OF THE
RECOMMENDATIONS THAT HE THAT ARE
HERE WITHOUT JEOPARDIZING THE
FEDERAL FUNDING, BECAUSE. THE
ONLY WAY THAT I UNDERSTAND IT IF
WE GO OUTSIDE OF THE FEDERAL
FUNDING DEFINITION, THEN IT
WOULD BE THE STATE OF CALIFORNIA
THAT WOULD HAVE TO FUND THOSE
PROGRAMS. IS THAT CORRECT? YES
YES, THAT'S CORRECT. IT WOULD BE
GENERAL FUND. AT THIS POINT,
WE'RE MOVING FORWARD ON THE
FEDERAL FUNDING THE FEDERAL FLOW
THROUGH ON THE MONEY COMING
FORWARD. ALL RIGHT. WELL, LET'S
LET'S SEE IF WE CAN'T GET
CREATIVE AND SEE IF THERE IS A
WAY. WITHOUT JEOPARDIZING THAT
WE WOULD DEFINITELY BE ENGAGED
AND WANT TO BE PART OF THAT
DISCUSSION. GREAT. THANK YOU. MR
CHAIR. I'LL BRING IT BACK IF I
CAN AND NOT REALLY A QUESTION AS
MUCH AS I WOULD APPRECIATE A
FOLLOW UP AND TRACKING WITH
ASSEMBLYMEMBER'S RAMOS REGARDING
WHAT OTHER STATES ARE DOING. I'D
LIKE TO UNDERSTAND IF THEY'VE
STOOD UP THESE PSYCHIATRIC
RESIDENTIAL TREATMENT FACILITIES
. ARE THEY FOLLOWING ALL OF THE
REGULATIONS? IN THE LAW IN EVERY
STATE, OR IS THERE ANY
FLEXIBILITY AND WE CAN TALK
ABOUT THAT OFFLINE BUT JUST
WANTED TO MAKE SURE TO RECEIVE
THAT INFORMATION FROM THE
ADMINISTRATION? WITH THAT WE
WILL THANK VERY MUCH. CHANNEL
FOUR AND MOVE ON TO ISSUE FIVE.
THE FOCUS OF THESE NEXT TWO
ISSUES IS ON SUICIDE PREVENTION.
BEGINNING WITH ISSUE FIVE, WHICH
IS AN OVERSIGHT ISSUE. OUR FIRST
SPEAKER IS LEASH ON FRANCIS,
SENIOR DIRECTOR OF BEHAVIORAL
HEALTH. WITH CHILDREN NOW. IF.
YEAH, I KNOW. PLEASE BEGIN WHEN
YOU'RE READY. THANK YOU. I THINK
I'M LASHAWN FRANCIS. LAST TIME I
CHECKED. THANK YOU. CHAIR
MEMBERS FOR HAVING ME TODAY. MY
NAME IS LASHAWN FRANCIS. I'M
WITH CHILDREN NOW. I'M GOING TO
SPEND SOME TIME TALKING TO YOU
TODAY ABOUT SUICIDALITY AND ITS
RELATIONSHIP WITH SOCIAL MEDIA.
THAT'S GOING TO BE THE CRUX OF
MY COMMENTS, BUT FIRST, LET'S
JUST LEVEL SET. OVERALL THE
NUMBER OF SUICIDES IN CALIFORNIA
HAVE DECREASED IN 2020 IN
PARTICULAR, BUT RATES OF
SUICIDES FOR CERTAIN SUBGROUPS.
AND INCREASED AND I THINK WE CAN
SAFELY CORRELATE THAT IN 2020.
BECAUSE OF EVERYTHING THAT WAS
HAPPENING IN THE WORLD. THAT IS
A LARGE REASON WHY WE SAW THAT
INCREASE SPECIFICALLY THOSE WHO
WERE AGES WITH 10 TO 18 THAT
SUBGROUP INCREASED BLACK AND
LATIN X YOUTH. SPECIFICALLY
BLACK YOUTH SUICIDE RATE HAS
DOUBLED SINCE 2014 SO NOT REALLY
SINCE 2020. BUT SINCE 2014 AND
THEN FEMALE YOUTH. THAT GROUP
ALSO INCREASED IN 2020.
TRADITIONALLY WE'VE ACTUALLY
SEEN MORE SUICIDE ATTEMPTS AMONG
FEMALE SUBGROUP, BUT MORE DEATHS
BY SUICIDE AMONG THE MALE YOUTH
. AND WHILE THAT TREND IS
GENERALLY TRUE, THERE'S BEEN AN
INCREASE IN DEATH BY SUICIDE
AMONG FEMALE YOUTH. AS AN ASIDE
THE USE OF FIREARMS AS A
MECHANISM FOR SUICIDE INCREASED
IN 2020. ONE THING THAT'S NOT
TALKED ABOUT OFTEN IS THE RATE
OF SUICIDALITY AMONG OUR RURAL
YOUTH. NATIONALLY THE RATE OF
SUICIDE AMONG RURAL YOUTH AGES
15 AND 19 IS 54% HIGHER THAN
THAT OF YOUTH AND URBAN AREAS.
GIVEN THE INCREASE OF ISOLATION
WITHIN THE PANDEMIC, WE REALLY
DO NEED TO LOOK MORE CLOSELY AT
OUR RURAL YOUTH AND HOW THEY'RE
DOING SINCE 2020 SUICIDE RELATED
BEHAVIORS COMPLICATED AND RARELY
THE RESULT OF A SINGLE SOURCE OF
TRAUMA OR STRESS YOUTH WHO ARE
AT RISK FOR INCREASED YOUTH WHO
ARE AT INCREASED RISK FOR
SUICIDE RELATED BEHAVIOR ARE
DEALING WITH A COMPLEX
INTERACTION OF MULTIPLE
RELATIONSHIP PEER FAMILY OR
ROMANTIC MENTAL HEALTH AND
SCHOOL STRESSORS. I WANT TO BE
CLEAR THAT WHILE SEVERAL SURVEYS
HAVE EXAMINED THE RELATIONSHIP
BETWEEN YOUNG PEOPLE AND SOCIAL
MEDIA AS IT PERTAINS TO THEIR
MENTAL HEALTH THERE ISN'T ENOUGH
EVIDENCE TO STATE THAT SOCIAL
MEDIA IS THE CAUSE OF
SUICIDALITY. HOWEVER WHAT IS
CLEAR IS THAT YOUNG PEOPLE ARE
REPORTING THAT SOCIAL MEDIA IS
THE MAIN REASON THEIR MENTAL
HEALTH IS GETTING WORSE, LIKE
INCREASING ANXIETY AND
DEPRESSION. RESEARCH SUGGESTS
THAT YOUNG PEOPLE WHO ARE HEAVY
USERS OF SOCIAL MEDIA SPENDING
MORE THAN TWO HOURS PER DAY ON
SOCIAL NETWORKING SITES LIKE
FACEBOOK, TWITTER OR INSTAGRAM,
OR MORE LIKELY TO REPORT POOR
MENTAL HEALTH, INCLUDING
PSYCHOLOGICAL DISTRESS,
PSYCHOLOGICAL DISTRESS LIKE
ANXIETY AND DEPRESSION.
ESSENTIALLY YOU'VE GOT THE FOMO
RIGHT HERE. YOU CONSTANTLY
SEEING FRIENDS ON HOLIDAY OR
ENJOYING NIGHTS OUT? THEY ARE
FEELING LIKE THEY'RE MISSING OUT
AND THEY'RE NOT ENJOYING LIFE
RIGHT? SO THAT IS PROMOTING THIS
COMPARE AND DESPAIR, ATTITUDE
AND YOUNG PEOPLE, AND THEY MIGHT
BE VIEWING IMAGES THAT ARE
HEAVILY PHOTOSHOPPED AND AS
YOUNG FOLKS WHO ARE GOING
THROUGH CHANGES WITH THEIR BODY
AND WITH THEIR SELF ESTEEM. THAT
CAN REALLY IMPACT THEM IN WAYS
THAT DON'T IMPACT ADULTS.
SPECIFICALLY WE'RE SEEING THAT
GIRLS WHO USE SOCIAL MEDIA
HEAVILY ARE 2 TO 3 TIMES MORE
LIKELY TO BE DEPRESSED. ONE
SURVEY THAT WAS DONE IN THE UK
REVEALED THAT INSTAGRAM IS
ACTUALLY THE WORST SOCIAL MEDIA
NETWORK FOR MENTAL HEALTH AND
WEALTH AND WELL BEING FOR YOUNG
ADULTS, WHILE THE PHOTO BASED
PLATFORM GOT POINTS FOR SELF
EXPRESSION AND SELF IDENTITY, IT
WAS ASSOCIATED WITH HIGH LEVELS
OF ANXIETY, DEPRESSION AND
BULLYING. WHAT'S INTERESTING TO
ME IS OUT OF THE FIVE SOCIAL
NETWORKS THAT WERE INCLUDED IN
THAT SURVEY. YOUTUBE ACTUALLY
RECEIVED THE HIGHEST MARKS FOR
HELP AND WELL BEING, AND IT WAS
THE ONLY SITE THAT RECEIVED A
NET POSITIVE SCORE BY
RESPONDENTS. TWITTER CAME IN
SECOND, WHICH IS MY PERSONAL
FAVORITE, FOLLOWED BY FACEBOOK
AND THEN SNAPCHAT AND THEN
INSTAGRAM DEAD LAST ANOTHER
INDICATOR RELATED TO SOCIAL
MEDIA IS SLEEP. WE KNOW THAT
STUDIES HAVE SHOWN THAT
INCREASED SOCIAL MEDIA USE HAVE
HAS A SIGNIFICANT ASSOCIATION
WITH POOR SLEEP QUALITY AND
YOUNG PEOPLE. USING SOCIAL MEDIA
ON PHONES, LAPTOPS AND TABLETS
AT NIGHT BEFORE BED HAS BEEN
LINKED WITH POOR QUALITY OF
SLEEP EVEN MORE SO THAN REGULAR
DAYTIME USE OF SOCIAL MEDIA. AS
YOU KNOW, SLEEPING MENTAL HEALTH
ARE TIGHTLY LINKED. POOR MENTAL
HEALTH CAN LEAD TO POOR SLEEP
AND POOR SLEEP CAN LEAD TO
STATES OF POOR MENTAL HEALTH,
AND THIS IS PARTICULARLY
IMPORTANT FOR TEENS WHO ARE
GOING THROUGH KEY STAGES OF
BRAIN DEVELOPMENT AT THAT TIME.
ONE IN FIVE YOUNG PEOPLE IN THAT
SURVEY SAID THAT THEY WOKE UP
DURING THE NIGHT TO CHECK
MESSAGES ON SOCIAL MEDIA. I ALSO
WANT TO SPEND A FEW MINUTES
TALKING ABOUT CYBERBULLYING.
THIS COMES UP A LOT. WHEN I TALK
, PEOPLE ASK ME WHAT'S THE
DIFFERENCE? WE GOT BULLIED WHEN
WE WERE KIDS, AND WE WERE FINE.
WHY ARE WE MAKING SUCH A BIG
DEAL OUT OF CYBERBULLYING? DON'T
KIDS JUST NEED TO TOUGHEN UP.
THAT IS MY FAVORITE QUESTION.
THE REALITY IS CYBERBULLYING IS
ACTUALLY AN EASIER WAY TO BULLY
BECAUSE, UNLIKE TRADITIONAL
BULLYING, IT DOESN'T INVOLVE
FACE TO FACE INTERACTION. TEENS
CAN BECOME DESENSITIZED TO A
COMPUTER SCREEN AND SAY OR DO
THINGS THEY WOULDN'T DO IN A
PERSON'S FACE. THE COMPUTER
DESENSITIZE IS TEENS AND
DECREASES THE LEVEL OF EMPATHY
THEY FEEL TOWARD THE VICTIM.
PLUS WHEN THEY CAN'T SEE THE
PERSON'S REACTION TO WHAT THEY
POST OR TEXT THEY MAY NOT EVEN
KNOW THAT THEY'VE GONE TOO FAR.
YOUTH WHO REPORT BOTH BULLYING
OTHERS AND BEING BULLIED.
BULLIED VICTIMS HAVE THE HIGHEST
RISK FOR SUICIDE RELATED
BEHAVIOR OF ANY GROUP THAT
REPORTS INVOLVEMENT IN BULLYING.
NEGATIVE OUTCOMES OF BULLYING
FOR YOUTHFULLY, OTHERS YOUTH WHO
ARE BULLIED AND YOUTH WHO WERE
BOTH BULLIED AND BULLIED. OTHERS
INCLUDE DEPRESSION, ANXIETY,
INVOLVEMENT IN INTERPERSONAL
VIOLENCE, SEXUAL VIOLENCE,
SUBSTANCE ABUSE, POOR, SOCIAL
FUNCTIONING. POOR SCHOOL
PERFORMANCE. LOW LOW GPS
STANDARDIZED TEST SCORES AND
POOR ATTENDANCE IN SCHOOLS. IN
SHORT, VERY BAD OUTCOMES ALL
AROUND FOR THOSE PARTICIPATING
IN BULLYING. ANY INVOLVEMENT
WITH BULLYING BEHAVIOR IS ONE
STRESSOR THAT MAY SIGNIFICANTLY
CONTRIBUTE TO THE FEELINGS OF
HELPLESSNESS AND HOPELESSNESS
THAT RAISED THE RISK OF SUICIDE.
SO THEN WHAT CAN WE DO? THERE
HAVE BEEN A NUMBER OF POLICY
SOLUTIONS FLOATED AROUND THAT WE
SHOULD ALL REALLY EXPLORE. SO TO
BE CLEAR. A LOT OF THESE
SOLUTIONS AREN'T LIVE, MEANING
WE HAVEN'T TRIED THEM, BUT
THINGS THAT HAVE BEEN DISCUSSED
WAS INTRODUCING THINGS LIKE A
POP UP HEAVY USAGE WARNING ON
SOCIAL MEDIA LIKE WE'RE WARNING
YOU THAT YOU'VE BEEN USING
SOCIAL MEDIA TODAY FOR MORE THAN
THREE HOURS. MAYBE IT'S TIME TO
GIVE YOURSELF A BREAK. UH UM
ANOTHER THING COULD BE WHEN THE
SOCIAL MEDIA PLATFORMS CAN
HIGHLIGHT WHEN PHOTOS HAVE BEEN
PHOTOSHOPPED OR DIGITALLY
MANIPULATED, SO PEOPLE KNOW. OH
SHE DOES NOT HAVE THE PERFECT
BODY AND YOU'RE JUST FINE. UM
AND THEN, HONESTLY, SAFE USE OF
SOCIAL MEDIA SHOULD BE TAUGHT IN
SCHOOLS. THAT'S SOMETHING THAT'S
LARGELY BEEN MISSING AND OUR
PUBLIC SCHOOL EDUCATION PROGRAM.
AND THEN MY PERSONAL FAVORITE
FAVORITE, REALLY DOING MORE
RESEARCH TO UNDERSTAND THE
EFFECTS OF SOCIAL MEDIA ON YOUNG
PEOPLE'S MENTAL HEALTH. THANK
YOU. NEXT WE HAVE SHARIS AND
WHISKEY VICE PRESIDENT OF CRISIS
CARE AT DD. HEARST MENTAL HEALTH
SERVICES, AFTERNOON CHAIR
ARAMBULA AND MEMBERS OF THE
COMMITTEE. I'M SHERRY SAND WELLS
G. VP OF CRISIS. CARROT DIDI
HIRSCH DD HURTS MENTAL HEALTH
SERVICES IS A PIONEER IN SUICIDE
PREVENTION AND CRISIS CARE FOR
ALL AGES AND HOME TO THE
NATION'S FIRST AND LARGEST
SUICIDE PREVENTION CENTER. WE
WERE PROUD TO BE SELECTED BY THE
DEPARTMENT OF HEALTH CARE
SERVICES TO BE THE STATEWIDE
LEADER FOR THE 12 988 CRISIS
CENTERS ACROSS CALIFORNIA. AS IT
WAS SAID SUICIDE IS A COMPLEX
PUBLIC HEALTH ISSUE THAT IS NOT
USUALLY THE RESULT OF ONE FACTOR
STRESSORS SUCH AS RELATIONSHIPS
, JOBS, SCHOOL OR FINANCIAL
ISSUES, AS WELL AS FACTORS SUCH
AS MENTAL ILLNESS, SUBSTANCE,
USE SOCIAL ISOLATE ISOLATION,
HISTORICAL TRAUMA. INEQUITIES
AND HEALTHCARE AND EASY ACCESS
TO LETHAL MEANS OF SUICIDE CAN
ALL CONTRIBUTE TO INCREASED RISK
. THE BOTTOM LINE IS THAT
SUICIDE IMPACTS EVERYONE. IN
FACT, ALMOST INEVITABLY, WHEN
SOMEONE TELLS ME ARE SOMEONE
SPEAKS TO ME ABOUT THE WORK,
THEY DO THAT I DO THEY TELL ME A
PERSONAL STORY ABOUT HOW SUICIDE
HAS IMPACTED THEM. LAST WEEK,
THE CDC RELEASED DATA
HIGHLIGHTING THAT THE OVERALL
SUICIDE RATE IN THE UNITED
STATES INCREASED BY 4.7% IN 2021
FROM 2020. IT ALSO SHOWED
INCREASED RATES OF SUICIDE AMONG
VARIOUS POPULATIONS,
SPECIFICALLY YOUTH COMMUNITIES
OF COLOR AND NATIVE AMERICANS.
AND WHILE THE OVERALL SUICIDE
RATE IN CALIFORNIA ONLY ROSE
SLIGHTLY TRENDS AMONG YOUTH
COMMUNITIES OF COLOR, AND NATIVE
AMERICANS ARE SIMILAR IN
CALIFORNIA TO THOSE SEEN
NATIONALLY. WHAT IS MORE
IMPORTANT TO REMEMBER WHEN
TALKING ABOUT TRENDS IS THAT
EACH ONE OF THESE NUMBERS IS A
HUMAN BEING. A LOVED ONE THAT
MATTERED. WE MUST CONTINUE TO
WORK TOGETHER TO HELP PEOPLE
CREATE LIVES THAT ARE WORTH
LIVING. WE MUST WORK TOGETHER TO
REDUCE THE LOSS OF LIFE AND
THOSE LEFT BEHIND TO GRIEVE.
SUICIDE PREVENTION IS A MENTAL
HEALTH CONCERN. SUICIDE
PREVENTION IS A PUBLIC HEALTH
CONCERN. SUICIDE PREVENTION IS
AN EDUCATIONAL CONCERN. SUICIDE
PREVENTION IS EVERYONE'S CONCERN
BECAUSE ANYONE CAN BE IMPACTED
BY SUICIDE. DON'T WE ALL WANT TO
CALIFORNIA, WHERE PEOPLE LIVE,
THRIVING, FULFILLING LIVES.
SUICIDE PREVENTION IS EVERYONE'S
BUSINESS AND SHOULD BE A CONCERN
FOR EVERY CALIFORNIAN. HIRSCH
RECOMMENDS THE FOLLOWING THINGS
THAT CAN BE DONE TO HELP INVOLVE
ALL CALIFORNIANS AND SUICIDE
PREVENTION. EDUCATE THE MEDIA ON
BEST PRACTICES WHEN REPORTING ON
SUICIDE. THIS INCLUDES NOT
GLAMORIZING STORIES OF SUICIDE
SHARING RESOURCES AND SHARING
STORIES OF HOPE AND HEALING. THE
PAPA GINO AFFECT SHOWS THAT
EXPOSURE TO POSITIVE EXAMPLES OF
PEOPLE WHO HAVE OVERCOME
SUICIDAL THOUGHTS OR CRISES CAN
PREVENT OR REDUCED SUICIDE
ATTEMPTS IN VULNERABLE
INDIVIDUALS. CONTINUE TO
DEDICATE FUNDING FOR PREVENTION
AND EARLY INTERVENTION. THE
OFFICE OF THE CALIFORNIA SURGEON
GENERAL HAS FOCUSED OUR
ATTENTION ON ADVERSE CHILDHOOD
EXPERIENCES AND THEIR IMPACT
OVER THE LIFESPAN, ACCORDING TO
THE CDC. HAVING ANY ADVERSE
CHILDHOOD EXPERIENCE IS
ASSOCIATED WITH AN INCREASED
RISK FOR SUICIDE, THE ODDS OF
EVER ATTEMPTING SUICIDE OR 30
TIMES HIGHER FOR ADULTS WITH
WITH FOUR OR MORE ADVERSE
CHILDHOOD EXPERIENCES. COMPARED
TO ADULTS WITH A NUN. CONTINUE
TO FUND MENTAL HEALTH
CURRICULUMS IN SCHOOLS FOR BOTH
STUDENTS AND STAFF. YOUNG PEOPLE
NEED TO BE JUST AS COMFORTABLE
COMMUNICATING WHEN THEY ARE IN
EMOTIONAL DISTRESS AS WHEN THEY
ARE EXPERIENCING A PHYSICAL
AILMENT. ADULTS NEED TO KNOW HOW
TO RESPOND TO THESE CONCERNS AS
EASILY AS THEY WOULD TO SYMPTOMS
OF A COMMON COLD. EVERYONE NEEDS
TO BE BETTER ABLE TO LISTEN.
WHEN SOMEONE IS IN DISTRESS. WE
TALKED ABOUT SCREENING EARLIER,
WHICH, OF COURSE I'M A PROPONENT
OF BUT WE HAVE TO BE CAREFUL
WITH SCREENING AS WELL AS WE
HEARD EARLIER. SOMETIMES PEOPLE
JUST SAY NO, BECAUSE THEY'RE
AFRAID OF THE IMPACT OF
ANSWERING SCREENING QUESTIONS,
SO WE REALLY NEED TO ALLOW
PEOPLE TO FEEL COMFORTABLE TO
TALK ABOUT HOW THEY'RE FEELING.
PARODY WITH PHYSICAL HEALTH CARE
AND MENTAL HEALTH CARE NOT JUST
IN REIMBURSEMENT RATES, WHICH
ARE IMPORTANT BUT IN TIMELY
ACCESS TO CARE WHEN NEEDED,
INCLUDING THE EXPANSION OF THE
988 CRISIS CARE CONTINUUM. AND
ENSURING THAT ALL SUICIDE
PREVENTION RESOURCES ARE CREATED
WITH A FOCUS ON DIVERSITY,
EQUITY AND INCLUSION SO THAT
EVERYONE HAS ACCESS TO SUPPORT
IN A WAY IN WHICH THEY NEED IT.
WE ARE EXCITED ABOUT THE
CREATION AND EXISTENCE OF A
STATEWIDE OFFICE OF SUICIDE
PREVENTION HOUSED WITHIN THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH. WE WOULD ENCOURAGE OUR
STATE LEADERS TO MAKE SURE IT
BECOMES A FOCAL HUB FOR
COORDINATING SUICIDE PREVENTION
EFFORTS IN OUR STATE WHILE STILL
IN ITS INFANCY, WE HOPE TO SEE
THE OFFICE OF SUICIDE PREVENTION
TAKE A LEADERSHIP ROLE TO HELP
COORDINATE SIMILAR NETWORKS
ACROSS THE STATE, BRINGING US
TOGETHER TO DISCUSS DISCUSS BEST
PRACTICES, GATHER RESOURCES AND
ENSURE THAT CALIFORNIA CONTINUES
TO BE A LATER AND LEADER IN THIS
SPACE. AND WE THINK
ASSEMBLYMEMBER'S RAMOS FOR
AUTHORING A B 21 12 CREATING THE
OFFICE OF SUICIDE PREVENTION. WE
VERY MUCH APPRECIATE THE
SUBCOMMITTEE'S OVERSIGHT OF THIS
ISSUE AND ARE GRATEFUL FOR YOUR
COMMITMENT TO SUICIDE PREVENTION
. THANK YOU FOR THE OPPORTUNITY
TO SPEAK FOR YOU TODAY, AND I'M
HAPPY TO ANSWER QUESTIONS. THANK
YOU. NEXT WE WILL HEAR FROM DR
TERRA LINDEN, PROFESSOR.
PSYCHIATRY EXECUTIVE DIRECTOR AT
UC DAVIS EARLY PSYCHOSIS
PROGRAM. OKAY THANK YOU. ALL SO
MUCH FOR YOUR TIME TODAY, SO AS
YOU MAY HAVE HEARD, I REPRESENT
ONE OF THE MANY EARLY PSYCHOSIS
PROGRAMS THAT EXIST IN
CALIFORNIA THAT ARE FUNDED
THROUGH A VARIETY OF FUNDING
STREAMS, INCLUDING THE MHS. A
MOSTLY PE I DOLLARS. THE SAMSON
MENTAL HEALTH BLOCK GRANT
DOLLARS AS WELL AS MEDICAL
DOLLARS. MY SAC COUNTY PROGRAM.
SERVES YOUTH AND YOUNG ADULTS IN
THE EARLIEST STAGES OF PSYCHOTIC
ILLNESS. UM AS WE'VE HEARD SO
ELOQUENTLY PUT TODAY,
INDIVIDUALS WITH MENTAL HEALTH
CHALLENGES ARE AT HIGH RISK FOR
SUICIDAL IDEATION AND BEHAVIOR,
BUT FOR INDIVIDUALS WITH EARLY
PSYCHOSIS, THE RISK IS EVEN
HIGHER, PARTICULARLY IN THE
FIRST 1 TO 2 YEARS AFTER ONSET
OF ILLNESS, SO IN THAT SPACE,
AND THAT BRIEF TIME PERIOD, UM
ABOUT ONE IN FOUR WILL ENDORSE
IDEATION AND ONE IN 10 WILL MAKE
AN ATTACK. CAN'T AND SO THEY ARE
EITHER. PASS AWAY OR HAVE
SIGNIFICANT INJURIES. AS A
CONSEQUENCE, WE'VE BEEN
COLLECTING DATA FROM EARLY
PSYCHOSIS PROGRAMS ACROSS THE
STATE AS PART OF OUR
COLLABORATIVE OUTCOMES, AND, UM
42% OF INDIVIDUALS AT INTAKE
REPORTS SOME FORM OF IDEATION,
SO I WANT TO HIGHLIGHT. THIS IS
A PARTICULARLY HIGH RISK GROUP.
AND CALIFORNIA'S EARLY PSYCHOSIS
PROGRAMS ARE PLAYING A REALLY
CRITICAL ROLE IN REDUCING
SUICIDAL IDEATION AND BEHAVIOR.
UM WE TRAIN OUR PROGRAMS TO USE
EVIDENCE BASED PRACTICES TO
PROVIDE A VERY THOROUGH
ASSESSMENT. WE DO PSYCHOSIS
SCORE. SORRY WE DO, UM, SUICIDE
SCREENING, AND THEN WE IMPLEMENT
EVIDENCE BASED PRACTICES TO
MANAGE RISK. SO THAT WE CAN
SUPPORT OUR CLIENTS AND LOVED
ONES TO STAY IN THE COMMUNITY
AND REDUCE COSTLY AND
TRAUMATIZING HOSPITALIZATIONS,
SO I REALLY JUST WANTED TO TAKE
THE TIME TO DAY TO HIGHLIGHT THE
ROLE THAT EVIDENCE BASED
PRACTICES CAN PLAY AND REDUCING
SUICIDE IN OUR COMMUNITIES AND
HOW ARE GROWING AVAILABILITY OF
EARLY PSYCHOSIS PROGRAMS HELPED
TO REDUCE THIS IN A PARTICULARLY
HIGH RISK AND VULNERABLE GROUP.
THANK YOU. THANK YOU. NEXT WE
WILL HEAR FROM SARAH MAN BY ONE
INJURY POLICY AND PROGRAMS
SEXUALLY CHIEF WITH THE CENTER
FOR HEALTHY COMMUNITIES.
AFTERNOON. THANKS FOR HAVING ME,
OKAY? HI. MY NAME IS SARAH MAN,
AND I SERVED AS CHIEF OF THE
OPPOSITE SUICIDE PREVENTION. ORO
SP. THE SP IS HOUSED WITHIN CITY
PHS CENTER FOR HEALTHY
COMMUNITIES THAT'S INTEGRATED
INTO THE ORGANIZATIONAL
STRUCTURE OF THE INJURY AND
VIOLENCE PREVENTION BRANCH TO
MAXIMIZE RESOURCES AND LEVERAGE
PROGRAM AND RESEARCH EXPERTISE
IN THE PREVENTION OF ALL FORMS
OF VIOLENCE, INCLUDING SUICIDE
FROM A PUBLIC HEALTH
PERSPECTIVE. OVERSIGHT OF THE SP
IS PROVIDED BY THE CENTERS,
DEPUTY DIRECTOR AND ASSISTANT
DEPUTY DIRECTOR. USP CONDUCTS
ACTIVITIES THAT ARE GUIDED BY
CALIFORNIA STRATEGIC PLAN FOR
SUICIDE PREVENTION, STRIVING FOR
ZERO AND OTHER RECOMMENDED
ACTIONS FROM THE CENTERS FOR
DISEASE CONTROL AND PREVENTION.
FEW KEY HIGHLIGHTS THE O. S P
HAS PRODUCED AND RELEASED
SEVERAL SUICIDE AND SELF HARM
DATA RESOURCES AND REPORTS WHICH
CAN BE FOUND ON CD PHS WEBSITE
UNDER THE SUICIDE PREVENTION
PROGRAM, RECENTLY PUBLISHED
RESOURCES INCLUDE SOCIAL MEDIA
SHAREABLE THAT RAISE AWARENESS
AROUND SUICIDE AND SUICIDE
PREVENTION. SUICIDE TRENDS IN
2020 DATA BRIEF WITH AN
ACCOMPANYING POWER POINT SLIDE
DECK WITH ADDITIONAL CHARTS AND
GRAPHS. VETERAN SUICIDE IN 2020
DATA. BRIEF OLDER ADULTS SUICIDE
IN 2019 FACT SHEET AND THE
CALIFORNIA VIOLENT DEATH
REPORTING SYSTEM ALSO REFERRED
TO AS CALVI DRS. BACK SHEET AND
INFOGRAPHIC ON SUICIDE IN
CALIFORNIA. ADDITIONALLY THE O.
S P HAS DISTRIBUTED
APPROXIMATELY 4500 LOCKBOXES TO
REDUCE ACCESS TO LETHAL MEANS
FROM THINGS LIKE FIREARMS AND
MEDICATIONS TO 10, LOCAL HEALTH
AND BEHAVIORAL HEALTH
DEPARTMENTS IN COUNTIES WITH
HIGHER RATES OF SUICIDE AND SELF
HARM. SP HAS ALSO DISTRIBUTED
38,000 MENTAL HEALTH RIVAL KITS
TO SCHOOLS THROUGHOUT THE STATE,
AS WELL AS LOCAL HEALTH AND
BEHAVIORAL HEALTH DEPARTMENTS IN
COUNTIES WITH HIGHER RATES OF
SUICIDE AND SELF HARM. THESE
KIDS CAN BE USED TO CELEBRATE
WELLNESS AND PROMOTE POSITIVE
COPING SKILLS FOR YOUTH WITH
EASY TO FOLLOW ACTIVITIES TO
ENHANCE BASIC SKILLS FOR SOCIAL
EMOTIONAL WELLNESS. ADDITIONALLY
THE SPS SPONSORED 40 SUICIDE
INSTITUTE INFORMATIONAL WEBINARS
FOR LOCAL HEALTH DEPARTMENTS,
BEHAVIORAL HEALTH DEPARTMENTS,
SCHOOL BASED HEALTH CENTERS,
PROVIDERS CLINICAL SUPERVISORS
STAFF WITH QUALITY IMPROVEMENT,
ASSURANCE ROLES, SUPPORT STAFF
AND OTHERS WHO WORK IN THE
HEALTHCARE FIELD AND ARE
INTERESTED IN LEARNING ABOUT HOW
TO PREVENT SUICIDE WITHIN THAT
CONTEXT. ADDITIONALLY THE SP IS
ALSO ADMINISTERING TO NEW YOUTH
SUICIDE PREVENTION PROJECTS AS
PART OF CAL HHS IS SPONSORED
CHILDREN AND YOUTH BEHAVIORAL
HEALTH INITIATIVE CAN GIVE A
BRIEF UPDATE ON THOSE TWO
PROJECTS AS WELL. UM ARE YOU ARE
YOU SUICIDE PREVENTION, MEDIA
AND OUTREACH CAMPAIGN? THE SP IS
IMPLEMENTING A TARGETED AND
COMMUNITY BASED YOUTH SUICIDE
MEDIA CAMPAIGN FOR YOUTH AT
INCREASED RISK. IN ADDITION TO
THE MEDIA CAMPAIGN GRANTS WILL
BE PROVIDED TO YOUTH SERVING
COMMUNITY BASED ORGANIZATIONS TO
PROMOTE CAMPAIGN MESSAGES AND
CONDUCT OUTREACH. UM THE MEDIA
CAMPAIGN WILL BE LAUNCHED IN THE
FALL OF 2023. THE PROCESS FOR
COMMUNITY BASED ORGANIZATIONS TO
APPLY FOR FUNDS HAS ALREADY
BEGUN APPROXIMATELY 30 TO 50
YOUTH SERVING CBOS WILL RECEIVE
TWO YEAR GRANTS RANGING FROM
150,000 TO 250,000 PER YEAR.
ADDITIONALLY, THE UNIVERSITY OF
CALIFORNIA IN LOS ANGELES WILL
SERVE AS AN INDEPENDENT
EVALUATOR FOR THE PROJECT. AND
THE SECOND PROJECT, THE YOUTH
SUICIDE REPORTING IN CRISIS
RESPONSE PILOT PROGRAM. THE USP
IS ALSO ADMINISTERING OR
IMPLEMENTING THIS PILOT TO
DEVELOP AND TEST MODELS FOR
RAPIDLY REPORTING YOUTH SUICIDES
AND SUICIDE ATTEMPTS THAT WILL
TRIGGER LOCAL LEVEL CRISIS
RESPONSE AND RESOURCE
CONNECTIONS INVOLVING SCHOOLS,
COMMUNITY BASED ORGANIZATIONS
AND OTHER PARTNERS. THE SP HAS
SELECTED 10 LOCAL PUBLIC HEALTH
AND OUR BEHAVIORAL HEALTH
DEPARTMENTS TO PARTICIPATE IN
THE PILOT PROGRAM. UM PILOT
COUNTIES WILL BEGIN IMPLEMENTING
THE PROGRAM IN JULY OF 2023.
COUNTIES WILL RECEIVE IN DEPTH
TRAINING AND TECHNICAL
ASSISTANCE AND SIMILARLY TO THE
MEDIA AND OUTREACH CAMPAIGN U. C
L A HAS BEEN IDENTIFIED TO SERVE
AS AN INDEPENDENT EVALUATOR FOR
THE PROGRAM. THANK YOU FOR
ALLOWING ME THE TIME TO SHARE
THESE UPDATES AND I LOOK FORWARD
TO YOUR QUESTIONS. NEXT WE WILL
HEAR FROM MARTHA DOMINGUEZ,
WHO'S THE HEALTH PROGRAM MANAGER
, THE CD PH. OFFICE OF HEALTH
EQUITY. GOOD AFTERNOON WHEN I
STARRED IS, UM I'M HERE. UM THE
OFFICE OF HEALTH EQUITY. OUR
CAMPAIGN IS ACTUALLY UNDER THE
CHILDREN AND YOUTH BEHAVIOR
HEALTH INITIATIVE. AND THE GOAL
OF THE CAMPAIGN IS REALLY TO
DEVELOP, IMPLEMENT AND EVALUATE
PUBLIC EDUCATION AND CHANGE
CAMPAIGN THAT IS CO DESIGNED FOR
AND BY USED TO ADVANCE EQUITY
AND RATES. BEHAVIOR HEALTH
LITERACY FOR CHILDREN, YOUTH
CAREGIVERS AND THEIR COMMUNITIES
IN CALIFORNIA AND PROVIDE PUBLIC
HEALTH EDUCATION CAMPAIGNS TO
FIVE PRIORITY POPULATIONS, SUCH
AS BLACK AND AFRICAN AMERICAN
LATINOS, NATIVE AMERICANS, ASIAN
PACIFIC ISLANDER AND THE L G B T
Q. PLUS COMMUNITY WHILE ALSO
CONSIDERING UNIQUE NEEDS OF THE
TRANSITIONAL H YOUTH PERSONS
WITH DISABILITY JUSTICE INVOLVED
YOUTH, FOSTER CARE YOUTH AND
THOSE LIVING IN RURAL AREAS. WE
HAVE THREE SUBJECT THREE
OBJECTIVES UNDER THIS CAMPAIGN.
UM, THE FIRST ONE IS REALLY TO
CREATE AWARENESS WITHOUT STIGMA
AROUND MENTAL, EMOTIONAL
BEHAVIORAL HEALTH, INCLUDING
SUBSTANCE ABUSE DISORDER AND
WELLNESS. OUR SECOND OBJECTIVE
IS REALLY TO PARTNER WITH CBOS
ACROSS CALIFORNIA TO DEVELOP
CULTURALLY LINGUISTIC AND AGE
APPROPRIATE CAMPAIGNS AIMED TO
REDUCE STIGMA AND JUST AND, UM
DISCRIMINATION. OUR THIRD
OBJECTIVE IS TO PARTNER WITH THE
COMMUNITY SUCH AS THE CHILDREN,
THE YOUTH, THE CAREGIVERS,
FAMILIES, COMMUNITIES TO CO
DESIGN REFLECT ON CULTURALLY
LINGUISTIC AND AGE, APPROPRIATE
PRODUCTS, TACTICS AND APPROACHES
WERE IN THIS PROCESS. WE'RE ALSO
DEVELOPING A MULTIFACETED
APPROACH THAT REALLY INCLUDES A
MACRO AND MICRO CAMPAIGNS
THROUGHOUT CALIFORNIA.
EVERYTHING FROM STATE TO LOCAL
WILL BE MULTICULTURAL AND MULTI
LINGUAL REGARDING THE KEY
LANGUAGES TO REACH OUR KEY
COMMUNITIES THAT HAVE ALREADY
LISTED WE HAVE ALSO HAVE
HIGHLIGHTED THAT OUR DEVELOPMENT
WILL HAPPEN IN THREE PHASES TO
DEVELOPMENT, IMPLEMENTATION AND
EVALUATION. THE DEVELOPMENT
ACTUALLY STARTED LAST YEAR WITH
US TALKING TO COMMUNITIES ACROSS
CALIFORNIA, WHERE THEM TALKING
AND GIVING US FEEDBACK ON HOW
THE PROCESS SHOULD BE IMPROVED.
NOT JUST THE BUSINESS PRACTICE
BUT ALSO THE DEVELOPMENT AND
IMPLEMENTATION. WE WERE VERY
EAGER TO HEAR FROM THE COMMUNITY
BUT ALSO TAKE SOME LEARNINGS
FROM OUR PREVIOUS EXPERIENCES TO
MAKE THE IMPROVEMENTS NOW IN
THIS PROCESS, SO WE HAVE APPLIED
THAT AND WILL CONTINUE TO DO
THAT. WE ALSO DEVELOP A BRAIN
TRUST, WHICH IS A GROUP OF
SUBJECT MATTER. EXPERTS THAT ARE
ACROSS CALIFORNIA, THE NATION
AND EVEN INTERNATIONAL. THE
BRAIN TRUST WILL BE OUR ADVISORY
COMMITTEE THAT WILL KEEP US
INTACT AND MAKING SURE THAT WE
ARE BEST APPLYING ALL BEST
PRACTICES AS OUR COLLEAGUE HAS
SHARED, BUT ALSO COMMUNITY BASED
APPROACHES, BUT ENSURING THAT WE
CONTINUE TO HAVE THE VOICES OF
THE COMMUNITY, FAMILIES AND
YOUTH. WE WILL ALSO HAVE A
FORMATIVE RESEARCH. WE'VE
DEVELOPED A MULTICULTURAL,
FORMATIVE RESEARCH MODEL. WE
HAVE ALREADY ENTERED CONTRACT
WITH THE CONTRACTOR THAT WILL
HELP US COLLECT THE DATA, UM, TO
TALK TO CHILDREN, YOUTH AND
FAMILIES ACROSS CALIFORNIA, AND
THEN WE'LL BE ALSO ENTERING INTO
MEDIA CONSULTING CONTRACT AS
WELL. TO DO THE MACRO LEVEL
CAMPAIGN AND ALSO CONTRACTING
WITH CBOS ACROSS CALIFORNIA TO
DO THE MICRO MEDIA CAMPAIGNS AND
THAT WILL ALL BE CONSIDERED PART
OF OUR IMPLEMENTATION. THE
IMPLEMENTATION ALSO WILL, UM
DETAILED THE EVALUATION KICK OFF
BECAUSE WE WILL HAVE A BASELINE
DATA THAT WILL HELP US MEASURE
AND TRACKED ALL THE COMPONENTS
AND TACTICS THAT WE DO ACROSS
FOR THE CAMPAIGN AND MULTIPLE
LANGUAGES AS WELL. AND WE'LL
ALSO USE THAT DATA TO DO ANY
QUALITY IMPROVEMENT. AND THEN
OBVIOUSLY THE EVALUATION WILL
ASSESS THE TRACKING OF THE WAVES
THAT OUR EFFORTS THROUGHOUT THE
CAMPAIGN AND THE DURATION, BUT
WE'LL ALSO HAVE AN INTERRUPTED
TIME SERIES ANALYSIS OF THE
RESOURCES AND SERVICES THAT
CALIFORNIANS NEED AND THAT WILL
ALLOW US TO ENSURE THAT WE'RE
PROVIDING THE PRESS APPROACHES
BUT ALSO RELATED TO CULTURAL,
HEALTH AND COMMUNITY BEST
PRACTICES WILL HAVE A PROCESS
AND OUTCOME EVALUATION AND THEN
WE'LL HAVE A THOROUGH REPORT
THAT WILL OUTLINE ALL OF OUR
EFFORTS THROUGHOUT I ALSO WANTED
TO GIVE YOU AN UPDATE IN TERMS
OF OUR BUDGET. UM AND HOW WE'RE
SPENDING OUR DOLLARS. UM SO
THROUGH 2024. WE HAVE ALREADY
PLANNING TO ALLOCATE $33 MILLION
FOR OUR MACKEREL CAMPAIGN AND
THEN $15 MILLION WILL BE FOR THE
MICRO MEDIA CAMPAIGNS. $5
MILLION IS GOING TO OUR
FORMATIVE EVALUATION RESEARCH
BUDGET AND THEN TWO MILLION FOR
ADMINISTRATIVE PERSONNEL BUDGET
THROUGH 2026 WILL HAVE AN
ADDITIONAL $5 MILLION SPENDING
FOR A MINISTRATIONS PERSONNEL
BUDGET. AND THEN WE'LL ADD
ANOTHER 20 MILLION FOR MACRO
CAMPAIGN IN ANOTHER 20 MILLION
FOR OUR MICRO MEDIA CAMPAIGNS,
UM OVERALL, WHAT WE WANTED TO
UNDERSCORE IS THAT WE'RE MAKING
SURE THAT HEALTH IS CULTURE IS
PART OF HEALTH. BUT ALSO
COMMUNITY IS PART OF HEALTH AND
WE WANT TO MAKE SURE THAT AND WE
ARE VERY CONFIDENT THAT WITH OUR
BEST PRACTICES AND ARE SUBJECT
MATTER, EXPERTISE WILL BE ABLE
TO INCREASE. MENTAL EMOTIONAL,
BEHAVIORAL, HEALTH AND SUBSTANCE
DISUSE DISORDER, EDUCATION AND
AWARENESS BUT ALSO PARTNER WITH
CAREGIVERS AND FAMILIES TO
ENSURE THAT THEY HAVE THE PROPER
RESOURCES AND SERVICES AND CO
DESIGN ALL OF OUR ELEMENTS
CULTURALLY AND LINGUISTICALLY TO
ENSURE ALL MESSAGES ARE
SATURATED ACROSS CALIFORNIANS.
THANK YOU. I MAY ASK, UM TO
CLEAR THE CHAIRS FROM NOW WE'LL
BRING YOU BACK FOR QUESTIONS IF
WE CAN. NEXT WE HAVE DIRECTOR
BOSS FOLLOWED BY J. C. COOPER
FOLLOWED BY TOBY YOU. WE'LL JUST
BE ME FOR DHC S. AH! SHE'LL BE
UP HERE IN A MINUTE AS OUTLINED
IN THE COMMITTEE AGENDA.
CALIFORNIA HAS SIGNIFICANTLY
INVESTED IN INITIATIVES TO
RESPOND TO SUICIDE AND SUICIDE
PREVENTION EFFORTS BRIEFLY
HIGHLIGHT A FEW. A FEW OF THEM
HAVE ALREADY BEEN DISCUSSED IN
PRIOR ITEMS ALL JUST QUICKLY
HIGHLIGHT AS PART OF THE 2022
BUDGET ACT. LEGISLATION
AUTHORIZED ADDITIONAL FUNDING TO
ADDRESS URGENT AND EMERGENT
ISSUES FOR CHILDREN AND YOUTH
AND FAMILIES. UH MISS BOYLAN,
JUST DISCUSS THAT. I JUST WANT
TO HIGHLIGHT AS PART OF THAT IT
WILL INCLUDE SOCIAL MEDIA,
HEALTHY USE OF SOCIAL MEDIA
TECHNOLOGY JUST IN RESPONSE TO
SOME OF THE PREVIOUS
CONVERSATIONS ON THIS ITEM, SO
THAT WILL BE PART OF THAT PIECE
THERE. ADDITIONALLY WOULD NOTE
THAT WE ARE TAKING ADVANTAGE OF
ENHANCED FEDERAL FUNDING
OPPORTUNITY FOR MOBILE CRISIS WE
IMPLEMENTED THAT BENEFIT THAT'S
AN INTEGRAL PART TWO RESPONSE
WITH REGARDING COMMUNITY WIKI
COMMUNITY BASED CARE AND NEEDS.
WE'VE SUBMITTED THE STATE PLAN
AMENDMENT TO CMS AND ISSUED
GUIDANCE DESCRIBING THE MINIMUM
REQUIREMENTS FOR THIS NEW
SERVICE, INCLUDING THE FEDERAL
REQUIREMENT THAT MOBILE CRISIS
SERVICES BE AVAILABLE FOR 24
HOURS A DAY, SEVEN DAYS A WEEK
AND 365 DAYS A YEAR. THE
EARLIEST POSSIBLE DATE FOR
COUNTIES TO IMPLEMENT THIS
BENEFIT WAS THIS PAST JANUARY,
AND ALL COUNTIES MUST IMPLEMENT
BY DECEMBER 31ST 2023 EXCEPT FOR
11, SMALL RURAL COUNTIES, WHERE
WE ARE STILL WORKING ON SOME OF
THE KEY RATE PIECES AND
FINALIZING RATES FOR OUR RURAL
COUNTIES BECAUSE THEY'RE UNIQUE
CONSIDERATIONS FOR THEM COUNTIES
WILL UNDERGO A READINESS PROCESS
TO ENSURE THEY MEET STATE AND
FEDERAL REQUIREMENTS, AND THE
DEPARTMENT IS PROVIDING
EXTENSIVE TECHNICAL ASSISTANCE
TO SUPPORT IMPLEMENTATION. I
WILL ALSO NOTE AS PART OF OUR
BEHAVIORAL HEALTH CONTINUE MINT.
STRUCTURE PROGRAM, THE FIRST
ROUND OF GRANT FUNDING WE
AWARDED 163 MILLION TO 49 CITIES
AND COUNTIES AND TRIBAL ENTITIES
TO FUND 245 NEW ENHANCED MOBILE
CRISIS RESPONSE TEAMS. AND THEN
FINALLY, JUST A BRIEF UPDATE ON
CALLE HOPE, WHICH MISS BOYLAN
REFERENCED AS WELL TODAY. AS OF
JANUARY, 23. WE PROVIDED
APPROXIMATELY 1.3 MILLION
INDIVIDUALS IN CALIFORNIA, WHO
HAVE ACTIVELY ADDRESSED RECEIVE
SERVICES THROUGH CAL HOPE SO
THAT'S KIND OF IN RESPONSE TO
CRISIS OR WANTING TO HAVE A
OPPORTUNITY TO CHAT WITH
SOMEBODY. SO I WOULD NOTE THAT
AS WELL AND THEN, LASTLY, AS
PART OF OUR CALIFORNIA
BEHAVIORAL HEALTH, COMMUNITY
BASED CONTINUUM WAIVER PROPOSAL
, WHICH WE ARE KIND OF ONE OF
THE PROPOSALS IN THE BUDGET, WE
HAVE ADDED UH, COORDINATED,
SPECIALLY CARE FIRST EPISODE
PSYCHOSIS AS AN OPTIONAL BENEFIT
FOR COUNTIES TO OPT INTO, SO
THAT IS ALSO PART OF THAT
PROPOSAL. HAPPY TO ANSWER ANY
QUESTIONS. THANK YOU, MR CHAIR
AND MEMBERS, UM IN IN TERMS OF
SOME OF THE SUICIDE PREVENTION
WORK, AS OUTLINED IN THE
MATERIALS FOR THAT HEARING TODAY
, THE COMMISSION PLAYED A KEY
ROLE IN PARTNERSHIP WITH THIS
SUBCOMMITTEE IN REALLY DRAFTING
A SUICIDE PREVENTION PLAN. AND
THANK YOU SOME BRAHMOS FEAR,
LEADERSHIP AND HELPING TO REALLY
PUSH FOR THE OFFICE OF SUICIDE
PREVENTION TO BE REESTABLISHED
WITHIN THE DEPARTMENT OF PUBLIC
HEALTH. UM YOU KNOW, ALONG THE
WAY, AND PARTICULARLY IN THE
CONTEXT OF COVID RESOURCES, AND
SOME OF THE FINDINGS THAT WE
WERE ABLE TO FREE UP IN RESPONSE
TO THE PANDEMIC, UM AND WE NOT
ONLY WORKING WITH THE DEPARTMENT
OF PUBLIC HEALTH TO REALLY
LAUNCH THAT OFFICE AND SUPPORT
THEM IN TRANSITION, SOME OF OUR
WORK TO THEM. BUT WE WERE ABLE
TO PROVIDE SOME RESOURCES FOR
TRAININGS WITHIN SCHOOL
DISTRICTS WITHIN CANADA HEALTH
DEPARTMENT. SOME OF THOSE
TRAININGS ARE AROUND
STRENGTHENING LOCAL SUICIDE
PREVENTION STRATEGIES, REALLY
BRINGING INTERNATIONALLY
RECOGNIZED EXPERTS TO MAKE THEM
AVAILABLE TO LOCAL AGENCIES SO
THAT THEY COULD UNDERSTAND BEST
PRACTICES. BUT ALSO, YOU KNOW,
RECOGNIZING WHAT WE REFER TO AS
POST MENTION, UM, YOU KNOW HOW
COMMUNITIES RESPOND WHEN THERE
IS AN ATTEMPT OR A LOSS OF LIFE
ASSOCIATED WITH SUICIDE. WE'VE
BEEN TRYING TO PLAY A SUPPORTIVE
ROLE WITH THE DEPARTMENT AND
AGENCY AROUND THE ROLLOUT OF 988
. WE DID A CONVENING WITH O ES
AND AGENCY TO REALLY TALK ABOUT
WHAT'S WORKING. YOU KNOW WHERE
THERE ARE CHALLENGES THE WORK
THAT HAS TO BE GET DONE ON 988.
PARTICULARLY RECOGNIZING THAT
IT'S GOING TO TAKE TIME NOT JUST
CALIFORNIA, BUT THE NATION.
SOMETIMES SOME YEARS TO REALLY
DESIGN A 988 SYSTEM TOOK US A
LONG TIME TO LEARN HOW TO GET
911 WORKING. IT'S GOING TO TAKE
US A WHILE TO LEARN. AND SO
WE'RE TRYING TO CREATE SPACE AND
RESOURCES FOR THAT. UM WHAT
WE'RE REALLY TRYING TO DO IS
TRANSITIONAL LOT OF THE VERY
SPECIFIC WORK THAT THE
COMMISSION HAS DONE IN THE PAST
AROUND SUICIDE PREVENTION OVER
TO THE ADMINISTRATION IN WAYS
THAT MAKE SENSE GIVEN, YOU KNOW
THEY'RE IMPROVED CAPACITY,
GREATER CAPACITY TO DO THAT WORK
EFFECTIVELY, BUT ALSO RECOGNIZE
WHERE WE THINK WE CAN HAVE A KEY
ROLE IN AN ONGOING WAY,
PARTICULARLY AROUND DATA
REPORTING AND ANALYSIS. YOU
KNOW, PART OF THAT OVERSIGHT IS
TO REALLY UNDERSTAND WHAT'S
WORKING AND WHAT'S NOT WORKING.
UM CONTINUING TO FOCUS ON YOUTH
AND COMMUNITY EMPOWERMENT
VETERANS IN ADDITION TO USE
NATIVE POPULATIONS, AND YOU
KNOW, SPECIFICALLY AND REALLY
UNDERSTAND HOW WE CAN SUPPORT
THEIR ABILITY TO ELEVATE THEIR
VOICES SO THAT THOSE VOICES ARE
PART OF THE CONVERSATIONS THAT
ARE HAPPENING NOT JUST AT THE
STATE OF CALIFORNIA, THE STATE
LEVEL BUT BUT MORE LOCALLY,
WHERE SO MUCH ON THE GROUND WORK
IS HAPPENING. UM A LOT OF STIGMA
REDUCTION AND SO YOU KNOW, PART
OF OUR EFFORT WITH KEN BURNS
THAT YOU KNOW, WORLD FAMOUS
DOCUMENTARY AND IS TO, YOU KNOW
, ELEVATE STORIES OF SURVIVAL
AND TRAUMA AND GRIEF SO THAT WE
CAN REDUCE THE STIGMA. YOU KNOW
MY OWN FAMILY. SOME RUSSIANS,
SOMEONE MENTIONED EVERY TIME
THERE'S A DIDI HIRSCH SPEAKER
SAID. EVERY TIME SOMEONE TELLS
THE STORY AND MY OWN FAMILY. WE
TALK OPENLY ABOUT PEOPLE WHO DIE
IN OUR FAMILY DUE TO CANCER OR
PNEUMONIA. BUT WE'VE HAD TWO
SUICIDE LOSSES AND NOBODY WILL
TALK ABOUT IT. SO STIMULATED
ACTION CAN WILL CONTINUE TO BE
SOMETHING THAT WE HOPE THE
COMMISSION WILL FOCUS ON IN
TERMS OF MAKING IT EASIER FOR
PEOPLE TO, YOU KNOW, PUT THIS
OUT THERE AND SHARE OUR STORIES.
SO THAT WE CAN ENGAGE AS FREELY
ABOUT WHAT'S HAPPENING IN OUR
MENTAL HEALTH SPACE AS WE DO
ABOUT HEALTH CARE, RIGHT? WE'VE
GOT THIS TREMENDOUS WILLINGNESS
TO SHARE OUR STORIES AROUND
CANCER AND BEING A CANCER
SURVIVOR. THERE'S STILL A
TREMENDOUS SHAME AND STIGMA
AROUND MENTAL HEALTH AND SUICIDE
IN PARTICULAR. AND LASTLY, I
WOULD SAY INNOVATION IS A SPACE
THAT THE COMMISSION HOPES TO
PRESERVE AND CONTINUE TO PUSH.
BECAUSE BECAUSE THAT IS A
FUNDING STREAM THAT HAS THIS
MANDATE FOR RECOGNIZING THAT WE
CAN DO BETTER, AND WE MUST TRY
TO DO BETTER IN A CONTINUOUS
SPACES. SO UM, YOU KNOW, ARE IN
THIS SLIDE DECK THAT WE PASSED
OUT. I LISTED SOME
ACCOMPLISHMENTS THAT WE'VE HAD
OVER THE LAST FEW YEARS AROUND
SUICIDE PREVENTION. MOST OF THAT
WORK WILL BEGIN TO END AS THE
FUNDS THAT WERE ONE TIME AND
WERE AVAILABLE ARE FULLY
EXHAUSTED, BUT WE HOPE TO
CONTINUE TO WORK WITH THE
DEPARTMENT OF HEALTH CARE
SERVICES WITH THE ABSENCE OF
SUICIDE PREVENTION AT CD PH. UM
BUT IN THOSE AREAS THAT I
MENTIONED DATA STIGMA,
INFORMATION INNOVATION CONTINUE
TO PUSH ON THIS AS A KEY AREA OF
CONCERN FOR THE STATE OF
CALIFORNIA IN THE COMMISSION.
DEPARTMENT OF FINANCE. ELIO.
NOTHING TO ADD, BUT WERE
AVAILABLE FOR QUESTIONS. I'LL
BRING IT UP TO THE DIOCESE WILL
BEGIN WITH ASSEMBLYMEMBER'S
ALMOST THANK YOU, MR CHAIR AND
THANK YOU FOR THE WORK THAT'S
BEING PUT IN TO THE OFFICE OF
SUICIDE PREVENTION AND ALL THE
DIFFERENT MATERIAL THAT WAS
DISCUSSED. UM PART OF THE BILL
ALSO TALKED ABOUT ENSURING THAT
WE WERE GETTING RESOURCES TO THE
DEMOGRAPHICS THAT DRASTICALLY
NEEDED. UM AT THAT TIME IT WAS
OUR YOUTH AND NATIVE AMERICANS.
LGBT Q AND VETERANS. SO ARE WE
ASSURING THAT THE RESOURCES THAT
NOW WE'RE MOVING FORWARD IN
THESE DIFFERENT PROGRAMS ARE
REACHING THOSE THAT ARE MOST
VULNERABLE THAT THAT DRASTICALLY
NEED. UM THE RESOURCE IS, UM IN
A TIMELY MANNER. YES SO FOR OUR
TWO YOUTH SUICIDE PREVENTION
PROJECTS, WE ARE FOCUSING ON
YOUTH DISPROPORTIONATELY
IMPACTED. SO WE ARE LOOKING AT
YOUTH WHO ARE BLACK YOUTH WHO
ARE WHO IDENTIFIES LATIN X
LATINO YOUTH OR AMERICAN INDIAN,
ALASKA NATIVE AND ALSO HOW THAT
WHO YOUTH WHO IDENTIFIES THOSE
PRIORITY POPULATIONS ALSO MAY
IDENTIFY AS LGBTQ. PLUS UM,
INVOLVEMENT IN THE FOSTER CARE
SYSTEM IN HISTORY OF MENTAL
HEALTH CONDITIONS. UM ETCETERA,
SO, YES, THAT IS THE PRIORITY
FOR THOSE THOSE PROJECTS SO THAT
WE CAN REACH THOSE YOU'VE
DISPROPORTIONATELY IMPACTED.
THANK YOU. THANK YOU FOR THAT,
AND THAT WAS A BIG COMPONENT OF
MAKING SURE WE'RE GETTING
RESOURCES TO THE AREAS THAT WERE
NEEDED. AND SO IT'S GREAT TO SEE
THAT THAT'S HAPPENING. UM BUT
ALSO AROUND THE STIGMA, THE
STIGMA OF MENTAL HEALTH. I KNOW
THERE WAS TALKING ABOUT SOME
TYPE OF, UM OUTREACH THAT WOULD
START TO DEAL WITH THE STIGMA
THAT'S OUT THERE ALSO, SO ARE WE
MOVING FORWARD IN THAT ON A
CAMPAIGN THAT WAY ALSO TO BREAK
DOWN THAT STIGMA SO THAT PEOPLE
COULD COME AND GET SUPPORT
SERVICES THAT THEY COULD TELL
THEIR SURVIVOR STORIES. I MEAN,
IN THE COMMUNITY. WE TALKED
ABOUT. HOW MENTAL HEALTH
SERVICES GROWING UP ON THE
INDIAN RESERVATION, THOSE THAT
WOULD GO IN TO GET DENTAL. THOSE
WHO THAT WE'RE GOING TO GET
MEDICAL AND THEN THOSE THAT WE
GO TO THE OFFICE TO GET
COUNSELING. THOSE THAT WENT OUT
TO THOSE AREAS ENDED UP HAVING
SOME TYPE OF AH, UM, CHATTER
ABOUT THEM MOVING ON THAT THEN
BROKE THEM DOWN, NOT TO GO OUT
AND SEEK ANY MORE SUPPORT
SERVICES. WE HAVE TO GET TO A
POINT TO WHERE HERE IN THE STATE
OF CALIFORNIA, IF NOT THE
NATION, IF NOT THE WORLD THAT WE
BREAK DOWN THAT STIGMA THAT
THOSE THAT ARE SEEKING MENTAL
HEALTH RESOURCES THAT IT'S
SOMETHING THAT'S ACCEPTABLE BY
OUR COMMUNITY. SO ARE WE. ALSO
TACKLING THAT ISSUE ON THE
FOREFRONT. REGARDS TO THE PUBLIC
EDUCATION CAMPAIGN. THAT IS THE
INTENTION OF THE MICRO MEDIA
CAMPAIGNS FOR LACK OF A BETTER
WORD. YOU MAY RECOGNIZE GUERILLA
MARKETING, SO IT'S SIMILAR
APPROACH, UM, WHERE WE CAN GO
DOWN TO THE COMMUNITIES AND THEY
CAN DEVELOP AND REALLY CREATIVE
INNOVATION OR TACTICS OR
APPROACHES THAT ALLOWS THEM TO
REACH THE COMMUNITY. GO TO THE
GROCERY STORE OR GO TO, UH, YOU
KNOW, UM, MAYBE IT'S UH, TRUSTED
MESSENGER WITHIN THEIR COMMUNITY
THAT CAN TALK TO THEM. I MAKE
THOSE THOSE PROPER REFERRALS OR
EVEN JUST HAVE THE CONVERSATION
. WE DO KNOW THAT WOULD STIGMA,
JUST COMMUNITIES AND ESPECIALLY
WITHIN THE BLACK AND LATINO AND
NATIVE AMERICAN COMMUNITIES AND
EVEN ASIAN PACIFIC ISLANDERS
FIVE PRIORITIES THAT I MENTIONED
EARLIER. THEY NEED TO DISCUSS
IT. THEY NEED TO TALK ABOUT IT.
SO WE WANT TO MAKE SURE THAT WE
CAN EMPOWER BUILD THAT SELF
EFFICACY SO COMMUNITIES CAN DO
THAT AND THEN GET REALLY
CREATIVE IN WAYS THAT THEY CAN
DO IT. WHETHER IT'S WE BUILD
THAT, UM, SELF EFFICACY WITH THE
STORE WITH THE MOMS AND POP
STORE OR A LAUNDRY LAUNDRY MAT,
THERE'S DIFFERENT WAYS FOR US TO
GET REALLY CREATIVE, AND THE
MICRO MEDIA APPROACH REALLY
WOULD ALLOW US TO DO THAT. AND
THEN THE MACRO CAMPAIGNS THAT
WILL BE SORT OF AT THE HIGHER
LEVEL WILL CONTINUE TO SUPPORT
THAT, UM, IT REALLY IS A
MULTIFACETED APPROACH BECAUSE WE
CAN'T JUST DO ONE REMEDY OR ONE
FORMULA FOR ALL TO REACH THE
COMMUNITY, SO WE DO WANT TO BE
CREATIVE. AND IS THE CAMPAIGN.
UM PARTNERING WITH THE AREAS
THAT ARE MOST VULNERABLE IN
GETTING THE DIFFERENT RESOURCES
TO SO THEN THE RESOURCE THAT'S
GOING INTO THIS POPULATION
DEMOGRAPHICS. WE HAVE AN ALSO
STIGMA, ANTI STIGMA CAMPAIGN
ALSO TACKLING THE SAME
DEMOGRAPHICS. YES THAT'S THE
INTENTION, AND THAT'S PART OF
THE CALL TO ACTION THAT WILL
HAVE TO BUNDLE AND WE'LL NEED TO
PRIORITIZE ALL THOSE DIFFERENT
RESOURCES WHETHER IF IT'S A
HOTLINE OR DIFFERENT KEY, UM,
COMMUNITIES WELLNESS CENTER.
OTHERS OR A DOCTOR, CURANDERA OR
WHATEVER THAT MAY LOOK LIKE, YOU
KNOW, THAT'S WHY I CAN'T GIVE
YOU A SORT OF A BLANKET ANSWER
BECAUSE IT'S GOING TO LOOK VERY
DIFFERENT FOR A LATINO COMMUNITY
AS OPPOSED TO A NATIVE COMMUNITY
NATIVE AMERICANS AND YOU KNOW
THIS BETTER THAN I DO. YOU GUYS
DO A LOT OF COMMUNITY MEDIA OR
DIFFERENT POWS WHERE THEY COME
TOGETHER TO LATINOS. THEY RELY
ON THE PROMO, TORRE'S AND THE
PERIOD OF PEER CONVERSATION, SO
WE WANT TO MAKE SURE THAT WE CAN
BUILD A STRUCTURE THAT ALLOWS
FOR THAT. AND CONTINUES TO
ALLOWS US TO BE CREATIVE
THROUGHOUT THE DURATION OF THE
CAMPAIGN. THEREFORE THE MONIES
WILL GO TO THOSE MOST VULNERABLE
AREAS AND THOSE PARTNERS THAT
CAN REALLY ALLOW US TO BE THAT
COMMUNITY BROKER THAT TRUSTED
MESSENGER WITHIN THOSE AREAS.
WELL THANK YOU FOR THAT. AND AS
ALWAYS, OUR OFFICE IS HERE TO
ASSIST YOU IN OUTREACH IN ANY
WAY THAT WE CAN, UM, LOOKING
FORWARD TO SEEING THESE
RESOURCES GET INTO THE COMMUNITY
OF THE MOST VULNERABLE THAT ARE
OUT THERE. THANK YOU. HOW BRING
IT UP TO THE CHAIR IF I CAN
GOING TO BEGIN, IN PART BECAUSE
OF WHAT DD, HURST SAID, AND ALSO
BECAUSE OF WHAT TOBY EWING
CALLED OUT AND THE COURAGE THAT
WAS SHOWN BY MS POLLS EARLIER,
AS WELL AS BY A YOUNG STUDENT,
ALYSSA WHEN WE ANNOUNCED THE
CHILDREN'S AND YOUTH BEHAVIORAL
HEALTH INITIATIVE, BUT WE MUST
START WITH STIGMA REDUCTION AND
ACKNOWLEDGING WHAT'S HAPPENED IN
OUR OWN FAMILIES. I SAY THIS TO
SHARE THAT MY MATERNAL
GRANDMOTHER COMMITTED SUICIDE
WHEN MY MOM WAS SEVEN. AND THAT
EFFECT ON OUR FAMILY AND
TRAUMAS. ONE OF THE MAJOR
REASONS WHY I AM SO FOCUSED ON
MAKING SURE THAT WE PROVIDE
SUPPORTIVE SERVICES TO COMMUNITY
MEMBERS AS WELL. AND IT'S
IMPORTANT FOR US TO MAKE SURE
THAT IT'S NOT ANYONE ELSE, BUT
IT'S ALL OF US, AND IT WILL TAKE
ALL OF US TO BE ABLE TO SOLVE
THIS LEVEL OF PROBLEMS. SO I
WANT TO APPRECIATE THE TESTIMONY
FROM SO MANY OF THE PANELISTS,
BUT IT WILL TAKE US AS WELL TO
MAKE SURE THAT WE'RE REDUCING
STIGMA. WE'LL TAKE A MOMENT TO
CALL UP MISS FRANCES, IF I CAN.
NOW YOU TOUCHED ON A NERVE AND
YOU DON'T EVEN KNOW IT. SO BOY,
I'LL START BY GOT THREE YOUNG
GIRLS AND 7, 10 AND 11 AND I'M
REALLY FOCUSED ON THE IMPACT
THAT SOCIAL MEDIA HAS ON THEIR
DEVELOPING BRAINS. AND SO WHEN
YOU'RE TELLING ME THE GIRLS ARE
TWO OR THREE TIMES MORE
DEPRESSED WHEN THEY USE SOCIAL
MEDIA ARE THERE ANY
RECOMMENDATIONS ON IF THEY
SHOULD BE USING SOCIAL MEDIA OR
ARE THEIR AGES THAT WE SHOULD BE
, UM, DISCOURAGING USE OF SOCIAL
MEDIA? I WOULD LOVE YOU TO
COMMENT ON IT. YES SO I'M NOT A
PHYSICIAN, SO I'LL SAY THAT
FIRST AND FOREMOST, UM THERE
HASN'T BEEN A LOT OF RESEARCH
ABOUT HOW YOUNG IS TOO YOUNG TO
BE FRANK. I THINK PEOPLE HAVE
MADE ASSUMPTIONS AND YOU KNOW,
SOCIAL MEDIA THEIR OWN PLATFORMS
. SAY THAT YOU HAVE TO BE. I
THINK 14 BEFORE YOU EVEN GO ON
INSTAGRAM OR FACEBOOK. UM I
THINK THAT IS PROBABLY MORE OF A
SUGGESTION, AS OPPOSED TO AN
ACADEMIC STANCE OR A MEDICAL
STANCE ON HOW YOUNG IS TOO
YOUNG. BUT I DO KNOW THAT WHAT
YOU'RE SEEING, PARTICULARLY WITH
GIRLS IS A COMPOUNDING OF WHAT'S
HAPPENING IN THE IN SOCIETY
ABOUT BODY IMAGE ISSUES, RIGHT
THAT'S NOT UNIQUE TO SOCIAL
MEDIA. GIRLS ARE FEELING THAT
BECAUSE SOCIALLY ON THEIR
TELEVISION SCREENS EVEN AS WELL
AS ON THEIR PHONES, THEY ARE
GETTING THESE MESSAGES THAT
MIGHT NOT ALSO ALIGNED WITH HOW
THEY'RE FEELING. WHAT WAS
INTERESTING TO ME, THOUGH, WHERE
THE YOUNG PEOPLE WHO ARE
REPORTING THAT THEY WERE FEELING
SOCIAL CONNECTEDNESS THROUGH THE
USE OF SOCIAL MEDIA, SO PEOPLE
WHO MIGHT HAVE TROUBLE GETTING
FRIENDS BASED ON FACE OR MAKING
FRIENDS BASED TO PHASE THEY WERE
FINDING COMMUNITY ONLINE. SO I
THINK THAT'S A HARD QUESTION TO
REALLY ANSWER. I THINK WHAT'S
BEEN HAPPENING IS FAMILIES ARE
TRYING TO FIGURE OUT WHAT WORKS
BEST. FOR THEIR INDIVIDUAL
CIRCUMSTANCES IF THEY HAVE A
CHILD WHO HASN'T BEEN MAKING
FRIENDS AT SCHOOL AND HAVE BEEN
MAKING FRIENDS ONLINE, THEY'VE
BEEN LETTING THE USE CONTINUE.
I'M GOING TO BE CAREFUL BECAUSE
YOU MENTIONED IN YOUR TESTIMONY.
THERE'S NOT CAUSALITY. AND YET
WHAT WE'RE HEARING FROM THE
YOUNG PEOPLE IS THAT IT IS
SOCIAL MEDIA THAT I LIKE TO
UNDERSTAND WHAT TYPE OF RESEARCH
WOULD WE NEED TO DO TO
UNDERSTAND THE CAUSALITY? YES SO
THIS ONE'S HARD BECAUSE THE
CAUSALITY IS REALLY IN REFERENCE
TO SUICIDALITY, NOT DEPRESSION,
RIGHT? SO WE KNOW THAT THEY ARE
DEPRESSED. WITH THE USE OF
SOCIAL MEDIA, RIGHT? THAT'S
THERE ALREADY REPORTING THAT THE
SUICIDALITY PIECE IS PROBABLY
MUCH MORE OF A LONG TERM
LONGITUDINAL STUDY TO SEE WHAT
WE'RE LOOKING AT, AS YOUNG
PEOPLE HAVE BEEN USING SOCIAL
MEDIA OVER TIME. HOW MANY HOURS
ETCETERA. UM SO WE AREN'T. I
ALSO DON'T WANT TO SAY THAT THE
ABSENCE OF EVIDENCE MEANS THAT
WE CAN SUDDENLY PROVED THAT THIS
EXISTS. BUT THE SPECULATION HAS
BEEN THE HIGH USE OF SOCIAL
MEDIA MEANS IT LEADS TO
DEPRESSION, WHICH MEANS IT LEADS
TO SUICIDE. BUT THE REALITY IS
SUICIDE IS A LITTLE BIT MORE
COMPLEX THAN THAT. IT'S NOT A 1
TO 1 RELATIONSHIP. SO WHAT
YOU'RE SEEING IS THAT YOUNG
PEOPLE HAVE A BUNCH OF OTHER
THINGS GOING ON, IN ADDITION TO
FEELING SAD ABOUT SOCIAL MEDIA,
SO IT'S NOT JUST SOCIAL MEDIA.
IT'S ALSO THEIR PEER
RELATIONSHIPS, THEIR PARENT
RELATIONSHIPS, THEIR ROMANTIC
RELATIONSHIPS. UM WHAT'S
HAPPENING ACADEMICALLY, SO THESE
ARE COMPOUNDING ISSUES AND
SOCIAL MEDIA IS THE ONE THING
THAT WE CAN POINT TO THAT IS NEW
AND DIFFERENT IN THE LAST 20
YEARS. THAN HOW I WAS RAISED OR
HOW YOU YOU WERE RAISED. I DON'T
EVEN WANT TO START TO THINK
ABOUT IT, BUT I'M SURE UM, MOST
CHILDREN MIGHT CONSIDER PLACING
A DIFFERENT AGE IN IF THAT
INCREASED THE LIKELIHOOD THAT
THEY COULD PARTICIPATE IN AN APP
THAT THEY WANTED TO PARTICIPATE
IN A DO ARE THERE STATES THAT
HAVE CREATIVE WAYS TO UM ENSURE
THAT WE ARE ABLE TO CREATE THOSE
LIMITS. WE HAVEN'T SEEN THAT
NATIONALLY IS YET BUT THAT THEY
DO. I HAVE NIECES AND NEPHEWS.
THAT IS EXACTLY WHAT THEY'RE
DOING. THEY'RE LYING ABOUT THEIR
AGE TO GET ON INSTAGRAM AND TO
GET ON FACEBOOK. THAT IS THAT IS
A FACT. UM AND WE DON'T REALLY
KNOW. I MEAN, OFTENTIMES I KNOW
PARENTS DON'T KNOW THAT THEIR
KIDS ARE ON SOCIAL MEDIA.
BECAUSE THEY HAVE SPOOF ACCOUNTS
, AND THEY HAVE ACCOUNTS THAT
AREN'T IN THEIR NAME THAT
THEY'RE USING. SO THIS IS A VERY
HARD THING TO MONITOR. THEY'RE
NOT SIGNING UP AS THEIR OWN NAME
BECAUSE THEIR MOM AND DAD ARE
ALSO USING INSTAGRAM. SO THAT
THAT'S A DIFFICULT THING TO
TRACK. UM FOLLOW UP, AND I MAY
DO THIS OFFLINE WITH THE OFFICE
OF SUICIDE PREVENTION, BUT I'D
LIKE TO UNDERSTAND WHAT OTHER
STATES ARE DOING THAT'S
INNOVATIVE IN THIS SPACE. WILL
JUST ELEVATE. WE DON'T TRY OUT
MEDICATIONS ON PEOPLE AND THEN
SEE THEIR EFFECT. AND YET IT
SEEMS THAT WE'RE TRYING OUT.
MANY OF THE APPS OR SOCIAL MEDIA
AND FINDING THE EFFECT WITHIN
OUR CHILDREN THAT KEEPS MANY OF
US PARENTS UP LATE AT NIGHT. UM
I DON'T BELIEVE MY KIDS HAVE
BEEN ON SOCIAL MEDIA BECAUSE
THEY DON'T HAVE PHONES YET RIGHT
ABOUT THAT EVERY DAY, AND I
THINK IT'S IMPORTANT FOR US TO
MAKE SURE WE'RE DOING ALL WE CAN
TO BE AS CAUTIOUS AND
PROTECTIVE. AS THEY
APPROPRIATELY DEVELOPED AND
START TO HAVE CONFIDENCE IN
THEMSELVES. AND SO I'LL HIT
PAUSE ON THAT, BUT JUST REALLY
APPRECIATE THIS ENTIRE PANEL AND
WE WILL NOW MOVE ON TO ISSUE
SIX.
ISSUE SIX IS ON THE NINE AND
EIGHT SUICIDE AND CRISIS
LIFELINE BUDGET CHANGE PROPOSAL
TRAILER BILL AND PROVISIONAL
LANGUAGE WE HAVE KIMBERLY CHAN
ASSISTANT SECRETARY PROGRAM AND
FISCAL AFFAIRS WITH CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
TO PRESENT THIS ISSUE. WELCOME
AND PLEASE BEGIN, MR CHAIR.
GOOD. GOOD EVENING. KIMBERLY
CHAN, ASSISTANT SECRETARY FOR
PROGRAM AND FISCAL AFFAIRS AT
KELLY DO JESS AS FOLKS. NO
FEDERAL LAW HAS DESIGNATED 988
AS THE NEW THREE DIGIT NUMBER
FOR THE NATIONAL SUICIDE
PREVENTION AND MENTAL HEALTH
CRISIS HOTLINE TO ADEQUATELY AND
SUSTAINABLY FUND THE 98 SYSTEM.
FEDERAL LAW AUTHORIZES STATES TO
IMPOSE A FEE ON ACCESS LINES FOR
PROVIDING 98 RELATED SERVICES.
ASSEMBLYMEMBER'S BAUER-KAHAN
BILL, HB 9 88 OF LAST YEAR WAS
SIGNED BY THE GOVERNOR DOES JUST
THAT TO SUPPORT THE BROADER
IMPLEMENTATION OF THE 98 SUICIDE
IN CRISIS PREVENTION LINE. THE
GOVERNOR SIGNED THE BILL WITH A
SIGNING MESSAGE INSTRUCTING THE
ADMINISTRATION TO PROPOSE
ADDITIONAL CLEANUP LANGUAGE IN
THE GOVERNOR'S 23 24 GOVERNOR'S
BUDGET. SO TODAY YOU HAVE THAT
BCP AND TRAILER BILL IN FRONT OF
YOU, WHICH COMBINES THE, UH,
SUGGESTION. THE TRAILER BILL AND
THE BCP FOR KELLY DIGEST, HCS
AND GMHC. UM AT THIS TIME, I CAN
GO THROUGH THE BCP AND TRAILER
BILL IN DETAIL, OR I CAN JUMP TO
THE STAKEHOLDER CONCERNS. YES
I'M SEEING HEADS, NOT TO
STAKEHOLDER CONCERNS. WONDERFUL
OKAY, GREAT. SO I WILL JUST SAY
THAT WE DID HAVE A CHANCE TO
MEET WITH STAKEHOLDERS LAST
TUESDAY TO DISCUSS THE TRAILER
BILL IN DETAIL. WE DISCUSSED
JUST ABOUT EVERY SINGLE ITEM ON
THE CONCERNS LIST AND I FEEL AND
FOLKS CAN SPEAK FOR THEMSELVES
HERE THAT WE ARE ON THE RIGHT
PATH TO HELPING TO GET TO A
RESOLUTION ON MOST, IF NOT ALL
OF THESE PIECES, AND WE DID
RECEIVE FROM THE STAKEHOLDERS IN
COORDINATION WITH REMEMBER ABOUT
BAUER-KAHAN REVISED LANGUAGE,
AND SO WE JUST GOT THAT THIS
MORNING. WE HAVEN'T HAD A CHANCE
TO REVIEW ALL OF IT YET, BUT WE
ARE PLEASED TO HAVE A DIALOGUE
GOING ON THAT. AND THEN FINALLY,
TO THE OTHER POINT, I THINK I
NOTED EARLIER. WE ARE PROPOSING
THIS AS TRAILER BULLYING, WHICH,
BECAUSE IT WAS IN THE GOVERNOR
SIGNING MESSAGE ASKING US TO
PLEASE PROPOSED TRAILER BILLING
LANGUAGE FOR CLEANUP JUST
BROADLY SPEAKING ON THE
STAKEHOLDER CONCERNS, UM, FIRST
OFF OUR TRAILER BILL LANGUAGE IS
MEANT TO PROMOTE MORE EFFICIENT
USE OF STAFF, TIME AND RESOURCES
AND, IN NO WAY IS TRYING TO
REMOVE LEGISLATIVE OVERSIGHT. WE
HAVE QUARTERLY IMPLEMENTATION
MEETINGS, BOTH FROM THE KELLY TO
SIDE AND KELO. YES ALONG WITH
THE FIVE YEAR IMPLEMENTATION
PLAN, SO WE'RE HAPPY TO CONTINUE
TO PROVIDE UPDATES, JUST REALLY
WANTING TO PRIORITIZE OUR STAFF
RESOURCES IN TIME. UM IN IN IN
REFERENCE TO THE SECOND POINT ON
MOBILE CRISIS TEAMS. WE WANTED
TO MAKE SURE THAT THAT WE'RE
PROVIDING AS MUCH FLEXIBILITY IN
THIS IN THIS BILL AS POSSIBLE.
UM NOT EVERY SINGLE CALL TO 988
IS GOING TO REQUIRE A MOBILE
CRISIS RESPONSE. PERHAPS IT'S
JUST AS IT IS TODAY, A PERSONAL
ONLINE PROVIDING ADDITIONAL
COUNSELING, PERHAPS DOWN THE
LINE. WE'RE ABLE TO DO REALLY
INNOVATIVE THINGS LIKE
CONNECTING TO A PROVIDER AND
NETWORK, RIGHT? IT MAY NOT
REQUIRE MOBILE CRISIS IN PERSON.
AND SO THAT'S THE KEY POINT.
WE'RE NOT TRYING TO REMOVE
MOBILE CRISIS TEAMS WERE REALLY
TRYING TO BROADEN IT SO THAT THE
COMPASS IS A RANGE OF BEHAVIORAL
HEALTH SERVICES, A PARTICULAR
INDIVIDUAL MIGHT NEED TO THE
NEXT POINT. UM I THINK THE KEY
POINT TO NOTE HERE IS THAT WE
BELIEVE THAT IT IS PREMATURE TO
BE SO PRESCRIPTIVE TO THE
LANGUAGE ON WHAT RECIPIENTS OF
FUNDS WILL HAVE TO REPORT. WE
MAY NOT HAVE ALL THIS
INFORMATION RIGHT NOW. IN FACT,
WE HAVE OPPOSE ALS IN OTHER
SPACES TO TRY TO GET TO THAT
LEVEL OF DETAIL. UM, THAT IS A
POINT THAT WE DID YOU KNOW, WE
ARE TALKING THROUGH WITH THE
STAKEHOLDERS TO SEE IF WE CAN
LAND ON A SWEET SPOT ON THAT.
BUT THE KEY PIECES THAT WE JUST
DON'T HAVE THAT LEVEL OF DATA
AND DETAILED THIS POINT. UM TO
BE SO PRESCRIPTIVE IN STATUTE,
UM AND LASTLY, ON THE LAST POINT
REGARDING INSURANCE PROTECTIONS
BROADLY, WE BELIEVE ARE PROPOSED
LANGUAGE IS ACTUALLY MUCH
STRONGER THAN EXISTING LAW AND
IN FEDERAL LAW. THERE ARE, OF
COURSE, NUANCES TO THE NEW
SUPPLY FEDERAL NO SURPRISES ACT
AND WE'RE HAPPY TO WORK WITH
STAKEHOLDERS TO WORK THROUGH HOW
TO BALANCE THAT FEDERAL LAW IN
OUR STATE LAW. WE DO HAVE STAFF
HERE FROM DEPARTMENT OF HEALTH
CARE SERVICES AND DEPARTMENT
MANAGED HEALTH. CARE TO ANSWER
ANY OF YOUR QUESTIONS YOU MIGHT
HAVE ON THE BCP OR TRAILER BILL,
SO I'LL JUST END IT THERE AND,
UM PASS IT ON TO THE OTHER
SPEAKERS ON THIS PANEL. NEXT WE
WILL HEAR FROM TAREQ GAMBOA
EASTMAN, SENIOR ADVOCATE WITH
THE SUNDBERG INSTITUTE. CHAIR
TARGET ABOUT EASTMAN WITH THE
STEINBERG INSTITUTE. WE WERE THE
PROUD CO SPONSORS OF THE BABY
988 LAST YEAR WITH THE KENNEDY
FORUM AS WELL AS OTHERS AND JUST
WANT TO TAKE A MOMENT TO
ACKNOWLEDGE THE COMMITTEE FOR
ALL OF YOUR TREMENDOUS WORK TO
IMPLEMENT THIS AS WELL AS THE
ADMINISTRATION. YOU GUYS HAVE SO
MUCH ON YOUR PLATE, AND WE'RE
JUST INCREDIBLY GRATEFUL FOR THE
HARD WORK THAT YOU'RE DOING, AND
FOR THE ONGOING CONVERSATIONS
AROUND THE TRAILER BILL LANGUAGE
, WE ALSO FEEL VERY POSITIVE
ABOUT THE DIRECTION OF THE
CONVERSATION AND THINK THAT WE
CAN FIND MUTUAL REALLY AGREEABLE
LANGUAGE. I THINK ON BOTH THE
ISSUES OF LEGISLATIVE OVERSIGHT
AND THE PLANNING AROUND MOBILE
CRISIS TEAMS, IT'S JUST AN ISSUE
OF SPECIFICITY. I THINK WE HAVE
FAITH IN THE WORK THAT THE
ADMINISTRATION IS DOING AND JUST
WANT TO MAKE SURE THAT THE GOALS
ARE CLEAR WHILE ALLOWING THEM
THE NEEDED FLEXIBILITY. ON THE
ISSUES RELATED TO THE FEE. UH.
TO ADD THE LANGUAGE AS PROPOSED
REMOVES LANGUAGE THAT WOULD
PREVENT THE 988 FEE REVENUE FROM
BEING USED FOR ANY OTHER PURPOSE
OR MOVED INTO ANOTHER FUND. THIS
IS A INCREDIBLY SERIOUS CONCERN
, GIVEN THE HISTORY OF 911 FEED
AVERSION ACROSS THE NATION.
CALIFORNIA HAS BEEN A LEADER AT
PREVENTING THAT ON THE 911 SIDE,
AND WE WANT TO ENSURE WE
CONTINUE TO BELIEVE LEADERS ON
THAT FRONT. ADDITIONALLY WHILE
WE UNDERSTAND THAT THERE MAY BE
EXISTING DATA CONCERNS THAT WE
NEED TO ADDRESS WHERE WORRIED
THAT IF WE'RE NOT REQUIRING FUND
RECIPIENTS TO REPORT, UH IF
THEY'VE BUILT INSURANCE
COMPANIES, AND IF THEY'VE
RECEIVED REIMBURSEMENT, WE MAY
HAVE A MISUSE OF TAXPAYER MONEY
AND ALSO MAY NOT BE USING OUR
RESOURCES MOST EFFECTIVELY OR
HAVE THE INFORMATION TO FIX
THAT. UM, THE LANGUAGE. ALSO
DELETES REPORTING REQUIREMENTS
AROUND UP SYSTEM PERFORMANCE
METRICS, AND WE WANT TO MAKE
SURE THAT WE'RE CONSISTENTLY
IMPROVING THE SYSTEM FOR THE
COLLARS ON THE ISSUES AROUND
INSURANCE. YES THE ISSUES WITH
THE NO SURPRISES ACT ARE QUITE
NUANCED. FROM OUR PERSPECTIVE,
THE LANGUAGE HAS WRITTEN IN THE
HEALTH AND SAFETY CODE WOULD
BOTH NARROW EXISTING LAW AND
CONFLICT WITH FEDERAL LAW. THE
FEDERAL NO. SURPRISES ACT
REQUIRES COVERAGE OF CERTAIN
POST STABILIZATION SERVICES
WITHOUT PRIOR AUTHORIZATION OR
REGARD FOR NETWORK PROVIDER
STATUS. UH WE BELIEVE THAT
CALIFORNIA SHOULD ENSURE THE
PROTECTIONS IN PLACE UNDER STATE
LAW ARE NOT LESS THAN THOSE
UNDER FEDERAL LAW. THE
DEFINITION OF BEHAVIORAL HEALTH
CRISIS SERVICES SHOULD ALSO
ALIGN WITH THE BROADER FEDERAL
DEFINITION IN ORDER TO ENSURE
THE STATE IS NOT UNNECESSARILY
LIMITING THE SCOPE OF SERVICES
AND BENEFITS PROTECTED UNDER
FEDERAL LAW WERE ALSO CONCERNED
ABOUT NARROWING EXISTING STATE
LAW, NAMELY SB 855, WHICH
REQUIRES THAT ALL MEDICALLY
NECESSARY BEHAVIORAL HEALTH
TREATMENT BE COVERED THE TRAILER
BILL LANGUAGE SETS MEDICAL
SERVICES AS A CEILING, REDUCING
THE COMMERCIAL COVERAGE
REQUIREMENTS IN PLACE UNDER SP
85. FIVE. WE PROPOSE MAINTAINING
EXISTING REQUIREMENTS WHILE
CLARIFYING THAT THESE
REQUIREMENTS INCLUDE AT MINIMUM
, THE SERVICES COVERED BY
MEDICAL, UH, WE DO ENJOY, OR, UH
, ARE EXCITED ABOUT MANY OF THE
PROTECTIONS INCLUDED IN THE
HEALTH AND SAFETY CLOTHES CODE,
NAMELY, MANDATING PAYMENTS FOR
SERVICES RENDERED, BUT WE ARE
CURRENT CONCERNED ABOUT THE
LIMITATIONS AS CURRENTLY WRITTEN
, UM, WE DO FEEL INCREDIBLY
OPTIMISTIC ABOUT WHERE WE'RE
HEADED AND LOOK FORWARD TO
WORKING WITH THE COMMITTEE.
THANK YOU. NEXT WE WILL HEAR
FROM SHERRY'S AND WOLSKI. THANK
YOU CHAIR. UH FIRST BEFORE I
START MY PREPARED REMARKS. I
JUST WANTED TO FIRST OFFER MY
CONDOLENCES FOR THE LOSS OF YOUR
GRANDMOTHER. I'M SORRY. YOU
NEVER GOT TO MEET HER. AND I
THINK YOU FOR SHARING THAT
PERSONAL STORY. I ALSO WANNA,
YOU KNOW, JUST RECOGNIZE ANYBODY
HERE IN THE ROOM WHO HAS LOST
SOMEONE TO SUICIDE BECAUSE MY
GUESS IS PROBABLY MOST PEOPLE
HAVE UM AND ALSO TO THE PEOPLE
IN THE ROOM WHO HAVE HAD THEIR
OWN THOUGHTS OF SUICIDE OR THEIR
OWN SUICIDE ATTEMPT. I HOPE THAT
THE WORK THAT WE'RE DOING TODAY
, UM, IS CREATING A COMMUNITY
WHERE THEY'RE MORE WILLING AND
ABLE TO REACH OUT FOR HELP. UM
WE KNOW THAT ONE IN 20 PEOPLE
HAVE HAD THOUGHTS OF SUICIDE AND
I KNOW THAT 988 IS AN
OPPORTUNITY FOR PEOPLE WHO HAVE
NOT BEEN COMFORTABLE AND ASKING
FOR HELP ARE DOING THAT NOW. AND
SO I JUST WANTED TO ACKNOWLEDGE
THAT UM, I'M STILL SHERRICE
UNWELL SKI. I'M STILL WITH DIDI
HIRSCH AND WE'RE STILL THE LEAD
IN THE STATE FOR OUR 9 88
IMPLEMENTATION AND WE'RE HONORED
TO WORK COLLABORATIVELY WITH THE
11. OTHER CALIFORNIA 988 CRISIS
CENTERS. CALIFORNIA CENTERS HAVE
LONG INFLUENCED BEST PRACTICES
AND LED INNOVATIONS AND HOTLINE
OPERATIONS. SAMSON'S LEADERSHIP
CONSISTENTLY COMMENDS THE
PERFORMANCE OF CALIFORNIA WITH
ITS ROLLOUT OF 988 AND POINTS TO
THE WORK IN THE STATE AS A
SHINING EXAMPLE OF 9 80
IMPLEMENTATION IN THE NATION. ON
AVERAGE, CALIFORNIA'S 988 CRISIS
CENTERS RESPOND TO MORE CONTACTS
THAN ANY OTHER STATE PER MONTH,
RESPONDING TO OVER 260,000 CALLS
, CHATS AND TEXT ANNUALLY 24 7
24 7988 SUICIDE AND CRISIS
LIFELINE IS NOT A NEW SERVICE,
BUT IT'S AN EASY TO REMEMBER
NUMBER. TO REACH THE NETWORK OF
CRISIS CENTERS THAT HAVE BEEN
PROVIDING SERVICES AS THE
NATIONAL SUICIDE PREVENTION
LIFELINE FOR YEARS. PREVIOUS
SAMSA EVALUATIONS HAVE FOUND
THAT SERIOUSLY SUICIDAL
INDIVIDUALS CALL THE LIFELINE
AND THAT THERE HAVE BEEN
SIGNIFICANT DECREASES IN COLLARS
, REPORTS OF INTENT TO DIE
HOPELESSNESS AND PSYCHOLOGICAL
PAIN AFTER SPEAKING TO A
LIFELINE COUNSELOR. ON 988
CRISIS CENTERS ARE ALIGNED WITH
LIFELINE EVALUATED BEST
PRACTICES, INCLUDING THE SUICIDE
SAFETY POLICY THAT REQUIRES THAT
ALL CENTERS PRACTICE AFTER
ACTIVE ENGAGEMENT WITH THE GOAL
TO ESTABLISH RAPPORT AND
COLLABORATE WITH INDIVIDUALS TO
SECURE THEIR OWN SAFETY.
UTILIZING THE LEAST INVASIVE
INTERVENTION AND ONLY USING
EMERGENCY INTERVENTIONS AS A
LAST RESORT. CALIFORNIA 988
CRISIS CENTERS DO AN OUTSTANDING
JOB AT ACHIEVING THIS GOAL.
APPROXIMATELY 96% OF CONTACTS
ARE RESOLVED BY CRISIS
COUNSELORS ON THE CONTACT AND DO
NOT REQUIRE FURTHER
INTERVENTION. SINCE LAUNCHING
988 IN JULY, 2022 TOTAL INSTINCT
, CONTACTS ANSWERED, HAVE
INCREASED BY 22% YOUNG PEOPLE
UNDER 24 HAVE ACCOUNTED FOR
NEARLY 40% OF TOTAL CONTACTS,
INDIVIDUALS REACHING OUT ABOUT
SOMEONE THEY WERE CONCERNED
ABOUT HAVE INCREASED BY OVER
150. HELP SEEKERS WERE 54%
FEMALE 43% MALE AND 3% TRANS
GENDER, NON BINARY OR OTHER
GENDER. 58% OF CONTACTS CAME
FROM BLACK, INDIGENOUS AND
PEOPLE OF COLOR AS WELL AS THOSE
IDENTIFYING WITH MULTIPLE RACES
OR OTHER RACES. THE 12
CALIFORNIA CRISIS CENTERS ARE
WORKING TO MAKE 988 A TRUSTED
RESOURCE FOR ALL CALIFORNIANS.
THERE'S CURRENTLY A PRESS OP.
ONE OPTION FOR VETERANS PRESS
TWO OPTIONS FOR SPANISH SPEAKING
INDIVIDUALS, AS WELL AS
TRANSLATION SERVICES FOR OTHER
LANGUAGES. A PRESS THREE OPTIONS
FOR LGBT Q PLUS HELP SEEKERS.
ADDITIONALLY DIDI HIRSCH HAS
RECENTLY CONVENED TO STATEWIDE
988 TRIBAL SUMMITS IN
COLLABORATION WITH
ASSEMBLYMEMBER'S RAMOS TO
ADDRESS SPECIFIC CULTURAL
CONSIDERATIONS TO MAKE 988 A
TRUSTED RESOURCE FOR
CALIFORNIA'S NATIVE COMMUNITIES.
WITHOUT QUESTION. 988 IS ALREADY
SAVING LIVES. A RECENT 14 YEAR
OLD CHAT USER WHO IDENTIFIED AS
NON BINARY WROTE IN I'M FEELING
BETTER. THANK YOU SO MUCH FOR
TALKING TO ME UNDERSTANDING ME
AND HELPING ME THROUGH THIS
NIGHT. YOU'RE A BEAUTIFUL HUMAN
BEING, AND I APPRECIATE THE
STUFF YOU DO FOR EVERYONE. YOU
ARE DOING. MIRACLE WORK. YOU
SAVE PEOPLE'S LIVES. YOU COME TO
MY MIND DOWN TONIGHT. AND I
THANK YOU SO MUCH FOR THAT YOU
FOREVER HAVE A SPECIAL PLACE IN
MY HEART. ANOTHER CALLER CALLED
IN TO SAY THANK YOU. ON THIS DAY
YEARS AGO, SHE HAD CALLED THE
LIFELINE WHILE IN A DARK PLACE,
AND THE COUNCIL WAS ABLE TO GIVE
HER THE FOUNDATION OF EMOTIONAL
SUPPORT SHE NEEDED TO SEEK HELP
INTO HELL. TODAY. SHE'S IN A
REALLY GOOD PLACE, AND SHE'S
CURRENTLY LOOKING TO BUY HER
FIRST HOME, AND SHE FELT
COMPELLED TO CALL INTO THE
LIFELINE AND EXPRESS HER THINGS.
THE VISION FOR 988 IS A CRISIS
CARE CONTINUUM CONSISTING OF
THREE COMPONENTS LIKE A THREE
LEGGED STOOL, SOMEONE TO CONTACT
SOMEONE TO RESPOND AND SOMEWHERE
TO GO 988 CRISIS CENTERS AND THE
ADMINISTRATION HAVE FOCUSED THIS
FIRST YEAR ON THE FIRST LEG OF
THE STOOL TO ENSURE THAT THERE
IS SUFFICIENT CAPACITY FOR 988
CONTACTS FROM EVERYWHERE IN
CALIFORNIA. WE KNOW THAT THE
VOLUME 2988 WILL ONLY INCREASE
WITH DIVERSIONS FROM 911 WITH
PEOPLE SEEKING MOBILE CRISIS AND
WITH INCREASED ADVERTISING.
THEREFORE IT IS CRITICAL. WE
ENSURE THAT THERE IS SUSTAINABLE
, PREDICTABLE FUNDING. IN PLACES
IN PLACE. AS THIS LIFE SAVING
RESOURCE BECOMES EVEN MORE
RECOGNIZED IN THE COMING YEARS.
I WANT TO THANK ALL OF OUR
INCREDIBLE 988, CALIFORNIA
CRISIS CENTERS FOR THEIR
TIRELESS WORK, SAVING LIVES AND
THEIR COMMITMENT TO MAKING THE
988 NETWORK IN CALIFORNIA THE
VERY BEST THAT IT CAN BE ON
BEHALF OF ALL OF THE 988 CRISIS
CENTERS. WE ALSO WISH TO EXPRESS
OUR GRATITUDE TO OUR STATE
PARTNERS AT THE DEPARTMENT OF
HEALTH CARE SERVICES, THE
CALIFORNIA HEALTH AND HUMAN
SERVICES AND THE CALIFORNIA
OFFICE OF EMERGENCY SERVICES.
FOR THEIR ONGOING SUPPORT AND
COLLABORATION AS WELL AS
ASSEMBLYMEMBER'S BECK ABOUT
BAUER-KAHAN, THE PURSE PRINCIPAL
AUTHOR OF A B 988. THANK YOU,
CHAIRMAN AND COMMITTEE MEMBERS
AND I'M HAPPY TO ANSWER ANY
QUESTIONS. NEXT WE WILL HEAR
FROM MICHELLE CABRERA WITH C B H
D A HI. GOOD EVENING CHAIR AND
MEMBERS UM MICHELLE KATARINA
WITH C B H D A. WE WANT TO FIRST
THANK THE ADMINISTRATION AND THE
LEGISLATURE FOR THE SIGNIFICANT
INVESTMENTS THAT HAVE HELPED TO
LAY SOME OF THE GROUNDWORK IN
THE FOUNDATION FOR BOTH OUR 9 80
CALL CENTER INFRASTRUCTURE AS
WELL AS OUR MOBILE CRISIS
INFRASTRUCTURE. UM COUNTIES HAVE
IN CALIFORNIA FOR THE LAST
COUPLE OF DECADES. UM REALLY
SEATED, THE INVESTMENTS THAT
HAVE MADE THE NETWORK OF SUICIDE
PREVENTION CALL CENTERS AND WARM
LINES THROUGHOUT THE STATE
POSSIBLE AND IN PARTICULAR, THEY
WERE ABLE TO LEVERAGE MHS A
FUNDING TO HELP BUILD OUT.
CALIFORNIA'S 988 CALL CENTER
CAPACITY FOR SPANISH LANGUAGE
SERVICES, WHICH THEN WAS THE
NATIONAL SUICIDE PREVENTION LINE
AND ARE TODAY AND CONTINUE TO BE
FUNDERS OF THOSE CALL CENTERS.
UM TO VARYING DEGREES, WITH TWO
OF THOSE CALL CENTERS BEING
OPERATED BY COUNTY BEHAVIORAL
HEALTH, SPECIFICALLY, UM IN THE
I'M GONNA SPEAK A LITTLE BIT
TOO. BOTH ARE EVERTS AROUND
MOBILE CRISIS, UM, SERVICES
IMPLEMENTATION AS WELL AS TO THE
9 88 ROLLOUT AND THE TRAILER
BUILT SO ON THE MOBILE CRISIS
SIDE AGAIN, WE'VE MUCH LIKE THE
SCHOOL BASED SERVICES. WE'VE GOT
A BIT OF A PATCHWORK RIGHT NOW
IN CALIFORNIA AND A BIG PART OF
THE REASON WHY IS BECAUSE
BECAUSE BEFORE THE MEDICARE
MEDICAID BENEFITS. WHICH CMS UM
YOU KNOW, JUST BROUGHT ONLINE.
UH THERE REALLY WAS SORT OF NOT
A CONSISTENT BENEFIT OR
SUSTAINED FUNDING AND WITH THE
MEDICAL BENEFIT, WE WILL HAVE
FUNDING FOR ONE OUT OF EVERY
THREE CALIFORNIANS TO RECEIVE A
MOBILE CRISIS SERVICE. UM WITH
THE BABY 9 80 A LEGISLATION LAST
YEAR. THE INTENTION I KNOW. WAS
TO, UM PUT LANGUAGE IN THAT
WOULD STRENGTHEN THE REQUIREMENT
FOR PRIVATE INSURANCE PLANS TO
REIMBURSE. WE ACTUALLY THINK
THAT THE ADMINISTRATION'S
PROPOSED TRAILER BILL, REVISIONS
OF THAT LANGUAGE DOES STRENGTHEN
THE OPPORTUNITY FOR US TO
RECEIVE REIMBURSEMENT FOR THOSE
OUT OF NETWORK. UM PRIVATE
INSURANCE PLAN SERVICES, AND IT
IS NUANCED, AND IT DOES GET INTO
YOUR INTERPRETATION OF FEDERAL
LAW. I WOULD SAY WE LEAN CLOSER
TO THE STATE'S INTERPRETATION
AND THINK THAT IT'S REALLY
IMPORTANT FOR US TO REMOVE THE
REQUIREMENT THAT EXISTS IN 988
TODAY FOR US TO ESTABLISH
MEDICAL NECESSITY FOR TO
REIMBURSE FOR CALL CENTER
SERVICES AND FOR A FIELD BASED
MOBILE CRISIS. WE ACTUALLY
PREFERRED THE ADMINISTRATION'S
ORIGINAL LANGUAGE, WHICH ALIGNED
REIMBURSEMENT REQUIREMENTS WITH
THE PRUDENT ONLY PERSON STANDARD
FOR, UM, AMBULANCE SERVICES. SO
GENERALLY IF YOU THINK YOU HAVE
AN EMERGENCY, AND IT SEEMS
REASONABLE THAT YOU THOUGHT THAT
THAT THE PROVIDER WILL GET
REIMBURSED FOR COMING OUT AND
SERVING YOU, SO WE PREFER PLAN A
IN TERMS OF WHAT HAS BEEN
OFFERED, BUT THINK THAT THIS
LANGUAGE IS A STEP IN THE RIGHT
DIRECTION. UM AND REIMBURSEMENT
ON THE PRIVATE SIDE IS ESSENTIAL
BECAUSE AGAINST 70% OF
CALIFORNIANS WON'T BE CAPTURED
UNDER THE MEDICAL BENEFITS. AND
YET WHEN PEOPLE CALL 988 AGAIN,
THEY'RE NOT GOING TO BE WHEN
SOMEONE'S HAVING SUICIDAL
IDEATION. IT'S NOT A GREAT TIME
TO SAY HEY, WHAT KIND OF
INSURANCE DO YOU HAVE, BY THE
WAY RIGHT OR WHEN THEY'RE IN THE
FIELD HAVING A CRISIS, AND SO WE
WANT TO REMOVE AS MANY BARRIERS
AS WE CAN ALL GET TO THAT
UNIFORM. UM, UNIFIED VISION. UM
IT IS GOING TO TAKE TIME TO
BUILD OUT OUR CAPACITY AND
INFRASTRUCTURE. THE FACT THAT
THE STATE PUT INFRASTRUCTURE
MONEY ON THE TABLE. WE'VE GOTTEN
A CMS PLANNING GRANT. ALL OF
THOSE THINGS ARE REALLY
WONDERFUL AND REALLY HELPED TO
SORT OF MOVE US IN THE RIGHT
DIRECTION. BUT RURAL CALIFORNIA
IS GOING TO BE TOUGH, RIGHT
FINDING THE HUMANS TO WORK A
NIGHT SHIFT TO SWING SHIFT. I'M
SURE YOU KNOW, DR ARAMBULA. IS
REALLY TOUGH, AND SO WE'VE BEEN
REALLY APPRECIATIVE TO THE STATE
FOR ALLOWING US TO CRAFT THE
BENEFIT FROM MOBILE CRISIS IN A
WAY WHERE WE CAN REALLY MAXIMIZE
OUR USE OF PARAPROFESSIONALS AND
PHASE IN THE IMPLEMENTATION,
INCLUDING WITH THOSE 11 FRONTIER
COUNTIES. UM, BUT WE DO THINK
THAT IT'S STILL GOING TO TAKE A
LOT TO GET THERE, AND SO WE NEED
TO TAKE A SORT OF STEADY.
FOCUSED APPROACH AGAIN WORKING
IN PARTNERSHIP WITH COMMUNITIES
AND ALONG WITH THE STATE. UM.
I'LL JUST SAY ONE OTHER QUICK
THING, WHICH IS THAT IN TERMS OF
THE 9 88 CALL CENTER STRUCTURES
AND INFRASTRUCTURE. IT WILL ALSO
TAKE TIME TO KNIT TOGETHER ARE 9
88 CALL CENTERS WITH THE MOBILE
CRISIS SERVICES ON THE GROUND,
RIGHT? UM RIGHT NOW WE HAVE
LARGELY VOLUNTEER OPERATED 9 80
CALL CENTERS AND DOING MOBILE
CRISIS DISPATCH IS REALLY A
PROFESSIONAL JOB, RIGHT? YOU
NEED A CLINICIAN TO DO THAT.
TRIAGE AND TO DETERMINE WHETHER
OR NOT YOU NEED TO SEND A MOBILE
CRISIS TEAM OUT. THAT IS A SKILL
SET IN AND OF ITSELF. WE'VE GOT
12 98 CALL CENTERS IN CALIFORNIA
TODAY, COMPARED WITH THE ALMOST
459 11 CALL CENTERS, AND SO THAT
JUST PUTS INTO PERSPECTIVE A
LITTLE BIT THE ROAD THAT WE'RE
GOING TO HAVE TO WALK TO GET TO
THAT THREE STOOL VISION THAT
SHERRY LAID OUT. AND HAPPY TO
TAKE ANY QUESTIONS. DEPARTMENT
OF FINANCE. THESE COMMENTS,
LANGUAGE. YEAH. ELIO. RYAN
MILLER CONCERNS.
WE'LL TRY AGAIN. DEPARTMENT OF
FINANCE. ROMMEL'S PART OF
FINANCE THIS TIME ON THE RECORD
, WE WOULD LIKE TO ECHO THE
HEALTH AND HUMAN SERVICES
AGENCIES COMMENTS THAT TRAY
LIBERAL LANGUAGE IS AN
APPROPRIATE VEHICLE. UH, FOR
THIS ISSUE, GIVEN THE GOVERNOR'S
SIGNING MESSAGE, AND THAT IT'S
RELATED TO MULTIPLE BUDGET
CHANGE PROPOSALS. ELIO. RYAN
MILLER. ELIO WE HAVE NO CONCERNS
WITH THIS PROPOSAL. BRING IT UP
TO THE DIESS. UM I'LL BEGIN. I
WANT TO FOCUS ON THE MOBILE
CRISIS TEAMS. I THINK THAT'S A
REALLY IMPORTANT PART. AND I'M
HEARING SOMETHING DIFFERENT THAN
I SAW WITHIN THE AGENDA, AND IT
REALLY SOUNDS LIKE YOU'RE TRYING
TO CREATE FLEXIBILITIES AND
BROADEN THE SERVICE AND
ACKNOWLEDGED THAT IT'S NOT A ONE
SIZE FITS ALL BUT MANY OF OUR
RURAL COUNTIES. MANY CERTAIN
FLEXIBILITIES, BUT I REALLY WANT
TO GET AN UNDERSTANDING ARE ARE
WE EXPECTING TO BE ABLE TO
OPERATIONALIZE THIS BY THE END
OF THE YEAR? COME NEXT YEAR. ARE
WE EXPECTING US TO BE ABLE TO
REALISTICALLY SAY WE'RE TREATING
THE BRAIN LIKE WE DO? MEDICAL
EMERGENCIES? I MEAN, I'M GONNA
JUST WE'LL GET NUANCED, TOO. BUT
IF WE HAVE A MEDICAL EMERGENCY,
AND IT'S A PRUDENT LAYPERSON
STANDARD WHY DO WE HAVE A
DIFFERENT STANDARD WHEN IT'S A
PSYCHIATRIC EMERGENCY? IN TERMS
OF CALLING AND NOT USING THAT
SAME ONE? SO I'M JUST TRYING TO
GET A SENSE? HOW HOW CAN WE MAKE
SURE WE'RE OPERATIONALIZED BY
NEXT YEAR? SURE I'LL TAKE THE
THOSE ARE TWO DIFFERENT
QUESTIONS, AND I WILL ALSO
WELCOME MY D HCS AND GMHC
COLLEAGUES TO SPEAK TO THE
MOBILE CRISIS PIECES AND, OF
COURSE, THE ADD ON TO THE
COMMERCIAL COVERAGE PIECES. I'LL
SPEAK FIRST TO THE COMMERCIAL
COVERAGE PIECES, I THINK UM,
WHAT YOU WILL SEE IS THAT WE
ACTUALLY MIRRORED THE STATUTORY
LANGUAGE THAT IS UNDER 911 AS
THE BASIS FOR THE PROCESS FOR
REIMBURSEMENT FOR 9 88. SO WE
DIDN'T WANT TO PUT IT IN THE 911
STATUTE FOR A NUMBER OF REASONS
, AND SO WE DECIDED TO MIRROR
THAT LANGUAGE, SO I DON'T KNOW
IF, UM MR SOUTHERN OR OTHERS
WANT TO ADD ON TO THAT, AND MR
SAID WITH IF YOU WANT TO ADD ON
TO THE MOBILE CRISIS PIECE OKAY?
GOOD EVENING, DAN SOUTHERN, FROM
THE DBC, AS MISS CHEN WAS NOTING
OUR TRAILER BILL LANGUAGE WAS
TRYING TO MIRROR OUR CURRENT
STATUTORY REQUIREMENTS FOR
EMERGENCY SERVICES, AND SO,
HELLO A REVIEW OF THAT, IF IN A
ROLY PRESENTS WITH A 98 CRISIS,
NO PRIOR AUTHORIZATIONS REQUIRED
BY THE HEALTH PLAN BEFORE THOSE
SERVICES ARE RENDERED. AND TELL
THE POINT OF STABILIZATION WHAT
WE'VE NOTED IN THE TRAIL OF OUR
LANGUAGES AT THE POINT OF
STABILIZATION THAT THE PROVIDER
WOULD NEED TO CONTACT THE HEALTH
PLAN TO REQUEST EITHER
AUTHORIZATION FOR THE SERVICES,
POST STABILIZATION OR TRANSFER
THE ENROLLEE TO AN IN NETWORK
PROVIDER. UM PAYMENT IS AT
REASONABLE AND CUSTOMARY FOR AN
OUT OF NETWORK PROVIDER AND THEN
THAT WERE PROVIDED WOULD BE THE
CONTRACTOR RATE. AND IT THE COST
SHARING FOR THE CONSUMER WILL BE
IN NETWORK COST SHARING, NO
MATTER WHICH PROVIDERS PROVIDING
SERVICES. SO THAT WAS OUR TRYING
TO MIRROR THAT, AND I KNOW WE'RE
WORKING WITH THE STAMBERG GETS
STUDENT KENNEDY FORUM TO
FINALIZE THAT LANGUAGE BECAUSE
THERE ARE SOME CONCERNS WITH THE
NO SURPRISE IS ACTUALLY A LITTLE
BIT FURTHER ON THE POST
STABILIZATION. IT'S MORE
SPECIFIC TO THE REQUIREMENT THAT
THE ENROLLEE COULD BE
TRANSFERRED. THROUGH A NON
EMERGENCY TRANSPORTATION SERVICE
, WHICH IS A LITTLE BIT OF
EXTENSION OF OUR CURRENT 911
REQUIREMENTS. BUT AGAIN MORE
THAN HAPPY TO WORK WITH THE
SUMMER AGAIN, STOUTE AND KENNY
FORMATTING LANGUAGE I'M GOING TO
UPLIFT THEIR COMMENTS ABOUT
FEELING POSITIVE. I TOO. I'M
ENCOURAGED BY THE CONVERSATION
THAT WE'RE HAVING HERE AND IT
DOES APPEAR. THE GOALS ARE
CLEAR. BUT I'M GONNA AND LIKE MS
CABRERA DID IT. IT WILL TAKE A
LOT FOR US TO GET THERE. AND I
THINK WHEN WE HEAR ABOUT THESE
PATCHWORKS UM, FOR US TO MAKE
SURE WE HAVE A STABLE SAFETY NET
REALLY TAKES COLLABORATION AND
SO LOOK FORWARD TO THOSE
CONTINUED CONVERSATIONS AND THE
DIRECTION THAT WE'RE MOVING. DID
YOU WANT MR SAD WITH TO SPEAK TO
THE MOBILE CRISIS, PLEASE? HI
GOOD EVENING CHAIR, TYLER SAID
WITH DEPUTY DIRECTOR DEPARTMENT
OF HEALTH CARE SERVICES DEPUTY
DIRECTOR FOR BEHAVIORAL HEALTH.
UM I WANTED TO PROVIDE
CLARIFICATION ON THE TIMELINE
FOR THE IMPLEMENTATION OF THE
MEDICAL MOBILE CRISIS BENEFIT.
UM UH, ONE PANELIST NOTED THAT
OH, THERE'S FLEXIBILITY FOR 11
COUNTIES, SO WE HAVE SUBMITTED A
STATE PLAN AMENDMENT TO OUR
FEDERAL PARTNERS AT CMS SEEKING
COVERAGE FOR THE NEW MEDICAL
MOBILE CRISIS BENEFIT, EFFECTIVE
JANUARY 1ST OF THIS YEAR. WE ARE
WORKING WITH OUR COUNTIES TO
ENSURE THEY HAVE OVER THE COURSE
OF THIS CALENDAR YEAR TO
IMPLEMENT IT SO THAT COUNTIES
WOULD GO LIVE WITH MEDICAL
MOBILE CRISIS BY THE END OF THIS
CALENDAR YEAR. THERE ARE 11
COUNTIES REPRESENTING LESS THAN
1% OF THE MEDICAL POPULATION
WHOSE POPULATION IS SO SMALL
THAT THE RATE DEVELOPMENT
PROCESS BASED ON PROJECTED
SERVICE UTILIZATION FOR THE 24
73 65 CAPACITY MEANS WE STILL
HAVEN'T FINALIZED RATES FOR
THOSE SMALL COUNTIES, SO WE HAVE
PROPOSED A SIX MONTH EXTENSION
SO THAT THOSE COUNTIES WOULD GO
LIVE JULY 1ST 2024. WITH THAT I
WILL THANK VERY MUCH THIS PANEL
AND WE WILL MOVE ON TO ISSUE
SEVEN. IS SHE.
IS SHE? SEVEN IS AN OVERVIEW OF
THE DEPARTMENT OF STATE
HOSPITALS AND THE PROPOSED SHH
BUDGET. OUR FIRST SPEAKER.
STEPHANIE CLENDENIN, DIRECTOR OF
THE DEPARTMENT OF STATE
HOSPITALS. WELCOME AND PLEASE
BEGIN. GOOD EVENING CHAIR
STEPHANIE CLINTON IN DIRECTOR
FOR THE DEPARTMENT OF STATE
HOSPITALS. THE DEPARTMENT OF
STATE HOSPITALS MANAGES THE
CALIFORNIA STATE HOSPITAL SYSTEM
. DSHS MISSION IS TO PROVIDE
EVALUATION AND TREATMENT IN A
SAFE AND RESPONSIBLE MANNER,
LEAVING INNOVATION AND
EXCELLENCE ACROSS THE CONTINUUM
OF CARE AND SETTINGS. WE OPERATE
THE FIVE STATE HOSPITALS LOCATED
THROUGHOUT CALIFORNIA WITH OVER
6000 INPATIENT BEDS THAT INCLUDE
ACUTE INTERMEDIATE SKILLED
NURSING FACILITY AND RESIDENTIAL
RECOVERY LEVEL OF BEDS. WE ALSO
OPERATE THE CONDITIONAL RELEASE
PROGRAM, WHICH IS A SYSTEM OF
COMMUNITY BASED SERVICES
OPERATED IN PARTNERSHIP WITH
COUNTY BEHAVIORAL, HEALTH AND
PRIVATE PROVIDERS THAT IS
DESIGNED TO TRANSITION PATIENTS
BACK INTO THE COMMUNITY
FOLLOWING A FORENSIC COMMITMENT
TO D. S H. WE ALSO HAVE A
PARTNERSHIPS WITH COUNTY
BEHAVIORAL HEALTH PROGRAMS,
PRIVATE PROVIDERS AND COUNTY
SHERIFF'S TO PROVIDE COMMUNITY
BASED RESTORATION. DIVERSION
OPPORTUNITIES AND JAIL BASED
TREATMENT PROGRAMS FOR
INDIVIDUALS COMMITTED TO THE
DEPARTMENT IS INCOMPETENT TO
STAND TRIAL, THE INDIVIDUALS
SERVED BY OUR SYSTEM OF CARE OR
MANDATED FOR MENTAL HEALTH
TREATMENT BY EITHER A CRIMINAL
OR CIVIL COURT JUDGE OR THE
BOARD OF PAROLE HEARINGS. THE
MAJORITY OF THE INDIVIDUALS. WE
SERVE OUR FORENSIC COMMITMENTS
THEY HAVE EITHER COMMITTED OR
HAVE BEEN ACCUSED OF COMMITTING
CRIMES LINKED TO THEIR MENTAL
ILLNESS AND COME TO US DIRECTLY
THROUGH THE CRIMINAL COURTS OR
AFTER THEY HAVE COMPLETED A
SENTENCE AT THE CALIFORNIA
DEPARTMENT OF CORRECTIONS AND
REHABILITATION. WE SERVE SIX
DIFFERENT TYPE OF PATIENT
COMMITMENTS. THESE INCLUDE
INCOMPETENT TO STAND TRIAL, THE
NOT GUILTY BY REASON OF
INSANITY. INDIVIDUALS WHO HAVE
COMPLETED A SENTENCE AT SEA VCR
FOR THEIR CRIMES, BUT THEN ARE
COMMITTED TO THE DEPARTMENT AS
OFFENDERS WITH MENTAL HEALTH
DISORDERS OR SEXUALLY VIOLENT
PREDATORS AFTER THEY'VE
COMPLETED THEIR SENTENCE, AND
THEN CURRENT INMATES FROM CDCR
WHO REQUIRE INPATIENT MENTAL
HEALTH TREATMENT, AND FINALLY,
WE SERVE INDIVIDUALS CONSERVED
BY A CIVIL COURT UNDER THE LAND,
ARMIN PETRAS SHORT ACT HE
REQUIRE STATE HOSPITAL LEVEL
TREATMENT. THE 23 24 GOVERNORS
BUDGET INCLUDES A TOTAL BUDGET
OF 3.2 BILLION FOR D S H
OPERATIONS AND INCREASE OF 35.5
MILLION OR 1% FROM THE 2022
BUDGET ACT WITH 49.7 PROPOSED
NEW POSITIONS IN 23 24. THE
PROPOSED BUDGET AUGMENTATIONS
GENERALLY INCLUDE INVESTMENTS TO
CONTINUE THE DEPARTMENT'S
EFFORTS TOWARDS IMPROVING THE
DEPARTMENT'S OPERATIONS AND
DELIVERY OF SERVICES AND STATE
HOSPITAL FACILITY IMPROVEMENTS.
THE CASELOAD ESTIMATE IS
PROJECTED TO EXCEED 9000 BY THE
END OF FISCAL YEAR. 23 24 WITH A
TOTAL OF 5468 PATIENTS ACROSS
THE STATE HOSPITALS, 2772 AND
CONTRACTED PROGRAMS AND 1049 IN
THE CONDITIONAL RELEASE
PROGRAMS. BEFORE I PROCEED. I
DID WANTED TO CHECK IN WITH THE
CHAIR TO MY IMPROVED PREPARED.
WE ARE PREPARED TO PRESENT AN
OVERVIEW OF EACH OF THE
ESTIMATES THAT RECOGNIZE AND IN
TIME WHETHER YOU WOULD LIKE US
TO DO THAT, OR NOT. UM HIGH
LEVEL OVERVIEWS ARE OKAY DUE TO
THE LATENESS OF THE HOUR AND
STILL 22 ISSUES FOR US TO
ADDRESS TONIGHT. UM LET'S LET'S
KEEP IT HIGH LEVEL IF WE MET,
OKAY, SO I'LL GO AHEAD AND TURN
IT OVER TO CHIEF DEPUTY DIRECTOR
HAUSER TO COVER SOMETHING THE
FIRST HALF OF THEM. GOOD EVENING
CHAIR. MY NAME IS BRENT HAUSER,
CHIEF DEPUTY DIRECTOR OF
OPERATIONS. I'LL SPEAK AT A VERY
HIGH LEVEL TO SPECIFIC PROGRAM
AND CASELOAD. UPDATES GIVEN THE
HOUR STARTING WITH THE COUNTY
BED BILLING REIMBURSEMENT
AUTHORITY. THIS ITEM IS
COMPRISED OF TWO MAIN COMPONENTS
THAT THE COUNTY REIMBURSES THE
DEPARTMENT FOR PATIENT TREATMENT
. THE FIRST BEING BLANCHED
ALMOND PETRA SORT POPULATION AND
THE SECOND BEING NON RESTORE A
BILL AND COMPETENT TO STAND
TRIAL. DEFENDANTS WERE NOT
TIMELY TRANSPORTED AND RETURNED
TO THE COMMITTEE COUNTY WITHIN
STATUTORY TIMELINES. AT THE 2023
GOVERNOR'S BUDGET, THE
DEPARTMENT PROPOSES TO MAINTAIN
THE CURRENT REIMBURSEMENT
AUTHORITY OF 191.6 MILLION
MOVING ON TO A DIFFERENT ITEM.
UNDERESTIMATE THE DSA.
METROPOLITAN INCREASED SECURE
BED CAPACITY PROJECT. THE
DEPARTMENT REFLECTS AT ONE TIME
SAVINGS OF $11.2 MILLION GENERAL
FUND IN THE CURRENT YEAR. THE
PROJECT, WHICH ORIGINATED WITH
THE CAPITAL OUTLAY PROJECT IN
2016 ADDED SECURITY, FENCING AND
INFRASTRUCTURE CAN EXISTING
PATIENT BUILDING AT THIS
HOSPITAL SO THE BED CAPACITY
COULD BE USED TO SERVE
ADDITIONAL FORENSIC PATIENTS.
THE CONSTRUCTION PROJECT WAS
COMPLETED IN TWO OF THE FIVE
PATIENT UNITS WERE ACTIVATED
PRIOR TO THE PANDEMIC FOR
TREATMENT OF INDIVIDUALS FOUND
INCOMPETENT TO STAND TRIAL. THE
GOVERNOR'S BUDGET. ONE UNIT IS
BEING USED FOR COVID ISOLATION
SPACE AND THE OTHER TWO UNITS OR
HOUSING. TSH METROPOLITAN SNIFF
PATIENTS, THE SAVINGS IDENTIFIED
OR RELATED TO PERSONAL SERVICES
ASSOCIATED WITH THE DELAY AND
ACTIVATION OF THE REMAINING
UNITS. PROVIDING A QUICK UPDATE
ON ENHANCED TREATMENT PROGRAM.
DSHS REPORTING A ONE TIME
SAVINGS OF 4.8 MILLION IN THE
CURRENT YEAR IN THE PRIOR YEAR
BUDGET ACT WAS APPROPRIATED
CAPITAL OUTLAY FUNDING TO
CONVERT EXISTING PATIENT UNITS
INTO AN ENHANCED TREATMENT
PROGRAM. UNITS AND RESOURCES
WERE AUTHORIZED TO ACTIVATE
THOSE UNITS WHEN THEY WERE
COMPLETED. TSH PREVIOUSLY
COMPLETED THE CONSTRUCTION OF A
13 BED UNIT AT D. SHH ATASCADERO
AND THAT HAS BEEN ACTIVATED
SINCE SEPTEMBER. 2021. THE 2ND
10 BIT. YOU DIDN'T ADD. THE S H
PATENT IS UNDERWAY AND AS OF THE
GOVERNOR'S BUDGET, DSHS
EXPERIENCING A NINE MONTH
PROGRAM ACTIVATION DELAY FOR
THIS UNIT DUE TO CONSTRUCTION.
AND THAT'S WHAT THE SAVINGS ARE
REFLECTING. MOVING ON TO DSHS
MISSION BASED REVIEW INITIATIVES
IN THE 20TH 23 24 GOVERNORS
BUDGET TSH REFLECTS THE SAVINGS
OF 44.9 MILLION IN CURRENT YEAR
SAVINGS OF 24 MILLION AND 46 A
HALF POSITIONS AT 23, 24 10
MILLION AND 46 POSITIONS IN 24
25. LASTLY, A SAVINGS OF 10.9
MILLION AND 46 A HALF POSITIONS
AND 25 26 SEVERAL YEARS AGO, TSH
INITIATIVE INITIATED AN EFFORT
TO EVALUATE STAFFING PRACTICES
ACROSS THE STATE HOSPITALS AND
REVIEWED FOR COMPONENTS.
HOSPITAL FORENSIC DEPARTMENTS.
24 HOUR CARE, NURSING SERVICES,
PROTECTIVE SERVICES AND
TREATMENT, PLANNING AND
DELIVERY. AS A RESULT OF THESE
PROCESSES PROPOSED STAFFING
METHODOLOGIES IN POSITIONS
REQUESTING ADJUSTMENTS WERE
REQUESTED AND AUTHORIZED TO BE
PHASED IN OVER A MULTIYEAR
PERIOD FOR THESE FOUR COMPONENTS
, AND THE SAVINGS ARE REPORTED
OR DUE TO DELAYS AND CHALLENGES
EXPERIENCED WITH HIRING
POSITIONS THAT WERE AUTHORIZED
RECOGNIZING THE CHALLENGES WITH
RECRUITING AND HIRING HAS BEEN
IMPLEMENTING A MULTIFACETED
APPROACH TO EXPAND ITS
RECRUITMENT AND RETENTION
EFFORTS THROUGH MARKETING AND
OUTREACH. PIPELINE DEVELOPMENT
VIA EDUCATIONAL PARTNERSHIPS AND
STREAMLINING THE HIRING PROCESS.
TWO MORE ISSUES FOR ME. I'M JUST
SUMMARIZING HIGH LEVEL FOR THE
PATIENT DRIVEN OPERATING
EXPERIENCE, EXPENSES AND
EQUIPMENT. UPDATE TSH REQUEST
20.5 MILLION ONGOING TO SUPPORT
THE INCREASE IN PATIENT DRIVEN
SUPPORT COSTS WITHIN THE TSH
SYSTEM, WHICH INCLUDES BUT IS
NOT LIMITED TO CLOTHING,
PERSONAL SUPPLIES. FOOD LAUNDRY
MEDICATION OUTSIDE MEDICAL
EXPENSES. SHH IS UTILIZING THE
METHODOLOGY ESTABLISHED AND
PRIOR BUDGET ACTS TO INCLUDE A
FUNDING REQUEST IN THE BUDGET
YEAR AND ONGOING BASED ON 21.
2021 22 ACTUAL EXPENDITURES AND
2023 24 PROJECTED SENSES. IN
RELATION TO THE COVID 19
RESPONSE AND THE BUDGET YEAR
DSHS REQUESTING 51 POINT
3,000,001 TIME TO CONTINUE TO
SUPPORT INFECTION CONTROL
MEASURES TO PROTECT THE HEALTH
AND SAFETY OF OUR PATIENTS AND
OUR EMPLOYEES BEYOND THE STATE
OF EMERGENCY END DATE WITH THE
ONSET OF THE COVID 19 PANDEMIC,
THE DEPARTMENT HAS EXECUTED A
COVID 19 RESPONSE PLAN IN
ALIGNMENT WITH CDC, CD PH AND
LOCAL PUBLIC HEALTH DEPARTMENTS
AND WE ADJUST THIS PLAN ON AN
ONGOING BASIS BASED ON THE
NATURE OF THE PANDEMIC RESOURCES
ARE NEEDED TO CONTINUE TO
SUPPORT TESTING SURGE CAPACITY
RESOURCES FOR PUBLIC HEALTH
RELATED PERSONNEL AND PP WITH
THAT WE'LL GO AHEAD AND TURN IT
OVER TO THE CHIEF DEPUTY
DIRECTOR OF PROGRAMS SERVICES TO
CONCLUDE THIS ITEM. HI HI CHRIS
EDEN'S CHIEF DEPUTY DIRECTOR
PROGRAM SERVICES. I'LL BE
COMMENTING ON THE CONDITIONAL
RELEASE PROGRAM NON S VP
CASELOAD THE DEPARTMENT IS
REQUESTING 2.6 MILLION AND TWO
POSITIONS IN 23 24, ONGOING IN
RESPONSE TO INCREASED WORKLOAD
AND COSTS FOR THE DEPARTMENT AND
ARE CONTRACTED PROVIDERS AND
EVALUATORS, WHICH IS DRIVEN BY
THE ACTIVATION OF NEW PLACEMENT
OPTIONS ESTABLISHED UNDER
CONTRACTS. EXPANDING CONTINUUM
OF CARE. THE CONRAD PROGRAM IS
DSHS SYSTEM OF COMMUNITY BASED
SERVICES DESIGNED TO TRANSITION
INDIVIDUALS WHO ARE TREATED IN
THE STATE HOSPITALS AND BACK
INTO THE COMMUNITY. UM DURING
THE PAST SEVERAL BUDGET ACTS,
THE DEPARTMENT HAS BEEN
AUTHORIZED TO EXPAND THE
CONTINUUM OF CARE, AND IT'S
CONRAD PROGRAM TO PROVIDE
ADDITIONAL TREATMENT SETTINGS TO
INCREASE THE NUMBER OF
INDIVIDUALS WHO ARE ABLE TO
TRANSITION FROM THE STATE
HOSPITALS. THIS IS INCLUDED
ESTABLISHING A NEW CONTRACT.
FORENSIC ASSERTIVE COMMUNITY
TREATMENT REGIONAL PROGRAM,
EXPANDING THE STATEWIDE
TRANSITIONAL RESIDENTIAL PROGRAM
AND INCREASING THE NUMBER OF IMD
BEDS IN THE CONRAD PROGRAM TO
HELP INDIVIDUALS TRANSITION. THE
PROJECTED CONTRACT CASELOAD IS
1020. CONRAD CLIENTS IN 22 23,
AS WELL AS IN 23 24. LASTLY WE
DO HAVE AN ITEM WITHIN OUR ISTEA
SOLUTIONS ESTIMATE ITEM. WITH
RESPECT TO THIS. THE BUDGET
ADJUSTMENT REFLECTED IN THIS
ITEM IS SPECIFIC TO THE JAIL
BASED COMPETENCY TREATMENT
PROGRAMS AND THE ONE TIME
INFRASTRUCTURE FUNDING
AUTHORIZED IN 22 23 TO DEVELOP
RESIDENTIAL HOUSING SETTINGS. UH
TO SUPPORT FELONIOUS TO
INDIVIDUALS PARTICIPATING IN
EITHER COMMUNITY BASED
RESTORATION OR DIVERSION
PROGRAMS. THE DEPARTMENT IS
REQUESTING. ONE POSITION IN 23
24 ONGOING TO SUPPORT THE SHIFT
IN ADMINISTRATIVE WORKLOAD FROM
CLINICIANS TO AN OFFICE
TECHNICIAN, WHICH IS GOING TO
FREE THE CLINICAL STAFF TO FOCUS
ON PATIENT CARE ISSUES AND
PROVIDER OVERSIGHT. ADDITIONALLY
THE DEPARTMENT IS REFLECTING A
NET SAVINGS OF 27.4 MILLION IN
THE CURRENT YEAR AND 3.1 MILLION
IN THE BUDGET, URINE ONGOING
PRIMARY DRIVER OF THE SAVINGS IS
A REDUCTION IN THE SAN
BERNARDINO JAIL BASED COMPETENCY
TREATMENT PROGRAMS CAPACITY FROM
146 BEDS TO 64, WHICH WAS
EFFECTIVE IN SEPTEMBER OF LAST
YEAR. AH IN ADDITION, THERE ARE
A NUMBER OF OFFSETS TO THE LEVEL
OF BUDGET YOUR SAVINGS DUE TO A
NUMBER OF PROGRAMS THAT ARE
PENDING ACTIVATION. UM THREE
ADDITIONAL PROGRAMS WERE ABLE TO
INCREASE THEIR BED CAPACITY BY
40 BEDS AND BED RIGHT INCREASES
ANTICIPATED FOR 20 OF THE
PARTICIPATING COUNTIES. AS OF
DECEMBER 2022. THERE WERE 413
BEDS ACROSS 23. COUNTY PROGRAMS.
AND WITH THAT, I WILL CONCLUDE
MY PRESENTATION AND ASK IF
THERE'S ANY QUESTIONS,
DEPARTMENT OF FINANCE.
DEPARTMENT OF FINANCE. YOU KNOW
HONG, NO FURTHER COMMENTS.
CARILLO. WILLOW INZELL. AH, WE
HAVE NO CONCERNS WITHIN THE
PROPOSALS. WITH THAT I WILL.
THANKS VERY MUCH THIS PANEL WILL
MOVE ON TO ISSUE EIGHT. ISSUE
EIGHT IS AN OVERSIGHT ISSUE ON
BEHAVIORAL HEALTH AND JUSTICE
INVOLVEMENT. OUR FIRST SPEAKER
WILL BE TSH DIRECTOR STEPHANIE
CLENDENIN. THANK YOU, MR CHAIR
STEPHANIE CLINTON AND DIRECTOR
FOR THE DEPARTMENT OF STATE
HOSPITALS. THE 2022 BUDGET ACT,
AUTHORIZED 535 MILLION
INCREASING TO 638 MILLION IN
FISCAL YEAR 25 26. WHERE THE
DEPARTMENT OF STATE HOSPITALS TO
IMPLEMENT INCOMPETENT TO STAND
TRIAL SOLUTIONS TO HELP ADDRESS
THE GROWING NUMBER OF
INDIVIDUALS BEING REFERRED FROM
THE COURT TO THE DEPARTMENT AS
INCOMPETENT TO STAND TRIAL.
INDIVIDUALS WHO ARE INCOMPETENT
TO STAND TRIAL HAVE BEEN
ARRESTED FOR A CRIME AND AS A
RESULT OF THEIR MENTAL ILLNESS
ARE UNABLE TO UNDERSTAND THE
NATURE OF THE CHARGES AGAINST
THEM. OR A SISTER COUNCIL IN
THEIR DEFENSE. THE COURTS MAKE
THE DETERMINATION WHETHER AN
INDIVIDUAL IS INCOMPETENT TO
STAND TRIAL BASED ON THE
EVALUATION BY A COURT APPOINTED
EVALUATOR, INDIVIDUALS WHO ARE
FOUND INCOMPETENT TO STAND TRIAL
AND FELONY CHARGES ARE TYPICALLY
REFERRED TO THE DEPARTMENT FOR
RESTORATION OF COMPETENCY
TREATMENT. OVER THE LAST DECADE
, DESPITE DSHS EFFORTS TO EXPAND
TREATMENT CAPACITY, AMONG OTHER
EFFORTS THAT INCREASING NUMBER
OF INDIVIDUALS BEING FOUND IST
AND REFERRED TO THE DEPARTMENT
OUTPACED THE DEPARTMENT'S
EFFORTS AND RESULTED IN AN
ONGOING WAITLIST FOR INDIVIDUALS
NEEDING RESTORATION OF
COMPETENCY SERVICES.
ADDITIONALLY DUE TO THE COVID 19
PANDEMIC AND NECESSARY INFECTION
CONTROL MEASURES THAT WE HAD TO
IMPLEMENT AT THE STATE HOSPITALS
DURING THE FIRST TWO YEARS OF
THE PANDEMIC, THE WAITLIST
INCREASE SIGNIFICANTLY. AS A
RESULT OF A 2015 LAWSUIT BY THE
CL YOU REGARDING THE TIME THAT
IST DEPENDENTS WERE WAITING IN
JAIL TO BE TRANSFERRED TO DSHS
TREATMENT PROGRAMS, THE COURT
ORDERED THE DEPARTMENT TO
INITIATE SUBSTANTIVE TREATMENT
SERVICES WITHIN 28 DAYS FOR IEST
DEFENDANTS BY FEBRUARY, 2024
ALSO SET INTERIM BENCHMARKS FOR
THE DEPARTMENT TO ACHIEVE
BETWEEN AUGUST 22. FEBRUARY
2024. THE ADDITIONAL SOLUTIONS
FUNDED IN THE 2022 BUDGET ACT,
ALONG WITH OTHER RECENT
INVESTMENTS IN PRIOR BUDGET ACTS
INCLUDED SHORT TERM AND LONG
TERM STRATEGIES CENTERED AROUND
TWO PRIMARY GOALS, THE FIRST
BEING INITIATING TREATMENT
SERVICES FOR I S T INDIVIDUALS
WITHIN THE 28 DAYS, AS REQUIRED
BY THE COURT, AND SECONDLY,
REALLY CHANGING THE ARC OF THE
LIVES OF THOSE THAT TSH SERVICE
BY REDUCING CRIMINALIZATION OF
INDIVIDUALS WITH SERIOUS MENTAL
ILLNESS. THE S T SOLUTIONS ARE
FOCUSED ON THREE STRATEGIES.
THEY INCLUDE EXPANDING THE
TREATMENT CONTINUUM, MAXIMIZING
EFFICIENCIES AND REDUCING DEMAND
. NOW, I WOULD LIKE TO TURN IT
OVER TO CHIEF DEPUTY DR CHRIS
EDENS, WHO WILL WALK THROUGH OUR
AND PROVIDED A BRIEF OUTLINE OF
THE IMPLEMENTATION EFFORTS
ASSOCIATED WITH THESE EACH OF
THESE STRATEGIES. BUT BEFORE I
DO, I DID WANT TO ACKNOWLEDGE AS
SHE FROM PRESENTS ALL THESE THAT
WE HAVE BEEN ABLE TO ACCOMPLISH
ALL OF THIS THROUGH THE
TREMENDOUS PARTNERSHIPS WITH
COUNTY BEHAVIORAL HEALTH
SHERIFF'S DEPARTMENTS AND
PRIVATE PROVIDERS AND JUST
REALLY WANT TO THANK THEM ALL
FOR THEIR PARTICIPATION IN ALL
THESE EFFORTS AS WELL BECAUSE
THE DEPARTMENT CANNOT DO IT
ALONE. HI CHRIS EDEN'S CHIEF
DEPUTY DIRECTOR PROGRAM SERVICES
. SO FOR THE FIRST STRATEGY, WE
FOCUSED ON SIGNIFICANTLY
EXPANDING THE TREATMENT
CONTINUUM FOR IST INDIVIDUALS.
WITH AN EMPHASIS ON COMMUNITY
BASED TREATMENT OPTIONS SUCH AS
COMMUNITY BASED RESTORATION AND
DIVERSION THAT CONNECT
INDIVIDUALS TO TREATMENT IN
THEIR COMMUNITIES, RATHER THAN
INSTITUTIONALIZATION IN ESTATE
HOSPITAL, HOWEVER, BUILDING OUT
THE INFRASTRUCTURE NEEDED TO
SIGNIFICANTLY EXPAND COMMUNITY
TREATMENT OPTIONS WILL TAKE
MULTIPLE YEARS AND WE HAVE
INDIVIDUALS ON THE WAIT LIST WHO
NEED TREATMENT NOW. SO WE HAVE
HAD TO INCLUDE MORE SHORT TERM
STRATEGIES, SUCH AS JAIL BASED
TREATMENT OPTIONS TO HIGHLIGHT
SOME OF THE KEY INVESTMENTS
UNDER THIS STRATEGY. IN THE
SHORT TERM, WE AUGMENTED CURRENT
DIVERSION PILOT CONTRACTS WITH
COUNTIES TO PROVIDE ONE TIME
HOUSING AUGMENTATION TO PROVIDE
GREATER OPPORTUNITIES FOR
INDIVIDUALS ON THE WAIT LIST TO
BE SERVED IN THE EXISTING
DIVERSION PILOT PROGRAMS.
ADDITIONALLY WE IMPLEMENTED
EARLY ACCESS AND STABILIZATION
SERVICES, WHICH IS DESIGNED TO
PROVIDE EARLY ACCESS TO
TREATMENT FOR INDIVIDUALS ON THE
WAIT LIST. CURRENTLY, WE'VE
IMPLEMENTED THIS PROGRAM IN 32
COUNTIES AS OF JULY OF LAST YEAR
AND OVER 1000 IST INDIVIDUALS
HAVE RECEIVED TREATMENT IN THIS
PROGRAM. IN THE LONGER TERM. THE
CURRENT AND PRIOR BUDGET ACT
SUPPORTED A SIGNIFICANT
EXPANSION OF COMMUNITY TREATMENT
OPTIONS, WHICH INCLUDED FUNDING
TO DEVELOP UP TO 5000 BEDS OVER
A FOUR YEAR PERIOD. AND THAT
INCLUDES BOTH THE INFRASTRUCTURE
FUNDING AND ONGOING OPERATIONAL
FUNDING TO PROVIDE THE DEDICATED
HOUSING AND TREATMENT NEEDED TO
SUPPORT THE IST POPULATION
SERVED. IN COMMUNITY BASED
RESTORATION OR DIVERSION
PROGRAMS. WE HAVE CONTRACT ID
WITH ADVOCATES FOR HUMAN
POTENTIAL TO HELP US ADMINISTER
THE INFRASTRUCTURE PROGRAM. AND
THE REQUEST FOR PROPOSAL FOR
FUNDING WAS RELEASED TWO
COUNTIES IN FEBRUARY OF THIS
YEAR. AH IN ADDITION, THE 21 22
BUDGET ACT PROVIDED FUNDING FOR
THE DEPARTMENT TO CONTRACT FOR
COMMUNITY INPATIENT FACILITIES.
THESE FACILITIES PRIMARILY ARE
ENVISIONED TO PROVIDE TREATMENT
AND STABILIZATION FOR IEST
INDIVIDUALS TO INCREASE
OPPORTUNITIES FOR PLACEMENT IN
COMMUNITY BASED TREATMENT AND
DIVERSION. IN THE PAST YEAR. WE
HAVE CONTRACT ID WITH THE
SACRAMENTO BEHAVIORAL HEALTH.
HOSPITAL FOR 78 BEDS AND
CONTINUE NEGOTIATIONS FOR
ADDITIONAL FACILITIES WITH
SERVICE PROVIDERS OVER THE NEXT
18 TO 24 MONTHS. THE SECOND
STRATEGY IS FOCUSED ON IMPROVING
PROCESSES TO HELP MAXIMIZE
EFFICIENCIES IN THE PLACEMENT
PROCESS. I WILL HIGHLIGHT A
COUPLE OF EFFORTS IN THIS
STRATEGY THAT WERE FUNDED IN THE
22 BUDGET ACT, AND THEY INCLUDE
IMPLEMENTING NEW CARE
COORDINATION TEAMS. THESE TEAMS
WILL HELP THE DEPARTMENT TO
SCREEN ALL FELONIOUS T PATIENTS
TO DETERMINE APPROPRIATE
PLACEMENT WITHIN DSHS BROAD AND
EXPANDING CONTINUUM OF CARE,
PROVIDE ENHANCED MONITORING OF
THE WAITLIST AND PROVIDE
COMMITMENT TO ADMISSION CASE
MANAGEMENT TO MAXIMIZE BED USAGE
FOR THE S T POPULATION SINCE
JULY. WE'VE WORKED TOO RAPIDLY
HIRE NEW STAFF AND HAVE
IMPLEMENTED CARE COORDINATION
ACROSS 34 COUNTIES. IN ADDITION,
WE ARE PILOTING A NEW
INDEPENDENT PLACEMENT PANEL FOR
CONRAD TRANSITIONAL PATIENTS TO
INCREASE THE NUMBER OF STATE
HOSPITAL PATIENTS SERVED IN THE
COMMUNITY WITHIN THE CONDITIONAL
RELEASE PROGRAM. WE ARE
CURRENTLY PLANNING TO BEGIN
IMPLEMENTATION OF THIS NEW
PROGRAM WITHIN BY JULY, 2023.
THE THIRD STRATEGY FOCUSED ON
REDUCING DEMAND FOR I S T
TREATMENT SERVICES INCLUDES THE
I S T RE EVALUATION PILOT
PROGRAM THAT WAS IMPLEMENTED IN
21 22. THIS PROGRAM RE EVALUATES
INDIVIDUALS IN JAIL AND ON THE
WAIT LIST PENDING PLACEMENT TO A
D S H TREATMENT PROGRAM TO SEE
IF THEY HAVE ALREADY RESTORED A
COMPETENCY AND NO LONGER NEED
TREATMENT. IN A D S H BED. TO
DATE THIS TEAM HAS PERFORMED
OVER 2500 RE EVALUATIONS AND
NEARLY 30% OF THOSE, UM, OF THE
INDIVIDUALS THAT HAVE BEEN
REEVALUATED WERE FOUND COMPETENT
BY THE EVALUATORS AND THE OTHER
70% WERE IDENTIFIED AS NOT
COMPETENT AND REMAINED ON THE
PATHWAY TO ADMISSION INTO A
TREATMENT PROGRAM. ADDITIONALLY
FUNDING WAS PROVIDED IN 2022
BUDGET ACT FOR TSH TO PARTNER
WITH THE JUDICIAL COUNCIL TO
DEVELOP AND IMPLEMENT TRAINING
AND WORKFORCE DEVELOPMENT
PROGRAMS FOR COURT APPOINTED
EVALUATORS WITH THE GOAL OF
IMPROVING THE QUALITY OF I S T
EVALUATIONS UTILIZED BY THE
COURTS TO DETERMINE IF SOMEONE
IS INCOMPETENT TO STAND TRIAL.
WE HAVE NOW ENTERED INTO AN
INTERAGENCY AGREEMENT WITH THE
JUDICIAL COUNCIL FOR THE
DEVELOPMENT OF THE S T COURT
APPOINTED EVALUATOR TRAINING.
LASTLY THE ISTEA SOLUTIONS ALSO
INCLUDED IMPLEMENTATION OF A
FELONIOUS T GROWTH CAP TO HELP
ENSURE THAT THE EXPANSION OF
DOSCH FUNDED COMMUNITY BASED
CARE DOES NOT CREATE UNINTENDED
INCENTIVES THAT MAY DRIVE
ADDITIONAL I S T DETERMINATIONS
. IN DECEMBER, THE DEPARTMENT
ISSUED TO COUNTY MINISTRATIONS,
THE COURTS, SHERIFFS, DISTRICT
ATTORNEYS AND PUBLIC DEFENDERS
INFORMATION ABOUT THE GROWTH CAP
PROGRAM HELP PENALTY
CALCULATIONS WILL BE MADE. EACH
COUNTY'S 2021 22 BASELINE
DETERMINATIONS AND THE COUNTY'S
FIRST QUARTER 22 23
DETERMINATIONS AND HOW THAT
COMPARED TO THEIR BASELINE. LAST
MONTH, THE DEPARTMENT PROVIDED
AN UPDATE TO THE SAME RECIPIENTS
ON EACH COUNTY, SECOND QUARTER
REFERRALS AND TRENDS COMPARED TO
THEIR BASELINE. THE DATA SHOWED
OVERALL STATEWIDE REFERRALS IN
TOTAL ACROSS THE FIRST TWO
QUARTERS HAVE INCREASED. BY
ABOUT 20% OVER LAST YEAR, WHICH
IS THEIR BASELINE YEAR. BUT IN
COMPARING THE FIRST QUARTER TO
THE SECOND QUARTER, THERE WAS A
4% DECREASE IN IN THE TOTAL
REFERRAL STATEWIDE BETWEEN
QUARTER ONE QUARTER TWO, WITH 30
COUNTIES EXPERIENCING A DECLINE
BETWEEN THESE TWO QUARTERS. TO
HIS DISC COUNTIES AND
IDENTIFYING STRATEGIES TO REDUCE
THE NUMBER OF ISTEA
DETERMINATIONS. THE DEPARTMENT
IS PARTNERING WITH THE COUNCIL
ON STATE GOVERNMENTS JUSTICE
CENTER TO DEVELOP TRAINING AND
TECHNICAL ASSISTANCE
OPPORTUNITIES FOR COUNTIES AND
IN DECEMBER, THE DEPARTMENT
RELEASED A COUNTY IS A REQUEST
FOR APPLICATION FUNDING PROCESS
FOR $100,000 ANNUALLY. FOR EACH
COUNTY TO ESTABLISH
COLLABORATIVE STAKEHOLDER
WORKGROUPS THAT TARGETS
STRATEGIES TO AND SEEK SOLUTIONS
TO END THE CRIMINALIZATION OF
INDIVIDUALS WITH SERIOUS MENTAL
ILLNESS IN THEIR COMMUNITIES.
TODAY. 32 COUNTIES HAVE APPLIED
FOR THIS FUNDING TO CONVENE
THESE WORKGROUPS IN THEIR
COUNTIES, AND THE DEPARTMENT
WILL BE HOSTING ANOTHER ROUND OF
FUNDING APPLICATIONS FOR THE NEW
FISCAL YEAR. THE AGENDA DID
INCLUDE A COUPLE OF QUESTIONS
FOR THE DEPARTMENT CAN PROVIDE A
RESPONSE TO NUMBER TWO, THEN
HAND IT BACK TO THE DIRECTOR TO
PROVIDE A RESPONSE TO NUMBER ONE
IN CLOSE THAT UP. UM QUESTION
NUMBER TWO IS WHEN IS IT
REASONABLE TO EXPECT THAT THE
DEPARTMENT WILL HAVE OUTCOMES
DATA NEEDED TO EVALUATE THE
MENTAL HEALTH DIVERSION PROGRAM.
I WILL SAY THAT THE INITIAL I S
T PILOT DIVERSION PROGRAM IS
STILL CURRENTLY UNDERWAY. UM
THIS PROGRAM WAS EXTENDED
EFFECTIVE WITH THE 21 22 BUDGET
ACT DUE TO THE IMPACTS OF THE
PANDEMIC. UM AND THE DELAY IN
IMPLEMENTING SOME OF THESE
PROGRAMS IN THE IN THE COUNTIES
TO THAT AND THE PILOT PROGRAM.
IS NOT EXPECTED TO END UNTIL
JUNE OF 2025, HOWEVER, WHILE
THIS PROGRAM IS UNDERWAY EACH
YEAR, THE DEPARTMENT COLLECTS
AND REPORTS ON DATA AND OUTCOMES
OF THE INDIVIDUALS THAT ARE
BEING SERVED WITHIN OUR
DIVERSION PROGRAMS, AND WE
PUBLISHED THIS AS PART OF OUR
BUDGET ESTIMATE IN THE
GOVERNOR'S BUDGET AND MAY
REVISION. AH THERE ARE
INFORMATION THAT'S INCLUDED IN
THIS REPORT INCLUDES NUMBER OF
INDIVIDUALS PARTICIPATING IN THE
PROGRAM. DEMOGRAPHICS DIAGNOSES
, THE CHARGES THAT WERE
ASSOCIATED WITH THEIR ARREST.
THE CURRENT STATUS OF
PARTICIPANTS, INCLUDING THE
NUMBER OF INDIVIDUALS THAT ARE
IN THE DIVERSION PROGRAM, WHO
HAVE COMPLETED THE PROGRAM,
THOSE WHO MAY NOT HAVE
SUCCESSFULLY COMPLETED THE
PROGRAM. WE ALSO INCLUDE SUCCESS
RATES FOR INDIVIDUALS WITH
CERTAIN FACTORS SUCH AS
HOMELESSNESS, SUBSTANCE OF USE
DISORDERS TREATMENT WITH WITH
LONG ACTING INJECTABLE
MEDICATION. FURTHER OUTCOMES ARE
DEPENDENT UPON THE DEPARTMENT'S
ACCESS TO DOJ CRIMINAL RECORD.
AH DATA CRIMINAL OFFENDER RECORD
DATA AND THERE IS A PROPOSAL
THAT'S CURRENTLY BEING HEARD
LATER TO BE ABLE TO ACCESS THIS
INFORMATION TO LOOK MORE AT LONG
TERM OUTCOMES FOR THIS
POPULATION. ADDITIONALLY FUNDING
IN THE S T SOLUTIONS BUDGET WAS
INCLUDED TO PERFORM A MORE
COMPREHENSIVE EVALUATION OF I S
T SOLUTIONS, INCLUDING OUR
DIVERSION PROGRAM, AND TO THAT
END, WE HAVE ENTERED INTO A
CONTRACT WITH POLICY RESEARCH
ASSOCIATES TO DESIGN AND
IMPLEMENT A PHASE EVALUATION OF
THE DIVERSION PROGRAMS. WE
EXPECT THIS INITIAL REPORT. TO
BE COMPLETED NEXT YEAR IN 2024.
AND THEN JUST CLOSE UP WITH THE
FINAL QUESTION, WHICH WAS TO
PROVIDE THE MOST RECENT
ASSESSMENT OF PROGRESS BEING
MADE WITH REGARDS TO THE
WAITLIST AND CHIEF DEPUTY
DIRECTOR IAN'S PROVIDED AN
OVERVIEW OF ALL THE
IMPLEMENTATION EFFORTS THAT WE
HAVE, UM, IMPLEMENTED ACROSS
THIS LAST YEAR. UM, AND AS A
RESULT OF THAT RAPID
IMPLEMENTATION OF THESE
SOLUTIONS AS WELL AS EASING OF
THE PANDEMIC RELATED INFECTION
CONTROL MEASURES THAT WERE
REQUIRED ON HEALTHCARE
FACILITIES. DURING THE PAST YEAR
. WE HAVE A SIGNIFICANTLY
REDUCED BOTH THE ISTEA WAIT LIST
AND, UH AND THE TIME TO
TREATMENT SINCE THIS TIME LAST
YEAR IN MARCH OF 2022, WE HAD
OVER 1900 INDIVIDUALS ON THE
WAIT LIST IN APRIL OF THIS YEAR
. WE ARE CURRENTLY AT 1008,
WHICH IS A 48% REDUCTION IN THE
WAITLIST. UM AND OF THOSE 1008
ON THE WAIT LIST. ACTUALLY 100
AND 74 ARE ALREADY RECEIVING
TREATMENT THROUGH THE EARLY
ACCESS AND STABILIZATION
SERVICES PROGRAM THAT WE
IMPLEMENTED THIS YEAR WITH
COUNTIES. SHERIFFS AND THEN WITH
RESPECT TO THE WAIT TIME, THE
AVERAGE WAIT. TIME TO TREATMENT
HAS REDUCED FROM AN AVERAGE OF
134 DAYS IN MARCH OF LAST YEAR
TO 60 DAYS IN MARCH OF THIS
YEAR, WHICH IS A 55% REDUCTION,
SO WE ARE SEEING TREMENDOUS
PROGRESS AND AS A RESULT ABOUT
THE EFFORTS THAT WE ARE WORKING
ON WITH EVERYBODY AND OUR
PARTNERS THANK YOU. NEXT, WE
WILL HEAR FROM DR EWING WITH THE
COMMISSION.
THANK YOU VERY MUCH, MR CHAIR
MEMBERS, UM SO THE YOU KNOW, THE
COMMISSION HAS DONE A NUMBER OF
THINGS IN TERMS OF TRYING TO
FOCUS ON UPSTREAM OPPORTUNITIES
TO PREVENT THE YOU KNOW THAT THE
DEPARTMENT SAID HOSPITALS SORT
OF THE END OF THE LINE, SO TO
SPEAK IN TERMS OF SOME OF OUR
MOST NEGATIVE OUTCOMES. IT'S A
COMBINATION OF HOSPITALIZATION,
TIED TO CRIMINAL JUSTICE
INVOLVEMENT, AND WE KNOW THERE'S
A SIGNIFICANT FACTOR OF
HOMELESSNESS ASSOCIATE WITH THE
POPULATION WHO IS AN EXCEPTIONAL
RISK. SO IN MANY WAYS THAT THE
DEPARTMENT AND ITS WORK IS, UM
YOU KNOW, CATCHING ALL OF THE
MISSED OPPORTUNITIES, SO TO
SPEAK THAT HAVE HAPPENED ALONG
THE WAY THE COMMISSION'S WORK IS
, YOU KNOW, IN THE CONTEXT OF
THE CHALLENGES LAID OUT IN THE
HEARING MATERIALS. UM YOU KNOW,
WE WOULD SAY THERE'S A YOU KNOW,
A COUPLE OF OPPORTUNITIES HERE
JUST AN INTEREST OF TIME. WE
NEED TO DO TO DO THE DATA WORK
TO UNDERSTAND WHAT'S HAPPENING
UPSTREAM. RIGHT THAT THE
DEPARTMENT HAS DONE SOME
PHENOMENAL WORK TO SHOW A HIGH
LEVEL OF CRIMINAL JUSTICE
INVOLVEMENT AT THE COUNTY LEVEL
WELL BEFORE SOMEONE HAS A FELONY
CHARGE. WE'VE BEEN WORKING WITH
LOCAL OFFICIALS TO ENCOURAGE
THEM TO ASK SOME FUNDAMENTAL
QUESTIONS. WHO'S WHO'S WHO'S IN
THEIR JAIL WHO'S RECEIVING
MENTAL HEALTH SERVICES? AND ARE
THOSE FOLKS KNOWN TO THEIR
BEHAVIOR HEALTH SYSTEM? IF
THEY'RE KNOWN TO THEIR
BEHAVIORAL HEALTH SYSTEM, THEN
IT'S CLEAR THAT WE MAY HAVE A
QUALITY OF CARE PROBLEM. IF
THEY'RE NOT KNOWN TO THEIR
BEHAVIORAL HEALTH SYSTEM, THEN
THEY MAY HAVE AN ACCESS PROBLEM.
THEY'RE ACCESSING MENTAL HEALTH
SERVICES FOR THE FIRST TIME
THROUGH LAW ENFORCEMENT
INVOLVEMENT, AND THAT'S
INAPPROPRIATE. UM, I WANT TO
DISTINGUISH BETWEEN PEOPLE WHO
ARE COMMITTING, UH, YOU KNOW,
CRIMINAL JUSTICE INFRACTIONS OR
, YOU KNOW VERY SERIOUS CRIMINAL
BEHAVIOR VERSUS CRIMINAL
BEHAVIOR THAT MAY BE SIMPLY TIED
TO UNADDRESSED. MENTAL HEALTH
NEEDS MY COMMENTS EARLIER ABOUT
THE IMPORTANCE OF EARLY
INTERVENTION IN PSYCHOSIS
BECAUSE THE PRESUMPTION IS BUT
WE DON'T KNOW AS MUCH AS WE
COULD KNOW, LOOKING AT THE DATA
THAT THE STATE HAS BETWEEN THE
DEPARTMENT OF JUSTICE, THE
DEPARTMENT HEALTHCARE SERVICES
AND DEPARTMENT, STATE HOSPITALS
REALLY UNDERSTAND THE PATTERNS
IN TERMS OF UM, WHETHER IT IS
PSYCHOSIS THAT IS LEADING TO
INVOLVEMENT WITH THE DEPARTMENT,
STATE HOSPITALS AND HOW AN
EXPANSION TO YOUR POINT OF
HIGHLY EFFECTIVE OF EARLY
PSYCHOSIS CARE AVAILABLE ON A
STATEWIDE BASIS COULD ACTUALLY
FUNDAMENTALLY REDUCE THOSE COSTS
. UM SO YOU KNOW, THAT'S PART OF
THE REASON WHY I MADE MY
COMMENTS ABOUT EARLY PSYCHOSIS
EARLIER. UM BUT THE STATE'S
INVESTMENT IN FULL SERVICE
PARTNERSHIPS. THOSE PROGRAMS
WERE DESIGNED ORIGINALLY TO
BRING PEOPLE OUT OF STATE
HOSPITALS. MORE OF AN L. P S
POPULATION OF CIVIL COMMITMENT
POPULATION AT THE TIME 20 YEARS
AGO PLUS THAN A FORENSIC
POPULATION, BUT AGAIN, WE NEED
TO ASK THAT QUESTION OF WHY ARE
PEOPLE UM, BECOMING IN THE
CONTACT WITH THE CRIMINAL JUST
JUSTICE SYSTEM AT THE RATE THAT
LEADS TO THEM LANDING AT THE
DEPARTMENTS OF HOSPITALS IN THE
FIRST PLACE. SO THROUGH, YOU
KNOW, BASED ON THE GRAPHIC THAT
I SHARED WITH YOU EARLIER
COMMISSIONS APPROACH IS REALLY
TO SAY BEFORE SOMEONE GETS TO A
STATE HOSPITAL BEFORE THEY HAVE
THAT JUSTICE INVOLVEMENT THAT
PATTERN THERE NEEDS TO BE A
ROBUST PHOSPHORUS PARTNERSHIP
STRATEGY. BUT THAT'S ALSO
EXPENSIVE AND WE HAVE LIMITED
CAPACITY. TO REDUCE DEMAND ON
THAT COMPONENT OF OUR SYSTEM OF
CARE. WE NEED TO HAVE AN
AGGRESSIVE EARLY PSYCHOSIS
STRATEGY AND AN UPSTREAM
STRATEGY FROM THERE IS OUR YOUTH
DROP IN WORK BECAUSE PSYCHOSIS
IS LIKELY TO OCCUR IN THE LATE
TEENS, EARLY TWENTIES, AND
THAT'S WHERE YOU THIS USE DROP
IN PROGRAM IS DESIGNED IS HOW DO
WE CREATE TRUST? HOW DO WE
CREATE UNDERSTANDING? SO WHEN
SOMEONE BEGINS TO DEVELOP
SYMPTOMS, ASSOCIATES PSYCHOSIS.
THEY'RE NOT MASKING THAT THEY'RE
THEY'VE ALREADY DEVELOPED THE
TRUSTING RELATIONSHIPS WITH THE
PROVIDER COMMUNITY TO ENABLE
THEM TO STOP BY AND SAY, HEY, I
NEED HELP AND THROUGH THAT USED
DROP AND BE ABLE TO GET A
REFERRAL TO A HIGH QUALITY,
EFFECTIVE PROGRAM. EVEN FARTHER
UPSTREAM GETS AT THE COMMENTS
THAT DR JACKSON MADE AROUND
SCHOOL MENTAL HEALTH IS HOW DO
WE CREATE AN AWARENESS? HOW DO
WE DO THE ANTI STIGMA WORK? SO
THAT SO THAT FOR THE THAT
PERCENTAGE OF THE POPULATION
THAT IS LIKELY TO FACE THOSE
RISKS AS THEY MOVE DOWN THAT
CONTINUUM WITH AN ILLNESS THAT
THEY HAVE THE RESOURCES, THE
TOOLS THE SUPPORTS THE TRUST
THAT IS NECESSARY TO GET IN
FRONT OF THIS PROBLEM VERY EARLY
ON FOR US. IT STARTS WITH DOING
THE DATA ANALYSIS AND BUILDING
OUT OF PREVENTION STRATEGY
THAT'S RESPONSIVE TO THAT
ANALYTIC FRAMEWORK. I WILL NOW
CALL UP AND APOLOGIES FOR
JUMPING OVER HER BEFORE, BUT
NEXT IS J. C. COOPER STATE
MEDICAID DIRECTOR WITH
DEPARTMENT OF HEALTH CARE
SERVICES. IT'S OKAY. APOLOGIES.
UM. J C. COOPER, STATE MEDICAID
DIRECTOR. THERE'S TWO MAIN
INTERSECTIONS WITH WHAT THE
DEPARTMENT HAS BEEN WORKING ON
BOTH THAT WILL BE PRESENTED
LATER IN THIS HEARING, SO I'LL
BE VERY SHORT WITH MY COMMENTS,
MAINLY THE MAIN INTERSECTION IS
AROUND OUR JUSTICE INVOLVED.
WAIVER WOULD JUST WANT TO SAY
COVERAGE OF INDIVIDUALS,
INCOMPETENT CITY AND CHILD WOULD
ONLY BE COVERED IF SOMEONE IS
PENDING. SO IN A JAIL FACILITY
FOR THOSE 90 DAYS. SO WE THINK
IT WOULD BE A VERY SMALL TOUCH
IN REGARDS TO ANY AREA
INTERACTION THERE, BUT THERE IS
AN OPPORTUNITY IF THEY ARE IN A
JAIL SETTING FOR ANY TIME BEFORE
OR AFTER THEIR TIME AT A STATE
HOSPITAL THAT THEY WOULD BE ABLE
TO RECEIVE SERVICES. THEY'RE THE
ONLY OTHER PIECE I WOULD FLAG IS
WITHIN OUR CAL BH CBC WAIVER
DEMONSTRATION WAIVER FOR
BEHAVIORAL HEALTH UM THE
ADDITION OF FACT, WOULD ALLOW
FOR US TO PROVIDE SOME
ADDITIONAL SERVICES FOR
INDIVIDUALS IN THE COMMUNITY AND
COUNTIES COULD OPT INTO THAT AS
AS AN OPTION AND WILL PROVIDE
MORE INFORMATION. THE IN THE
HEARING LATER REGARDING BOTH OF
THOSE OPTIONS. THANK YOU. NEXT
WE WILL HEAR FROM PV BELL THAT
WITH THE NEVADA COUNTY
BEHAVIORAL HEALTH WAS THERE.
DIRECTOR WELCOME. HI GOOD
EVENING. THANKS FOR HAVING ME
AND IN THE INTEREST OF BREVITY,
I'LL TRY TO KEEP THIS SHORT. AH
FIRST AND FOREMOST COUNTY
BEHAVIORAL HEALTH DEPARTMENT
VERY MUCH ARE LINED WITH THE
DEPARTMENT OF STATE HOSPITALS,
AND I'M SURE EVERYONE IN THIS
ROOM AND OUR DESIRE TO KEEP
PEOPLE WITH MENTAL ILLNESS OUT
OF JAIL AND IN TREATMENT. TO
THAT END. WE REALLY APPRECIATED
THE PARTNERSHIP IN THE GREAT
PROGRAMS THAT TSH HAS PUT
FORWARD, AND MOST COUNTIES HAVE
BEEN TAKING FULL ADVANTAGE OF
THOSE, INCLUDING MY OWN NEVADA
COUNTY. UM AND IN ADDITION,
WE'VE ALWAYS DONE WORK IN THE
WITH THIS POPULATION AND
CONTINUE TO DO SO. IN NEVADA
COUNTY. WE HAVE STAFF EMBEDDED
IN THE JAIL STAFF AND THE
PROBATION DEPARTMENT STAFF IN
THE PUBLIC DEFENDER'S OFFICE
STAFF SPECIALTY COURTS, AND WE
HAVE STAFF WORKING IN THE COURTS
EVERY DAY, SO WE DEEPLY
UNDERSTAND THE NEED TO FIND WAYS
TO, UM PULL PEOPLE OUT OF THAT
SYSTEM AND INTO TREATMENT. MY
COMMENTS TODAY, THOUGH, ARE
REALLY ON OUR CONCERNS WITH THE
NEW GROWTH CAP POLICY THAT'S ON
TRACK TO BE IMPLEMENTED THIS
YEAR. UM THE GROWTH CAP IS
DESIGNED TO COMPEL COUNTIES TO
REDUCE THE NUMBER OF INDIVIDUALS
WHO ULTIMATELY END UP ON THE
STATE HOSPITAL WAITLIST BY
FINANCIALLY PENALIZING THOSE WHO
SEND GREATER NUMBERS HAVE FELL
IN THE I S T S TO THE STATE YEAR
OVER YEAR. CAN HE BEHAVIOR
HEALTH AGENCIES OPPOSE THIS
POLICY LAST YEAR, IN LARGE PART
BECAUSE WE HAVE VERY LITTLE
INFLUENCE ON THE KEY DRIVERS OF
I S T. WE KNOW THAT HOUSING
STATUS IS ONE OF THE MOST
CRITICAL INDICATORS OR RISK
FACTORS FOR BEING FOUND SD.
SIMILARLY, THE DECISION TO UM
ARREST SOMEBODY OR NOT ARREST
SOMEBODY TAKE THEM INTO A CRISIS
SYSTEM OR ARREST THEM. THE
DECISION TO FILE FELONY CHARGES
ARE NOT THERE MULTIPLE SYSTEMS
THAT IMPACT THAT OUTCOME, AND
IT'S A COMPLEX DRIVER OF THE
OUTCOME OF AN ARTIST FINDING
WE'RE CONCERNED THAT COUNTIES
HAVE NOT BEEN INVOLVED IN THE
DEVELOPMENT OF THE GROWTH CAP
METHODOLOGY, AND WE THINK THAT
SOME OF THE APPROACHES BEING
USED NOW IS PRETTY FUNDAMENTALLY
FLAWED. FIRST AND FOREMOST, THE
STATE'S OWN GUIDANCE, SAYS THAT
ALL DETERMINATIONS BY THE COURTS
WILL BE COUNTED TOWARDS THE CAP.
EVEN WHEN INDIVIDUALS NEVER GO
TO THE DEPARTMENT OF STATE
HOSPITAL BECAUSE THEY'RE
DIVERTED BECAUSE THEY'VE BEEN
FOUND COMPETENT, YOU KNOW,
BEFORE THEY ACTUALLY GET TO THIS
STATE HOSPITAL OR EVEN BECAUSE
THEY'RE DECEASED, THEY STILL
COUNT TOWARDS OUR CAP, WHICH IS
PROBLEMATIC. UM THIS
PARTICULARLY PROBLEMATIC TO
COUNT ALL DETERMINATIONS BECAUSE
WE KNOW THE QUALITY OF STD
DETERMINATIONS IS THAT GREAT? UM
DSHS OAN REVIEW FOUND THAT
THERE'S MANY ISSUES WITH THE
DETERMINATION PROCESS AND
INCLUDING THAT FACT THAT AT
LEAST 30% OF INDIVIDUALS TURN
OUT TO BE FOUND COMPETENT ON
REEVALUATION. SO GIVEN THE
CONSIDERABLE LACK OF CONSISTENCY
AND QUALITY MONITORING OF
EVALUATIONS. FINDINGS OF
INCOMPETENCY BY THE COURT SHOULD
NOT BE THE NUMBERS USED BY D S
H, BUT RATHER THIS ACCOUNT THE
PEOPLE WHO ACTUALLY MAKE IT INTO
D S H BEDS. IN ADDITION, THE
STRUCTURE OF THE GROWTH CAP
ACTUALLY DISINCENTIVIZE IS
COUNTIES LIKE MINE FROM
PARTICIPATING IN DIVERSION AND
COMMUNITY BASED RESTORATION. AS
WE'RE STILL PENALIZED FOR THIS
POPULATION, EVEN WHILE WE'RE
WORKING TO SOLVE FOR KEEPING
PEOPLE OUT OF TSH AND THEN ALSO
, LASTLY, THE METHODOLOGY AS IT
CURRENTLY STANDS, UM
DISPROPORTIONATELY IMPACT
SMALLER COUNTIES, WHO
TRADITIONALLY NOT SENT MANY
INDIVIDUALS TO THE STATE
HOSPITALS AS FELL IN THE I S D
S. SO SEE BHD A WOULD LIKE TO
SEE CHANGES TO THE STATUTE THAT
ENSURE THAT THE PROPOSED GROWTH
CAP DOES NOT INADVERTENTLY FIND
COUNTIES WHO BUILD OUT DIVERSION
AND COMMUNITY BASED RESTORATION
OPTIONS. ASSURANCE THAT COUNTIES
WILL BE CONSULTED IN THE
DEVELOPMENT OF THE GROWTH CAP,
METHODOLOGY AND INSURANCE THAT
DUE PROCESS AND AN APPEALS
PROCESS WILL BE DEVELOPED SO
THAT COUNTIES CAN VERIFY AND
VALIDATE ANY INDIVIDUALS WHO WHO
MAY COUNT TOWARDS THEIR PENALTY.
AS IT CURRENTLY STANDS. COUNTIES
LIKE MY OWN, ARE ON TRACK TO PAY
COLLECTIVELY MILLIONS OF DOLLARS
IN FINES THIS YEAR, WITH NO
GUARANTEE THAT THE STATE
DIRECTED INVESTMENTS WILL
ULTIMATELY BE SUCCESSFUL IN
TURNING THE TIDE. UM THIS IS FOR
ME PERSONALLY PARTICULARLY
IRONIC BECAUSE MY COUNTY
CURRENTLY HAS THE LOWEST RATE OF
REFERRALS TO TSH IN THE STATE.
AND YET WE'RE ON TRACK TO PAY
FINES THIS YEAR. WE NEED A
SYSTEM THAT INCENTIVIZES
SYSTEMIC SOLUTIONS TO THE S, T.
UM, CHALLENGE AND DOESN'T
INDISCRIMINATELY PENALIZED
COUNTIES. WE URGED THE
LEGISLATURE AND THE
ADMINISTRATION TO CONTINUE TO
WORK WITH US ON SOLUTIONS THAT
WILL GET US TO THAT END. THANK
YOU. DEPARTMENT OF FINANCE. YOU
KNOW, HAND DEPARTMENT OF FINANCE
NOTHING FURTHER, TAD. JULIO.
WILL OWENS, A LEO AND NOTHING
FOR THE RED, BUT IF THEY PREFER
QUESTIONS BRING IT UP TO THE
DIESS. I'M GOING TO BEGIN IF I
CAN. THE COURT DETERMINATIONS.
THE COURT MAKES THE
DETERMINATIONS AND YOU SAID
THERE WERE 2500 OF VALUATIONS
AND 31% OF THOSE WERE RESTORED.
IS THAT AN APPROPRIATE NUMBER
FOR US TO RESTORE? IS THERE AN
APPROPRIATE AMOUNT OF CONCERN
THAT THIS NUMBER IS SO HIGH? IT
SOUNDED EARLIER THAT YOU'RE
WORKING WITH, UM, THE JUDICIAL
COUNCIL ON COURT APPOINTED
EVALUATIONS. WILL THAT HELP US
TO MAKE SURE THAT THOSE
DETERMINATIONS ARE MORE
ACCURATE. THANK YOU FOR THE
QUESTION. UM SO WITH RESPECT TO
THE RE EVALUATIONS, THE 2500
INDIVIDUALS THAT HAVE BEEN
REEVALUATED AND 30% WERE FOUND
COMPETENT. IT'S IMPORTANT TO
NOTE THAT THE FINDING OF
COMPETENCY MANY OF THESE
INDIVIDUALS HAD BEEN TREATED AND
WITHIN THE JAIL PROGRAMS AND SO
THEY MAY HAVE RESTORED JUST BY
THE NATURE OF THE AMOUNT OF TIME
WE'VE GOT TO REMEMBER THE LAST
COUPLE OF YEARS. PEOPLE HAVE
BEEN VERY WAITING AND INORDINATE
AMOUNT OF TIME ON THE WAIT LIST
TO GET INTO TREATMENT AND WE'RE
RECEIVING SOME LEVEL OF
SERVICES. UM SO THAT THAT'S
GOING TO BE ONE FACTOR THAT
PROBABLY DROVE THAT THAT NUMBER
HIGHER IN RECENT YEARS THAN WHAT
WE WOULD ANTICIPATE OUR WORK
WITH THE, UM UH, WITH THE U. C.
DAVIS UM AND LOOKING AT THE
INCOMPETENT TO STAND TRIAL
POPULATION HISTORICALLY LOOKED
AT MORE. I THINK IT WAS ABOUT A
20% RATE OF INDIVIDUALS COMING
INTO OUR SYSTEM IN THE
HISTORICAL YEARS IN LOOKING AT
THE NUMBERS THAT WERE COMING
INCOMPETENT AGAIN, IT'S
DIFFICULT TO TELL HOW MUCH OF
THAT IS DUE TO TREATMENT
RECEIVED VERSUS REALLY LOOKING
UNTIL YOU GET IN AND DO A STUDY
OF THE REPORTS WE DID DO IS A
REVIEW OF THE REPORTS. AND I'M
GOING TO FAIL TO REMEMBER THE,
UM I THINK IT WAS A B 13 94 1934
WHICH REQUIRED US TO ESTABLISH,
UM, REQUIREMENTS FOR THE COURTS
ON KIND OF EVALUATOR, TRAINING
OR EXPERTISE THAT THEY SHOULD
HAVE IN ORDER TO BE COURT
APPOINTED EVALUATORS. AND WHEN
WE DID DO IT, EVERY VIEW OF
THOSE REPORTS. WE DID FIND THAT
YOU KNOW A GOOD PORTION. I MEAN,
PROBABLY NOT. THAT'S SIMPLY NOT
THE APPROPRIATE WAY TO SAY
BECAUSE WE ONLY SAMPLED THE
REPORTS, BUT WE DID FIND A
PORTION OF THOSE REPORTS THAT WE
SAMPLED DID HAVE, UM UH THEY
WERE REPORTS THAT DID NOT MEET
ALL THE CRITERIA OF THE EITHER
THE STATUTE OR REALLY DIDN'T
HIGHLIGHT, YOU KNOW, CLEAR
CRITERIA FOR THE COURT AS TO THE
REASON THAT THE INDIVIDUAL
SHOULD OR SHOULDN'T BE FOUND
COMPETENT AND SO WE DO KNOW THAT
AS WE SEE, UM AND ARE PERFORMING
EVALUATIONS AND RE EVALUATIONS,
WE DO QUESTION SOME OF THE COURT
APPOINTED EVALUATOR FINDINGS. I
ELEVATED AS THERE'S AN
ACCEPTABLE AMOUNT OF APPENDIX IS
YOU CAN TAKE TO THE O R WITHOUT
HAVING ALL OF THEM BE INFECTED
THAT WE NEED TO BE CAUTIOUS. AND
IF THE COURT APPOINTED, UM, IS
DETERMINING THAT TOO MANY ARE
BEING LABELED I S T THAT HAS
COMPLICATIONS AS WELL. AND SO I
LOOK FORWARD TO THE CONTINUED
WORK THAT YOU'RE DOING. I WANT
TO BRING UP WHAT THE DIRECTOR
HAD JUST TALKED ABOUT THE ABOUT
THE DETERMINATIONS, ALL COUNTING
AGAINST THE CAP. AYE. I WAS
REALLY STRUCK BY THE DEAD PEOPLE
ARE COUNTING AGAINST THE CAB.
WHY AREN'T WE LOOKING TOWARDS
THOSE WHO END UP AND DEPARTMENT
OF STATE HOSPITAL BEDS? UM TOTAL
RATHER THAN UM ALL THAT COME UP
FOR DETERMINATIONS. THANK YOU.
THAT'S A REALLY GOOD QUESTION,
YOU KNOW, JUST KIND OF LOOKING
AT A HISTORICAL PERSPECTIVE OF
ALL OF THE DEPARTMENT'S EFFORTS,
THE DEPARTMENT AND THE
ADMINISTRATION AND THE
LEGISLATURE HAVE ALL INVESTED A
TREMENDOUS AMOUNT OF MONEY AND
TIME RESOURCES AND EFFORT INTO
BUILDING UP CAPACITY FOR
INDIVIDUALS WHO ARE FOUND
INCOMPETENT TO STAND TRIAL AND
WHAT WE'VE SEEN IS, AS WE BUILD
MORE CONTINUE TO BE, UM UM,
REFERRED TO THE DEPARTMENT AND
SO THE END WHEN WE SAY THE
DEPARTMENT THE ADMINISTER, YOU
KNOW, THE ADMINISTRATION THE
BUDGET, THE GENERAL FAN IS
FUNDING ALL PROGRAMS, NOT JUST
THE ONES OF INDIVIDUALS COMING
TO THE DEPARTMENT OF STATE
HOSPITALS, BUT THIS INCLUDES THE
COMMUNITY BASED RESTORATION
PROGRAMS. THIS INCLUDES
INDIVIDUALS THAT ARE COMING, UM
AND BEING PARTICIPATING IN
DIVERSION. AND THIS, YOU KNOW AN
END OR JAIL BASED TREATMENT
PROGRAMS. SO IT'S ALL OF THOSE
SERVICES. ALL OF THAT CAPACITY
THAT WE'RE BUILDING OUT IN ORDER
TO ADDRESS THIS INCREASING
NUMBER OF INDIVIDUALS WHO ARE
BEING ARRESTED AND COMMITTED TO
THE DEPARTMENT'S TOTAL PROGRAMS
. AND SO THAT'S WHY, AS WE LOOK
AT, UM THE DETERMINATIONS. WE'RE
LOOKING ACROSS ALL THE PROGRAMS
BECAUSE THE STATE'S INVESTING IN
ALL OF THESE PROGRAMS IN ORDER
TO ADDRESS THIS CONTINUING
GROWTH OF INDIVIDUALS THAT ARE
BEING REFERRED ARE DEAD. PEOPLE
INCLUDED IN ALL OF THOSE
PROGRAMS AS I'M JUST TRYING TO
REALLY STRUCK BY THAT EXAMPLE.
THAT'S A GOOD QUESTION, AND
WE'LL HAVE TO GO BACK AND TAKE A
LOOK AT AT WHETHER WE ADJUSTED
FOR THOSE INDIVIDUALS. BUT THAT
DOESN'T NECESSARILY MEAN THEY
DIDN'T RECEIVE ANY OF THE
DEPARTMENT SERVICES WHILE THEY
WERE WAITING ON THE WAITLIST,
PARTICULARLY WE DO HAVE THAT
REALLY ACCESS SERVICES PROGRAM
SO WE WOULD HAVE TO TAKE A LOOK
AT AND LOOK TO SEE WHAT IT IS
JUST WOULD LIKE TO STRESS LIKE
WHAT COUNTIES WANTED TO PARTNER
AS WE ARE, IN MANY WAYS WITH
TSH. TO AGAIN SERVE THESE PEOPLE
IN A COMMUNITY SETTING. WE KNOW
THE OUTCOMES ARE BETTER IF WE
USE THIS OPPORTUNITY TO GET
PEOPLE CONNECTED INTO LONG TERM
RESOURCES AND CARE AND SO
CONTINUING TO INCENTIVIZE THAT
WORK FEELS MORE IMPORTANT THAN
PENALIZING A DECISION THAT, YOU
KNOW. HAS MULTIPLE FACTORS
WEIGHING INTO THE DECISION THAT
WAS MADE TO IDENTIFY SOMEBODY AS
I S T TO BEGIN WITH. UM I WANTED
TO POINT OUT LAST QUESTION OF
TOP OF PAGE 73 YEARS. A LOT OF
THE DATA REGARDING THE LONG
ACTING IN INJECTABLES THAT I'M
TRYING TO, UM. IT'S PRETTY
CONVINCING WHEN YOU LOOK AT THE
HOMELESS WHO ARE I S AND THE USE
OF THE LONG ACTING INJECTABLES,
HAVE WE DETERMINED WHETHER THIS
IS STATISTICALLY SIGNIFICANT, OR
WE WORKING WITH RESEARCHERS TO
MAKE SUGGESTIONS BASED ON THIS
DATA. UM THERE ARE TRENDS, BUT
I'M JUST TRYING TO UNDERSTAND IF
THIS IS ARE WE ABLE TO CREATE
ACTIONS OUT OF IT? YEAH. UM I
MEAN, I THINK WE CURRENTLY WE
ARE WORKING WITH, UM OUR MEDICAL
DIRECTOR IS, UM WORKING WITH UC
DAVIS AND HAS BEEN FOR A NUMBER
OF YEARS TO KIND OF QUANTIFY AND
TRACK THE NUMBER OF INDIVIDUALS
AND THE TYPES OF INDIVIDUALS
THAT ARE COMING INTO OUR STATE
HOSPITAL SYSTEM. AND WE FIND
THAT NEARLY 70% OF THOSE THAT
HAVE BEEN ADMITTED TO A STATE
HOSPITAL HAVE ONE OF THE THREE
UM, HIGHLY TREATABLE DIAGNOSES
AND THAT'S SCHIZOPHRENIA,
SCHIZOAFFECTIVE DISORDER AND
BIPOLAR DISORDER. UM AND JUST BY
VIRTUE OF THOSE TYPES OF
DIAGNOSES, WE ALSO KNOW THAT
THOSE ARE REALLY EFFECTIVE, UM,
WITH TREATMENT BY MEDICATION.
UM, UM, WE'RE ALSO WORKING WITH
WE DO HAVE AN EXTENSIVE PRN, UM
, PHARMACIST IN PSYCH
PSYCHIATRIST TEAM. WHO ARE, UM,
CONSTANTLY LOOKING AT NEW
RESEARCH. AND SO IT'S JUST BY
VIRTUE OF ALSO JUST THE
INFORMATION THAT IS COMING UP
THROUGH THAT PIPELINE IN THE NEW
RESEARCH AND LITERATURE OUT
THERE ON THE EFFECTIVENESS OF
THE MEDICATIONS AND HOW THEY DO
SUPPORT, UM INDIVIDUAL
STABILIZING TO BE ABLE TO
TRANSITION, UM THAT'S PART OF
WHAT WE'VE BEEN HIGHLIGHTING AS
FAR AS RECOMMENDATIONS TO OUR
COUNTY PARTNERS IN ESTABLISHING
SOME OF THESE COUNTY PROGRAMS
AND JUST LOVED ADD TO THAT, UM
YOU KNOW, WE RELY HEAVILY ON
LONG ACTING INJECTABLES AT THE
COUNTY LEVEL THROUGHOUT THE
STATE, AND WE KNOW THAT CAN BE
HIGHLY EFFECTIVE. WHAT WE ALSO
KNOW IS THAT PROVIDING LONG TERM
MEDICAL CARE TO SOMEBODY WHO'S
UNSHELTERED AND HARD TO FIND AND
HARD TO MAKE SURE THAT THEIR
LABS ARE OKAY AND ALL THE
DIFFERENT PARTS THAT GO WITH
THAT. IS REALLY CHALLENGING AND
I JUST CAN'T STRESS ENOUGH
HOMELESSNESS IS THE UNDERLYING
VARIABLE MORE THAN THE LACK OF
TREATMENT. WE KNOW HOW TO TREAT
PEOPLE. IT'S JUST VERY, VERY,
VERY HARD TO DO WHEN WE CAN'T
FIND SHELTER FOR THEM. WITH THAT
I WILL. THANKS VERY MUCH THIS
PANEL AND WE WILL MOVE ON TO
ISSUE NOT. ISSUE NINE IS ON THE
DEPARTMENT OF STATE HOSPITAL
CRIMINAL OFFENDER RECORD
INFORMATION DATA TRAILER BILL
MHM. WE WILL HAVE J. C THOMPSON
, WHO IS THE DEPUTY DIRECTOR OF
THE HOSPITAL, STRATEGIC PLANNING
AND IMPLEMENTATION OF TSH TO
PRESENT THIS ISSUE. WELCOME AND
PLEASE BEGIN. THANK YOU. GOOD
EVENING, JASON THOMPSON
DEPARTMENT OF STATE HOSPITALS
DEPARTMENT IS PROPOSING CHANGES
TO TWO SECTIONS FIRST. PENAL
CODE SECTION 1 11 05. UM AND
WICK 40 40 WELFARE AND
INSTITUTIONS CODE. 40 40
REQUIRES TSH TO CONDUCT RESEARCH
AND EVALUATION STUDIES, WHICH
HAVE AN APPLICATION TO MENTAL
HEALTH POLICY AND MANAGEMENT
ISSUES. THIS PROPOSED LANGUAGE
WOULD AMEND PENAL CODE SECTION 1
11 05 TO INCLUDE THE DEPARTMENT
OF STATE HOSPITALS AS A NAMED
AGENCY HAVING STATUTORY
AUTHORITY TO OBTAIN ACCESS TO
CRIMINAL OFFENDER INFORMATION
THROUGH THE DEPARTMENT OF
JUSTICE. FOR THE SPECIFIC
PURPOSES OF CONDUCTING RESEARCH
PROGRAM, EVALUATION, DATA
ANALYTICS AND LEGISLATIVE
REPORTING ON AREAS WITH
IMPORTANT IMPLICATIONS TO MENTAL
HEALTH POLICY AND MANAGEMENT.
ACCESS TO THIS DATA WILL ASSIST
THE DEPARTMENT IN STUDYING
PROGRAM OUTCOMES RELATED TO IST
SOLUTIONS PROGRAM AS SUCH AS
DIVERSION. THE SECOND CODE
THAT'S PROPOSED FOR CHANGES AS
WELFARE AND INSTITUTIONS CODE 40
46. THESE CHANGES WOULD
CLARIFIED CHS ABILITY TO
EXCHANGE CRIMINAL IDENTIFICATION
INFORMATION NUMBERS WITH THE
CALIFORNIA DEPARTMENT OF
CORRECTIONS AND REHABILITATION,
SO THE STATE EXCHANGE PROMOTES
ACCURATE RECORD MATCHING OF THE
DATA NECESSARY TO PERFORM THIS
RESEARCH. NEXT WE HAVE JENNA
LOUDER, TSH RESEARCH DATA
CENTER. AND I JUST ECHO
EVERYTHING THAT JC THOMPSON JUST
SAID THAT IF YOU HAVE ANY
QUESTIONS, I'LL BE HAPPY TO
ANSWER THEM. DEPARTMENT OF
FINANCE YOU KNOW HONG DEPARTMENT
OF FINANCIAL NOTHING FURTHER,
DAD. HELLO. WILL OWENS AT LEO.
WE HAVE NO CONCERNS WITH THE
PROPOSAL. THANKS VERY MUCH THIS
PANEL AND WE WILL MOVE ON TO
ISSUE. ISSUED TENDERS ON THE
CALLUM JUSTICE INVOLVED
INITIATIVE. FIRST WE HAVE COOPER
STATE MEDICAID DIRECTOR. PLEASE
BEGIN WHEN YOU ARE READY. ALL
RIGHT. THANK YOU, UM, OVER
400,000, ADULTS AND YOUTH ARE
RELEASED FROM CORRECTIONAL
SETTINGS EVERY YEAR FROM PRISONS
, JAILS IN JUVENILE FACILITIES,
AND AT LEAST 80% OF THOSE
INDIVIDUALS ARE ELIGIBLE FOR
MEDICARE, AL, UM, IN JANUARY,
CALIFORNIA BECAME THE FIRST IN
THE NATION TO BE APPROVED TO
OFFER TARGETED MEDICAID SERVICES
TO SOMEONE WHILE INCARCERATED IN
PRISONS, JAILS AND JUVENILE
FACILITIES. OF CORRUPTION 90
DAYS PRIOR TO RELEASE THE INTENT
OF THE DEMONSTRATION IS TO BUILD
ON COMMUNITY BASED CARE AND TO
REALLY ENSURE THAT WE ARE
WORKING TO STABILIZE, DIAGNOSED
AND DO A COORDINATED RE ENTRY
INTO THE COMMUNITY TO SEE
BETTER, SUCCESSFUL OUTCOMES FOR
INDIVIDUALS AS THEY TRANSITION
INTO THE COMMUNITY. SINCE
OCTOBER OF 2021, THE DEPARTMENT
OF HEALTH CARE SERVICES HAS
CONVENED A STATEWIDE ADVISORY
COMMITTEE INFORMING THIS POLICY
THE ENTIRE TIME WE WERE
NEGOTIATING WITH CMS. WE'VE
APPRECIATED THE FEEDBACK OF THAT
ADVISORY COMMITTEE. IT HAD
SHERIFF DEPARTMENT PROBATION
CDCR COUNTIES, MANAGED CARE
PLANS COMMUNITY BASED
ORGANIZATIONS. WE WILL CONTINUE
TO CONVENE THAT GROUP AS WE'RE
ALSO WORKING THROUGH SOME
IMPLEMENTATION, A DESIGN AND
FEEDBACK AS WELL. PEOPLE WHO ARE
NOW OR HAVE SPENT TIME IN JAILS
. PRISONS EXPERIENCED A PORTION
DISPROPORTIONATELY HIGHER RATES
OF PHYSICAL AND BEHAVIORAL
HEALTH DIAGNOSES AND ARE HIGHER
RISK FOR INJURY AND DEATH AS A
RESULT OF TRAUMA, VIOLENCE,
OVERDOSE SUICIDE AND THEN PEOPLE
WHO HAVE NOT BEEN INCARCERATED,
INCARCERATED INDIVIDUALS WHO
HAVE A BEHAVIORAL HEALTH
DISORDER. ARE MORE LIKELY THAN
THOSE WITHOUT A DISORDER TO HAVE
BEEN HOMELESS IN THE YEAR PRIOR
TO INCARCERATION LESS LIKELY TO
HAVE BEEN EMPLOYED PRIOR TO
THEIR ARREST AND ARE MORE LIKELY
TO REPORT A HISTORY OF PHYSICAL
OR SEXUAL ABUSE. PEOPLE
INCARCERATED IN STATE FEDERAL
PRISONS. NATIONALLY THE
MORTALITY RATE TWO WEEKS POST
RELEASE FROM PRISON HAS BEEN
FOUND TO BE 12.7 TIMES HIGHER
THAN THE NORMAL RATE THAT IS
SIGNIFICANT ONE OF THE CORE
PIECES OF THIS WAIVERS FOCUSING
ON THAT REENTRY TO REDUCE THAT
CYCLE FOR THOSE TWO WEEKS UPON
RELEASE. WE DO KNOW THERE'S A
LOT OF DATA THAT SHOWS UPON
RELEASE. SOMEONE WILL EMERGENCY
IMMEDIATELY GO TO AN EMERGENCY
ROOM WHERE THEY CAN OFTEN TIMES
BE ADMITTED. OR THEY GO INTO THE
COMMUNITY. THEY STOPPED TAKING
THEIR MEDICATION, AND THEN THEY
WITHIN SIX MONTHS OR WITHIN THE
TWO WEEK PERIOD SHOW UP IN AN
EMERGENCY WHERE ROOM OR GET
ADMITTED AS WELL. ADDITIONALLY
WHILE WE KNOW INCARCERATED
INDIVIDUALS OFTEN FACE
SIGNIFICANT, COMPLEX MEDICAL
CONDITIONS WE KNOW FOR THE PAST
DECADE THE PROPORTION OF
INCARCERATED INDIVIDUALS IN
CALIFORNIA JAILS WITH AN ACTIVE
MENTAL HEALTH CASE HAS ROSE BY
63% IN CALIFORNIA. UM AND, UH,
WE ALSO KNOW THAT THE OVERDOSE
RATE FOR INDIVIDUALS
INCARCERATED IS THREE TIMES THE
HIGHER THAN THE NATIONAL RATE.
UM ADDITIONALLY, THE ISSUE OF
POOR HEALTH OUTCOMES AND DEATH
FOR INDIVIDUALS FOR THOSE WHO
HAVE BEEN INCARCERATED IS A
CRITICAL HEALTH EQUITY ISSUE.
BECAUSE CALIFORNIA IN CALIFORNIA
PEOPLE OF COLOR ARE
DISPROPORTIONATELY INCARCERATED
. FOR EXAMPLE, INCARCERATION
MONTH RATES AMONG BLACK MEN ARE
4000 PER 100,000. LATINO MEN
1000 PER 100,000. WHEREAS MEN OF
ALL OTHER RACES ARE AND
ETHNICITIES 314 PER 100,000, SO
THE DISPARITIES ARE CLEAR IN
REGARDS TO NEEDING TO INTERVENE
. ADDITIONALLY OUR GOAL IS TO
PROVIDE AN OPPORTUNITY FOR
PHYSICAL AND BEHAVIORAL HEALTH
CARE INTERVENTIONS AT EARLIER
OPPORTUNITIES TO REDUCE ACUTE
SERVICE UTILIZATION AND ADVERSE
HEALTH OUTCOMES WHILE PROVIDING
A COORDINATED RE ENTRY INTO THE
COMMUNITY FOR INCARCERATED
INDIVIDUALS. BUT I WOULD ALSO
SAY IS WE COME TO THIS WITH
EXPERIENCE IN CALIFORNIA. WE HAD
A WHOLE PERSON CARE PILOTS FROM
2016 TO 2021 THAT HAD
DEMONSTRATED IMPROVED OUTCOMES.
MANY OF THESE PILOTS AIM TO
INCREASE ACCESS TO HOUSING AND
SUPPORTIVE SERVICES FOR PEOPLE
LEAVING INCARCERATION AND
INDEPENDENT EVALUATION SHOWED
THAT FOCUSING ON RE ENTRY AND
DOING A COORDINATED RE INJURY
WHILE SOMEONE IS INCARCERATED
PRIOR TO RELEASE SHOWED AN
IMPROVEMENT IN REGARDS TO
SOMEONE BEING CONNECTED TO
HOUSING SUPPORTS UPON LISTEN TO
THE COMMUNITY. ADDITIONALLY THE
PILOTS WHO CHOSE TO REPORT THE
INFORMATION REPORTED THE NUMBER
OF INCARCERATIONS THAT A CURED
OCCURRED FOR THOSE AGES. 14 AND
OLDER THE GEL INCARCERATION RATE
DECREASED FROM 18 INCARCERATIONS
PER 1000 MEMBER MONTHS TO SIX
INCARCERATIONS PER 1000 MEMBER
MONTHS FOR THOSE PARTICIPATING
IN THESE PROGRAMS, SO
DEMONSTRATED SUCCESS HERE IN
CALIFORNIA WITH THE PILOTS AND
TAKING THIS STATEWIDE. UNDER
THIS INITIATIVE, INDIVIDUALS OR
RECEIVE PRERELEASE SERVICES CAN
INCLUDE CASE OR CARE MANAGEMENT
SERVICES. IT CAN INCLUDE
TREATMENT SERVICES, DIAGNOSIS
AND ASSESSMENT SERVICES WILL
ALSO INCLUDE SERVICES LIKE M 80
OR MEDICATION, A TREATMENT UM,
AS WELL AS WARM HANDOFFS TO OUR
COUNTY BEHAVIORAL HEALTH
PARTNERS, WHICH IS REQUIRED FOR
SOMEONE WITH SERIOUS MENTAL
ILLNESS OR SUBSTANCE USE AS
DIAGNOSED OR IDENTIFIED WHILE
INCARCERATED TO ENSURE THAT WE
ARE CONTINUING THAT TREATMENT
THE GOAL IS TO REALLY IDENTIFY
THAT WITHIN THE INCARCERATED
SETTING, CONNECT THEM TO TRUSTED
PARTNERS, WHETHER COUNTY OR
COMMUNITY BASED ORGANIZATIONS
AND FOCUSING ON THAT REENTRY.
ADDITIONALLY UPON RELEASE,
EVERYONE WILL RECEIVE A
MEDICATION, UH, PRESCRIPTION OR
DME FOR ANYTHING THAT THEY NEED,
AND THEY WILL BE FOCUSED ON
ENHANCED CARE MANAGEMENT FOR OUR
JUSTICE POPULATION, WHICH WILL
FOCUS ON COORDINATING ALL OF THE
SERVICES NEEDED ONCE THEY ARE IN
THE COMMUNITY. THAT WOULD
INCLUDE CONNECTION TO OUR
COMMUNITY SUPPORTS LIKE HOUSING
, SUPPORTIVE SERVICES, OR, FOR
EXAMPLE, SOMEONE COULD BE
DISCHARGED FROM JAIL TO ONE OF
OUR CREW RECUPERATIVE CARE
SETTINGS IF THE COORDINATION CAN
HAPPEN TIMELY, IN ADDITION TO
THE WAIVER, UM WE'RE ALSO
PROPOSING WAS ALSO APPROVED IS
561 MILLION FOR WHAT WE CALL
PROVIDING ACCESS AND
TRANSFORMING HEALTH OR PATH
DOLLARS FOR THE JUSTICE
INITIATIVE. THESE DOLLARS ARE
REALLY TO HELP COUNTIES AND CDCR
AS WELL AS OUR COUNTY
BEHAVIORAL, HEALTH AND SHERIFF.
PROBATION PARTNERS. BE READY FOR
THIS PROPOSAL. WE'VE BEEN
RELEASING GUIDANCE IN REGARDS TO
THESE FUNDS IN LOOK FORWARD TO
PARTNERING WITH THEM AS THEY
IMPLEMENT PROVISIONS OF THE
PRERELEASE INCARCERATED
INDIVIDUALS WILL GO LIVE NO
SOONER THAN APRIL OF 2024. CMS
AND THE STATE OF CALIFORNIA DID
HAVE TO NEGOTIATE A NUMBER OF
READINESS CRITERIA THAT COUNTIES
WOULD HAVE TO DEMONSTRATE PRIOR
TO BEING ABLE TO GO. LIVE. AND
WE NEED THE PATH DOLLARS TO GET
INTO THE HANDS OF THE COUNTY SO
THEY CAN BE PREPARED FOR THE
SERVICES THAT THEY ARE DOING.
COUNTIES WILL HAVE UP TO 24
MONTHS TO ELECT TO GO LIVE
ANYTIME BETWEEN THAT APRIL OF
2024 THROUGH APRIL OF 2026 TO GO
LIVE WITH PRERELEASE SERVICES.
UM WE DO LOOK FORWARD TO
IMPLEMENTING THIS AND PARTNERING
WITH OUR COUNTY PARTNERS TO DO
THIS. WE DO THINK THIS IS ONE OF
THE PIECES IN KILLING THAT TRULY
CAN CHANGE THE TRAJECTORY OF
SOMEONE'S LIFE. AND WE LOOK
FORWARD TO WORKING WITH THE
LEGISLATURE AND OUR PARTNERS. TO
IMPLEMENT THIS INITIATIVE. NEXT
WE HAVE PHOEBE BELL, DIRECTOR OF
NEVADA COUNTY BEHAVIORAL HELP
DIRECT ASSOCIATION. ALL THOSE
THINGS THINGS. UM. SO FIRST OFF.
I JUST WANT TO STRESS THAT CAN'T
BEHAVIOR. HEALTH DEPARTMENTS ARE
SUPER EXCITED ABOUT CALIFORNIA'S
FIRST IN THE NATION WAIVER TO
ALLOW FOR MEDICAL ENROLLMENT AND
REIMBURSEMENT FOR PRERELEASE
SERVICES, INCARCERATE SETTINGS
AND REALLY APPRECIATE THE WORK
OF THE STATE IN MAKING THIS
HAPPEN. UM I JUST HIGHLIGHTED
MINUTES AGO. MUCH OF THE WORK
THAT COUNTIES ALREADY DO IN THIS
SPACE. WE ARE DEEPLY COMMITTED
TO SERVING THIS POPULATION JUST
WANTED TO ADD A COUPLE OTHER
QUICK THINGS. UM NEVADA COUNTY
IS ONE OF 37 COUNTIES IN
CALIFORNIA THAT'S PARTICIPATING
IN THE STEPPING UP INITIATIVE,
AND WE PULL TOGETHER ALL OUR
PARTNERS THAT INTERSECT IN THIS
SPACE TO TALK TOGETHER ABOUT HOW
DO WE DO BETTER BY THIS
POPULATION? WE ALSO ARE A COUNTY
THAT THROUGH A GRANT FROM THE A
C AS AN INNOVATION INCUBATOR
PROJECT, AND WE'RE ABLE TO BRING
IN DATA ANALYSIS RESOURCES THAT
REALLY HELPED US BETTER
UNDERSTAND THIS POPULATION. AND
THERE HAVE BEEN FLOW THROUGH OUR
SYSTEMS AND REALLY HAVE HELPED
INFORM SOME GREAT, UM,
INITIATIVES AND PROGRAMS AND
RECENTLY LEAD US TO BEING
RECOGNIZED AS AN INNOVATOR
COUNTY THROUGH THE STEPPING UP
INITIATIVE, ONE OF THE FEW IN
CALIFORNIA AND THEN LASTLY, WE
KNOW THAT OUR IMAGE TO SAY
FUNDED PROGRAMS ARE HIGHLY
EFFECTIVE AT KEEPING PEOPLE OUT
OF JAIL. WE SEE ALMOST A 70%
REDUCTION IN JUSTIN JUSTICE
INVOLVEMENT FOR OUR CLIENTS
ENROLLED IN FSP. SO WE ARE
EXCITED TO BE PARTNERING WITH
PHDS TO, UM, HELP SHAPE THIS
REALLY EXCITING BENEFIT AND JUST
WANT TO FLAG A FEW THINGS, WHICH
WE THINK ARE JUST AREAS OF
CONCERN THAT I THINK THE STATE
IS ALSO AWARE OF, BUT ONE OF THE
MOST CRITICAL ASPECTS OF THIS
POLICY IS THE IDEA THAT PEOPLE
ARE IN JAIL FOR A WHILE. AND
WHAT WE KNOW FROM OUR DATA WORK
IS THAT UM 70% OF JAIL BOOKINGS
ARE IN JAIL FOR LESS THAN THREE
DAYS IN THE VAST MAJORITY OF
THOSE ARE IN JAIL FOR LESS THAN
24 HOURS. AND SO HOW TO WORK
WITH THAT POPULATION IS A PRETTY
CRITICAL COMPONENT OF HOW TO
OPERATIONALIZE THIS IDEA AND
MAKE IT EFFECTIVE. WE ALSO KNOW
THAT, UM THE UNPREDICTABILITY OF
WHEN PEOPLE ARE GETTING RELEASED
, MAKES IT VERY CHALLENGING AS
WELL. AND COURTS AND JAILS GO
BACK AND FORTH ON THAT, AND THIS
CAN MAKE WARM HANDOFFS AND
TRANSPORTATION A BIG CHALLENGE.
WE WANT TO FLAG THAT THIS PEOPLE
SERVICE MODEL INSIDE THE JAIL
WHERE CORRECTIONS FACILITIES ARE
DECIDING WHO AND HOW SERVICES
ARE PROVIDED JUST NEEDS TO HAVE
THE SAME KIND OF QUALITY
ASSURANCE EXPECTATIONS THAT WE
HAVE IN A COMMUNITY SETTING SO
THAT WE HAVE COMPARABLE
SERVICES. UM AND THEN, LASTLY,
WE REALLY WANT TO FLAG THAT
WORKFORCE IS GOING TO BE A
CHALLENGE. UM, WE REALLY SUPPORT
THE BUILD OUT OF USING PEERS IN
THIS SPACE AND OTHER CREATIVE
SOLUTIONS BECAUSE THE WORKFORCE
ISSUES ARE SO MASSIVE AND WE
DON'T WANT TO GET INTO BIDDING
WARS WITH OUR JAILS ABOUT THE
FEW CLINICIANS THAT WE HAVE OUT
THERE LEFT TO TRY TO RECRUIT SO
BY BRINGING THIS MEDICAL
REIMBURSEMENT INTO THE FOLD, WE
CAN BEGIN TO DEVELOP THE SYSTEMS
AND ACCOUNTABILITY STRUCTURES TO
TACKLE THESE ISSUES AND IMPROVE
THE QUALITY OF SERVICES. WE'RE
EXCITED ABOUT THAT. DEPARTMENT
OF FINANCE. MANRIQUEZ DEPARTMENT
OF FINANCE HERE TO ANSWER ANY
QUESTIONS. WILL WE HAVE NO NO
CONCERNS WITH THIS PROPOSAL.
I'LL BRING IT BACK TO THE
DIOCESE. I'M A HUGE FAN OF THE
PROPOSAL AND ONE OF APPRECIATE
THE ADMINISTRATION FOR BRINGING
IT FORWARD, THE TWO THIRDS
REDUCTION THAT OCCURS FROM THE
PROGRAM THAT YOU STATED HERE
TODAY GOING FROM 18 DOWN TO SIX
IS VERY GOOD DATA, AND IT'S A
STRONG REASON AND RATIONALE FOR
US TO BE EXTENDING MEDICAL AND
I'M TRYING TO BRING IN WHAT MISS
BELL HAD TALKED ABOUT, THOUGH
ABOUT BEING IN FOR THREE DAYS OR
LESS THAN 24 HOURS TO
UNDERSTAND. HOW WE CAN
REALISTICALLY PROVIDE THOSE
SUPPORTIVE SERVICES AND ALIGN,
UM, THOSE HOUSING SUPPORTS. AND
SO I JUST LOVE TO HAVE YOU
COMMENT ON THAT IF POSSIBLE?
SURE UM, SO WHEN IT WE HAVE
SEGMENTED ALL OF THE DATA, AND
WE WORKED VERY CLOSELY WITH OUR
SHERIFF PROBATION IN CDCR TO
UNDERSTAND, OBVIOUSLY, FOR
SOMEONE IN CDCR, THEY'RE GOING
TO PROBABLY BE ABLE TO MAXIMIZE
THE FULL 90 DAYS. UM FOR
INDIVIDUALS IN THE JAILS. WE DO
KNOW THAT THERE IS A LARGE
PORTION THAT ARE IN AND OUT
WITHIN 24 HOURS. MOST LIKELY
THEY WILL NOT BE ABLE TO TAKE
ADVANTAGE OF THIS INITIATIVE. I
JUST WANT TO BE REALLY FRANK.
THERE WITH INDIVIDUALS. WE ALSO
SEE ON AVERAGE STATEWIDE,
PROBABLY CLOSER TO A WEEK AND 14
DAYS WHERE YOU DO HAVE SOME
OPPORTUNITIES TO AT LEAST ASSESS
, DIAGNOSE AND HAVE A SMALL
AMOUNT OF INFORMATION THAT COME
AND GO OUT. WE'RE ACTUALLY
WORKING ON POLICY, AND WE HAVE A
SMALL WORKGROUP FOCUSING ON LIKE
THE SHORT TERM STAY. HOW DO WE
MAXIMIZE THE SHORT TERM STAY
VERSUS THOSE WHO ARE LONGER. WE
DO KNOW WE HAVE INDIVIDUALS IN
THE JAILS WHO DO HAVE LONGER
PERIOD TIME. SO FROM OUR
OPINION, IT'S UP TO THAT 90
DAYS, SO WE WILL TRY TO MAXIMIZE
AS MUCH OF THAT AS WE CAN AND
HAVE BEEN DOING SOME GREAT
THINKING WITH PEOPLE WHO WOULD
LOVE TO BRING YOU TO THE TABLE
TO HAVE THOSE CONVERSATIONS. UM
TO REALLY THINK THROUGH THE
DIFFERENT MODELS, DEPENDING ON
THE TIME PERIOD THAT SOMEONE IS
IN, UM, BUT SOME OF THESE WILL
TAKE TIME IN REGARDS TO
CONNECTING PEOPLE, SO EVERYTHING
MAY NOT BE AVAILABLE FOR SOMEONE
IN THOSE SHORTER STAYS, BUT THAT
IS WHY WE ALSO HAVE THE JUSTICE
RELEASED ENHANCED CARE
MANAGEMENT. ANYONE WHO'S
RELEASED FROM INCARCERATION
WOULD BE ABLE TO BE CAPTURED
EVEN WITHIN THE COMMUNITY AND
THEN RECEIVE AND GET CONNECTED
TO MANY OF THE VARIOUS SUPPORTS
WHERE SOMEONE THEY'RE WORKING
WITH PEERS WHO HAVE PREVIOUSLY
BEEN INCARCERATED, FOR EXAMPLE,
OR VARIOUS PIECES AND ON THE
COMMENT FOR THE WORKFORCE. WE'RE
ALSO INCLUDING COMMUNITY HEALTH
WORKERS IN HERE. WE'RE HOPING
THAT CAN BE A GOOD USE AS WELL
AS PEERS TO REALLY FOCUS ON SOME
OF THE NON CLINICAL WORKFORCE
THAT COULD REALLY DO A LOT OF
THIS CARE, COORDINATION,
CONNECTIONS, TRUST BUILDING AND
CONNECTION TO SERVICES IN THE
COMMUNITY AND INCARCERATED
SETTINGS. WE HEARD FROM DR EWING
EARLIER ABOUT THE IMPORTANCE OF
US GETTING UPSTREAM, HELPING TO
PREVENT SOME OF THOSE OVERDOSES
OR UM, CASES OF HOMELESSNESS
THAT OCCURRED POST RELEASE OUR,
UM UM VERY STRONG RATIONALES FOR
US TO BE MAKING THESE CHANGES
AGAIN. JUST WANT TO APPRECIATE
THE ADMINISTRATION. WITH THAT WE
WILL THINK VERY MUCH THIS PANEL
AND MOVE ON TO ISSUE 11. AS I
HOPE WE'RE HALFWAY THROUGH THE
HEARING. I'M GOING TO TAKE A TWO
MINUTE BREAK AND THEN COME RIGHT
BACK. BUT IF I CAN HAVE 11 COME
FORWARD. HI.
GONNA PULL US BACK TO ORDER IF I
CAN AND APPRECIATE THE
APPRECIATE THE PAUSE. ESTIMATION
POLICY. WE WILL FOCUS ON ISSUE
11, WHICH IS AN OVERSIGHT ISSUE
ON BEHAVIORAL HEALTH AND
HOMELESSNESS. OUR FIRST SPEAKER
IS DR TARA NEEDHAM WITH U C.
DAVIS. THANK YOU, DOCTOR BEGIN.
WHENEVER YOU'RE READY. THAT ONE
CAUGHT ME BY SURPRISE. UM,
EXCUSE ME. THERE'S ALREADY BEEN
A LOT OF DISCUSSION ABOUT HOW
INDIVIDUALS WITH PSYCHOTIC
DISORDERS LIKE SCHIZOPHRENIA,
SCHIZOAFFECTIVE DISORDER AND
THEN INDIVIDUALS WITH BIPOLAR
DISORDER CAN ALSO HAVE PSYCHOTIC
FEATURES AND THAT THESE
INDIVIDUALS DISPROPORTIONATELY
REPRESENT THOSE IN THE JUSTICE
SYSTEM AND THAT HOMELESSNESS IS
A KEY DRIVER OF FOLKS ENTERING
WITH THESE DIAGNOSIS ENTERING
OUR JUSTICE SYSTEM, SO I'M HERE
TO TALK ABOUT HOMELESSNESS. UM
SO UM. I'M HERE TO REPRESENT
THOSE EARLY PSYCHOSIS PROGRAMS
ACROSS THE STATE WHO ARE
SURVEYING OR WANT TO SERVE THESE
INDIVIDUALS WHO HAVE THESE EARLY
SIGNS OF PSYCHOSIS. I WOULD LIKE
TO HIGHLIGHT THAT ACROSS THESE
PROGRAMS WERE ONLY ABLE TO SERVE
LESS THAN 10 1/10 OF THE NUMBER
OF CALIFORNIANS. SO UM,
INCIDENTS ESTIMATES WOULD
SUGGEST THAT WE SHOULD SEE
27,000 INDIVIDUALS PER YEAR.
WITH A NEW DIAGNOSIS OF
PSYCHOSIS. AND SO WE'RE ABLE TO
CAPTURE ABOUT A LITTLE OVER
2000. OF THOSE FOLKS IN OUR
CURRENT PROGRAMS. UM AND SO THAT
MEANS THERE'S ABOUT 20,000
RESIDENTS WHO ARE AT HIGH RISK
FOR FUTURE HOMELESSNESS. UM SO
WITH THE SUPPORT OF THE NHS, SO
A, C AND D H C S WE'VE
COLLABORATIVELY CO DEVELOPED AND
OUTCOMES EVALUATION FOR USE IN
EARLY PSYCHOSIS PROGRAMS. WE DID
A LOT OF ENGAGEMENT WITH VARIOUS
COMMUNITY PARTNERS, CLIENTS,
FAMILIES, PROVIDERS, STATE AND
LOCAL LEADERSHIP TO UNDERSTAND
WHAT OUTCOMES MATTERED AND HOW
BEST TO MEASURE THOSE AND
HOMELESSNESS AND RISK FOR
HOMELESSNESS WAS ONE OF THOSE,
ALTHOUGH IT WAS A VERY COMMON
REFRAIN AS WE WERE DOING THESE
ENGAGEMENT MEETINGS TO HEAR FROM
PROVIDERS OUR CLIENTS WEREN'T
HOMELESS. WE DON'T SEE THAT IN
EARLY PSYCHOSIS. AND THEN WE
STARTED LOOKING AT THE DATA,
WHICH IS PRIMARILY SELF REPORT,
AND WHAT WE LEARNED IS THAT I'M
COMING INTO THESE PROGRAMS 38%
OF INDIVIDUALS WITH EARLY
PSYCHOSIS INDOORS, HOUSING
INSTABILITY, UM, PRIOR TO ENTRY
INTO THE PROGRAM, AND 13% OF
THEM HAD BEEN LIVING ON THE
STREET EITHER BY THEMSELVES OR
WITH THEIR FAMILIES, SO WE HAVE
A HIGH RISK POPULATION BECAUSE
OF THEIR MENTAL HEALTH
DIAGNOSIS. AND THAT IS INCREASED
WHEN YOU LOOK AT SOMEBODY WHO'S
BEEN HOMELESS BEFORE OR HAD
HOUSING INSTABILITY BEFORE, SO
THESE INDIVIDUALS HAVE A LOT OF
RISK FACTORS FOR HOMELESSNESS
AND THEREFORE JUSTICE
INVOLVEMENT. UM SO I JUST REALLY
WANT TO HIGHLIGHT THAT IS DR
EWING HAS POINTED OUT MULTIPLE
TIMES, WHICH I APPRECIATE EARLY
PSYCHOSIS PROGRAMS ARE OF VITAL
UPSTREAM. INTERVENTION THAT
FOCUS ON SUPPORTING OUR CLIENTS
AND LOVED ONES TOWARDS WELLNESS
, HOPING A BRIGHT FUTURE AND SO
I JUST REALLY WANT TO HIGHLIGHT
HOW WE ARE KEY AND SEE OURSELVES
AS KEY TO REDUCING FUTURE AND
CURRENT HOMELESSNESS HERE IN
CALIFORNIA. THANK YOU. NEXT. WE
HAVE DR JONATHAN ORTEZ. CHIEF
EXECUTIVE OFFICER. SANDRA CLARK
. HARVEY HAS REPLACED THANK YOU
. I AM NOT DOCTOR PARTY IS HE
HAD TO GO TO A BOARD MEETING,
BUT I WILL TRY MY BEST. I'M DR
LEANDER CLARK HARVEY, CEO OF C
B, H I AND WALL SPACE WHO DR
PARTIES REPRESENTS IS ONE OF OUR
MEMBERS, SO I WILL READ HIS
TESTIMONY FOR HIM WHILE SPACES
AND FQ HC FEDERALLY QUALIFIED
HEALTH CENTER, PROVIDING
BEHAVIORAL HEALTH SERVICES TO
OVER 125,000 MEDICAL PATIENTS OF
ALL AGES. 12, THOUSANDS OF WORDS
OF WHICH ARE UNINSURED. SERVICES
INCLUDE SOBERING DETOX,
OUTPATIENT AND RESIDENTIAL
SERVICES. WALL SPACE IS ALSO A
CERTIFIED COMMUNITY BEHAVIORAL
HEALTH CENTER IN A 988 CRISIS
CENTER. THEY ANSWER CALLS FOR
OVER 20 COUNTIES, AND THEY'RE
ALSO SERVICES BACKUP CALL CENTER
FOR 38 COUNTIES, MEANING THAT
WHEN SOMEONE DOESN'T GET A CALL
ANSWERED AT A PRIMARY CALL
CENTER. THEY ROLL OVER TO WELL
SPACE AND INDEEDY HIRSCH AS
WELL. SO WHILE SPACE HAS HAD TWO
FULL TIME STREET NURSES DOWNTOWN
SACRAMENTO SINCE 2015 AND THESE
INDIVIDUALS HAVE COLLECTIVELY
SERVED OVER 25,000 PEOPLE,
THAT'S AMAZING. THAT'S HOW MUCH
WORK THEY'RE DOING AND HOW MUCH
NEED THERE IS. THERE'S NEVER
BEEN. THIS HAS NEVER BEEN A
BILLABLE SERVICE. THESE NURSES
WORK OFF A GRANT FUNDS AND SO
KELLUM REALLY DOES HAVE A
PROMISE OF IMPROVING THE BILLING
SYSTEM THAT HAS NOT BEEN
POSSIBLE TO DATE. WELL, SPACE
WANTS YOU ALL TO KNOW THAT
STREET MEDICINE. IT'S NOT A
SOLUTION. THIS IS A TEMPORARY
VEHICLE FOR ENGAGING PEOPLE
WHERE THEY'RE AT BUILDING TRUST
. TAKING CARE OF THEM IS NEEDED,
BUT ALWAYS, REALLY ULTIMATELY
TRYING TO GET THEM TO ENGAGE AS
A PATIENT AND A MORE
COMPREHENSIVE AND INTEGRATED
CARE ENVIRONMENT LIKE THE ONE
THAT THERE ARE OTHER CENTERS
PROVIDE SO PEOPLE THAT LIVE IN
DOWNTOWN SACRAMENTO HAVE THREE
CENTERS TO CHOOSE FROM THEIR
OPEN SEVEN DAYS A WEEK AND SO
WELL, SPACE REALLY FOCUSES ON
ENGAGING PEOPLE ON THE STREET.
GREAT AS LONG AS THEY NEED, WITH
THE GOAL OF GETTING THEM INTO
PRIMARY AND PREVENTIVE
INTEGRATIVE CARE SETTINGS. TO
DATE PLANS. HEALTH PLANS HAS HAD
TO SET UP KIND OF COMPLETE
BILLING MECHANISMS FOR
EVERYTHING, WHICH MEANS THAT
WEALTH SPACE REPORTS THEY'RE
STILL OWED FOR HALF OF THEIR
2022 BUILDING. THAT'S A HUGE
DEBT. SO A SUGGESTION THAT THEY
HAD WOULD BE MORE STATE
OVERSIGHT. OBVIOUSLY ON HOW
MONEY IS SPENT, SO THAT PLANS
DON'T HAVE TO CREATE THIS TYPE
OF ISSUE WITH BEHAVIORAL HEALTH
SERVICES. WELL SPACED LIKE SO
MANY OF OUR OTHER MEMBER'S
STANDS READY TO PROVIDE SERVICES
, REGARDLESS OF THE FUNDING
SOURCE, AND REALLY LOOKS FORWARD
TO THE PROVINCE OF CALLUM AND
WORKING WITH THE DEPARTMENT AND
OTHERS. THANK YOU. NEXT. WE HAVE
PHOEBE BELT.
HELLO AGAIN. UM THANKS FOR THE
CHANCE TO SPEAK TO THIS TOPIC. I
AM INCREDIBLY PASSIONATE ABOUT
THE HUMANITARIAN CRISIS THAT IS
HOMELESSNESS IN OUR STATE AND
COUNTRY. WE KNOW THERE'S AN
EXCESS BETWEEN HOMELESSNESS AND
BEHAVIORAL HEALTH IN THE
INDIVIDUALS WITH BEHAVIORAL
HEALTH CONDITIONS ARE FAR MORE
LIKELY TO FALL INTO HOMELESSNESS
AND THAT THE TRAUMA BEING ON
HOUSE CAN TRIGGER AND DEEPEN
BOTH MENTAL HEALTH AND SUBSTANCE
USE DISORDERS. IT'S FOR THIS
REASON THAT OUR EFFORTS TO
PREVENT HOMELESSNESS OR SO
IMPORTANT, PARTICULARLY FOR THE
MULTIPLE VULNERABLE AND
DISPROPORTIONATELY IMPACTED
INDIVIDUALS, INCLUDING DOMESTIC
VIOLENCE, SURVIVORS, GTB QUÊ
YOUTH, BLACK CALIFORNIANS,
VETERANS, INDIVIDUALS TO SECURE
SIGNIFICANT BEHAVIOR, HEALTH
CHALLENGES LIKE THE CLIENTS WE
SERVE. WE ALSO KNOW THAT THE
LACK OF AFFORDABLE AND
ACCESSIBLE HOUSING AND SHELTER
IS THE MAJOR CONTRIBUTOR TO
HOMELESSNESS THROUGHOUT OUR
STATE, AND THAT FAR MORE OF OUR
CLIENTS WANT HOUSING, THEN WE
HAVE THE ABILITY TO PROVIDE LAST
YEAR, TBH DÍAS SURVEYED OUR
MEMBERSHIP AND FOUND THAT IN THE
PRIOR YEAR, COUNTY F SPS HAD
SUCCESSFULLY OUTREACH TO AND
ENGAGED ROUGHLY 15,000 AND
HOUSED INDIVIDUALS INTO SERVICES
. BUT WE COULD ONLY HOUSE FEWER
THAN HALF AROUND 7000
INDIVIDUALS. WE ARE UNABLE TO
HOUSE THE REMAINING 8000 AS OUR
CLIENTS WERE EITHER SCREENED OUT
DID A CRIMINAL BACKGROUND CHECKS
OR CREDIT HISTORIES OR, MORE
LIKELY, WE WERE SIMPLY UNABLE TO
FIND A HOUSING UNIT FOR THEM. IN
THE BATTLE COUNTY. THIS IS
CERTAINLY BEEN OUR EXPERIENCE IN
A POINT IN TIME LOOK AT OUR 75
CLIENTS RECEIVING FSP LEVELS OF
CARE. MORE THAN ONE THIRD OF
THOSE INDIVIDUALS HAD NO STABLE
PLACE TO CALL HOME DESPITE BEING
HIGHLY ENGAGED IN TREATMENT
SERVICES. OUR FINDINGS AND
EXPERIENCE WERE BACKED UP BY
IRAN STUDY RELEASED THIS YEAR,
WHICH INTERVIEWED CHRONICALLY ON
HOUSED INDIVIDUALS LIVING IN L.
A THEY FOUND THAT 90% OF THOSE
INTO INTERVIEWED INDICATED A
STRONG INTEREST IN HOUSING AND
29% WERE ALREADY ON A WAIT LIST
AGAIN IN NEVADA COUNTY. THIS
POINT WAS DRIVEN HOME DURING
COVID WHEN WE HAD ACCESS TO NEW
FUNDS AND FLEXIBILITIES, AND WE
QUICKLY HAS MANY INDIVIDUALS IN
HOTELS AND HAD NO ONE REFUSED
THIS OPPORTUNITY. WE KNOW THAT
THE VAST MAJORITY EVENT
SHELTERED PEOPLE WANT HOUSING.
OUR CHALLENGES REST WITH HOUSING
SUPPLY, HOUSING, STABILITY AND
ACCESS TO HOUSING AND AN
EXTREMELY COMPETITIVE HOUSING
MARKET. AND I JUST WANT TO
HIGHLIGHT WHAT WE'VE BEEN DOING
IN NEVADA COUNTY BECAUSE I THINK
IT'S SYMBOLIC OF WHAT'S
HAPPENING THROUGHOUT THE STATE.
UM THERE'S BEEN A LOT OF GREAT
RESOURCES COMING TO THE TABLE
OVER THE PAST FEW YEARS AND
COUNTIES ARE WORKING LIKE CRAZY
TO TAKE ADVANTAGE OF THEM. IN
NEVADA COUNTY. WE GOT A PROJECT
HUNKY GRANT THAT ALLOWED US TO
PURCHASE AN OLD HOTEL, WHICH IS
ON ITS WAY TO BECOMING 20 UNITS
OF PERMANENT HOUSING. WE GOTTA
NO PLACE LIKE HOME GRANT THAT
ALLOWED US TO BUILD 40 UNITS OF
HOUSING, 12 OF WHICH ARE FOR
PEOPLE WITH SERIOUS MENTAL
ILLNESS, ALL OF WHICH ARE FOR
PEOPLE EXITING STREET
HOMELESSNESS. WE GOT HIS
COMMUNITY SERVICES
INFRASTRUCTURE GRANTED A LOT OF
US TO PURCHASE A FOUR BEDROOM
HOUSE FOR PEOPLE WITH CRIMINAL
JUSTICE, HISTORY AND BEHAVIOR,
HEALTH NEEDS AND HOMELESSNESS.
WE GOTTA COMMUNITY CARE
EXPANSION GRANT COMBINED WITH NO
PLACE TO COME SECOND GRANT TO
CREATE SIX UNITS OF INDIVIDUAL
HOUSING. WE USE RM HSCEI FUNDS
TO PURCHASE A FOUR BEDROOM HOME
FOR PERMANENT SUPPORTIVE HOUSING
FOR SIX MORE PEOPLE, AND WE
GOTTA BEHAVIOR HEALTH COMMUNITY
INFRASTRUCTURE GRANT ALLOW US TO
CONVERT A COMMERCIAL FACILITY
INTO A DAYTIME SERVICE CENTER
FOR PEOPLE EXPERIENCING
HOMELESSNESS. WE ALSO STOOD UP
AND ENHANCED CARE MANAGEMENT
TEAM AND ARE ON OUR WAY TO
SERVING 150 CLIENTS THROUGH
THAT, AND WE ARE THE RECIPIENTS
OF GRANTS, HAVE A HUB AND SPOKE
EARLY PSYCHOSIS PROGRAM. THROUGH
ALL THOSE EFFORTS, WE WERE ABLE
TO ADD 72 BEDS OF HOUSING FOR
PEOPLE OVER THE PAST YEAR,
PEOPLE LEAVING HOMELESSNESS AND
WE'RE SUPER PROUD ABOUT THAT.
AND DESPITE ALL THESE EFFORTS,
DAD BEDS AND SERVICES WE HAD 200
PEOPLE ENTER HOMELESSNESS FOR
THE FIRST TIME IN NEVADA COUNTY
IN THAT SAME YEAR. IT'S SO
FRUSTRATING AS WE ALL KNOW, UM,
BEYOND THESE INVESTMENTS.
COUNTIES ARE ALSO ELIGIBLE TO
RECEIVE CLOSE TO $1 BILLION.01
BILLION DOLLARS IN ONE TIME
BEHAVIOR. HEALTH BRIDGE HOUSING
FUNDS WERE EXTREMELY GRATEFUL
FOR THESE DOLLARS, UM AND WANT
TO NOTE THERE. THE ONLY FUN
SPECIFICALLY EARMARKED
PRIORITIZE CARE COURT
PARTICIPANTS. WE'RE CONCERNED
THAT THE FUNDING CRITERIA MAY BE
OVERLY RESTRICTIVE. UM, FOR
EXAMPLE, IF WE WANT TO USE THEM
FOR INFRASTRUCTURE, WE NEED
SPECIAL PERMISSION TO DO SO. BUT
WE'RE MOST CONCERNED THAT NOT
ENOUGH HOUSING, STOCK OR
BOARDING CARE FACILITIES EXIST
IN THE IMMEDIATE TERM.
MEANINGFULLY APPLY THESE FUNDS
IN THIS WAY, AND WE'RE FEARFUL
OF WHAT WILL HAPPEN TO THE
SUBSIDIZED BEDS. WHEN THIS ONE
TIME FUNDING DR DRIES UP. UM WE
ARE REALLY ENGAGED IN THIS WORK
AND WE WANT TO BE GOOD PARTNERS
AND WE REALLY WANT TO DRIVE
HOME. THE CLEAR POINT THAT THE
SITUATION OF HOMELESSNESS IN OUR
COUNTRY IS NOT THE RESULT OF A
FAILED BEHAVIORAL HEALTH SYSTEM.
IT'S THE RESULT OF INADEQUATE
HOUSING FOR OUR COMMUNITY
MEMBERS AND WE'RE HERE TO
PARTNER ON MAKING THAT BETTER.
AND LASTLY, WE ALSO REALLY
SUPPORT THE C SAC AT HOME
INITIATIVE AND ALL THE OTHER
GOOD EFFORTS OUT THERE. THANKS.
NEXT WE WILL HEAR FROM DR EWING
WITH THE COMMISSION. THANK YOU
VERY MUCH. MR. CHAIR AND
MEMBERS. UM YOU KNOW, A COUPLE
OF QUESTIONS HERE AROUND, UH,
YOU KNOW SOME OF THE RATE ISSUES
UM, YOU KNOW, AS AS MENTIONED BY
DIRECTOR BELL COST OF HOUSING,
ECONOMIC OPPORTUNITY THAT IS
AVAILABLE IN CALIFORNIA FOR
PEOPLE WHO NEED TO PAY FOR THAT
HOUSING OR KEY FACTORS.
CERTAINLY MENTAL HEALTH NEED
CREATES RISK, AS DOES SUDDENLY
USE DISORDERS. UM AND OTHER
FACTORS. THERE'S A RANGE OF
RESEARCH. I DON'T HAVE ALL THAT
IN FRONT OF ME. BUT YOU KNOW,
ESTIMATES ARE AS LOW AS 20% OF
THE OF THE HOMELESS POPULATION
IN CALIFORNIA, STRUGGLING WITH
SEVERE AND PERSISTENT ILLNESS TO
AS HIGH AS 90% SOME OF THE
DIFFERENCES HAS TO DO WITH WHERE
THE RESEARCH WAS DONE. THE
DEFINITIONS THAT WERE USED
WHETHER OR NOT YOU FACTOR IN
ISSUE DÍAS PART OF MENTAL
HEALTH, OR YOU SEPARATED OUT UM
, BUT BUT CLEARLY THIS IS A
COMPLICATED PROBLEM. IN TERMS OF
, UM YOU KNOW THE QUESTIONS ON
THE AGENDA THAT REALLY LEND
THEMSELVES TO THE COMMISSION
PARTICULAR WORK AROUND FOSTER
RISK PARTNERSHIPS. UM YOU KNOW,
AS WAS MENTIONED EARLIER, WE
FIND THESE TO BE VERY SUCCESSFUL
AND YOU KNOW THE HISTORY OF FULL
SERVICE PARTNERSHIPS REALLY WERE
THEY WERE THEY WERE INVENTED AND
DESIGNED HERE IN CALIFORNIA. BY
SOME OF THE MEMBERS OF DR CLARK
HARVEY'S ORGANIZATION. UM
SPECIFICALLY FOR THE PURPOSES OF
BRINGING PEOPLE OUT OF STATE
HOSPITALS. AND NOT ONLY ENSURING
THAT THEY DID NOT EXPERIENCE
HOMELESSNESS, BUT THAT THEY
FOUND EMPLOYMENT. AND THE GOAL
OF THE VERY FIRST FOSTERING
PARTNERSHIPS WERE DESIGNED
ACTUALLY TRANSITION PEOPLE FROM
DEPENDENCE ON AN INSTITUTIONAL
SYSTEM TO INDEPENDENCE IN THE
COMMUNITY. WHICH IS WHY THE
LANGUAGE THIS WHATEVER IT TAKES
APPROACH. OF A FOUR SEROUS
PARTNERSHIP. IT IS DESIGNED AS A
PARTNERSHIP BETWEEN THE CLIENT
THE INDIVIDUAL BEING SERVED, AND
THE PROVIDER THAT THE LET THE
WORDS THAT ARE USED HERE REALLY
ARE MEANINGFUL AND IT'S FULL
SERVICE THAT YOU CAN DO WHATEVER
YOU NEED TO DO TO HELP THAT
PERSON NOT BE HOMELESS, SO THE
MODEL IS ACTUALLY HIGHLY
EFFECTIVE. AND THERE'S SOME
HISTORICAL WORK THAT SHOWS THAT
DRAMATIC IMPROVEMENTS IN TERMS
OF LOWER JUSTICE, INVOLVEMENT,
HOMELESSNESS AND
HOSPITALIZATION. BUT WE'RE
CURIOUS, AS ARE YOU OF SO IF WE
HAVE THIS HIGHLY EFFECTIVE MODEL
PROGRAM INVENTED HERE IN
CALIFORNIA BY VERY THOUGHTFUL
PEOPLE, UM AND WE HAVE A
COMMITMENT UNDER THE MENTAL
HEALTH SERVICES ACT FOR A
MAJORITY OF COMMUNITY SERVICE
AND SUPPORT FUNDS TO BE
DEDICATED TO FOSTER RISK
PARTNERSHIPS. WHY ARE WE SEEING
THE NUMBERS WE'RE SEEING TODAY
OF THESE THREE? DEVASTATING
AREAS OF IMPACT. PERSONALLY
FINANCIALLY, YOU KNOW, IN TERMS
OF, YOU KNOW, THE LIKE QUALITY
OF LIFE AND LIFESPAN OF THE
INDIVIDUALS THAT WE ARE
CONCERNED ABOUT, UM, NOW WITH
AUTHORIZATION FROM SOME RECENT
LEGISLATION. THE COMMISSION IS
DIGGING IN TO LOOK AT THIS WILL
BE HOLDING A SITE VISIT ON APRIL
26TH HERE IN SACRAMENTO. YOU'RE
WELCOME TO JOIN US TO VISIT SOME
FULL SERVICE PARTNERSHIPS, UM,
RUN BY SOME OF THE MEMBERS OF
THE ASSOCIATION WILL BE HOLDING
A PUBLIC HEARING ON THE 27TH
WITH SOME OF THE ORIGINAL
DESIGNERS HAVE FULL SERVICE
PARTNERSHIPS TO REALLY
UNDERSTAND WHAT'S WORKING AND
WHAT'S NOT WORKING AND SORT OF
THE COURSE OF THE NEXT YEAR.
WE'RE REALLY TRYING TO UNPACK.
THE DIFFERENCE BETWEEN WHAT THE
CONCEPT AND THE PHILOSOPHY AND
THE RESOURCES SUGGESTS, SHOULD
BE HAPPENING AND WHAT IS
HAPPENING IN TERMS OF THE
CHALLENGES THAT COUNTIES ARE
FACING IN DELIVERING THIS KIND
OF CARE IN A WAY THAT IS
AFFORDABLE AND COST EFFECTIVE. I
WOULD SAY THAT, UM. YOU KNOW, WE
REALLY WANT TO UNDERSTAND WHAT'S
WORKING AND WHAT'S NOT WORKING,
AND WE DO WANT TO TRACK THE LINK
BETWEEN PSYCHOSIS ACCESS TO THAT
EARLY PREVENTATIVE CARE AND NOT
JUST PREVENTING THE NEGATIVE
OUTCOMES OF HOMELESSNESS,
INCARCERATION, HOSPITALIZATION,
BUT ACTUALLY SECURING THE
POSITIVE OUTCOMES OF FAMILY
CONNECTEDNESS. OF EMPLOYMENT OF
EDUCATIONAL SUCCESS, AND WE NEED
TO MOVE AWAY FROM TRYING TO
REDUCE THE BAD STUFF. AND REALLY
HIGHLIGHT OPPORTUNITIES TO
ACHIEVE THE GOOD STUFF THAT THAT
IS, IT IS REALLY ABOUT SECURING,
SUPPORTING AND PROMOTING MENTAL
HEALTH. RATHER THAN SIMPLY
RESPONDING AND LIMITING THE
NEGATIVE IMPACTS OF MENTAL
ILLNESS. AND WE HAVE A LONG WAY
TO GO TO GET THERE. THANK YOU.
XP OF J. C. COOPER, STATE
MEDICAID DIRECTOR. THANK YOU SO
MUCH. THE GOVERNOR'S BUDGET
REALLY REFLECTS A LONG TERM
COMMITMENT TO ADDRESSING
CALIFORNIA'S HOMELESSNESS CRISIS
, INCLUDING THROUGH THE
STRATEGIC SO TO DIRECT ITS LATE
SORRY STRATEGIC USE OF MEDICAL,
REALLY ALLOWING US TO DRAW DOWN
FEDERAL FUNDS FOR THINGS THAT
HISTORICALLY WE'VE NEVER DRAWN
DOWN FEDERAL FUNDS FOR
ESPECIALLY SO DOLLARS, LIKE MHS
SAY CAN BE USED FOR OTHER THINGS
AND OR THE NON FEDERAL SHARE BUT
MAXIMIZING THOSE DOLLARS. ONE OF
THE THINGS ABOUT KELLY. MRS
REALLY MEANT TO BREAK DOWN THE
WALLS OF HEALTHCARE AND MEET
PEOPLE WHERE THEY ARE. UM AND SO
WE'RE HAPPY ABOUT THESE NEW
ADDITION INITIATIVES. I WON'T GO
THROUGH ENHANCE YOUR MANAGEMENT
COMMUNITY SUPPORT BECAUSE WE
PRESENTED THAT PREVIOUSLY TO YOU
ALL BUT JUST REMIND YOU IN
REGARDS TO THE NEW FRONT
FOOTPRINT OF SOME OF THOSE
SERVICES AND THEN I'LL GO INTO
SOME OF THE OTHER ITEMS AS WELL.
SO AS OF FEBRUARY, 2023. WE'RE
SEEING THAT THERE ARE 479 NEW
ENHANCED CARE MANAGEMENT
PROVIDER STATEWIDE, PROVIDING
SERVICES TO PEOPLE EXPERIENCING
HOMELESSNESS AND AS OF Q THREE
OVER ABOUT 23,000 INDIVIDUALS
RECEIVING DIRECT ENHANCED CARE
MANAGEMENT SERVICES LIKE
INDIVIDUALS MENTIONED EARLIER
ACROSS SMALL AND LARGE COUNTIES
ACROSS THE ENTIRE STATE OF
CALIFORNIA. ALSO ALL 58 COUNTIES
HAVE ELECTED TO OFFER AT LEAST
THE THREE HOUSING SUPPORT
SERVICES IN CALAIS IN WHICH IS
GREAT AND REALLY IMPORTANT. THE
NAVIGATION SERVICES THAT
DEPOSITS IN THE LIAISON SERVICES
THERE ARE 642 HOUSING RELATED
COMMUNITY SUPPORT PROVIDERS IN
THE STATE AND OVER 30,000 PEOPLE
IN JUST THE FIRST THREE QUARTERS
OF 2022 RECEIVING THOSE
SERVICES. WHEN IT COMES TO THE
EXPANSION OF ST MEDICINE
SERVICES. RECENTLY THE
DEPARTMENT OF HEALTH CARE
SERVICES RELEASED EXTENSIVE
GUIDANCE AROUND ELIGIBILITY OF
HOW TO INCREASE PEOPLE
EXPERIENCING HOMELESSNESS EASIER
TO GET INTO MEDICAL BILLING. WE
RELEASED A SIGNIFICANT NUMBER OF
CODES TO ALLOW FOR MORE BILLING
OF ST MEDICINE SERVICES, UM, AS
WELL AS ELIGIBILITY GUIDANCE FOR
OUR OUR MANAGED CARE PLANS, AND
THEN AN ALL PLANNED LETTER
SHOWING THEM HOW IT CAN BE
EASIER FOR THEM TO CONTRACT WITH
STREET MEDICINE PROVIDERS. TO
ALLOW FOR THOSE DOLLARS TO BE
EASIER FLOW TO THOSE PROVIDERS.
UM, I WOULD ALSO NOTE THAT CH CF
RECENTLY RELEASED A CALIFORNIA
STREET MEDICINE ASSESSMENT
REPORT INDICATING THAT THERE ARE
AROUND 25 STREET MEDICINE
PROGRAMS OPERATING IN CALIFORNIA
, ACCORDING TO THEIR FIDELITY
AND MODEL IN THIS REPORT IS WHAT
I WOULD SAY THE MAJORITY OF
THOSE ARE LOCATED IN LOS ANGELES
COUNTY AND SAN FRANCISCO. NEARLY
HALF OF ALL OF THE LARGE STREET
MEDICINE PROVIDERS ARE RESCUE
HCS, OTHER SPONSORS OR HOSPITALS
, NONPROFIT PROVIDERS, UM
COUNTIES, ACADEMIC INSTITUTIONS
AND SOME HEALTH PLANS. STREET
MEDICINE IS ALSO A CRITICAL
ACCESS POINT FOR PEOPLE OF COLOR
, ACCORDING TO THE STUDY. BY CH
CF ABOUT 25% OF PATIENTS HAVE
IDENTIFIED AS BEING BLACK AND
23% LATIN X UM, AS WELL AS MORE
THAN TWO THIRDS OF THE STREET
MEDICINE PROGRAMS DIAGNOSED AND
TREATED MENTAL HEALTH CONDITIONS
AND SUBSTANCE USE DISORDER AND
60% HAVING PROVIDED MEDICATION
ASSISTED THERAPY, THE MAJORITY
PROVIDED PRIMARY CARE SERVICES
WHILE OUT ON THE STREETS AS WELL
AND WOULD NOTE THAT THE STREET
MEDICINE, ACCORDING TO THIS
STUDY, SHOWED AT LEAST 57%
HAVING MEDICAID BUT ALSO OTHER
PAYERS AS WELL IN REGARDS TO THE
IMPORTANCE OF PEOPLE
EXPERIENCING HOMELESSNESS. I'M
NOT ALL BEING MEDICAID. THERE IS
ABOUT 14% MEDICAID, MEDICARE. SO
ARE DUAL INDIVIDUALS AS WELL. UM
BUT LARGER PROPORTION ALSO NOT
ON MEDICAID OR OR DUALLY
ELIGIBLE. WHEN IT COMES TO
TRANSITIONAL RENT. THE
GOVERNOR'S BUDGET DOES IDENTIFY
TRANSITIONAL RENT AS A NEW
COMMUNITY SUPPORT SERVICES
INTENDED REALLY, TO COVER SIX
MONTHS OF TEMPORARY RENT FROM
SOMEONE TRANSITIONING
TRANSITIONING FROM INCARCERATION
, INSTITUTIONAL LEVELS OF CARE,
UM AS WELL AS INDIVIDUALS
TRANSITIONING OUT OF UM, CHILD
WELFARE, FOR EXAMPLE, REALLY
FOCUSING ON THOSE CRITICAL
TRANSITIONS, CATCHING SOMEBODY
THROUGH THOSE TRANSITIONS IN
PAYING FOR THAT SIX MONTHS OF
RENT. OBVIOUSLY THAT'S A HUGE
DEAL TO DRAW DOWN FEDERAL FUNDS
FOR THOSE PIECES, SO NOT ONLY
WILL WE PUT, UM AFFORDED
AMENDMENT OF COURSE, IF APPROVED
IN THE BUDGET THROUGH CALAIS,
BUT ALSO OFFERING IT FOR OUR
COUNTY PARTNERS THROUGH THE CALC
EIGHT BH CBC WAIVER, SO BOTH
COUNTIES AND MANAGED CARE PLANS
COULD TAKE ADVANTAGE OF
PROVIDING THAT SIX MONTHS OF
TRANSITIONAL RENT FOR
INDIVIDUALS ACROSS THE STATE OF
CALAIS. IF ORANJE THE BUDGET
INCLUDES $17.9 MILLION TOTAL
FUND 6.3 MILLION GENERAL FUND IN
25 26. FOR THAT INVESTMENT, OF
COURSE, THAT WOULD REQUIRE
FEDERAL APPROVAL SO WE WOULD
HAVE TO DO FORMAL AMENDMENTS TO
SEEK THAT. THE BEHAVIORAL BRIDGE
. HOUSING FUNDS ARE INTENDED TO
REALLY INCREASE IN PROVIDE
SERVICES INTENDED SERVICES FOR
HOUSING FOR INDIVIDUALS
EXPERIENCE WITH BEHAVIORAL
HEALTH SERVICES AND EXPERIENCING
HOMELESSNESS IN FEBRUARY, DHD D
. HCS RELEASED APPLICATIONS TO
COUNTY BEHAVIORAL HEALTH
AGENCIES FOR $907 MILLION AND
THEN WE WILL ALSO BE RELEASING
APPLICATIONS FOR OUR TRIBAL
ENTITIES AND PARTNERS IN MAY OR
JUNE OF THIS YEAR AS WELL. A
TOTAL OF 500 MILLION ALLOCATED
IN 23 24 24 25 WILL BE USED FOR
COMPETITIVE ARE PHASE FOR THE
ADDITIONAL FUNDS IN BOTH THE
SUMMER OF 2023 24 FOR OUR COUNTY
AND TRIBAL ENTITIES TO CLOSE THE
GAP IN SERVICES. ADDITIONALLY
OTHER PROGRAMS AS WAS JUST
MENTIONED, UM, THROUGH THE
MENTAL HEALTH SERVICES ACT IN
FULL SERVICE PARTNERSHIP ARE
HUGE OPPORTUNITIES. THE EXACTLY
WHAT IT TAKES SERVICES ARE
REALLY CRITICAL. AND THERE HAVE
BEEN EXTENSIVE. UM UH,
EVALUATIONS BOTH AT LOCAL LEVELS
, AS WELL AS STATEWIDE LEVELS
THAT HAVE DEMONSTRATED THE
SUCCESS OF THOSE FULL SERVICE
PARTNERSHIPS THAT BEING SAID WE
WOULD ALSO NOTE THE
ADMINISTRATION AND THE GOVERNOR
THROUGH HIS STATE OF THE STATE
ANNOUNCED SOME CHANGES TO MHS,
SAYING, WE LOOK FORWARD TO
DISCUSSING THOSE IN A FEW. ER A
SETTING TO ENGAGE IN THOSE
CONVERSATIONS AS WELL.
DEPARTMENT OF FINANCE. HEY,
WILLIAMS DEPARTMENT OF FINANCE.
THERE WAS ONE QUESTION IN THE
AGENDA ABOUT THE NO PLACE LIKE
HOME PROGRAM. SO I WAS GOING TO
GO AHEAD AND ANSWER THAT FOR
YOU. NO PLACE LIKE HOME PROGRAM
IS ACTUALLY ADMINISTERED BY THE
DEPARTMENT OF HOUSING AND
COMMUNITY DEVELOPMENT AND IT
FUNDS CONSTRUCTION OF NEW
PERMANENT SUPPORTIVE HOUSING
PROJECTS OR HOUSING UNITS. UM
THE PROGRAM ACTUALLY MEASURES
ITSELF AS OPPOSED TO, UM THE
NUMBER OF PEOPLE THAT HOUSES IT
MEASURES JUST THE UNITS THAT
THEY'VE BUILT. SO TO DATE THAT
THE PROGRAM HAS BUILT 6300 UNITS
, AND IF YOU HAVE ANY OTHER
QUESTIONS ABOUT THE PROGRAM, I'M
HAPPY TO TAKE THOSE BACK TO MY
COLLEAGUES. HELLO. I WILL OWN
DEALIO. SO WE HAVE NO COMMENT IN
PARTICULAR. ON THIS ITEM.
HOWEVER WE HAVE A FEW
RECOMMENDATIONS SPECIFICALLY ON
THE BRIDGE HOUSING AS WELL AS
THE CARE ACT THAT WILL COME UP
IN THE NEXT COMING ISSUES SO
HAPPY TO TALK ABOUT THOSE
PERFECT UM, I'LL BRING IT UP TO
THE DIET WILL BEGIN. UM IF I CAN
WITH DR LINDHOLM AGAIN, IT
SOUNDED AS IF YOU WERE STATING
THAT WE'RE SERVING ONLY 1/10 OF
ALL OF THE EARLY PSYCHOSIS THAT
WE HAVE. EXPECTED FOR OUR STATE
. YES THAT SOUNDS LIKE A
TREMENDOUS OPPORTUNITY FOR THOSE
OTHER COUNTIES WHO HAVE NOT
CHOSEN TO FOLLOW UP AND THERE'S
ONLY 14 58 TO INCREASE. UM UM,
PARTICIPATION AND JUST WANTED TO
MAKE SURE THOSE DATA POINTS WERE
CORRECT AND ACCURATE. YES THEY
ARE CORRECT, SO THEY'RE BASED ON
ESTIMATES FROM A COUPLE OF
DIFFERENT STUDIES LOOKING AT, UM
PSYCHOSIS BROADLY IN BOTH
MEDICAL POPULATIONS AND IN
COMMERCIAL INSURANCE, SO WE HAVE
SOME KIND OF SIMPLE MODELS.
WE'RE WORKING. WE'RE GETTING
DATA FROM THE STATE TO DO MUCH
MORE FINE GRAIN MODELS TO LOOK
AT WHERE PEOPLE ARE LIVING. AND
HOW THEY'RE COMING TO CARE OR
NOT COMING TO CARE, USUALLY
THROUGH THE E D. BUT I THINK
MOST PEOPLE THINK THAT PSYCHOSIS
IS VERY RARE. IT'S JUST A
HANDFUL OF PEOPLE. AND SO MOST
FOLKS ARE SHOCKED WHEN I SAY THE
NUMBERS THAT ARE ACTUALLY
HAPPENING IN IN THE COUNTIES. DR
EWING. WELL, I WAS JUST, UM WANT
TO MAKE A DISTINCTION BETWEEN
THE 10% THAT ARE ACCESSING CARE
AND THE PERCENT THAT ARE
ACTUALLY GETTING BEST AVAILABLE
CARE? AND SO, UM, DOCTOR NEED.
UM WHAT IS YOUR IS THE ESTIMATE
OF PEOPLE WHO ARE GETTING WHAT
WE WOULD CONSIDER TO BE EVIDENCE
BASED CARE. BECAUSE IT'S ONE
THING TO HAVE ACCESS TO A
SERVICE. IF 90% OR NOT EVEN
GETTING CARE, BUT THAT DOESN'T
NECESSARILY MEAN THAT 10% ARE
GETTING THE CARE THAT IS
NECESSARY TO RESULT IN THE
REDUCTION, THE NEGATIVE OUTCOMES
THAT WE'RE TRYING TO ACHIEVE.
YES THIS IS A VERY IMPORTANT
POINT, AND WE'VE BEEN VERY
GRATEFUL FOR THE PARTNERSHIP
WITH MHS O A C AND NOW DHC S
TWO. WE HAVE A PARTNERSHIP
BETWEEN UC DAVIS, STANFORD AND
UCSF TO DEVELOP A TRAINING AND
TECHNICAL ASSISTANCE GROUP FOR
THE STATE SO THAT WE CAN DO THIS
AT SCALE INSTEAD OF COUNTY BY
COUNTY, WHICH IS WHAT MOST OF US
WERE DOING BEFORE, AND SO I
WOULD SAY THAT PROBABLY LESS
THAN HALF ARE GETTING EVIDENCE
BASED CARE. EVEN THOUGH PEOPLE
ARE PROVIDING CARE, SAYING THAT
IT'S AN EARLY PSYCHOSIS PROGRAM
OR A COORDINATED SPECIALTY CARE
PROGRAMS. SO WE'VE BEEN WORKING
WITH OUR COUNTY'S GOING IN AND
TALKING AND HELPING THEM SORT OF
UNDERSTAND WHAT THE EVIDENCE
BASED PRACTICES AND HELPING THEM
PROBLEM SOLVE, YOU KNOW, BASED
ON THE NEEDS OF THEIR LOCAL
COMMUNITY ABOUT THE BEST WAY TO
STAND THAT PRACTICE UP. IT
SOUNDED LIKE YOUR TESTIMONY
EARLIER STATED UNTREATED
PSYCHOSIS PREDISPOSES YOU
POTENTIALLY TO HOMELESSNESS. SO
WHAT DO YOU SAY TO ALL THOSE
COUNTIES WHO ARE EXPERIENCING
ISSUES WITH HOMELESSNESS THAT
EVALUATING AND LOOKING TOWARDS
AN EARLY PSYCHOSIS PROGRAM COULD
HELP THEM TO ADDRESS THEIR
HOMELESSNESS ISSUE. I THINK WE
COULD HELP THEM ADDRESS MANY
ISSUES, AND I CAN SAY WE HAVE
PARTNERS IN THE ROOM THAT WE
HAVE BEEN WORKING WITH THAT HAVE
IN PARTNERSHIP. SEEN THE VALUE
OF WHAT WE DO. I THINK AGAIN.
MOST PEOPLE THINK OF IT AS A
RARE ISSUE, AND ONCE WE START TO
WORK WITH THEM, THEY SEE HOW
COMMON IT IS. SO I WOULD SAY TO
THEM. GIVE ME A CALL. I'M HAPPY
TO TALK TO YOU AND HELP YOU
SERVE YOUR COMMUNITY. BETTER
HOPE. THERE ARE, UM MORE
COUNTIES AND NOT AS RARE OF
PARTICIPATION AS WE'RE SEEING
RIGHT NOW. DO YOU WANT TO COME
BACK TO YOU, DR EWING, IF I
COULD, IN TERMS OF FULL SERVICE
PARTNERSHIPS, YOU SAID THEY WERE
CREATED FOR THAT TRANSITION FROM
DEPENDENCE TO INDEPENDENCE AND
ITS WHATEVER IT TAKES THAT I'M
TRYING TO UNDERSTAND WHAT
HAPPENS WHEN PEOPLE ARE LEAVING
CDC ARE ARE WE USING THAT
ENHANCED CARE MANAGEMENT TO MAKE
SURE THAT WORK CONNECTING THEM
TO. ALL OPTIONS THAT ARE OUT
THERE IF THEY HAVE A MENTAL
ILLNESS PRIOR TO DISCHARGE ARE
WE CONNECTING THEM TO THOSE FULL
SERVICE PARTNERSHIP SINCE IT
SOUNDS AS IF THAT WAS THEIR
INITIAL INTENT? WELL TO CLARIFY
THE INITIAL INTENT WAS ACTUALLY
TO PULL PEOPLE OUT OF LONG TERM
STATE HOSPITALIZATION. NOT
ACTUALLY THE CORRECTIONAL SYSTEM
. IT REALLY WAS DESIGNED TO. UM
THIS WAS, UH, SORT OF A BET.
THAT AN ENTERPRISING COMMUNITY
PROVIDER IN LONG BEACH, MADE
WITH L, A COUNTY MENTAL HEALTH,
WHO WAS SENDING LARGE NUMBERS OF
PEOPLE TO METROPOLITAN STATE
HOSPITAL, AND THEN IT WAS
EXPANDED THROUGH LEGISLATIVE
INVESTMENT UNDER THE LEADERSHIP
OF VENICE MEMBER DARRELL
STEINBERG WITH A B 34. IT'S
CALLED THE INTEGRATED SERVICES
FOR HOMELESS ADULTS ACT. UM AND
SO, SO, UM, BUT TO YOUR GET YOUR
QUESTION IN TERMS OF FOLKS THAT
ARE COMING OUT OF CORRECTIONAL
INSTITUTIONS, THERE'S NO REASON
WHY AN FSP COULD NOT BE MADE
AVAILABLE. UM I DON'T HAVE THE
ANSWER FOR YOU OF WHETHER OR NOT
IT'S HAPPENING, UM THERE ARE
LOTS OF REASONS WHY IT MIGHT NOT
BE HAPPENING. UM LINKED TO SORT
OF, YOU KNOW, CULTURE AND
TRADITIONS AROUND, UM, WHO'S
RESPONSIBLE FOR CARE DELIVERY
FOR FOLKS WHO MAY BE ON PAROLE
OR PROBATION. THERE'S LONG
HISTORIES IN THE PAST WHERE
THESE SYSTEMS DID NOT WORK WELL
TOGETHER. THAT'S CHANGING
DRAMATICALLY BECAUSE OF, UM. YOU
KNOW, A HISTORY OF INVESTMENTS
IN THE STATE HAS MADE BECAUSE OF
STRONGER RELATIONSHIPS BETWEEN
LOCAL LAW ENFORCEMENT AND LOCAL
BEHAVIORAL HEALTH. PART OF
WHAT'S FRUSTRATING FOR ME TO
HEAR IS, UM, YOU KNOW, WE'RE ON
THE SAME TEAM. LOCAL LAW
ENFORCEMENT, LOCAL SHERIFF'S
DEPARTMENT AND LOCAL BEHAVIOR.
HEALTH DEPARTMENTS ARE ON THE
SAME TEAM. UM, THE DISCONNECT
BETWEEN COUNTY BEHAVIORAL HEALTH
STRATEGIES AND WHAT'S HAPPENING
IN THE JAILS OR WHAT'S HAPPENING
. POST RELEASE IS FRUSTRATING.
AND AS AS DIRECTOR BELL
MENTIONED THAT WE'VE BEEN
PROVIDING RESOURCES TO HELP
COUNTIES DO THE DATA WORK TO
UNDERSTAND WHO'S IN THEIR
CRIMINAL JUSTICE SYSTEM AND TO
LINK AND TO REALLY REINFORCED
OPPORTUNITIES. TO CO INVEST, UM
BUT THAT DOESN'T MEAN THAT SINCE
IT CAN HAPPEN, THAT IT IS
HAPPENING THE WAY THAT'S
CONSISTENT WITH YOUR QUESTION. I
THINK MOST SERVICE PARTNERSHIPS
ARE CERTAIN VERY MUCH AN
OPPORTUNITY THERE, AND THE STATE
IS NOT FULLY LEVERAGED THE WORK
THAT WE THAT HAS BEEN DONE BY
SOME OF OUR COUNTIES AND
COMMUNITY PROVIDERS, AND WE NEED
TO BE ASKING VERY STRATEGIC
QUESTIONS ABOUT WHAT IS OUR
CAPACITY. AND HOW DO WE MAKE
SURE THAT CAPACITY IS MOST
EFFECTIVELY USED AND BE SMART
ABOUT GROWING THAT CAPACITY
WHERE WE NEED TO, BUT ALSO
REDUCING THE NEED FOR THAT HIGH
LEVEL OF CARE JUST LIKE WE MIGHT
THINK ABOUT HOSPITALIZATION OR
REHAB CENTER AND YOU KNOW, AND
IN THE BROADER HEALTHCARE SPACE,
WE DON'T WANT PEOPLE IN THOSE
PROGRAMS. YOU DON'T NEED THOSE
PROGRAMS. WHICH MEANS WE HAVE TO
HAVE APPROPRIATE STEP DOWN
OPPORTUNITIES. AND SO THERE'S A
LOT OF WORK TO DO TO REALLY
UNDERSTAND WHETHER OR NOT WE'RE
ACHIEVING OUR POTENTIAL WITH
FULL SERVICE PARTNERSHIPS, AND
IF WE'RE SUPPORTING FULL SERVICE
PARTNERSHIPS THROUGH STRATEGIES
LIKE EARLY PSYCHOSIS THROUGH
APPROPRIATE STEP DOWN
OPPORTUNITIES SO THAT PEOPLE
DON'T LEAVE A HIGH LEVEL OF CARE
AND THEN, UM, SORT OF, YOU KNOW,
CYCLE BACK IN BECAUSE WE DIDN'T
HAVE AN APPROPRIATE STEP DOWN
OPPORTUNITY. THAT CHANGES IN
STATE RULES AROUND MEDICAID
FUNDING. UM ARE VERY IMPORTANT.
THERE'S AN INCENTIVE FOR
COUNTIES TO BUILD MEDIC AL FOR
SERVICES THAT ARE ELIGIBLE WHEN
THEY'RE PROVIDED THROUGH A FULL
SERVICE PARTNERSHIP. AND WE DO
NOT KNOW THE EXTENT THAT
COUNTIES ARE MAXIMIZING THAT, UM
, BUT WE'RE ALSO CONCERNED THAT
THE INCENTIVE TO DRAW DOWN
MEDICAL MAY LIMIT THE
WILLINGNESS TO PROVIDE COVERAGE
FOR SERVICES THAT MEDICAL WON'T
PAY FOR BECAUSE IT MEANS
SPENDING AN MHS A DOLLAR ON A
SERVICE THAT ISN'T AVAILABLE FOR
FEDERAL DOLLAR DRAWDOWN. AND SO
WE HAVE TO FIND THAT THAT
BALANCE IN A WAY THAT FULLY
LEVERAGES FEDERAL FUNDING BUT
DOESN'T LOSE THE WHATEVER IT
TAKES APPROACH THAT IS THAT GOES
BEYOND WHAT MEDICAL CAN PAY FOR.
DIRECTOR COOPER, CAN I PULL YOU
IN? I'M TRYING TO UNDERSTAND HOW
YOU VISUALIZE OR C E. C M S
PLAYING A ROLE HERE AND
INTERACTING WITH FULL SERVICE
PARTNERSHIPS AND THE TRANSITION.
SURE SO WE'VE ACTUALLY LOOKED AT
THIS, UM, BOTH FOR THE E. C M
JUST FOR INDIVIDUALS WITH
SERIOUS MENTAL ILLNESS AS WELL
AS FOR THE JUSTICE INVOLVED
POPULATION AS WELL AS FOR THOSE
EXPERIENCING HOMELESSNESS, SO IF
YOU THINK ABOUT THE CMU CAN CUT
ACROSS ALL OF THOSE POPULATIONS
, UM AND ONE OF THE HARD THINGS
WHEN IT COMES TO FULL SERVICE
PARTNERSHIP IS ALL COUNTIES
APPROACH IT A LITTLE BIT
DIFFERENTLY. UM THERE'S NOT
EXACTLY ONE MODEL OUT THERE.
THERE'S A NUMBER OF MODELS THAT
COMES WITH THE COMBINATION OF
VARIOUS MENTAL HEALTH OR SUD
SERVICES, CARE, COORDINATION OR
AM LIKE SERVICES, AS WELL AS THE
HOUSING VARIOUS INTERVENTION
SERVICES AND THEN THE WHATEVER
IT TAKES, WHETHER IT'S FOOD OR
CLOTHING OR WHATEVER IT IS
TRANSPORTATION THAT COUNTIES DO
A GREAT JOB OF WRAPPING AROUND,
SO I DON'T THINK IT'S A FAIR
COALITION A CONNECTION AND WOULD
LOVE MY COUNTY EXPERTS TO WEIGH
IN ON THIS DIRECT CONNECTION
BETWEEN JUST FSP ANDY CM BECAUSE
FSP TO THE POINTS EARLIER,
THEY'RE CONNECTING ALL OF THE
VARIOUS PIECES TOGETHER. UM AND
SO I THINK IT'S REALLY ABOUT
BOTH A COMBINATION OF SERVICES
THAT INTENSIVE COORDINATION AS
WELL AS THE OTHER SERVICES THAT
MEDICAL DOES NOT DRAW DOWN
FEDERAL FUNDS FOR AND SO WHAT? I
THINK YOU KNOW, ONE OF THE
PIECES THAT WERE LEAKING OUT
WITHIN THE CALS BH CBC WAIVER IN
ADDITION TO HAVING DRAWN DOWN
FEDERAL FUNDS FOR THE EARLY
PSYCHOSIS SERVICES IS ALSO ACTED
AND FORENSIC A CT REALLY
FOCUSING ON YOU KNOW, BRINGING
FIDELITY POTENTIALLY Tð. TO THE
FSP MODEL IN CERTAIN WAYS, AND I
THINK THAT THERE ARE
OPPORTUNITIES THERE TO MAXIMIZE
FEDERAL FUNDS TO DO SOME
BUNDLING FOR PAYMENT, BUT IT MAY
NOT SOLVE THOSE ADDITIONAL NON
MEDICAID REIMBURSABLE SERVICES.
UM AS WELL AND SO I THINK THAT
THERE ARE STILL FUTURE
OPPORTUNITIES, BUT THOSE TYPES
OF THINGS WOULD NEED TO BE
FUNDED WITH IMAGES SAY ONLY
DOLLARS BECAUSE WE CAN'T DRAW
DOWN FEDERAL FUNDS AND SO OUR
HOPE THAT YOU WOULD BE ABLE TO
CONNECT THAT. MY LAST POINT
BEFORE I'LL TURN IT OVER TO
DIRECTOR BELL WOULD BE THAT
WE'RE REALLY HOPING THAT THOSE
MANDATED WARM HANDOFFS FROM AND
CORRECTIONAL SETTINGS INTO THE
COMMUNITY AND DIRECTLY WITH OUR
COUNTY BEHAVIORAL HEALTH
PARTNERS WILL BE ABLE TO TIE
BETTER CONNECTIONS AS WELL AS
FUTURE POTENTIAL OPPORTUNITIES.
I THINK SOME COUNTIES ARE
ALREADY DOING THAT TODAY BASED
ON OUR CONVERSATIONS, BUT WHERE
WE COULD SCALE THAT UP ACROSS
THE STATE. I THINK THERE ARE
OTHER OPPORTUNITIES. THANKS I
THINK I THINK YOU COVERED A LOT
OF THE KEY POINTS, BUT A COUPLE
OF THINGS I JUST WANT TO
HIGHLIGHT ONE IS, UM AROUND THAT
CONNECTIVITY FROM INCARCERATION
TO FSP. I THINK MOST COUNTRIES
DO A REALLY GOOD JOB OF WORKING
WITH OUR LOCAL JAILS. LIKE I
SAID, WE TEND TO BE IN THEM AND
DOING THE ASSESSMENTS AND MAKING
THE CONNECTIONS. IT'S A LOT MORE
CHALLENGING WITH STATE PRISON
AND I THINK THAT'S WHERE SOME OF
THAT THAT FALL APART HAPPENS,
BUT ALSO TO ADD THAT POPULATION
IS ALSO SIGNIFICANTLY HARDER TO
HOUSE BECAUSE OFTEN THEIR THEIR
CRIMINAL HISTORY AND THEIR
CREDIT HISTORY REALLY HARD TO
FIND HOUSING FOR. SO UM, THERE'S
THAT FACTOR IN THERE. I THINK
THE RELATIONSHIP BETWEEN
ENHANCED CARE MANAGEMENT AND
FULL SERVICE PARTNERSHIP IS LIKE
STILL TO BE FIGURED OUT. WE DO
KNOW THAT FULL SERVICE
PARTNERSHIP IS A MUCH MORE
INTENSIVE, UM, LEVEL OF CARE.
AND HOW DOES THE CME FIT WITHIN
THAT IN THE SYSTEM OF CARE TO BE
MOST EFFECTIVE AND TO MAXIMIZE
THAT RESOURCES, SOMETHING THAT I
THINK WE'RE ALL EXPLORING STILL,
BUT IT'S A GREAT KIND OF
ADDITION TO THE MIX. I WILL.
THANKS VERY MUCH THIS ENTIRE
PANEL AND WE WILL MOVE ON TO
ISSUE 12. ISSUE. 12 IS ON THE
PROPOSED FUNDING DELAYS FOR THE
BEHAVIORAL HEALTH, BRIDGE
HOUSING PROGRAM AND BEHAVIORAL
HEALTH CONTINUUM INFRASTRUCTURE
PROGRAM DIRECTOR BOSS BEING WHEN
YOU ARE READY. AS A RESULT OF
THE STATES PROJECTED, BUT BUDGET
DOES DEFICIT. THE DEPARTMENT IS
PROPOSING TO DELAY 480 MILLION
ALLOCATED TO ROUND SIX OF THE
BEHAVIORAL HEALTH INFRASTRUCTURE
CONTINUING PROGRAM. CURRENTLY
ROUNDS ONE THROUGH FIVE ARE
UNDERWAY IN THE SIXTH ROUND OF
FUNDING HAS NOT STARTED AND SO
DELAYING THIS ROUND, WE THINK
WILL PROVIDE SOME MORE TIME FOR
PROGRAM STAFF TO ASSESS THE
NEEDS KIND OF WHAT'S THE GAPS
THAT ARE REMAINING, UM, AND
PROVIDES MORE OPPORTUNITY TO DO
THAT. AND THEN WE'RE REGARD TO
THE BEHAVIORAL HEALTH BRIDGE
HOUSING PROGRAM DIRECTOR COOPER
JUST WENT THROUGH THAT A LITTLE
BIT OF THE GOVERNOR'S BUDGET
DELAYS. 250 MILLION OF THE 23 24
FUNDING UNTIL 24 25 AGAIN GIVEN
THE GENERAL FUND REVENUE DECLINE
THAT IS PROJECTED AND THEN DUE
TO UPDATED TIMELINES RELEASE
ABOUT 50 MILLION OF THE FUNDS
THAT WERE SLATED FOR 2022 23 TO
BE SPENT IN 23 24. DEPARTMENT OF
FINANCE. THEY WILLIAMS
DEPARTMENT OF FINANCE. NOTHING
FURTHER. DAD HELLO, RYAN MILLER
, ELIO, SO IN THE CONTEXT OF
WHAT DIRECTOR BOSS SET UP AS A
SIGNIFICANT BUDGET PROBLEM THIS
YEAR, FIRST WITH REGARD TO THE
BEHAVIORAL HEALTH CONTINUUM
INFRASTRUCTURE PROGRAM, GIVEN
THE PROGRESS THAT'S BEEN MADE SO
FAR AND THAT THE PROJECTS ARE
LONG TERM IN NATURE. WE THOUGHT
THAT IT WAS REASONABLE THAT THE
ADMINISTRATION LOOKED HERE FOR
POTENTIAL BUDGET SOLUTION. AND
ALSO ACKNOWLEDGING DIRECTOR
BOSSES COMMENTS CONCERNING
AROUND SIX OF FUNDING AND THAT
IT WOULD GIVE THE STATE MORE
TIME TO REALLY DO A FULLER NEEDS
ASSESSMENT NOW RELATING TO THE
BRIDGE HOUSING FUNDING. UM UH,
PART OF THE BASIS FOR THAT
PROGRAM WAS TO PROVIDE BRIDGE
HOUSING OPTIONS IN THE INTERIM,
WHILE THE CONTINUING
INFRASTRUCTURE PROGRAM AND
RELATED EFFORTS ARE ARE UNDERWAY
AND WILL EVENTUALLY COME ONLINE
SO LOOKING AT THE CONTINUED
INFRASTRUCTURE PROGRAM IN THE
BRIDGE HOUSING TOGETHER, WE
THOUGHT THAT IT WAS ALSO
REASONABLE TO DELAY THE FUNDING
FOR BRIDGE HOUSING AS WELL.
BRING IT UP TO THE DIET, SO TAKE
A MOMENT AND APPRECIATE THE LAO
FOR WORK. WRITE UP OF THIS
EARLIER ON. IT WAS VERY HELPFUL
FOR US AND HAVE NO QUESTIONS AS
WE'VE DISCUSSED IN A PREVIOUS
JOINT HEARINGS WITH THAT I WILL
THANKS VERY MUCH CHANNEL 12 AND
MOVE ON TO ISSUE 13. ISSUE 13 IS
ON THE CARE ACT. SB 13 38 BCP
STATE MEDICAID DIRECTOR J. C.
COOPER, PLEASE BEGIN WHEN YOU
ARE READY. HELLO THE DEPARTMENT
IS REQUESTING TO PERMANENT
POSITIONS AND EXPENDITURE
AUTHORITY OF FIVE MILLION
GENERAL FUNDING BUDGET. YOU'RE
AN ONGOING TO FURTHER SUPPORT
THE IMPLEMENTATION OF CARE ACT
PROGRAM ACTIVITIES. THE
REQUESTED RESOURCES WILL PROVIDE
TRAINING AND TECHNICAL
ASSISTANCE TO KIND OF BEHAVIORAL
HEALTH AGENCIES IN MINISTER
TECHNICAL ASSISTANCE TRAINING
ACTIVITIES FOR VOLUNTEER
SUPPORTERS ON THE CARE ACT
PROCESS RETAIN AN INDEPENDENT,
RESEARCH BASED ENTITY TO DEVELOP
AN INDEPENDENT EVALUATION OF THE
EFFECTIVENESS OF THE CARE ACT.
ADDITIONALLY WOULD NOTE FURTHER
, WHILE THE FIVE MILLION WAS A
PART OF THE BUDGET BILL JR IN
ONE TIME FUNDING SHOULD HAVE
BEEN ONGOING. AND SO THIS IS A
TECHNICAL CORRECTION. HAPPY TO
TAKE ANY QUESTIONS. DEPARTMENT
OF FINANCE ROMMEL'S DEPARTMENT
OF FINANCE. OH, THE DEPARTMENT
STANDS ON THIS, UM AND WE WANT
TO ACKNOWLEDGE THAT THE AGENDA
INCLUDES AN L. A RECOMMENDATION
TO APPROVE ONLY ONE YEAR FUNDING
FOR THIS, AND WE SEE THIS AS
ONGOING RESOURCE REQUEST FOR
ONGOING WORKLOAD WILL CONTINUE
TO MONITOR THIS PROGRAM AS IT'S
FACED IN. WE APPRECIATE THE
STAFF RECOMMENDATION TO APPROVE
THIS PROPOSAL IN THE FUTURE HERE
A LITTLE YES, A LITTLE WILL OWNS
A LEO. UM SO WE DON'T
NECESSARILY HAVE AN ISSUE IN
THIS SPECIFIC BUDGET PROPOSAL,
BUT RATHER WE HAVE A STATE OF
RECOMMENDATION THAT WE'RE
PREPARED TO DISCUSS WITH THE
COMMITTEE AT THIS TIME REGARDING
THE FUNDING FOR THE CARE PROGRAM
AS A WHOLE. UM SO JUST TO KIND
OF JUST SET ON PAGE 82 OF THE
AGENDA, THERE IS THE TABLE THAT
SHOWS THE FUNDING FOR CARE
PROGRAM ACROSS BOTH THE JUDICIAL
BRANCH AND THE HCS. SO ELIO HAS
THREE MAJOR RECOMMENDATIONS AS
IT RELATES TO THE CARE PROGRAM
AS A WHOLE. AS STATED, LIKE IT
SAID IN THE AGENDA IS THAT WE
WOULD RECOMMEND THE APPROVAL OF
JUST ONE YEAR OF FUNDING
SPECIFICALLY FOR COHORT ONE. WE
UNDERSTAND THIS IS A LEGISLATIVE
PRIORITY. THIS IS GOING TO BE AN
ONGOING PROGRAM AND WILL NEED
FUNDING IN THE FUTURE. HOWEVER
DUE TO THE UNCERTAINTY OF THE
PROGRAM IN TERMS OF, UH, NEEDS
THE NUMBER OF PARTICIPANTS, UM
WE BELIEVE IT'S BETTER TO FUND
THE PROGRAM FOR A SINGLE YEAR TO
GIVE THE LEGISLATURE OPPORTUNITY
TO EVALUATE THE PROGRAM AS A
WHOLE AND BETTER UNDERSTAND
POTENTIAL ONGOING COSTS.
ADDITIONALLY THE LEGISLATURE MAY
WISH TO PURSUIT STATUTORY
CHANGES TO THE PROGRAM AFTER THE
INITIAL FUNDING FOR COHORT. ONE
RELATED TO THIS OVERALL
RECOMMENDATION IS JUST A COUPLE
OF PIECES. THE SECOND
RECOMMENDATION WOULD BE TO
REQUIRE INTERIM DATA REPORTING
FOR COHORT ONE. UM SO THE CARE
ACT DOES REQUIRE A FAIRLY ROBUST
, UM, ANNUAL REPORT FOR KEY
PROGRAM METRICS AND OUTCOMES. UM
BUT THIS REPORT LIKELY WOULD NOT
BE AVAILABLE UNTIL AFTER 24
FISCAL YEAR 24 25 BUDGET YEAR.
DELIBERATIONS AND SO BY
REQUIRING AN ENORMOUS REPORT
WITH THEM MORE, UM SLIM DOWN
DATA REQUIREMENTS JUST TO GIVE
THE LEGISLATURE MORE INFORMATION
. MORE DATA AS IT'S PREPARING TO
APPROVE ONGOING COSTS FOR THE
PROGRAM. UM AND THEN,
ADDITIONALLY, WE RECOMMEND THAT
THE LEGISLATURE CONSIDER
SPECIFYING THE PROCESS FOR THE
DEVELOPMENT OF ONGOING FUNDING
REQUIREMENTS. AH, SO WE WOULD
RECOMMEND THE LEGISLATURE ADOPTS
SOME TRAIL HERBAL LANGUAGE THAT
WOULD SPECIFY THE PROCESS BY
WHICH THE ESTIMATE FOR THE CARE
PROGRAM COSTS. UM WOULD WOULD BE
FOR THE ONGOING FUNDING
REQUIREMENTS AND, YOU KNOW WE
WOULD RECOMMEND USING THE DATA
THAT WE ALIGN OUR PREVIOUS
DISCUSSION AS WELL AS IN OUR OUR
PREVIOUS REPORT TO KIND OF. GIVE
THE LEGISLATURE AN OPPORTUNITY
TO BETTER TAILOR. ONGOING
FUNDING ESTIMATES FOR THIS
PROGRAM. THANK YOU BRING IT UP
TO THE DIESS. WE'RE GOING TO
TAKE YOUR COMMENTS INTO
CONSIDERATION AND JUST
APPRECIATE VERY MUCH THIS PANEL.
WE WILL MOVE ON TO ISSUE 14.
ISSUE. 14 IS ON THE ENHANCED
LANDERMAN PETRUS SHORT ACT DATA
AND REPORTING. SB 9 29 TRAILER
BILL. TYLER'S SAD WITH. THE
DEPUTY DIRECTOR OF THE
BEHAVIORAL HEALTH AT DHC S WILL
BEGIN WHEN YOU'RE READY. THANK
YOU. GOOD AFTERNOON CHAIR. UM
SENATE BILL 9 29 PASSED IN 2022
INCREASES THE REQUIREMENTS FOR
DATA COLLECTION RELATED TO
INVOLUNTARY HOLDS EVALUATIONS
AND TREATMENT UNDER THE
LANDERMAN, PETRA'S SHORT ACTOR,
THE LPS ACT. THIS BILL NOW
REQUIRES THE DEPARTMENT TO
COLLECT DATA QUARTERLY AND
PUBLISH AN ANNUAL REPORT.
INCLUDING QUANTITATIVE DE
IDENTIFIED INFORMATION RELATING
TO PERSONS DETAINED OR ADMITTED
PURSUANT TO THE LPS ACT AND
REQUIRES THE JUDICIAL COUNCIL TO
PROVIDE DATA TO THE DEPARTMENT
FROM EACH SUPERIOR COURT. THAT
IS NECESSARY FOR DHC S TO
COMPLETE THE RECORD, AND IT
REQUIRES EACH COUNTY BEHAVIORAL
HEALTH DIRECTOR OR ENTITY
INVOLVED IN IMPLEMENTING THE
PROVISIONS TO PROVIDE DATA AS
PRESCRIBED BY THE DEPARTMENT.
SENATE BILL 9 29 IS AN IMPORTANT
STEP, AND I BETTER IDENTIFYING
TRENDS AND CHARACTERISTICS IN
UTILIZATION OF INVOLUNTARY HOLDS
EVALUATIONS AND TREATMENTS. THIS
NEW DATA CAN BE USED TO IMPROVE
TREATMENT AND SERVICE OUTCOMES.
THE DEPARTMENT IS PROPOSING
TRAILER BILL LANGUAGE TO ADDRESS
TWO ISSUES. FIRST THE DEPARTMENT
SEEKS TO CLARIFY THE ROLES AND
RESPONSIBILITIES OF DATA
REPORTING AMONG THE DEPARTMENT
COUNTIES AND PROVIDERS IN THE
LPS ACT SYSTEM. THE DEPARTMENT
DOES NOT HAVE AUTHORITY OVER ALL
FACILITIES IN INDIVIDUALS THAT
ARE DESIGNATED TO INITIATE AND
IMPLEMENT LPS HOLDS. THE TRAILER
BILL WOULD CLARIFY THAT DATA
SHOULD FLOW FROM DESIGNATED
FACILITIES AND OTHER ENTITIES TO
COUNTIES. FIRST COUNTIES ARE
RESPONSIBLE FOR ADMINISTERING
THE LPS ACT UNDER STATE LAW. AND
DESIGNATE FACILITIES AND
INDIVIDUALS TO INITIATE AND
IMPLEMENT INVOLUNTARY HOLDS.
THEN FROM COUNTY IS THE DATA
WOULD BE REPORTED TO THE
DEPARTMENT. THE DEPARTMENT WOULD
PROVIDE GUIDANCE TO ENSURE DATA
IS REPORTED IN A STANDARDIZED
MANNER ACROSS THE STATE. THE
DEPARTMENT RECOGNIZES COUNTIES
MAY HAVE CONCERNS ABOUT ASSUMING
RESPONSIBILITY FOR DATA
COLLECTION AND REPORTING. THAT
WE CONTINUE TO BELIEVE THE
APPROACH OUTLINED IN TRAILER
BILL IS APPROPRIATE BECAUSE
UNDER LAW COUNTY IS RATHER THAN
THE DEPARTMENT HAVE THE
RESPONSIBILITY FOR IMPLEMENTING
INVOLUNTARY ASPECTS OF THE LPS
ACT. THEY DESIGNATE FACILITIES
AND INDIVIDUALS TO IMPLEMENT
INVOLUNTARY HOLDS, AND THEY HAVE
DIRECT RELATIONSHIPS WITH THE
ENTITIES THEY DESIGNATE TO
ADMINISTER LPS ACTIVITIES.
REQUIRING LPS DESIGNATED
FACILITIES TO REPORT DATA TO
COUNTIES WILL ALSO GIVE COUNTIES
THE OPPORTUNITY TO IMPROVE DATA
INTEGRITY BY REVIEWING LOCAL
DATA AND ADDRESSING QUESTIONS OR
INACCURACIES PRIOR TO REPORTING
TO THE DEPARTMENT. SECOND THE
TRAILER BILL WOULD ALSO PROVIDE
THE DEPARTMENT THE ABILITY TO
IMPOSE CIVIL MONETARY PENALTIES
AGAINST BOTH DESIGNATED
FACILITIES IN COUNTIES FOR
FAILURE TO SUBMIT DATA TIMELY.
WITHOUT THIS ADDED LANGUAGE ON
PENALTIES, DHC S WOULD BE UNABLE
TO SUCCESSFULLY ENFORCED
COMPLIANCE FOR ENTITIES THAT DO
NOT HAVE CONTRACTS OR ARE
LICENSED BY THE DEPARTMENT. MISS
TRAILER BILL LANGUAGE WOULD
GRANT TH THE DEPARTMENT THE
ABILITY TO IMPOSE CIVIL MONETARY
PENALTIES FOR NON COMPLIANCE
RELATED TOO LATE OR INCOMPLETE
DATA REPORTING IT WOULD ALLOW
FACILITIES AND COUNTIES TO
SUBMIT WRITTEN APPEALS AND TO
REQUEST A FORMAL HEARING FOR ANY
CIVIL MONETARY PENALTIES LEVIED
AGAINST THEM. THIS IS PROPOSED
AS TRAILER BILL LANGUAGE BECAUSE
THERE IS AN ASSOCIATED BUDGET
CHANGE PROPOSAL AND THE
DEPARTMENT WOULD LIKE TO
IMPLEMENT THE BILL'S PROVISIONS
PROMPTLY AND EFFECTIVELY. IN
ADDITION, THE PROPOSED TRAILER
BILL LANGUAGE IS NOT INTENDED TO
REDESIGN OR RE LITIGATE THE
POLICY. RATHER THE DEPARTMENT
AND THE AUTHORS OFFICE, SENATOR
EDMUND AGREED AT THE END OF LAST
SESSION THAT CLEANUP WOULD BE
NEEDED TO CLARIFY HOW DATA WOULD
BE REPORTED TO THE DEPARTMENT.
WE ACKNOWLEDGE THAT MONETARY
PENALTIES WERE NOT PART OF THE
ORIGINAL LEGISLATION, AND WE ARE
HAPPY TO REVIEW THAT PROPOSED
LANGUAGE WITH ALL RELEVANT
PARTIES WERE HAPPY TO ENGAGE
WITH OUR LEGISLATIVE PARTNERS
AND LOOP BACK FOR CONFIRMATION
REGARDING THE LANGUAGE. NEXT WE
WILL HEAR FROM MICHELLE CABRERA
, EXECUTIVE DIRECTOR OF C B H D
A. THANK YOU SO MUCH. MR CHAIR
ON BEHALF OF THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION. WE HAVE SIGNIFICANT
CONCERNS WITH THE PROPOSED
TRAILER BUILT CHANGES TO SB 9 29
FROM LAST YEAR. COUNTY
BEHAVIORAL HEALTH STRONGLY
SUPPORT THE EXPANSION AND
IMPROVEMENT OF LPS DATA
COLLECTION. LET ME BE CLEAR. WE
ACTUALLY SPONSORED TWO BILLS ON
THIS TOPIC THE LAST COUPLE OF
YEARS, WHICH WERE AUTHORED BY
YOUR COMMITTEE MEMBER
ASSEMBLYMEMBER'S RAMOS. WE WERE
EXCITED ABOUT THE OPPORTUNITY
WITH SB 9 TO 9 AS WELL. TO
REALLY SIGNIFICANTLY EXPAND THE
BREADTH OF DATA THAT WE'RE
CURRENTLY ABLE TO CAPTURE FOR
LPS. UM AS YOU PROBABLY KNOW,
UNDER THE LANTERN AND PETRA
SHORT ACT, A LAW ENFORCEMENT IS
SPECIFICALLY CALLED OUT IN THE
LAW AS ABLE TO PLACE HOLDS. NOW
COUNTIES DO HAVE THE
RESPONSIBILITY FOR DESIGNING
DECIDING WHO THEN GETS TO
DISPENSE WITH THOSE RIGHT DO THE
EVALUATION LIFT HOLDS ETCETERA
AND, UM, THE CURRENT REPORTING
STRUCTURE, WHICH I THINK WE ALL
AGREE IS INSUFFICIENT IS
STRUCTURED TO ALIGN FAIRLY
CLOSELY WITH THE TRAILER BILL
REQUESTS MEANING COUNTIES ARE
RESPONSIBLE FOR REPORTING TO THE
STATE. AND WE ARE SUPPOSED TO
GET THAT INFORMATION ONLY FROM
DESIGNATED FACILITIES. BUT AS
YOU KNOW, AS AN EMERGENCY ROOM
PHYSICIAN, WE CAN ALSO DESIGNATE
INDIVIDUALS WORKING IN VARIOUS
TYPES OF FACILITIES, SO IT'S NOT
A FACILITY BASED STRUCTURE. AND
IF WE WERE TO REVERT TO THE
PROPOSAL IN THE TRAILER BILLING
, WHICH WE REALLY WOULD BE
TAKING A SIGNIFICANT STEP
BACKWARDS, WHICH IS NOT WHAT,
HOW WE UNDERSTOOD THE INTENTION
OF SB 9 29 IN OUR NEGOTIATIONS
WITH THE AUTHOR ALONGSIDE
HOSPITALS AND THE EMERGENCY ROOM
PHYSICIANS. INSTEAD WE PRESENTED
DHC S WITH A VISION OF UH, WE'RE
IN 2023 PERHAPS INVESTING IN A
BETTER, UM, TECHNOLOGY BASED
SOLUTION FOR CAPTURING DATA
ACROSS THE CONTINUUM OF
DIFFERENT STAKEHOLDERS WHO
REALLY TOUCHED THE LPS PROCESS,
TRYING TO DIGIT DIGITIZE IT AND
REALLY MAKE USE OF EASIER WAYS
TO REPORT THIS SO THAT WE CAN
UNDERSTAND. HOW MANY PEOPLE ARE
PUT ON HOLDS BY LAW ENFORCEMENT
. HOW MANY OF THOSE HOLDS TURN
OUT TO BE APPROPRIATE? HOW MANY
PEOPLE ARE PUT ON HOLDS IN NON
DESIGNATED FACILITIES VERSUS
DESIGNATED FACILITIES? AND WHAT
ARE THE OUTCOMES OF THOSE HOLDS
? WE THINK THAT THESE ARE REALLY
IMPORTANT POLICY CONVERSATIONS
THAT WE DON'T HAVE THE
INFORMATION TOGETHER, AND WE
CERTAINLY WOULDN'T BE ANYWHERE
CLOSER TO ANSWERING IF WE WERE
TO ADOPT THIS TRAILER BILL
LANGUAGE BECAUSE MUCH LIKE THE
STATE DOESN'T HAVE, UM,
AUTHORITY OVER. UM LPS
DESIGNATED FACILITIES. WE
ACTUALLY DON'T HAVE AUTHORITY
OVER NON DESIGNATED FACILITIES,
AND, UM, WE THINK THAT IT'S
REALLY, REALLY IMPORTANT FOR THE
LAW TO REFLECT THE PUBLIC'S
INTEREST IN THE FULL BREADTH OF
LPS. AND IN TERMS OF THE FINDS,
YOU KNOW WE ARE CONCERNED. WITH
THE PROPOSAL. WE EXPRESS THOSE
CONCERNS LAST YEAR, THE AUTHOR,
UM YOU KNOW PASSED. THE BILL
REJECTED THE PROPOSAL FROM THE
STATE TO APPLY THOSE FINDS. UM
WE OBJECT TO THE NOTION THAT THE
STATE WOULD FUND ITS OPERATION
OF THIS BASED ON THOSE FINES AND
PENALTIES AND WE THINK THAT, UM
THIS STATE SHOULD LOOK AT OTHER
SOLUTIONS TO MORE SUSTAINABLY
FUND THIS. THANK YOU. DEPARTMENT
OF FINANCE. GENERAL WAS
APPOINTED FINANCE HERE TO ANSWER
ANY QUESTIONS. OH WELL. OWEN'S
ELIO OF WE HAVE NOT CONCERNED
RAISED CONCERNS WITH THE
PROPOSAL BUT ARE AVAILABLE FOR
QUESTIONS. BRING IT UP TO THE
DIOCESE. UM DEPUTY DIRECTOR. IT
SOUNDED LIKE YOU HAD STATED
THERE WAS AN UNDERSTANDING WITH
SENATOR EGGMAN AT THE END OF
LAST YEAR ABOUT A NEED FOR US TO
CLARIFY THE ROLES AND
RESPONSIBILITIES. BUT YOU DIDN'T
MENTION THE PORTION REGARDING
THE FIND. AND SO I'D LIKE TO
UNDERSTAND IF THE SENATOR IS I
HAD AN OPPORTUNITY TO CONSIDER,
INCLUDING THAT AT THE END OF
LAST YEAR AND UM IF UM, THE
SENATOR DID NOT INCLUDED. IT
SEEMS LIKE A SIGNIFICANT POLICY
DEVIATION FROM THE INTENT THAT
THEY HAD SOME JUST HOPING YOU
CAN COMMENT ON WHETHER THERE
WERE THOSE CONVERSATIONS. THANK
YOU. CHAIR FOR YOUR QUESTION THE
CONVERSATIONS WITH THE SENATOR'S
OFFICE REGARDING CLEANUP, UH,
FOCUSED PRINCIPALLY ON THE FLOW
OF DATA REPORTING AND THE
RESPONSIBILITIES FOR DATA
REPORTING THOSE CONVERSATIONS
DID NOT CENTER ON THE MONETARY
PENALTIES. UM. WITHOUT COMING TO
A CONCLUSION. TODAY I SHARE SOME
OF THE SIGNIFICANT CONCERNS AND
HOPE WE CAN FIND A CARROT RATHER
THAN, UH, STICK TO ENCOURAGE OUR
PARTNERS TO PARTICIPATE IN BUT
WITH THAT I WILL. THANKS VERY
MUCH THIS PANEL AND MOVE ON TO
PANEL 15. ISSUE 15 AS AN
OVERSIGHT ISSUE ON THE
BEHAVIORAL HEALTH WORKFORCE, OR
FIRST SPEAKER IS DR JANET
KAUFMAN. ASSOCIATE DIRECTOR OF
UCSF INSTITUTE FOR HEALTH POLICY
STUDIES. UH THANK YOU VERY MUCH.
DOCTOR ARAMBULA. CAN YOU ALL
HEAR ME PERFECTLY, THANK YOU.
OKAY THANK YOU. DR ARAMBULA
COMMITTEE MEMBERS. IT'S MY HONOR
TO TESTIFY BEFORE THIS COMMITTEE
TODAY. UM WHEN I COMMEND ALL OF
YOU WHO HAVE TESTIFIED TODAY
ABOUT YOUR OWN EXPERIENCES IN
YOUR FAMILY'S EXPERIENCES WITH
BEHAVIORAL HEALTH? I THINK OUR
FAMILY TOO, IS ONE THAT NEEDS TO
LITTLE LITTLE BETTER JOB OF
TELLING HER TRUTH. A BETTER
EXPERIENCE WITH BEHAVIORAL
HEALTH. UM BUT SINCE THE HOUR IS
LATE, I WANT TO REALLY FOCUS ON
THE FINDINGS FROM OUR RESEARCH
THAT I'D LIKE TO SHARE THAT I
THINK WILL PROVIDE CONTACTS FOR
THE COMMITTEE'S DELIBERATIONS ON
FUNDING FOR BEHAVIORAL HEALTH
WORKFORCE DEVELOPMENT. OUR
RESEARCH DOCUMENTS THAT
CALIFORNIA IS FACING A
BEHAVIORAL HEALTH WORKFORCE
CRISIS BECAUSE THE SIZE
DISTRIBUTION AND CHARACTERISTICS
OF OUR BEHAVIORAL HEALTH
WORKFORCE ARE INADEQUATE TO MEET
GROWING DEMAND. OKAY? FOR
BEHAVIORAL HEALTH SERVICES
FORECAST THAT MIGHT COLLEAGUES
AND I AT YOU SEE A SUB GENERATED
PRIOR TO THE COVID 19 PANDEMIC
SUGGESTS THAT CALIFORNIA WILL
NOT HAVE ENOUGH PSYCHIATRISTS,
PSYCHOLOGISTS, MARRIAGE AND
FAMILY THERAPIST, PROFESSIONAL
CLINICAL COUNSELORS AND SOCIAL
WORKERS TO MEET DEMAND OVER THE
NEXT DECADE. AND I WOULD SAY
THAT THIS FORECAST PROBABLY
UNDERSTATE CALIFORNIA SHORTAGE
OF BEHAVIORAL HEALTH
PROFESSIONALS FOR SEVERAL
REASONS. UH FIRST, THE COVID 19
PANDEMIC ACCELERATED DEMAND FOR
BEHAVIORAL HEALTH SERVICES
BECAUSE SOCIAL ISOLATION,
BEREAVEMENT ETCETERA TRIGGERED
AND EXACERBATED MENTAL HEALTH
CONDITIONS AND SUBSTANCE USE
DISORDERS. UM, AND WHILE THE
STATE OF EMERGENCY IS OFFICIALLY
OVER. I THINK A LOT OF THOSE
EFFECTS STILL LINGER FOR PEOPLE
. SECOND CALIFORNIA HAS EMBARKED
ON MULTIPLE NEW INITIATIVES
AIMED AT IMPROVING ACCESS TO
BEHAVIORAL HEALTH SERVICES FOR
WHICH ADDITIONAL BEHAVIORAL
HEALTH WORKERS WILL BE NEEDED.
TALKED ABOUT CARE ACT CHILDREN
USING BEHAVIORAL HEALTH
INITIATIVE. MANY OF THOSE
INITIATIVES TODAY THAT ARE
REALLY IMPORTANT FOR MEETING THE
NEEDS OF CALIFORNIANS. AND SO
WITHIN THIS CONTEXT, WE FIND
THAT EMPLOYERS ARE HAVING
INCREASING DIFFICULTY RETREATING
AND RETAINING SUFFICIENT STAFF
AND THAT THIS IS ESPECIALLY THE
CASE FOR COUNTY BEHAVIORAL
HEALTH AGENCIES IN THE COMMUNITY
BASED ORGANIZATIONS WITH WHICH
THEY CONTRACT AND THESE
TRADITIONAL EMPLOYERS ARE
COMPETING WITH TELE BEHAVIORAL
HEALTH STARTUPS THAT OFFER
BEHAVIOR, HEALTH PROFESSIONALS,
REMOTE WORK AND FLEXIBLE HOURS.
AND THE MENTAL DISTRIBUTION OF
BEHAVIORAL HEALTH PROFESSIONALS
EXASPERATES THESE CHALLENGES IN
MANY IN MANY PARTS OF THE STATE.
13 MILLION CALIFORNIANS. ABOUT
ONE THIRD OF THE STATE'S
POPULATION LIVE IN COMMUNITIES
DESIGNATED AS MENTAL HEALTH
PROFESSIONAL STORAGE AREAS DUE
TO THEIR LOW SUPPLIES OF
PSYCHIATRIST PER CAPITA.
SHORTAGES OF ALL TYPES OF
LICENSED BEHAVIORAL HEALTH
PROFESSIONALS ARE SEVERE AND THE
INLAND EMPIRE AND IN THE SAN
JOAQUIN VALLEY AND EVEN IN THE
BAY AREA, WHERE SUPPLIES OF
PROVIDERS ARE ABUNDANT SAFETY
NET BEHAVIOR, HEALTH AGENCIES
ARE STILL FACING STIFF
COMPETITION FOR STAFF. SUPPORT
GEOGRAPHIC DISTRIBUTION OF
CALIFORNIA'S BEHAVIORAL HEALTH
WORKFORCE IS COMPOUNDED BY
DEMOGRAPHIC CHALLENGES. THE
BEHAVIORAL HEALTH WORKFORCE IS
LESS DIVERSE THAN CALIFORNIA'S
POPULATION, WHICH MAKES IT
DIFFICULT FOR PEOPLE TO OBTAIN
CARE FROM LINGUISTICALLY AND OR
RACIALLY ETHNICALLY CONCORDANT
PROVIDERS, WHICH CAN BE VERY
IMPORTANT FOR FORGING TRUSTING
THERAPEUTIC RELATIONSHIPS. IN
ADDITION, MANY BEHAVIORAL HEALTH
PROFESSIONALS ARE AT OR NEAR
RETIREMENT AGE. DATA ON TRENDS
AND GRADUATIONS FROM EDUCATIONAL
PROGRAMS FOR BEHAVIORAL HEALTH
PROFESSIONALS SUGGEST THAT THE
NUMBER OF GRADUATES IS
INSUFFICIENT TO REPLACE RETIREES
FROM 2016 TO 2020, THE MOST
RECENT YEAR FOR WHICH
COMPREHENSIVE DATA ARE AVAILABLE
. THE NUMBER OF GRADUATES OF
SUBSTANCE USED TO SORT OF
COUNSELOR PROGRAMS DECREASED. SO
IN THIS TIME OF, YOU KNOW, AN
ONGOING SUBSTANCE USE. CRISIS
MADE WORSE BY THE COVID 19
PANDEMIC DECREASE AND GRADUATES
OF SUBSTANCE USE DISORDER
COUNSELING PROGRAMS. ALSO LITTLE
GROWTH IN GRADUATES FOR MASTER'S
DEGREE PROGRAMS FOR HERE. PEOPLE
FOR LICENSURE AS BEHAVIORAL
HEALTH PROFESSIONALS. NUMBER OF
PSYCHIATRY RESIDENTS HAS
INCREASED. THAT'S GOOD NEWS, BUT
THEIR NUMBERS REMAIN FAR BELOW
THE NUMBER NEEDED TO REPLACE
RETIREES. AND SO RECOGNIZING THE
NEED TO INCREASE THE BEHAVIORAL
HEALTH WORKFORCE, THE
ADMINISTRATION IN THE STATE
LEGISLATURE CAME TOGETHER AND IN
THE 2022 CALIFORNIA STATE BUDGET
ALLOCATED 326 MILLION IN GENERAL
FUND DOLLARS TO THE DEPARTMENT
OF HEALTH CARE, ACCESS AND
INFORMATION TO PROVIDE FINANCIAL
ASSISTANCE TO BEHAVIOR. HEALTH
STUDENTS. AND GRADUATE RECENT
GRADUATES AND ALSO TO PROVIDE
GRANTS TO BEHAVIORAL HEALTH
PROFESSIONS EDUCATION PROGRAMS
TO EXPAND THEIR CAPACITY IN MY
UNDERSTANDING IS THAT TO DATE
HAS AWARDED 97 MILLION TO EXPAND
EDUCATIONAL PROGRAMS FOR
PSYCHIATRISTS, PSYCHIATRIC,
MENTAL HEALTH, NURSE
PRACTITIONERS AND SOCIAL WORKERS
. SO I THINK THIS IS GOOD. GOOD
NEWS. THAT'S REALLY KIND OF PUT
US ON. THE RIGHT TRACK TO
SCALING OUR BEHAVIORAL HEALTH
WORKFORCE TO MEET THE STATE'S
NEEDS AND TO STAFF THESE
INITIATIVES THAT WE'RE EMBARKING
THEM ON. HOWEVER THE GOVERNOR'S
BUDGET FOR FISCAL YEAR 23 24
CALLS FOR REDUCING FUNDING FOR
BEHAVIORAL HEALTH WORKFORCE
DEVELOPMENT BY 50 MILLION IN FY
22 23 BY 81 MILLION IN FY 23 24.
AND IN THIS CERTAINLY
UNDERSTANDABLE IN LIGHT OF THE
DECREASES IN STATE TAX REVENUE.
THIS WOULD REALLY SWART
CALIFORNIANS EFFORTS TO IMPROVE
THE LIVES OF PEOPLE WITH MENTAL
HEALTH CONDITIONS AND SUBSTANCE
USE DISORDERS TO SORT OUR
ABILITY TO IMPLEMENT THESE GREAT
THESE PROMISING INITIATIVES THAT
WE'VE BEEN TALKING ABOUT MEETING
CALIFORNIA'S BEHAVIORAL HEALTH
WORKFORCE NEEDS REQUIRES ONGOING
SUSTAINED INVESTMENT OF STATE
FUNDS TO SUPPORT EDUCATIONAL
PROGRAMS. THAT HAVE A TRACK
RECORD OF TRAINING DIVERSE
STUDENTS TO CARE FOR
CALIFORNIANS WITH GREATEST
BEHAVIORAL HEALTH NEEDS. THIS
JUST REALLY ISN'T TO PUT IT
COLLOQUIALLY THE TIME TO TAKE
OUR FOOT OFF THE GAS IN
BEHAVIORAL HEALTH WORK FIRST.
FUNDING SO I WANNA THANK YOU.
THANK YOU FOR YOUR TIME, DR
ARAMBULA. NEXT WE HAVE DOCTOR
NAMED, UM YOU SEE THIS? THANK
YOU SO MUCH. UM SO I REALLY
APPRECIATED HEARING THAT DATA
ABOUT THE CRISIS THAT WE'RE IN.
AND I KNOW DR JACKSON WAS ALSO
REALLY HIGHLIGHTING THIS MENTAL
HEALTH CRISIS. SO THE PIECE THAT
I WOULD I WOULD LIKE TO
HIGHLIGHT A SPECIALTY CARE. AND
SO NOT ONLY DO WE HAVE A CRISIS
IN GENERAL MENTAL HEALTH CARE,
WE HAVE A EVEN BIGGER CRISIS IN
SPECIALTY MENTAL HEALTH CARE.
AND I SPEAK ABOUT THIS BECAUSE
I'VE PROBABLY TRAINED CLOSE TO
30,000 PEOPLE. IN WHAT IT MEANS
TO IDENTIFY SOMEONE WITH EARLY
PSYCHOSIS AND HOW TO REFER THEM
TO APPROPRIATE CARE. AND I AM
CONSISTENTLY DISAPPOINTED BY THE
LACK OF KNOWLEDGE. OUR OWN
MENTAL HEALTH CARE PROVIDERS
HAVE ABOUT PSYCHOSIS. PEOPLE ARE
SHOCKED BY THE NUMBERS. THEY'RE
SHOCKED BY THE OUTCOMES, AND
THAT'S WHEN I REALLY SIT DOWN
AND TALK TO HIM. I'M LIKE, HEY,
HOW MANY DAYS DID YOU SPEND
TALKING ABOUT PSYCHOSIS NEAR
LIKE, MAYBE THERE WAS ONE
LECTURE. MAYBE AND I'M LIKE,
RIGHT, SO THE PIECE THAT I WOULD
REALLY LIKE TO HIGHLIGHT TODAY
IS THAT WE HAVE WE DO STILL HAVE
FOLKS COMING OUT OF THESE
TRAINING PROGRAMS, MANY OF THEM
WITH MASTER'S DEGREES, FAR FEWER
WITH PH. D S. BUT THEY ARE OFTEN
TRAINED TO SERVE LOW TO MODERATE
ANXIETY, DEPRESSION, AND HERE WE
ARE HEARING ABOUT SUBSTANCE USE.
I AM HERE TALKING ABOUT
PSYCHOSIS AND CURRENT MOOD
DISORDERS. THEY AREN'T GETTING
THE TRAINING THEY NEED TO SERVE
THE FOLKS WHO ARE IN OUR
MODERATE TO MODERATE SEVERE
PROGRAMS, WHICH ARE THE FOLKS
WITH THE HIGHEST NEED WHO HAVE
THE WORST OUTCOMES. UM AND VERY
FEW OF THEM HAVE BEEN TRAINED ON
EVIDENCE BASED PRACTICES FOR
THESE ILLNESSES. SO WHAT ENDS UP
HAPPENING? THEY COME INTO AN
EARLY PSYCHO. THIS PROGRAM AND I
HAVE THE PRIVILEGE OF TEACHING
THEM ABOUT EARLY PSYCHOSIS. BUT
I'M ALSO TEACHING THEM JUST
COGNITIVE BEHAVIORAL THERAPY. I
AM TEACHING THEM BASIC COPING
SKILLS. HOW DO YOU TEACH SOMEONE
COPING SKILLS? HOW DO YOU
PROVIDE PSYCHO EDUCATION? AND SO
WE ARE BASICALLY RETRAINING OUR
MENTAL HEALTH WORKFORCE TO SERVE
THESE FOLKS, AND THAT IS A VERY
BIG LIFT FOR OUR PROGRAMS. I'M
ASKING FOR HOURS AND HOURS OF
THEIR STAFF TIME. TO JUST TEACH
. TRAIN THEM IN ONE OF OUR
COMPONENTS, EVIDENCE BASED
PRACTICES. UM AND SO WHAT I
WOULD REALLY LIKE TO ASK IS FOR,
UM, THE LEGISLATURE TO THINK OF
WAYS IN WHICH WE CAN INCENTIVIZE
OUR EDUCATIONAL PROGRAMS HERE IN
THE STATE OF CALIFORNIA TO TRAIN
THE WORKFORCE FOR WHAT WE NEED
THEM TO DO. AND I KNOW WE DON'T
WANT TO. I'M A PROFESSOR. I
DON'T WANT PEOPLE TELLING ME
WHAT THE TEACHER NOT TO TEACH.
BUT I ALSO HAVE EXPECTATIONS AND
GUIDELINES I TEACH IN A MEDICAL
SCHOOL. THERE ARE THINGS I HAVE
TO TEACH AND THEN THINGS THAT
ARE NICE TO TEACH. I'M NOT SURE
WHY WE AREN'T USING THOSE SAME
GUIDELINES IN OUR GRADUATE
PROGRAMS ARE PSYCHOLOGY PROGRAMS
OR OTHER MASTERS PROGRAMS. AND
SO I REALLY WANT TO ENCOURAGE US
TO FIND WAYS TO INCENTIVIZE
CHANGE SO THAT WE CAN MEET THE
NEEDS OF OUR GROWING MENTAL
HEALTH DEMAND. THANK YOU SO MUCH
. DOCTOR LEANDRA, CLARK HARVEY.
GOOD EVENING. I AM DR LANDRY.
CLARKE. HARVEY I'M A
PSYCHOLOGIST. I'M ALSO THE CEO
OF THE CALIFORNIA COUNCIL OF
COMMUNITY BEHAVIORAL HEALTH
AGENCIES. WE ARE AN ADVOCACY
ORGANIZATION REPRESENTING MENTAL
HEALTH AND SUBSTANCE USE
DISORDER AGENCIES THAT
COLLECTIVELY SERVE OVER ONE
MILLION CALIFORNIANS ARE MEMBERS
PROVIDE SERVICES FROM BIRTH TO
END OF LIFE. THEY RUN 988 CALL
CENTERS. THEY ARE FEDERALLY
QUALIFIED HEALTH CENTERS,
OUTPATIENT AND INPATIENT
SERVICES. THEY DO IT ALL. BUT
WHEN I PULL OUR MEMBERS ABOUT
THE TOP ISSUE THAT KEEPS THEM UP
AT NIGHT. WORKFORCE CONTINUES TO
RANK AMONG THE HIGHEST NOW, MY
COLLEAGUES HAVE ALREADY SHARED
STATISTICS THAT THIS COMMITTEE
HAS BECOME ALL TOO FAMILIAR WITH
AND IF THE PANDEMIC DID NOTHING
ELSE HAS SHONE A LIGHT BRIGHTER
LIGHT ON THE DEFICITS WITHIN THE
BEHAVIORAL HEALTH SYSTEM IN
TERMS OF WORKFORCE, AND
ESPECIALLY FOR DIVERSE
CLINICIANS, SO SIMPLY PUT AS
YOU'VE HEARD, ALREADY, WORKERS
NEED INCREASED INCENTIVES FOR
CONTINUED WORK AND THE BEHAVIOR
OF PUBLIC BEHAVIORAL SYSTEM,
ESPECIALLY WHEN AMAZON AND FEDEX
ARE PAYING THEM MORE. MY UBER
DRIVER ON THE WAY OVER HERE TOLD
ME THAT SHE HAS A MASTER'S
DEGREE, BUT SHE'S DRIVING UBER
BECAUSE SHE NEEDS TO PAY THE
BILLS. THIS IS THE REALITY THAT
WE'RE ENCOUNTERING RIGHT NOW.
AND AS MY COLLEAGUE JUST SAID
TRAINING IS OBVIOUSLY VERY
ESSENTIAL. AND AS A PSYCHOLOGIST
THAT WORKED IN A VARIETY OF
SETTINGS, CORRECTIONAL,
INPATIENT OUTPATIENT, ETCETERA.
I HAD THE OPPORTUNITY TO DO THAT
LEARNING ON THE JOB. H CHI HAS A
LONG HISTORY OF CREATING
WORKFORCE FUNDING FOR TRAINEES
IN PARTICULAR. IN FACT, I'VE
BENEFITED FROM THAT FUNDING 13
YEARS AGO WHEN I WAS PURSUING MY
POSTDOC AT U C L. A CHILDREN'S
HOSPITAL. THE STIPEND THAT I GOT
SUPPLEMENTED MY MEAGER POSTDOC
SALARY SO THAT I COULD LITERALLY
LIVE AND EAT SANDWICHES DURING
TRAINING, AND I'M GRATEFUL FOR
THAT. BUT I ALSO RECOGNIZE THE
NEED TO ENSURE THAT WE ARE
ADEQUATELY SERVING THE ENTIRE
PIPELINE. NOT JUST THOSE WHO
WERE LUCKY AND PRIVILEGED LIKE
ME TO GET MY PHD AND THAT TOOK A
MINUTE, BUT WE SHOULD ALSO BE
INVESTING IN PROGRAMS IN HIGH
SCHOOLS AND COMMUNITY COLLEGES.
THERE'S A LOT OF WORK THAT CAN
HAPPEN THERE. AND IF WE EXAMINE
THE ANNUAL HK REPORT THAT WAS
RECENTLY RELEASED AMONGST MANY
OTHERS, IT ILLUSTRATES THE NEED
FOR RACIALLY AND ETHNICALLY
DIVERSE TRAINEES THAT MIRROR THE
CLIENT THAT NEEDS SERVICE. SAYS.
SO IN FACT, IN EVERY CLINICAL
SETTING, I PRACTICE AND WHETHER
IT BE OUTPATIENT, INPATIENT
CORRECTIONAL, ETCETERA. AND
REGARDLESS OF THE POPULATION.
SADLY I WAS THE ONLY DIVERSE
CLINICIAN ON STAFF AND I
PRACTICED IN MADISON, WISCONSIN
AND HERE IN CALIFORNIA. SO ONCE
NEW PROFESSIONALS INTO THE WORK
FORCE, WE HAVE TO RECOGNIZE WHAT
IT TAKES TO KEEP THEM THERE. SO
COMPETITIVE SALARIES AND
BENEFITS AND THE MAJORITY OF
THEIR TIME SHOULD REALLY BE
SPENT PROVIDING DIRECT SERVICE
TO THE POPULATIONS THAT THEY
TRAINED TO WORK WITH. AND WE'VE
ACKNOWLEDGED THE STATE'S EFFORTS
HERE. UM AND THEY ARE GREAT, BUT
WE JUST CAN'T AFFORD TO BURN OUT
OUR WORKFORCE WITH
ADMINISTRATIVE BURDENS, SUCH AS
VARYING PAPERWORK REQUIREMENTS
THAT DETRACT FROM CLINICAL CARE
AND CREATE OFF PUTTING
ENVIRONMENT FOR CLIENTS DURING
THEIR INITIAL CLINICAL
ENCOUNTERS. NOT MANY FOLKS I
KNOW TRAINED TO BE A CLINICIAN
BECAUSE IT'S LUCRATIVE. THEY
DIDN'T GO INTO THIS TO MAKE A
LOT OF MONEY. BUT MOST OF THESE
INDIVIDUALS ARE DOING THE WORK
BECAUSE IT'S THEIR PASSION. IT'S
THEY'RE CALLING AND WE HAVE TO
MAKE IT EASIER FOR THEM TO DO
THIS, AND OUR STATE HAS NOT BEEN
THE MOST FRIENDLY TO OUT OF
STATE PROVIDERS WHO LOOKED AT
TRANSITION THEIR LICENSES TO
CALIFORNIA TO BOLSTER OUR
WORKFORCE, ESPECIALLY IN TIMES
OF CRISIS. SO LICENSE
RECIPROCITY SOLUTIONS MUST BE
EXAMINED HERE, TOO. ESPECIALLY
SINCE AS HAS BEEN DISCUSSED
PREVIOUSLY. THERE AREN'T ENOUGH
TRAINING PROGRAMS AND RESIDENCY
SITES FOR PSYCHOLOGISTS AND
PSYCHIATRISTS IN CALIFORNIA.
TRAINING IS ESSENTIAL. AND SO AS
A STATE INVEST AND BUILD AN
INNOVATIVE PROGRAMS AND SERVICES
. FOR EXAMPLE, WE'VE TODAY HEARD
ABOUT THE CHILDREN YOUTH
BEHAVIORAL HEALTH INITIATIVE
CARE COURT, FULL SERVICE
PARTNERSHIP, MOBILE CRISIS,
ETCETERA AND CREATING HOUSING
FOR BEHAVIORAL CLIENTS. WE
CANNOT FORGET THAT A WELL
SUPPORTED PIPELINE AND WORKFORCE
IS ESSENTIAL TO THE SUCCESS OF
THESE NEEDED INITIATIVES, AND,
MOST IMPORTANTLY, THE CLIENTS
THAT THEY START SO I JUST FEEL
LIKE IT'S TIME TO DO BETTER AND
BOLSTER FUNDING, NOT TAKE IT
AWAY. THANK YOU FOR ALLOWING ME
TO SHARE THIS PERSPECTIVE ON
BEHALF OF OUR MEMBERS. NEXT WE
HAVE MICHELLE CAPOEIRA. THANK
YOU, MR. CHAIR MICHELLE CABRERA
WAS C B H D A. AND WE'RE REALLY
PLEASED TO HEAR FROM DR KAUFMAN
, WHO ANALYZED THE BEHAVIORAL
HEALTH WORKFORCE WITHIN THE
COUNTY BEHAVIOR HALL SAFETY NET
. WE WERE REALLY STRUCK BY HER
FINDINGS. I WILL SAY WE LEARNED
THAT ALREADY A THIRD OF OUR
WORKFORCE, OUR
PARAPROFESSIONALS. WE HAD NO
IDEA. I MEAN, THAT'S JUST A
PRETTY SIGNIFICANT CHUNK ON THE
MENTAL HEALTH SIDE FOR SUBSTANCE
USE DISORDER. 68% ARE SUD
COUNSELORS AND REALLY
PROBLEMATIC IS THAT THE NUMBER
OF SUD COUNSELOR GRADUATES HAS
ACTUALLY GONE DOWN BY ABOUT 20%
IN THE LAST SEVERAL YEARS. UM WE
ALSO HAVE AN EXTREMELY, UM,
AGING GROUP OF CLINICIANS AND
OUR SYSTEM. SO UM, WE HAVE A
THIRD JUST OVER A THIRD. OF OUR
PSYCHIATRISTS, AND THIS IS
LICENSED OVERALL. SO NOT JUST
COUNTY BEHAVIORAL HEALTH. ARE
AND THEY'RE PRACTICING ARE 65
YEARS OF AGE OR OLDER IF WE
DON'T GET STARTED NOW, IN MAKING
THESE INVESTMENTS, WE ARE
DEFINITELY GOING TO BE WIDENING
THAT DEFICIT IN TERMS OF THE
WORKFORCE AND THEN 20 JUST OVER.
25% OF OUR PSYCHOLOGISTS ARE
ALSO PRACTICING OVER THE AGE OF
65 SO UM YOU KNOW, THESE ARE
THESE ARE REALLY SERIOUS
CONCERNS. UM WE ALSO HAVE A
FORTHCOMING STRATEGIC PLAN TO
LOOK AT VARIOUS STRATEGIES FOR
HOW WE CAN IMPROVE THE PIPELINE
AND OUR WORKFORCE. UM WE SUGGEST
IN OUR STRATEGIC, UM, PLAN THAT
WE SHOULD START WITH THE
PIPELINE EARLY, AS IN LEVERAGING
SOME OF OUR SCHOOL BASED
PROGRAMS TO MAKE SURE THAT YOUNG
PEOPLE PARTICULARLY BIPAC, YOUNG
FOLKS, ESPECIALLY IN YOUR NECK
OF THE WOODS KNOW ABOUT CAREERS
IN BEHAVIORAL HEALTH. UM WE
THINK THAT SCHOOLS NEED TO TELL
HER THEIR CURRICULA IS DOCTOR,
NEEDHAM SAID, SO THAT PEOPLE ARE
PREPARED TO WORK WITH SAFETY NET
POPULATIONS AND LEVELS OF
SEVERITY. RIGHT NOW, THE SCHOOLS
ARE JUST PUMPING THEM OUT TO DO
CASH PAY, YOU KNOW, CLINICIAN
TYPE OF WORK, VERY MILD,
MODERATE. UM THE OTHER THING IS
FUNDING. IT NEEDS TO GO BEYOND
LOAN REIMBURSEMENT. THERE'S A
LOT HAPPENING IN LOAN
REIMBURSEMENT RIGHT NOW, WHICH
IS GREAT, BUT WE'RE GETTING TO
KIND OF A POINT WHERE WE REALLY
NEED TO LOOK AT STIPENDS AND
ESPECIALLY IF WE WANT TO
DIVERSIFY LOW INCOME FOLKS JUST
DON'T HAVE THE MONEY TO FLOAT IN
UNPAID INTERNSHIPS. UM THE OTHER
THING IS SUPERVISION. WE NEED TO
UNDERSTAND THAT WITH ALL THE
TURNOVER AS PEOPLE ARE GETTING
RECRUITED HERE AND THERE, AND
EVERYWHERE WE REALLY NEED TO
EMPHASIZE SUPPORTING OUR
MANAGERS AND OUR CLINICAL
OVERSIGHT TEAMS BECAUSE THEY'RE
GOING TO BE REALLY NECESSARY. UM
OUR COUNTY BEHAVIORAL HEALTH
DIRECTORS. I CANNOT TELL YOU.
HOW MANY OF THEM I NEED TO DO A
SURVEY ACTUALLY DO TEACHING JOBS
ON THE SIDE, SO THEY ARE WORKING
IN COLLEGES AND UNIVERSITIES
TRAINING THE NEXT GENERATION OF
CLINICIANS, AND SO HATS UP UP TO
THEM FOR THAT. UM AND THEN, YOU
KNOW, OBVIOUSLY, WITH STAFF
RECRUITMENT AND RETENTION, IT
REALLY DOES COME DOWN TO PAY,
WHICH MEANS WE NEED TO MAKE SURE
THAT THE BASE CORE LEVEL OF
FUNDING FOR THE SAFETY NET IS
SUFFICIENT SO THAT WE CAN BE
COMPETITIVE. AND THEN OVER THE
LONG RUN, DR KAUFMAN REALLY
NEEDS, UM MORE DATA SO THAT WE
CAN ANALYZE AND SS OVER THE WHAT
OUR IMPACT HAS BEEN. THANK YOU.
NEXT WE HAVE KAREN RESOLVED.
DEPUTY DIRECTOR OF HEALTH
WORKFORCE DEVELOPMENT,
HEALTHCARE ACCESS AND
INFORMATION. GOOD EVENING. I'M
CHAIR AMULET. UM PLEASED TO BE
HERE TODAY TO TALK ABOUT SOME OF
THE THINGS THAT H CHI IS DOING
TO ADDRESS THESE BEHAVIORAL
HEALTH WORKFORCE CHALLENGES THAT
WE'VE HEARD TODAY. UM SO I'LL
TALK ABOUT SOME OF THE THINGS
THAT THAT WERE DOING SO OUR
HEALTH WORKFORCE PROGRAMS HAVE
THREE MAIN GOALS AND IT'S REALLY
AROUND. HOW DO WE SERVE
MEDICALLY UNDERSERVED AREAS? HOW
DO WE BUILD A WORKFORCE THAT
REPRESENTS THE CALIFORNIA IT
SERVES? THE RACIAL AND LANGUAGE
DIVERSITY. AND HOW DO WE SERVE
THE MEDICAL POPULATION? SO TO
ACHIEVE THESE GOALS WERE WORKING
ACROSS THE CONTINUUM FROM THE
PIPELINE TO GRADUATE MEDICAL
EDUCATION, SO I WANT TO TALK A
LITTLE BIT ABOUT THE PIPELINE
WORK THAT WE'RE DOING AND
RECOGNIZING THE NEED THAT WE
NEED TO BUILD THE WORKFORCE. SO
WE HAVE SEVERAL PROGRAMS THAT
WERE OPERATING THE HEALTH
PROFESSIONS PATHWAYS PROGRAM AS
I'VE, UM, AS I'VE MENTIONED
PREVIOUSLY IT HAS ESTABLISHED A
MENTORING AND SUPPORT FOR
STUDENTS IN HIGH SCHOOLS AND
COMMUNITY COLLEGES TO HELP THEM
PURSUE HEALTHCARE CAREERS,
INCLUDING INCLUDING BEHAVIORAL
HEALTH CAREERS ARE NEXT
APPLICATION OPENING IN AUGUST,
WILL SUPPORT BUILDING A PIPELINE
FOR SYSTEM AND JUSTICE INVOLVED
YOUTH. RECOGNIZING THE NEED TO
SUPPORT UM, THAT POPULATION WERE
ALSO HAVE A PROGRAM TO SUPPORT
HEALTH CAREERS EXPLORATION,
WHICH IS THOSE HANDS ON
EXPERIENCES TO PROVIDE EXPOSURE
TO, UH TO HEALTHCARE CAREERS ARE
RECENT AWARDS, UH, SUPPORTED
APPROXIMATELY 6000 STUDENTS TO
BE ABLE TO BE EXPOSED TO HEALTH
CARE CAREERS. AND WE'RE ALSO
SUPPORTING A NEW PROGRAM CALLED
THE YOUTH MENTAL HEALTH ACADEMY,
UM, TO BUILD THAT BEHAVIORAL
HEALTH PIPELINE WORKING WITH
HIGH SCHOOLS AND COMMUNITY
COLLEGE STUDENTS OPERATING WITH
A CONTRACT WITH CHILD MIND
INSTITUTE. UM THAT WILL RECRUIT
AND SUPPORT 2500 STUDENTS
THROUGHOUT THE STATE OVER THE
NEXT THREE YEARS. THE NEXT THING
THAT WE'RE DOING IS REALLY
AROUND BUILDING THAT EDUCATION
CAPACITY. HOW ARE WE TRAINING
MORE OF THE PROVIDERS THAT WE
NEED TO SERVE TO SERVE THE
POPULATION THAT WE HAVE? AND SO
A COUPLE OF THINGS THAT WE'VE
DOING OUR PSYCHIATRIC EDUCATION
CAPACITY EXPANSION PROGRAM?
THAT'S BEEN THAT'S WE'VE BEEN
OPERATING FOR A FEW YEARS.
THAT'S UH, PROVIDE SUPPORT TO
NEW AND EXPANDING PSYCHIATRIC
RESIDENCY AS WELL AS
PSYCHIATRIC. MENTAL HEALTH NURSE
PRACTITIONER PROGRAMS. OUR
LATEST AWARD CYCLE, UH, OPERATED
OR AWARDED TO NEW PSYCHIATRY,
RESIDENCY PROGRAMS AND SIX
EXPANDING PROGRAMS, WHICH TRAINS
45 NEW PSYCHIATRY RESIDENTS
ACROSS THE STATE. UM AND WE ALSO
SUPPORTED THREE NEW PSYCHIATRIC
MENTAL HEALTH NURSE PRACTITIONER
PROGRAMS. AND FOR EXPANDING
PROGRAMS THAT SUPPORT THE
TRAINING OF 7 700 NEW
PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONERS. UM OVERALL, WITH
PREVIOUS CYCLES THAT WE'VE
OPERATED. WE'VE BEEN SUPPORTED
THE TRAINING OF ALMOST 1000 NEW
PSYCHIATRIC, MENTAL HEALTH NURSE
PRACTITIONERS AND 80 NEW
PSYCHIATRISTS. WE KNOW THAT WE
NEED MORE, BUT IT'S A START. WE
ALSO RECOGNIZE THE NEED TO BUILD
THE SOCIAL WORK. UM WORKFORCE
AND SO OUR LATEST AWARDS AWARDS
, UM ADDED 835 NEW SOCIAL WORK
STUDENT SLOTS IN CALIFORNIA.
WHICH ESTABLISHED NEW BACHELOR'S
AND MASTER'S LEVEL PROGRAMS, AS
WELL AS BEING ABLE TO SUPPORT
THOSE THAT ARE BUILDING THOSE
ACCELERATED PROGRAMS. TALKING
ABOUT PEER AND PEAR PEAR
PROFESSIONALS. WE OPERATE OUR
PEER PERSONNEL TRAINING IN
PLACEMENT PROGRAM THAT OVER THE
LAST TWO YEARS WILL TRAIN OVER
2800 NUCLEAR PERSONNEL. AND UH,
SINCE 2019 HE WAS SUPPORTED THE
TRAINING OVER 5000 NEW PEER
PERSONNEL SERVING IN OUR PUBLIC
BEHAVIORAL HEALTH SYSTEM. BUT
ALSO NEEDING THE WE RECOGNIZE TO
BE ABLE. HOW DO WE SUPPORT
PRIMARY CARE PROVIDERS IN GIVING
THOSE THAT ADDITIONAL TRAINING
WITH TWO OF OUR PROGRAMS ARE
TRAINING TRAINERS PRIMARY CIRCUS
PRIMARY CARE PSYCHIATRY AS WELL
AS TRAINING AND EDUCATION AND
ADDICTION MEDICINE? A NEW
PROGRAM. BOTH OF THESE RUN OUT
OF UC IRVINE TO REALLY PROVIDE
THAT SUPPORT TO PRIMARY CARE
PROVIDERS. ALSO OUR PROGRAMS ARE
LOOKING AT. HOW DO WE SUPPORT
INDIVIDUALS AND BEING ABLE TO
PURSUE? UH. ENTERING THE HEALTH
WORKFORCE. SO THROUGH OUR OUR
MENTAL HEALTH SERVICES ACT IN
GENERAL FUND DOLLARS WERE
WORKFORCE EDUCATION AND TRAINING
PROGRAM. WE WERE ABLE TO AWARD
40 MILLION TO FIVE WET REGIONAL
COUNTY PARTNERSHIPS THAT ALLOW
THEM TO USE THOSE FUNDS TO BE
ABLE TO RECRUIT AND RETAIN THE
WORKFORCE IN THE PUBLIC
BEHAVIORAL HEALTH SYSTEM. UM WE
ALSO LAUNCHED ARE RECOGNIZING
ALSO TO BUILD THE WORKFORCE AND
THE BEHAVIORAL HEALTH WORK
PUBLIC BEHAVIORAL HEALTH SYSTEM.
AS WE HAD OUR COMMUNITY BASED
ORGANIZATION BEHAVIORAL HEALTH
WORKFORCE GRANT THAT JUST
RECENTLY AWARDED 134
ORGANIZATIONS THAT WILL SUPPORT
OVER 5000 SCHOLARSHIP, BLOOMING
PAYMENTS, STIPENDS AND
RECRUITMENT AND RETENTION
OPPORTUNITIES IN THE IN OUR
COMMUNITY BASED ORGANIZATIONS.
UM WE ALSO ESTABLISHED OUR NEW
STIPEND PROGRAM FOR MASTERS OF
SOCIAL WORK, RECOGNIZING HOW WE
SUPPORTING THEM PURSUING THEIR
THEIR MASTERS AS WELL AS THEIR
ONTO LICENSING TO BE ABLE TO
SUPPORT WITH FELLOWSHIPS, UM, TO
SUPPORT MSW GRADUATES PURSUING
THEIR LICENSER. UM AND AS WAS
MENTIONED THE ON THE JOB
TRAINING IS WE KNOW THAT WE NEED
TO DO MORE OF THAT. AND SO WE
HAVE OUR NEW SUBSTANCE USE
DISORDER, EARN AND LEARN PROGRAM
THAT WE ARE JUST FINISHING UP
AND WE ARE GETTING READY TO MAKE
AWARDS. BUT THAT'S REALLY
SUPPORTING ORGANIZATIONS TO
BUILD THE SUD WORKFORCE WITH
TRAINING NEW STUDENTS AND TO BE
ABLE TO SUPPORT THEM WITH ON THE
JOB AND PAID EXPERIENCE WHILE
THEY'RE PURSUING THAT, UM, AND
SO WE'RE EXCITED ABOUT MAKING
THOSE AWARDS SHORTLY. UM AND
THEN ALSO, WE'RE LAUNCHING TWO
NEW PROGRAMS ARE GOLDEN STATE
SOCIAL OPPORTUNITIES PROGRAM AND
OUR BEHAVIORAL HEALTH
SCHOLARSHIPS PROGRAM THAT WILL
AGAIN SUPPORT SCHOLARSHIPS FOR
BEING FOR STUDENTS PURSUING A
BEHAVIORAL HEALTH DEGREE AND
AGREEING TO SERVE IN UNDERSERVED
AREAS AND THE PUBLIC BEHAVIORAL
HEALTH SYSTEM. SO THAT'S KIND OF
A SUMMARY OF THE OF THE WORK
THAT WE'VE BEEN DOING TO ADDRESS
. SOME OF THESE CHALLENGES
EARLIER HURT. YOU HEARD ABOUT
THE WORK THAT WE'RE DOING,
BUILDING THE WELLNESS COACHES
AND RECOGNIZING THE IMPORTANCE
OF BUILDING THAT WORKFORCE TO BE
ABLE TO ADDRESS SOME OF THE GAPS
BUT ALSO TO BUILD THE DIVERSITY
. WE RECOGNIZE WE THINK THAT'S A
WAY TO REACH IN AND BUILD THAT
DIVERSE. UM BEHAVIORAL HEALTH
WORKFORCE TO SERVE OUR CHILDREN
AND YOUTH. UM. BECAUSE ONE OF
THE GOALS OF THE WELLNESS
COUCHES WAS REALLY TO ESTABLISH
THIS ROLE WITHIN THE BEHAVIOR,
HEALTH FRAMEWORK AND CREATE A
PATHWAY. WE WANT TO CLEAN
RECOGNIZED THAT THERE ARE PEER
PROFESSIONALS AND COMMUNITY
HEALTH WORKERS AND OTHER MASTERS
LEVELS. WE WANT THIS WELLNESS
COACH TO BE A DESIRABLE UM,
OCCUPATION FOR FOLKS WITH AN A
DEGREE AND THEN CAN SET THE
FOUNDATION FOR A BACHELOR'S
DEGREE AND THEN COULD HELP THEM
AND SUPPORT THEM MOVING TO A
MASTER'S LEVELS LATER. FINALLY I
JUST WANTED TO SHARE ALSO THE
RECOGNIZING THAT WE HAVE OUR
CALIFORNIA HEALTH WORKFORCE
EDUCATION AND TRAINING COUNCIL,
WHICH IS REALLY LOOKING
ESTABLISHED IN IN LAST YEAR.
EIGHT THE 18 MEMBERS OF THIS
PUBLIC BODY REPRESENT THE
COMMUNITY COLLEGE, THE CSU, THE
UC SYSTEM. SEVERAL STATE
DEPARTMENTS AND LEADERS IN OUR
IN BEHAVIORAL HEALTH, PRIMARY
CARE OR HEALTH AND NURSING. AND
ONE OF THE THINGS THAT THE
COUNCIL HAS BEEN DOING IS
LOOKING AT BEHAVIORAL HEALTH
WORKFORCE AND WHAT ARE THE
THINGS THAT THEY CAN BE THINKING
ABOUT? AND PRIORITIZING FOR THE
STATE TO ADDRESS SOME OF OUR
BEHAVIORAL HEALTH, WORKFORCE,
EDUCATION AND TRAINING NEEDS,
AND SO THEY DEVELOPED A SET OF
PRIORITIES AND RECOMMENDATIONS
FOR US TO PURSUE? UM AND MANY OF
THESE ARE THINGS WE'VE BEEN
TALKING ABOUT TODAY THAT
SUPPORTING SCHOLARSHIPS AND
STIPENDS. TO BE ABLE TO SUPPORT
AN INCREASE IN ACCELERATED
PROGRAMS AND HOW WE CAN CONTINUE
TO SUPPORT THEM JUST TO SUPPORT
THE SUPERVISION OF BEHAVIORAL
TRAINING TRAINEES AND COMMUNITY
HEALTH SETTINGS. RECOGNIZING
THAT THAT'S A PRIORITY FOR US AS
WELL TO EXPAND LOAN REPAYMENT
PROGRAMS TO INCLUDE FACULTY. ONE
OF THE THINGS WE KNOW IS THAT WE
NEED TO BE ABLE TO HAVE MORE
FACULTY TO BE ABLE TO TRAIN MORE
PROVIDERS. SO HOW CAN WE INCENT
THAT UM AND THEN ALSO JUST HOW
DO WE BUILD AGAIN THE EDUCATION
CAPACITY TO BE ABLE TO SERVE IN
OUR UNDERSERVED COMMUNITIES AND
TO STREAMLINE THOSE EDUCATIONAL
PATHWAYS, INCLUDING, INCLUDING
LOOKING AT CURRICULUM MODELS
CREDIT FOR PRIOR LEARNING. HOW
DO WE HELP PEOPLE? UH, ENTER THE
WORKFORCE. I MENTIONED ALSO THE
DATA WITH OUR HEALTH WORKFORCE
RESEARCH DATA CENTER AND AS
WE'RE CONTINUING TO DEVELOP AND
GATHER UM, INFORMATION AROUND
WHO THE BEHAVIORAL HEALTH
WORKFORCE IS WHAT WHERE THEY ARE
AND WHERE THE GAPS ARE. UM SO
ALL TOLD, WE ESTIMATE ABOUT
25,000 ADDITIONAL BEHAVIORAL
HEALTH PROFESSIONALS WILL BE
SUPPORTED BY OUR TRAINING. UM
AND 16,000 YOUNG PEOPLE HAVE THE
OPPORTUNITY TO SUPPORT, UM, TO
BE ABLE TO EXPLORE CAREERS IN
BEHAVIORAL HEALTH. UM SO WE
REMAIN FOCUSED ON OUR GOALS TO
BUILD THE WORKFORCE OF
CALIFORNIA NEEDS. UM AND HAPPY
TO PROVIDE ANY MORE DETAILS
ABOUT ANY OF OUR PROGRAMS OR
ANSWER ANY QUESTIONS. DEPARTMENT
OF FINANCE. JOSEPH DAWSON
DEPARTMENT OF FINANCE AND
ADDITIONAL COMMENTS BUT HAVE TO
ANSWER ANY QUESTIONS. THANK YOU,
LEO. JASON KANSEN TRIO CELIO
ALSO AVAILABLE FOR QUESTIONS.
THANK YOU, UM. I'M GOING TO
BRING IT UP TO THE DIESS. I HAVE
QUESTIONS. I THINK I'M GOING TO,
UM HOLD UNTIL OUR NEXT ISSUE ON
THE PROPOSED FUNDING DELAY AS I
BELIEVE IT WILL TIE IN, AND
WE'LL USE MANY OF THE COMMENTS
HERE. WITH THAT I EXCEPT YOU'RE
NOT ON THE PANEL NEXT, SO I'M
GONNA. I WAS REALLY DRAWN
TOWARDS MISS KAUFFMAN'S COMMENTS
THAT THIS MAY THWART OUR ABILITY
TO IMPLEMENT OUR INITIATIVES
INSIDE LIKE TO ASK BHD A IF WE
POTENTIALLY DELAY FUNDING FOR
BEHAVIORAL HEALTH INVESTMENTS.
WILL THIS WORK? OR ABILITY. HI
MICHELLE CABRERA WAS C B H D. A.
I WOULD ARGUE THAT WE HAVE BEEN
THWARTED. THIS IS NOT GOING TO
THIS IS A HAS HAPPENED. WE ARE
LIVING IT. WE ARE EXPERIENCING
IT IN REAL TIME. WE UM PUT I
THINK THIS REPORT OUT WHICH
SHOWS SIGNIFICANT GAPS AND WE
ARE WILLING TO SHARE THE GAPS.
AH UNDERSTANDING THAT YOU KNOW,
IT'S A LITTLE BIT OF A RISK TO
SAY WE'VE GOT WE? WE DON'T HAVE
ENOUGH STAFF FOR OUR PROGRAMS,
AND THIS HASN'T SIGNIFICANT
RIPPLE EFFECT RIGHT? IT'S ACCESS
ISSUES, BUT IT'S ALSO, UM
FUNDING FOR THE SYSTEM, BECAUSE
IF I DON'T HAVE ENOUGH
CLINICIANS TO BILL INSURANCE FOR
SERVICES, GUESS WHAT WE LEAVE
FEDERAL DOLLARS ON THE TABLE
EVERY SINGLE DAY. PEOPLE DON'T
GET SERVED. AND AS I MENTIONED
EARLIER IN THE DAY, UM PEOPLE
ARE VERY FRUSTRATED AND THEY
DON'T UNDERSTAND. WHY CAN'T WE
GET MORE? WHY ISN'T THE SYSTEM
MOVING? WHY CAN'T I FIND THE
SPECIALIST THAT MY CHILD NEEDS?
WHY DON'T THEY SPEAK THE
LANGUAGE THAT I NEED THEM TO
SPEAK, ETCETERA, ETCETERA. AND
SO WE WOULD ARGUE THAT IF WE
REALLY WANT TO LIVE INTO THE ALL
OF THE VALUES THAT WE'VE BEEN
TALKING ABOUT OVER THE LAST
SEVERAL YEARS WITH RESPECT TO BE
HERO HEALTH, WE NEED TO PUT OUR
MONEY WHERE OUR MOUTH IS. WE
NEED TO INVEST IN THE HUMAN
BEINGS WHO ARE GOING TO BE
NECESSARY TO CARRY FORWARD ALL
OF THESE INITIATIVES, AND I'LL
JUST SAY ONE MORE THING.
WORKFORCE CHALLENGES ARE TOTALLY
SOLVABLE. THESE ARE NOT LIKE
INTRACTABLE PROBLEMS FOR US FROM
A PUBLIC POLICY STANDPOINT,
WHICH SHOULD GIVE US A LOT OF
HOPE, RIGHT? WE PUT THE MONEY IN
THE SCHOOLS. WE PUT THE MONEY IN
THE STIPENDS WE GIVE. WE
PROMISED THESE STUDENTS A WELL
PAID JOB ON THE OTHER SIDE.
THAT'S THE SECRET SAUCE RIGHT
THERE. WE WILL TURN THIS AROUND.
AND IT'LL BE A LITTLE BIT LATE
FOR THE PEOPLE THAT ARE THERE
NOW, BUT I PROMISE YOU IF WE
DON'T DO THIS, WE'RE GONNA BREAK
SOMETHING THAT'S ALREADY PRETTY
FRAGILE, FRAGILE TO BEGIN WITH.
DR CLARK HARVEY, IF I CAN WE
ALSO HEARD FROM DR KAUFMAN THAT
THIS IS NOT THE TIME TO TAKE OUR
FOOT OFF THE GAS, HOPING YOU CAN
COMMENT. WE HEARD ABOUT ALL THE
GREAT WORK THAT WE ARE DOING
SURE, BUT IS THIS THE TIME FOR
US TO BE DELAYING FUNDING
TOWARDS WORKFORCE WOULD LOVE
YOUR COMMENTS? IS THAT A
RHETORICAL QUESTION? UM NO, IT'S
NOT DEFINITELY NOT. I MEAN, LIKE
I SAID, IT'S BEEN THE NUMBER ONE
ISSUE FOR OUR PROVIDERS AND
THERE IN THE TRENCHES DOING THE
WORK. UM AND THEY'LL DO WHATEVER
IT TAKES. THAT'S WHAT THEY'VE
DONE FOR YEARS FOR DECADES, BUT
THEY CAN'T AFFORD TO DO SO ANY
LONGER AND WE CAN'T TALK CAN'T
SPEAK OUT OF BOTH SIDES OF OUR
MOUTH AND SAY THAT WE'RE
INVESTED AND WE HAVE ALL THESE
STUDIES IN THIS DATA. THAT'S
EVIDENCING THIS NEED AND AT THE
SAME TIME, TAKE MONEY AWAY OR
DIVERT IT FOR OTHER REASONS, SO
MOST DEFINITELY NOT TO BELIEVE,
OR THE POINT THAT DR LINDHOLM
EARLIER YOU SAID THAT THERE'S
10. OF THOSE WITH EARLY
PSYCHOSIS WHO ARE GETTING
TREATMENT. DO YOU THINK THIS IS
THE TIME TO TAKE OUR FOOT OFF
THE GAS AND INVESTMENTS IN THE
WORKFORCE WITH THAT MUCH NEED
AND NO, CERTAINLY CERTAINLY NOT.
AND I CAN SAY IS I'M WORKING
WITH THE COUNTIES WHO WAS TRYING
TO START THESE PROGRAMS.
WORKFORCE IS THEIR BIGGEST ISSUE
AND DELAY IMPLEMENTATION EVERY
SINGLE TIME, SO I WOULD I WOULD
AGREE WHOLEHEARTEDLY. THIS IS
ONE OF THE MOST IMPORTANT THINGS
WE NEED TO THINK ABOUT RIGHT
NOW. FOR MISS ROSELLE. IF I CAN
JUST REAL QUICKLY, THERE WAS A
YOUTH MENTAL HEALTH INSTITUTE.
NEITHER OF US HAD HEARD OF THAT.
SO WE LOVE SOME INFORMATION
ABOUT FUNDING STREAMS OFFLINE
AND DOESN'T HAVE TO BE HERE
TODAY, BUT YOU ALSO MENTIONED
THE WET COUNCIL AND THERE WAS
GIVING YOU RECOMMEND STATIONS. I
WONDER IF WE WENT TO THE WET
COUNCIL AND ASKED THEIR OPINION
ON THE DECREASED FUNDING THAT'S
BEING PROPOSED AND WHAT THEIR
OPINION OF THAT WOULD BE. UM.
GOOD QUESTION. UM, I KNOW WELL.
I KNOW THAT THEY ARE ABSOLUTELY
IN SUPPORT OF THE WORK THAT WE
HAVE BEEN DOING. I WILL LEAVE IT
THERE AND THANKS VERY MUCH THIS
PANEL AND WE'LL MOVE ON TO ISSUE
16. ISSUE 16 IS ON THE PROPOSED
FUNDING THE WAYS FOR BEHAVIORAL
HEALTH WORKFORCE PROGRAMS.
JOSEPH DONALDSON AND MATTHEW
AGUILERA, WITH THE DEPARTMENT OF
FINANCE WILL BEGIN. ALL RIGHT.
GOOD EVENING. HONORABLE CHAIR.
JOSEPH DONALDSON DEPARTMENT
FINANCE. I'LL BE PRESENTED ON
THIS TOPIC. SO DUE TO DECLINING
STATE REVENUES, THE BUDGET
PROPOSES DELAYING 68 MILLION IN
CURRENT YEAR AND 329.4 MILLION
IN BUDGET YEAR FOR VARIOUS
HEALTH CARE WORKFORCE PROGRAMS
INCLUDED IN THE 2022 BUDGET
UNDER EACH KAIZEN MINISTRATIONS
, INCLUDING THESE DELAYS ARE
CERTAIN BEHAVIORAL HEALTH
WORKFORCE INVESTMENTS. THESE
INCLUDE THE ADDICTION,
PSYCHIATRY AND MEDICINE GRADUATE
FELLOWSHIP PROGRAMS. UNIVERSITY
GRANTS FOR BEHAVIORAL HEALTH
PROFESSIONALS AND EXPANDING MSW
SLOTS AT PUBLIC UNIVERSITIES.
WHILE THE BUDGET DOES PROPOSE
THE WHILE THE BUDGET PROPOSES
THESE DELAYS ADMINISTRATION IS
STILL VERY MUCH COMMITTED TO
INCREASING THE CAPACITY OF OUR
STATES HEALTHCARE WORKFORCE,
THESE PROGRAMS WILL REMAIN FULLY
FUNDED, BUT THE FUNDS WOULD JUST
GO OUT LATER THAN ORIGINALLY
PLANNED TO THE REPAYMENTS. FOR
THESE DELAYS WOULD GO OUT IN 24
25 25 26 THE AMOUNT OF 198.7
MILLION IN EACH OF THOSE
SPECIFIED YEARS AND THEN IN
CONCLUSION, WE ACKNOWLEDGE THAT
THESE ARE DIFFICULT DECISIONS TO
CONSIDER. HOWEVER THE
ADMINISTRATION BELIEVES THE
THESE ARE NECESSARY ACTIONS TO
ADDRESS BOTH THE CURRENT REVENUE
SHORTFALL WILL ALSO MAINTAIN OUR
COMMITMENT TO OUR STATES
HEALTHCARE WORKFORCE. HAPPY TO
ANSWER ANY QUESTIONS YOU MAY
HAVE. NEXT. WE HAVE MICHELLE
CABRERA WITH BHD. A. THANK YOU
AS WE'VE BEEN DISCUSSING THE
CUMULATIVE IMPACT OF THESE
DELAYS. IT'S REALLY THAT WE WILL
NOT HAVE STARTED ON WHAT WE NEED
TO DO TO CATCH UP TO THE CURRENT
CATASTROPHE. AND SO OUR REQUEST
IS FOR THE LEGISLATURE TO REJECT
THE PROPOSAL ON THE DELAYS
BECAUSE IT WILL TAKE YEARS TO
BUILD OUT THE WORKFORCE. THIS IS
A PROBLEM THAT IS STARING US IN
THE FACE RIGHT NOW. UM WE ALSO
JUST WANT TO HIGHLIGHT THAT, TO
THE EXTENT THAT NOT ONLY, UM,
MEDICAL PLANS, BUT ALSO PRIVATE
PLANS FAILED TO MEET TIMELY
ACCESS STANDARDS, NETWORK
ADEQUACY STANDARDS AND OTHERS WE
CAN BE HELD LIABLE FOR FAILURE
TO MEET THOSE, UM, REQUIREMENTS
AND WE THINK IT'S REALLY
IMPORTANT FOR US TO BE ABLE TO
BE COMPETITIVE IN THE FIRST
PLACE, OR THE STATE OUGHT TO
RECONSIDER ITS POLICIES AROUND.
NETWORK ADEQUACY UNDERSTANDING
THAT THERE NEEDS TO BE IN
AVAILABLE SUPPLY OF PROVIDERS
THAT WE COULD EVEN TRY TO BRING
INTO OUR NETWORKS TO BEGIN WITH.
AND SO WE WOULD REQUEST THAT THE
LEGISLATURE REJECT THIS PROPOSAL
AND MOVE FORWARD WITH THIS
FUNDING. HELLO. JASON KANSEN
TOURO, CELIO. ARE WE DISCUSSED
OUR ANALYSIS ON THE PROPOSED
WORK FORCE DELAYS IN A PREVIOUS
HEARING TO THIS COMMITTEE, AND
IN THAT ANALYSIS, WE NOTED THAT
THE GOVERNOR'S OVERALL FOCUS ON
BUDGET SOLUTIONS WAS PRUDENT
GIVEN THE STATE'S BUDGET
SITUATION BUT ALSO NOTED A FEW
DIFFERENT OPTIONS FOR THE
LEGISLATURE TO CONSIDER WITH
REGARD TO THE PROPOSED WORKFORCE
SOLUTIONS. THAT ANALYSIS EXTENDS
TO THE BEHAVIORAL HEALTH
WORKFORCE INITIATIVES THAT
YOU'RE HEARING TODAY AND GIVEN
TODAY'S PACKED AGENDA, WE
THOUGHT IT WOULD MAKE SENSE TO
JUST DEFER TO THE Q AND A. IF
THERE ARE SPECIFIC OR ADDITIONAL
QUESTIONS ABOUT OUR ANALYSIS,
AND HOW THAT RELATES TO
BEHAVIORAL HEALTH. I DID WANT TO
POINT JUST IN CASE IT'S HELPFUL
FOR THE FOR THE COMMITTEE THAT
THERE ARE TWO TABLES HERE THAT
ARE COULD BE OF HELP. UM ON PAGE
99, YOU CAN SEE THE FALL. UH
PACKAGE OF WORKFORCE INITIATIVES
, INCLUDING THE BEHAVIORAL
HEALTH INITIATIVES KIND OF IN
THE MIDDLE OF THAT TABLE. AND
THEN ON PAGE 97. YOU CAN SEE
THEIR PROPOSED, UM, DELAYS AGAIN
THERE. IT INCLUDES ALL OF THE
INITIATIVES, BUT THERE YOU'LL
SEE THE SUBSET THAT'S RELATED TO
BEHAVIORAL HEALTH. AND AGAIN
JUST WANTED TO EMPHASIZE THAT
THE DELAYS AFFECT A PORTION OF
THE BEHAVIORAL HEALTH
INITIATIVES. BUT THERE ARE SOME
BEHAVIORAL INITIATIVES HEALTH
INITIATIVES THAT WOULD NOT BE
IMPACTED BY THE DELAYS AGAIN
AVAILABLE FOR QUESTIONS OR FOR
QUESTIONS. UM. I'LL BEGIN JUST
BY NOTICING THAT THERE ARE
GEOGRAPHICAL DISPARITIES OVER
LAID IN THE BEHAVIORAL HEALTH
WORKFORCE, AND THAT EXACERBATES
FOR MANY OF OUR REGIONS THAT ARE
ALREADY BEHIND. AND LEAVE THAT
AS A, UM, INDICATION OF WHERE I
INTEND TO LEAD US TOWARDS BUT
LOOK FORWARD TO THE
CONVERSATIONS WITH THE
LEGISLATURE AND APPRECIATE VERY
MUCH THIS PANEL. WE WILL MOVE ON
TO ISSUE 17. ISSUE 17 IS ON THE
PSYCHIATRY, WORKFORCE, PIPELINE
RECRUITMENT, HIRING AND
RETENTION BUDGET CHANGE
PROPOSAL. WE WILL BEGIN WITH
BRENT HAUSER WITH TSH. GOOD
EVENING AGAIN. CHAIR BRENT
HAUSER. DEPARTMENT OF STATE
HOSPITALS, ALSO ACCOMPANIED BY
DEPARTMENT, STATE HOSPITALS,
MEDICAL DIRECTOR DR KATHRYN
WARBURTON. FOR THIS PARTICULAR
PROPOSAL AND ISSUE NUMBER 17.
THE DEPARTMENT REQUESTS A TOTAL
OF SEVEN POSITIONS IN 23 24
ONGOING GENERAL FUND OF 6.5
MILLION IN 23 24, INCREASING TO
8.3 MILLION GENERAL FUND IN 2027
28, ONGOING FOR THE DEVELOPMENT
AND IMPLEMENTATION OF PIPELINE
RECRUITMENT AND RETENTION IF SHE
GIVES TO SUSTAIN AND GROW DSHS
PSYCHIATRY WORKFORCE.
SPECIFICALLY THIS PROPOSAL
FOCUSES ON IMPLEMENTING A FOUR
PRONGED APPROACH TO SOLVING THE
RECRUITMENT RETENTION CHALLENGES
OF PSYCHIATRISTS IN THE
DEPARTMENT OF STATE HOSPITAL
SYSTEM FIRST DEVELOPING A NEW
RESIDENCY PROGRAM MODELED AFTER
D S H. NAPA'S EXPERIENCES BUT IN
A DIFFERENT HOSPITAL IN SOUTHERN
CALIFORNIA, TSH PATTON THIS
PROGRAM WILL INCLUDE COHORTS OF
UP TO FOUR RESIDENTS PER YEAR
AND ONCE FULLY FUNDED, MAY HAVE
UP TO 20 RESIDENTS. THE SECOND
APPROACH IS ADDING FUNDING FOR
PSYCHIATRIC FELLAS THAT
FELLOWSHIPS ACROSS THE FIVE
STATE HOSPITALS IN THE SYSTEM,
WHICH COVERS NORTHERN CALIFORNIA
, CENTRAL CALIFORNIA AND
SOUTHERN CALIFORNIA. THE THIRD
APPROACH IS ADDING FUNDING FOR
RESIDENCY ROTATIONS ACROSS THE
FIVE STATE HOSPITALS. THE
RESIDENTS AND FELLOWS WILL
PROVIDE A PERCENTAGE OF THEIR
TIME PROVIDING DIRECT PATIENT
CARE AND THE ULTIMATE OUTCOME
GOAL BEING THAT THE CHINESE
ULTIMATELY APPLY AND ARE HIRED
AS DSHS PSYCHIATRIST OR EXISTING
RESEARCH, RESEARCH AND
EXPERIENCES REFLECT THAT
PROVIDERS HAVE A HIGHER
LIKELIHOOD OF STAYING WHERE
THEY'RE TRAINED. THE FOURTH
COMPONENT OF THIS PROPOSAL IS
DEVELOPING AN OFFICE OF
CONTINUING MEDICAL EDUCATION AND
MEDICAL ADVANCEMENT WITHIN OUR
CLINICAL OPERATIONS DIVISION TO
FURTHER DEVELOP DSHS, EXISTING
EDUCATION AND ACADEMIC EFFORTS
TO PROMOTE BEST PRACTICES
ENGAGED IN RESEARCH AND
KNOWLEDGE SHARING AMONGST TSH
PSYCHIATRIST, WHICH WILL RESULT
IN INCREASED COLLABORATION AND
MORALE AMONGST ARE CURRENTLY
SHH. PSYCHIATRIST. AT THIS TIME.
I'M HAPPY TO TAKE ANY QUESTIONS
THE COMMITTEE MAY HAVE THE NEXT
WE HAVE DR WARBURTON. IF YOU
HAVE ANY COMMENTS NO, THANK YOU
. NEXT WE HAVE DEPARTMENT OF
FINANCE DEPARTMENT FINANCE NINA
HONG, NOTHING FURTHER TO ADD
HAPPY TO ANSWER ANY QUESTIONS.
WILL OWEN ZELENA. WE HAVE NO
CONCERNS WITH THIS PROPOSAL. THE
ONLY QUESTION I'LL BRING IT UP
TO THE DIAGNOSIS. THE ONLY
COMMENT I REALLY HAVE IS ON PAGE
ONE OF TWO. THE SECOND PARAGRAPH
STATES THAT THE CALIFORNIA
FUTURE HEALTH WORKFORCE
COMMISSION ESTIMATED THAT WE
NEED TO TRAIN 527 ADDITIONAL
FIRST YEAR PSYCHIATRY. RESIDENTS
PER YEAR. TO ALLEVIATE THE
SHORTAGE OF PSYCHIATRISTS THAT
WE HAVE TO PUT IT INTO CONTEXT.
WE'RE CURRENTLY TRAINING 198.
AND IT SOUNDED LIKE WE'RE
INCREASING. FOUR. AND ARE WE
MAKING SIGNIFICANT INROADS INTO
THE SCOPE OF THE PROBLEM THAT WE
HAVE BEFORE US? VERY
APPRECIATIVE OF THE PROPOSAL AND
UNDERSTAND WE'RE FOCUSED ON
STATE HOSPITALS HERE, BUT SIMPLY
WANTED TO MAKE THE COMMENT ABOUT
THE TOTAL SCOPE OF THE ISSUE
THAT WE'RE FACING. WITH THAT I
WILL. THANKS VERY MUCH. THIS
PANEL WE WILL MOVE ON THE ISSUE.
80. ISSUE 18 IS AN OVERSIGHT
ISSUE ON BEHAVIORAL HEALTH
ISSUES IN MANAGED CARE. OUR
FIRST SPEAKER IS RICHER, RACHEL
HEARTS APPEAR ADVOCATE HAUTE.
EXCUSE ME, YOUR ADVOCATE. SORRY.
WHAT'S UP? HI. UM. I HOPE YOU'RE
BOTH DOING WELL TODAY. I KNOW I
AM TODAY IS A VERY IMPORTANT DAY
BECAUSE I GET TO TALK TO YOU. SO
I'M SORRY. APPARENTLY MOVING,
LIKE EXHAUSTED ME. SO LET ME
CATCH MY BREATH FOR A SECOND. AH
SO IT IS MY INTENTION TO EXPLAIN
EXACTLY WHY COMMERCIAL MANAGED
CARE SHOULD COVER MORE SERVICES
FOR THOSE SUFFERING FROM MENTAL
DISTRESS. I'M ALSO HERE TODAY TO
THANK YOU BOTH FOR TAKING THE
TIME TO NOT JUST LISTEN TO MY
STORY, BUT TO CONSIDER MY WORDS.
UM SO AS A CHILD, I
WHOLEHEARTEDLY BELIEVED THAT I
WOULD NEVER MAKE IT TO 30. AND
THIS SUMMER I WILL CELEBRATE MY
31ST BIRTHDAY. THANKS TO THE
CARE MY FAMILY STUMBLED UPON
THAT WAS NOT COVERED BY THEIR
INSURANCE, BUT THAT I WAS ABLE
TO RECEIVE DESPITE THIS UM MY
NAME IS RACHEL HOSTS AND I MUST
SURVIVOR. SO I'M ASKING YOU
TODAY TO HEAR ME AS A LIVING,
BREATHING AND THRIVING
INDIVIDUAL WHO HAS GIVEN A
CHANCE AT LIFE. UM I HAVE NO
EXPECTATIONS THAT MY WORDS WILL
CONVINCE YOU OF HOW IMPORTANT IT
IS TO HAVE ACCESS TO ALL MENTAL
HEALTH SERVICES FOR THOSE WITH
COMMERCIAL INSURANCE BECAUSE I'M
ONLY ONE PERSON. BUT I WAS GIVEN
THE CHANCE TO SPEAK TODAY AND I
CAN ONLY HOPE THAT MY SPEAKING
ON THIS ISSUE WILL ECHO BEYOND
MYSELF. SO IT WASN'T UNTIL THE
EARLY YEARS OF HIGH SCHOOL IN MY
LIFE TOOK A TURN FOR THE WORSE.
I JUST STARTED HIGH SCHOOL. FROM
MY PERSPECTIVE. I WAS JUST A
YOUNG TEENAGER TRYING TO SURVIVE
IN A BUSY WORLD WITH BUSY PEOPLE
WITH BUSY SCHEDULES. I WENT FROM
A STRAIGHT A STUDENT IN 7TH AND
8TH GRADE TO A GIRL STRUGGLING
TO COMPLETE ANYTHING. MY
PERCEPTION OF MYSELF THEN WAS
THAT WHATEVER I TOUCHED WOULD
FAIL. UM I WAS FOCUSING LESS ON
MY STUDIES AND MORE ON THE
SUFFOCATING DEPRESSION THAT
ALMOST DROWNED ME. BUT I DIDN'T
WANT TO GO BACK TO HOW THINGS
WERE IN MIDDLE SCHOOL BECAUSE
EVEN THEN, THE PRESSURE OF
TRYING TO ACE EVERY SUBJECT
TURNED INTO A CRY JUST TO BE
NOTICED, WHICH MORPHED INTO OVER
A YEAR OF SELF HARM AND SUICIDAL
IDEATIONS. I DIDN'T KNOW. WHAT
MY PARENTS ARE TEACHERS
PERSPECTIVES WORTH ME AT THE
TIME, BUT I DO KNOW THAT I WAS
INVOLUNTARILY ON A DESTRUCTIVE
PATH THAT THAT FELT IMPOSSIBLE
TO TURN AWAY FROM MONTHS PASSED
YEARS PASSED AND I FELT LIKE
THERE WAS NO SAFE SPACE IN THIS
WORLD FOR ME. VIOLENTLY LASHED
OUT AT MY PARENTS THROW AND
BREAK THINGS. I'D CALL MY OWN
FAMILY EVERY NAME IN THE BOOK.
UM TALKING THINGS OUT WAS NEVER
AN OPTION. I PREFERRED
SCREAMING, BUT MY VOICE WAS LOST
IN THE CHAOS. WHO I WAS BECAME
BLURRY AND WHAT I FELT BECAME
NUMBNESS. MY MENTAL STATE
AFFECTED MORE THAN JUST ME, BUT
I WAS TOO FAR GONE TO SEE THAT
THERE WAS A RIFT IN MY FAMILY
AND IN MY RELATIONSHIPS APART
FROM HOME. UM AT SOME POINT, MY
PARENTS CAME ACROSS A PROGRAM AT
THE U. C. DAVIS BEHAVIORAL
HEALTH CENTER. I DIDN'T KNOW
WHAT IT WAS THEN, BUT I KNOW NOW
THAT IT WAS A COORDINATED
SPECIALTY CARE PROGRAM TO TREAT
YOUNG PEOPLE WITH PSYCHOSIS. I
STILL CAN'T REMEMBER HOW
FREQUENTLY WE MET UP OR WHAT WE
TALKED ABOUT. BUT TO MY PARENTS,
THIS PROGRAM WAS A BEACON OF
LIGHT. BUT MY LACK OF TRUST AND
GROWING PARANOIA LED ME TO FEEL
LIKE EVERY PERSON IN MY LIFE WAS
TRYING TO CHANGE WHO I WAS LIKE.
I WASN'T GOOD ENOUGH. I HONESTLY
DON'T KNOW HOW I WAS ABLE TO
PARTICIPATE IN THIS PROGRAM.
MAYBE THE COORDINATORS WERE
MOVED BY MY FAMILY STRUGGLE. BUT
SOMEHOW I GOT IN. AND I KNOW NOW
THAT IF I HADN'T BEEN LET IN BY
THESE PEOPLE, I WOULD NOT BE
HERE TODAY. MY PARENTS HAVE
ALWAYS BEEN HARD WORKING. THEY
BOTH HAD FULL TIME JOBS WITH
GREAT BENEFITS. BUT THOSE
BENEFITS DID NOT INCLUDE THE
SPECIFIC MENTAL HEALTH SERVICES
THAT I SO DESPERATELY NEEDED. UH
THEY BOTH FOUGHT FOR ME AND I
HAVE BEEN SO FORTUNATE AND LUCKY
TO NOT ONLY HAVE BEEN A
PARTICIPANT OF THIS PROGRAM, BUT
THE MANY OTHER PROGRAMS THAT
FOLLOWED I MAY JUST BE ONE VOICE
TODAY, BUT I WANT YOU ALL TO
KNOW THAT IF COMMERCIAL MANAGED
CARE CAN COVER ADULTS LIKE ME,
OR LIKE CHILDREN LIKE I WAS,
THERE WILL BE MORE THAN JUST MY
VOICE HERE FIGHTING FOR A BETTER
FUTURE. AND LASTLY, I WANT TO
ADDRESS THE PEOPLE WHO ARE
SUFFERING LIKE I DID. UM IN
NOVEMBER, 2009, THE PSYCHIATRIST
I WAS SEEING GAVE ME A DIAGNOSIS
. SO HE SAID THAT I HAD A SEVERE
PSYCHIATRIC CONDITION CALLED
BIPOLAR ONE MOST RECENT EPISODE
MIXED WITH DEPRESSION AND MANIA
, AS WELL AS PSYCHOSIS,
PARANOIA, AND I KNOW THAT'S A
MOUTHFUL. UM AS YOU CAN IMAGINE
THIS FELT LIKE A HUGE OBSTACLE
IN THE WAY OF THE LIFE I WANTED.
AT THE TIME. HE ALSO SAID THAT
IN HIS CLINICAL OPINION, I WOULD
NOT BE ABLE TO HOLD A JOB OR
EVEN HANDLE MY MONEY BECAUSE OF
THE SEVERITY OF MY CONDITION.
BUT IT WAS WITH HIS SUPPORT AS
WELL AS THE SUPPORT OF EVERY
PERSON IN THE PROGRAMS. I
PARTICIPATED IN THROUGH UC DAVIS
THAT LED ME TO WHERE I AM NOW. I
CAN WORK. I CAN MANAGE MY OWN
MONEY AND MY FUTURE FINALLY
LOOKS BRIGHT. AH BUT I OFTEN
THINK BACK TO THIS DIAGNOSIS
LETTER AND I WONDER WHAT LIFE
WOULD HAVE BEEN, LIKE HAD I NOT
RECEIVED THE CARE THAT I DID. SO
PLEASE CONSIDER MY WORDS AND
HELP THOSE WHO FEEL HOPELESS
LIKE I DID, BECAUSE OUR LIVES
HAVE THE POSSIBILITY TO NOT BE
CONFINED WITHIN THE BORDERS OF
OUR DIAGNOSIS. THANK YOU. THANK
YOU, RACHEL. NEXT WE HAVE BONNIE
HEARTS, FAMILY ADVOCATE. GOOD
EVENING WHEN ASKED IF I WOULD
SPEAK TO THIS COMMITTEE TODAY
ABOUT MY FAMILY'S SEARCH FOR
HELP IN THE EARLY STAGES OF OUR
DAUGHTER'S MENTAL ILLNESS, I HAD
TO SAY YES. IT IS IMPORTANT TO
KNOW THE IMPACT OF YOUR
DECISIONS ON REAL PEOPLE LIKE
RACHEL AND MYSELF. AND IN THIS
CASE WHERE EARLY INTERVENTION
FOR PSYCHOSIS WAS AND IS STILL
NOT AVAILABLE TO FAMILIES WITH
COMMERCIAL HEALTH INSURANCE. THE
IMPACT CAN BE DEVASTATING, SO I
REALLY APPRECIATE THIS
OPPORTUNITY TO SHARE MY FAMILY
STORY. AS STATE EMPLOYEES. MY
HUSBAND AND I HAD WHAT WE
THOUGHT WERE EXCELLENT HEALTH
BENEFITS. WE NEVER DREAMED THAT
THE LIFESAVING TREATMENT OUR
DAUGHTER WOULD NEED WAS NOT
COVERED. AS YOU HEARD FROM
RACHEL. SHE WAS 14 AND HAD JUST
STARTED HIGH SCHOOL. AND FROM
OUR PERSPECTIVE, SHE HAD ALL HER
DUCKS IN A ROW. SHE WAS A FOUR
POINT OH, SCHOLAR. SHE DIDN'T
MENTION BUT SHE WAS AN AWARD
WINNING MUSICIANS. SHE PLAYED
THE FLUTE AND VERY TALENTED
VOLLEYBALL PLAYER WITH A WICKED
SERVE. WITHIN MONTHS. HOWEVER,
ALL THAT CHANGED, AS DID RACHEL
HERSELF. ONCE LOVING, HIGH,
ACHIEVING AND FOCUSED. SHE
BECAME WITHDRAWN, DISORGANIZED
AND AGGRESSIVE. SHE ABANDONED
ALL HER EXTRACURRICULAR
INTERESTS AND THEN HER
SCHOOLWORK STARTED TO SUFFER.
ONCE AN AVID READER, SHE
STRUGGLED TO GET THROUGH
ASSIGNMENTS. AND HAD TROUBLE
FOLLOWING LECTURES. IS QUICKLY
SLID INTO SEAS AND THEN DS AND
FS. ALARMED MY HUSBAND AND I MET
WITH RACHEL'S TEACHERS, AS
PARENTS WOULD DO, AND THE SCHOOL
COUNSELOR THROUGH OUR EMPLOYER
HEALTH PLAN. WE HAD HER
EVALUATED BY HER PEDIATRICIAN.
AS WELL AS A PSYCHIATRIST, AND
WE ALSO ENGAGED MULTIPLE
THERAPISTS, ALL TO NO AVAIL. WE
WATCHED HELPLESSLY AS RACHEL
SLIPPED FURTHER AND FURTHER AWAY
FROM US ULTIMATELY FOLLOWING
FALL INTO THAT DARK PLACE OF
SELF HARM AND THOUGHTS OF
SUICIDE. DESPERATE WE AGAIN
STARTED CALLING PROVIDERS LISTED
ON OUR HEALTH INSURANCE WEBSITE.
AND TOOK THE FIRST APPOINTMENT
OFFERED, WHICH HAPPENED TO BE
WITH A PSYCHIATRIST AT THE UC
DAVIS BEHAVIORAL HEALTH CENTER.
I REMEMBER THAT APPOINTMENT WELL
IN JUST ONE SESSION THAT ONE
SESSION, THE DOCTOR SAW WHAT
EVERYONE ELSE HAD MISSED OR
EXPLAINED AWAY FOR SO LONG AND
RIGHT, THEN REFERRED US TO AN
EARLY INTERVENTION PROGRAM THAT
U. C. DAVIS WAS PILOTING AT THE
TIME. FUNDED NOT BY COMMERCIAL
INSURANCE, BUT BY A GRANT. THIS
PROGRAM, A COORDINATED SPECIALTY
CARE APPROACH TO TREATING
PSYCHOSIS AND YOUNG PEOPLE. WAS
ABLE TO QUICKLY ROLL BACK THE
WORST OF RACHEL SYMPTOMS AND SET
HER AND US ON THE ROAD TO
RECOVERY. YEARS LATER, I'M STILL
STRUCK BY HOW THAT ONE
APPOINTMENT LITERALLY CHANGED
OUR LIVES. AND WHAT MIGHT HAVE
HAPPENED WITHOUT IT. SO ALTHOUGH
I'M GRATEFUL, SO GRATEFUL. I'M
ALSO ANGRY. I'M ANGRY THAT OUR
COMMERCIAL HEALTH INSURANCE
FAILED US. AND THAT IT TOOK
ALMOST TWO YEARS OF WATCHING OUR
DAUGHTER. RACHEL FALL APART
PRECIOUS TIME IN HER YOUNG LIFE.
BEFORE WE FOUND A TREATMENT
PROGRAM THAT COULD HELP AND EVEN
NOW, IT INERT. IT UNNERVES ME
THAT IT WAS ONLY BY CHANCE. THAT
WE FOUND THE HELP SHE NEEDED. BY
CHANCE. HOW MANY OTHER FAMILIES
LIKE OURS ARE NOT GETTING THAT
CHANCE? THIS HAS TO CHANGE. THE
ONSET OF PSYCHOSIS CAN BE
DEVASTATING TO A CHILD. IT
JEOPARDIZES THEIR DEVELOPMENT,
THEIR EDUCATION THEIR VERY LIFE.
AND CAN OVERWHELM EVEN THE
STRONGEST FAMILY. NOT
UNDERSTANDING WHAT IS GOING ON
AS YOUR CHILD DETERIORATES RIGHT
BEFORE YOUR EYES AND WITH NO
HELP IN SIGHT, PARENTS MAY BLAME
THEMSELVES. EACH OTHER. EVEN
THEIR CHILD. I KNOW BECAUSE
THAT'S WHAT WE DID. BUT IT
DOESN'T HAVE TO BE THIS WAY.
EVERYONE SHOULD HAVE ACCESS TO
THIS TREATMENT IF THEY NEED IT.
BE FOUR YOUNG LIVES ARE
DISRUPTED AND THEIR FUTURES
DERAILED, PERHAPS PERMANENTLY. I
WISH SERIOUS MENTAL ILLNESS HAD
NEVER TOUCHED MY FAMILY, BUT IT
DID. AND IT OPENED MY EYES TO A
HUGE UNMET NEED AND INJUSTICE
REALLY IN OUR COMMERCIAL
HEALTHCARE SYSTEM. OUR
CHILDREN'S WELL BEING, AND THEIR
FUTURES ARE TOO IMPORTANT TO
LEAVE THIS GAP. IN ACCESS TO
LIFE SAVING CARE. I HOPE THAT
HEARING OUR STORY HELPS TO RIGHT
THAT WRONG. THANK YOU SO MUCH.
THANK YOU, MARNIE AND RACHEL
YOUR WORDS TOBACCO BEYOND
YOURSELF. THANK YOU FOR THAT.
NEXT WE HAVE DR EWING WITH THE
O. E. C. ANDERSON. THANK YOU
VERY MUCH. MR CHAIRMAN MEMBERS
TOBY EWING ON BEHALF OF THE
COMMISSION. I DON'T THINK
THERE'S ANYTHING MORE THAN I CAN
SAY THAN WHAT YOU'VE HEARD. UM
BUT YOU KNOW THAT THAT STORY IS
REPEATED. YOU KNOW TOO MANY
TIMES, 27,000 TIMES. AH YOU
KNOW, BASED ON THE RESEARCH THAT
HAS BEEN DONE AT THROUGH THESE
PARTNERS AT UC DAVIS, UCSF AND
STANFORD AND, UM YOU KNOW OTHER
STATES HAVE ANOTHER COUNTRIES
HAVE ACTUALLY ESTABLISHED CLEAR
AND EXPLICIT GOALS. TO DOCUMENT
THE PREVALENCE RATE. TO UM PUT
IN PLACE STRATEGIES TO ENSURE
THAT PEOPLE RECEIVE CARE WITHIN
A TIME PERIOD OFTEN, UM, TWO
WEEKS, SIX WEEKS. TO ENSURE THAT
WE'RE AGGRESSIVE. IN IDENTIFYING
NEEDS UPON FIRST EPISODE FIRST
BREAK. THERE'S A LOT OF WORK TO
DO. THERE'S STILL UM UM, SOME
UNSETTLED UNDERSTANDING OF, UM
UH YOU KNOW, HIGH RISK AND WHAT
CONSTITUTES FIRST EPISODE. UM,
BUT CALIFORNIA HAS THAT ACADEMIC
AND RESEARCH CAPACITY TO FIGURE
THAT OUT. AND SO, I YOU KNOW IF
THE STATE WANTS TO MAKE PROGRESS
IN THE KEY OUTCOMES THAT WE'VE
TALKED ABOUT TODAY AGAIN, THIS
IS WHY, IN MY VERY FIRST
COMMENTS EMPHASIZED EARLY
PSYCHOSIS NEEDS TO BE A FOCAL
POINT. PREVENTION AND EARLY
INTERVENTION STRATEGY SO THAT WE
CAN ACTUALLY GET IN FRONT OF THE
CHALLENGES AND AGAIN AS AS, UM,
YOU JUST HEARD. HELP PEOPLE
ACHIEVE RECOVERY IN WAYS THAT
THEY CAN WORK, MANAGE THEIR
MONEY AND AVOID ALL THOSE
NEGATIVE OUTCOMES THAT ARE, UM
TOO MUCH THE FOCUS OF TODAY'S
CONVERSATION. THANK YOU. NEXT WE
HAVE MICHELLE CABRERA, EXECUTIVE
DIRECTOR WITH CB HD, A HIGH
CHAIR. UM WORLDWIDE BEHAVIORAL
HEALTH CONDITIONS ARE THE NUMBER
ONE CAUSE OF DISABILITY. AND
THEY IMPACT EVERYONE FROM EVERY
SOCIO DEMOGRAPHIC BACKGROUND. UM
THE ROLE OF COUNTY BEHAVIORAL
HEALTH IS THE SAFETY NET IN
CALIFORNIA HAS REALLY BEEN, UM,
TO SORT OF BE THERE TO CATCH
EVERYONE, NOT JUST THOSE WHO ARE
LOW INCOME. UM, BUT OUR
RESOURCES ARE STRETCHED
EXTREMELY THIN. AND I WANT TO
SPEAK TO A FEW DIFFERENT PIECES
. YOU KNOW THE EARLY PSYCHOSIS
NETWORK THAT WE HAVE IN THE
STATE OF CALIFORNIA WAS BUILT
WITH MH ESSAY AND MEDICAL
FUNDING. THESE ARE PUBLIC
DOLLARS THAT INVESTED IN THE
INFRASTRUCTURE BUILD OUT AND
TODAY, UM, COUNTIES DO PAY IN
SOME PLACES TO PROVIDE THAT.
COVERAGE TO PEOPLE WITH PRIVATE
INSURANCE, WHOSE INSURANCE PLANS
WON'T COVER THOSE SERVICES. WE
HAVE SEVERAL PROBLEMS WHEN IT
COMES TO PRIVATE COMMERCIAL
INSURANCE. COUNTY BEHAVIORAL
HEALTH PLANS COULD ADD ALONGSIDE
EARLY PSYCHOSIS PROGRAMS, UM,
CRISIS SERVICES, FOR EXAMPLE, IN
CRISIS STABILIZATION UNITS.
MOBILE CRISIS SERVICES,
SUBSTANCE USE DISORDER,
RESIDENTIAL TREATMENT, SCHOOL
BASED SERVICES I COULD GO ON IN
TERMS OF THE KINDS OF SERVICES
THAT ROUTINELY ARE PROVIDED AS A
PUBLIC BENEFIT TO SOME EXTENT.
AND WE CAN ALMOST NEVER GO FAR
ENOUGH TO COVER THE WHOLE
POPULATIONS NEEDS. I WOULD ARGUE
. WE SHOULD NOT BE COVERING THE
WHOLE POPULATIONS NEEDS BECAUSE
THAT'S NOT WHAT COUNTY BEHAVIOR
HEALTH IS STRUCTURED TO DO
TODAY. THAT'S NOT HOW WE'RE
FINANCED. THAT'S NOT HOW THE
LAWS ARE INTENDED TO WORK. WHEN
I'VE ASKED OUR MEMBERS WHY IS IT
THAT YOU'RE CONTINUING TO
PROVIDE THESE SERVICES TO PEOPLE
WITH PRIVATE INSURANCE COVERAGE
WHEN, THEORETICALLY, UNDER THE
LAW, THEIR PRIVATE INSURANCE
PLAN SHOULD BE COVERING IT. THEY
TURNED TO ME WITH A REALLY GOOD
ANSWER, WHICH IS PEOPLE WILL
DIE. AND SO THERE'S A HUGE
BURDEN MORAL BURDEN OF
CONSCIENCE ON MANY OF OUR COUNTY
BEHAVIORAL HEALTH DEPARTMENTS
THAT THEY NEED TO OTHERWISE.
THEY WILL BE CONFRONTED WITH
DEATH AND DYING IN FAMILIES AND
OR SEVERE LIFE CHANGING
DISABILITY THAT ULTIMATELY LEADS
TO THE VERY HOMELESSNESS AND
JUSTICE INVOLVEMENT THAT WE'VE
BEEN TALKING ABOUT TODAY. SO YOU
KNOW, FROM OUR PERSPECTIVE,
THOSE THAT SORT OF ONE CORE
ISSUE WE KNOW THAT GMHC AND
DEPARTMENT OF INSURANCE HAVE
BEEN WORKING REALLY HARD THAT,
UM ARE PARITY LAWS ARE AMONG THE
STRONGEST IN THE NATION AND
PARODY LAW ENSURES THAT YOUR
BEHAVIORAL HEALTH INSURANCE
FUNCTIONS THE SAME WAY THAT YOUR
PHYSICAL HEALTH INSURANCE DEBTS,
SO IF YOU HAVE COST PAID BECAUSE
SHARING IN DEDUCTIBLES, ETCETERA
AND THOSE THINGS ARE A FINANCIAL
BARRIER A BURDEN TO YOU. THEY
WILL CONTINUE TO BE AND PERHAPS
EVEN MORE SO FOR A PERSON WITH
THE SIGNIFICANT BEHAVIORAL
HEALTH NEED. I'LL GIVE YOU AN
EXAMPLE FROM YOUR OWN DISTRICT.
UM THE COUNTY BEHAVIORAL, HEALTH
FUNDED SCHOOL BASED SERVICES, WE
OFTEN FIND THAT THERE ARE A LOT
OF LOW INCOME FAMILIES IN YOUR
DISTRICT WITH PRIVATE INSURANCE
COVERAGE RIGHT THEIR PARENTS
MIGHT BE IN WORKING IN FARM WORK
JOBS THAT HAVE INSURANCE OR THEY
MIGHT BE IN MANUFACTURING OR
OTHER SORTS OF JOBS. THEY HAVE
COVERAGE. THEY JUST CAN'T AFFORD
TO ACCESS IT, BECAUSE WITH EVERY
VISIT COMES A COPAY THAT THEIR
THEIR FAMILY IS LIVING SO
MARGINALLY THAT THEY CAN'T COVER
AND SO EVEN WHEN THERE IS
COVERAGE IN THEORY, IN REALITY,
IT DOESN'T EXIST, AND WE REALLY
HAVE TO THINK LONG AND HARD
ABOUT WHAT WILL WE DO TO MAKE
SURE THAT THERE'S ALIGNMENT
ACROSS BENEFITS? NOT JUST AROUND
? UM, INSURANCE UNDERWRITING
RULES, AND WE COMMEND THE THIS
ADMINISTRATION FOR ITS
LEADERSHIP IN THIS AREA. UM IT
DOES TIE BACK TO THE WORKFORCE
PIECES WELL, BECAUSE THE MORE WE
PRESS ON PRIVATE INSURANCE TO DO
MORE UNDER THAT INSURANCE,
STRICT FRAMEWORK, THE MORE
PRESSURE THAT PUTS ON THE
WORKFORCE, GENERALLY SPEAKING,
BECAUSE THERE'S MORE COMPETITION
, BUT ULTIMATELY THE GOALS ARE
THE RIGHT ONES, AND WE REALLY DO
NEED AN EXPANSION OF BENEFITS.
NOT JUST, UM THAT'S STOPPING
WITH PARODY, BUT GOING BEYOND
THAT, TO MAKE SURE THAT PEOPLE
WITH PRIVATE COMMERCIAL
INSURANCE GET WHAT THEY NEED AS
WELL. THANK YOU. NEXT. WE HAVE
JED HAMPTON, DIRECTOR OF
LEGISLATIVE AFFAIRS WITH
CALIFORNIA ASSOCIATION OF HEALTH
PLANS.
GOOD EVENING, MR CHAIR. FORMER
MEMBERS OF THE COMMITTEE THAT
ARE NOT HERE ANYMORE. JED
HAMPTON WITH THE CALIFORNIA
ASSOCIATION OF HEALTH PLANS
REPRESENTING 43 KNOCKS KEEN
LICENSED HEALTH PLANS IN THE
STATE COVERING NEARLY 27 MILLION
LIVES WOULD LIKE TO THANK YOU
AND THE SUBCOMMITTEE FOR THE
OPPORTUNITY TO BE HERE TODAY AND
SHARE SOME OF THE THINGS THAT
HELP PLANS ARE DOING AROUND
MENTAL HEALTH. BOTH IN THE
COMMERCIAL MARKET AND MEDICARE
MANAGED CARE. FIRST I WANTED TO
START BY SAYING THAT HEALTH
PLANS UNDERSTAND THAT MENTAL
HEALTH IS AN ESSENTIAL PART OF
OVERALL HEALTH AND WELL BEING.
WE UNDERSTAND THERE'S MORE WE
ALL MUST DO TO MEET THE
INCREASING INCREASING TREATMENT
NEEDS OF THOSE SUFFERING FROM
ADDICTION AND MENTAL ILLNESS,
AND WE WILL CONTINUE TO INVEST,
AND THERE'S UH IN THE MENTAL
HEALTH OF ALL CALIFORNIANS. WE
BELIEVE THAT IF WE CONTINUE TO
WORK COLLABORATIVELY IN A SPIRIT
OF SHARED RESPONSIBILITY THAT
HEALTH PLANS AND PROVIDERS ALONG
WITH STATE LEADERS, ADVOCATES
AND OTHER STAKEHOLDERS CAN BRING
CALIFORNIA'S MENTAL HEALTH
CRISIS UNDER CONTROL, SAVE LIVES
AND IMPROVE THE MENTAL AND
PHYSICAL WELL BEING OF ALL
CALIFORNIANS. CALIFORNIA'S
HEALTH PLANS, SUPPORT STATE AND
FEDERAL LAWS REQUIRING PARITY
BETWEEN COVERAGE FOR MENTAL
HEALTH AND PHYSICAL HEALTH. AS
YOU ARE PROBABLY AWARE, UM, YOU
KNOW, IN THE IN THE COMMERCIAL
MARKET, CALIFORNIA FANS ARE
REQUIRED TO COVER MEDICALLY
NECESSARY TREATMENT OF MENTAL
HEALTH AND SUBSTANCE USE
DISORDERS LISTED IN THE MENTAL
AND BEHAVIORAL DISORDERS CHAPTER
OF THE MOST RECENT EDITION OF
THE INTERNATIONAL CLASSIFICATION
OF DISEASES OR THE DIAGNOSTIC
AND STATISTICAL MANUAL OF MENTAL
DISORDERS. WE COVER A FULL
SPECTRUM OF ALL MEDICALLY
NECESSARY TREATMENTS IN ALL
SETTINGS, INCLUDING INPATIENT
AND OUTPATIENT TREATMENT. AH WE
ARE. WE DO NOT LIMIT BENEFITS OR
COVERAGE TO THE SHORT TERM OR
ACUTE TREATMENT. UM IF WE ARE
UNABLE TO DELIVER THOSE SERVICES
IN NETWORK, WE ARE REQUIRED TO
ARRANGE FOR CARE FOR OUT OF
NETWORK SERVICES FOR MEDICALLY
NECESSARY TREATMENT WHEN THOSE
SERVICES ARE NOT AVAILABLE IN
NETWORK. AND THAT PROVISION DOES
NOT ALTER THE PLANTS OBLIGATION
TO ENSURE ITS CONTRACTING
NETWORK PROVIDES READILY
AVAILABLE AND ACCESSIBLE HEALTH
CARE SERVICES TO EACH ONE OF THE
PLAN'S ENROLLEES REDDIT SERVICE
AREA I WANTED TO ALSO SHARE SOME
OF THE THINGS THAT HEALTH PLANS
ARE DOING IN TERMS OF INVESTMENT
AND PIONEERING INNOVATIVE
PROGRAMS TO IMPROVE THE MENTAL
HEALTH OF OUR ENROLLEES.
SPECIFICALLY HEALTH PLANS ARE
WORKING CLOSELY WITH PROVIDERS
TO HELP MEMBERS RECEIVE MENTAL
HEALTH CARE AT MANY DIFFERENT
TOUCH POINTS BEYOND THE TYPICAL
OFFICE SETTING. INCLUDING BY
EMBEDDING MENTAL HEALTH
PROVIDERS AND EMERGENCY ROOM
DEPARTMENTS AND PRIMARY CARE
CLINICS AND OFFICES. WE'RE ALSO
PROVIDING ONLINE WELLNESS AND
COACHING PROGRAMS AND FREE
ACCESS TO TRUSTED MENTAL HEALTH
APPS WHICH ARE NOT INTENDED TO
REPLACE TREATMENT, BUT I WISH
EVIDENCE SHOWS CAN BE PROVIDED
SIGNIFICANT RELIEF TO THOSE WITH
MILD TO MODERATE ANXIETY AND
DEPRESSION. HEALTH PLANS ARE
ALSO PROVIDING COVERAGE FOR
TELEHEALTH ACCESS, WHICH HAS
BEEN INSTRUMENTAL FOR MEMBERS
THROUGHOUT THE PANDEMIC THAT WE
JUST EMERGED FROM AS WELL AS IN
RURAL AREAS. IN FACT, ALMOST 40%
OF ALL MENTAL HEALTH VISITS IN
2020 WERE CONDUCTED THROUGH
TELEHEALTH COMPARED TO LESS THAN
1% IN 2019, WHICH IS NEARLY 100%
INCREASE. AND WE'VE SEEN THAT
CONTINUE AS WE HAVE STARTED TO
COME OUT OF THE BACK END OF THE
PANDEMIC. AND WE ARE ALSO
ENGAGING IN INVESTING IN ANTI
STIGMA OR EDUCATIONAL CAMPAIGNS
TO INCREASE AWARENESS AND
ENCOURAGE CALIFORNIA'S TO SEEK
MENTAL HEALTHCARE AND SUPPORT
WHEN THEY NEED IT. IN TERMS OF
WHAT WE'RE DOING IN THE PUBLIC
MENTAL HEALTH SYSTEM. HEALTH
PLANS ARE ALSO SUPPORTING
CALIFORNIA'S PUBLIC MENTAL
HEALTH SYSTEM IN PARTNERSHIP
WITH THE STATE COUNTY PARTNERS
AND PROVIDERS. MEDICAL MANAGED
CARE PLANS ARE INVESTING IN
SHELTERS, SERVICES AND HOUSING
TO ADDRESS THE HOME TO ADDRESS
HOMELESSNESS. EXCUSE ME
THROUGHOUT CALIFORNIA, INCLUDING
SOME OF THE WORK THAT WE DID
WITH PROJECT CONKEY WITH THE
ADMINISTRATION. HEALTH PLANS
HAVE ESTABLISHED IN OUR INDOOR
APPROACH FOR MEDICAL AND
RELEASED QUICKLY AND EASILY
ACCESS MENTAL HEALTH AND
SUBSTANCE USE DISORDER SERVICES
, REGARDLESS OF THE DELIVERY
SYSTEM, WHERE THEY INITIALLY
SEEK CARE. WE ARE CONTINUING TO
BUILD CAPACITY TO PROVIDE
INTENSIVE COMMUNITY BASED CARE
COORDINATION FOR ENROLLEES
LIVING WITH SERIOUS MENTAL
ILLNESS, SUBSTANCE USE DISORDER
OR SERIOUS EMOTIONAL DISTURBANCE
THROUGH THROUGH IN CANCER
MANAGEMENT PROJECT THROUGH CAL
AIM AND WE'RE ALSO WORKING IN
COLLABORATION WITH COMMUNITY
ORGANIZATIONS TO ESTABLISH
PROGRAMS THAT PROVIDE CRITICAL
SOCIAL HEALTH NEEDS LIKE HOUSING
SUPPORTS AND ALTERNATIVES TO THE
EMERGENCY ROOM VISITS AND
HOSPITALIZATIONS FOR THOSE
SUFFERING FROM SUBSTANCE USE OR
SERIOUS MENTAL ILLNESS CRISIS.
WE ARE ALSO WORKING TO FIND
SOLUTIONS TO ADDRESS THE MENTAL
HEALTH NEEDS OF CHILDREN AND
ADOLESCENTS WITHIN THE RIGHT
RANGE OF INNOVATIVE AND
COLLABORATIVE APPROACHES.
OBVIOUSLY FOR A LOT TODAY ABOUT
THE CHILDREN BEHAVIORAL HALF
NICHE, NEVIN LARA, THE GOOD WORK
THAT'S BEING DONE AROUND THAT
WITH THE STATE OF THE COUNTIES
AND WITH MEDICAID MANAGED CARE
PLANS. UM YOU KNOW SOME OF THE
THINGS THAT WE'RE DOING IN THAT
SPACE OR DEVELOPING INNOVATIVE
PROGRAMS THAT HELP EQUIP TEENS
WITH THE TOOLS TO HAVE
MEANINGFUL CONVERSATIONS ABOUT
MENTAL HEALTH WITH THEIR PEERS
AND THEIR COMMUNITIES, INCLUDING
TIPS FOR ACTIVE LISTENING,
CONVERSATION STARTERS AND
ADDITIONAL RESOURCES WERE ALSO
WORKING ON FUNDING SCHOOL AND
COMMUNITY BASED PROGRAMS BY
PROVIDING ACCESS TO CLINICIANS
AND MIDDLE AND HIGH SCHOOLS. AND
TRAINING EDUCATORS TO SPOT SIGNS
OF MENTAL HEALTH ISSUES. THIS IS
SOME OF THE WORK THAT WE'VE BEEN
DOING IN THIS SPACE. UM YOU
KNOW, DESPITE MUCH OF THE WORK
THAT WE HAVE BEEN DOING, YOU
KNOW, I THINK YOU'VE HEARD IT
QUITE A BIT TODAY. UM YOU KNOW,
SYSTEMIC WORKFORCE PROVIDER.
SHORTAGES CONTINUE TO PERSIST,
AND YOU KNOW THE 2019 FUTURE
HEALTHCARE WORKFORCE COMMISSION
STUDY THAT YOU CITED DOCTOR
ARAMBULA. UM YOU KNOW, SAID BY
2028, CALIFORNIANS WILL HAVE 50%
FEWER PSYCHIATRISTS AND 28%
FEWER PSYCHOLOGISTS, MARRIAGE
AND FAMILY THERAPIST AND
LICENSED COUNSELORS AND SOCIAL
WORKERS. SO IT'S YOU KNOW, AS A
HEALTH PLAN, THAT'S THAT'S
OBVIOUSLY STRUGGLE IS ENSURING
THAT WE'RE ABLE TO WORK WITH
CONTRACT WITH. UM THESE, UH
THESE PROVIDERS TO ENSURE THAT
WE HAVE A ROBUST AND FULL
NETWORK AND OUR OUR ENROLLEES
HAVE ADEQUATE ACCESS TO THOSE,
UM TO THOSE SERVICES. AH! IN
ADDITION TO THAT, YOU KNOW,
NEARLY ONE THIRD OF CALIFORNIA'S
POPULATION IS CURRENTLY LIVING
IN A MENTAL HEALTH PROFESSIONAL
SHORTAGE AREA ONCE AGAIN KIND OF
GOES TOWARDS THE WORKFORCE ISSUE
AS I'M SURE YOU'RE AWARE, DR
ARAMBULA, UM, AND HEALTH PLANS
ARE SEEKING TO ADDRESS THAT
WORKFORCE CRISIS BY INVESTING IN
BUILDING A BROADER NETWORK OF
MENTAL HEALTH PROVIDERS,
PARTNERING WITH THE STATE AND
COUNTY ORGANIZATIONS TO RESOLVE
CALIFORNIA'S MENTAL HEALTH
WORKFORCE CHALLENGES. IN
COMMUNITIES ACROSS THE STATE. SO
THESE ARE JUST SOME OF THE
THINGS THAT WE'RE DOING ON OUR
END TO TRY TO ADDRESS SOME OF
THE WORKFORCE CHALLENGES. JUST A
COUPLE OF EXAMPLES. IF I CAN,
YOU KNOW, WERE ADDITIONALLY,
PARTNERING, YOU KNOW, AGAIN WITH
THE STATE AND THE COUNTIES, UM
TO, UH, INVEST IN A MENTAL
HEALTH WORKFORCE NEEDS
ASSESSMENT IN ORDER TO INFORM
POLICY CHANGES THAT SEEK TO
INCREASE IN DIVERSIFIED
CALIFORNIA'S MENTAL HEALTH
WORKFORCE. WE'RE INVESTING IN
OUR OWN WORKFORCE WITHIN THE
HEALTH PLANS. SO YOU KNOW WE'RE
WE'RE INVESTING IN OUR OWN
MENTAL HEALTH, CLINICIANS,
RECRUITMENT, EDUCATION AND
TRAINING PROGRAMS TO ENSURE THAT
WE BRING ENOUGH INDIVIDUALS AND
PROVIDERS ON BOARD. UM AND ALSO
, HEALTH PLANS ARE OFFERING
SCHOLARSHIPS AND LOAN
FORGIVENESS PROGRAMS TO PROMOTE
AND INCENTIVIZE QUALIFIED
CANDIDATES TO CHOOSE, UM, MENTAL
HEALTH CARE AS A CAREER. SO
AGAIN, THESE ARE JUST SOME OF
THE THINGS THAT HEALTH PLANS ARE
DOING. WE UNDERSTAND THAT
THERE'S MORE THAT WE ALL MUST BE
DOING TO INCREASE THE TREATMENT
NEEDS OF THOSE SUFFERING FROM
ADDICTION AND MENTAL ILLNESS,
AND WE'LL CONTINUE TO INVEST IN
THE MENTAL HELP OF ALL
CALIFORNIANS WORKING WITH OUR
STATE COUNTY AND PROVIDER
PARTNERS. I'M HAPPY TO ANSWER
QUESTIONS ONCE THIS PANEL IS
DONE, THANK YOU. NEXT WE HAVE
DIRECTOR MARY WATANABE WITH THE
DEPARTMENT OF MANAGED HEALTH
CARE. GOOD EVENING. I AM THE
MATERIALS FOR TODAY'S HEARING.
HAVE A PRETTY COMPREHENSIVE
OVERVIEW. WHAT THE DEPARTMENT
DOES, UM I WILL SAY HAVING HEARD
RACHEL AND BONNIE'S TESTIMONY
THAT RINGS A LITTLE HOLLOW, SO
I'M NOT GONNA L SPARE YOU GOING
THROUGH THAT IN DETAIL. I WILL
JUST HIGHLIGHT A COUPLE OF
THINGS THAT THE DEPARTMENT IS
ENGAGED IN FIRST AS OUR
BEHAVIORAL HEALTH
INVESTIGATIONS. WHICH REALLY WAS
A RESPONSE TO WHAT YOU HEARD
EARLIER. TODAY WE HAVE SOME OF
THE STRONGEST CONSUMER
PROTECTIONS. WE'VE DONE A
TREMENDOUS AMOUNT OF WORK. WE'VE
BEEN A LEADER IN THE COUNTRY ON
OUR OVERSIGHT OF PARODY. UM, AND
DESPITE ALL OF THAT, WHAT WE
KNOW IS THAT IF YOU ARE A PERSON
IN CRISIS YOU ARE LEFT IN THE
COMMERCIAL MARKET TO NAVIGATE
FOR YOURSELF TO MAKE PHONE CALLS
AND AS A DESPERATE PARENT OR
CONSUMER, UM, YOU OFTEN RUN OUT
OF OPTIONS AND THEN BE THERE IN
THE EMERGENCY ROOM. WE'RE PAYING
OUT OF POCKET SO OUR BEHAVIORAL
HEALTH INVESTIGATIONS REALLY ARE
SEEKING TO UNDERSTAND WHAT THOSE
BARRIERS ARE, WHETHER THERE'S
VIOLATIONS OF THE LAW OR WHETHER
WE JUST NEED SOMETHING ELSE OR
PEOPLE NEED SOMETHING MORE. THAN
WHAT THEY GET ON THE MEDICAL
SURGICAL SIDE. UM YOU HEARD A
LOT ABOUT THE CHILDREN YOUTH
BEHAVIORAL HEALTH INITIATIVE.
THAT REALLY IS AN INTENT THAT
FOR OUR COMMERCIAL ENROLLEES
THAT SHOW UP AT THE WELLNESS
CENTER ARE NOT TOLD THIS IS NOT
FOR YOU BECAUSE YOU HAVE PRIVATE
INSURANCE. GO CALL YOUR HEALTH
PLAN. WE WANT TO MAKE SURE THAT
THERE IS AN AVENUE FOR EVERY
SINGLE CHILD AND YOUNG ADULTS TO
GET CARE THROUGH THEIR SCHOOL
SETTING. UM THERE'S A LOT THAT
WE'RE DOING AND STILL TRYING TO
UNDERSTAND, I WILL SAY AS PART
OF THE GOVERNOR'S BEHAVIORAL
HEALTH REFORM PROPOSAL, THERE
WAS A SMALL ITEM THAT MAY HAVE
GONE UNNOTICED. BUT IT'S FOR US
TO WORK VERY CLOSELY WITH THE
DEPARTMENT OF HEALTH CARE
SERVICES TO UNDERSTAND WHAT IS
COVERED IN MEDICAL AND WHERE THE
GAPS ARE WITH COMMERCIAL
COVERAGE, BUT WE OFTEN HEAR IS
IF YOU HAVE A BEHAVIOR HEALTH
CONDITION, FIGURE OUT HOW TO GET
INTO MEDICAL. WE DON'T WANT
EVERYBODY GOING INTO MEDICAL
WHEN YOU CAN HAVE COMMERCIAL
INSURANCE. SO WE REALLY WANT TO
UNDERSTAND. WHY IS THAT? WHAT
ARE THOSE WRAPAROUND SERVICES
THAT SUPPORT FAMILIES AND
INDIVIDUALS THAT WE SHOULD
CONSIDER? ARE THERE THOSE THINGS
THAT SHOULD BE COVERED IN THE
COMMERCIAL MARKET? ARE THERE
OTHER BE A PARODY? PRIOR
AUTHORIZATION UTILIZATION
MANAGEMENT REQUIREMENTS? UM AND
TO ALL THE THEME HERE ABOUT THE
SERVICES THE COUNTIES ARE
COVERING FOR COMMERCIAL ROLE IS
WHAT DO WE DO ABOUT THAT? SO
WE'LL BE SPENDING THE NEXT YEAR
THINKING ABOUT THAT AND COMING
UP WITH THE PLAN SOMEWHERE TO
COME ON THAT, UM THE QUESTION
THAT YOU HAD FOR ME WAS IS, I
THINK SOMETHING TO THE EXTENT OF
HAVE HAVE ALL THESE STATE AND
FEDERAL LAWS MADE A DIFFERENCE.
UM I WILL SAY THAT THEY ARE VERY
TECHNICAL. UM AND THEY INVOLVE
FEDERAL MENTAL HEALTH PARITY
INVOLVES REVIEWING THINGS LIKE
COST SHARING AND POLICIES AND
PROCEDURES. IF YOU ARE A PERSON
IN CRISIS, NONE OF THAT MATTERS
. THIS IS ABOUT ACCESS TO CARE
AND NAVIGATION AND SUPPORT IN
GETTING THE CARE THAT YOU NEED.
BUT IF YOU LOOK AT THE TOTALITY
OF THE THINGS THAT WE'VE DONE AT
THE FEDERAL LEVEL HERE IN
CALIFORNIA, THERE IS A LOT OF
TOOLS THAT HAS THE REGULATOR. I
HAVE TO SEND THE MESSAGE THAT
BEHAVIORAL HEALTH IS CRITICAL TO
YOUR OVERALL HEALTH. THAT NEARLY
$600 IN PREMIUMS THAT YOU ARE
PAYING. YOU ARE ENTITLED TO GET
THE BEHAVIORAL HEALTH YOU NEED.
SO I WOULD SAY IN PARTICULAR
WITH SPF 55 SP 2 TO 1. WE HAVE
REALLY STRENGTHENED OUR LAWS IN
CALIFORNIA AND THE PROTECTIONS
FOR CONSUMERS. THANK YOU. NEXT
WE HAVE STATE MEDICAID DIRECTOR
JASON COOPER. THANK YOU. AND
GOOD EVENING. I AGREE WITH MANY
OF THE REMARKS MADE BY DIRECTOR
WATANABE. I'LL JUST FOCUS ON A
FEW PIECES SPECIFIC TO THE TO
THE MEDICAID SIDE. WE ALSO HAVE
EXTENSIVE CONTRACT REQUIREMENTS
. AUDITING REQUIREMENTS. UM A
FEW PIECES WHEN IT COMES TO
NETWORK ADEQUACY AND DATA
REPORTING THAT I THINK WE'RE
DOING WHERE WE'RE TAKING THINGS
TO THE NEXT LEVEL. HISTORICALLY
WHAT WE'VE SEEN IN MEDICAL
HOUSE. SOME OF OUR MANAGED CARE
PLANS WILL HAVE LARGE
SUBCONTRACTORS WITH YOU. EITHER
OTHER LARGE PLANS OR OTHER LARGE
GROUPS. I E P A S. IN ONE OF THE
THINGS THAT WILL START IN
JANUARY OF 2024, IS THAT MANAGED
CARE PLANS WILL BE REQUIRED TO
REPORT ALL THE WAY DOWN AT THE
SUBCONTRACTOR LEVEL THAT
INCLUDES FOR NETWORK ADEQUACY,
INCLUDING AROUND MENTAL HEALTH
ACCESS SERVICES, AS WELL AS
QUALITY REPORTING. SO THERE'S
FULL TRANSPARENCY. NOT JUST THAT
WHAT WE CALL OUR PRIME
CONTRACTOR, BUT ALSO THOSE
SUBCONTRACTORS WHO THAT THINGS
ARE BEING LOST AS WE AS WE CALL
IT, THE WATERFALL. THAT WE HAVE
MORE TRANSPARENCY IN REGARDS TO
ACCESS. THE OTHER THING, I WOULD
NOTE IS THAT CMS RECENTLY HAS
ANNOUNCED THAT THEY WILL MOST
LIKELY BE MOVING IN A NEW
DIRECTION WHEN IT COMES TO
NETWORK ADEQUACY FOR MEDICAID,
NOT ONLY JUST LOOKING AT TIME
AND DISTANCE. IN FACT, THEY MAY
ACTUALLY SENSE IT TIME AND
DISTANCE BECAUSE THEY'RE NOT
SEEING THAT IT'S DEMONSTRATING
TRUE ACCESS, BUT LOOKING AT
TIMELY ACCESS. HOW FAST CAN
SOMEONE GET AN APPOINTMENT FOR A
REGULAR VISIT OR AN URGENT VISIT
IN MOVING TO THAT AS POTENTIALLY
THE NEW FEDERAL STANDARD? THOSE
REGULATIONS OR PROPOSED
REGULATIONS ARE SUPPOSED TO DROP
SOMETIME IN THE SPRING TO SUMMER
OF THIS YEAR, SO WE'LL WE'LL
LOOK AT THOSE IN BETTER
UNDERSTAND WHAT THEY ARE
PROPOSING ON THAT SIDE. THEY'RE
ALSO PROPOSING THINGS LIKE
SECRET SHOPPERS. CALIFORNIA
ALREADY DOES MANY OF THESE BEST
PRACTICES. WE HAVE SOME OF THE
BEST PROTECTIONS AS AS MARY
MENTIONED. IN THE NATION, BUT
REALLY EXCITED TO SEE WHERE CMS
MAYBE GOING AND WHAT
OPPORTUNITIES FOR ADDITIONAL
ENHANCED COMPLIANCE OVERSIGHT
THAT WE CAN BE LOOKING AT
CURRENTLY LOOK AT TIME, TIMELY
ACCESS IN CALIFORNIA TODAY, BUT
KIND OF STRENGTHENING THAT AND
LOOKING AT WHAT OTHER STATES ARE
DOING. WE'RE REALLY LOOKING
FORWARD TO. I WOULD ALSO WANT TO
NOTE THAT D HCS HAS ALSO
ANNOUNCED THIS YEAR. A SPECIAL
AUDIT FOR BEHAVIORAL HEALTH
ACROSS ALL OF OUR MEDICAL
MANAGED CARE PLANS. WE ALSO ARE
SEEING TRENDS SIMILAR TO OUR
COLLEAGUES. WE WANTED TO MAKE
SURE THAT WE WERE LOOKING AT NOT
JUST THE POLICIES AND PROCEDURES
OR THE PARODY FILINGS OR THE
VARIOUS PIECES THAT YOU CAN
EASILY SHOW DEMONSTRATED
COMPLIANCE WITH WHEN IT COMES TO
CONTRACTS. BUT REALLY, WHAT ARE
THE OPERATIONAL ISSUES? WHAT ARE
SOME OF THE BARRIERS? WHAT ARE
SOME OF THE OTHER UNDERLYING
ISSUES THAT MAY BE CAUSING
ACCESS TO MILD, MODERATE
SERVICES? THOSE WILL BE
CONDUCTED OVER THE ENTIRE
CALENDAR YEAR. 2023 WE WOULD
LOOK FORWARD TO, UH, DISCLOSING
SOME OF THE OUTCOMES OF THOSE
VARIOUS AUDITS AS WELL.
OBVIOUSLY THE DEPARTMENT HAS A
NUMBER OF OTHER VEHICLES UNDER
OUR BELT. WE HAVE SANCTIONS AND
OTHER PIECES TO BE LOOKING AT.
BUT AT THIS TIME, WE'RE STILL
JUST COLLECTING INFORMATION. YOU
ALSO HEARD A NUMBER OF WAYS OF
WHERE WE'RE TRYING TO PARTNER
TODAY ON C Y B H I OR OTHER
PIECES WITH SCHOOLS AND WE
REALLY LOOK FORWARD TO WORKING
WITH GMHC IN REGARDS TO THE
PARODY ASSESSMENT ACROSS
MEDICAID. IN COMMERCIAL PLANS.
DEPARTMENT OF FINANCE. JUST DOWN
THE DEPARTMENT OF FINANCE HERE
TO ANSWER ANY QUESTIONS. THANK
YOU. WE'RE ALSO AVAILABLE FOR
QUESTIONS. I'M GOING TO BRING IT
BACK TO THE CHAIR. I'M GONNA
UPLIFT IF I CAN. THE COMMENTS
AGAIN FROM BOTH RACHEL AND
BONNIE HOT EARLIER, MISS
HAMPTON. I'M HOPING YOU CAN
COMMENT ON THEIR EXPERIENCES.
THIS PERVASIVE THIS ANECDOTAL
EXAMPLE IS, IS THIS CONSISTENT?
I MEAN, WE HEARD THE DIRECTOR
SAY IF YOU HAVE PRIVATE
INSURANCE FIGURE OUT HOW TO GET
ON MEDICAL. IS THAT REALLY WHY
YOU GET PRIVATE INSURANCE IS
WHEN YOU GET ILL YOUR THAN
TRYING TO FIGURE OUT HOW TO GET
OFF OF IT. IS THAT ANECDOTAL
EXPERIENCE? REAL, OR, UM, WAS
WHAT YOU HEARD FROM MS HEARTS.
UH, THE EXCEPTION. YEAH THANK
YOU, MR CHAIR. YOU KNOW, I YOU
KNOW, FIRST OF ALL, OBVIOUSLY
WANT TO, UM, YOU KNOW, COME IN
MISS HOSPITAL FOR COMING IN
DISCUSSING THIS ISSUE. I THINK
THOSE ISSUES ARE VERY REAL
ISSUES. YOU KNOW THAT THOSE ARE
HUMAN ISSUES, AND THOSE THINGS
HAPPEN. UM AND I THINK THAT
AGAIN HEALTH PLANS, YOU KNOW,
AMONGST OTHER PROVIDERS, YOU
KNOW AGAIN REALLY NEED TO DO A
BETTER JOB ACROSS THE BOARD AND
ENSURING THAT INDIVIDUALS,
MENTAL MENTAL HEALTH NEEDS AND
SUBSTANCE USE, NEEDS OR ADDRESS
YOU KNOW, AND THE MOST
COMPREHENSIVE WAY POSSIBLE, I
WILL SAY, UM, GENERALLY SPEAKING
, UM THAT THAT EXAMPLE IS NOT
ONE THAT WE HEAR OF OFTEN IN
TERMS OF THAT TYPE OF SITUATION
OCCURRING AND AGAIN. I DON'T I
DON'T SAY THAT IN ANY WAY, SHAPE
OR FORM TO MINIMIZE THE
EXPERIENCE OF OUR PREVIOUS
WITNESSES, BECAUSE AGAIN THAT
THEY ARE REAL AND THAT THEY HAD
THAT EXPERIENCE. UM I THINK IT'S
IMPORTANT TO KNOW THAT AS AN
INDUSTRY, YOU KNOW WE'VE BEEN
DISCUSSING THESE TYPES OF ISSUES
FOR THE FOR THE BETTER PART OF
TWO DECADES. IT'S NOT SOMETHING
THAT'S UM YOU KNOW, JUST CROPPED
UP IN THE LAST HANDFUL OF YEARS
, OBVIOUSLY, WITH THE COVID 19
PANDEMIC. UM THOSE, UH, THOSE
ISSUES HAVE BECOME MORE
PRONOUNCED. I THINK THAT YOU'VE
SEEN ACROSS THE BOARD WHETHER
IT'S WITH ITS CHILDREN, ADULTS.
I THINK IT'S REALLY ACROSS THE
BOARD AGAIN. I THINK THAT THE
WORKFORCE CHALLENGES AND
WORKFORCE NEEDS OR SUPPRESSING
BECAUSE AGAIN FROM THE HEALTH
PLAN SIDE AS WELL. YOU KNOW,
WE'RE STILL SEEKING TO CONTRACT
WITH MORE REAL PROVIDERS TO
BUILD AN ADEQUATE NETWORK. UM TO
ENSURE THAT THIS INCREASE IN
DEMAND FOR SERVICES IS MET WITH
WITH WITH AN ADEQUATE RESPONSE.
SO YOU KNOW, I WILL SAY THAT
AGAIN. GENERALLY SPEAKING,
THAT'S NOT SOMETHING THAT THAT,
UM IS THE THAT NARRATIVE IS NOT
SOMETHING THAT'S PERVASIVE, YOU
KNOW, THROUGHOUT OUR INDUSTRY,
PER SE, UM, BUT AGAIN, I'M NOT
SAYING THAT IT DOESN'T HAPPEN. I
THINK YOU KNOW EVERYBODY IN THIS
IN THIS SAFETY NET, UH, YOU KNOW
SYSTEM HAS TO DO A BETTER JOB OF
ADDRESSING ADDRESSING THESE
NEEDS, AND I THINK IT STARTS
WITH THE HEALTH PLANS TO
PROVIDERS COUNTIES, AND I THINK
THAT THERE IS ROOM FOR
IMPROVEMENT EVERYWHERE, ENSURING
THAT WE'RE ADDRESSING THE NEEDS
OF THESE INDIVIDUALS, YOU KNOW,
MOVING FORWARD, I WILL SAY JUST
ADDITIONALLY IF I CAN, MR CHAIR
YOU KNOW, WE, YOU KNOW, CONTINUE
TO WORK WITH, YOU KNOW, EVERY
AGENCY IN CALIFORNIA WITH OUR
REGULATORS TO THE RIGHT OF ME
THE IMAGE C D HCS, CALITRI,
CHESS AND OTHERS TO ENSURE THAT
WE BUILD THAT INTEGRATED SYSTEM
OF CARE THAT WE ARE ADDRESSING
AND CATCHING THOSE INDIVIDUALS
WHO MAY BE FALLING THROUGH THE
CRACKS. WE CERTAINLY UNDERSTAND
THAT THAT'S NOT ACCEPTABLE AND
THAT THESE INDIVIDUALS MAY BE
FALLING THROUGH THE CRACKS. BUT
WE WOULD WANT TO ENSURE THAT
WE'RE EXAMINING THE ROOT CAUSES
OF SOME SOME OF THOSE
DISRUPTIONS. YOU KNOW, THAT'S
THINGS LIKE WHETHER THERE'S
AVAILABILITY OF THE RIGHT HYPER
PROVIDER OR WHETHER WE HAVE TO
EXAMINE. UM YOU KNOW WHAT TIMELY
ACCESS LOOKS LIKE OR EVIDENCE
THAT THE SERVANTS IS ARE BEING
OFFERED OR EFFECTIVE AND SAFE.
THERE'S A MYRIAD OF FACTORS THAT
GO INTO THOSE DETERMINATIONS AND
AGAIN. IT'S NOT TO SAY THAT WE
THAT WE FIND IT ACCEPTABLE THAT
INDIVIDUALS FALL THROUGH THE
CRACKS, BUT WE DO KNOW THAT
THERE ARE NO GAPS IN COVERAGE
AND YOU KNOW FROM AGAIN FROM THE
PROVIDER SIDE FROM THE COUNTY
SIDE. I MEAN, THERE'S YOU KNOW.
THERE'S BEEN WELL DOCUMENTED
CHALLENGES ACROSS THE BOARD OF
ENSURING THAT WE'RE SERVING, UH
, THESE INDIVIDUALS TO THE TO
THE BEST WE CAN. WHICH IS WHY I
THINK WE BELIEVE WE BELIEVE THAT
YOU KNOW, WE NEED TO ENSURE THAT
WE'RE PARTNERING AND MOVING
FORWARD WITH OUR PARTNERS TO
ENSURE THAT WE HAVE A MORE
COMPREHENSIVE COVERAGE SYSTEM.
UH I'LL BEGIN IF I CAN. I JUST
WANT TO VERIFY WITH THE
CALIFORNIA YOUTH AND BEHAVIORAL
HEALTH INITIATIVE. THE HEALTH
PLANS DIDN'T HELP TO CONTRIBUTE
, EVEN IF THE ENROLLEES ARE
RECEIVING BENEFITS. THERE WASN'T
A HELP TO BUILD OUT. THAT SYSTEM
IS THAT CORRECT HELP TO
CONTRIBUTE? HASN'T Y B H I WAS
THERE. HELP WITH EITHER
INFRASTRUCTURE DOLLARS WAS THEIR
HELP WITH THE ONLINE PLATFORM.
UM SO THERE IS THERE ANY
INVOLVEMENT OF THE PLANS? IF YOU
ARE RECIPIENTS ARE GOING TO BE
RECEIVING BENEFITS? YES UM, MR
CHAIR, JUST SOME OF THE THINGS
THAT WE'VE DONE. UH, IN THAT
SPACE, UM. UH IS THAT YOU KNOW?
YEAH. WE'VE HELPED DEVELOP SOME
OF THESE. UM YOU KNOW, SOME OF
THESE PROGRAMS YOU KNOW, WORKING
WITH WITH THE DEPARTMENT,
HEALTHCARE SERVICES AND
DEPARTMENT MANAGED HEALTH CARE,
YOU KNOW, IN TERMS OF LIKE
INFRASTRUCTURE BUILDING OUT. I
MEAN, I WOULD LEAVE IT TO IT TO
OUR RETAILERS TO DESCRIBE, YOU
KNOW, MORE DETAIL ABOUT WHAT
THEY'RE DOING. I KNOW WE ARE
CERTAINLY AT THE TABLE WITH
THEM. HAVING THOSE DISCUSSIONS
WITH THEM. WE OBVIOUSLY HAVE,
YOU KNOW A SERIES OF MANDATES
WITHIN THAT WITHIN THAT PROGRAM
THAT WE WERE REQUIRED TO COMPLY
WITH AND FOLLOW. UM BUT I WANTED
TO BE SURE THAT I FULLY
UNDERSTAND YOUR QUESTION. IN
TERMS OF YOU KNOW WHAT YOU'RE
ASKING ABOUT THE PLANS
CONTRIBUTED SPECIFICALLY TO
MAYBE I'LL TURN THE QUESTION. IT
WAS ONLY PUBLIC DOLLARS. THAT
HELPED TO CORRECT FOR THE ONLINE
SO THAT THIS THE COORDINATING
THE SETUP OF THE C Y B H I IS
WITH WITH STATE FUNDING. WHAT
THE HEALTH PLANS WILL BE PAYING
FOR IS THE SERVICES PROVIDED TO
THEIR ENROLLEES THROUGH THE
SCHOOLS. SO THAT'S THE YOU HEARD
ABOUT THE FEE SCHEDULE THAT DHC
SS DEVELOPING. WE WILL BE
ISSUING GUIDANCE TO THE
COMMERCIAL HEALTH PLANS BY THE
END OF THIS YEAR THAT THEY WILL
BE PAYING WHATEVER THAT FEE
SCHEDULE IS. FOR ANY SERVICES
PROVIDED THE ONLY OTHER PIECE I
WOULD ADD, IS THE SCHOOL BASED
LINK SERVICES THROUGH THE
MEDICAL MANAGED CARE PLANS IS
TECHNICALLY TUCKED UNDER THERE
AS WELL, UM IN PARTNERSHIP IN
THE AND THAT'S WHERE MAJOR CARE
PLANS ARE PARTNERS SCHOOLS AGAIN
, REALLY THE PARTNERSHIP AROUND
SCHOOLS AND THE FEE SCHEDULE?
THE REST IS, UH, IS EITHER IS
DOMINANTLY GENERAL FUND DOLLARS
CORRECT. MISS MRS WATANABE.
WE'LL TALK ABOUT IT IN THE NEXT
ISSUE REGARDING THE BUDGET
CHANGE PROPOSAL, BUT I WANT TO
COME BACK TO MR HAMPTON'S
COMMENT IF I COULD ON THE
SYSTEMIC WORKFORCE SHORTAGES ARE
WE ABLE TO MEET NETWORK ADEQUACY
STANDARDS AND IF NOT, OR WE
APPROPRIATELY INVESTING INTO
ADDRESSING THOSE SYSTEMIC
WORKFORCE SHORTAGES. YEAH AND SO
I THINK, UM, MR CHAIR, YOU KNOW,
IN JUST SOME OF THE KIND OF
POINTS THAT WE MADE ABOUT WHAT
THAT HEALTH PLANS ARE DOING IN
TERMS OF, UM, YOU KNOW,
INVESTING IN THAT WORKFORCE
DEVELOPMENT AGAIN. WE'RE DOING A
LOAN FORGIVENESS, OFFERING
SCHOLARSHIPS, INVESTING IN OUR
OWN MENTAL HEALTH CLINICIANS.
THAT'S WHAT WE'RE DOING
INTERNALLY, YOU KNOW, PER PER
PARITY LAWS HERE IN THE STATE IF
WE ARE NOT ABLE TO PROVIDE THAT
, THAT NETWORK WE NEED TO
ARRANGE FOR THOSE SERVICES TO BE
COVERED OUT OF NETWORK, THE
NETWORK PRICE SO UM, YOU KNOW
AGAIN, WHILE WE ARE BUILDING UP
THAT INTERNAL INFRASTRUCTURE TO
ENSURE THAT WE HAVE A ROBUST,
ADEQUATE AND HIGH QUALITY
NETWORK THE YOU KNOW WE DO HAVE
THE BACKSTOP. YOU KNOW, IN
STATUTES AS IF WE'RE NOT
BUILDING THAT NETWORK OUT
ADEQUATELY ENOUGH. AND THEN WE
AS HEALTH PLANS HAVE THE
OBLIGATION TO ARRANGE FOR THAT
CARE OUT OF NETWORK AND ENSURE
THAT THOSE SERVICES ARE BEING
DELIVERED. AND I REALLY AM
LOOKING FOR A PARTNERSHIP HERE
AS THE STATE IS INVESTING PUBLIC
RESOURCES WERE NOT SOLELY
RESPONSIBLE FOR ADDRESSING THE
WORKFORCE SHORTAGES AND NEED OUR
PLANS TO PLAY AN ACTIVE ROLE AND
SO HEARING HOW SYSTEMIC ISSUES
ARE. I THINK IT'S AN ALL OF THE
ABOVE APPROACH I'M LOOKING FOR
AND JUST WANTING TO MAKE SURE WE
HAVE THAT LEVEL OF
COMMUNICATION. AYE. QUESTION
WHETHER WE'RE MEETING THE
NETWORK ADEQUACY SINCE I DIDN'T
HEAR A RESPONSE FROM YOU THAT WE
WERE AND THAT REALLY MAKES ME
QUESTION WHY WE HAVEN'T BEEN
MAKING THESE INVESTMENTS PRIOR
TO NOW, AND I AND I THINK YOU'RE
SAYING WE'RE DOING SOME BUT YOU
ALSO CAN'T THEN SAY THAT YOUR
NETWORKS ARE ADEQUATE. TO DEAL
WITH THE NEED. I MEAN, I THINK
IT WOULD BE MR CHAIR. I THINK IT
WOULD BE. YOU KNOW, IT'S KIND OF
THE CHICKEN OR AN EGG TYPE OF
SITUATION. YOU KNOW IF THE
WORKFORCE ISN'T THERE IS
OBVIOUSLY VERY DIFFICULT TO
BUILD AN ADEQUATE HIGH QUALITY
AND ROBUST NETWORK IF WE DON'T
HAVE A ROBUST, HIGH QUALITY
NETWORK, YOU KNOW, THEN WE HAVE
THE CHALLENGES OF CONTRACTING
WITH AND WORKING WITH WITH, YOU
KNOW, GETTING THOSE PROVIDERS IN
NETWORK ESTABLISHED, YOU KNOW,
WE'LL RUN NETWORK SO YOU KNOW, I
THINK WE ARE ABSOLUTELY THAT'S A
THAT'S A HIGH PRIORITY. FOCUS. I
KNOW WITH THE DEPARTMENT OF
HEALTH CARE AND THE HEALTH CARE
SERVICES AS WELL, YOU KNOW,
WE'RE WORKING IN CONJUNCTION
WITH OUR WITH THE STATE TO
ENSURE THAT THAT YOU KNOW IS A
IT'S A LONG TERM, SUSTAINABLE,
HIGH QUALITY NETWORK MOVING
FORWARD, BUT AGAIN, WE NEED TO
DO WHAT WE CAN DO TO ADDRESS THE
WORKFORCE SHORTAGE TO ENSURE
THAT WE CAN BUILD THOSE NETWORKS
AND HAVE HAVE THOSE PROVIDERS
CONTRACT WITH US BECAUSE I
SHOULD POINT OUT YOU KNOW THAT
EVEN IF THERE ARE PROVIDERS THAT
ARE OUT THERE, UM, OFTENTIMES
THEY DON'T WANT TO CONTRACT WITH
WITH THE PLANS. THEY WOULD, YOU
KNOW, PREFER TO TAKE PRIVATE PAY
DOLLARS. UM YOU KNOW, DON'T WANT
TO BE BOUND BY THE BY THE
CONTRACT THAT THAT YOU KNOW,
THERE'S NEGOTIATED BETWEEN THE
PLANT AND THE PROVIDER. UM AND
THAT CREATES ADDITIONAL
CHALLENGES. WHERE WE HAVE
PROVIDERS ARE OUT THERE WHO ARE
JUST NOT WILLING TO CONTRACT
WITH US TO BUILD THAT NETWORK
OUT, SO IT'S CERTAINLY A MULTI
MULTI PRONGED ISSUE SOMETHING
THAT WE'RE VERY FOCUSED ON. UM
AND CONTINUED TO WORK ON MOVING
FORWARD. IS THERE ANY
OPPORTUNITY FOR THE
ADMINISTRATION TO IDENTIFY THIS
ANECDOTAL EXAMPLE IS HAPPENING
MORE FREQUENTLY, OR ARE WE
SHIFTING COSTS FROM PRIVATE
INSURANCE ONTO PUBLIC SYSTEMS?
HOW WOULD WE BE ABLE TO TRACK
AND FOLLOW THAT? I WANT TO TALK
ABOUT. UM I DON'T KNOW IF WE'D
BE ABLE TO NECESSARILY TRACK I'D
HAVE TO THINK ABOUT THAT A
LITTLE BIT MORE TO BE THOUGHTFUL
ON THAT RESPONSE, BUT WE DO WE
ARE SEEING THAT THERE. THERE
CLEARLY IS TIMES WHEN SOMEONE
WHO OTHERWISE HAS COMMERCIAL
INSURANCE IF THEY'RE STRUGGLING
WITH A MENTAL HEALTH DIAGNOSIS
OR SUBSTANCE USE, THEY CAN
SOMETIMES LOSE THEIR JOB.
BECAUSE OF THAT, THEY LOSE THEIR
COMMERCIAL INSURANCE. AND THEN
THEY COME ON MEDICAL. WE ALSO
KNOW THAT MEDICAL BARLEY COVERS
A LARGER ARRAY OF SERVICES AND
SUPPORTS FOR INDIVIDUALS. AND SO
SOMETIMES THERE ARE STRATEGIC
FAMILY DECISIONS THAT HAVE TO BE
MADE IN ORDER TO GET ACCESS TO
THOSE TYPES OF SERVICES. AND I
THINK THAT'S WHAT WE'RE TRYING
TO PREVENT. IN PARTNERING WITH
THE MHC ON THIS PARODY
INITIATIVE AND OTHER PIECES
BECAUSE WE THINK IT'S IMPORTANT
FOR ANYONE, REGARDLESS OF THEIR
INSURANCE. WITH HIS MEDICAL
DEGREE, THEY SHOULD HAVE ACCESS
TO ALL NEEDED MENTAL HEALTH AND
SUD SERVICES. UM AND SO AND ALSO
MAKING SURE THAT WE ARE
INTERVENING EARLIER AND YOU
KNOW, AT LEAST IN MEDICAL. IT'S
DIFFERENT FOR ON THE COMMERCIAL
SIDE. YOU KNOW, OUR MEDICAL
MEDICARE PLANS ARE ONLY
RESPONSIBLE FOR COVERING MILD TO
MODERATE SERVICES, BUT OFTEN THE
LACK OF THOSE, UM, ADEQUATE
ACCESS TO THE SERVICES ARE
LEADING TO A HIGHER CRISIS OF
MENTAL HEALTH SERVICES, PUTTING
THAT BURDEN ON OUR COUNTY
PARTNERS AND SO REALLY MAKING
SURE THAT OUR MEDICAL MANAGED
CARE PLANS ARE STEPPING UP TO
MEET THAT NEED, SO WE HAVE A LOT
OF EXAMPLES OF THAT. I'D HAVE TO
THINK THROUGH HOW HE COULD LOOK
AT DATA. IN THAT WAY. THAT'S A
LITTLE HARDER, BUT BUT THAT IS
WHY WE ARE ALL DOUBLING DOWN IN
REGARDS TO ACCESS TO THOSE
EARLIER INTERVENTION UPSTREAM
SERVICES TO PREVENT THE CRISIS
SERVICES. BUT ALSO TO MAKE SURE
THAT ANYONE THAT NEEDS ACCESS
HAS ACCESS TO THOSE SERVICES. UM
FINAL COMMENT. IF I CAN, I'M
GOING TO COME BACK TO MRS
HOTTEST STATEMENT EARLIER, THERE
SHOULD BE PARITY BETWEEN OUR
SYSTEMS IF WE'RE REQUIRING IT
FOR PUBLIC PLANS OR PRIVATE
PLANS, IN MY OPINION, SHOULD
HAVE SIMILAR STYLES. AND SO I
LOOK FORWARD TO THAT POLICY
DISCUSSION AS WE GO FORWARD AND
WELL, THANKS VERY MUCH. THIS
ENTIRE PANEL WE WILL NOW MOVE ON
TO ISSUE 19. 19 IS ON THE
ARGUMENT OF THE BEHAVIORAL
HEALTH FOCUSED INVESTIGATION.
WORKLOADS BRING FINANCE LETTER
ISSUE. MR SOUTHERN WHEN YOU ARE
READY.
GOOD EVENING, MR CHAIR TODAY AND
SOUTHERN FROM THE D. M. H C.
TEAM WHICH IS OFFICER PLAN
MONITORING, OR OPM PERFORMS
ROUTINE MEDICAL SURVEYS EVERY
THREE YEARS FOR EVERY DEMON, SEE
LICENSE, BEHAVIORAL HEALTH AND
SPECIAL HEALTH PLAN, ESPECIALLY
ITS HEALTH PLAN. THESE SURVEYS,
INCLUDING REVIEW OF THE
PROCEDURES FROM TEAMING
HEALTHCARE SERVICES, THEIR
PROCEDURES FOR REGULATING
UTILIZATION REVIEW MECHANISMS,
INTERNAL PROCEDURES FOR ASSURING
QUALITY OF CARE OVERALL
PERFORMANCE OF THE HEALTH PLAN
AND PROVIDING HEALTH CARE
BENEFITS AND MEETING THE HEALTH
NEEDS OF THEIR SUBSCRIBERS INTO
ROLLEY'S. IN FISCAL YEAR 2021 C,
RECEIVED APPROVAL AND FUNDING TO
CONDUCT FOCUSED INVESTIGATIONS
OF 25 FULL SERVICE. COMMERCIAL
HEALTH PLANS REGULAR BY
REGULATED BY THE DMC TO ASSESS
WHETHER ENROLLEES HAVE
CONSISTENT ACCESS TO MEDICALLY
NECESSARY BEHAVIOR. HEALTH
SERVICES. THE BEHAVIOR. HEALTH
FOCUS. INVESTIGATIONS ASSESS
AREAS OF HEALTH PLAN DELIVERY
SYSTEMS THEY'RE NOT COMMONLY
ASSESSED DURING OUR ROUTINE
MEDICAL SURVEYS. THE D. M. E C.
ANTICIPATED CONDUCTING THE
INVESTIGATIONS OVER A PERIOD OF
FIVE YEARS BY INVESTIGATING FIVE
HEALTH PLANS PER YEAR. DURING
THIS PROCESS TO DEVIANCY HAS
IDENTIFIED THREE ADDITIONAL
HEALTH PLANS FOR A TOTAL OF 28
HEALTH PLANS. MEETING
INVESTIGATION ELIGIBILITY
CRITERIA. ADDITIONALLY SEVERAL
FACTORS HAVE INCREASED THE
COMPLEXITY, DIFFICULTY AND
VOLUME OF WORK ASSOCIATION
ASSOCIATED WITH THESE
INVESTIGATIONS. THOSE FACTORS
INCLUDES THE DNC'S EXPANDED THE
SCOPE OF THE INVESTIGATIONS TO
INCORPORATE A REVIEW AND
ANALYSIS OF THE HEALTH PLANS,
NON QUANTITATIVE TREATMENT
LIMITATIONS OR IN CONCEALS, AND
THIS WAS A RESULT OF OUR
ENGAGEMENT WITH STAKEHOLDERS
PRIOR TO INITIATING THESE
BEHAVIORAL INVESTIGATIONS, BUT
AFTER WE RECEIVED THE BCP
APPROVAL THIS COMPONENT OF THE
INVESTIGATION WAS NOT CONSIDERED
AS PART OF THE ORIGINAL PROPOSAL
SINCE THE FEDERAL LAW
OPPORTUNITIES AND NON QUANTITY
RE TREATMENT LIMITATIONS PASSED
IN DECEMBER OF 2020, WHICH WAS
SUBSEQUENT TO THE SUBMITTAL OF
THE ORIGINAL PROPOSAL.
INVESTIGATIONS REQUIRE HEALTH
MANSOUR SMITH DOCUMENTS, DATA
AND INFORMATION NOT OTHERWISE
REQUESTED AS PART OF THE HEALTH
PLANS, ROUTINE SURVEYS REVIEWING
THIS DOCUMENTATION REQUIRES
SIGNIFICANT TIME AND
COORDINATION BETWEEN THE D M E C
AND THE CONTRACTOR COMPLETE THE
REVIEWS. A SIGNIFICANT AMOUNT OF
TIME IS ALSO SPENT WITH THE
SPECIAL INVESTIGATORS IN THE D.
V. C S OFFICE OF ENFORCEMENT WHO
HAVE BEEN CONDUCTING ENROLLING
AND PROVIDER INTERVIEWS TO
DETERMINE BARRIERS TO OBTAINING
AND PROVIDING BEHAVIOR. HEALTH
SERVICES. DUE TO THE SIGNIFICANT
IMPACT OF THE FACTORS IDENTIFIED
ABOVE THE DVC IS UNABLE TO
TIMELY COMPLETE THE FOCUS
INVESTIGATIONS WITHOUT THE
ADDITIONAL REQUESTED RESOURCES
CONDUCTING THE FOCUS
INVESTIGATIONS IS NECESSARY TO
DETERMINE WHY ENROLLEES CONTINUE
TO EXPERIENCE DELAYS IN
OBTAINING BEHAVIOR HEALTHCARE
SERVICES. AND IDENTIFY NON
COMPLIANT PRACTICES OR BARRIERS
SECURE AND HEALTH PLANS DELIVERY
SYSTEM. THE DEMON SHE'S OFFICER
. PLANNED MONITORING IS
REQUESTING EIGHT POSITIONS AND
APPROXIMATELY $3 MILLION IN
FISCAL YEAR 23 24. DECREASING
THE $2.9 MILLION IN FISCAL YEAR
24 25 ONLY THEREAFTER FROM THE
MANAGED CARE FUND TO CONTINUE
AND COMPLETE THE FOCUS
BEHAVIORAL FIST INVESTIGATIONS
INTO INCORPORATE LONG RANGE
BEHAVIORAL HEALTH FOCUS
ASSESSMENTS INTO OUR ROUTINE
MEDICAL SURVEYS. THIS REQUEST
INCLUDES CONSULTING FUNDING OF
$1.3 MILLION ANNUALLY FOR
STATISTICAL AND CLINICAL
CONSULTANT TO ASSIST AND
IDENTIFYING BEHAVIOR HEALTH
COMPLIANCE ISSUES IN CONDUCTING
THE INVESTIGATIONS THAT
CONCLUDES MY OVERVIEW WEREN'T
HAPPY TO ANSWER ANY QUESTIONS.
DEPARTMENT OF FINANCE. ALRIGHT
FINANCE, NO ADDITIONAL COMMENTS
. BUT CAN YOU ANSWER ANY
QUESTIONS? THANK YOU. WE HAVE
NOT RAISED CONCERNS WITH THIS
PROPOSAL WILL BRING IT UP TO THE
DIESS. FIRST IF I CAN DO YOU
HAVE CONFIDENCE WITH THIS BCP
THAT YOU'LL BE ABLE TO GET TO
THE FIVE BEHAVIORAL HEALTH PLAN
EVALUATIONS PER YEAR THAT YOU'RE
EXPECTING? YES, WE GROSSLY
UNDERESTIMATED THE WORKLOAD IN
OUR FIRST PROPOSAL, AND WE HAVE
SUFFICIENT RESOURCES AND OUR
OFFICE ENFORCEMENT BUT DIDN'T
REQUEST ENOUGH RESOURCES ARE
OFTEN PLAYING MONITORING. MY
UNDERSTANDING IS THESE ARE FOR
THE ROUTINE SURVEYS. WILL THIS
ASSIST OR HELPING THE NON
ROUTINE SURVEYS AS WELL? SO THIS
IS THIS REQUEST IS SPECIFICALLY
FOR BEHAVIORAL HUDSON
INVESTIGATIONS OVER THE FIRST
FIVE YEARS TO COMPLETE THE 28
HEALTH PLANS, AND THEN WE WILL
ROLL THIS WORKLOAD INTO OUR
ROUTINE MEDICAL SURVEYS. AND NON
ROUTINE MEDICAL SURVEY IS IF WE
ARE ALERTED TO AN EGREGIOUS ACT
BY A HEALTH PLAN, WE CAN CONDUCT
A NON ROUTINE SURVEY AND THE
DIFFERENCE BETWEEN THAT AND A
ROUTINE SURVEY IS THE HEALTH
PLAN PAYS FOR US TO CONDUCT AN
AND ROUTINE SURVEY, BUT IT'S A
SPECIFIC ISSUE THAT'S BEEN
BROUGHT TO OUR ATTENTION. MAYBE
THROUGH A WHISTLEBLOWER
COMPLAINT OR TWO OF OUR STATE
COLLEAGUES. IS THERE AN
APPROPRIATE AMOUNT OF TIME FOR
THOSE NON ROUTINE SURVEYS TO BE
CONDUCTED SINCE, UM IT WOULD
SEEM THAT YOU'RE ABLE TO
CONCLUDE A BEHAVIORAL HEALTH.
PLAN ASSESSMENT WITHIN 12
MONTHS. PERIOD. WHY ARE THERE
CERTAIN PRIVATE INSURANCE PLANS
THAT HAVE LONGER TIMELINES FOR
NON ROUTINE SERVICE. SO IT'S A
GOOD QUESTION. WE ARE NOT
CONDUCTING THE EAST CURRENTLY IN
THE 12 MONTH PERIOD, WHICH IS
WHY WE'RE COMING BACK FOR THE
ADDITIONAL RESOURCES. WE
ANTICIPATE OUR FIRST YEAR. FIVE
HILLS PLAN INVESTIGATIONS. TO
REDUCE OUR TO PRODUCE THOSE
REPORTS, PROBABLY IN THE NEXT
QUARTER, SO IT IS TAKING US MORE
THAN 12 MONTHS CURRENTLY TO
CONDUCT THESE BEHAVIORAL
INVESTIGATIONS IF THE PLANS ARE
PAYING FOR THE NON ROUTINE
SURVEYS, SHOULDN'T WE THEN BE UM
, INCREASING HOW MUCH WE'RE
CHARGING TO MAKE SURE WE CAN GET
THESE IN A TIMELY FASHION.
SHOULDN'T THERE BE SIMILAR
TIMELINES THAT WE'RE DOING WITH
THE BABY OR HEALTH EVALUATIONS
OR DO WE NOT THINK WHISTLEBLOWER
COMPLAINTS ARE SUFFICIENT REASON
FOR US TO COMPLETE THESE IN A
TIMELY FASHION. SORRY THE NON
ROUTINE SURVEYS GENERALLY TAKE
ABOUT 18 MONTHS. UM IT DEPENDS
ON THE ISSUE THAT WE'RE LOOKING
AT. AND HOW MANY ISSUES WE'RE
LOOKING AT TO HOW MANY FILES THE
SIZE OF A HEALTH PLAN DEPENDS ON
HOW MANY FILES WE NEED TO REVIEW
HOW MANY POLICIES PROCEDURES WE
NEEDED TO REVIEW SO I'M STANDING
GENERALLY, IT TAKES ABOUT 18
MONTHS, IT COULD BE A LITTLE
SHORTER. DEPENDING ON THE
ISSUES, MAYBE A TIME BIT LONGER.
TO SUPPORT YOUR HEALTH PLAN WITH
MULTIPLE ISSUES IN A NON ROUTINE
SURVEY, AND I HOPE WHAT YOU'RE
HEARING FROM US IS SUPPORT FOR
THE BCP AND WANTING TO ENSURE
THAT WE ARE ABLE TO COMPLETE
THESE UM, STUDIES. IT'S SIMPLY
QUESTIONING WHETHER WE'RE DOING
IT AT A FAST ENOUGH TIME FRAME
TO MAKE SURE WE HAVE INFORMATION
SO WE CAN THEN MAKE WORKFORCE
DECISION. CORRECT NETWORKS. I AM
HEARING YOUR CONCERNS, AND
THAT'S WHY WE'RE REQUESTING.
THIS IS TO SPEED UP OUR
BEHAVIORAL INVESTORS.
INVESTIGATIONS. GET US BACK ON
TRACK. TO THE FIVE PER YEAR.
WITH THAT I WILL THANK VERY MUCH
THIS PANEL AND WE WILL MOVE ON
TO ITEM ISSUE 19. EXCUSE ME,
ISSUED 20. ISSUE 20 YEARS AND
OVERSIGHT ON THE BEHAVIORAL
HEALTH COMPONENTS OF CAL AIM. I
HAVE MS. COOPER UP FIRST. MS
COOPER. OH, SORRY. NO. GOOD.
PLEASE CONTINUE. YEAH I'LL TAKE
THAT AS A COMPLIMENT. IT WOULD
BE A COMPLIMENT. GOOD AFTERNOON
. GOOD EVENING CHAIR. UM HAPPY
TO PROVIDE AN OVERVIEW AND
IMPLEMENTATION UPDATES ON
BEHAVIORAL HEALTH COMPONENTS OF
KELL AM TODAY, NEARLY ONE IN 20
, CALIFORNIA ADULTS LIVES WITH A
SERIOUS MENTAL ILLNESS AND MORE
THAN TWICE AS MANY HAVE
SUBSTANCES DISORDER TO IMPROVE
ACCESS TO CARE AND MEMBER
EXPERIENCE IN PROVIDER
EXPERIENCE. KLM INCLUDES OVER A
DOZEN BEHAVIORAL HEALTH, UH,
POLICY INITIATIVES. WE CONTINUE
TO ROLL OUT AND TO OVERSEE THE
IMPLEMENTATION OF THESE CALAIS
IN BEHAVIORAL HEALTH POLICY
CHANGES WILL HIGHLIGHT A FEW
INITIATIVES RIGHT NOW IN OUR
REMARKS AND HAPPY TO ANSWER
QUESTIONS ABOUT OTHERS AS
NEEDED. UPDATED ACCESS CRITERIA
FOR SPECIALTY MENTAL HEALTH
SERVICES WENT INTO EFFECT.
JANUARY 2022 THIS GUIDANCE
CLARIFIES THAT SPECIALTY MENTAL
HEALTH SERVICES CAN BE PROVIDED
DURING THE ASSESSMENT PERIOD,
INCLUDING BEFORE A DIAGNOSIS IS
MADE. IT ESTABLISHES FURTHER
ALIGNMENT WITH FEDERAL EARLY IN
PERIODIC SCREENING, DIAGNOSIS
AND TREATMENT REQUIREMENTS. IT
STREAMLINES MEDICAL NECESSITY.
IT ESTABLISHES ACCESS CRITERIA
FOR SPECIALTY MENTAL HEALTH
SERVICES, INCLUDING TRAUMA,
INFORMED ACCESS FOR CHILDREN AND
YOUTH UNDER 21. ALSO IN JANUARY
OF LAST YEAR, THE DEPARTMENT
IMPLEMENTED A VARIETY OF
IMPROVEMENTS AND POLICY UPDATES
TO OUR DRUG MEDICAL ORGANIZED
DELIVERY SYSTEM. ON JULY 1ST OF
2022 NO WRONG DOOR POLICIES WERE
IMPLEMENTED TO ENSURE
INDIVIDUALS CAN ACCESS NEEDED
BEHAVIORAL HEALTH SERVICES. NO
MATTER WHAT DOOR THEY COME
THROUGH, AND NO MATTER THE
DELIVERY SYSTEM, THE INITIALLY
SEEK CARE. UNDER NO WRONG DOOR.
MEDICAL MEMBERS ARE ABLE TO
RECEIVE MENTAL HEALTH SERVICES
DURING THE ASSESSMENT PROCESS
EVEN BEFORE A DIAGNOSIS IS
ESTABLISHED, NO WRONG DOOR
CLARIFIES THERE IS NO WRONG
PRIMARY DIAGNOSIS AND MEMBERS
CAN RECEIVE MENTAL HEALTH
SERVICES EVEN IF THEY HAVE A CO
OCCURRING SUBSTANCES DISORDER
AND VICE VERSA. NO WRONG DOOR
PERMITS CONCURRENT TREATMENT SO
INDIVIDUALS CAN RECEIVE BOTH NON
SPECIALTY MENTAL HEALTH SERVICES
THROUGH THEIR MEDICAL MANAGED
CARE PLAN. AND SPECIALTY MENTAL
HEALTH SERVICES THROUGH THEIR
COUNTY PROVIDED THOSE SERVICES
ARE COORDINATED AND NOT
DUPLICATIVE. IN JULY. 1ST OF
LAST YEAR, THE DEPARTMENT ALSO
IMPLEMENTED DOCUMENTATION REFORM
POLICIES TO STREAMLINE AND
STANDARDIZE CLINICAL
DOCUMENTATION REQUIREMENTS
ACROSS SPECIALTY MENTAL HEALTH,
DRUG, MEDICAL AND DRUG MEDICAL
ORGANIZED DELIVERY SYSTEM. I'D
LIKE TO HIGHLIGHT THAT WHILE THE
DEPARTMENT ISSUED GUIDANCE TO
THAT EFFECTIVELY STREAMLINED
MEDICAL CLINICAL DOCUMENTATION
REQUIREMENTS, THERE ARE SEVERAL
INTERCEPTING FEDERAL
REQUIREMENTS PERTAINING TO
CLINICAL DOCUMENTATION THAT
CONTINUE TO POSE CHALLENGES FOR
OUR PROVIDERS. WE ARE ACTIVELY
SEEKING FEDERAL APPROVAL TO
WAIVE THESE REQUIREMENTS AND TO
FULLY ACHIEVE THE GOAL OF
DOCUMENTATION REFORM. WE
CONTINUE TO WORK CLOSELY WITH
OUR STAKEHOLDERS AND OUR KEY
PARTNERS TO ADDRESS
IMPLEMENTATION CONCERNS IN THIS
AREA. WE PLAN TO ISSUE UPDATED
GUIDANCE THIS YEAR THAT WILL
CLARIFY FURTHER SIMPLIFY AND
FURTHER STREAMLINE CLINICAL
DOCUMENTATION FOR BEHAVIORAL
HEALTH. ONE MORE KELLEN POLICY
UPDATE FOR BEHAVIORAL HEALTH
THAT HAS GONE INTO EFFECT IS THE
MEDICAL MANAGED CARE PLAN AND
COUNTY MENTAL HEALTH PLAN
SCREENING IN TRANSITION OF CARE
TOOLS FOR ADULTS AND YOUTH. THIS
WENT LIVE IN JANUARY OF THIS
YEAR. THESE SCREENING TOOLS
PROVIDE A BRIEF SET OF
STANDARDIZED QUESTIONS TO
DETERMINE THE MOST APPROPRIATE
DELIVERY SYSTEM FOR AN INITIAL
REFERRAL AND FOR AN INITIAL
ASSESSMENT FOR MEMBERS WHO
CONTACT THEIR MANAGED CARE PLAN
OR THEIR COUNTY SEEKING MENTAL
HEALTH SERVICES. THE TRANSITION
OF CARE TOOL IS USED TO SUPPORT
TIMELY AND COORDINATED CARE AS
MEMBERS MOVE IN BETWEEN THOSE
DELIVERY SYSTEMS. THESE TOOLS
WERE DEVELOPED OVER A TWO YEAR
PERIOD WITH ROBUST STAKEHOLDER
ENGAGEMENT. THIS INCLUDED
STAKEHOLDER WORKING GROUPS AND
MULTIPLE ROUNDS OF TESTING WITH
MEDICAL MANAGED CARE PLANS AND
COUNTIES. FIELD TESTING SHOWS
POSITIVE RESULTS, INCLUDING HIGH
BENEFITS, HIGH MEMBER
SATISFACTION, QUICK AND RAPID
ADMINISTRATION. THE ABILITY TO
IMPLEMENT THESE TOOLS FOR STAFF
WITH VARIED TRAINING LEVELS AND
CREDENTIALS, AND THEY RESULTED
IN CONFIDENCE IN THE
APPROPRIATENESS OF THE
REFERRALS. THE NEXT PELEMBE
BEHAVIORAL HEALTH INITIATIVE
THAT WILL BE IMPLEMENTED IS
BEHAVIORAL HEALTH PAYMENT
REFORMS SCHEDULED TO GO INTO
EFFECT JULY OF THIS YEAR. THE
GOAL IS TO REFORM BEHAVIORAL
HEALTH PAYMENT METHODOLOGIES
WITH THE GOAL OF INCENTIVIZING
QUALITY, PROVIDING ADDITIONAL
INVESTMENT AND FLEXIBILITY IN
THE COUNTY BEHAVIORAL HEALTH
DELIVERY SYSTEM AND REDUCING
ADMINISTRATIVE BURDEN ON
COUNTIES AND PROVIDERS, WHILE
PROVIDING ADDITIONAL DATA ON THE
TYPES OF SERVICES PROVIDED WE
WILL PROVIDE MORE INFORMATION ON
THIS ISSUE. 22. THE DEPARTMENT
RECENTLY SOLICITED FEEDBACK ON
FINAL, UH, CAL IN BEHAVIORAL
HEALTH POLICY INITIATIVE, WHICH
IS BEHAVIORAL HEALTH,
ADMINISTRATIVE INTEGRATION,
WHICH WILL BE IMPLEMENTED
BETWEEN NOW AND 2027.
ADMINISTRATIVE INTEGRATION
BUILDS ON KELLEN POLICY
IMPROVEMENTS THAT ARE REALLY
ALREADY IN PLACE TO FURTHER
IMPROVE COORDINATED CARE FOR
MEMBERS WITH CO OCCURRING MENTAL
HEALTH AND SUBSTANCE USE
DISORDER BY EFFECTIVELY
COMBINING THE MEDICAL MENTAL
HEALTH PROGRAM AND THE SUBSTANCE
USE DISORDER PROGRAM INTO ONE
SINGLE BEHAVIORAL HEALTH PROGRAM
WITHIN EACH COUNTY. BY 2027. THE
STATE AND ALL COUNTIES WILL
ADMINISTRATIVELY INTEGRATE
SPECIALTY MENTAL HEALTH SERVICES
AND SPECIALTIES. SUBSTANCE USE
DISORDER SERVICES INTO A SINGLE
STATE COUNTY CONTRACT. THIS. THE
GOAL IS REALLY TO IMPROVE HEALTH
OUTCOMES AND THE BENEFITS YOUR
EXPERIENCE BY REDUCING
ADMINISTRATIVE COMPLEX
COMPLEXITY IN BURDEN. AS NOTED
IN THE HEARING AGENDA, A TOTAL
OF $86 MILLION HAS BEEN MADE
AVAILABLE TO COUNTY BEHAVIORAL
HEALTH AGENCIES THROUGH THE
BEHAVIORAL HEALTH QUALITY
IMPROVEMENT PROGRAM TO SUPPORT
THE IMPLEMENTATION OF KELLY AND
BEHAVIORAL HEALTH INITIATIVES.
THIS FUNDING IS AVAILABLE OVER
THREE YEARS BEGINNING IN FISCAL
YEAR 21 22. TO PROVIDE TECHNICAL
ASSISTANCE TO OUR COUNTY AND
PROVIDER PARTNERS. THE
DEPARTMENT LAUNCHED
TRANSFORMATIONAL WEBINARS AND
WEB BASED DOCUMENTATION, VIDEOS
AND GUIDES. FORMAL GUIDANCE ARE
COMPREHENSIVE F A Q S AND WEEKLY
OFFICE HOURS TO DATE OVER 90,000
TRAINING COURSES HAVE BEEN
COMPLETED BY COUNTY STAFF AND BY
PROVIDER STAFF. THE DEPARTMENT
IS FOCUSED ON MONITORING
PERFORMANCE OF THE
IMPLEMENTATION OF KEY KELLY
ADMINISTRATIVE, PARTICULARLY THE
ACCESS CRITERIA FOR SPECIALTY
MENTAL HEALTH SERVICES. NO WRONG
DOOR IN THE SCREENING AND
TRANSITION TOOLS. COUNTY
CONTRACTS ARE UPDATED TO HOLD
COUNTIES ACCOUNTABLE FOR THESE
NEW REQUIREMENTS. THIS ENABLES
THE DEPARTMENT TO INCORPORATE
NEW KALLEN POLICIES INTO
EXISTING MONITORING PROTOCOLS,
INCLUDING ANNUAL COMPLAINTS
REVIEWS AND TO IMPOSE CORRECTIVE
ACTION AS NEEDED FOR IDENTIFIED
DEFICIENCIES. IN ADDITION, THE
DEPARTMENT HAS DEVELOPED A
PERFORMANCE MONITORING PLAN FOR
THE ROLLOUT OF THESE NEW
INITIATIVES. THE DEPARTMENT IS
PRODUCING DATA ANALYTICS TO
ASSESS UM EARLY AND MEDIUM TERM
IMPLEMENTATION OF THESE
INITIATIVES. IN ADDITION, THE
DEPARTMENT PLANS TO CONDUCT
SURVEYS AND INTERVIEWS WITH
COUNTY MENTAL HEALTH PLANS,
MEDICAL MANAGED CARE PLANS AND
MEMBERS CONSUMERS TO GAIN MORE
INSIGHT INTO PLAN EXPERIENCE AND
THE MEMBER EXPERIENCE FOR THESE
CHANGES. WE ARE ALSO COLLECTING
AND REVIEWING RELEVANT POLICIES
AND PROCEDURES, UPDATING MEMORY
AND MEMORANDUM OF UNDERSTANDING
BETWEEN COUNTIES IN THE MEDICAL
MANAGED CARE PLANS AND USING
BEHAVIORAL HEALTH QUALITY
IMPROVEMENT PROGRAM DATA TO
BETTER UNDERSTAND OUR FINDINGS.
ALL RIGHT. IN EARLY 2020 FOR THE
DEPARTMENT PLANS TO DEVELOP AND
RELEASE A REPORT FOR EACH KELLY
. UM INITIATIVE THAT SUMMARIZES
OUR FINDINGS. SO WITH THAT HAPPY
TO PROVIDE ANY FURTHER
INFORMATION OR ANSWER ANY
QUESTIONS NEXT, WE ARE GONNA
SHELL CABRERA, EXECUTIVE
DIRECTOR OF C B H T A. THANK YOU
SO MUCH CHAIR. UM TYLER DID AN
AMAZING JOB OF LAYING OUT THE
WHAT? BEHIND OUR CALLUM
BEHAVIORAL HEALTH REFORM
INITIATIVES. THIS HAS BEEN A
MASSIVE OVERHAUL OF HOW WE DO
BUSINESS WITH THE STATE OF
CALIFORNIA AND OUR MEDICAL
BENEFICIARIES. I'M GOING TO TALK
A LITTLE BIT ABOUT THE WISE, UM
, WHEN WE GOT TOGETHER IN 2019
SCALLION WAS SORT OF BEING
PULLED TOGETHER. WE WERE LOOKING
AT WHAT ARE THE WHAT ARE THE
THINGS THAT ARE REALLY HOLDING
OUR COUNTY BEHAVIORAL HEALTH
PLANS BACK THAT ARE MAKING THE
EXPERIENCE UNTENABLE FOR OUR
BENEFICIARIES AND FOR OUR
PROVIDERS, AND ESPECIALLY FOR
THE OUTCOMES THAT WE WERE SEEING
FOR THE POPULATIONS WE WERE
SERVING. AND WE IDENTIFIED
NUMEROUS KEY STRUCTURAL ISSUES.
ONE OF THE COURT ISSUES WAS THAT
ACCESS CRITERIA RIGHT IT USED TO
BE TALKED ABOUT IN TERMS OF
MEDICAL NECESSITY CRITERIA AND
WE WERE, UM ARE CLINICIANS WERE
HAVING TO TIE THEMSELVES UP IN
KNOTS TO TRY TO IDENTIFY A
DIAGNOSIS AND TO MAKE SURE THAT
IT WAS THE RIGHT ONE BECAUSE ALL
OF OUR SERVICES WOULD BE AUDITED
TO THAT ORIGINAL DIAGNOSIS, AND
IT WAS REALLY THE GATEKEEPER
BETWEEN WHETHER YOU COULD BE
BASICALLY FUNDED UNDER MEDICAL
SPECIALTY, BEHAVIORAL HEALTH OR
NOT, AND SO REVISING, THAT IS A
REAL GAME CHANGER. STRUCTURALLY
OVER THE LONG TERM, IT REALLY
FREES US UP TO BE ABLE TO LOOK
AT OURSELVES AS A TRUE SPECIALTY
PLAN. PROVIDING SPECIALTY CARE
SERVICES, RIGHT REGARDLESS OF
WHAT SOMEONE'S DIAGNOSIS IS,
WE'RE LOOKING MORE AT FUNCTIONAL
IMPAIRMENT. UM THE OTHER PIECES
. WE WORKED HARD WITH THE
DEPARTMENT AND WITH MANAGED CARE
PLANS TO COME UP WITH THOSE
TRANSITION OF CARE TOOLS THAT
REALLY SUPPORT THE NO WRONG DOOR
APPROACH AND MAKING SURE THAT
PEOPLE DO LAND IN THE RIGHT
SYSTEM, REGARDLESS OF THEIR
THEIR THEIR DIAGNOSIS AND WITH
THE RIGHT SETS OF SERVICES. UM
AND THEN, FINALLY, THE PAYMENT
REFORM INITIATIVE IS JUST REALLY
CRUCIAL. WE ALONG WITH
DOCUMENTATION REFORM, WE WANT TO
SHIFT AWAY FROM A COMPLIANCE
MINDSET AND ORIENTATION THAT
REALLY SEEKS TO SERVE OUR STATE
AUDITORS. SORRY TO PUT IT THAT
WAY, BUT MORE TO A PATIENT
CENTERED APPROACH WHERE WE'RE
LOOKING AT THE NEEDS AND OF THE
CLIENTS AND THE BENEFICIARIES,
AND PART OF THAT IS REALLY
SUPPORTING THE WORKFORCE AS WELL
. SO UM ARE CLINICIANS WOULD
TELL US ABOUT HOW THEY FELT LIKE
THEY HAD TO DOCUMENT ALL OF
THEIR SERVICES EXACTLY IN SUCH A
WAY OTHERWISE, THOSE SERVICES
WOULD BE DISALLOWED. IF THEY
WEREN'T DONE APPROPRIATELY. WE
SHOULDN'T BE PRIORITIZING
PAPERWORK THAT WAY. UM AND THEN,
IN TERMS OF THE PAYMENT REFORM
INITIATIVE AS TYLER LAID OUT
MOVING FROM A COST BASED SYSTEM
, WHICH WAS TIED TO THEM LITERAL
MECHANISM OF HOW WE WERE
PROVIDING THE NON FEDERAL SHARE
FOR MEDICAL SERVICES. UM WILL
ALLOW US TO MOVE AWAY FROM
CARRYING HUNDREDS OF MILLIONS OF
DOLLARS OF RISK EVERY YEAR, AND
THAT'S PART OF THAT AUDITING AND
RESET COST SETTLEMENT PROCESS
THAT IS TIED TO OUR CERTIFIED
PUBLIC EXPENDITURE. TIED TO OUR
COST BASED REIMBURSEMENT. NOW
THERE'S SOME SECURITY BLANKET
AND SAFETY AND COST BASED
REIMBURSEMENT WHERE SHIFTING TO
FEED FOR SERVICE, WHICH IS OLD
SCHOOL IN MEDICAL MODELS AND NEW
SCHOOL FOR US, BUT ONE OF THE
POTENTIAL BENEFITS IS THAT WE
REALLY ARE GOING TO BE LINKING
IT TO THAT BETTER, UM, CODING
AND SO WELL THAT D H C S WILL
HAVE A LOT BETTER INSIGHT INTO
THE KINDS OF SERVICES THAT WE'RE
PROVIDING. AND THEN IN ADDITION,
WE'RE GOING TO BE INCENTIVIZING.
MORE PRODUCTIVITY AMONG OUR
PROVIDERS, WHICH MEANS TRYING TO
GET MORE, UM, BEING FOR A BUCK
IN TERMS OF WHAT? WHAT CAPACITY
WE DO HAVE IN OUR SYSTEM. THIS
HAS BEEN A MASSIVELY HEAVY LIFT
AND ON AN EXTREMELY AGGRESSIVE
TIMELINE AND ON TOP OF A GLOBAL
PANDEMIC, I WILL SAY AND SO I DO
THINK YOU KNOW, WE'RE ASKING FOR
A LITTLE BIT OF GRACE COUNTIES.
LITERALLY I THINK LESS LAST WEEK
RECEIVED THE LAST OF OUR RATES
IN MOST CASES FOR PAYMENT
REFORMS. SO FOR THE FIRST TIME
THIS WEEK. THEY ARE LAST WEEK
THEY HAD THE ABILITY TO PIECE
TOGETHER WHAT RATES THEY WOULD
BE RECEIVING ACROSS ALL LINES OF
BUSINESS TO DO SOME MODELING,
AND I JUST WANT TO SAY THAT,
BASED ON INITIAL MODELING. AND
BECAUSE OF THE VERY COMPLEX
FINANCING PICTURE. UM SOME
COUNTIES ARE VERY CONCERNED
ABOUT HOW CLOSE TO THE MARGIN
THEY ARE BETWEEN THE AMOUNT OF
REVENUES THAT WERE RECEIVING
THIS YEAR ARE PROJECTED
EXPENDITURES UNDER PAYMENT
REFORM AND THE NEW PAYMENT RATES
. SO THE PROPOSAL TO PROVIDE
FUNDING TO SUPPORT THE
IMPLEMENTATION OF PAYMENT
REFLECTS FORM IS ESSENTIAL. WE
WILL NOT HAVE THE CASH FLOW. UM
IN MANY CASES WITHOUT THAT
FUNDING, SO TAKEN TOGETHER AT
THE WHOLE, VERY HARD, VERY HEAVY
LIFT, BUT WE THINK IT'S
STRUCTURAL CHANGE THAT WILL
SUPPORT THE MODERNIZATION OF OUR
SYSTEM AND BRINGING US INTO THE
21ST CENTURY OR AT LEAST CLOSE
TO THE END OF THE 20TH. THANK
YOU. DEPARTMENT OF FINANCE.
ILEANA ROMMEL'S DEPARTMENT OF
FINANCE HERE TO ANSWER ANY
QUESTIONS WILL OWNS AVAILABLE
FOR QUESTIONS. BRING IT UP TO
THE DIESS, VERY APPRECIATIVE OF
MANY OF THE CHANGES THAT ARE
BEING MADE WANTED TO FOCUS ON
THE ADMINISTRATIVE INTEGRATION
AND THE SINGLE STATEWIDE OR
STATE COUNTY CONTRACT. HOW ARE
WE GOING TO OPERATIONALIZE THIS?
WHAT TRANSITIONS LOOK LIKE
BRAIDING MHS S¼ FUNDS. I'M JUST
TRYING TO UNDERSTAND. ABSOLUTELY
IT'S VERY TECHNICALLY COMPLEX.
THANK YOU FOR YOUR QUESTION
CHAIR. UM WE HAD JUST, UH, ENDED
, UM, SORT OF A STAKEHOLDER
INPUT COMMENT PERIOD ON A DENSE
CONCEPT PAPER THAT LAYS OUT THE
VISION AND THE PROPOSED PHASES
FOR IMPLEMENTING ADMINISTRATIVE
INTEGRATION. THE DEPARTMENT HAS
IDENTIFIED 11 CORE COMPONENTS OF
ADMINISTRATIVE INTEGRATION.
TODAY MANY COUNTIES ARE ALREADY
UM ACHIEVING OR PERFORMING IN
AND ADMINISTRATIVELY INTEGRATED
CAPACITY. AND SOME OF THESE
COMPONENTS, UM WE'RE IDENTIFYING
THAT PHASE ONE IS AN OPPORTUNITY
FOR COUNTIES TO VOLUNTARILY. UH
ACHIEVEMENT ADMINISTRATIVE
INTEGRATION OVER SOME OF THOSE
COMPONENTS WHERE THEY HAVE THE
STATUTORY AND REGULATORY ABILITY
TO DO SO. WE VIEWED THIS PHASE
AS SORT OF PRIME FOR 2023
THROUGH 2025. WE ARE WORKING
WITH OUR FEDERAL PARTNERS TO
RECEIVE APPROVAL TO ALLOW
COUNTIES TO VOLUNTARILY. UH UM,
ENTER INTO AN ADMINISTRATIVE
CONTRACT. THESE WOULD BE THE 37
COUNTIES PARTICIPATING IN THE
DRUG MEDICAL ORGANIZED DELIVERY
SYSTEM, SO THEY HAVE THE OPTION
TO ACTUALLY ACCELERATE THEIR
TIMELINE FOR, UM, TRANSITIONING
FROM OPERATING A STANDALONE
MENTAL HEALTH MANAGED CARE PLAN
AND A STANDALONE SUBSTANCES
MANAGED CARE PLAN. AND BY 2025.
IF THEY CHOOSE, THEY COULD
INTEGRATE THOSE TWO PLANS AND
OPERATE A SINGLE BEHAVIORAL
HEALTH MANAGED CARE PLAN. WE
HOPE OUR FEDERAL PARTNERS WILL
APPROVE THAT AND THEN BY JANUARY
, 2027 AS ESTABLISHED IN STATUTE
, COUNTIES WILL ENTER INTO A
SINGLE CONTRACT WITH THE
DEPARTMENT. SO WE'RE CHUNKING IT
OUT INTO, UM SORT OF SORT OF
FUNCTIONAL COMPONENTS AND
WORKING WITH OUR COUNTY PARTNERS
ON WHAT'S DOABLE. HOW DO WE TAKE
THIS ONE STEP AT A TIME. MM HMM.
CABRERA ANY COMMENTS? YES MAY I
JUST SAY HOW COOL IS THAT? UM,
BUT THE REALLY COOL PART ABOUT
IT IS THAT WE LOOK FORWARD TO
HAVING ONE SINGLE EXTERNAL
QUALITY REVIEW PROCESS. FOR
EXAMPLE, NOT HAVING RIGHT NOW WE
HAVE TO DUPLICATE AND IT'S THE
SAME COUNTY BEHAVIORAL HEALTH
AGENCY. OFTENTIMES THE SAME
STAFF RIGHT, WHO HAVE TO GO
THROUGH VERY PARALLEL.
DUPLICATIVE PROCESSES VIS A VIS
THE STATE AS OUR REGULATOR AND
SO BEING ABLE TO STREAMLINE.
THAT WILL BE A MASSIVE BENEFIT.
WE THINK TO BOTH US AND TO THE
STATE. WITH THAT I WILL. THANKS
VERY MUCH. THIS PANEL WILL MOVE
ON TO ISSUE 21. WHICH IS ON THE
CALIFORNIA BEHAVIORAL HEALTH
COMMUNITY BASED CONTINUUM. CAL
BH CBC WAIVER, TYLER SAID WITH
PLEASE BEGIN WHEN YOU'RE READY.
THANK YOU. CHAIR THE PROPOSED
CALIFORNIA BEHAVIORAL HEALTH
COMMUNITY BASED CONTINUUM OR CAL
BH. CBC DEMONSTRATION SEEKS TO
IMPROVE CARE FOR ADULTS WHO ARE
LIVING WITH SERIOUS MENTAL
ILLNESS AND CHILDREN WITH
SERIOUS EMOTIONAL DISTURBANCE.
THE DEMONSTRATION HAS MULTIPLE
COMPONENTS, ALL OF WHICH ARE
PRIMARILY DESIGNED TO EXPAND
ACCESS TO EVIDENCE BASED
BEHAVIORAL HEALTH CARE IN THE
COMMUNITY. IN ADDITION, THIS
DEMONSTRATION WILL ALLOW THE
STATE TO DRAW DOWN FEDERAL
MATCHING FUNDS FOR SHORT TERM
CARE PROVIDED AN INPATIENT AND
MENTAL HEALTH, INPATIENT AND
RESIDENTIAL MENTAL HEALTH
SETTINGS. INCLUDING SETTINGS
THAT MEET THE CRITERIA FOR
INSTITUTIONS FOR MENTAL DISEASES
, OR I M D. S. THIS WILL ALLOW
OUR MEDICAID DOLLARS TO GO
FURTHER. WE THE DEPARTMENT
INTENDS TO APPLY FOR THIS WAIVER
IN 2023, SUBJECT TO OUR FEDERAL
APPROVAL BEGIN A STAGED
IMPLEMENTATION IN 2024. THROUGH
THE WAIVER. THE DEPARTMENT AIMS
TO EXPAND THE CONTINUUM OF
COMMUNITY BASED BEHAVIORAL
HEALTH CARE AVAILABLE TO MEDICAL
MEMBERS IMPROVE THE QUALITY OF
CARE, INPATIENT AND RESIDENTIAL
TREATMENT SETTINGS. STRENGTHEN
THE TRANSITIONS IN THE DISCHARGE
, PLANNING AND CONTINUED CARE
DURING STEP DOWNS FROM THESE
SETTINGS TO THE COMMUNITY.
ENHANCE COUNTY ACCOUNTABILITY
AND OVERSIGHT AND SUPPORT THE
IMPLEMENTATION OF NEW BENEFITS
THROUGH UH, INCENTIVE PROGRAMS
AVAILABLE TO COUNTIES ROBUST
TECHNICAL ASSISTANCE IN PRACTICE
TRANSFORMATION SUPPORTS THAT
WOULD BE AVAILABLE TO OUR COUNTY
PARTNERS AND PROVIDERS JUST TO
PROVIDE EXAMPLES OF SOME NEW
SERVICES AND ACTIVITIES THAT
WOULD BE IMPLEMENTED THROUGH THE
WAIVER. THESE INCLUDE EXPANSION
OF EVIDENCE BASED AND IN HOME
THERAPIES FOR CHILDREN,
INCLUDING CHILDREN IN FOSTER
CARE, AND WITH JUVENILE JUSTICE
EXPERIENCE ON A STATEWIDE BASIS
, EXPANSION OF EVIDENCE BASED
MODELS SERVICE MODELS FOR ADULTS
, INCLUDING ASSERTIVE COMMUNITY
TREATMENT, FORENSIC ASSERTIVE
COMMUNITY TREATMENT. SUPPORTED
EMPLOYMENT AND COORDINATED
SPECIALTY CARE FOR FIRST
EPISODE, PSYCHOSIS, WHICH WAS
REFERENCED IN FOUR SEPARATE
PANELS TODAY, SO UNDER THE
WAIVER COUNTY IS WOULD HAVE THE
OPPORTUNITY TO COVER THESE
SERVICES ON AN OPT IN BASIS. THE
WAIVER PROPOSES A CROSS SECTOR
INCENTIVE POOL THAT WOULD
INCENTIVIZE MEDICAL MANAGED CARE
PLANS, COUNTY MENTAL HEALTH
PLANS AND COUNTY CHILD WELFARE
AGENCIES TO IMPROVE OUTCOMES FOR
MULTI SYSTEM YOUTH FOR CHILDREN
AND CHILD WELFARE WHO ARE
RECEIVING SERVICES FROM THE
SYSTEMS. IT WOULD SUPPORT THE
IMPLEMENTATION OF COMMUNITY
HEALTH WORKERS IN COUNTY
BEHAVIORAL HEALTH TO REALLY HELP
DRY DOWN FEDERAL FUNDING FOR
THAT INTENSIVE OUTREACH AND
ENGAGEMENT THAT THEY CAN'T GO
FOR TODAY. IT WOULD PROVIDE RENT
AND TEMPORARY HOUSING FOR
POPULATIONS WITH, UH, BEHAVIORAL
HEALTH CONDITIONS WHO HAVE
HOUSING NEEDS, AND FINALLY, IT
WOULD PROVIDE COUNTIES WITH THE
OPPORTUNITY TO OPT IN AND TO
COVER SHORT TERM INPATIENT AND
RESIDENTIAL PSYCHIATRIC CARE
FACILITIES THAT ARE MDS AND TO
PARTICIPATE IN THE OPPORTUNITY
TO COVER MDS COUNTIES. WORD
REALLY COMMIT TO ENSURING THAT
THAT INTENSIVE IN PATIENT CARE
IS AVAILABLE AND PART OF THE
FULL CONTINUUM OF CARE. UM AND
SO COUNTY IS THAT OPT INTO THE
IMD OPTION WOULD BE EXPECTED TO
OVER A PERIOD. UH, OVER AN
IMPLEMENTATION TIMELINE OVER THE
WAIVER TO COVER THOSE OTHER NEW
SERVICES THAT I MENTIONED. SO IN
THE SPIRIT OF THIS LATE HOUR,
THAT'S A BRIEF OVERVIEW. HAPPY
TO ANSWER ANY QUESTIONS, MISS
CABRERA. GOOD EVENING CHAIR. I
WILL ALSO TRY TO BE VERY BRIEF
INTO THE POINT, BUT I'M HAPPY TO
FOLLOW UP ON ANY OF THIS. SO WE
HAVE SOME DISAGREEMENT IN TERMS
OF THE PROJECTED SAVINGS
ASSOCIATED WITH THIS PACKAGE OF
REFORMS. ALTHOUGH WE ARE VERY
MUCH IN SUPPORT OF THE OVERALL
VISION OF THE CAL BH CBC, SO OF
ALL THE SERVICES THAT, UM,
DEPUTY SAID WITH WALKED THROUGH
COUNTIES BELIEVE THAT WE WILL
SEE SAVINGS IN TERMS OF OUR
COMMUNITY HEALTH WORKERS.
COMPONENT AS WELL AS RENT AND
TEMPORARY HOUSING ASSISTANCE.
HOWEVER OH, AND I'M SORRY. SOME
PROJECTED SAVINGS WITH OUR I M D
S. BECAUSE THESE THIS IS
COVERAGE ONLY FOR SHORT TERM I M
D S AND BECAUSE I AM DS, THAT
SORT OF CLASS OF I M D S THAT
PRIMARILY WILL GENERATE SHORT
TERM IMD SAVINGS IS RELATIVELY
SMALL. WE DON'T THINK THAT THE
SAVINGS TO US FROM THAT COVERAGE
WILL BE AS HIGH AS AS PROJECTED
RIGHT IF WE WERE ABLE TO TAP
INTO SAVINGS FOR EXAMPLE, MENTAL
HEALTH REHABILITATION CENTERS.
THAT WOULD BE A TOTALLY
DIFFERENT STORY. UM THE OTHER
THING IS THAT, UM, WE BELIEVE
THAT THERE COULD BE SAVINGS
ASSOCIATED WITH COVERAGE OF
SUPPORTED EMPLOYMENT. HOWEVER
THAT WOULD ONLY BE FOR THOSE
COUNTIES THAT ARE CURRENTLY
DELIVERING THOSE SERVICES TO
FIDELITY. AND THAT'S CERTAINLY
NOT EVERYONE IF IT COUNTY
DECIDED TO ADD SUPPORTED
EMPLOYMENT, THAT WOULD BE A NEW
COST. WE BELIEVE THAT THERE WILL
BE MINIMAL SAVINGS ASSOCIATED
WITH IMPLEMENTATION OF ACT AND
FACT. Tð FIDELITY, AS WELL AS
FIRST EPISODE PSYCHOSIS, AND
THIS IS BECAUSE WE THINK THAT
WE'RE DOING A PRETTY GOOD JOB OF
GENERATING FEDERAL FINANCIAL
PARTICIPATION WHERE IT'S
POSSIBLE FOR THOSE SERVICES
RIGHT NOW FOR COUNTIES THAT ARE
NOT PROVIDING THOSE SERVICES
AGAIN ACT TO FIDELITY FACT
INFIDELITY YOUR FIRST EPISODE
PSYCHOSIS. THIS WILL BE A NEW
COST FOR THEM TO ADD THOSE
SERVICES, SO THERE WILL BE, UM
MORE COSTS THAN POTENTIAL
BENEFIT THERE. AND THEN, UM, WE
THINK THAT WE WILL ALSO CARILLO
ADDITIONAL COSTS ASSOCIATED WITH
REQUIRED EVIDENCE BASED
PRACTICES, WHICH ARE NOT
PROPOSED TO BE FUNDED. SO
OVERALL, IT SEEMS THAT THE
AMOUNT OF SAVINGS THAT WE WILL
HAVE FROM THE WAIVER MAY
ACTUALLY BE LOWER THAN WHAT THE
STATE IS EXPECTING, AND WE HAVE
BEEN ENGAGING WITH THE HCS IN
THIS CONVERSATION AND HOPE TO DO
SOME WORK. THANK YOU. YOU WANT
TO FINANCE LENA ROMMEL'S
DEPARTMENT OF FINANCE HERE TO
ANSWER ANY QUESTIONS? YES WELL
OWNS ELIO JUST WANTED TO STATE
THAT GENERALLY WE FIND THIS
PROPOSAL DOES FIT WITHIN THE
STATES. BROADER EFFORTS, UH,
PARTICULARLY AROUND EXPANDING
BEHAVIORAL HEALTH SERVICES. UM
THAT BEING SAID, SINCE WE ARE
STILL WAITING FOR THE FINAL
SUBMISSION TO CMS AND WHAT THAT
FINAL APPROVAL FROM CMS WILL
LOOK LIKE WE CAN PROVIDE A FULL
ASSESSMENT OF THE PROPOSAL AT
THIS TIME BUT HAPPY TO ANSWER
ANY QUESTIONS. I'LL BRING IT UP
TO THE DIESS. I'M GONNA
APPRECIATE THE STATED GOAL OF
THE PROPOSAL. UM AND ADMIT THAT
AFTER READING 197 PAGES OF THE
AGENDA YESTERDAY, I THEN CLICKED
ON THE LINK FOR THE EXTERNAL
CONCEPT PAPER AND READ THE 40
PAGES THAT WERE HERE AND, UH,
BEHAVIORAL HEALTH CBC, AS I DO
BELIEVE YOU'RE ON THE RIGHT
TRACK AND JUST WANT TO ENCOURAGE
AND SUPPORT WITH THAT I WILL.
THANKS VERY MUCH THIS PANEL AND
WE WILL MOVE ON TO ISSUE 22.
ISSUE 22 IS ON THE BEHAVIORAL
HEALTH PAYMENT REFORM TRAILER
BILL AND CASH FLOW FUNDING.
BEGIN WITH MS COOPER. GOOD
EVENING, MR CHAIR. SORRY. DID
YOU LOOK FIRST? YOUR FIRST
SURRENDER. SORRY YES. 1ST 1ST.
YOU'RE ALWAYS FIRST. SORRY, JC
MY BAD. IT'S LATE, AND I'M
CONFUSED, OKAY? ALL RIGHT. THANK
YOU SO MUCH. UH I'M NOT GOING TO
DUPLICATE A LOT OF WHAT TYLER
JUST SAID REGARDING THE
BEHAVIORAL PAYMENT REFORM, BUT
IT IS, UH, PROJECTED TO GO LIVE
IN JULY, ONE OF 2023. I THINK
THERE'S A FEW PIECES, THOUGH. I
JUST WANT TO HIGHLIGHT.
SPECIFICALLY IT ALSO INCLUDES
THE TRANSITION OF US GOING TO AN
ADDITIONAL ADDITIONAL CODING
SYSTEM. SO WE IMPLEMENTED HICK
PICK CODES, WHICH IS VERY COMMON
ACROSS THE VARIOUS HEALTH
SERVICES, BUT WEREN'T OFTEN
BEING USED ON THE BEHAVIORAL
HEALTH SIDE. THE ONE REASON WHY
I FLAGGED THIS AS IT WILL ALLOW
US TO HAVE BETTER LEVEL DATA.
INDIVIDUAL DATA, THE MORE DETAIL
ON THE TYPES OF SERVICES BEING
PROVIDED BY OUR COUNTY PARTNERS,
INCLUDING THE PROVIDER TYPES,
AND SO WE'RE REALLY EXCITED
ABOUT THE NEW LEVEL OF DATA THAT
WILL COME WITH THIS. UM WE
ISSUED THE GUIDANCE AROUND THIS
IN AUGUST OF 2022. THE COUNTY
HAS BEEN WORKING TO BUILD THAT
INTO THEIR SYSTEM TO TRAIN THEIR
PROVIDERS AROUND THAT THAT WILL
BE A TRANSITION AS WELL. UM IN
ADDITION TO THE PAYMENT REFORM,
BUT JUST WANTED TO HIGHLIGHT
THAT IS ONE OF THE OTHER VERY
POSITIVE PIECES OF THE PAYMENT.
UM REFORM TRANSITION, UM AS WELL
AS MOVING TO THE FEE SCHEDULE.
UM THAT WAS WAS SPOKEN ABOUT
EARLIER. I THINK THE ONE PIECE
WE REALLY WANTED TO HIGHLIGHT
WHEN IT COMES TO THIS HAS TO DO
WITH THE FUNDING FOR OUR COUNTY
PARTNERS. GIVEN THE TRANSITION,
THIS TRANSITION IS CRITICAL, AND
WE WILL STILL HAVE COST REPORTS
, FOR EXAMPLE, THAT WE ARE
RECONCILING WITH OUR COUNTY
PARTNERS FOR QUITE SOME TIME. UM
AND THEY WILL HAVE TO BE ABLE
TO, UH, YOU KNOW, SETTLE THOSE
INTERIM COSTS RECONCILE.
SOMETIMES THERE'S PAYMENTS
INVOLVED IN THAT, AND THAT
CREATES A CASH FLOW ON TOP OF
THE FACT THAT WE HAVE TO REQUEST
THE FUNDS PRIOR TO WHICH IS A
LITTLE DIFFERENT THAN WHAT WE'VE
DONE HISTORICALLY, SO IT WOULD
HAVE A CASH FLOW IMPACT ON OUR
COUNTY PARTNERS. THAT IS WHY WE
HAVE REQUESTED IN THE IN THE
BUDGET THAT 375 MILLION GENERAL
FUND ONE TIME USE FOR THE NON
FEDERAL SHARE IN LIEU OF THE I
G. T S FOR THE 1ST 90 DAYS OF
PAYMENT REFORM IMPLEMENTATION
AND STRONGLY FEEL LIKE THAT WILL
HELP OUR COUNTY PARTNERS BE ABLE
TO MOVE TO THIS VERY, VERY
CRITICAL AND IMPORTANT CHANGE SO
HAPPY TO ANSWER ANY QUESTIONS.
THANK YOU, MISS CABRERA. THANK
YOU SO MUCH WITH RESPECT TO THIS
REQUEST AGAIN. WE ARE SUPER
GRATEFUL TO THE ADMINISTRATION
FOR PUTTING FORWARD THE PROPOSAL
AND BASED ON THE INITIAL
MODELING THAT ARE COUNTIES HAVE
BEEN DOING. THEY ARE VERY
CONCERNED AT THIS POINT THAT
THEY WILL NOT HAVE SUFFICIENT
CASH ABSENT THIS FUNDING IN
ORDER TO SUPPORT THE I G T
TRANSITION. I'LL SAY THERE ARE A
COUPLE OF ADDITIONAL FACTORS
HERE THAT INTERSECT AND ONE IS
THE TAX DEFERRAL. WHICH IS
IMPACTING OUR ACTUAL MHS A
FUNDING RECEIPTS RIGHT NOW AND
SO COUNTIES HAD PLANNED AROUND A
CERTAIN LEVEL OF MHS A FUNDING
BUT WITH THE TAX DEFERRAL, WE'RE
GOING TO BE RECEIVING WHAT WE
ARE RECEIVING LESS FUNDING RIGHT
NOW AND SAY THAT WE HAD PLANNED
FOR AND THAT IS CREATING A
LITTLE BIT OF A LONG JAM WITH
RESPECT TO OUR FUNDING, AND
WE'RE CONCERNED BECAUSE IN SOME
CASES, WE WORKED REALLY HARD TO
TRY TO MAKE OUR FEE FOR SERVICE
RATES. HIGHER SO THAT WE COULD
SUPPORT PAYING BETTER SO THAT WE
COULD MAXIMIZE THE BENEFIT OF
OUR PAYMENT REFORM PROPOSAL, BUT
THAT MEANS WE'RE ALSO GOING TO
HAVE TO FRONT LOAD, PUTTING UP
MORE MONEY TO DRAW DOWN THE
FEDERAL MATCH. AND SO EVENTUALLY
WE THINK THINGS WILL SHAKE OUT
AND THEY'LL THEY'LL EVEN OUT BUT
IN THE IMMEDIATE WE REALLY DO
NEED THIS FUNDING TO SUPPORT THE
TRANSITION FOR PAYMENT REFORM
AND RESPECTFULLY REQUEST YOUR
CONSIDERATION OF THAT REQUEST.
DEPARTMENT OF FINANCE. HONORABLE
DEPARTMENT OF FINANCE. WE THINK
THIS IS A CRUCIAL COMPONENT FOR
THE SUCCESS OF KELLY. HELLO.
YES, WELL OWNS A LEO. WE DO FIND
THE GOVERNMENT OF PRESIDENT TO
BE REASONABLE TO ENSURE THE
SUCCESSFUL IMPLEMENTATION UM OR
AT LEAST HELP THE SUCCESSFUL
IMPLEMENTATION OF THIS PROCESS.
YOU KNOW, WE DO FIND WITHOUT THE
FUNDING THAT COUNTIES COULD FACE
A FAIRLY SIGNIFICANT CASH FLOW
PROBLEMS. GOOD SOUNDS LIKE WE'RE
ALL ON THE SAME PAGE WITH THAT.
THANKS VERY MUCH THIS PANEL AND
MOVE ON TO ISSUE 23. IS SHE 23
YEARS ON THE SACRAMENTO AND
SOLANO COUNTIES, KAISER
SPECIALTY MENTAL HEALTH CARVE
OUT WE WILL BEGIN WITH COOPER. I
THANK YOU. OVER THE LAST SEVERAL
YEARS, THE DEPARTMENT HAS
ENGAGED IN EXTENSIVE TRANSITION
PLANNING AND GOOD FAITH THAT
GOSHI ATIONS WITH SACRAMENTO AND
SOLANO COUNTIES TO EFFECTUATE
THE TRANSITION. UM THE
DEPARTMENT FIRST ANNOUNCED THIS
TRANSITION IN OCTOBER OF 2019
WHEN WE PUBLICLY ANNOUNCED THE
CALEN PROPOSAL IN MARCH OF 2021
THAT KELLYANNE PROPOSAL WAS THEN
AGAIN PUBLICLY POSTED FOR
STAKEHOLDER FEEDBACK. THE
DEPARTMENT IN THAT UPDATE
PROPOSAL JANUARY ONE OF 2022
START DATE, UM GIVEN THE
CONVERSATION AND VARIOUS PIECES
WE DID BACK AND FORTH GOOD FAITH
NEGOTIATION BETWEEN THE
ADMINISTRATION AND THE COUNTIES.
TO TRANSITION THAT START DATE TO
JULY ONE OF 2023, THE MAIN
DRIVER BEHIND TRANSITIONING TO A
JULY ONE OF 2023 DATE WAS TO TIE
IT TO PAYMENT REFORM. THE REASON
WHY THAT MATTERED IS THAT THE
COUNTIES AT THE TIME WANTED TO
MAKE SURE THAT THEY COULD
CONTRACT BACK WITH KAISER FOR
THOSE SERVICES AND AN INTERIM
TIME PERIOD TO ALLOW FOR A PHASE
TRANSITION TO EFFECTUATE THE
TRANSITION. WE'VE THAT WAS VERY
REASONABLE OF A REQUEST AND
AGREED TO IT WITH OUR COUNTY
PARTNERS. UM SACRAMENTO AND
SOLANO HAVE HAD AROUND TWO YEARS
OF ENGAGEMENT, THOUGH I WOULD
FLAG WHILE KAISER HAS
PARTICIPATED OVER THOSE TWO
YEARS IN GOOD FAITH,
NEGOTIATIONS AND TRANSITIONS. WE
HAVE REALLY STRUGGLED TO GET TO
THE COUNTY PARTNERS TO THE TABLE
TO REALLY EFFECTUATE THE
TRANSITION. UM AND I'LL KIND OF
WALK THROUGH THE VARIOUS PIECES
TIED TO THE FUNDING TIED TO THIS
PROPOSAL AS WELL. I THINK THE
OTHER THING I WOULD JUST FLAGS.
THE TRANSITION IS ESTIMATED
IMPACT AROUND 4836 MEMBERS IN
SACRAMENTO IN 2091 MEMBERS IN
SOLANO, RESPECTIVELY, THAT
REPRESENTS AROUND 10.9% OF THE
LIVES IN SACRAMENTO IN 23.6% OF
THE LIVES IN SOLANO'S
MEMBERSHIP. THE STATE HAS ACTED
TO ADDRESS THE COUNTY'S FUNDING
CONCERNS WITH THIS TRANSITION AS
WELL. IN JANUARY OF 2023, THE
DEPARTMENT OF FINANCE MADE
MODIFICATIONS TO THE REALIGNMENT
ALLOCATIONS THAT RESULTED IN
INCREASED ALLOCATIONS 11.6
MILLION ANNUALLY FOR SACRAMENTO
COUNTY AND 7.7 MILLION ANNUALLY.
FIRST ALONSO COUNTY THE FUNDING
SHOULD BE MATCHED WITH FEDERAL
FUNDS TO SUPPORT THE PROVISION
OF SPECIALTY MENTAL HEALTH
SERVICES TO THE TRANSITIONING
POPULATIONS, WHICH COMBINED
BRINGS THE TOTAL OF FUNDS TO
APPROXIMATELY 34.2 MILLION IN
22.7 RESPECTFULLY, UM OR YEAH,
RESPECTIVELY, COMBINED WITH A
MEANING ABOUT A $56.9 MILLION
GOING TO SACRAMENTO AND SOLANO
FOR THE PURPOSES OF THIS
TRANSITION. WE CURRENTLY ONLY
PAY KAISER $22 MILLION TOTAL
FUND FOR THESE LIVES TODAY AND
HAVE FOR QUITE SOME TIME. UM SO
WHEN IT CAME TO REALIGNMENT
ADJUSTMENTS, UM, THE RESPONSE TO
THE COMMITTEE'S QUESTIONS AROUND
THE ESTIMATE AND HOW IT WAS
DEVELOPED. AND CALCULATED THERE
ARE TWO COMPONENTS TO
REALIGNMENT FUNDING TOTAL
MEDICAL MONTHS IN COUNTY
BEHAVIORAL HEALTH CLAIMS. KAISER
MEMBER MONTHS WERE INCLUDED IN
EACH ALLOCATION FOR EACH COUNTY
ALWAYS INCLUDED IN THOSE COSTS.
HOWEVER THE COSTS ASSOCIATED
WITH THE POPULATION CLAIMS WERE
NOT INCLUDED. BECAUSE SACRAMENTO
AND SOLANO WE'RE NOT PROVIDING
THOSE CLAIMS. GIVEN THAT WE HAD
INCLUDED THE POPULATION IN THEIR
HISTORICAL FUNDING FOR
REALIGNMENT, BUT NOT THE COST TO
THE CLAIMS DEPARTMENT AGREED TO
GO BACK AND DO AN ASSESSMENT OF
WHAT THAT WOULD LOOK LIKE WE
WENT BACK TO THE 2016 17 TIME
PERIOD TO ADJUST TO MAKE SURE
THAT IT WOULD ACCUMULATE OVER
TIME AND NOT JUST THIS ONE TIME
WITHIN THIS YEAR. WE WORKED VERY
CLOSELY WITH THE COUNTIES TO
IDENTIFY THE POPULATIONS. WE
AGREED TO THAT WE ALSO APPLIED
THEIR STANDARD REALIGNMENT P M.
P. M TWO THAT METHODOLOGY TO
COME UP WITH WITH WHAT THE
CURRENT WOULD BE ON A ROLLING
AND CUMULATIVE BASIS TO WHAT
THEY WOULD HAVE BEEN PAID. AND
THAT WAS THE 19 MILLION I
MENTIONED EARLIER. UM, AND SO
WE'VE HAD THOSE EXTENSIVE AROUND
THE QUESTION AROUND THE TOTAL
PERCENT OR IMPACT TO OTHER
COUNTIES. BUT WE WOULD SAY IS,
THE DEPARTMENT KNOWS THAT IT
REPRESENTS 0.9% OF THE TOTAL
REALIGNMENT REVENUES, AND SO WE
FELT LIKE THIS WAS AN
APPROPRIATE ADJUSTMENT.
ADDITIONALLY THE DEPARTMENT OF
EVALUATED BOTH SACRAMENTO AND
SOLANO'S NETWORK ADEQUACY AND
STAFFING IN BASED ON THE FILINGS
WITH THE DEPARTMENT, BASED ON
THEIR PROJECTED ABILITY TO
PROVIDE SERVICES AS WELL AS THE
UTILIZATION COMING IN BOTH
SACRAMENTO AND SOLANO BROADLY
HAD A NETWORK ADEQUACY WITHIN
THEIR NETWORKS, FILINGS WITH THE
DEPARTMENT TO BE ABLE TO PROVIDE
ACCESS TO THESE SERVICES. I
WOULD SAY THERE WAS ONE
EXCEPTION. AND THAT WAS
SACRAMENTO COUNTY, WHERE WE DID
SAY THAT THEY SEE THAT THEY
NEEDED TO INCREASE THEIR
PSYCHIATRIC SERVICES FOR
CHILDREN AND YOUTH. BASED ON
THIS ADJUSTMENT, THE DEPARTMENT
REACHED OUT DIRECTLY TO
SACRAMENTO TO SEE IF WE COULD
WORK ON WHAT WE COULD DO TO
TRANSITION OR FIX THAT ISSUE IN
SACRAMENTO DID NOT ENGAGE WITH
THE DEPARTMENT IN REGARDS TO
THOSE CONVERSATIONS AND
DISCUSSIONS. UM GIVEN THE LACK
OF ENGAGEMENT, WE DID ISSUE A
LETTER TO BOTH SACRAMENTO AND
SOLANO ON MARCH 1ST OF 2023
ASKING IF THEY'RE COMMITTING TO
THE JULY 1ST TRANSITION, GIVEN,
UH, THE ENGAGEMENT. UM THEY
RESPONDED BACK WITH THE LETTER,
AND THEN WE MET IN. ULTIMATELY
THEY SAID THAT THEY COULD NOT
AGREE TO THE JULY ONE TRANSITION
DOMINANTLY OF FOCUSED ON THE
FUNDING THAT WAS BEING
REQUESTED. UM WE AGREED THAT WE
WANT THESE SERVICES TO
TRANSITION TO SACRAMENTO.
SOLANA. WE ARE HOPING THAT WE
CAN COME TO AGREEMENT ON THAT IN
THE NEAR FUTURE SOONER, THE
BETTER, BUT WE HAD TO
ESSENTIALLY MOVE FORWARD TO
PROCURE AND REALLY STICK HERE, I
THINK IS A BETTER WORD. DON'T
TAKE THE WORD PROCURE THE WRONG
WAY BUT SECURE KAISER TO
MAINTAIN PROVIDING THESE
SERVICES WE HAD ALREADY GIVEN.
KAISER DO NOTICE. THAT WE WERE
TRANSITIONING THE SERVICES. SO
WE ARE CURRENTLY WORKING
DIRECTLY WITH KAISER TO HAVE
THEM CONTINUE TO PROVIDE
SERVICES. UM, FOR AFTER JULY,
1ST. WE'RE HOPING WE CAN COME TO
A RESOLUTION WITH OUR COUNTY
PARTNERS ARE INTENT IS FOR THEM
TO CONTINUE TO OR TO PROVIDE
SERVICES. FOR THESE
BENEFICIARIES. HOWEVER, WE
HAVEN'T BEEN ABLE TO ESSENTIALLY
LAND THERE YET. BUT WE ARE
COMMITTED TO CONTINUE TO WORKING
WITH OUR COUNTIES TO EVENTUALLY
TRANSITION THESE LIVES TO THE
COUNTIES AND HAPPY TO ANSWER ANY
QUESTIONS AT THE TIME COMES MR
CABRERA, LEATHER. THANK YOU SO
MUCH CHAIR. SO OF ALL OF THE
VARIOUS PIECES OF THE CALLUM
REFORM, WHICH WE ARE VERY
EXCITED ABOUT WORKING REALLY
WELL, IN PARTNERSHIP WITH THE
STATE AROUND. THIS IS THE ONE
WHERE I THINK WE'VE WE OBVIOUSLY
HAVE HIT SOME SPEED BUMPS. UM
KAISER, UM, SERVICES FOR
SPECIALTY MENTAL HEALTH ARE ONLY
CARVED IN IN THESE TWO COUNTY,
SOLANO AND SACRAMENTO AND, UM,
LUCKILY, I GET TO PRESENT ON
BEHALF OF BOTH OF OUR COUNTY SO
HOPEFULLY THAT'LL STREAMLINE OUR
PRESENTATION TONIGHT. I WILL
SAY, UM COUNTIES HAVE BEEN
REALLY ENGAGED IN THIS PROCESS.
TO THE EXTENT THAT, UM YOU KNOW
WHEN WE FIRST LEARNED ABOUT THIS
PROPOSAL, COUNTIES SAID. WE NEED
THREE THINGS FROM THE STATE. WE
NEED TO KNOW HOW MANY PEOPLE
WILL BE TRANSITIONING HOW WE
WILL BE EXPECTED TO PAY FOR
THESE EXPANDED SERVICES. AND
THEN WILL WE HAVE SUFFICIENT
INFORMATION AND TIME TO BUILD
OUT THE APPROPRIATE AND
CONNECTED NETWORK OF SERVICES ON
THE QUESTION OF HOW MANY PEOPLE
WOULD TRANSITION? WE LEARNED
PRETTY EARLY ON THAT IT WAS
DIFFICULT FOR KAISER TO ESTIMATE
THIS BECAUSE THEY DON'T
DISTINGUISH AROUND SEVERITY OF
NEED FOR THEIR BENEFICIARIES.
AND SO IN ORDER TO MAKE SURE
THAT WE HAD, UM WHAT WE NEEDED
IN TERMS OF AN ESTIMATE. IT WAS
ACTUALLY SACRAMENTO COUNTY THAT
, UM, DECIDED TO DO A ROUGH
ESTIMATE, BASED ON THE
PROPORTION OF MEDICAL
BENEFICIARIES FROM THEIR OTHER
FOUR CONTRACTED MEDICAL MANAGED
CARE PLANS WHO ARE SEEN IN
COUNTY BEHAVIOR HALL. BUT ALL
THAT GAVE US WAS REALLY A
BALLPARK, RIGHT WE'RE GOING
BASED, ON AVERAGE IS NOT REAL
ACTUAL PATIENTS SERVED IN KAISER
IN THESE TWO COUNTIES, AND SO IT
WAS BASED ON THAT BALLPARK
ESTIMATE THAT WE WERE ABLE TO
COME UP WITH A BALLPARK FUNDING
ESTIMATE TO SAY THIS IS HOW MUCH
, UM, FUNDING WE THINK WE WOULD
NEED BUT WE STILL DON'T KNOW
EVEN TODAY. WHO ARE THESE
PEOPLE? RIGHT ARE THEY CHILDREN
? ARE THEY SYSTEM INVOLVED?
CHILDREN UM DO THEY NEED
INPATIENT? DO THEY NEED
RESIDENTIAL AND THIS KIND OF
INFORMATION IS REALLY CRUCIAL.
BECAUSE UNLESS WE KNOW, UM
EXACTLY WHO'S COMING, WE DON'T
KNOW WHAT KINDS OF SERVICES TO
PROCURE WHETHER IT'S FROM KAISER
OR FROM ANY OTHER CONTRACTORS IN
OUR COMMUNITIES. AND THAT
QUESTION OF KAISER CONTRACTING
IS IMPORTANT. MY UNDERSTANDING
IS THAT, UM KAISER IS NOT
NECESSARILY PHªN DOOR OPEN TO
THE IDEA OF HAVING TO MEET ALL
OF THE SPECIALTY BEHAVIORAL
HEALTH. UM CRITERIA FOR
PROVIDING SERVICES. WE HAVE
UNIQUE, UM, CRITERIA THAT COME
ALONG WITH THE DELIVERY OF OUR
SERVICES. AND SO THERE'S KIND OF
AN OPEN QUESTION THERE. UM
REGARDLESS, WE KNOW IT WOULD
TAKE TIME AND WE ALSO WERE VERY
INSISTENT AND HAVE BEEN ALL
ALONG THAT THIS IS A TRANSITION
THAT NEEDS TO BE FUNDED. WE
CAN'T JUST ABSORB THOUSANDS OF
NEW BENEFICIARIES IN EACH OF
THESE COUNTIES WITHOUT IMPACTING
ACCESS FOR BOTH THE KAISER
BENEFICIARIES WHO BE
TRANSITIONING AS WELL AS OUR
EXISTING CLIENTS, RIGHT, WE'RE
VERY CONCERNED ABOUT HAVING
SUFFICIENT CAPACITY WITHOUT ANY
NEW FUNDING. HOW HOW WE'RE ARE
WE SUPPOSED TO DO THAT? AND SO,
UM, WE HAD ASKED THE STATE TO
LOOK AT COULD THEY REDIRECT A
PORTION OF THE FUNDING THAT THEY
WERE SENDING TO KAISER FOR THIS
RIGHT TO BRING DOWN THE COST TO
THE STATE FOR PAYING FOR THE
ADDITIONAL ADJUSTMENT. UM
COUNTIES COMMUNICATED. WE DID
TALK WITH THE STATE FROM THE
SUMMER INTO THE FALL ABOUT OUR
CONCERNS WITH THE PROPOSAL TO
REDIRECT REALIGNMENT GROWTH, I
DO WANT TO SAY THAT WHILE IT MAY
BE 0.9% OF THE OVERALL
REALIGNMENT FUND, IT WAS A
SIGNIFICANT CHUNK OF OUR
REALIGNMENT GROWTH THAT WAS
REDIRECTED RIGHT AND WE HAVE NOT
GOTTEN REALIGNMENT GROWTH PRIOR
TO THE PANDEMIC FOR A VERY LONG
TIME. 2011 REALIGNMENT IS
CRUCIAL FOR COUNTY BEHAVIOR
HEALTH BECAUSE IT IS ONE OF THE
ONLY COURSE SOURCES OF FUNDING
THAT WE HAVE FOR SUBSTANCE USE
DISORDERS AND IN THE MIDST OF
THE FENTANYL CRISIS. WE'RE
REALLY RELYING ON THIS 2011
REALIGNMENT GROWTH TO HELP
SUSTAIN THAT. IT'S ALSO OF
COURSE, SOURCE OF FUNDING FOR
MPS, DT MEANING CHILDREN'S
SERVICES AND AGAIN. A LOT OF OUR
FUNDING HAS STRINGS ATTACHED TO
IT. SO WE REALLY WERE LOOKING TO
THIS 20 LIVE 11-3 LIMIT GROWTH.
SOLANO AND SACRAMENTO COUNTIES
DID NOT THINK IT WAS FAIR TO
SIPHON FUNDING AWAY FROM ALL OF
THE OTHER COUNTIES IN ORDER TO
OFFSET THE COSTS THAT WOULD BE
NECESSARY. AND WE REALLY, UM DO
HOPE THAT WE CAN GET TO A PLACE
WHERE WE CAN FULLY FUND THE
TRANSITION FOR KAISER, SOLANO
AND UM, SACRAMENTO BENEFICIARIES
. UM THE FUNDING HAS ALREADY
BEEN REQUESTED TO BE PULLED FROM
THE REALIGNMENT GROWTH FORMULA,
WHICH AGAIN COUNTY SUBJECTED TO
BOTH. SEE SACK AND C B H D A.
AND WE DO THINK THAT IN ORDER TO
SAFELY TRANSITION PEOPLE WE NEED
TO MEET ALL OF THREE OF THOSE
PRONGS THAT WE ASKED FOR, AND
I'M HAPPY TO ANSWER ANY
QUESTIONS. DEPARTMENT OF
FINANCE. BILJANA ROMMEL'S
DEPARTMENT OF FINANCE. WE WOULD
JUST LIKE TO ECHO MISS COOPER'S
COMMENTS THAT REALIGNMENT
FUNDING IS APPROPRIATE FUNDING
SOURCE FOR THIS, AND WE DO HOPE
TO COME TO A RESOLUTION WITH OUR
COUNTY CURRENT PARTS.
TECHNICALLY SPEAKING, THIS IS
NOT A PROPOSAL IN THE
GOVERNMENT'S BUDGET, SO EVEN
PRODUCED A FORMAL ANALYSIS BUT
WERE AVAILABLE FOR QUESTIONS.
BRING IT UP TO THE DIOCESE. UM.
YOU KNOW, I STRUGGLED A LITTLE
BIT WITH THIS PROPOSAL BECAUSE
WE'VE SEEN IT NOW. I THINK OUR
THIRD YEAR LOOKING AT IT AND
STILL SEEMS THAT WE'RE NOT ABLE
TO COME TO AN AGREEMENT BETWEEN
THE TWO SIDES THAT I'M REALLY
WANTING TO FIGURE OUT HOW WE CAN
UM, HAVE THAT COLLABORATION THAT
WE'VE BEEN SO SUCCESSFUL AND ALL
THE OTHER ASPECTS OF CALAIS AND
SO UM I WILL JUST LEAN IN AND
SUPPORT THAT. I HOPE WE ARE ABLE
TO COME TO THAT RESOLUTION AND
FIGURE OUT THE DISCREPANCIES. I
WILL SAY THE DIFFERENCES BETWEEN
19 MILLION AND 50 PLUS MILLION
SEEMS LIKE YEAH, WE'RE OFF BY 30
MILLION THAT IT. SCREAMS TO ME
THAT WE NEED TO ANALYZE AND
EVALUATE WHAT THE REAL COST IS
THE ONLY PUSH BACK ALL I'LL ADD
, IS THE THIRD BULLET POINT DO
WE NEED TO BUILD IT OUT? UM DO
WE REALLY NEED TO BUILD IT OUT?
IF WE CONTRACT BACK WITH KAISER?
WHAT? WHAT WOULD WE? BUILD OUT.
AND WHAT ARE YOU ENVISION? SO
THERE ARE SEVERAL THINGS ONE
AGAIN. WE'RE NOT CLEAR THAT
KAISER IS OPEN TO MEETING
SPECIALTY BE RALPH SPECIALTY
MENTAL HEALTH, UM, CONTRACTOR
REQUIREMENTS, SO THAT'S ONE
CONCERN, RIGHT? WE HAVE
DIFFERENT REQUIREMENTS, AND
THOSE ARE STATE REQUIREMENTS.
AND SO, UM, YOU KNOW, WE CAN'T
REALLY CHANGE THOSE. SO ONE BIG
QUESTION OR CONCERN IS WHETHER
THAT WOULD EVEN BE AN OPTION FOR
US. UM EVEN SO, WE DO PROVIDE
DIFFERENT KINDS OF SERVICES THAN
KAISER DOES. AND SO WE PROVIDE
FIELD BASED SERVICES. UM WE
COVER I M D RELATED COSTS. WE DO
A FULL ARRAY OF FIELD BASED HOME
BASED ETCETERA. AND SO THERE ARE
VERY DIFFERENT KINDS OF SERVICES
THAT PEOPLE BENEFIT FROM BY
BEING IN THE SPECIALTY MENTAL
HEALTH SYSTEM, WHICH IS WHY OUR
COUNTY'S THINK THIS
BENEFICIARIES WOULD BE BETTER
SERVED. DID WITH US, BUT WE NEED
TO DO IT IN A WAY THAT IS SAFE
TRANSITION. FOR THE KINDS OF
BENEFICIARIES AND THAT DOESN'T
DISRUPT SERVICES FOR OUR
EXISTING MEDICAL BENEFICIARIES.
YEAH SO WE'VE BEEN IN
CONVERSATIONS WITH KAISER FOR
THE WHOLE TWO YEARS THAT THE
COUNTIES HAVE HAD TO TRANSITION
THESE SERVICES AND NOT AT ONE
POINT HAS, KAISER SAID THAT THEY
WOULD NOT BE WILLING TO CONTRACT
BACKED. IN FACT, WE'VE HAD MANY
CONVERSATIONS WITH THEM IN THE
LAST FEW WEEKS SPECIFICALLY ON
THAT CONVERSATION, AND THEY HAVE
NO ISSUES IN REGARDS TO
CONTRACTING BACK TO PROVIDE
THOSE SERVICES. SO WE'RE HOPING
THAT KAISER AND THE COUNTIES CAN
COME TO THOSE TO THOSE
AGREEMENTS. AND I DO AGREE THAT
THE SERVICES ARE DIFFERENT, BUT
WE ALSO KNOW THAT KAISER IS
CURRENTLY PROVIDING THESE
SERVICES TODAY. UM AND WE SUBSET
AND SEGREGATE THE SPECIALTY
MENTAL HEALTH SERVICES IN THE
RIGHT. SO WE DO HAVE AN
UNDERSTANDING, BUT THAT INVOLVES
US SITTING DOWN WITH THE COUNTY
TO ACTUALLY TALK ABOUT THOSE
TRANSITIONS AND START DOING
THOSE CASE IN PROFILING WITH
HIM, AND THAT'S WHAT WE LOOK
FORWARD AND HOPE TO DO WITH THE
COUNTY SOON. UM YOU SAID WE WERE
TYING IT TO THE PAYMENT REFORM.
WHAT HAPPENS IF WE DON'T? THE
LANGUAGE WE NEGOTIATED IN GOOD
FAITH GAVE SOME FLEXIBILITY,
UNFORTUNATELY, WHICH IS WHY WE
ARE CONTINUING TO PUNT THE BALL
. UNFORTUNATELY SO THAT IS THE
PIECE SO WE TIED IT A PAYMENT
REFORMS SO THAT COUNTIES COULD
CONTRACT BACK WITH KAISER. THAT
WAS THEIR REQUEST. WE THOUGHT IT
WAS REASONABLE. UM AND SO WE
WANTED TO MAKE SURE THAT THERE'S
A IT'S EASIER TO DO IN PAIN
REFORM BECAUSE THE DOCUMENTATION
REFORM THE CODING SIMPLER. WE
HAD DONE A NUMBER OF THINGS IN
CALLUM, SO WE THOUGHT THAT WAS A
REASONABLE ASK. AND SO THAT'S
WHY WE MOVED HERE. WE'RE HOPING
WE CAN RESOLVE ANY OTHER ISSUES
THAT COUNTIES HAVE SOON SO THAT
WE CAN CONTINUE TO MOVE FORWARD
WITH THE TRANSITION. WITH THAT I
WILL. THANKS VERY MUCH THIS
PANEL AND WE WILL MOVE ON TO
ISSUE 24. ISSUED 24 IS OVERSIGHT
ON SUBSTANCE ABUSE PREVENTION
AND TREATMENT. OUR FIRST SPEAKER
IS LARA THOMAS, SENIOR DIRECTOR
OF HIV AND HARM REDUCTION POLICY
WITH THE SAN FRANCISCO AIDS
FOUNDATION. YES. CAN YOU HEAR
ME? WE CAN THANK YOU. WONDERFUL
THANK YOU SO MUCH, DOCTOR
ARAMBULA HAVE FOR HAVING ME ON
AND, UM FOR LETTING ME UH, RIGHT
. THIS TESTIMONY. VIRTUALLY MY
NAME IS LAURA THOMAS AND THIS IN
YOUR DIRECTOR OF HIV AND HARM
REDUCTION POLICY AT THE SAN
FRANCISCO IT'S FOUNDATION
LOCATED AND SURPRISINGLY IN SAN
FRANCISCO. AND WE ARE STATE
LICENSED SUBSTANCE USE DISORDER
TREATMENT PROGRAM IN A HARM
REDUCTION PROVIDER. WE FOCUS OUR
SERVICES ON THE L G B T Q.
POPULATION PEOPLE LIVING WITH
HIV PEOPLE WHO ARE ON HOUSED IN
SAN FRANCISCO AND WE ARE ABLE TO
PROVIDE COMPREHENSIVE SERVICES
FOR PEOPLE WHO USE DRUGS,
INCLUDING SYRINGE, ACCESS AND
DISPOSAL, OVERDOSE PREVENTION
AND NALOXONE DISTRIBUTION.
HEPATITIS C TESTING AND
TREATMENT. WE PROVIDE NAVIGATION
TO MEDICATIONS FOR OPIOID USE
DISORDER. WE PROVIDE CONTINGENCY
MANAGEMENT WE PROVIDE IN
CONJUNCTION WITH THE DEPARTMENT
OF PUBLIC HEALTH ARE ABLE TO
PROVIDE PRIMARY CARE WOUND CARE
, ETCETERA. UM AND SO IT IS FROM
THAT PERSPECTIVE. UH, THAT YOU
KNOW, IT'S VERY CLEAR THAT THAT
CALIFORNIA IS NOT GOING THROUGH
ONE CRISIS, BUT MANY CRISES AT
THE SAME TIME, AND I THINK YOU
KNOW THE ONE THAT IS TOP OF MIND
FOR ME. I KNOW WE'RE TALKING
ABOUT SUBSTANCE USE, BUT IT'S
REALLY ABOUT HOUSING AND THE
EXTENT TO WHICH THE LACK OF
HOUSING AH EXACERBATES EVERY
SINGLE THING THAT THE PEOPLE WE
SERVE. FACE THAT IT INCREASES
PEOPLE'S TRAUMA INCREASES
PEOPLE'S RELIANCE ON SUBSTANCES
TO MAKE IT THROUGH THE NIGHT.
MAKE IT THROUGH THE DAY WHEN
THEY'RE ON HOUSED AND MAKES IT
THAT MUCH HARDER FOR PEOPLE TO
ACCESS. OTHER SERVICES.
CALIFORNIA IS OBVIOUSLY ALSO IN
THE MIDST OF AN OVERDOSE CRISIS
THAT HAS BEEN PRIMARILY DRIVEN.
BY THE ARRIVAL OF FENTANYL IN
THE ILLICIT DRUG SUPPLY
ILLICITLY MANUFACTURED FENTANYL
IN THE DRUG SUPPLY IN CALIFORNIA
THAT HAS JUST HAPPENED OVER THE
LAST COUPLE OF YEARS. BUT WE'VE
SEEN A HUGE SPIKE IN OVERDOSE
FATALITIES CERTAINLY LOCALLY AS
WELL AS AROUND THE STATE.
BECAUSE OF THAT, UM AH, YOU
KNOW, WE ALSO WE HAVE HIV CRISIS
. WE HAVE A HEPATITIS C CRISIS.
WE HAVE SEXUALLY TRANSMITTED
INFECTION CRISIS AND ALL OF
THOSE EPIDEMICS EXACERBATE EACH
OTHER AND OFTEN ARE AFFECTING
THE SAME PEOPLE. UM WE'RE ALSO
AS YOU HEARD EARLIER, FACING A
WORKFORCE CRISIS AS WELL. BUT
OTHER PEOPLE, UH COMMENTED ON
THAT, AND SO CALIFORNIA HAS MANY
OPPORTUNITY RIGHT NOW TO DO MORE
AND TO DO BETTER WHEN IT COMES
TO SUBSTANCE USE TREATMENT.
INDEPENDENCE UM AND PREVENTION
UP, BUT UNFORTUNATELY WE ALSO
HAVE THE OPPORTUNITY TO MAKE
THINGS WORSE. AND SO I'M VERY
HOPEFUL THAT WE ARE ABLE TO ASK
RESOURCES AND THINGS THAT WORK
AND AVOID DOING THE THINGS THAT
MIGHT MAKE THIS WORK. THE STATE
SO FAR HAS MADE SOME REALLY
STELLAR EFFORTS TO EXPAND
SUBSTANCE USE DISORDER TREATMENT
AND THE FULL CONTINUUM OF CARE
FOR PEOPLE WHO USE DRUGS,
INCLUDING REALLY DRAMATICALLY
EXPANDING IMPACT TO MEDICATIONS
FOR OPIOID USE DISORDER,
ESPECIALLY BUPRENORPHINE. THE
ADDITION OF CONTINGENCY
MANAGEMENT AS A TREATMENT FOR
STIMULANT METHAMPHETAMINE USE
DISORDER IN CALAIS, MISS.
FANTASTIC BEING ALLISON
DISTRIBUTION PROGRAM IS A REALLY
GREAT WAY MECHANISM TO GET
NALOXONE OUT INTO INTO
COMMUNITIES. ONE OF THE UH, I
THINK HIGHLIGHTS OF WHAT
CALIFORNIA HAS BEEN DOING HAS
BEEN THE INVESTMENT IN THE
CALIFORNIA HARM REDUCTION
INITIATIVE, OR CHEERY, WHICH
STARTED IN 2020 AND HAS FUNDED
STAFF IN MANY OF THE SYRINGE
ACCESS PROGRAMS AROUND THE STATE
, INCLUDING THE ONE IN FRESNO,
UM, AND HAS MADE A HUGE HUGE
IMPACT ON THE ABILITY OF THOSE
PROGRAMS TO PROVIDE SERVICES.
AND PARTICULARLY WHEN WE THINK
ABOUT OVERDOSE. THESE ARE THE
STAFF WHO ARE GETTING NALOXONE
INTO THE HANDS OF PEOPLE WHO ARE
MOST LIKELY TO BE AT THE SCENE
OF AN OVERDOSE REFERENCED IN
ELECTION DISTRIBUTION PROGRAM,
WHICH IS GREAT AT GETTING THE
LUXAN OUT, BUT IT IS THE STAFF
THAT ARE FUNDED THROUGH CHEERY
THAT ARE GETTING IT INTO THE
HANDS OF PEOPLE WHO USE DRUGS
AND WHO ARE AT THE SCENE OF AN
OVERDOSE. SO WE KNOW, UM FROM
THE NDP, THEN ALEXA AND
DISTRIBUTION PROGRAM, UM, ABOUT
7% OF THE PROGRAMS THAT THEY
DISTRIBUTED ALEXA INTO WAR, THE
HARM REDUCTION PROGRAMS. THEY
RECEIVED A LITTLE UNDER 30% OF
THE NALOXONE THAT WAS
DISTRIBUTED AND THEY REPORT
AROUND 60% OF THE OVERDOSE
REVERSALS, SO THEY ARE CLEARLY
PUNCHING WAY ABOVE THEIR WEIGHT
WHEN IT COMES TO EFFECTIVENESS
AND ARE JUST REALLY THE COST
EFFECTIVE SERVICES THAT
CALIFORNIA IS PROVIDING RIGHT
NOW, UM, BUT WE HAVE SOME
CHALLENGES. THE FEDS ARE IN THE
PROCESS OF TRYING TO CHANGE SOME
OF THE TELEHEALTH ACCESS TO HAVE
YOU BEEN ORPHAN IN PARTICULAR,
WHICH HAS BEEN A LITERAL
LIFESAVER FOR MANY PEOPLE,
ESPECIALLY DURING COVID. UM AND,
UH AND WE'RE PROBABLY GOING TO
SEE THE ROLLBACK OF SOME OF THE
OTHER COVID ERA POLICIES THAT
REALLY RELAXED ACCESS TO
METHADONE, FOR EXAMPLE, BOTH
METHADONE AND BUPRENORPHINE
SHOULD BE AS EASILY AVAILABLE AS
ILLICIT FENTANYL IS IF WE REALLY
WANT TO GET A HANDLE ON OPIOID
USE DISORDER IN THIS STATE. UM
THE NALOXONE DISTRIBUTION
PROGRAM IS GREAT, BUT THERE THEY
ARE HAVING A SHORTFALL IN
FUNDING, UM, THAT I KNOW YOU'RE
ALSO GOING TO BE HEARING ABOUT,
AND, UH, AS A RESULT, THESE HARM
REDUCTION PROGRAMS ARE GETTING
THE SUPPLIES BEING THROTTLED. WE
ARE UNABLE TO GET THE AMOUNT OF
NARCAN THAT WE NEED FROM THE
STATE AND THAT WE COULD BE
DISTRIBUTING. UM HERE IN SAN
FRANCISCO. AH AND IN FACT, THIS
AMAZING CALIFORNIA HARM
REDUCTION AND INITIATIVE IS
CURRENTLY SLATED TO END THE END
OF JUNE OF THIS YEAR BECAUSE THE
FUNDING WAS NOT RENEWED LAST
YEAR, SO THIS IS AN OPPORTUNITY
FOR THE STATE TO STEP UP AND
CONTINUE THE FUNDING FOR THE
CALIFORNIA HARM REDUCTION
INITIATIVE. UM YOU KNOW, I'M I'M
CONCERNED ABOUT. THERE IS A
DISCONNECT BETWEEN THE RESOURCES
THAT WE HAVE AVAILABLE AND THE
PEOPLE WHO ARE MOST VULNERABLE
AND MOST IN NEED, AND WE NEED TO
BE ENSURING THAT AS WE ARE
MAKING POLICY DECISIONS AROUND
NARCAN ACCESS NALOXONE FENTANYL
FENTANYL TEST STRIPS THAT WE ARE
MATCHING THE RESOURCES WITH THE
PEOPLE WHO ARE MOST VULNERABLE
AND MOST IN NEED OF THOSE
RESOURCES. UM IT IS. YOU KNOW,
WE NEED TO LOOK AT THE DATA WE
NEED TO REALLY BE, UH, SMART
ABOUT HOW WE PRIORITIZE SCARCE
RESOURCES AND MAKE SURE THEY'RE
REALLY GOING TO THE RIGHT PLACE.
SO UM, YOU KNOW I WILL STOP
THERE, BUT I'M VERY HAPPY TO
ANSWER ANY QUESTIONS AND THANK
YOU AGAIN FOR HEARING THIS ITEM.
THANK YOU. NEXT. WE HAVE
MICHELLE CABRERA. THANK YOU SO
MUCH. I WAS ASKED TO SPEAK A
LITTLE BIT, TOO, ARE DRUG
MEDICAL ODS SYSTEM AND FIRST I
WANT TO ALIGN MYSELF WITH SO
MANY OF THE COMMENTS THAT WERE
JUST MADE VERY TRUE. ALL OF THEM
PARTICULARLY, WE, WE DID WEIGH
IN ON THE PROPOSED FDA CHANGES
THAT WILL RESTRICT PRESCRIBING
FOR PEOPLE MORPHINE. WITH THE
FEDERAL GOVERNMENT, AND I HOPE
THAT THEY DO NOT MOVE FORWARD
WITH THAT, BECAUSE THAT WOULD BE
A DEVASTATING CHANGE FOR OUR
SYSTEM. UM I THINK IT'S
IMPORTANT TO PROVIDE A LITTLE
BIT OF CONTEXT BEFORE WE WERE
THE FIRST IN THE NATION TO GET
APPROVAL FOR A 90 DAY JAIL IN
REACH PROPOSAL WE WERE THE FIRST
IN THE NATION TO DO AND I AM THE
WAIVER FOR RESIDENTIAL IMPATIENT
DRUG TREATMENT. UM AND YOU KNOW
, IT'S I THINK, ACTUALLY HAVE
COME TO BELIEVE THAT THE I M D
EXCLUSION IS FUNDAMENTAL. WE AND
INHERENTLY BIASED IN THAT IT
TAKES FEDERAL FUNDING AWAY FROM
MEDICAL BENEFICIARIES WHO NEED
ACCESS TO INPATIENT. DRUG
TREATMENT AND MENTAL HEALTH
TREATMENT. FULL STOP. UM WE HAVE
OTHER TOOLS IN THE 21ST CENTURY
TO ENSURE QUALITY AROUND LENGTHS
OF STAY AND INAPPROPRIATELY LONG
LENGTHS TO STAY. CURRENTLY WE
OVER THE LAST 56 YEARS COUNTIES
HAVE BEEN, UM, OPTING INTO THAT
NEW BENEFIT, BUT I DON'T THINK
THAT MOST PEOPLE REALIZE THAT
YOU KNOW THE THING THAT WE DID
THAT WAS SO RADICAL. UM 56 YEARS
AGO, WAS TO ALLOW FOR MEDICAL TO
PAY FOR INPATIENT AND
RESIDENTIAL DRUG TREATMENT AND
EVEN STILL MUCH LIKE WITH THE
MENTAL HEALTH SIDE OF THINGS.
THERE'S A 30 DAY AVERAGE LENGTH
OF STAY THAT WE NEED TO BE
COMPLIANT WITH WHICH, FOR SOME
PEOPLE WITH WHEN IT COMES TO
THEIR, UM, DRUG TREATMENT NEEDS,
THAT'S NOT ENOUGH, RIGHT? AND SO
WE HIT ANOTHER CLIFF THERE. AND
AS I MENTIONED EARLIER ARE
FUNDING SOURCES, WHICH ARE
AVAILABLE FOR US TO USE AS A
SOURCE OF MATCH FOR SUD
TREATMENT SERVICES ARE LIMITED.
SOME COUNTIES WERE ATTEMPTING TO
BRING ONLINE THE ODS BENEFIT
DURING THE PANDEMIC, AND I DON'T
KNOW IF YOU RECALL, BUT I
CERTAINLY DO. UM RESIDENTIAL
TREATMENT SETTINGS WERE NOT THE
BEE'S KNEES DURING THE HEIGHT OF
THE PANDEMIC, RIGHT, AND SO WE
REALLY STRUGGLED WITH JUST
KEEPING PROVIDERS DOORS. OPEN
DURING THE PANDEMIC AND JUST
KEEPING THAT RESOURCE AVAILABLE.
BECAUSE ONCE WE HIT THE COURT
THAT TURNED THE CORNER AND
STARTED COMING OUT OF SOME OF
THE WORST OF IT. WE SAW THAT WE
DID HAVE THIS EPIDEMIC LEVEL OF
NEED FOR PEOPLE WITH SUBSTANCE
USE DISORDERS. WE KNOW THAT
ALCOHOL USE WENT UP DURING THE
PANDEMIC. WE KNOW THAT CANNABIS
USE WENT UP AND CERTAINLY THE
MOST DEADLY OF ALL. FENTANYL UM
, WE ARE SO PROUD OF CALIFORNIA
FOR THE CONTINGENCY MANAGEMENT
PILOT, WHICH WE'RE ROLLING OUT.
UM THE BRIDGE NAVIGATOR PROGRAM
, WHICH WE'VE BEEN DOING IN
CALIFORNIA. ALL OF THIS
CUMULATIVELY COMES TOGETHER TO
PROVIDE, UM SOME OF THE BEST
LEVEL OF CARE FOR MEDICAL THAT
WE ARE MEDICAID THAT WE SEE IN
THE COUNTRY. BUT AGAIN, WE
DIDN'T WE NEED TO DO SO MUCH
MORE. WE'RE JUST BUILDING THE
FOUNDATION RIGHT NOW FOR WHAT
NEEDS TO BE A MUCH MORE ROBUST
AND VIBRANT SYSTEM OF CARE, AND
IN PARTICULAR. YOU KNOW, WE'VE
WORKED HARD IN PAYMENT REFORM TO
TRY AND BRING THE LEVEL OF
REIMBURSEMENT TO WHERE IT NEEDS
TO BE TO SUPPORT A GOOD
WORKFORCE. BUT, UM, WE'VE BEEN
ADVOCATING FOR STANDARDS TO BE
IMPROVED AS WELL FOR OUR SUD
COUNCIL WORKFORCE, EVEN THOUGH
WE'RE IN THE MIDST OF A
WORKFORCE CRISIS BECAUSE WE
THINK THAT THE BENEFICIARIES
DESERVE TO HAVE QUALITY SERVICES
PROVIDED TO THEM. AND SO, WITH
ALL OF THIS, I WILL JUST HAND IT
OVER TO MY STATE PARTNERS. THANK
YOU. DIRECTOR BOSS, I THINK YOU
ALSO ASKED TO COMMENT A LITTLE
BIT ON THE DRUG MEDICAL
ORGANIZED DELIVERY SYSTEM AND
JUST THE CAPACITY OF SUBSTANCE
USE DISORDER TREATMENT SERVICES
IN THE STATE, AS MICHELLE,
MENTIONED IN 2015, CALIFORNIA
WAS THE FIRST DAY TO IMPLEMENT
11 15 SECTION WAIVER FOR
SUBSTANCE USE DISORDER SERVICES
, IN ADDITION TO THE MD PIECES
THAT MICHELLE REFERENCE, ALSO
PROVIDING A COORDINATED APPROACH
TO DRUG MEDICAL POWER TO
SUBSTANCE USE SERVICES AT THE
COUNTY LEVEL TODAY, 90% 96%
SCENT OF MEDICAL MEMBERS RESIDE
IN THE 37 COUNTIES PARTICIPATING
IN THIS WAIVER IN ADDITION TO
THIS TO DRUG MEDICAL ODS, THE
DEPARTMENT RECENTLY EXPANDED
MEDICAL BENEFITS FOR INDIVIDUALS
WITH SUBSTANCE USE DISORDER,
INCLUDING MOBILE CRISIS SERVICES
, WHICH WE SPOKE ABOUT EARLIER.
PEER SUPPORT SERVICES AND
CONTINGENCY MANAGEMENT, WHICH
WAS ALSO MENTIONED CONTINGENCY
MANAGEMENT. CALIFORNIA WAS THE
FIRST IN THE NATION TO RECEIVE
FEDERAL APPROVAL FOR THIS
BENEFIT IN THE MEDICAL PROGRAM.
UH TODAY ABOUT I THINK WE HAVE
24 DRUG MEDICAL ODS COUNTIES
COVERING 88% OF THE MEDICAL
POPULATION WILL PARTICIPATE IN
THE CONTINGENCY MANAGEMENT PILOT
, INCLUDING LOS ANGELES, WHICH
HAS BEGUN SERVICE DELIVERY THERE
. THE DRUG MEDICAL, UH,
ORGANIZED DELIVERY SYSTEM WAIVER
HAS REALLY RESULTED IN SOME
POSITIVE OUTCOMES. UCL A
RESEARCH ON THIS 92%
SATISFACTION RATE BY THE
MEMBERS. UM 9% INCREASE IN IN
RETENTION AND RESIDENTIAL
TREATMENT HAS LED TO A 30%
REDUCTION IN RIO RIO OVERDOSE
RATES. UM IN ADDITION, WANTED TO
SPEAK A LITTLE BIT ABOUT THE
CAPACITY OF AND WHAT THE NEED
MIGHT BE AS PART OF OUR
BEHAVIORAL HEALTH CONTINUUM
INFRASTRUCTURE PROGRAM.
SUBSTANCE USE FOR DISORDER
FACILITIES WERE INCLUDED AS PART
OF THE ELIGIBLE APPLICANTS JUST
TO GIVE YOU SOME SOME KIND OF
FLAVOR FOR SOME OF THE PROJECTS
THAT WERE AWARDED. WE HAD THREE
GRANTS AWARDED TO DEVELOP OR
EXPAND RESIDENTIAL SUD
FACILITIES FOR TRANSITION AGE
YOUTH SPECIFICALLY THREE GRANTS
WERE AWARDED TO DEVELOP OR
EXPAND RESIDENTIAL SUD
FACILITIES FOR ADOLESCENTS FOR
GRANTS WERE AWARDED TO DEVELOP
SHORT TERM RESIDENTIAL
THERAPEUTIC PROGRAMS. NINE
GRANTS WERE AWARDED TO DEVELOP
OR EXPAND CHILDREN'S CRISIS
RESIDENTIAL, WHICH ALSO INCLUDES
THAT KIND OF THE KOA CREAM 17
GRANTS WERE AWARDED TO DEVELOP
OR EXPAND COMMUNITY WELLNESS AND
YOUTH PREVENTION CENTERS. AND
THEN THERE WERE SEVERAL DOZEN
GRANTS RELATED TO EXPANDING
OUTPATIENT, COMMUNITY BASED
SUBSTANCE USE DISORDER TREATMENT
FACILITIES, AND SOME OF THOSE
WILL SERVE ADOLESCENTS. NEXT WE
HAVE MARIA KOA. ASSISTANT DEPUTY
DIRECTOR CENTER FOR HEALTHY
COMMUNITIES THAT CD PH. THANK
YOU. GOOD EVENING, MARIA OCHOA.
UM THE SUBSTANCE AND ADDICTION
PREVENTION BRANCH WAS FORMED IN
2020 TO BRING TOGETHER DISPERSED
SET OF PROGRAMS AND TO CREATE A
HOME FOR BEHAVIORAL HEALTH
APPROACH TO SUBSTANCE MISUSE AND
ADDICTION PREVENTION UNDER THE
CENTER FOR HEALTHY COMMUNITIES.
THE BRANCH AIMS TO PREVENT AND
REDUCE HARMS CAUSED BY SUBSTANCE
RELATED AND ADDICTIVE DISORDERS
AND IS HOME TO THREE SUBSTANCE
MISUSE AND OVERDOSE PREVENTION
INITIATIVES THAT ADDRESS YOUTH,
CANNABIS USE ALCOHOL ISSUES AND
OPIOID OVERDOSE PREVENTION. THE
OVERDOSE PREVENTION INITIATIVE
LEADS THE CALIFORNIA DEPARTMENT
OF PUBLIC HEALTH APPROACH TO THE
OPIOID EPIDEMIC. THIS CRITICAL
WORK IS SUPPORTED BY BOTH
FEDERAL FUNDING THROUGH THE
CENTERS FOR DISEASE CONTROL AND
PREVENTION AND BY STATE OPIOID
SETTLEMENT FUND. DOLLARS FEDERAL
FUNDING SUPPORTS RESEARCH AND
SURVEILLANCE, INCLUDING THIS,
INCLUDING SUPPORT OF THE
CALIFORNIA OVERDOSE SURVEILLANCE
DASHBOARD. OVERDOSE PREVENTION
PROJECTS, INCLUDING PARTNERSHIPS
WITH THE DEPARTMENT OF JUSTICE,
CLINICAL PROVIDERS AND SUPPORT
FOR THE STATES' OVERDOSE
PREVENTION COALITIONS, WHICH ARE
HOUSED IN LOCAL HEALTH
JURISDICTIONS AND COMMUNITY
BASED ORGANIZATIONS ACROSS THE
STATE. HOWEVER AS YOU HEARD
GIVEN CHANGES IN THE FEDERAL
FUNDING STRATEGY, SUPPORT FOR
THE PREVENTION WORK WILL BE
SIGNIFICANTLY REDUCED IN
SEPTEMBER 2023, INCLUDING
ELIMINATION OF FUNDING TO
SUPPORT THE COALITIONS. THE
STATE OF OPIOID SETTLEMENT
FUNDING SUPPORTS THE FORTHCOMING
STATEWIDE MEDIA CAMPAIGN TO
ADDRESS YOUTH AND ADULT OPIOID
USE WITH A FOCUS ON FENTANYL AND
HARM REDUCTION STRATEGIES. CITY
PH RECEIVED 40.5 MILLION FROM
THE OPIOID SETTLEMENT FUND UNTIL
2025 TO SUPPORT A STATEWIDE
MEDIA CAMPAIGN AND EVALUATION
WITH THREE PRIMARY AIMS AND
AUDIENCES. TO PREVENT SUBSTANCE
MISUSE AMONG TEENS AND YOUNG
ADULTS TO STOP OVERDOSE AND
OVERDOSE DEATHS AMONG ADULTS
WITH HARM REDUCTION APPROACH AND
TO RAISE AWARENESS AMONG
FAMILIES AND COMMUNITIES, REDUCE
STIGMA AND EQUIP THEM WITH THE
INFORMATION THEY NEED TO RESPOND
TO THE OVERDOSE EPIDEMIC WITH
LIFE SAVING SOLUTIONS AND
STRATEGIES. THE CAMPAIGN WILL BE
DEPLOYED STATEWIDE WITH A
HEAVIER PRESENCE IN AREAS
BEARING HIGHER BURDEN OF
OVERDOSE. SOME OF THE UPCOMING
ACTIVITIES INCLUDE GIVEN THE
URGENCY OF THE OVERDOSE CRISIS,
THE INITIAL CAMPAIGN MESSAGES
ARE ANTICIPATED TO BE LAUNCHED
IN SPRING OF 2023, WITH THE FULL
MEDIA CAMPAIGN LAUNCHED LATER IN
THIS CALENDAR YEAR. THE BRANCHES
YOUTH CANNABIS PREVENTION
INITIATIVE INCLUDES THE
CALIFORNIA CANNABIS SURVEILLANCE
SYSTEM AND THE CANNABIS
EDUCATION YOUTH PREVENTION
PROGRAM. THERE'S SURVEILLANCE
SYSTEM IS A PUBLIC HEALTH DATA
COLLECTION AND ANALYSIS SYSTEM
FOR YOUTH AND ADULT CANNABIS USE
LEGAL, SOCIAL AND ENVIRONMENTAL
IMPACTS AND HEALTH OUTCOMES. THE
PREVENTION PROGRAM PROVIDES
HEALTH EDUCATION AND PREVENTION
TO REDUCE THE NEGATIVE IMPACTS
AND CONSEQUENCES OF CANNABIS
USED TO STATE AND LOCAL
PARTNERSHIPS AND PUBLIC
AWARENESS CAMPAIGNS. THIS YEAR,
THE BRANCH LOST LAUNCHED THEIR
12 MILLION YOUTH CANNABIS
PREVENTION CAMPAIGN AIMED AT
YOUTH, THEIR PARENTS AND
GUARDIANS. THE YOUTH FOCUSED
CAMPAIGN MIND OVER MARIJUANA
AIMS TO EDUCATE YOUTH AGES, 13
TO 17 ABOUT THE RISKS AND
CONSEQUENCES ASSOCIATED WITH
CANNABIS USE. MIND OVER
MARIJUANA LAUNCHED ON SOCIAL
MEDIA, RADIO, TELEVISION AND
OUTDOOR ADVERTISING, SUCH AS
BILLBOARDS AND BUS STOPS. MIND
OVER MARIJUANA ADDRESSES HOW
CANNABIS USE CAN AFFECT PARTS OF
THE TEEN BRAIN RESPONSIBLE FOR
FORMING MEMORIES AND REGULATING
EMOTIONS, MAKING STRESS AND
ANXIETY HARDER TO MANAGE. LET'S
TALK CANNABIS IS THE PARENT
GUARDIAN EXTENSION OF MIND OVER
MARIJUANA, WHICH FOCUSES ON
SUPPORTING PARENTS AND GUARDIANS
AND HAVING OPEN AND HONEST
CONVERSATIONS WITH TEENS TO
PREVENT CANNABIS. USE. RESOURCES
FOR PARENTS AND GUARDIANS
INCLUDE TALKING POINTS AND A
CONVERSATION GUIDE, WHICH ARE
AVAILABLE IN BOTH ENGLISH AND
SPANISH. SOME OF THE UPCOMING
ACTIVITIES INCLUDE EVALUATION OF
THE CAMPAIGN EFFICACY, WHICH IS
UNDERWAY WITH RESULTS
ANTICIPATED FOR FALL 2023. WORK
WITH LOCAL HEALTH JURISDICTIONS
AND COMMUNITY BASED PARTNERS TO
AMPLIFY MESSAGES AND PROVIDE
HELPFUL RESOURCES. THE BRANCHES.
ALCOHOL HARMS PREVENTION
INITIATIVE WORKS TO SUPPORT
STATEWIDE EFFORTS TO REDUCE THE
HARMFUL ECONOMIC, HEALTH AND
SOCIAL IMPACTS OF EXCESSIVE
ALCOHOL USE AND RELATED HARMS ON
THE LIVES OF CALIFORNIANS. THE
ALCOHOL HARMS PREVENTION
INITIATIVE BUILDS PARTNERSHIPS
CONDUCTS RESEARCH, DEVELOPS
HEALTH EDUCATION MATERIALS AND
PROMOTES EVIDENCE BASED
STRATEGIES FOR PREVENTING
EXCESSIVE ALCOHOL USE AND
RELATED HARMS IN CALIFORNIA. AND
FINALLY, THE OFFICE OF PROBLEM.
GAMBLING IS DEDICATED TO
PROMOTING AWARENESS AND
PREVENTION OF PROBLEM GAMBLING
DISORDER AND MAKING TREATMENT
AVAILABLE TO THOSE NEGATIVELY
IMPACTED BY PROBLEM GAMBLING
OFFICER PROBLEM GAMBLING
PROVIDES TRAINING RELATED TO THE
TREATMENT OF GAMBLING DISORDER
FOR COUNSELORS THROUGH THE STATE
AND NO COST TREATMENT TO PEOPLE
WHO NEED SUPPORT. AND OFFICER
PROBLEM GAMBLING PREVENTION
PROGRAM IS COMPRISED OF A
HOTLINE 1 800 GAMBLER TRAINING
AND TECHNICAL ASSISTANCE, PUBLIC
AWARENESS CAMPAIGNS AND
RESEARCH. NEXT WE HAVE TOBY
EWING, EXECUTIVE DIRECTOR OF THE
ALWAYS SEE. THANK YOU, MR CHAIR.
UM. SO CLEARLY, THERE'S A LOT
HAPPENING IN TERMS OF THE STD
SERVICE. WHEN WE DO COMMUNITY
ENGAGEMENT WITH THE COMMUNITY
FORUMS. WE TALKED WITH FAMILIES
. YOU KNOW THIS IS A CHALLENGING
ISSUE BECAUSE THE SYSTEMS ARE
HARD TO NAVIGATE. AND ALTHOUGH
THERE'S A LOT HAPPENING IN TERMS
OF PAYMENT OPPORTUNITIES THE
BOTTOM LINE IS WHAT WE HEAR
CONTINUOUSLY IS JUST HOW
DIFFICULT IT IS. TO ACCESS
SERVICES, PARTICULARLY ON DEMAND
SERVICES. THEN HOW? GIVEN THE
NATURE OF ADDICTION. THAT'S
IMPORTANT BECAUSE WHEN PEOPLE
ARE READY FOR CARE THEY NEED TO.
THEY NEED TO RECEIVE IT. AND WE
ALSO NEED TO RECOGNIZE THAT
PEOPLE WORKING THROUGH
ADDICTION. MAY CYCLE THROUGH,
YOU KNOW, MAY NEED SERVICES
MULTIPLE TIMES. AND SO, UM, THIS
IS ANOTHER AREA WHERE THE
SERVICE DELIVERY SYSTEM IS.
DIFFICULT TO UNDERSTAND BY THE
PUBLIC HARD TO ACCESS. AND IT'S
DIFFICULT TO AND FOR FAMILIES TO
ENSURE THAT THEY'RE RECEIVING
THE SERVICES THAT ARE SORT OF
BEST ALIGN WITH THEIR NEEDS. UM,
THE ONE OF THE QUESTIONS IN THE
IN THE A PACK IT IS, YOU KNOW,
WHAT IS THE INTERSECTION OF THE
ESSAY AND SUD SERVICES? AND
WE'LL JUST TAKE SOME CUES THAT
THE MEMBERSHIP OF THE COMMISSION
INCLUDES A PHYSICIAN WITH
EXPERTISE IN ADDICTION MEDICINE.
AND SO, UM, YOU KNOW, FROM HIS
PERSPECTIVE, AND I THINK THE
PERSPECTIVE OF THE COMMISSION UM
, ADDICTION DISORDERS ARE MENTAL
ILLNESSES AND THEIR RECOGNIZED
IN THE DSM. BUT THAT ISN'T WHAT
THE CULTURE AND TRADITIONAL
PRACTICES. AND IT WAS WITHIN THE
BROADER MENTAL HEALTH COMMUNITY.
IN IN COUNTIES. WE SEE DIRECTORS
WHO BEHAVIOR HEALTH DIRECTORS
WHO HAVE THE ADDICTION SIDE AND
THE MENTAL HEALTH SIDE. UM AND
SO THIS ISSUE IS A LITTLE
UNSETTLED THAT WE HAVE SPONSORED
TWO BILLS TO REALLY APPROACH
THIS ISSUE. KIND OF GENTLY. THE
FIRST, UM ESTABLISHED WHAT WE
CALLED PRESUMPTIVE ELIGIBILITY
FOR INDIVIDUALS WHO NEEDED CARE
, BUT IT WAS UNCLEAR WHAT WAS
HAPPENING IN THEIR IN THEIR
MINDS AND BODIES AT THE MOMENT.
IT COULD HAVE BEEN PSYCHOSIS. IT
COULD BE DRUG INDUCED PSYCHOSIS
AND THAT WE HEARD CONCERNS FROM
COUNTIES THAT IF THEY USE
IMAGES, THE FUNDS TO PROVIDE
THAT SERVICE IS THEY COULD FACE
AN AUDIT EXCEPTION AND HAVE TO
UM, REIMBURSE THOSE USING OTHER
DOLLARS. SO WE SPONSORED
LEGISLATION TO CLARIFY THAT
LET'S HOLD PROVIDERS IN COUNTIES
HARMLESS IN A STRATEGY TO ENSURE
THAT WE DELIVER CARE FIRST AND
THEN SETTLE UP AFTER THE FACT
WITH THAT, WITH A NO WRONG DOOR
APPROACH, AT LEAST AN INITIAL
ASSESSMENT. UM A LOT OF SUPPORT
FOR THAT GOVERNOR SIGNED IT, UM
SECOND, WE RE SPONSORED
LEGISLATION TO CLARIFY THAT
IMAGES. ÁP EI FUNDS CAN BE USED
FOR ADDICTION SERVICES
INDEPENDENT OF CO OCCURRING
DISORDERS AND THE IDEA THERE IS
PARTICULARLY FOR CHILDREN AND
YOUTH IS, UM IT CAN BE REALLY
DIFFICULT TO SORT OUT WHAT'S
HAPPENING IN THE LIFE OF A YOUNG
PERSON. AND WHERE DOES THAT
WHERE DOES THAT BEHAVIOR FALL?
INTO KIND OF THE MIX OF SERVICES
THAT A COUNTY OR COMMUNITY
PROVIDER OR A SCHOOL DISTRICT
MIGHT BE PROVIDING. UM THIS WAS
ALL TOWARDS TRYING TO MOVE THE
CONVERSATION TO IN THE BROADER
MENTAL HEALTH. COMMUNITY TO GIVE
COUNTIES TO FLEXIBILITY TO MAKE
THOSE DECISIONS BASED ON THE
RANGE OF RESOURCES THEY HAVE
AVAILABLE TO THEM IN THE RANGE
OF NEEDS THEY HAVE IN THEIR
COMMUNITY. WE'RE CURRENTLY
WORKING TO EXPLORE WAYS THAT WE
CAN LEVERAGE MENTAL HEALTH
WELLNESS ACT FUNDS AS INCENTIVE
DOLLARS TO STRENGTHEN ACCESS TO
CARE. UM WE'RE LAUNCHING A NEW
STRATEGIC PLANNING INITIATIVE
AND ONE OF THE CONVERSATIONS
THAT COMMISSIONS ARE STARTING TO
HAVE IS, CAN WE ESTABLISH AN
EXPECTATION FOR ON DEMAND
ADDICTION SERVICES ACROSS
CALIFORNIA? AGAIN IF WE WANT TO
GET IN FRONT OF THE CHALLENGE
THAT FACES SO MANY COUNTS. YOU
KNOW TOO MANY CALIFORNIANS AND
THAT RESULTS IN UNNECESSARY AND
INAPPROPRIATE LOSS OF LIFE. CAN
WE CREATE AGAIN? NO WRONG DOOR
ON DEMAND ACCESS TO ADDICTION
SERVICES. WHAT WOULD THAT LOOK
LIKE? AND SO WE'VE TALKED WITH
SOME COUNTIES ABOUT THEIR
INTEREST IN RECEIVING GRANT
FUNDING FROM THE COMMISSION TO
BEGIN TO EXPLORE. BUILDING UPON
THE SYSTEM THAT'S ALREADY
AVAILABLE FOR SERVICE. BUT
ACTUALLY TRYING, YOU KNOW,
LEVERAGING AMATEUR S¼ DOLLARS TO
SUPPLEMENT THAT, PARTICULARLY IN
WAYS THAT CAN BE RESPONSIVE TO
PEOPLE WHO MAY NOT HAVE
IMMEDIATE ACCESS TO PAYMENTS.
THEY MAY NOT BE ON MEDICAL, FOR
EXAMPLE, OR THAT MEDICAL SERVICE
MAY NOT BE AVAILABLE. AND SO
THIS WOULD BE SORT OF THAT, YOU
KNOW. VERY FLEXIBLE FUNDING THAT
COULD CREATE SOME GAP FILLERS
WORKING WITH COMMUNITY PROVIDERS
AND COUNTIES AND OTHER PARTNERS.
THIS IS WORK THAT, UM UH,
COMMISSIONER IT? I DON AVIK, OUR
ADDICTION MEDICINE SPECIALIST.
HE'S AT CEDAR SINAI HAS REALLY
BEEN PUSHING THE COMMISSION TO
ENGAGE ON AND SO WE'RE REALLY
JUST GETTING STARTED IN THAT
AREA, BUT WE RECOGNIZE THAT IT
IS A CORE CHALLENGE THAT TOO
MANY COMMUNITIES, UM ARE HAVING
TO FACE AND WE'RE FOLLOWING
SHORT IN TERMS OF ACCESS TO CARE
AND SERVICES. I HAVE PERSONALLY
BEEN CALLED AND ENGAGED.
COLLEAGUES AND FRIENDS TO, YOU
KNOW, DO US A FAVOR TO PROVIDE
UM, YOU KNOW, SAME DAY SERVICES
, INCLUDING ON BEHALF OF YOU
KNOW PEOPLE FROM THIS BUILDING,
RIGHT? AND SO THIS IS JUST AN
INDICATION OF HOW PERVASIVE THIS
NEED IS AND HOW DIFFICULT IT IS
TO ADDRESS AND HOW MUCH WORK WE
HAVE TO DO TO REALLY MOVE
TOWARDS A VERY GOAL DRIVEN
POPULATION BASED STRATEGY.
THAT'S PUBLIC HEALTH FOCUS TO
ENSURE THAT NOBODY, UM MRS
ACCESS TO THE SERVICES THAT WE
CAN PROVIDE WHEN THEY NEED THEM.
DEPARTMENT OF FINANCE. NATE
WILLIAMS DEPARTMENT OF FINANCE
NOTHING TO ADD, BUT AVAILABLE
FOR QUESTIONS, ELIO NOTHING TO
ADD AVAILABLE FOR QUESTIONS.
BRING IT BACK. UM I WANTED TO
DIG IN TO MRS THOMASES COMMENT
AND MRS CABRERA'S FOLLOW UP
REGARDING METHADONE AND YOU
PRINT ORPHAN. I UNDERSTAND. IT'S
AN FDA REGULATION THAT THEY'RE
LOOKING TO PROMULGATE. ARE THERE
ANY FLEXIBILITIES THAT
CALIFORNIA WILL. BE ABLE TO
REPLACE IF THE F D A PROMULGATES
THESE REGULATIONS OR UM, HOW DO
WE ENSURE THAT FLEXIBILITIES
WHICH WERE ALLOWED DURING THE
PANDEMIC, OR AFFORDED TO STATES
MHM. I MEAN, NOT TO MY
KNOWLEDGE, BUT I'M HAPPY TO
FOLLOW YOUR LENA. WE'VE
RESEARCHED THIS. WE SENT IN A
LETTER WE'VE YOU KNOW, DONE OUR
PART TO TRY TO, UM, REQUEST THAT
THE FDA, UM NOT MOVE IN THIS
DIRECTION, BUT I'M NOT AWARE
THAT THERE WOULD BE A STATE WORK
AROUND UNLESS YOU HAVE ONE.
YEAH, I DON'T KNOW. IF THERE ARE
WAYS FIRST DATES TO WAVE
REQUIREMENTS. AND SOME OF THESE
ARE D E A RESTRICTIONS. UM UH,
THE D E A INSERTS ITS SELF AND
CLINICAL AND MEDICAL ISSUES WHEN
IT COMES TO TREATMENT FOR
SUBSTANCE USE DISORDER, WHICH I
THINK SHOULD BE STAYING SOLIDLY
IN THE HEALTHCARE WORLD AND NOT
IN THE WORLD OF ENFORCEMENT. BUT
UM, THE D E A CHOOSES TO GO
THERE. SO YES, SOME OF THESE, UM
RESTRICTIONS THAT WERE LIFTED
DURING COVID, I THINK ARE GOING
TO CONTINUE TO STAY WITH SOME
FLEXIBILITY. WHICH IS GOOD,
BECAUSE WE'VE BEEN ABLE TO DO
EVALUATIONS AND GET REALLY GOOD
, UM, INFORMATION ABOUT
INCREASED ACCESS PEOPLE STAYING
ON LONGER PEOPLE REALLY
IMPROVING THEIR HEALTH STATUS.
UM BUT, YEAH, I THINK YOU KNOW
IF THE IF THE STATE LEGISLATURE
. YOU KNOW, DR GHALI WANTED TO
SEND A LETTER. UM AND A LITTLE
BIT OUT OF MY DEPTH IN TERMS OF
HOW CALIFORNIA CAN INFLUENCE THE
FEDERAL GOVERNMENT ON THIS, BUT
I THINK THERE ARE THE FOLKS
THERE IN THE ROOM WHO PROBABLY
HAVE A BETTER IDEA HOW TO MAKE
THAT HAPPEN. DEPUTY DIRECTOR.
THANK YOU CHAIR, SO I THINK
THERE ARE TWO, UM FEDERAL ISSUES
AT PLAY WITH RESPECT OF
MEDICATIONS FOR OPIOID USE
DISORDER. THE PANELISTS HAVE
MENTIONED THE D E A WALKING BACK
SOME COVID ERA FLEXIBILITIES
WITH RESPECT TO TELE PRESCRIBING
OF BUPRENORPHINE KHN SUBJECT TO
THE RYAN HEIGHT. ONLINE ACT, SO
I THINK A NUMBER OF ENTITIES IN
THIS ROOM, INCLUDING THE HCS
HAVE PROVIDED COMMENTS TO THE D
A. TO RETAIN THOSE FLEXIBILITIES
, WHICH WERE REALLY CRUCIAL FOR
INDIVIDUALS TO HAVE TELEHEALTH
ACCESS TO BE ON OUR FRIEND.
SEPARATE LISTING FROM THAT, UM,
SAMSUNG, OUR FEDERAL PARTNERS AT
SAMSUNG AND THE D. E. A ALSO
ISSUED FLEXIBILITIES WITH
RESPECT TO THE PROVISION OF
METHADONE AND BUPRENORPHINE AND
AT WHAT CALIFORNIA CALLS
NARCOTIC TREATMENT PROGRAMS. UM
SO WE ARE WORKING WITH OUR
FEDERAL PARTNERS TO ENSURE
CALIFORNIA IS ABLE TO IMPLEMENT
AND SUSTAIN THOSE FLEXIBILITIES
FOR METHADONE IN PARTICULAR IN
OUR NARCOTIC TREATMENT PROGRAMS.
I HAVE AN INTEREST IN THIS
SUBJECT AREA AND WOULD
APPRECIATE A FOLLOW UP REGARDING
HOW THE A MAKES THEIR DECISION.
AND JUST A COMMENT ON THE HARM
REDUCTION INITIATIVE. UM, IN
LIGHT OF THE. FENTANYL OVERDOSE
THAT WE'RE SEEING AS A STATED UM
, DOESN'T SEEM TO MAKE A WHOLE
BUNCH OF CENTS NOT TO CONTINUE
FUNDING BEYOND. JUNE OF THIS
YEAR AND WOULD AGREE WITH YOU.
WITH THAT I WILL. THANKS VERY
MUCH THIS PANEL AND WE WILL MOVE
ON TO ISSUE 25. ISSUE 25 IS ON
THE OPIOID SETTLEMENTS FUND.
STATE DIRECTED PROGRAMS BCP.
TYLER SAT WITH WHEN YOU ARE
READY. GOOD EVENING, MR CHAIR.
THE DEPARTMENT IS REQUESTING IN
THIS BCP. FOUR YEAR LIMITED TERM
EXPENDITURE AUTHORITY OF 32
MILLION IN BUDGET YEAR 23
MILLION FOR FISCAL YEAR 24 25.
$12 MILLION IN FISCAL YEAR 25 26
THROUGH 26 27. THIS IS ALL TO
SUPPORT THE DEPARTMENT'S
NALOXONE DISTRIBUTION PROJECT
FOR THE NDP. WHICH ANOTHER
PANELIST, UH, REFERENCED SO JUST
AS BACKGROUND REQUESTS FOR
NALOXONE HAVE SIGNIFICANTLY
INCREASED OVER THE LAST YEAR,
LARGELY DUE TO RISING RATES OF
OVERDOSES, INCLUDING FENTANYL,
AND NOW AN EMERGING TREND OF
FENCING. ALL UH, CONTAMINATED
WITH THE PRESENCE OF ZILLA SCENE
, WHICH IS INCREASING THE
LETHALITY OF FENCE AND ALL. TO
DATE, THE DEPARTMENT HAS
DISTRIBUTED OVER TWO MILLION
UNITS OF NALOXONE WHICH HAVE
RESULTED IN OVER, 140,000
REPORTED OVERDOSE REVERSALS. FOR
FISCAL YEAR, UH, THE NALOXONE
DISTRIBUTION PROJECT ANTICIPATES
TOTAL DISTRIBUTION OF OVER 1.2
MILLION UNITS OF, UH OF NALOXONE
, COSTING APPROXIMATELY $59.5
MILLION DUE TO EVER. EXCUSE ME
EVER INCREASING DEMANDS FOR
ACCESS THAT WE RECEIVED THROUGH
APPLICATIONS TO THE NDP WE
EXPECT TO DISTRIBUTE OVER 1.8
MILLION UNITS, COSTING
APPROXIMATELY $88 MILLION IN
BUDGET HERE. THE FDA RECENTLY
APPROVED OVER THE COUNTER STATUS
OF NALOXONE THAT HAS YET TO COME
TO FRUITION IN OUR RETAIL
PHARMACIES. WE DO NOT ANTICIPATE
THE FDA DECISION TO MAKE
NALOXONE AVAILABLE OVER THE
COUNTER WILL HAVE A MAJOR IMPACT
ON THE AMOUNT OF REQUESTS THAT
THE NDP RECEIVES. UM THE
DEPARTMENT RECEIVED, UH,
$2,716,000 IN OPIOID SETTLEMENT
FUNDS FOR CURRENT YEAR AND 2.6
MILLION FOR BUDGET YEAR.
THROUGHOUT THE TERMS OF THE
SETTLEMENTS OF THE OPIOID
SETTLEMENT FUND. UM THE NATIONAL
SETTLEMENT AGREEMENTS OUTLINED
USE OF FUNDS TO BE USED FOR
OPIOID REMEDIATION ACTIVITIES TO
COMBAT THE CURRENT OPIOID CRISIS
. THESE FUNDS ARE BEING SPENT ON
PREVENTION AND IMMEDIATE HARM
REDUCTION ACTIVITIES, WHICH ARE
ALLOWABLE ACTIVITY IS CONSISTENT
WITH THE INTENT OF THE
SETTLEMENT AGREEMENTS. UM FROM
THE SETTLEMENTS CURRENTLY
RECEIVED IN THE OPIOID
SETTLEMENT FUNDS. THE DEPARTMENT
, THE CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH, AND THE
DEPARTMENT OF REHABILITATION ARE
THE THREE STATE DEPARTMENTS
WHICH HAVE BEEN ALLOCATED THE
STATE'S ALLOCATION OF OPIOID
SETTLEMENT FUNDS. OTHER UM
RECIPIENTS OF OPIOID SETTLEMENT
FUNDS INCLUDED PARTICIPATING
SUBDIVISIONS. MHM MISS CABRERA.
THANK YOU SO MUCH. UM AND GOOD
EVENING. WE AS COUNTY BEHAVIORAL
HEALTH ARE AMONG THE RECIPIENTS
OF THE LOCAL ABATEMENT FUNDS,
AND WE HAVE BEEN IN
CONVERSATIONS WITH THE STATE
ABOUT THE ALLOCATION OF THE
STATE OPIOID SETTLEMENT FUNDS
FOR SEVERAL REASONS. FIRST. AS
MENTIONED BEFORE THERE ARE
LIMITED SOURCES OF FUNDING
AVAILABLE FOR SUBSTANCE USE
DISORDER PREVENTION AND
TREATMENT AT THE LOCAL LEVEL,
AND, UM, THE LOCAL ABATEMENT
BONES ACTUALLY COME WITH PRETTY
PRESCRIBED ALLOWABLE
EXPENDITURES, WHEREAS THERE'S
MORE FLEXIBILITY AT THE STATE
LEVEL. WE DO SEE THE OPIOID
SETTLEMENT FUNDS IN THE VARIOUS
ROUNDS THAT ARE THAT THAT HAVE
ALREADY COME IN ARE ABOUT TO
COME. AS A REALLY SIGNIFICANT
OPPORTUNITY FOR US TO MAKE SOME
CHANGES THAT WILL HAVE
GENERATIONAL IMPACT. AND SO I
WANTED TO SHARE A LITTLE BIT
ABOUT OUR THOUGHTS ON THAT. WE
DO SUPPORT THE NDP. LET ME BE
CLEAR. HOWEVER IN UM AS WE'RE
RECEIVING NEW STATE LEVEL OPIOID
SETTLEMENT FUNDS WE HAVE
RECOMMENDED TO THE STATE THAT WE
LOOK AT PRIORITIZING INVESTMENTS
IN PREVENTION. AS WELL AS HARM,
REDUCTION AND TREATMENT. UM YOU
KNOW, OUR PRIOR SPEAKERS TALKED
A LITTLE BIT ABOUT THE
IMPORTANCE OF HARM REDUCTION
INITIATIVES. UM IT WOULD BE OF
GREAT BENEFIT TO PROMOTING AND
EXPANDING HARM REDUCTION IF
STATE FUNDS WERE MADE AVAILABLE
TO THE LOCAL LEVEL WITH THAT AS
A AS PART OF THE CRITERIA,
RIGHT, SO REALLY REMOVING, UM,
BARRIERS THAT MIGHT EXIST IN
PERCEIVED, YOU KNOW. UM
DOWNSIDES RELATED TO HARM
REDUCTION BY MAKING IT A STATE
PRIORITY AND WE HAVE WE HOPE TO
PARTNER WITH THE STATE IN
REALIZING THAT VISION. IN
ADDITION, WE HAVE VERY LIMITED
SOURCES OF FUNDING FOR BOTH
PREVENTION AND TREATMENT SIDE
AND SO WE'RE HOPING THAT WE CAN
AUGMENT THE FUNDS THAT ARE
AVAILABLE THROUGH LOCAL AGREED
SETTLEMENT FUNDS WITH STATEWIDE
FUNDS THAT ARE EARMARKED IN
THOSE WAYS. IN ADDITION AGAIN TO
THE DISTRIBUTION OF NALOXONE,
THANK YOU. DEPARTMENT OF FINANCE
NATE WILLIAMS, THE DEPARTMENT OF
FINANCE NOTHING FURTHER THAT
HELLO, CONCERNS BRING IT UP TO
THE DIESS. IT MAY BE A PARKING
LOT ISSUE AND DUE TO THE
LATENESS OF THE MADE, I WILL, UM
NOT REQUIRE AN ANSWER, BUT THE
STATE IS MANUFACTURING THROUGH
HELL. RX INSULIN. IS THERE EVER
A THOUGHT? DUE TO THE CRISIS
WE'RE FACING. TO PRODUCING
NALOXONE AS WELL. THANK YOU, MR
CHAIR. UM THE ADMINISTRATION IS
EXPLORING OPTIONS AND ASSESSING
THE, UH THE OPPORTUNITY FOR THE
CATTLE RX INITIATIVE TO INCLUDE
THE MANUFACTURER OF GENERIC
NALOXONE WITH THAT I WILL THANKS
VERY MUCH THIS PANEL AND MOVE ON
TO ISSUE 26. ISSUE 26 IS ON THE
FENTANYL PROGRAM GRANTS 23 65
INNOVATIVE APPROACHES TO MAKE
FENTANYL TEST STRIPS AND A LOCKS
LOOMS. MORE WIDELY AVAILABLE.
TCP WE WILL BEGIN WITH MARIA
OCHOA. GOOD EVENING AGAIN. SO
THE GOVERNOR'S BUDGET REFLECTS
AN INCREASE OF 7.5 MILLION AND
THE OPIOID SETTLEMENTS, FUNDS
AND FISCAL YEAR 23 24 3.5
MILLION AND FISCAL YEAR 24 25
1.5 MILLION IN FISCAL YEAR 25 26
FISCAL YEAR 26 27 TO SUPPORT TO
PROJECTS TO ADDRESS THE OPIOID
CRISIS PER THE REQUIREMENTS OF A
B 23 65. THE FIRST PROJECT WILL
ISSUE 61 TIME COMPETITIVE GRANTS
TO REDUCE FENTANYL USE IN
OVERDOSE. THE GRANTS WILL BE
ALLOCATED BY REGION TO A
NORTHERN CALIFORNIA TO IN THE
CENTRAL VALLEY AND TWO AND
SOUTHERN CALIFORNIA WITH THE
GOAL OF SUPPORTING LOCAL EFFORTS
AND EDUCATION, TESTING, RECOVERY
AND SUPPORT SERVICES. THE GRAND
PERIOD WILL COVER THREE YEARS
FROM JANUARY 2024 THROUGH
JANUARY. I MEAN THROUGH
DECEMBER, 2026 WITHIN AVERAGE
AWARD OF 427,000 OVER THREE
YEARS. AND I WILL NOW TURN IT
OVER TO ALEXANDRA. GOOD EVENING
, ALEXANDER ROSS WITH THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH OF THE CENTER FOR
INFECTIOUS DISEASES TO SPEAK TO
THE SECOND OF THESE TWO
PROPOSALS, AND THAT IS $4
MILLION OVER FOUR YEARS FROM
OPIATES SETTLEMENT FUNDS, AND
THIS PROPOSAL WILL BUILD ON TWO
OF THE TOOLS THAT ARE AVAILABLE
TO HELP STEM THE OVERDOSE CRISIS
AND SAVE LIVES. THE FIRST IS TO
EXPAND THE NALOXONE DISTRIBUTION
WORK THAT'S CURRENTLY BEING DONE
BY SYRINGE SERVICES PROGRAMS IN
CALIFORNIA. AND THEN THE SECOND
WILL INCREASE ACCESS TO FENTANYL
TEST STRIPS THROUGHOUT THE
STATE. THE CENTER FOR INFECTIOUS
DISEASES WILL ISSUE A REQUEST
FOR INFORMATION TO EXPLORE
INNOVATIVE APPROACHES TO THE
WORK USE THAT INFORMATION TO
ISSUE COMPETITIVE GRANTS TO
ESTABLISH A LOW COST NALOXONE
SUPPLY FOR SURRENDER SERVICES
PROGRAMS AND EXPAND ACCESS TO
FENTANYL TEST STRIPS. UM AS LARA
THOMAS MENTIONED IN HER
TESTIMONY. SARIN SERVICES
PROGRAMS ARE THE PRIMARY VEHICLE
FOR REACHING PEOPLE WHO ARE AT
GREATEST RISK OF EXPERIENCING AN
OVERDOSE BECAUSE THEIR CENTRAL
MISSION IS TO WORK WITH PEOPLE
WHO ARE CONTINUING TO USE DRUGS
, AND THEY'RE ALSO THE PRIMARY
SOURCE OF NALOXONE AND TRAINING
AND HOW TO USE IT FOR THE PEOPLE
WHO ARE MOST LIKELY TO WITNESS
AND REVERSE AN OVERDOSE, A CD
PH. FUNDED STUDY THAT WE DID THE
LAST YEAR OF 1500 ZARIN SERVICES
PROGRAM. PARTICIPANTS FOUND THAT
65% OF THEM HAD WITNESSED AN
OVERDOSE IN THE PREVIOUS SIX
MONTHS. 55% HAD USED NALOXONE TO
REVERSE AN OVERDOSE AND 95% OF
THEM HAD GOTTEN THAT NALOXONE
FROM A SYRINGE SERVICES PROGRAM
. SO THAT'S WHERE THE WORK IS
REALLY BEING DONE ON THE GROUND,
AND WHEN WE TALK ABOUT BOOTS ON
THE GROUND THOSE ARE THE BOOTS.
THOSE ARE THE FEET AND THAT'S
WHERE THE MONEY NEEDS TO BE. SO
A SURVEY WE DID OF THE 68
PROGRAMS IN CALIFORNIA THAT DO
THIS WORK. ALL OF THEM SAID THEY
WOULD BE ABLE TO SCALE UP AND SO
THAT'S WHAT THIS PROPOSAL IS
AIMING TO DO THE OTHER
OPPORTUNITIES THAT WE'RE TRYING
TO TAKE ADVANTAGE OF COMES FROM
RECENT CHANGES TO THE LAW LAST
YEAR THAT MADE FENTANYL TEST
STRIPS MORE BROADLY AVAILABLE BY
DECLARING THEM NOT TO BE
OFFICIALLY DRUG PARAPHERNALIA,
SO THIS WILL ALSO BE AN
OPPORTUNITY THAT WE CAN TAKE
ADVANTAGE OF, AND THAT'S WHAT
WE'RE HOPING TO DO. MISS THOMAS.
THANK YOU. I WILL TRY TO KEEP
THIS BRIEF. I KNOW THIS IS GOING
SO LATE. UM JUST A COUPLE OF
COMMENTS. YOU KNOW, THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH HAS REALLY TAKEN A
LEADERSHIP ROLE IN SUPPORTING
HARM REDUCTION AND, UH,
SUPPORTING THAT, UM, AS YOU JUST
HEARD FROM MISS ROSS, UM AND I
THINK, YOU KNOW WHETHER IT'S
HAPPENING THROUGH CD PH. D HCS
JUST CONTINUING TO EXPAND THE
RESOURCES AND ENSURING THAT
THEY'RE GETTING WHERE THEY NEED
TO GO. ONE THING I WOULD SAY
ABOUT THE FENTANYL TEST STRIPS.
I THINK FENTANYL TEST STRIPS ARE
VERY USEFUL FOR PEOPLE WHO ARE
NOT REGULAR OPIOID USERS, FOR
EXAMPLE, WHO MAY BE USING
STIMULANTS AND ARE NOT EXPECTING
TO FIND FENTANYL IN THEIR
SUBSTANCES. UM I THINK THAT THE
STATE WOULD BE WELL SERVED TO
HAVE SOME FLEXIBILITY AROUND HOW
THAT MONEY IS SPENT. YOU HEARD,
I THINK FROM, UH, TYLER SAD WITH
EARLIER THAT ZILLA SCENE IS
STARTING TO SHOW UP IN THE
CALIFORNIA DRUG SUPPLY. THERE.
NOW'S ISLANDS IN TEST STRIPS,
BEING ABLE TO CONTINUE TO, UH,
TO OFFER THESE KINDS OF TEST
STRIPS IN A SORT OF MORE
FLEXIBLE WAY THAN JUST LIMIT.
EATING IT. ONE PARTICULAR KIND
AND EXPANDING IT TO BROADER DRUG
CHECKING PROGRAMS AT THE SAN
FRANCISCO IT'S FOUNDATION. WE
HAVE A FANTASTIC DRUG CHECKING
PROGRAM THAT USES A F T A R
MACHINE THAT USES INFRARED TO
BETTER DETECT THE SUBSTANCES AND
PROVIDE PEOPLE WITH MORE
ACCURATE INFORMATION ABOUT THE
SUBSTANCES THAT THEY'RE GOING TO
DO. SO BEING ABLE TO ENSURE THAT
STATE SUPPORT IS THAT IT CAN BE
AS FLEXIBLE AS POSSIBLE,
RECOGNIZING THE CHANGING DRUG
SUPPLY, I THINK WOULD BE, UM,
WELL SERVED. I KNOW THAT THE
GOVERNOR HAS REFERENCED NALOXONE
MANUFACTURER BY THE STATE. UM
BUT THE ONE THING I WILL SAY
ABOUT THAT SINCE I HAVE THE MIC.
UH NALOXONE ITSELF IS A GENERIC
MEDICATION THAT IS VERY CHEAP,
INEXPENSIVE TO MANUFACTURE AND
DISTRIBUTE WHAT COSTS MONEY IS
THE NARCAN BRANDED NASAL INHALER
. THAT IS WHERE THE PRICING
ISSUE IS IN THE COST IS, UM, I
WOULD BE DELIGHTED IF THE STATE
OF CALIFORNIA FIGURED OUT HOW TO
MANUFACTURE THOSE AND WORK OUT
THE PATENT ISSUES THAT WOULD
DEFINITELY MAKE IT. MORE
ACCESSIBLE, BUT THAT'S ALSO
BEYOND MY PAY SCALE. SO THANK
YOU VERY MUCH. DEPARTMENT OF
FINANCE. GOOD EVENING, MR CHAIR
. NICK MILLS DEPARTMENT FINANCE
NOTHING FURTHER TO ADD, BUT I
HAVE TO ANSWER ANY QUESTIONS.
YEAH WELL, OWENS HELLO. WE HAVE
NO CONCERNS WITH THIS PROPOSAL.
I WILL THANK VERY MUCH PANEL 26
. WE WILL MOVE ON TO PANEL 27.
27 IS ON THE FENTANYL PROGRAM
GRANTS REPORTING REQUIREMENTS A
B 23 65. TRAILER BILL MARIA
CHORE. GOOD EVENING. MARIA OCHOA
SED PH. SO I WON'T GO INTO GREAT
DETAIL ABOUT IT BECAUSE WE JUST
HEARD AN UPDATE ON THE PROPOSAL.
BUT THE PROPOSED TRAILER BILL
FOR A B 23 65 ADDRESSES TWO
ISSUES THAT WERE IDENTIFIED. IN
A B 23 65 1. THERE WAS NO
DEPARTMENT IDENTIFIED WITHIN COW
HHS TO ADMINISTER THE FENTANYL
PROGRAM GRANTS AND MANDATED
REPORTING AND TO THE TIMEFRAME
FOR REPORTING TO THE LEGISLATURE
AND GOVERNOR'S OFFICE DID NOT
ACCOUNT FOR THE TIME NECESSARY
FOR C D PH. TO DEVELOP THE GRANT
PROGRAM AND FOR GRANTEES TO
IMPLEMENT THE ACTIVITIES. AND
FOR CD PH TO REPORT ON THE
OUTCOMES OF THE FENTANYL GRANT
PROGRAMS. SO THE TRAILER BILL
LANGUAGE ADDRESSES THE LEAD
DEPARTMENT ROLE BY IDENTIFYING
CD PH AND ADDRESSES THE TIMELINE
BY SPECIFYING THAT THE REPORT
DUE TO THE LEGISLATURE ON
JANUARY 1 2026 WORK CONSISTS OF
AN INTERIM REPORT ON THE
PROGRESS OF THE GRANT PROGRAMS
AND ADDS A SECOND REPORT DUE ON
JANUARY 1 2028, WHICH SUMMARIZES
THE INFORMATION PROVIDED TO CD
PH. AND IT EXTENDS THE SUNSET
DATE OF THE CHAPTER UNTIL
JANUARY. 1 2029 DEPARTMENT OF
FINANCE. IT SMELLS DEPARTMENT OF
FINANCE NOTHING FURTHER TO ADD L
U NO CONCERNS ABOUT THIS
PROPOSAL. THANKS VERY MUCH PANEL
27. WE WILL MOVE ON TO ISSUE 28.
ISSUED 28 IS ON THE DHC
STRENGTHENING OVERSIGHT FOR
SUBSTANCE USE DISORDER,
LICENSING AND CERTIFICATION. BCP
AND TRAILER BILL. WE WILL BEGIN
WITH DIRECTOR BOSS. HI THERE. UH
WELL, THE DEPARTMENT HAS MADE
STRIDES TO IMPROVE LICENSING AND
CERTIFICATION, OVERSIGHT AND
STREAMLINE PROCESSES WITH OUR
EXISTING RESOURCES. THE
DEPARTMENT PROPOSES A BCP AND
TRADER BUILDING WHICH TO
STRENGTHEN OUR OVERSIGHT
CAPABILITIES FOR SUBSTANCE USE
DISORDER TREATMENT FACILITIES.
WITH THIS PROPOSAL, THE
DEPARTMENT SEEKS TO IMPLEMENT A
FEE INCREASE EFFECTIVE JULY 1ST
2023 FOR FEES ASSOCIATED WITH
THE RESIDENTIAL AND OUTPATIENT
PROGRAM LICENSING FUND. MAKE
STATUTORY CHANGES TO IMPROVE THE
FEED PROCESSES AND ESTABLISH A
NEW REQUIREMENT FOR MANDATORY
CERTIFICATION AT OUTPATIENT
SUBSTANCES. FACILITIES INCREASED
THE EXPENDITURE AUTHORITY FOR
THE DEPARTMENT TO IMPLEMENT
MANDATORY CERTIFICATION OF
OUTPATIENT SUD FACILITIES AND TO
ADDRESS THE INCREASED LICENSING
AND CERTIFICATION WORKLOAD IN
THE SOUTHERN CALIFORNIA REGION,
WHICH EXPERIENCES THE HIGHEST
RATE OF COMPLAINTS AND
DEFICIENCIES AND RESOURCE
INTENSIVE INVESTIGATIONS. UPON
APPROVAL OF THE PROPOSED FREE
INCREASED THE DEPARTMENT
REQUESTS 12 PERMANENT POSITIONS
TO STRENGTHEN OVERSIGHT AS I
JUST MENTIONED AND TO ESTABLISH
THE NEW MANDATORY CERTIFICATION
PROGRAM WITHOUT THE FEE,
INCREASE THE RESIDENTIAL OUTRAGE
OUTPATIENT PROGRAM LICENSING,
FUN OR ROLF, I WILL NOT BE ABLE
TO SUPPORT ANY ADDITIONAL
OVERSIGHT REQUIREMENTS AT HIS
HIS CURRENTLY INSUFFICIENT TO
COVER EXISTING LICENSING AND
CERTIFICATION ACTIVITIES. FOR
SOME CONTEXT, THE ROOF WAS LAST
DEFEAT. INCREASES WERE LAST
INCREASED IN 2014, AND
THROUGHOUT THE LAST SEVERAL
YEARS, ADDITIONAL LEGISLATION
AND REQUIREMENTS HAVE BEEN
IMPLEMENTED THAT HAVE EXPANDED
THE DEPARTMENT'S RESPONSIBILITY
FOR LICENSING AND CERTIFICATION
ACTIVITIES. THIS INCLUDES
PATIENT BROKERING LAWS. PAYMENT
PROHIBIT PROHIBITION FOR PAYMENT
FOR INDIVIDUALS THAT OR ENTITIES
THAT REFER PATIENTS TO SUD
TREATMENT PROVIDERS. THE
REQUIREMENT FOR RESIDENTIAL
FACILITIES TO HAVE A LEVEL OF
CARE DESIGNATION AND FACILITY
REQUIREMENTS TO HOLD VARIOUS
INSURANCE POLICIES. AT THE SAME
TIME, THE LEGISLATION HAS
EXPANDED THE FUNCTIONS, THE
SCHOOL AND THE SCOPE OF
LICENSURE WORKLOAD. SINCE 2018,
THE FUND HAS EXPERIENCED A
STEADY DECLINE IN REVENUE DUE TO
PROGRAM CLOSURES AND THE
PANDEMIC. THE LOSS OF REVENUE
HAS. THE DEPARTMENT RECOGNIZES
THAT A FEE INCREASE OF ANY
AMOUNT COULD HAVE AN IMPACT ON
THE PROVIDER FIELD, BUT
SPECIFICALLY, HOW MUCH IS 75%
FEE INCREASE WOULD IMPACT THE
FIELD IS UNKNOWN. AND AT THIS
TIME THE DEPARTMENT WE DON'T
COLLECT INFORMATION ON GROSS
REVENUE OR OPERATING MARGINS
FROM A LICENSED OR CERTIFIED
PROVIDERS, HOWEVER, WE WANTED TO
PROVIDE SOME EXAMPLES TO
ILLUSTRATE HOW MUCH THE PROPOSED
FEE INCREASE ACTUALLY IS. AN
EXISTING CERTIFIED OUTPATIENT
PROVIDER WOULD FACE AN INCREASE
OF ABOUT $2800, WHICH WOULD BE
ASSESSED EVERY OTHER YEAR. SO
THIS IS AN INCREASE OF ABOUT 4
$1400 PER YEAR FOR A RESIDENTIAL
PROVIDER WITH 50 BEDS. THE
PROPOSED 75% FEE INCREASE WOULD
COME OUT TO ABOUT 12,000 EVERY
TWO YEARS ABOUT 6000 EVERY YEAR.
SO WE HYPOTHESIZED JUST TO GET A
SENSE FOR THE AMOUNT OF REVENUES
THAT MEDICAL PAY SOME OF THESE
PROVIDERS, SO RESIDENTIAL
PROVIDER OPERATING WITH 50 BEDS
THAT ONLY PROVIDES MEDICAL MEN
ONLY PROVIDES CARE TO MEDICAL
MEMBERS. SO WE HAVE THAT WE
UNDERSTAND THE COST FOR THAT
GENERATES ABOUT 5.6 MILLION IN
CLAIMS THAT 5.6 MILLION CLAIMS
ANNUALLY AND IF WE ADJUST FOR
OCCUPANCY, WE THINK THAT GETTING
IT ABOUT 5.6 MILLION PER YEAR.
AND THEY WOULD FACE A $6000
INCREASE TO THEIR FEET ANNUALLY
. WE'RE COMMITTED TO WORKING
WITH THE PROVIDER COMMUNITY AND
THE LEGISLATURE TO ENSURE
CALIFORNIANS ARE ABLE TO
CONTINUE TO ACCESS SUBSTANCE USE
DISORDER TREATMENT WHILE THE
DEPARTMENT RECEIVED THE FUNDING
NECESSARY TO IMPLEMENT THE
LEGISLATIVELY MANDATED LICENSURE
AND OVERSIGHT FUNCTIONS. THANK
YOU. NEXT WE HAVE ROB LANE,
EXECUTIVE DIRECTOR OF CALIFORNIA
ASSOCIATION OF ALCOHOL AND DRUG
PROGRAM EXECUTIVES, MR CHAIR CAN
BE HIS SUPPORTS THE DEPARTMENT'S
PROPOSAL TO ESTABLISH THE
MANDATORY CERTIFICATION FOR ALL
OUTPATIENT STD PROGRAMS. WE HAVE
A LONG HISTORY IN THE ADVOCATING
FOR THE MANDATORY CERTIFICATION
IN ORDER TO BRING MORE
ACCOUNTABILITY AS YOU WERE
TALKING ABOUT TO THE SUD FIELD.
WE DO SIGNET'S SUGGEST THE
COMMITTEE CONSIDERED FURTHER
DISTINGUISHING THE INDIVIDUAL
PROVIDERS TO ENSURE THE RIGHT
PROVIDER TYPES ARE CAPTURED BY
THIS PROPOSAL, SO A LITTLE BIT
OF TECHNICAL ASSISTANCE WE'RE
HAPPY TO HELP WITH ON THAT
PROPOSAL, HOWEVER, CANOPY DOES
RESPECTFULLY PROPOSED THE
INCREASE TO THE RALPH OR THE
RESIDENTIAL AND OUTPLACEMENT
PROGRAM LICENSING FUND. THIS
PROPOSAL WILL ONLY FURTHER
BURDEN SUD PROVIDERS WITH
UNNECESSARY COSTS AND EXACERBATE
THE NETWORK OF PROGRAMS THAT
WE'RE ALL RELYING ON TO PROVIDE
CARE. ACCORDING TO THE HCS DATA
, THE TOTAL NUMBER OF LICENSED
RESIDENTIAL TREATMENT PROGRAMS
DECREASED FROM 912 TO 877. FROM
MARCH 2022 MARCH 2021. THE TOTAL
NUMBER OF BEDS DECREASED FROM
18,155 TO 17,962. KEEP IN MIND.
THIS IS OCCURRING AT THE SAME
TIME THAT DEATHS BY OVERDOSE
HAVE SKYROCKETED AND THE
AVAILABLE WORKFORCE AS WE
DISCUSSED EARLIER HAS
SIGNIFICANTLY DECREASED. THE
PROPOSAL TO INCREASE FEES AS
COUNTER TO THE ACTIONS IN OUR
OPINION TAKEN BY THE STATE TO
INCREASE TREATMENT ACCESS,
INCLUDING MATT EXTENT EXPANSION
PROGRAMS, KELLYANNE REFORMS
CONTINGENCY MANAGEMENT AND OTHER
PROGRAMS LAST YEAR DURING THE
BUDGET PROCESS, THE GOVERNOR
PROPOSED A SIMILAR 63% FEE
INCREASE THAT I DON'T WAS
ULTIMATELY REJECTED, AND WE'RE
ASKING THAT YOU DO THE SAME THIS
YEAR. IN CLOSING. I DO HAVE TO
TECHNICAL ISSUES TO ADDRESS
CURRENTLY LICENSED AND CERTIFIED
PROVIDERS WHO WISH TO OPEN A NEW
SORT OF NEW SERVICE LOCATION
MUST UNDERGO A FULL APPLICATION
PROCESS FOR EACH SITE. THIS
REDUNDANCY PLACES AND UNDUE
BURDEN ON DHC S AND ALSO TO
PROVIDERS. WE ASK THAT THE
APPLICATION PROCESS REFINED FOR
NEW SITES WHEN A PROVIDER
ORGANIZATION IS AN ALREADY
APPROVED ENTITY. D H. C S SHOULD
ONLY REQUIRE NEW INFORMATION
NECESSARY TO OPEN NEW SERVICE
SITES. NOT ONLY WILL THIS HELP
PROVIDERS EXPAND SERVICES, BUT
THIS WILL HELP CREATE PARITY
WITH OTHER HEALTH CARE SETTINGS
. IN OUR OPINION. LASTLY
PROVIDERS ARE REQUIRED TO ANNUAL
REPORT AND PURCHASE THE NUMBER
OF TREATMENT BEDS THIS ONEROUS
AND ALMOST IMPOSSIBLE. IT'S
ALMOST IMPOSSIBLE TO PROJECT HOW
MANY BEDS WE WILL ACTUALLY NEED.
CAD PIECE SUGGESTS THAT THE
DEPARTMENT AND ADMINISTRATION
CONSIDERED QUARTERLY REPORTING
STRUCTURES THAT WILL ALLOW
PROVIDERS TO PAY FOR BEDS THAT
ARE ACTUALLY USED, AND NOT JUST
THE PROJECTED NEEDS MORE TEA.
DID MORE DETAIL WILL BE FOUND IN
OUR LETTER, BUT I'M HAPPY TO
ANSWER QUESTIONS. THANK YOU.
DEPARTMENT OF FINANCE NATE
WILLIAMS, THE DEPARTMENT OF
FINANCE NOTHING FURTHER AT L.
YOU HAVE NOT RAISED CONCERNS
WITH THIS PROPOSAL. I'M GOING TO
BRING IT UP TO THE DIESS. UM
TOTAL COST OF THE INCREASE
YOU'RE PROPOSING IN TERMS OF
FUND IF IT'S 877 FACILITIES,
USING YOUR UPPER LIMIT OF 6000.
MY MATH GETS US CLOSE TO FIVE
MILLION GIVE OR TAKE IS THAT
ROUGHLY WHAT THE STATE IS ASKING
FOR? ABSOLUTELY MINOR. SORRY
UNFAIRNESS. I AM WORKING OFF OF
2021 MEMBERS AS WELL. UM I'M
HAPPY TO TAKE THIS OFFLINE DUE
TO THE LATENESS OF THE HOUR. AND
WITH THAT, I WILL THANK VERY
MUCH PANEL 28 MOVE ON TO PANEL
29. OUR FINAL PANEL IS ON THE
DRUG MEDICAL CLAIMING TIMELINES
TRAILER BILL WE WILL BEGIN WITH
TYLER SAT WITH. THANK YOU, MR
CHAIR. IT SHOULD BE SHORT AND
SWEET. THE DEPARTMENT PROPOSES
TO CHANGE THE DRUG MEDICAL CLAIM
TIMELINESS SUBMISSION DEADLINE
FROM SIX MONTHS TO 12 MONTHS TO
CREATE PARODY AND BE CONSISTENT
. WE HAVE CLAIMED TIMELINESS
REQUIREMENTS FOR MEDICAL FEE FOR
SERVICE, SPECIALTY MENTAL HEALTH
SERVICES AND FEDERAL
REGULATIONS. IN ADDITION TO
CREATING PARODY, THIS PROPOSAL
WILL PROVIDE DRUG MEDICAL
PROVIDERS ADDITIONAL TIME TO
SUBMIT CLAIMS AND IT WILL ALSO
REDUCE THE ADMINISTRATIVE BURDEN
AND WORKLOAD ON BOTH THE
DEPARTMENT AND COUNTIES
ASSOCIATED WITH REQUESTS FOR, UH
LATE CLAIM APPROVALS. MICHELLE
KARP BARRERA. FOR SOMEONE TO SAY
THANK YOU SO MUCH AND COMMITTEE
STAFF FOR UM SUCH A THOUGHTFUL
APPROACH TO ALL THE BEHAVIORAL
HEALTH ISSUES THAT WE HAVE GOING
RIGHT NOW, AND I WANT TO EXPRESS
CB HDS SUPPORT FOR THIS PROPOSAL
. THIS WAS SOMETHING THAT COUNTY
BEHAVIORAL HEALTH AGENCIES ASKED
FOR IT AS A PART OF OUR MENTAL
HEALTH AND SUD ADMINISTRATIVE
INTEGRATION. THANK YOU.
DEPARTMENT OF FINANCE WISE, THE
DEPARTMENT OF FINANCE NOTHING
FURTHER AND. CONCERNS BRING IT
UP TO THE DIETS, AND I WILL
THANK THIS PANEL AS WELL AS ALL
OF OUR PANELISTS, AND WE WILL
NOW MOVE ON TO PUBLIC COMMENT.
AGAIN WE WELCOME PUBLIC COMMENT
ON ALL 48 ISSUES THAT ARE ON
TODAY'S AGENDA, BUT ASK YOU TO
KEEP IT TO THOSE ISSUES. WE WILL
BEGIN WITH PUBLIC COMMENT WOULD
BE OKAY FACE, OKAY? WITH
INDIVIDUALS WHO ARE HERE IN THE
HEARING ROOM, AND THEN WE WILL
GO TO THE PHONE LINES. LET'S
BEGIN WITH IN THE HEARING ROOM.
THANK YOU VERY MUCH. JACQUELINE
WONG HERNANDEZ WITH THE
CALIFORNIA STATE ASSOCIATION OF
COUNTIES. THANK YOU FOR HOLDING
THIS IMPORTANT HEARING AND
POWERING THROUGH THIS EVENING.
SEASICK APPRECIATES THE
LEGISLATURES AND THE GOVERNOR'S
COMMITMENT TO CRITICAL
INVESTMENTS MADE TO SUPPORT THE
CALLUM INITIATIVE. COUNTIES
RECOGNIZE THE POTENTIAL BENEFITS
OF BOTH THE JUSTICE INVOLVED
INITIATIVE AND THE PROPOSED
BEHAVIORAL HEALTH. COMMUNITY
BASED CONTINUUM DEMONSTRATION
WAIVER AND WE LOOK FORWARD TO
CONTINUED COLLABORATION WITH
BOTH THE LEGISLATURE AND THE
ADMINISTRATION TO ACHIEVE THOSE
GOALS. WE SUPPORT BEHAVIORAL
HEALTH PAYMENT REFORM AND TRULY
APPRECIATE THE INVESTMENTS IN
WORKFORCE DEVELOPMENT THAT ARE
SO CRITICALLY NEEDED. JUST WANT
TO TOUCH ON A FEW MORE ITEMS.
SPECIFIC ITEMS QUICKLY ISSUE
EIGHT. WE'D LIKE TO THANK THE
COMMITTEE FOR INCLUSION OF THE
ADMINISTRATION'S I S T GROWTH
CAP AND PENALTY PROGRAM ON
TODAY'S AGENDA AND REALLY
APPRECIATE THAT DISCUSSION. WE
ECHO THE COMMENTS YOU HEARD
EARLIER FROM NEVADA COUNTY
BEHAVIORAL HEALTH DIRECTOR
PHOEBE BELT, WHICH HIGHLIGHTED
THE COUNTY CONCERNS. COUNTIES
ARE GRATEFUL FOR THE EXISTING
COUNTY STATE PARTNERSHIPS AND
THE SIGNIFICANT INVESTMENTS
AIMED AT ADDRESSING THE RISING
ISTEA POPULATION. HOWEVER WE
REMAIN DEEPLY CONCERNED WITH THE
IMPLEMENTATION OF THE GROWTH CAP
AND PENALTY PROGRAM, AS HAS BEEN
MENTIONED, WHICH UNFAIRLY
PENALIZES COUNTIES FOR
INDIVIDUALS, EVEN IF THEY'RE
TREATED LOCALLY OR RESTORED. WE
DON'T BELIEVE THAT THAT WAS THE
INTENT. UM ISSUE 13 WAS THE CARE
ACT, AND WE APPRECIATE THAT AN
ONGOING ALLOCATION FOR CARE ACT
ACTIVITIES WAS INCLUDED IN THE
GOVERNOR'S PROPOSAL, BUT SEE
SACK ALONGSIDE OUR COUNTY
PARTNERS CONTINUE TO ENGAGE WITH
THE ADMINISTRATION TO UPDATE
THIS COST ESTIMATE TO FULLY
REFLECT THE ONGOING IMPACTS TO
COUNTY STATEWIDE THAT WILL BE
NECESSARY TO FULLY FUND AND
SUCCESSFULLY IMPLEMENT THE NEW
PROGRAM. UM AND THEN FINALLY
ISSUED 23 ON SACRAMENTO AND
SOLANO. UM I CAN APPRECIATE THE
CHAIRS, ENCOURAGEMENT FOR THE
STATE TO WORK WITH SACRAMENTO
AND SOLANO COUNTIES AND VICE
VERSA. BUT FOR US, THIS IS
BIGGER THAN TWO COUNTIES. THE
SPECIALTY MENTAL HEALTH CLIENTS
THAT KAISER HAS BEEN SERVING
UNDER CONTRACT WITH THE STATE
WERE NEVER INCLUDED IN THE
AGREEMENT. BETWEEN THE STATE AND
COUNTIES CAN COUNTIES BROADLY
CONCERNING 2011 REALIGNMENT, THE
STATE IS UNILATERALLY DECIDING
TO SHIFT NEW CARE COSTS TO
SACRAMENTO AND SOLANO COUNTIES
AND TO PAY FOR THOSE COSTS WITH
MONEY TAKEN FROM 56 OTHER
COUNTIES. WHILE THE TRANSITION
ISSUES HAVE BEEN HEARD BEFORE,
AND YOU'VE MENTIONED YOU'VE
HEARD FOR YEARS NOW, THE
PROPOSAL TO DIVERT REALIGNMENT
GROWTH FUNDS FROM OTHER COUNTIES
TO ACHIEVE STATE BUDGET SAVINGS
IS NEW THIS YEAR. THAT'S A NEW
PROPOSAL AND THIS IS ALL
HAPPENING AT A TIME WHEN AS YOUR
HEARING TONIGHT REALLY AMPLIFIED
COUNTY BEHAVIORAL HEALTH FUNDING
IS FRAGILE. THE WORKFORCE IS
STRETCHED THIN AND THE NEEDS ARE
GROWING. UM AND SO WANT TO WANT
TO LEAVE YOU WITH THAT AND WOULD
ENCOURAGE THE LEGISLATURE TO
REALLY THINK ABOUT WHAT THAT
PROPOSAL IS SORT OF ZOOMING OUT
FROM JUST THE TWO COUNTIES
INVOLVED. SO THANK YOU FOR YOUR
TIME. THANK YOU VERY MUCH.
SAYING NO MORE PUBLIC COMMENT IN
THE HEARING ROOM OPERATOR. WE
WILL TURN TO THE PHONE LINES AND
SEE IF THERE ARE ANY, UM, PUBLIC
COMMENT ON THE FILM LINES. AS A
REMINDER THE PHONE NUMBER AND
ACCESS CODE ON THE FIRST PAGE OF
OUR AGENDA ON THE SUBCOMMITTEE'S
WEBSITE AND SHOULD ALSO BE
APPEARING ON YOUR SCREEN. IF YOU
ARE WATCHING THE LIVESTREAM. THE
PHONE NUMBER AGAIN IS 877692.
AND THE ACCESS CODE IS 13151.
LET'S BEGIN. GENTLEMAN ON THE
PHONE LINES. IF YOU HAVE A
COMMENT, PLEASE PRESS ONE, THEN
ZERO. ONCE AGAIN FOR COMMENTS
OVER THE PHONE LINES, PLEASE
PRESS ONE, THEN ZERO.
IN ONE MOMENT, PLEASE. FOR YOUR
FIRST QUESTION.
WE'LL GO TO LINE NUMBER 33,
PLEASE GO AHEAD. YOUR LINE IS
OPEN. PLEASE GO AHEAD. HELLO ARE
YOU HEARING ME NOW? YES, MA'AM.
PLEASE GO AHEAD. THANK YOU
HONORABLE TERM MEMBER SHERRY
DAILY WITH THE CALIFORNIA
CONSORTIUM OF ADDICTION PROGRAMS
AND PROFESSIONALS. OUR
OPPOSITION TO THE INCREASE IN
THE ITEM 28 OVERSIGHT,
PERCEPTION DISORDER, LICENSING
AND CERTIFICATION OR SUBMITTED
VIA LETTER WITH NUMEROUS
AGENCIES AND PROGRAMS AS
SIGNATORIES. MANY OF OUR MEMBERS
ARE IN THE SIXTH BED CATEGORY,
WHICH MAKES UP HALF OF
CALIFORNIA'S RESIDENTIAL
CAPACITY. SMALL BUSINESSES WILL
DEFINITELY BE IMPACTED BY THE
PROPOSED INCREASE, AS THEIR
MARGINS ARE VERY SMALL, IS ALSO
SPONSORING A LEGISLATIVE
SOLUTION TO THIS PROBLEM IN A B
14 77, WHICH CALLS FOR FREEZING
THESE AT 2022 RATES FOR SEVEN
YEARS WITH A GRADUAL INCREASE
INTO THE FUND IS STABILIZED. WE
URGED COMMITTEE TO RECONCILE THE
REQUESTED ITEM 28 WITH THE AIMS
OF MS QUIRK-SILVA LEGISLATION.
CONSIDERING THE POLICY PROPOSAL
AND ITEM 28 TO REQUIRE MANDATORY
CERTIFICATION PROVIDERS SEE
CAPITAL LEAVES THAT A CHANGE OF
THIS DEGREE SHOULD HAVE BEEN
PRESENTED IN A BILL AND REVIEWED
BY POLICY AND APPROPRIATIONS
COMMITTEES. SHE KEPT THE
SPONSORED MULTIPLE BILLS TO
ADDRESS MANDATORY CERTIFICATION
BEGINNING WITH B 3 25 HILL. ONCE
IN HER HILL, RETIRED
PETRIE-NORRIS CARRIED THE TORCH
INTRODUCING EVERYTHING 20, WHICH
WAS A SUCCESSFUL BILL, AND THAT
IT PASSED WITH NO OPPOSITION AND
HAD ONLY ONE NO VOTE THROUGHOUT
ITS COMMITTEES. IT WAS DETAILED
IN OCTOBER. 2019 WAS THAT WERE
IN THE GOVERNOR ASKED THAT'S THE
LEGISLATURE AND SPONSORS WORK
CLOSELY WITH THE HDS ON A MORE
ROBUST FOR HIS CONSIDERATION.
THE MORE ROBUST PROPOSAL CAME IN
THE FORM OF A B 77 ALSO
PETRIE-NORRIS SPONSORED BILL,
WHICH WAS SIDELINED DURING THE
PANDEMIC, ALTHOUGH SHE HAS BEEN
LEADING THE EFFORT TO REQUIRE
THAT ALL SERVICES AND SUBSTANCE
USE DISORDERS SPACE BE REGULATED
, WE MUST POINT OUT THAT THE
TRAILER BILL LANGUAGE PROPOSED
BY THE DEPARTMENT LACKS THE
BASIC FOUNDATIONS NEEDED TO
IMPLEMENT A MANDATORY
CERTIFICATION PLAN. FOR
INSTANCE, THERE IS NO DEFINITION
IN THE LANGUAGE OF WHICH
SERVICES THIS WOULD REQUIRE A
LICENSE. BECAUSE CURRENT STATUTE
DESCRIBES OUR SERVICES BROADLY
AS TREATMENT AND RECOVERY
SERVICES, WHICH COULD BE MANY
THINGS, INCLUDING RECREATIONAL,
SOCIAL AND OTHER NON CLINICAL
SERVICES. THAT ALSO DOES NOT
RESOLVE WHAT THE DEFINITION OF A
PROGRAM IS THE TRAILER BUILDING
, WHICH SIMPLY SAYS IT IS A
BUSINESS ENTITY WITH AN ADDRESS
, WHICH PROVIDES TREATMENT
RECOVERY, DISCUSSED
DETOXIFICATION OR MEDICATION
SERVICES, NONE OF WHICH ARE
DEFINED. WHAT IS A RECOVERY
SERVICE, FOR INSTANCE, WHO WOULD
BE COMPELLED TO OBTAIN
CERTIFICATION? IS ONE PERSON'S
WRITING ADDICTION COUNSELING
PROGRAM, SO INDEPENDENT
PRACTITIONER WRITING SERVICES IN
OUR RURAL COUNTIES BOUND FROM
CONTINUING TO SEE PATIENTS. WE
HAVE ALSO NOT ADDRESSED THE
CONFUSION, THE PUBLIC WILL
EXPERIENCE IF WE CALL PROGRAMS
CERTIFIED WHEN THEY SHOULD
ACTUALLY BE DESIGNATED AS
LICENSED. IS THERE ONLY A FEW OF
THE UNANSWERED QUESTIONS THAT
NEED ATTENTION CONDUCTING A
MONUMENTAL POLICY SHIFT WITH
TRADABLE LANGUAGE THAT IS NOT
EVEN LINKED TO THIS ITEM FOR THE
PUBLIC TO SEE. MAKES IT
DIFFICULT TO HEAR THE INPUT OF
THE THOUSANDS OF TREATMENT
PROGRAMS AND WORKERS AND THE
MILLIONS OF PEOPLE IN RECOVERY
WHO SHOULD BE INVOLVED IN
SHAPING THIS POLICY PROVIDED
WRITTEN PRIESTS FEEDBACK TO THE
DEPARTMENT CONCERNED CONCERNING
SOME OF THESE ISSUES. TODAY, WE
ASK THAT COMMITTEE DISCUSSED THE
PROCESS BY WHICH THIS ISSUE IS
BEING APPROACHED. AT THE VERY
LEAST, TRAILER BILL SHOULD
ENCOMPASS THE POLICY DEVELOPED
THROUGH THE LEGISLATIVE PROCESS
FOR 89 20, WHICH INCLUDED HOURS
OF STAKEHOLDER MEETINGS.
ARTICULATE COMMITTEE ANALYSES,
ROBUST HEARINGS ON THE SUBJECT
AND THOROUGH VETTING BY BOTH
HOUSES OF BLOOD LECTURE. THANK
YOU FOR YOUR CONSIDERATION.
THANK YOU. NEXT CALLER, PLEASE.
AND AT THIS TIME THERE ARE NO
FURTHER COMMENTS. THANK YOU.
OPERATOR I WILL TAKE THAT AS THE
CONCLUSION OF PUBLIC COMMENT FOR
TODAY WILL THANK ALL OF OUR
PANELISTS. THE ADMINISTRATION L
. A OH, DEPARTMENT OF FINANCE
TECH. THE SERGEANT'S, UM, BUT I
WANT TO PARTICULARLY UPLIFT
ANDREA MARGOLIS FOR WRITING
NEARLY 200 PAGES OF AN AGENDA.
TODAY. UM AS WELL AS THE PUBLIC
FOR IMPROVING OUR PROCESS WITH
THAT WE ARE ADJOURNED FOR THE
NIGHT. HAVE A GOOD NIGHT, OKAY?