WE ARE GOING TO BRING THE SELECT
COMMITTEE ON CALIFORNIA'S MENTAL
HEALTH CRISIS TO ORDER I WANT TO
WELCOME EVERYONE TO THE FIRST OF
TWO SCHEDULED HEARINGS. ON THE
MENTAL HEALTH CRISIS. AND OUR
SECOND ONE WILL BE HELD ON
TUESDAY. MAY 16TH FOR THOSE WHO
WISH TO PARTICIPATE IN PUBLIC
COMMENT VIA PHONE. YOU MAY DO SO
BY CALLING 877692. THE PUBLIC
ACCESS CODE WILL BE 13151. AND
THE INFORMATION WILL BE ALSO ON
YOUR TV SCREENS. WE WILL BE
HANDLING PUBLIC COMMENT AT THE
END OF THE HEARING. LET ME FIRST
BEGAN THE HEARING BY SAYING THAT
CALIFORNIA HAS COME OUT OF A
PANDEMIC CRISIS. AND RIGHT INTO
A MENTAL HEALTH CRISIS. AND THE
U. S SURGEON GENERAL DECLARED.
THIS NATION IS IN A MENTAL
HEALTH CRISIS BACK IN 2021. THE
WHITE HOUSE SAID ON MARCH 2 2022
THAT OUR COUNTRY FACES AN
UNPRECEDENTED MENTAL HEALTH
CRISIS AMONG PEOPLE OF ALL AGES.
TWO OUT OF FIVE ADULTS REPORT
SINCE SYMPTOMS OF ANXIETY OR
DEPRESSION. AND BLACK AND BROWN
COMMUNITIES ARE
DISPROPORTIONATELY UNTREATED.
EVEN AS THEIR BURDEN A MENTAL
ILLNESS HAS CONTINUED TO RISE.
EVEN BEFORE THE PANDEMIC. RATES
OF DEPRESSION AND ANXIETY WERE
INCHING HIGHER. BUT THE TRUCK
BUT THE GRIEF TRAUMA AND
PHYSICAL ISOLATION OF THE LAST
TWO YEARS HAVE DRIVEN AMERICANS
TO A BREAKING POINT. THE WHITE
HOUSE ALSO SAYS THAT OUR YOUTH
HAS BEEN PARTICULARLY IMPACTED
AS LOSSES FROM COVID. AND
DISRUPTIONS AND ROUTINES AND
RELATIONSHIPS HAVE LED TO
INCREASED SOCIAL ISOLATION.
ANXIETY. AND LEARNING LOSS. MORE
THAN HALF OF PARENTS EXPRESSED
CONCERN OVER THEIR CHILDREN'S
MENTAL HEALTH WELL BEING. IN
2019 1 AND THREE HIGH SCHOOL
STUDENTS AND HALF OF FEMALE
STUDENTS REPORTED PERSISTENT
FEELINGS OF SADNESS. OR
HOPELESSNESS AND OVERALL
INCREASE OF 40% FROM 2009.
EMERGENCY DEPARTMENT VISITS WERE
WERE ATTEMPTED SUICIDE HAVE
RISEN 51% AMONG ADOLESCENT
GIRLS. OUR OWN CALIFORNIA
SECRETARY OF HEALTH AND HUMAN
SERVICES. STATED IN THE STATE OF
PUBLIC HEALTH IN CALIFORNIA.
THAT MENTAL HEALTH CONDITIONS
AFFECT MORE THAN HALF OF US
PEOPLE. OVER THEIR LIFETIME AND
CONTRIBUTE TO WORSE OVERALL
HEALTH AND RISK OF DEATH BY
SUICIDE. IN CALIFORNIA. SERIOUS
MENTAL ILLNESS AND SUBSTANCE USE
DISORDERS HAVE A SIGNIFICANT
IMPACT ON YOUNG ADULTS WITH MOOD
DISORDERS AND SCHIZOPHRENIA AS
THE 1ST AND 3RD LEADING CAUSES
OF HOSPITALIZATION, RESPECTIVELY
, FOR CALIFORNIANS AGED 15 TO
24. MENTAL HEALTH CONDITIONS ARE
THE SECOND LEADING CAUSE OF
YEARS LIVED. WITH THIS ABILITY
FOR CALIFORNIANS. AND THE
LEADING CALLS FOR CHILDREN
BETWEEN THE AGES OF FIVE AND 14.
EMPHASIZING THE NEED TO
STRENGTHEN PREVENTION. EARLY
IDENTIFICATION AND COMPASSIONATE
CARE. UNTREATED MENTAL HEALTH
PROBLEMS OR SUBSTANCE USE AND
ADDICTION CAN RESULT IN INJURY
AND PREMATURE DEATH. IN 2021
OVER 4000 CALIFORNIANS DIED BY
SUICIDE. THE OVERALL NUMBER OF
SUICIDE DEATHS HAVE INCREASED
HAVE DECREASED SINCE 2018
HOWEVER. SUICIDE AND SELF HARM
OR AMONG THE TOP FIVE CAUSES OF
DEATH FOR 15 TO 44 YEAR. OLDS
AND RATES HAVE BEEN RISING IN
RECENT YEARS AMONG YOUNG BLACK
AND LATINO CALIFORNIANS.
HOSPITALIZATIONS AND EMERGENCY
DEPARTMENT VISITS FOR MENTAL
HEALTH RELATED CONDITIONS OR
HIGHER AMONG BLACK INDIVIDUALS
THAN ANY OTHER RACE OR ETHNIC
GROUP. I AM MY OWN FAMILY HAVE
NOT BEEN IMMUNE TO THIS CRISIS.
HAVING LOST AN UNCLE TO
SCHIZOPHRENIA, ADDICTION AND
HOMELESSNESS. AND A BROTHER ON
THE STREETS OF CALIFORNIA AS WE
SPEAK AS HE SUFFERS FROM BY
QUARTER BIPOLAR DISORDER AND
ADDICTION. AND I MYSELF HAVE
SUFFERED FROM ANXIETY. THAT IS
WHY I HAVE MADE IT MY MISSION TO
ADDRESS THIS ISSUE SO CALIFORNIA
CAN FIND SOLUTIONS TO REDUCING
THE DEVASTATING EFFECTS OF
MENTAL ILLNESS. AND TO ENSURE
THAT THE STATE ACTS WITH THE
URGENCY. AND INGENUITY AS IT HAS
WITH COVID 19 AND THE HOMELESS
CRISIS. MENTAL ILLNESS NOT ONLY
AFFECTS THE INDIVIDUAL WHO WAS
SUFFERING BUT IT AFFECTS ALL
THOSE WHO ARE CLOSE TO THOSE
INDIVIDUALS AS WELL. THIS SELECT
COMMITTEE WAS CREATED TO ADDRESS
THESE ISSUES AND HELP FORMULATE
POLICIES THAT HOPEFULLY ARE
EFFECTIVE IN BOTH THE NEAR TERM
AND LONG TERM. AND HELP
CALIFORNIA'S HELP CALIFORNIANS
LIVE THEIR LIVES MORE PROSPEROUS
AND MORE JOYFUL. TO GUIDE THIS
CAN MEET HIS WORK. WE ASKED THE
FOLLOWING QUESTIONS. HOW DO WE
BREAK DOWN THE BARRIERS
NECESSARY TO USE THE FULL FORCE
OF OUR INSTITUTIONS? TO
STABILIZE THE CURRENT POPULATION
AS WE BUILD OUT THE LONG TERM
INFRASTRUCTURE. TO HOW DO WE
RESPOND WITH THE SAME SENSE OF
URGENCY TO MENTAL HEALTH AS WE
DO WITH PHYSICAL HARM? AND
THREE. HOW DO WE REDUCE THE
STIGMA ASSOCIATED WITH MENTAL
HEALTH AND IMPROVE THE LIVES OF
THOSE MOST AFFECTED? AND REDUCE
THIS CRISIS TO SOMETHING THAT IS
TREATABLE, MANAGEABLE AND
CURABLE. IT IS INDEED AN HONOR
TO SERVE WITH MY COLLEAGUES ON
THIS COMMITTEE, AND I'M LOOKING
FORWARD TO TAKING ACTION IN A
BIPARTISAN MANNER TO MEET THIS
URGENT MOMENT. AND IT IS MY
HONOR TO NOW TURN IT OVER TO MY
COLLEAGUE, MY PARTNER IN CRIME
IN THIS EFFORT. ASSEMBLY MEMBER
GAIL PELLERIN. THANK YOU VERY
MUCH. I'M GRATEFUL TO BE HERE
TODAY WITH MY COLLEAGUE FROM
RIVERSIDE COUNTY WHO HAS HIS
DECADES OF LEADERSHIP ON MENTAL
HEALTH AND TRAINING AS A SOCIAL
WORKER OR HUGE ASSETS TO THIS
LEGISLATIVE BODY. I CAME TO THE
MENTAL HEALTH SPACE AS A RESULT
OF PERSONAL EXPERIENCE. MY
FAMILY HAS BEEN PROFOUNDLY
IMPACTED BY MENTAL HEALTH FOR
THE PAST 15 YEARS. NAVIGATING
FINDING THE RIGHT MENTAL HEALTH
CARE FOR MY FAMILY WAS DAUNTING
, IDENTIFYING THE RIGHT
COUNSELORS, TREATMENT FACILITIES
AND FIGURING OUT HOW TO PAY FOR
IT ALL WAS OVERWHELMING. PLUS
THERE WAS A STIGMA THAT MADE IT
DIFFICULT FOR ME TO TALK TO MY
FAMILY AND FRIENDS. AND THEN IN
NOVEMBER OF 2018 MY HUSBAND 25
YEARS. DIED BY SUICIDE. SUICIDE
WAS NOT A TOPIC. I SPENT MUCH
TIME THINKING OR TALKING ABOUT
BEFORE MY HUSBAND, TOM TOOK HIS
OWN LIFE. TODAY I'M MOTIVATED TO
SPEAK OPENLY AND PUBLICLY ABOUT
SUICIDE. AND MENTAL HEALTH
CONDITIONS BECAUSE SUICIDE IS
PREVENTABLE AND MENTAL HEALTH
CONDITIONS CAN BE TREATED
SUCCESSFULLY. I DECIDED TO PUT
MY GRIEF TO WORK AFTER MY
HUSBAND'S SUICIDE AND MENTAL, UM
SO I SET OUT TO LEARN ABOUT
MENTAL HEALTH IN CALIFORNIA. AND
THEN I JOINED THE SANTA CRUZ
COUNTY NAMI BOARD IN 2020. MY
DESIRE TO WORK IN THIS SPACE WAS
ONE OF THE MOTIVATING FACTORS IN
MY DECISION TO RUN FOR THE STATE
ASSEMBLY. THE STATE OF OUR
MENTAL HEALTH IS A PUBLIC HEALTH
CRISIS. THERE IS A LACK OF
PARITY WITH PHYSICAL HEALTH CARE
, SHORTAGE OF TRAINED COUNSELORS
, DEFICIENCY OF RESOURCES,
INSUFFICIENT NUMBER OF BED
FACILITIES AND ABSENCE OF MOBILE
MILK, MENTAL HEALTH CARE TO NAME
JUST A FEW OF OUR CHALLENGES.
MENTAL HEALTH IMPACTS. ALL OF US
AND MANY ARE SUFFERING,
ESPECIALLY ARE MOST VULNERABLE.
I WAS BROKEN HEARTED TO LEARN
FROM TEACHERS AND CHILDCARE
PROVIDERS IN THE DAY THAT
CHILDREN AS YOUNG AS TWO YEARS
OLD ARE EXPERIENCING MENTAL
HEALTH CONDITIONS. MANY OF OUR
GRANDPARENTS, COWORKERS,
NEIGHBORS AND LOVED ONES ARE
EXPERIENCING MENTAL HEALTH
CHALLENGES, IN SOME CASES,
EXASPERATED BY THE PANDEMIC, THE
ISOLATION THE ECONOMIC TOLL THE
LAST FEW YEARS HAVE HAD ON OUR
FAMILIES. TODAY'S WORLD OF GUN
VIOLENCE, BULLYING SOCIAL MEDIA
IMPACTS CLIMATE CHANGE RACIAL
DISPARITIES. L G B T Q I A
DISCRIMINATION AND DIVISION HAD
MADE MANY OF US FEEL DEPRESSED
AND HOPELESS, AND I COUNT MYSELF
THERE AS WELL. I BELIEVE WE CAN
DO BETTER. TOGETHER, WE CAN
CREATE A MENTAL HEALTH CARE
SYSTEM WHERE PEOPLE GET THE CARE
THEY NEED AND THE TOOLS TO LIVE
A THRIVING LIFE. IT IS A GREAT
HONOR TO BE ON THIS COMMITTEE
AND SERVED WITH OUR CHAIRPERSON
ASSEMBLYMEMBER'S COREY JACKSON
AND MY COLLEAGUES. I'M HERE TO
LISTEN TO LEARN AND TO WORK ON
WAYS WE CAN ADDRESS THE PUBLIC
HEALTH CRISIS. THANK YOU ALL FOR
BEING HERE TODAY. NOW LET'S GET
TO WORK. THANK YOU. THANK YOU
VERY MUCH. ASSEMBLYMEMBER'S
WE'RE GOING TO JUST HOP RIGHT
INTO IT AND GO TO OUR FIRST
PANEL, WHICH IS THE STATE OF
MENTAL HEALTH AND CALIFORNIA. WE
ASK OUR TWO PANELISTS TO COME ON
UP. MICHELLE KUBRICK CABRERA.
THE EXECUTIVE DIRECTOR OF THE
COUNTY BEHAVIOR, HEALTH
DIRECTORS ASSOCIATION, AND ALSO
DR SUSAN HUNG, THE CHIEF MEDICAL
EXECUTIVE OF PROVIDENCE HEALTH.
WE WELCOME YOU AND WE WILL BEGIN
WITH MISS CANBERRA. AND THEN,
UH, WE WILL MOVE ON TO OUR NEXT
PANELIST, AND YOU MAY BEGIN WHEN
YOU'RE READY. THANK YOU SO MUCH
CHAIR AND MEMBER PELLERIN,
MICHELLE CABRERA WITH THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION OF CALIFORNIA. AND
IT'S A REAL HONOR TO BE HERE
TODAY WITH BOTH OF YOU TO KICK
OFF MENTAL HEALTH AWARENESS
MONTH AND I JUST WANT TO START
OFF BY THANKING YOU BOTH FOR
SHARING YOUR RESPECTIVE
EXPERIENCES WITH LIVED
EXPERIENCE AND UPLIFTING STORY
OF AN A MESSAGE OF HOPE AND
RECOVERY BECAUSE I THINK IT IS
IMPORTANT FOR ALL OF US TO KNOW
THAT IN SPITE OF THE CRISIS THAT
WE ARE CONFRONTING THAT PEOPLE
EVERY SINGLE DAY FIND, ACHIEVE
MAINTAINED RECOVERY AND LIVE
PURPOSEFUL LIVES. SO THANK YOU
FOR THAT. UM I'M GOING TO START
OFF BY PROVIDING A VERY HIGH
LEVEL BROAD OVERVIEW TO HELP
GROUND US ALL IN THE TOPIC OF
THE MENTAL HEALTH CRISIS THAT
CALIFORNIA IS FACING CURRENTLY,
IF WE CAN START OFF WITH JUST
THE VERY FIRST BASIC AND I KNOW
MANY OF YOU KNOW THIS, BUT WHEN
WE TALK ABOUT BEHAVIORAL HEALTH,
WE REALLY ARE TALKING ABOUT TWO
DISTINCT AREAS, WHICH IS MENTAL
HEALTH AND SUBSTANCE USE
DISORDERS. NEXT SLIDE. UM. AND
WE CAN KEEP GOING. THANK YOU.
ONE OF THE THINGS THAT I THINK
IS SO IMPORTANT, BECAUSE, UM,
YOU KNOW, I THINK WHEN WE TALK
ABOUT BEHAVIORAL HEALTH, WE'RE
REALLY TALKING ABOUT THE BIO
PSYCHO SOCIAL MODEL, AND THIS IS
REALLY IMPORTANT IN THE POLICY
SPHERE. UM BECAUSE WE TALK ABOUT
BIOLOGICAL FACTORS, THE BODY THE
PHYSICAL HEALTH, BUT WE ALSO
HAVE TO KEEP IN MIND. UM THE
EMOTIONAL PIECE AS WELL AS THE
SOCIAL AND ENVIRONMENTAL PIECE,
AND ALL OF THAT REALLY COMBINES
TO CONTRIBUTE TO OUR MENTAL
HEALTH INDIVIDUALLY AND AS A AS
A SOCIETY NEXT FLIGHT. UM.
COUNTY BEHAVIORAL HEALTH IS
REALLY RESPONSIBLE FOR MANAGING
OUR PUBLIC SAFETY NET FOR
BEHAVIORAL HEALTH. UM THAT
INCLUDES MEDICAL ENTITLEMENT
RESPONSIBILITIES FOR WHAT WE
CALL SPECIALTY MENTAL HEALTH. SO
IN PHYSICAL HEALTH, WE HAVE
SPECIALTIES, BUT WE ALSO DO FOR
MENTAL HEALTH AS WELL. AND THAT
INCLUDES RESPONSIBILITY FOR
CHILDREN AND YOUTH UNDER THE AGE
OF 21 FOR ALL SPECIALTY SERVICES
, AS WELL AS SPECIALTY MENTAL
HEALTH FOR ADULTS. WE ALSO
MANAGE ON SUBSTANCE USE DISORDER
TREATMENT FOR ALL MEDIC. HOW
BENEFICIARIES AND THEN THERE'S A
REALLY BROAD RANGE OF COMMUNITY
BEHAVIORAL HEALTH SERVICES,
WHICH ENCOMPASSES PREVENTION AND
WELLNESS, WHICH ARE OFTEN NOT
COVERED BY INSURANCE SERVICES
THAT ARE ALSO NOT FUND A BILL
THROUGH MEDICAL HEALTH, SUCH AS
OUTREACH AND ENGAGEMENT.
PROVIDING HOUSING DOING JAIL
BASED SERVICES, CRISIS AND
EMERGENCY CARE, UM, AND
TREATMENT AND FACILITIES LARGER
THAN 16 BEDS. SO ALL OF THOSE
THINGS FALL OUTSIDE OF MEDICAL
TODAY WE ALSO SERVE POPULATIONS
THAT CAN'T BE FUNDED UNDER
MEDICAL, SUCH AS ADULTS WHO MAY
NOT HAVE ACCESS TO MEDICAL DUTY,
THEIR INCOME OR BECAUSE OF THEIR
IMMIGRATION STATUS. MOVING
FORWARD. UM SO IN MEDICAL, WE
ALSO HAVE MEDICAL MANAGED CARE
PLANS, WHICH ARE RESPONSIBLE FOR
PROVIDING WHAT WE CALL NON
SPECIALTY MENTAL HEALTH. AND
THAT IS SORT OF, YOU KNOW,
INDIVIDUAL GROUP THERAPY. THOSE
SORTS OF THINGS THAT DON'T
REQUIRE A SPECIALIST NEXT SLIDE.
UM I WANTED TO UPLIFT AS WELL.
THE CALIFORNIA BRONZE AND
MCCORQUODALE ACT, WHICH IS ALSO
PART OF 1991 REALIGNMENT,
BECAUSE I THINK THAT THIS PIECE
OF OUR STATE LAW IS REALLY
INTERESTING. UM UNDER THE
BRONZE, UM, OF COURSE CADEL ACT
, WHICH ESTABLISHES THE
COMMUNITY MENTAL HEALTH SERVICES
IN CALIFORNIA. IT SAYS THAT OUR
MENTAL HEALTH SYSTEM NEEDS TO
ENSURE THAT INDIVIDUALS WITH
SEVERE AND DISABLING MENTAL
ILLNESS AS WELL AS CHILDREN WITH
SERIOUS EMOTIONAL DISTURBANCES
SHOULD HAVE ACCESS TO SERVICES
AND PROGRAMS THAT ASSIST THEM IN
A MANNER TAILORED TO EACH
INDIVIDUAL TO BETTER CONTROL
THEIR ILLNESS AND ACHIEVE THEIR
PERSONAL GOALS. TO DEVELOP
SKILLS AND SUPPORTS LEADING TO
LIVING THE MOST CONSTRUCTIVE AND
SATISFYING LIVES POSSIBLE IN THE
LEAST RESTRICTIVE AVAILABLE
SETTINGS. THE CAVEAT IS THAT THE
LAW SAYS THAT WE SHOULD DO THIS
IN CALIFORNIA TO THE EXTENT THAT
RESOURCES ARE AVAILABLE, SO WE
HAVE THIS REALLY WONDERFUL,
LOFTY ASPIRATIONAL GOAL NOTICE.
THERE'S NO SORT OF QUALIFIER
THERE ABOUT INSURANCE STATUS,
AND WHAT I LOVE ABOUT THIS IS TO
PUT IT IN LAYMAN'S TERMS WERE
REALLY DIRECTED TO ASSIST PEOPLE
WITH BEHAVIORAL HEALTH
CONDITIONS TO LIVE THEIR BEST
LIVES. BUT ONLY TO THE EXTENT
THAT WE CAN AFFORD TO DO SO.
NEXT SLIDE, PLEASE. THIS IS A
COMPARISON OF, UM OVER THE LAST
SEVERAL BUDGET YEARS. HOW MUCH
WE FUND PHYSICAL HEALTH AND THE
NON SPECIALTY MENTAL HEALTH SIDE
OF MEDICAL VERSUS HOW MUCH WE
FUND THE SPECIALTY PORTION OF
MENTAL HEALTH AND SUD SERVICES
IN CALIFORNIA. SO IF YOU CAN SEE
THE TALL BAR IS OUR MEDICAL
MANAGED CARE PLANS SYSTEM IN
CALIFORNIA. THE DARK BLUE IS THE
MEDICAL SPECIALTY, BEHAVIORAL
HEALTH AND THEN THE LIGHT BLUE.
MUCH MUCH SMALLER BAR IS THE
THAT STUFF WHICH SITS OUTSIDE OF
, UM MEDICAL IN THE COUNTY
BEHAVIORAL SAFETY NET. SO WHEN
WE'RE TALKING ABOUT SORT OF
RESOURCE ALLOCATIONS,
PARTICULARLY IN MEDICAL IN THE
SAFETY NET. I THINK IT'S
IMPORTANT TO REALLY PUT THINGS
IN SCALE. NEXT SLIDE, PLEASE.
THERE'S ALSO AND YOU KNOW, THE
CHAIR MENTIONED THIS AS WELL AS
ASSEMBLYMEMBER'S PELLERIN IN
YOUR OPENING COMMENTS, UH, THERE
ARE A LOT OF OTHER AREAS WHERE
WE REALLY HAVE GAPS AND
SHORTFALLS. SO MEDICARE, IT
TURNS OUT IS A TERRIBLE PAIR FOR
BEHAVIORAL HEALTH. THERE ARE
LOTS OF HOLES IN WHAT IT WILL
COVER. BUT IN ADDITION,
BEHAVIORAL HEALTH NEEDS ARE
OFTEN DE FACTO TREATED LIKE AN
ELECTIVE FOR PEOPLE WITH
COMMERCIAL INSURANCE, AND THIS
IS BECAUSE THE NETWORK ACCESS
AND QUALITY AND COVERAGE IS NOT
THERE ON PAR WITH WHAT'S
AVAILABLE IN OUR PUBLIC
SPECIALTY SAFETY NET. FEDERAL
INSTINCT FUNDING HAS OFTEN BEEN
LIMITED AS WELL. AS AND AGAIN I
THINK THAT WE NEED TO LOOK AT
STIGMA AS A POSSIBLE REASON FOR
THIS, BUT YOU KNOW OUR FEDERAL
ENTITIES LIKE SAMSA OFTENTIMES
ISSUED GRANTS, BUT THEY'RE
LIMITED RIGHT, SO IT'S SORT OF
WE'RE DOING A LITTLE BIT HERE IN
A LITTLE BIT THERE, BUT WE DON'T
REALLY HAVE THAT BROADER,
SYSTEMIC AND SUSTAINED
INVESTMENT IN BEHAVIORAL HEALTH
THE WAY WE DO WITH PHYSICAL
HEALTH. THE NET. RESULT OF THAT
IS THAT WE ALL PAY THE PRICE FOR
THIS. COLLECTIVE LACK OF
INVESTMENT. WHEN THE SPECIALTY
BEHAVIORAL HEALTH SAFETY NET HAS
THE BEST COVERAGE. THE MOST
ROBUST NETWORKS. YOU KNOW
SOMETHING'S UP. AND THERE'S A
LOT OF VARIATION THAT COMES FROM
THAT SPRINKLING GRANTS APPROACH
THE ONE TIME MONEY APPROACH AND
OFTEN TIMES OF THE LAST SEVERAL
YEARS, I'VE HEARD A LOT OF
FRUSTRATION FROM PROVIDERS FROM
COMMUNITY MEMBERS FROM
POLICYMAKERS ABOUT WHY IS THERE
SO MUCH VARIATION? WHY IS IT
THAT YOU CAN GET THIS IN THIS
COMMUNITY, BUT NOT THAT
COMMUNITY, AND IT REALLY DOES
DERIVED FROM A LOT OF THESE
ISSUES, AND THEN THERE'S THE
ISSUE THAT WE TALKED ABOUT IN
LAST NIGHT'S OVERSIGHT HEARING,
WHICH IS THIS COST SHIFT TO THE
PUBLIC SYSTEM FROM PEOPLE WHO
ARE SO INAPPROPRIATELY SERVED
AND UNDERSERVED WITH COMMERCIAL
INSURANCE. THAT THEY BECOME
DISABLED AND END UP QUALIFYING
FOR SAFETY NET SERVICES. NEXT
SLIDE, PLEASE. UM THE CHAIR
REALLY PROVIDED A VERY THOROUGH
OVERVIEW AT THE TOP OF THE
HEARING ABOUT THE IMPACT THAT
COVID HAS HAD ON OUR BEHAVIORAL
HEALTH. I WANTED TO UPLIFT A
COUPLE OF THINGS BECAUSE WE KNEW
VERY EARLY ON, ACTUALLY, THAT
THERE WAS A BIDIRECTIONAL
ASSOCIATION BETWEEN COVID AND
PEOPLE WITH BEHAVIORAL HEALTH
CONDITIONS WE KNEW SCIENTISTS
HAD ALREADY PINPOINTED THAT
INDIVIDUALS WITH SCHIZOPHRENIA
WERE FOUR TIMES MORE LIKELY TO
DIE. DUE TO COVID. AND THAT
COVID APPEARED TO BE TRIGGERING
BRAND NEW MENTAL HEALTH
CONDITIONS IN PEOPLE WHO HAD
NEVER HAD THEM BEFORE, AND SO
THERE WAS SOME SORT OF LINKAGE
THERE. UM WE ALSO KNOW THAT, UM
INDIVIDUALS WITH S, U. D S AND
PRE EXISTING CONDITIONS FACED
WORSE OUTCOMES AND USES OF
SUBSTANCES JUST REALLY SHOT UP
DURING THE PANDEMIC. UM WE KNOW
THAT OVERDOSE RELATED DEATHS
HAVE INCREASED BY 30% IN THE
FIRST YEAR OF THE PANDEMIC
ALONE. NEXT SLIDE. AND OF COURSE
, WITH CHILDREN AND YOUTH AGAIN
AS THE CHAIR VERY THOROUGHLY
LAID OUT AT THE TOP, UM, THE
RATES OF SUICIDALITY, UM, REALLY
SHUT UP AMONG BLACK AND LATINO X
YOUTH AND THE STATISTICS FOR
LGBTQ YOUTH ARE REALLY, UM,
SOMETHING THAT AGAIN IS ALSO
SIGNIFICANT AND WORTH CALLING
OUT. MORE THAN HALF OF
TRANSGENDER AND NON BINARY YOUTH
HAVE SERIOUSLY CONSIDERED DEATH
BY SUICIDE. AND THESE ARE
NATIONALS STATISTICS. THE CDC
DATA FROM FEBRUARY HAS ALSO
REALLY PUT AN EMPHASIS ON WHAT
UM YOUNG GIRLS ARE FACING IN
TERMS OF PERSISTENT FEELINGS OF
HOPELESSNESS AND DEPRESSION. UM
AND THESE ARE THE HIGHEST RATES
THAT WE'VE SEEN IN A LONG TIME.
AND INTERESTINGLY ENOUGH, I
LEARNED THIS FROM OUR MEMBERSHIP
. RATES OF YOUTH CRISIS ACTUALLY
INCREASE WHEN SCHOOL IS IN
SESSION, AND A LOT OF THAT WE
THINK IS DUE TO SOME OF THE
SOCIAL PRESSURES AND YOU KNOW
THE ANXIETY THAT COMES WITH
BULLYING THOSE SORTS OF
SITUATIONS BUT ALSO SCHOOL
PRESSURE PERFORMANCE, YOU KNOW,
AND ACHIEVEMENT, THOSE KINDS OF
THINGS, SO THERE'S A VARIETY OF
THINGS THAT HAPPEN WHEN KIDS ARE
IN SCHOOL THAT ACTUALLY AMPS UP
CRISIS. AND AT THE SAME TIME WE
KNEW DURING THE PANDEMIC THAT
MANY CHILDREN ARE NOT SAFE AT
HOME. AND SO FOR THOSE KIDS NOT
BEING IN SCHOOL, PUT THEM AT
HIGHER RISK. LOTS OF TRADE OFFS
THERE. NEXT SLIDE. BEHAVIORAL
HEALTH CONDITIONS GLOBALLY ARE
THE LEADING CAUSE OF DISABILITY
, AND WE, BY AND LARGE DO HAVE
STRONG LEGAL PROTECTIONS UNDER
THE A. D. A THE OLMSTEAD LAWSUIT
, UM IN TERMS OF EMERGENCY CARE
AND TALA AS WELL AS, UH, THE
LANTERN AND PETRUS SHORT ACT,
AMONG OTHER UM, LAWS THAT
PROTECT INDIVIDUALS WITH
BEHAVIORAL HEALTH DISABILITIES.
NEXT SLIDE. SO LET'S TALK ABOUT
SOME OF THE WORK THAT'S BEEN
UNDERWAY IN CALIFORNIA TO
ADDRESS OUR MENTAL HEALTH
CRISIS. NEXT SLIDE, PLEASE. THIS
IS NOT EVEN A FULL SUMMARY OF
ALL OF THE THINGS THAT WE
CURRENTLY HAVE UNDERWAY IN
CALIFORNIA TO REFORM AND
TRANSFORM OUR BEHAVIORAL HEALTH
SYSTEM. UNDER MEDICAL ALONE. WE
HAVE NUMEROUS BRAND NEW BENEFITS
THAT COUNTIES AND MANAGED CARE
PLANS ARE BRINGING ON BOARD.
THOSE THAT ARE NOTED WITH AN
ASTERIX. HERE ARE THE MANAGED
CARE PLAN BENEFITS AND THE
OTHERS ARE THE COUNTY BEHAVIORAL
HEALTH PLAN BENEFITS. THEY
INCLUDE THINGS LIKE MOBILE
CRISIS SERVICES. UM JAIL IN
REACH HERE. SUPPORT SPECIALISTS
CONTINGENCY MANAGEMENT. AS WELL
AS MORE SYSTEMIC REFORMS SUCH AS
REFORMING HOW WE PAY OUR COUNTY
BEHAVIORAL PLANS AND THEIR
PROVIDERS. CHANGING ELIGIBILITY
CRITERIA SO THAT MORE PEOPLE CAN
BE SERVED BY COUNTY BEHAVIORAL
HEALTH WITHOUT REQUIRING OUR
CLINICIANS TO PUT A DIAGNOSIS ON
THEM RIGHT AWAY. UM WE ARE ALSO
REFORMING HOW WE DO QUALITY. HOW
WE DO DOCUMENTATION AND SO MUCH
MORE. NEXT SLIDE. AND ALL OF
THOSE THINGS ARE HAPPENING AT
THE SAME TIME. LOOKING AHEAD. D
HCS HAS ALSO PROPOSED THAT CAL
BH CBC, WHICH IS JARGON FOR A
WAIVER OF THE MD EXCLUSION,
WHICH WILL ALLOW US TO GET
REIMBURSEMENT FOR SHORT TERM
STAYS IN INPATIENT AND
RESIDENTIAL MENTAL HEALTH
FACILITIES OVER 16 BEDS. THE
FEDERAL WAIVER, WHICH WOULD
ALLOW US TO DO THIS COMES WITH
TRADE OFFS. WE NEED TO
DEMONSTRATE TO THE FEDERAL
GOVERNMENT THAT WE ARE
AMPLIFYING COMMUNITY BASED
TREATMENT SERVICES FOR MENTAL
HEALTH IN ORDER TO OPT INTO THE
AVAILABILITY OF FEDERAL
REIMBURSEMENT FOR THOSE STATES.
I DO WANT TO TAKE A MOMENT TO
CALL OUT THAT IN OUR OPINION,
THE I M D EXCLUSION. WHICH AGAIN
LIMITS REIMBURSEMENT FOR UNDER
MEDICAID NATIONALLY FOR THESE
INPATIENT AND RESIDENTIAL STAYS.
IS YOU KNOW SOMETHING THAT WE
THINK THE FEDERAL GOVERNMENT
REALLY NEEDS TO TAKE ANOTHER
LOOK AT WHEN, UM MEDICAID WAS
BEGUN IN 1965. THEY WERE REALLY
TRYING TO LEAN INTO THE
DEINSTITUTIONALIZATION REFORMS
THAT PRESIDENT KENNEDY SIGNED
INTO LAW BEFORE HE WAS KILLED.
THERE WAS A REAL MOVEMENT AND A
PASSION FOR NOT LUCK,
WAREHOUSING AND LOCKING PEOPLE
UP, AND SO AT THE BIRTH OF
MEDICAID, MEDICAID SAID. WE'RE
NOT GOING TO PAY FOR THOSE
LARGER TREATMENT FACILITIES FOR
MENTAL HEALTH. WE WOULD ARGUE
THAT IN 2023, HOWEVER, WE HAVE
MUCH BETTER TOOLS THAT ARE
DISPOSAL TO MANAGE QUALITY AND
PATIENT CARE OUTCOMES THROUGH
DIFFERENT DRIVERS. YOU KNOW
LEVERS, UM, THAT ARE RELATED TO
PAYMENT. THE NON PAYMENT OF
THOSE INPATIENT AND RESIDENTIAL
TREATMENT SETTINGS REALLY PLACES
THEM OFF BOOK TO BOTH CMS AND
MEDICAID. IN A WAY THAT. WE
THINK IS PROBLEMATIC FOR ACCESS
FOR THOSE PEOPLE WHO MAY NEED
HIGHER LEVELS OF CARE. AND WHILE
THIS WAIVER IS A REALLY
IMPORTANT OPPORTUNITY FOR US TO
GET REIMBURSED FOR SOME OF THE
SHORT TERM STAYS, IT DOESN'T
ADDRESS THOSE PEOPLE WHO MAY
NEED LONGER TERM RESIDENTIAL OR
INPATIENT CARE. CALIFORNIA'S
WAIVER INTENDS TO SUPPORT THE
BUILD OUT OF COMMUNITY BASED
SERVICES BY REQUIRING THOSE
COUNTIES THAT OPT INTO THIS
WAIVER TO ALSO IMPLEMENT A
VARIETY OF NEW MEDICAL BENEFITS.
THAT ARE INTENDED TO BRING
ADDITIONAL FEDERAL DOLLARS INTO
OUR BEHAVIORAL HEALTH SAFETY NET
IN SOME CASES BY COVERING THINGS
THAT WE CAN'T COVER TODAY UNDER
MEDICAL AND IN SOME CASES BY, UM
UH, SUPPORTING OR UPLIFTING
CERTAIN SERVICES, SO I'LL GIVE
YOU A FEW EXAMPLES. RENT AND
TEMPORARY HOUSING WOULD BE A
REQUIREMENT FOR THOSE OPT IN
COUNTIES AS WELL AS COMMUNITY
HEALTH WORKERS. COVERAGE OF
FIRST EPISODE PSYCHOSIS
SUPPORTED EMPLOYMENT BUT ALSO A
SORT OF COMMUNITY TREATMENT AND
FORENSIC ASSERTIVE COMMUNITY
TREATMENT. UH IT WOULD ALSO
REQUIRE ALL COUNTIES TO
IMPLEMENT NEW EVIDENCE BASED
PRACTICES FOR CHILDREN AND YOUTH
SO HAPPY TO DISCUSS MORE. THAT
WAIVER STILL HAS NOT BEEN
SUBMITTED TO CMS, BUT TH CS IS
WORKING VERY CLOSELY WITH
COUNTIES ON PUTTING TOGETHER THE
CONCEPTS NEXT SLIDE. BEYOND
COUNTY BEHAVIORAL, HEALTH AND
MEDICAL. HOW MANY CARE PLANS?
THERE ARE A VARIETY OF OTHER
INITIATIVES THAT THIS
ADMINISTRATION AND THE
LEGISLATURE HAVE ADVANCED OVER
THE COURSE OF THE LAST 2 TO 3
YEARS. FIRST WE MUST UPLIFT THAT
CALIFORNIA HAS SOME OF THE
STRONGEST COMMERCIAL PLAN PARITY
LAWS IN THE NATION, THANKS TO
SENATOR WIENERS. SB 55. OUR
COMMERCIAL PARODY PLAN LAWS ARE
REALLY IMPORTANT, AND THEY
REALLY DICTATE HOW INSURANCE
PLANS TO UNDERWRITING AND COST
SHARING, MEANING THEY CAN'T
APPLY UNFAIR RULES TO HOW THEY,
UM, MANAGE THEIR HEALTH PLAN. IT
DOESN'T REALLY SPEAK TO COVERAGE
AND BENEFITS. HOWEVER, RIGHT SO
COLLOQUIALLY. I LIKE TO SAY THAT
PARODY LINE SHOES THAT YOUR
MENTAL HEALTH SERVICES WILL BE
COVERAGE WILL BE AS BAD AS YOUR
PHYSICAL HEALTH COVERAGE. SO IF
YOU HAVE HIGH COST SHARING,
DEDUCTIBLES, THOSE KINDS OF
THINGS WITH YOUR PHYSICAL HEALTH
COVERAGE YOU'LL HAVE THOSE WITH
YOUR MENTAL HEALTH COVERAGE AS
WELL, RIGHT JUST AS LONG AS IT'S
FAIR. UM FOR CHILDREN AND YOUTH
. WE HAVE THE C Y B H I, WHICH I
KNOW BOTH OF YOU ARE VERY
FAMILIAR WITH $4.4 BILLION
INVESTMENT IN VIRTUAL SERVICES
PLATFORM CORE CAPITAL
INFRASTRUCTURE AS WELL AS
EVIDENCE BASED PRACTICES. ONE
TIME FUNDING. WE HAVE THE
COMMUNITY SCHOOLS EVER UNDER THE
DEPARTMENT OF EDUCATION, AS WELL
AS THE COMMUNITY HEALTH OR
BEHAVIORAL HEALTH CONTINUUM
INFRASTRUCTURE PROGRAM, WHICH
WAS $2.2 BILLION THAT I WOULD
ARGUE, ARE FLYING OUT THE DOOR.
DEMAND FOR THE B CHIP HAS FAR
EXCEEDED THAT THE 2.2 BILLION
THAT WAS EARMARKED FOR THAT WE
HAVE MM. MANY COUNTIES. MOST
COUNTIES WHO APPLIED DID NOT GET
FUNDING UNDER THE B CHIP. UM,
AND THAT WAS AVAILABLE TO
INDIVIDUAL PROVIDERS, NOT JUST
COUNTIES AS WELL. AND THEN WE
HAVE 1.5 BILLION ENBRIDGE
HOUSING FUNDING AGAIN. ONE TIME
FUNDING FOR, UM, RENTAL
SUBSIDIES, SHELTER, INTERIM
HOUSING THOSE SORTS OF THINGS,
UM, THE WORKFORCE INVESTMENTS
UNDER LAST YEAR'S BUDGET, THE
PASSAGE OF 89 88 LAST YEAR TO
ALLOW CALIFORNIA TO ASSESS A
FEE. WE'RE CALL CENTERS AND
MOBILE CRISIS CARE COURT, WHICH
IS UNDERWAY CURRENTLY AND
NUMEROUS REFORMS RELATED TO THE
DEPARTMENT OF STATE HOSPITALS,
WHICH ARE DRIVING COMMUNITY
BASED RESTORATION AND DIVERSION
EFFORTS. SO ALL OF THAT IS
HAPPENING AS WELL. IN ADDITION
TO THE OTHER MEDICAL REFORMS
NEXT SLIDE. I WANTED TO TALK A
LITTLE BIT ABOUT OUR CRISIS
SYSTEM IF WE CAN GO TO THE NEXT
SLIDE, AS THAT IS THE TOPIC OF
TODAY'S HEARING AND TALK ABOUT
WHAT IS AVAILABLE. NEXT SLIDE,
PLEASE. UM. AND WE CAN KEEP
GOING. SORRY FOR ALL THOSE
HEADER SLIDES JUST A QUICK
OVERVIEW ABOUT THE SORT OF
HISTORY BEHIND 988. WE'RE REALLY
LOOKING AT EFFORTS ALONG THE
LAST 25 ISH YEARS FROM WHEN
CONGRESS FIRST APPROPRIATED
FUNDING FOR TO ESTABLISH A
NETWORK OF SUICIDE PREVENTION
HOTLINES. TO THE ESTABLISHMENT
OF THE NATIONAL SUICIDE
PREVENTION LINE. AND THROUGH TO
THE PASSAGE OF LEGISLATION AT
THE FEDERAL LEVEL IN 2020 TO
ESTABLISH AN EASY TO REMEMBER
THREE DIGIT NUMBER FOR THOSE,
UM, SUICIDE PREVENTION HOTLINES
988. NEXT SLIDE, AND THAT WENT
LIVE LAST YEAR IN JULY IN
CALIFORNIA, WE HAVE 13 NATIONAL
SUICIDE PREVENTION OR 988
HOTLINES, INCLUDING TWO THAT ARE
RUN BY COUNTIES IN SANTA CLARA
AND KERN. UM THE MAJORITY OF
WHICH ARE, UM, PROVIDED THROUGH
COMMUNITY BASED ORGANIZATIONS,
THE ONES THAT YOU SEE UP HERE.
NEXT SLIDE. UM AND THE
LEGISLATION WHICH WAS PASSED
LAST YEAR, A B 988 WOULD
ESTABLISH A TECHNICAL ADVISORY
BOARD UNDER THE OFFICE OF
EMERGENCY SERVICES TO WORK ON
911 COORDINATION AND DIRECTS THE
HEALTH AND HUMAN SERVICES AGENCY
TO DEVELOP A FIVE YEAR PLAN FOR
IMPLEMENTATION. AS YOU ARE AWARE
, THERE IS TRAILER BILL THAT IT
SEEKS TO EXTEND THE TIMELINE FOR
THAT AND MAKE SOME OTHER
MODIFICATIONS. IT ALSO WOULD
IMPOSE OR ALLOW FOR THE
IMPOSITION OF A NEW TAX ON PHONE
USERS TO HELP FUND THE CALL
CENTERS AND MOBILE CRISIS. UM
BUT AGAIN, UH, THAT THAT'S SORT
OF WHAT IT'S GOING TO FUND IS UP
IN THE AIR BASED ON THE OUTCOME
OF THE TRAILER BILL, AS WELL AS
COVERAGE FOR ENSURING COVERAGE
AND FOR 9 88 SERVICES BY
COMMERCIAL PLANS NEXT SLIDE.
NEXT SLIDE, PLEASE. OKAY LET'S
TALK ABOUT MOBILE CRISIS IN
CALIFORNIA. UM. TODAY WE HAVE A
PATCHWORK OF MOBILE CRISIS
SERVICES, UM, AVAILABLE IN
CALIFORNIA. THIS IS BASED ON A
SURVEY THAT, UM, THE COUNTY BE
ABLE HEALTH DIRECTORS
ASSOCIATION DID WITH OUR MEMBERS
TO FIND OUT WHERE MOBILE CRISIS
SERVICES WERE ALREADY HAPPENING
THROUGHOUT THE STATE AND THE
FEDERAL GOVERNMENT HAS PROVIDED
A NEW OPPORTUNITY FOR MEDICAL TO
COVER MOBILE CRISIS. UM BUT THIS
REALLY REFLECTS AGAIN. THE LACK
OF HISTORICAL, MEDICAID OR
COMMERCIAL INSURANCE COVERAGE OF
MOBILE CRISIS SERVICES. SO
SOMETIMES AGAIN, I LIKE TO SAY
TO THE YOU GET WHAT YOU GET
MODEL OF SERVICES, WHICH IS
FOLKS DOING WHAT THEY CAN AFFORD
TO DO THROUGHOUT THE STATE.
YOU'LL NOTE THAT THE COUNTIES
THAT HAVE NO MOBILE CRISIS
SERVICES TODAY ARE REALLY
LARGELY RURAL COUNTIES THAT ARE
EITHER IN THE EAST OR THE
NORTHERN PARTS OF THE STATE.
NEXT SLIDE. SO AS I MENTIONED
THE NEW MEDICAL MOBILE CRISIS
BENEFIT WILL LAUNCH BY THE END
OF THIS YEAR. UM IT WILL BE
FULLY COVERED BY THE STATE AND
FEDERAL GOVERNMENT, WITH FEDERAL
MATCHING DOLLARS AT 85% UNTIL
2027 SO THIS WAS AN INCENTIVE BY
THE FEDERAL GOVERNMENT TO GET
STATES TO LIFT THIS UP. THE
FEDERAL CRITERIA DO APPLY A
PRETTY HIGH BAR. HOWEVER WE'RE
GOING FROM IN SOME CASES, 0 TO
24 7 COVERAGE WITH TWO PERSON
TEAMS. UM D HCS DID PROVIDE $205
MILLION IN GRANTS UNDER B CHIP
TO HELP COUNTIES PURCHASE
VEHICLES AND IPAD THINGS LIKE
THAT TO HELP SUPPORT THE BUILD
UP. UM AND WE'VE JUST RECEIVED
CRITERIA THIS YEAR IN TERMS OF
WHAT? HOW THE BENEFIT SHOULD
FUNCTION IN CALIFORNIA. WE ALSO
APPLIED FOR A CMS PLANNING GRANT
WITH THE HCS AND ARE SUPPORTING
COUNTIES WITH TECHNICAL
ASSISTANCE IN TERMS OF TRYING TO
LIFT THIS UP. NEXT SLIDE. UM
THERE ARE SOME CHALLENGES,
HOWEVER, EVEN WITH THE GENEROUS
FEDERAL MEDICAID BENEFIT, FIRST
OF ALL MEDICAL ONLY COVERS ONE
OUT OF EVERY THREE CALIFORNIANS
. AND SO 70% OF CALIFORNIANS
EITHER DON'T HAVE COVERAGE UNDER
MEDICAL BECAUSE THEY'RE
UNINSURED, OR THEY HAVE
COMMERCIAL INSURANCE AND AGAIN,
DEPENDING ON HOW THEY ACCESS
THOSE MOBILE CRISIS SERVICES. WE
MAY NOT HAVE ANY REIMBURSEMENT
FOR THEM. THERE'S REALLY NOT A
STABLE SOURCE OF FUNDING RIGHT
NOW FOR DISPATCH, WHICH IS CORE.
MANY RURAL COMMUNITIES LACK BOTH
WORKFORCE AS WELL AS BROAD BAND
FOR THESE AND AGAIN WORKFORCE IS
JUST THE PREEMINENT CHALLENGE
FOR MOBILE CRISIS AND MANY OTHER
SERVICES. NEXT SLIDE, PLEASE. SO
LET'S GET TO MORE MINUTES MORE
MINUTES. OKAY LET'S REAL QUICKLY
THEN I'M NOT GOING TO GO THROUGH
ALL THE DATA, BUT I WILL TELL
YOU THAT THERE ARE SIGNIFICANT
DISPARITIES BASED ON GEOGRAPHY
WHEN IT COMES TO OUR WORKFORCE
SHORTAGE WITH THE SUMMER KI¾M
VALLEY BEING THE MOST
SIGNIFICANTLY IMPACTED AS YOU
CAN SEE HERE, NEXT SLIDE. AND WE
CAN SKIP THIS ONE AS WELL. UM
FOR BOTH COUNTIES AND OUR
PROVIDERS. THE MAJOR BARRIERS
ARE COMPETITION FROM OTHER
EMPLOYERS AGAIN AS WE'RE TRYING
TO BEEF UP TO ADDRESS THE CRISIS
, THERE'S A LOT MORE DEMAND IN
TERMS OF ENFORCING PARODY LAWS,
BUT ALSO WAY MORE PEOPLE
EXPERIENCING DISTRESSING NEEDING
SERVICES. THERE'S ALSO
RECRUITMENT FROM MANY TELE
HEALTH PROVIDERS, AND, UM, WILL
NOTE THAT THERE'S A LACK OF
ALIGNMENT BETWEEN THE WORKFORCE
AND THE PEOPLE WERE SERVING SO
JUST THE PEOPLE WHO ARE LICENSED
TODAY TEND TO BE WHITE WOMEN IN
CALIFORNIA THAT DOES NOT ALIGN
WITH THE MAJORITY OF PEOPLE WHO
WE NEED TO SERVE, ESPECIALLY IN
MEDICAL NEXT SIDE. WE DID LAUNCH
OUR PEER SUPPORT SPECIALIST
BENEFIT IN CALIFORNIA, WHICH
WILL HELP US WITH
PARAPROFESSIONALS WHO CAN
PROVIDE EXTENDERS IN IN OUR
SYSTEM. NEXT SLIDE. AND THEN
WE'LL JUST MOVE QUICKLY. NEXT
SLIDE, PLEASE. UM. I COVERED
THIS A LITTLE BIT EARLIER, WHICH
IS THAT WE ARE CHANGING CRITERIA
TO EXPAND ACCESS UNDER MEDICAL
FOR SPECIALTY MENTAL HEALTH
SERVICES. I KNOW YOU'LL HAVE A
WHOLE OTHER PLANT PANEL TOUCHING
ON THIS NEXT SIDE. AND THEN, UM
, WITH THE SCHOOL BASED
INITIATIVES. WE HAVE THE PAYER
FEE SCHEDULE, WHICH IS COMING
DOWN UNDER THE C Y B H I, BUT WE
ALSO HAVE INVESTMENTS THROUGH
MENTAL HEALTH SERVICES ACT, FOR
EXAMPLE, IN BUILDING THOSE
PARTNERSHIPS AS WELL AS UNDER
MEDICAL MANAGED CARE PLAN
INCENTIVES NEXT SLIDE. UM COUNTY
BEHAVIORAL HEALTH AGAIN ALREADY
HAD A FAIRLY GOOD PRESENCE IN,
UM, PROVIDING SERVICES TO 85% OF
CALIFORNIANS. UM BUT WE ARE
LOOKING TO EXPAND THOSE
PARTNERSHIPS NEXT SLIDE. AND IN
TERMS OF HOUSING AND
HOMELESSNESS. OBVIOUSLY THERE'S
A SIGNIFICANT OVERLAP THERE. UM
WITH, UH AND I THINK WE MAY HAVE
SKIPPED ASIDE. I'M SORRY. YOU
CAN GO BACK ONE, I GUESS NOT
NEXT SLIDE. UM WE BELIEVE THAT
IT'S IMPORTANT FOR OUR
POLICYMAKERS TO FOCUS ON THE
WORKFORCE PIPELINE, PARTICULARLY
THOSE FUNDS THAT HAVE BEEN
PROPOSED TO BE DELAYED. WE
CANNOT WAIT ON INVESTING IN THE
PIPELINE AND THIS THIS SUPPLY
FOR OUR WORKFORCE. WE ALSO
REALLY URGED THE LEGISLATURE TO
CONSIDER THE CHALLENGES OF ONE
TIME INVESTMENTS TO US THAT IS
MORE OF THE SAME. THAT IS WHAT
WE'VE BEEN DOING, AND IT'S
WHAT'S LED TO, UM, CARE. THAT
IS, UH, YOU KNOW IN THAT SHOWS
UP IN WAYS IN POCKETS RATHER
THAN YOU KNOW A SUPPORTED ROBUST
SAFETY NET. WE ALSO FEEL LIKE
WE'VE HIT THE TURNING POINT ON
THE CHALLENGES WITH PEOPLE WITH
COMMERCIAL INSURANCE, AND WE
REALLY NEED TO MOVE BEYOND
PARODY TO IMPROVE BOTH COVERAGE
AS WELL AS AFFORDABILITY. PLENTY
OF LOW INCOME CALIFORNIANS HAVE
COVERAGE THAT THEY CAN'T AFFORD
TO USE. AND AGAIN, THIS STIGMA
AND UNCONSCIOUS BIAS THAT PROVE
IS REALLY PERVASIVE, BOTH AMONG
THE PUBLIC BUT ALSO AT TIMES
WITH OUR PROVIDERS AND OUR
INSTITUTIONS, AND IT'S
UNCONSCIOUS AND MANY TIMES, BUT
IT REALLY IMPACTS HOW PEOPLE CAN
ACCESS AND SHOW UP FOR CARE. SO
WITH THAT, I'LL JUST SAY THANK
YOU SO MUCH AND HAPPY TO ANSWER
ANY QUESTIONS. THANK YOU VERY
MUCH. DOCTOR KHÔNG. GREAT THANK
YOU SO MUCH. THANK YOU FOR YOUR
TIME AND THANK YOU FOR THE
INVITATION. IT'S AN HONOR TO BE
HERE TODAY, AND WE APPRECIATE
THIS OPPORTUNITY TO SHARE MORE
ABOUT PROVIDENCE IS VANTAGE
POINT. GIVE THEM THAT WE HAVE
FACILITIES AND A FOOTPRINT THAT
SPANS ACROSS CALIFORNIA. AND
THERE'S NO TIME MORE APPROPRIATE
THAN THIS MONTH WITH IT BEING
MENTAL HEALTH AWARENESS MONTH
AND EARLIER IN YOUR STATEMENT,
YOU COMMENTED ON THE U. S
SURGEON GENERAL VIVEK MURTHY
STATEMENTS ABOUT THE MENTAL
HEALTH CRISIS AND REALLY THE
URGENCY THAT WE NEED TO ADDRESS
THESE ISSUES NOW, AND HE
RECENTLY REPORTED ALSO THAT
REALLY THE NEXT PUBLIC HEALTH
PRIORITY IS LONELINESS AND
ISOLATION. AND AS YOU MENTIONED
WE NEED MORE ATTENTION ON MENTAL
HEALTH, SIMILAR TO HOW WE ARE
ADDRESSING PHYSICAL HEALTH NEEDS
AND WHAT WE KNOW IS SIMILAR TO
HOW WE THINK ABOUT DIABETES AND
HYPERTENSION AS MULTIPLIERS AND
RISK FACTORS FOR THINGS LIKE
EARLY MORBIDITY, EARLY MORTALITY
WE KNOW THE SAME IS TRUE FOR
MENTAL HEALTH ISSUES AS WELL. UM
AT ANY POINT IF YOU HAVE
COMMENTS, QUESTIONS, PLEASE FEEL
FREE TO INTERJECT AS WELL. SO MY
NAME IS DR SUSAN HUANG. I'M THE
CEO OF THE PROVIDENCE HEALTH
NETWORK, AND I'M, THE CHIEF
MEDICAL OFFICER OF THE
PROVIDENCE SELF DIVISION, WHICH
COVERS CALIFORNIA AND BY WAY OF
BACKGROUND, PROVIDENCE HAS 17
ACUTE CARE HOSPITALS ACROSS THE
FOOTPRINT OF THE STATE AND OVER
10,000 PHYSICIAN MEDICAL STAFF.
UM AND WE COLLECTIVELY SERVED
1.5 MILLION PATIENTS OVER THE
LAST YEAR. OVER HALF A MILLION
OF THOSE PATIENTS WERE AMONG THE
POOR AND VULNERABLE. SO THAT IS
PART OF OUR MISSION. UM IN OUR
FOOTPRINT, WE HAVE THREE LPS
DESIGNATED FACILITIES. THEY'RE
ALL IN SOUTHERN CALIFORNIA.
THEY'RE LOCATED AND SAN PEDRO
AND LAGUNA BEACH AND IN ORANGE,
SO AN OC AND L. A COUNTY'S IN
OUR VISION OF PROVIDENCE IS
HEALTH FOR A BETTER WORLD. WE'RE
ON A MISSION TO ACHIEVE THAT
THROUGH SHEDDING LIGHTS ON THE
GROWING BEHAVIORAL HEALTH NEEDS
OF OUR CALIFORNIA COMMUNITIES
AND ALSO A COMMITMENT TO OTHER
COMMUNITIES THAT WE SERVE ALL
RACES, ALL ETHNICITIES AND
REALLY, ALL OF THIS POPULATIONS
OF THE COMMUNITIES OF
CALIFORNIA. AND AS YOU STATED
SOME OF THE STATISTICS AROUND
MENTAL HEALTH EARLIER TODAY, SO
WE KNOW THAT OVER ABOUT 7.5
MILLION PEOPLE IN CALIFORNIA
EXPERIENCED MENTAL HEALTH
DISORDERS IN ANY GIVEN YEAR AND
THEN FROM 2011 TO 2020. THERE
WAS A 68% INCREASE IN THAT
STATISTIC IN THE NUMBER OF
MENTAL HEALTH PATIENTS AND
EMERGENCY DEPARTMENTS THAT ARE
SEEKING TREATMENTS. AND UM, AS
MENTIONED EARLIER THAT THIS DATA
IS STILL BEING COMPILED. WE KNOW
THAT COVID 19 WAS A BIG DRIVER
OF THIS, AND, UM WE CERTAINLY ON
ANECDOTAL BASIS IF YOU DO ROUNDS
THROUGH OUR HOSPITALS AND YOU
WALK, WALK THE FLOORS. WHAT YOU
SEE IS THAT THERE ARE DIFFERENT
TYPES OF ISSUES. THERE ARE MORE
AND MORE FREQUENT SINCE COVID 19
. WHAT WE'RE SEEING IS A
POPULATION OF YOUNGER PATIENTS,
NOT JUST OLDER PATIENTS WHO WE
KIND OF DEEMED AS COMPLEX
PATIENTS IN THE PAST. THERE'S
INCREASING SOCIAL COMPLEXITY AS
WELL. SO ISSUES WITH
HOMELESSNESS, FOOD INSECURITY,
TRANSPORTATION, SOCIAL ISOLATION
, ALONG WITH MENTAL HEALTH, UM,
ISSUES, TOO, AND, UM WHAT WE'RE
ALSO SEEING IS THAT THERE'S A
CONFLATION OF THERE'S A
COMBINATION OF THOSE TYPES OF
ISSUES THE SOCIAL ISSUES WITH
ALSO INCREASING MEDICAL
COMPLEXITY AS WELL. SO NOW WE'VE
GOT THIS OVERALL POPULATION THAT
HAS INCREASED SOCIAL COMPLEXITY
, MENTAL HEALTH, UM, ILLNESS AND
THEN ALSO MULTIPLE COMORBIDITIES
, WHICH ARE ALSO INCREASING. SO
WHAT IT MEANS IS THAT THE
POPULATION WERE SERVING IT'S
BECOMING MORE AND MORE COMPLEX
ON MANY FRONTS. UM SO WE KNOW
THAT PATIENT PLACEMENT HAS ALSO
BEEN IMPACTED BY COVID 19, AND
THAT'S DUE TO YOU KNOW MANY OF
THE FACILITIES, BEHAVIORAL
HEALTH FACILITIES, NOT HAVING
THAT INFRASTRUCTURE TO ISOLATE
PATIENTS OR TO CREATE THE NEW
SPACES THAT ARE NEEDED FOR THESE
PATIENTS AS WELL. AND SO BECAUSE
OUR 17 HOSPITALS, WE, SPEARMAN,
UM KIND OF URBAN AREAS AND
SUBURBAN AND RURAL AREAS. WE
HAVE SOME OF THESE UNIQUE
INSIGHTS IN TERMS OF WHAT THAT
VARIATION LOOKS LIKE, UM, IN
TERMS OF HOW BEHAVIORAL HEALTH
SERVICES ARE ADMINISTERED. SO UM
, WHAT WE ARE SEEING IS WE ARE
SEEING THAT PSYCHIATRIC PATIENTS
ARE BEING BROUGHT TO THE
EMERGENCY DEPARTMENTS AND THESE
ARE BEING BROUGHT TO OUR NON
LPS. DESIGNATED E. R S. AND THAT
RESULTS IN WHAT WE CALL BOARDING
WERE PATIENTS STAY THERE UNTIL A
MORE APPROPRIATE FACILITY IS
IDENTIFIED IN THIS OCCURS ACROSS
BOTH ARE KIND OF NORTHERN
CALIFORNIA AND SOUTHERN
CALIFORNIA. FOOTPRINTS UM
PATIENTS ARE BEING BROUGHT BY
LAW ENFORCEMENT AND BY E. M. S
AS WELL. THEY'RE TAKING PATIENTS
TO THE NEAREST FACILITY,
REGARDLESS OF LPS DESIGNATION,
AND REALLY, THEY AREN'T REALLY
ABLE TO DO THAT NAVIGATION TO
REALLY PROPERLY MATCHED THE
PATIENTS TO WHERE THEY WOULD BE
BEST. SERVED. AND WHAT WE KNOW
IS THAT A LOT OF THESE NON LPS
FACILITIES, THESE EMERGENCY
ROOMS ARE REALLY NOT THE BEST
PLACES FOR PATIENTS WITH MENTAL
HEALTH, UM, EPISODES OR NEEDS TO
BE, THEY'RE NOT PROPERLY STAFFED
WITH THE PROPERLY TRAINED STAFF
. IF YOU JUST THINK ABOUT THE
ENVIRONMENT OF AN EMERGENCY ROOM
AS WELL, THERE'S A LOT OF
SOMETIMES HUSTLE AND BUSTLE
THERE MIGHT BE PATIENTS BOARDED
ON STRETCHERS, INSERTING CASES
AND IT'S NOT THE CALMING
ENVIRONMENT WITH THE PROPERLY
TRAINED STAFF THAT WE ACTUALLY
NEED PATIENTS TO MORE QUICKLY
AND MORE EFFICIENTLY BE
TRANSFERRED TO UM, AND THE
ABILITY FOR A NON LPS FACILITY
TO HOLD A PATIENT ON AN
APPLICATION TO TRANSFER TO L P.
C L P S FACILITY PLACED OUT INTO
THE FIELD HAS BECOME EXTREMELY
CHALLENGING AS WELL. UM. WHAT WE
ALSO SEE IS SOMETIMES YOU KNOW,
WE IN OUR FACILITIES, WE DO OUR
BEST TO MEET THE NEEDS OF THE
PATIENTS SO SOMETIMES BECAUSE
IT'S VERY HARD TO GET THE
PATIENTS TO THE PROPER FACILITY
. WE MIGHT DO A ADMISSION INTO A
MEDICAL OR SURGICAL FLOOR IN OUR
HOSPITAL AND AGAIN. YOU'RE NOT
REALLY HAVING THAT FOCUS, UM,
STAFFING THAT THAT WOULD BE THE
BEST PLACE FOR THAT PATIENT.
SOMETIMES THE PATIENTS COME WITH
BOTH MEDICAL NEEDS AND ALSO
MENTAL HEALTH NEEDS AS WELL. AND
SO WHAT WE'RE SEEING IS
SOMETIMES IF, UM THE PATIENTS
MEET ADMISSION CRITERIA FOR
MEDICAL REASON WHERE THE 51 50
APPLICATION IS NO LONGER
RECOGNIZE THEM. THE NON LPS
FACILITY ONLY HAS IMMUNITY
PROVIDED UNDER HEALTH AND SAFETY
CODE 17 99 FOR UP TO 24 HOURS
AND THEY MUST CONTINUE TO
DOCUMENT ATTEMPTS TO PLACE THE
PATIENT OF BEHAVIORAL HEALTH
FACILITY EVEN IF THE PATIENT IS
NOT MEDICALLY STABLE. AND WHAT
WE ALSO SEE IS THAT UM, PATIENTS
MIGHT HAVE NEEDS THAT ARE ALSO
HIGHLY MEDICAL AS WELL. THEY
MIGHT NEED SPECIALTY BEDS,
CERTAIN TYPES OF BEDS. MAYBE
THEY HAVE CERTAIN WOUNDS OR
ULCERS, RIGHT AND, UM AND YOU
CAN ACTUALLY SEE THE PHYSICAL
AILMENTS WITH THEM THE MEDICAL
MENTAL HEALTH ISSUES, UM, KIND
OF GOING TOGETHER, RIGHT? SO
IT'S NOT UNCOMMON THAT YOU'RE
SEEING MULTIPLE ISSUES TOGETHER
, THEY MIGHT NEED INTRAVENOUS
PUMPS IVY PUMPS, THEY MIGHT NEED
SPLINTER CRUTCHES. AND SO WE
REALLY HAVE TO KIND OF THINK
ABOUT HOW DO WE ADDRESS THIS
PATIENT POPULATION, WHICH HAS
MULTIPLE NEEDS. UM WHEN WE THINK
ABOUT PATIENTS WHO ARE BOARDING
THERE ARE ALSO TAKING UP CRUCIAL
SPACES THAT RIGHT NOW WE KNOW
THAT, UM A LOT OF OUR E. D S.
THEY'RE AT CAPACITY, SO WHEN
THEY'RE BOARDING A IT'S NOT THE
BEST PLACE FOR OUR PATIENTS. BUT
BE WE KNOW THAT THERE IS A
CRUNCH FOR PATIENTS WHO DO HAVE
ACUTE ILLNESSES. TO BE IN THOSE
ROOMS AS WELL. SO WHEN THIS
HAPPENS, PATIENTS MUST WAIT. THE
YOU KNOW, REMAIN BOARDED IN THE
E D UNTIL AN INDIVIDUAL
DESIGNATED BY THE COUNTY
BEHAVIORAL HEALTH DIRECTOR CAN
ASSESS THE PATIENT AND IT
DETERMINED THE NEXT STEPS. AND
SOMETIMES THIS CAN ACTUALLY TAKE
A VERY, VERY LONG TIME. THE
STAFFING CHALLENGES THAT WERE
FACED BY COUNTY BEHAVIORAL
HEALTH DEPARTMENTS. UM UM,
REALLY KIND OF PLACES THAT
BURDEN, UM, ALSO IN THE ACUTE
CARE MINISTRIES WHOSE WORKFLOWS
AND OPERATIONS AND SYSTEMS WERE
NOT NECESSARILY SET UP TO REALLY
ACCOUNT FOR THIS ADDITIONAL
PRESSURE. WE'RE SEEING EVEN
GREATER BURDEN GREATER
DIFFICULTY IN GETTING
ADOLESCENTS TO THE RIGHT PLACE.
SO JUST ANECDOTALLY. UM JUST
YESTERDAY WE HAD ONE PATIENT WHO
BOARDED FOR OVER 90 HOURS IN THE
EMERGENCY DEPARTMENT. AND SO
THERE ARE MANY, MANY ANECDOTAL
STORIES OF INDIVIDUALS BEING
HELD OR BOARDED IN PLACES,
REALLY, WHICH ARE JUST NOT IDEAL
. THE OTHER NEED IS ALSO KIND OF
LEARNED LONG TERM CARE
PLACEMENTS AS WELL. WE RECENTLY
UM WE HAD A PATIENT WHO STAYED
IN ONE OF OUR ACUTE CARE
FACILITIES FOR A YEAR AND A HALF
BEFORE WE COULD FIND A SAFE.
LONG TERM CARE PLACEMENT
FACILITY THAT REALLY MET THEIR
NEEDS, AND THAT IS THAT IS JUST
FAR TOO LONG. UM AND THEN FOR
CRISIS STABILIZED STABILIZATION
UNITS. THERE ARE ALSO SOME
INTRICACIES IN TERMS OF WHETHER
THEY ARE ON HOSPITAL LICENSE OR
THEY'RE KIND OF FREESTANDING.
SEE SUS AS WELL. WE DO HAVE A
CSUN CM PEDRO ON THE HOSPITAL
LICENSE. BUT WHEN A E M S BRINGS
A PATIENT WHO NEEDS THAT CSU BED
, THEY ACTUALLY ARE REQUIRED TO
BRING THEM TO OUR EMERGENCY
DEPARTMENT FIRST, SO INSTEAD OF
A DIRECT ADMISSION, WHICH THEY
COULD DO IF THAT CSU WAS
FREESTANDING, THAT PATIENT IS
NOW HAVING TO GO THROUGH OUR
EMERGENCY DEPARTMENT. SO AGAIN,
JUST JUST NOT IDEAL IN TERMS OF
WHEN YOU THINK ABOUT UM, WHAT IS
THE OFFICIAL? WHAT IS REALLY THE
RIGHT EASY DIRECT PATH FOR THESE
PATIENTS SO WE CAN NAVIGATE THEM
TO THE RIGHT CARE AT THE RIGHT
PLACE AT THE RIGHT TIME AS WELL.
IN SOUTHERN CALIFORNIA. WE TAKE
CARE OF 3000 PSYCHIATRIC
PATIENTS, 70% OF THEM BOARDED
FOR A MINIMUM OF FOUR HOURS IN
OUR ACUTE CARE FACILITIES. SO,
UM. THE THESE SEEM TO BE MORE
BEHAVIORAL HEALTH RESOURCES IN
SOUTHERN CALIFORNIA AS COMPARED
TO SOME OF OUR ROLE COMMUNITIES
AND OUR FOOTPRINT IN NORTHERN
CALIFORNIA. WE'RE STILL SEEING
THAT REALLY, THE NEED IS
THROUGHOUT THE FOOTPRINTS THAT
WE SERVE. AND I SHARE THESE
STORIES. AND THESE EXAMPLES AND
THESE ANECDOTES KNOWING THAT WE
ARE NOT ALONE IN DEALING WITH
THESE CHALLENGES OF WARDING, AND
IT'S REALLY NAVIGATING OUR
MENTAL HEALTH PATIENTS THE RIGHT
PLACE AT THE RIGHT TIME, AND
WE'VE IDENTIFIED POTENTIAL
OPPORTUNITIES. UM THROUGH THE
LPS ACT THAT IF CLARIFIED, ER
IMPLEMENTED CONSISTENTLY WE
BELIEVE WOULD IMPROVE THE
CURRENT STATE. SO WHAT CAN BE
DONE TO ENSURE THAT WHEN IT'S
PSYCHIATRIC PATIENT IS
STABILIZED, THEY'RE TAKEN TO THE
APPROPRIATE LEADER DESIGNATED
FACILITY. AND IT'S IN THE BEST
INTEREST OF OUR PATIENTS AND OF
OUR SYSTEMS AS WELL TO REALLY
HAVE THE RIGHT RESOURCES TO
SUPPORT THEM. AND THEN WHAT CAN
WE DO TO REALLY THINK ABOUT
MOVING CARE UPSTREAM AS WELL?
AND MAYBE THAT'S THROUGH KIND OF
THESE MOBILE RESPONSE UNITS AND
MAYBE THINKING CREATIVELY ABOUT
NEW WAYS NEW CARE MODELS THAT WE
CAN REACH THOSE PATIENTS SOONER?
INSTEAD OF BEING EXTREMELY
REACTIVE. FOR ONCE THEY GET TO
OUR EMERGENCY DEPARTMENTS IF
THEY GET TO OUR EMERGENCY
DEPARTMENTS RIGHT, SO THINKING
ABOUT REAL NEW CARE MODELS,
MEANING PATIENTS AT HOME OR
WHERE THEY ARE, UM, BECAUSE IT
IS EXTREMELY HARD FOR FAMILIES
AND PATIENTS, RIGHT, ESPECIALLY
IF THEY'RE IN A CRISIS SITUATION
TO NAVIGATE THEMSELVES. AND
SECONDLY, AS ALLUDED TO EARLIER
COUNTY BEHAVIORAL HEALTH
DIRECTORS HAVE THE AUTHORITY TO
DESIGNATE INDIVIDUALS THAT CAN
PLACE AND REMOVE PSYCHIATRIC
HOLDS. BUT THESE DO NOT
NECESSARILY NEED TO BE COUNTY
EMPLOYEES. SO AS ESPECIALLY AS
WE SEE THAT THERE ARE THESE HUGE
WORKFORCE CHALLENGES, CAN WE
REALLY BE A LITTLE BIT MORE
FLEXIBLE TO THINK ABOUT WHAT ARE
ALL THE EMPLOYEES IN THE
CAREGIVERS IN OUR HEALTHCARE
ECOSYSTEM? HOW CAN WE LEVERAGE
THOSE INDIVIDUALS BY PROVIDING
THE RIGHT TRAINING AND, OF
COURSE, THE RIGHT REGULATIONS
AND GUARDRAILS. SO THAT WE DON'T
HAVE THIS ADDITIONAL KIND OF
BARRIER. UM WHEN WE DO NEED THE
WHEN WE NEED PEOPLE PLACED ON
HOLDS OR OR TAKEN OFF, HOLDS AS
WELL. UM THERE ARE OPPORTUNITIES
I BELIEVE FOR PRIVATE AND PUBLIC
PARTNERSHIPS IN ORANGE COUNTY.
WE HAVE A PARTNERSHIP BE WELL. O
C, WHICH IS A PRIVATE PUBLIC
PARTNERSHIP. AND CAN WE REALLY
THINK ABOUT SOME OF THESE
MODELS, UM MORE BROADLY AS
WELCOMING SCALE THOSE MODELS BE
WELL IS GOING TO USE SCALE OUT
TO L, A COUNTY AS WELL. UM AND
IS THERE OPPORTUNITY TO BROUGHT
IN THE CRITERIA AS WELL TO
DESIGNATE APPROPRIATE
INDIVIDUALS AT THESE NON LPS
FACILITIES JUST KIND OF DO THAT
PRIOR POINTS, SO THERE'S NO EASY
SOLUTION, AND I THINK A LOT OF
THE DIFFERENT PIECES THEY'RE
INTERTWINED. WE INHERIT THE
SYSTEM THAT WE ARE OPERATING IN
TODAY, AND I THINK OUR JOB
REALLY IS TO FIGURE OUT WHAT ARE
THOSE NEW MODELS. HOW CAN WE
REALLY THINK FLEXIBLY ABOUT
WORKFORCE KNOWING THAT THERE IS
A HUGE WORK FOR SHORTAGE AS
WELL? UM SO THAT WE CAN REALLY
CREATIVELY CO CREATE WHAT THESE
SOLUTIONS ARE TO ADDRESS OUR
POPULATION OF MENTAL HEALTH
PATIENTS. UM AND I'M HERE TO
POINT OUT THAT THERE ARE THESE
IMPLEMENTATION OPPORTUNITIES
THEY HAVE THE POTENTIAL TO
GREATLY IMPACT THE APPROPRIATELY
AND TIMELY PLACEMENT OF OUR
PATIENTS. SO WHEN SOME
PROVIDENCE IS EAGER TO PARTNER
AND DEVELOP SOLUTIONS IN THIS
SPACE, WE'RE ACTIVELY PURSUING
OPPORTUNITIES AND COUNTIES
ACROSS OUR STATE TO BUILD OUT
BEHAVIORAL HEALTH CAPACITY. AND
WE WELCOME FUTURES. FUTURE
COLLABORATIONS TO REALLY EASE
THE WAY OF OUR PATIENTS. THANK
YOU FOR YOUR TIME AND HAPPY TO
ENTERTAIN ANY QUESTIONS. THANK
YOU QUESTIONS OR COMMENTS. LET
ME START OFF BY, UM THANK YOU
ALL VERY MUCH FOR REALLY
ARTICULATING. AH THE WHOLE ISSUE
WHEN IT COMES TO OUR BEHAVIOR
HEALTH NEEDS AND OBVIOUSLY THIS
IS VERY HELPFUL TO ME. BECAUSE A
LOT OF TIMES WE HEAR BITS AND
PIECES HERE AND THERE, BUT WE
DON'T SEE HOW IT'S ALL
CONNECTED. UM, AND OBVIOUSLY, AS
WE BEGIN TO MAKE OUR FIRST ROUND
OF ATTEMPTS TO ADDRESS THIS
CRISIS, WE KNOW THAT THERE'S
GOING TO BE MANY OTHER ROUNDS.
AND SO WHAT WE'RE TRYING TO DO
IS GET AHEAD OF THE NEXT ROUND.
OF WHAT NEEDS TO HAPPEN. UH
THROUGH OUR NEXT ROUND OF
LEGISLATION AND POLICY
PROPOSALS. AH! WAIT CAN WE? WHAT
ARE WE MISSING RIGHT NOW,
THOUGH, IN THIS FIRST ROUND THAT
WHEN MAKING AN IMPACT AND
HELPING TO STABILIZE OUR
POPULATION AS SOON AS POSSIBLE.
WELL I THINK YOUR QUESTION IS A
REALLY GOOD ONE CHAIR BECAUSE
YOU'RE ASKING ABOUT THE
COMMUNITY, RIGHT? AND WHAT? WHAT
CAN WE DO BETTER TO MEET THEM
WHERE THEY'RE AT? I WILL UPLIFT
A COUPLE OF THINGS THAT I THINK
YOU KNOW, I REALLY DIDN'T
HIGHLIGHT IN MY OVERVIEW
PRESENTATION AND AGAIN. I THINK
THAT JUST SPEAKS TO THE
SIGNIFICANT VOLUME OF SORT OF
EFFORTS THAT ARE CONCURRENTLY
UNDERWAY TODAY. EARLIER IN THE
PANDEMIC WE WORKED ON CODE
DESIGNING CAL HOPE WITH THE
STATE, WHICH WAS IN BUILT AS THE
FIRST OF ITS KIND, UM, COMMUNITY
COUNSELING PROGRAM FUNDED UNDER
FEMA THAT ALLOWED US TO USE
PIERCE TO DO TEXT, BASE AND FOAM
BASED AS WELL AS IN PERSON
COUNSELING FOR PEOPLE WHO WERE
EXPERIENCING STRESS. AND UM,
CRISIS DUE TO THE PANDEMIC, AND
THERE'S SO MUCH THAT WE CAN DO
TODAY WITH OUR EXISTING NETWORKS
OF PEER SPORTS SPECIALISTS IN
CALIFORNIA. UM THE STATE HAS
REALLY BEEN A WONDERFUL PARTNER
IN TRYING TO HELP US SORT OF
LOOSEN UP CERTAIN RESTRICTIONS
AND EXPAND AND SORT OF GET THE
MOST OUT OF THE SYSTEM THAT WE
HAVE TODAY. WHILE WE'RE TRYING
TO BUILD OUT FOR THE FUTURE. BUT
SOME OF THOSE, UM YOU KNOW
CONNECTIONS THROUGH PEOPLE WITH
LIVED EXPERIENCE WHO ARE WORKING
IN OUR SPECIALTY SYSTEM OR SOME
OF THE MOST EFFECTIVE, YOU KNOW,
SORT OF IMMEDIATE SOLUTIONS THAT
WE CAN DEPLOY IN OUR COMMUNITIES
. THEY'RE THEY'RE REALLY THE
OUTCOMES ARE REALLY THERE WITH
PEER MODELS AND YOU KNOW IT'S A
LOT SHORTER RUNWAY IN TERMS OF
GETTING PEERS OUT IN THE
WORKFORCE, THEN IT CAN BE WITH
PEOPLE WHO REQUIRE LICENSURE
CERTIFICATION. UM THE OTHER
THING THAT WE CAN DO IS REALLY
PRIORITIZE BEHAVIORAL HEALTH AND
CONTINUE TO PRIORITIZE
BEHAVIORAL HEALTH. THE GOVERNOR
AND THE LEGISLATURE HAVE SHOWN
THAT SINCE THE BEGINNING OF THE
PANDEMIC, A REAL SORT OF PEDAL
TO THE METAL APPROACH, HOWEVER,
WITH THE STATE OF OUR BUDGET
CURRENTLY THERE, YOU KNOW THERE
ARE PROPOSED DELAYS AND WE'RE
TALKING ABOUT. MAYBE WE CAN WAIT
AND I CAN ASSURE YOU WE CANNOT
WAIT FOR THINGS LIKE THE
WORKFORCE DOLLARS TO HIT THE
STREETS BECAUSE THE RESULT OF
DELAYS ON THE WORKFORCE SIDE IS
THAT WE'LL HAVE ALL OF THESE
WONDERFUL LAWS IN PLACE. THAT
ARE NOT ACTUALLY GOING TO BE
REALIZED, BECAUSE THE HUMANS
DON'T EXIST TO IMPLEMENT THEM
THOSE, SO I THINK THAT THERE'S A
LOT THAT THE LEGISLATURE CAN DO
TO HELP US. I WILL TELL YOU, YOU
KNOW, FOLKS ARE UNFORTUNATELY
BURNING THEMSELVES OUT RIGHT NOW
IN THE WORKFORCE, TRYING TO MEET
ALL OF THE OVERWHELMING NEEDS
AND DEMANDS THAT ARE OUT THERE.
AND OUR CLIENTS DESERVE BETTER.
UM YOU KNOW, THEY GET THE BEST
THAT WE CAN OFFER TODAY, BUT
THEY DEFINITELY DESERVE BETTER.
I THINK THAT'S A WONDERFUL
QUESTION. AND AS I THINK ABOUT
THIS WHOLE ISSUE, IT'S UM DON'T
BOIL THE OCEAN, YOU KNOW, START
WITH A COUPLE OF T APPROACH AND
IF I JUST THINK ABOUT KIND OF
THIS ISSUE FROM A VERY PRACTICAL
LENS FROM FROM AT LEAST YOU KNOW
OUR OUR EXPERIENCES THAT WE HAVE
AT PROVIDENCE. I WOULD SAY A LOT
OF IT IS AROUND THE WORKFORCE.
UM BECAUSE RIGHT NOW WE ARE JUST
SEEING THAT THERE'S THIS TRAFFIC
JAM. ESSENTIALLY IN OUR
FACILITIES AND YOU'RE GETTING
PEOPLE CAUGHT IN THE TRAFFIC,
WHICH SHOULDN'T BE CAUGHT IN THE
TRAFFIC, MEANING THEY'RE
BOARDING IN THE E D S OR THEY'RE
BEING HELD IN THERE IN MED
SEARCH BEDS FOR AN INORDINATELY
LONG PERIOD OF TIME. SO I THINK
THINKING, WHAT MIGHT BE THOSE
EASY LITTLE THINGS SO CAN WE
BROADEN THAT DESIGNATION OF
PEOPLE, NON LPS FACILITIES. WHO
CAN DO THOSE ASSESSMENTS? UM
EVEN THINKING ABOUT DOCTORS AS
WELL. AND BECAUSE IN CALIFORNIA
, YOU KNOW, SOMETIMES THESE
THINGS ARE TIED UP IN OTHER
POLICIES AND LAWS. THEY WERE
CORPORATE PRACTICE OF MEDICINE
STATE WHERE WE DON'T DIRECTLY
EMPLOYED DOCTORS. BUT CAN WE
THINK OF EVEN USING DOCTORS AS
WELL TO DO SOME OF THOSE
ASSESSMENTS? SO I THINK THERE'S
MIGHT BE SOME OF THE LOWER
HANGING FRUITS AS WE THINK ABOUT
. OKAY IMMEDIATELY. WE DO HAVE
SOME LITTLE FIRES THAT THAT NEED
TO BE ADDRESSED AND THEN
CERTAINLY KIND OF OUR LONGER
TERM STRATEGIC APPROACH WOULD BE
MOVING UPSTREAM, CREATING THAT
THOSE BIGGER POLES OF WORKFORCE
BUT IN THE MEANTIME REALLY
THINKING FLEXIBLY I KNOW AND L.
A. THERE WERE DIFFERENT PILOTS
GOING ON IN TERMS OF LEVERAGING
ADDITIONAL SOCIAL WORKERS AND
OTHER PARTS OF THE WORKFORCE TO
DO THOSE EVALUATIONS. BUT IF WE
CAN REALLY THINK ABOUT SCALING
THAT OUT MORE EFFECTIVELY AND
QUICKER, I THINK THAT WOULD BE
THAT WOULD BE, UM, JUST
SOMETHING FAST OR HER THAT THAT
WE CAN DO TO ADDRESS THE CORRECT
PROBLEM. ALL RIGHT, GO AHEAD.
THANK YOU. I KNOW WORKFORCE IS
ABSOLUTELY KEY TO BE ABLE TO
MOVE FORWARD AND I'M
PARTICULARLY INTERESTED IN THE
MOBILE MENTAL HEALTH CRISIS
SUPPORT TEAMS AND I LOVE WHAT
ORGANS DONE WITH THE CAHOOTS
PROGRAM. AND UM, I KNOW SOME
COUNTIES ONLY HAVE MOBILE
MILITARY MENTAL HEALTH CARE FOR
SET NUMBER OF HOURS IN A WEEK
AND DAYS, AND SOMETIMES IT'S
ONLY FOR PEOPLE THAT ARE ALREADY
IN THE COUNTY BEHAVIORAL SYSTEM.
AND OUR BACKUP REALLY IS HAVING
THE MENTAL HEALTH CARE PROVIDER
AS A RIDE ALONG WITH THE POLICE
TEAMS THAT ARE GOING OUT AND
ABOUT AND AGAIN THOSE HOURS ARE
LIMITED. AND, YOU KNOW, AS A
RESULT, UM WE'VE HAD SOME
HORRIBLE, TRAGIC INCIDENCES
WHERE PEOPLE WHO HAVE MENTAL
HEALTH CONDITIONS HAVE BEEN SHOT
AND KILLED. AND UM, SO HOW DO WE
MOVE FORWARD? AND I'M SUPER
CONCERNED ABOUT THE CURRENT?
MAYBE 988 THAT IT LOOKS LIKE THE
FUNDING FOR MOBILE MENTAL HEALTH
CRISIS TEAMS HAS BEEN, UM IT'S
NO LONGER IN THE BILL, AND SO
THERE'S A LOT OF CONCERN THERE
AND WHAT ARE YOUR IDEAS ON THIS
AND YOU SEE MOBILE MENTAL HEALTH
CARE AS AN ESSENTIAL PIECE TO
GETTING US TO WHERE WE NEED TO
GO. UM I'LL BE HAPPY TO TAKE
THIS ONE ASSEMBLYWOMAN PILLAR
AND SO AS I MENTIONED WE HAVE A
PATCHWORK TODAY. IN CALIFORNIA
AND ACROSS THE NATION. THIS IS
THE FIRST OF ITS KIND, YOU KNOW
, STANDARD BENEFIT. THE FEDERAL
GOVERNMENT REQUIRES 24 7
COVERAGE UNDER MEDICAID IN ORDER
TO OPT INTO THIS, AND SO THE
CHALLENGE FOR COUNTY BEHAVIORAL
HEALTH, WHICH WILL BE
IMPLEMENTING THIS UNDER MEDICAL
IS TO GET FROM THOSE, YOU KNOW,
LIMITED HOURS TO 24 7. AND I
WOULD ARGUE THAT YOU KNOW, WE
REALLY NEED TO BE AWARE THAT
BUILDING THAT MOBILE CRISIS
SYSTEM OUT TO BE ON PAR WITH
WHAT WE SEE WITH 911 IN LAW
ENFORCEMENT TODAY IS GOING TO
TAKE TIME BECAUSE THE
INFRASTRUCTURE NEEDS TO BE BUILT
OUT. THE WORKFORCE NEEDS TO BE
BUILT OUT. ALL OF IT NEEDS TO BE
BUILT OUT. AND AS I MENTIONED,
WE'VE GOT A THIRD OF THE FUNDING
WITH MEDICAL RIGHT, SO THERE'S
TWO THIRDS THAT WE STILL NEED TO
CLOSE THAT GAP. MY UNDERSTANDING
OF THE ADMINISTRATION'S PROPOSAL
IS NOT THAT IT ELIMINATES MOBILE
CRISIS AS SOME A SERVICE THAT
CAN BE FUNDED WITH 988, BUT
RATHER IT BROADENS 9 88 FEES SO
THAT THEY CAN PAY FOR A BROADER
ARRAY OF CONNECTED MENTAL HEALTH
CRISIS SERVICES PURSUANT TO THE
FEDERAL LAW, SO THE FEDERAL LAW
SAYS THAT ANY OF THE MENTAL
HEALTH SERVICES THAT SORT OF
FLOW THROUGH 98 THAT COME
THROUGH THAT 98 CALL OR TEXT CAN
BE FUNDED BY THE FEE, AND I
BELIEVE THE ADMINISTRATION'S
PROPOSALS TRYING TO SINK THAT UP
WITH THE FEDERAL LAW, WHICH IS
MUCH MORE OPEN. UM WHICH MEANS
MENTAL MOBILE CRISIS SERVICES
THAT ARE, UM REQUESTED THROUGH 9
88 COULD BE FUNDED WITH THE FEE.
I WANT TO POINT OUT THAT THERE
ARE PLENTY OF MOBILE CRISIS
SERVICES THAT MIGHT NOT COME
THROUGH THAT 9 80 DOOR FOR
PEOPLE WITH PRIVATE INSURANCE,
WHO THEN WOULD BE A GAP FOR US
IN TERMS OF COVERAGE, AND SO WE
STILL HAVE A LOT MORE TO DO TO
KIND OF BUILD OUT THOSE
NETWORKS. THE SORT OF ELEMENT
WITH LAW ENFORCEMENT IS ALSO
TRICKY, RIGHT? THE MOBILE CRISIS
TEAMS WILL NOT BE REIMBURSED FOR
ANY LAW ENFORCEMENT. FOLKS WHO
ARE PART OF THE RESPONSE AND
IT'S PRETTY STANDARD RIGHT NOW
ACROSS THE COUNTRY, NOT JUST IN
CALIFORNIA THAT IF THERE'S A
SITUATION THAT IS CONSIDERED
PUBLIC SAFETY RISK, SO YOU THINK
ABOUT SOMEONE WHO MIGHT BE
SUICIDAL AND HAVE A WEAPON OR
SOMETHING LIKE THAT ENFORCEMENT
IS LIKELY TO BE DEPLOYED TO
ENSURE THE PUBLIC SAFETY IN
THOSE SITUATIONS. AND SO THE
AVAILABILITY OF A AND
ALTERNATIVE TO LAW ENFORCEMENT
RESPONSE WHEN THE CONDITIONS ARE
APPROPRIATE IS ABSOLUTELY
SOMETHING THAT WILL BE FOR THE
FIRST TIME REALLY WELL SUPPORTED
THROUGH MEDICAL, BUT WE'VE GOT A
LONG WAY TO GO TO GET TO A PLACE
WHERE WE CAN ENSURE THAT THERE'S
ALWAYS GOING TO BE AN
ALTERNATIVE THERE BECAUSE WE
HAVE TO BUILD OUT THAT SYSTEM
AND IT TOOK YEARS TO GET TO 911,
AND IT LIKELY WILL TAKE YEARS
FOR US TO GET TO A ROBUST UM,
UNIQUE SORT OF MOBILE CRISIS
RESPONSE SYSTEM IN CALIFORNIA.
WITH THAT. WE WANT TO THANK THIS
PANEL VERY MUCH FOR YOUR TIME
AND LOOKING FORWARD TO DOING
SOME FOLLOW UP WITH YOU. WE ARE
GOING TO GOOD RIGHT NEXT TO OUR
NEXT PANEL, THE CHILDREN'S
MENTAL HEALTH CRISIS. SO WE
ASKED OUR NECKS PANELS,
PANELISTS THAT COME ON UP FROM
THE CALIFORNIA ACADEMY OF CHILD
AND ADOLESCENT PSYCHIATRY,
CALIFORNIA ASSOCIATION OF SCHOOL
ACCOUNT COUNSELORS. AND FIRST
FIVE CALIFORNIA UM, OF COURSE WE
ARE GOING JUST LIKE ANY OTHER
TIME WHERE YOU'RE GOING TO TRY
TO MOVE A LITTLE BIT FASTER
HERE. SO THAT WEEKEND CATCH UP
WITH OUR TIME. AND SO WE ASKED
THAT OUR PANELISTS. B S THOROUGH
, BRIEF BUT THOROUGH AS POSSIBLE
. IF THAT MAKES SENSE AND
LOOKING FORWARD TO THIS
CONVERSATION OF FIRST WE WILL
START. UH UM, WITH DOCTOR AND
MCBRIDE AND THEN WE WILL MOVE ON
TO DR LORETTA UH, WHITSON AND
THEN SARAH, UH WATCH THIS WATCH
AS THANK YOU. OKAY DR MCBRIDE.
OKAY, GOOD. GOOD MORNING. UM
FIRST I WANT TO START BY
THANKING YOU BOTH FOR SHARING
YOUR OWN. EXPERIENCES UM, IT'S
SO IMPORTANT THAT WE'RE TALKING
ABOUT THESE ISSUES. AND SO THANK
YOU FOR THE INVITATION TO SPEAK
WITH YOU TODAY. MY NAME IS DR
ANNE MCBRIDE. I'M A PHYSICIAN
WHO SPECIALIZES IN CHILD AND
ADOLESCENT AND FORENSIC
PSYCHIATRY. I'M CURRENTLY THE
DIVISION CHIEF FOR CHILD AND
ADOLESCENT PSYCHIATRY AT UC
DAVIS HERE IN SACRAMENTO. I AM
HERE TODAY REPRESENTING THE
CALIFORNIA ACADEMY OF CHILD AND
ADOLESCENT PSYCHIATRY. AS A
CHILD AND ADOLESCENT AND
FORENSIC PSYCHIATRIST. I WORK
WITHIN MULTIPLE SYSTEMS OF CARE.
AH IN A TYPICAL WEEK, I TREAT
CHILDREN AND FAMILIES IN OUR
SACRAMENTO COUNTY CHILD AND
ADOLESCENT OUTPATIENT CLINIC
WHERE WE SERVE YOUTH AGED 0 TO
21. WITH MEDICAL AT THIS CLINIC
. MANY OF THE YOUTH ARE OR HAVE
BEEN INVOLVED IN THE CHILD
WELFARE SYSTEM, LEADING TO
HIGHER RATES OF TRAUMA RELATED
DISORDERS, AS WELL AS THE COMMON
DISORDERS. WE TREAT, UM IN
CHILDREN'S MENTAL HEALTH LIKE
DEPRESSION, ANXIETY A D H. D. I
ALSO WORK AT OUR UNIVERSITY
OUTPATIENT CHILD PSYCHIATRY
CLINIC WHERE WE TREAT YOUTH AND
FAMILIES WITH PRIVATE INSURANCE.
AND I WORK AT THE MINE
INSTITUTE, WHERE WE TREAT
CHILDREN ADOLESCENTS WHEN THERE
ARE DEVELOPMENTAL DISORDERS SUCH
AS AUTISM, UM, INCLUDING MANY
WHO FURTHER DEVELOPMENTAL
DISABILITIES INTERFACE WITH OR
INVOLVED WITH OUR STATES
REGIONAL CENTERS. WHERE STAFF
BURNOUT AND TURNOVER APPEAR
HIGH. AND I YOU SEE DAVIS, OUR
CATCHMENT AREA IS GEOGRAPHICALLY
LARGE THAT EXTENDS ACROSS
NORTHERN AND CENTRAL CALIFORNIA
. AND WE INCLUDES ABOUT 33
COUNTIES. AS A JUVENILE FORENSIC
PSYCHIATRIST. IN A TYPICAL WEEK
, I EVALUATE MINERS WHO INVOLVED
WHO ARE INVOLVED IN THE JUVENILE
JUSTICE SYSTEM. FOR ISSUES SUCH
AS WHETHER THEY ARE COMPETENT TO
STAND TRIAL. WHAT IS THE RISK OF
REOFFENDING? WHAT ARE THEIR
TREATMENT NEEDS? IN THEIR
CAPACITY FOR REHABILITATION
WITHIN THE JUVENILE JUSTICE
SYSTEM. THIS YOUTH AND THEIR
FAMILIES ARE SOME OF THE MOST
UNDERSERVED. THAT I SEE FURTHER
OVERALL HIGH MENTAL HEALTH AND
OTHER NEEDS. FOR EXAMPLE, LAST
WEEK I EVALUATED AN ADOLESCENT
WHO WAS FACING SERIOUS FELONY
CHARGES. AND I FOUND THAT HE HAD
ALMOST NO MENTAL HEALTH
TREATMENT HISTORY. DESPITE AN
EXTENSIVE HISTORY OF
MALTREATMENT, TRAGIC LOSS OF A
PARENT DURING CHILDHOOD. AND
VERY CLEAR, SUBSEQUENT POST
TRAUMATIC STRESS DISORDER,
DEPRESSION AND SEVERE SUBSTANCE
USE DISORDER. I BELIEVE I WAS
THE FIRST PERSON TO DIAGNOSE
THESE DISORDERS AND ONLY IN THIS
CIRCUMSTANCE OF FOLLOWING A
COURT ORDERED EVALUATION. WHILE
I HOPE THIS YOUTH CAN NOW GET
THE RESOURCES HE NEEDS, WE
CANNOT WAIT UNTIL JUVENILE
JUSTICE ENTRY. AH WHEN WE KNOW
THE ASSOCIATED OUTCOMES WITH
THIS POPULATION ARE MUCH POORER.
FOR YOUTH. WE CANNOT WAIT TO
IDENTIFY AND TREAT THE SERIOUS
MENTAL HEALTH NEEDS THAT WE
ALREADY KNOW EXIST IN THIS
POPULATION. WHEN I THINK ABOUT
THE SCHOOL SYSTEMS THAT THESE
YOUTH INTERFACE WITH WHILE I
KNOW THAT SCHOOLS ARE THE IDEAL
SETTING FOR FRONTLINE
IDENTIFICATION OF YOUTH WITH
MENTAL HEALTH NEEDS, AND I'M
VERY EXCITED THAT THE SCHOOL
SYSTEMS ARE SUCH A BIG PART OF
OUR STATE'S CHILDREN'S MENTAL
HEALTH INITIATIVES. I ALSO SEE
FIRSTHAND THE SYSTEMIC ISSUES
THAT PERPETUATES STRUCTURAL
RACISM WITHIN THE JUVENILE
JUSTICE SYSTEM BY THE SCHOOL OF
THE PRISON PIPELINE.
ADDITIONALLY DURING THE PANDEMIC
, I THINK WE'VE ALL PROBABLY
HEARD ABOUT THE LEARNING AND
SOCIAL EMOTIONAL, DEVELOPMENTAL
LOSS ASSOCIATED WITH SOCIAL
ISOLATION. AH AND DISTANCE
LEARNING. BUT LET'S NOT FORGET
ABOUT THE ABSENTEEISM THAT
OCCURRED WITH STUDENTS,
ESPECIALLY WITHIN RACIAL AND
ETHNICALLY MINORITIES.
COMMUNITIES I CAN THINK OF
NUMEROUS EXAMPLES OF JUSTICE
INVOLVED YOUTH I SAW WHO WERE
SIMPLY LOST. TWO SCHOOLS WHEN
THEY STOPPED ATTENDING. AH OFTEN
SPENDING MORE TIME IN THE
STREETS WHERE COMMUNITY VIOLENCE
EXPOSURE WAS HIGH. AND THEN
ENTERING THE JUVENILE JUSTICE
SYSTEM. IN EVERY SETTING. I WORK
IN MENTAL HEALTH, ACCESS AND
EQUITY ARE THE MOST IMPORTANT
ISSUES I SEE. UM FINALLY, IN MY
TYPICAL WEEK, I'M AN EDUCATOR
AND A PROGRAM DIRECTOR FOR OUR
CHILD ADOLESCENT, UH, PSYCHIATRY
FELLOWSHIP. WE'RE TRAINING THE
NEXT GENERATION OF CHILD AND
ADOLESCENT SICK PSYCHIATRISTS.
HOWEVER WE DESPERATELY NEED MORE
PROVIDERS. WE'VE KNOWN FOR YEARS
THAT THERE IS A NATIONAL AND
STATE SHORTAGE OF CHILD
PSYCHIATRISTS, ALONG WITH
SHORTAGES IN CHILDREN'S MENTAL
HEALTH PROVIDERS OVERALL. EVERY
SINGLE SETTING I WORK WITHIN IS
UNDERSTAFFED, WHICH MEANS WE
SIMPLY CANNOT ACCOMMODATE ALL
THE REFERRALS WE RECEIVE. LET
ALONE IDENTIFY THE YOUTH WHO
NEED MENTAL HEALTH SERVICES
DURING A TIME WHEN WE HAVE
REMAINED IN A CHILDREN'S MENTAL
HEALTH CRISIS. IN OCTOBER. 2021
THE AMERICAN ACADEMY OF CHILD
AND ADOLESCENT PSYCHIATRY, THE
AMERICAN ACADEMY OF PEDIATRICS
AND THE CHILDREN'S HOSPITAL
ASSOCIATION DECLARED A NATIONAL
STATE OF EMERGENCY IN CHILDREN'S
MENTAL HEALTH. I'M SO GRATEFUL
THAT THIS COMMITTEE HAS BEEN
CONVENED TO EXAMINE CALIFORNIA'S
MENTAL HEALTH CRISIS. WE KNOW
THAT MOST MENTAL HEALTH AND
SUBSTANCE USE DISORDERS START
WITHIN CHILDHOOD ADOLESCENCE OR
YOUNG ADULTHOOD. UM, AND WE ALSO
KNOW THAT MANY ARE PREVENTABLE.
AND WE ALSO KNOW THAT THE
EARLIER WE INTERVENE WITH
EVIDENCE BASED PRACTICE AND
TREATMENT, THE LESS NEED. WE'RE
GOING TO RUN INTO DOWN THE ROAD.
I LOOK FORWARD TO AIDING THIS
COMEDIAN UNDERSTANDING THE
CHILDREN'S MENTAL HEALTH CRISIS
AS WE WORK TOGETHER TO GENERATE
SOLUTIONS. THANK YOU. THANK YOU.
OKAY? GOOD MORNING. I AM SO
HAPPY TO BE HERE AND THANK YOU,
DR JACKSON FOR HOSTING THIS. I
THINK IT'S A VERY IMPORTANT
TOPIC AND UM AND DEAR TO MY
HEART I AS EXECUTIVE DIRECTOR
FOR THE CALIFORNIA ASSOCIATION
OF SCHOOL COUNSELORS. IT'S THE
LARGEST STATE ASSOCIATION
REPRESENTING SCHOOL COUNSELORS
IN THE NATION. PRIOR TO THAT I
WASN'T ADMINISTRATOR ALL WE'RE
SEEING MENTAL HEALTH IN A
DISTRICT. IN THE LOS ANGELES
COUNTY AREA, SO THAT'S WHERE I
DRAW A LOT OF MY EXPERIENCES
TRYING TO MAKE MENTAL HEALTH
WORK AT THE SCHOOL SETTING, UM
IT IS. SO IMPORTANT TO LOOK AT
HOW WE STRUCTURE THE THINGS THAT
WE DO ON SCHOOL CAMPUSES TO
REALLY BE EFFECTIVE AND NOT
LETTING ANY KIDS FALL THROUGH
THE CRACKS. UM WE KNOW THAT
MENTAL HEALTH CONDITIONS CAN
AFFECT HIS CHILD'S ACADEMIC
PERFORMANCE, THEIR RELATIONSHIPS
WITH THEIR PEERS AND TEACHERS
AND THEIR OVERALL QUALITY OF
LIFE. ON SCHOOL CAMPUSES
STUDENTS OVERALL MENTAL HEALTH
HAS ERODED HAS BEEN SAID
EARLIER. AND, UM ESPECIALLY IN
THE LAST 10 YEARS, EVEN THOUGH
IT'S BEEN ESCALATED SINCE COVID
AH, SCHOOLS ARE EXPERIENCING
MORE BEHAVIOR ISSUES. THERE ARE
MORE STUDENTS EXPERIENCE
DISABLING ANXIETY, BULLYING,
STRESS AND SUICIDE IDEATION. UM
. ALWAYS WHEN I ASKED WHEN I
TALKED TO A SCHOOL COUNSELOR, I
SAY, TELL ME A STORY. WHICH IS
ALWAYS SO INTERESTING TO SEE HOW
THEY HANDLE THEIR DAY. UM
ACCORDING TO 2020 REPORT ISSUED
BY THE CENTER FOR DISEASE
CONTROL AND PREVENTION, 54% OF
SCHOOLS REPORT DIFFICULTY AND
PROVIDING MENTAL HEALTH SERVICES
BECAUSE OF INADEQUATE FUNDING.
IN ADDITION, THERE IS A
CORRELATION WITH A LACK OF
MENTAL HEALTH SERVICES IN
SCHOOLS AND HIGH LEVELS OF
POVERTY, WHICH IS WHERE WE NEED
TO HAVE MORE SERVICES. UM
PROVIDING MENTAL HEALTH SERVICES
ON SCHOOL CAMPUSES CAN BE
EFFECTIVE AND EFFICIENT AND
TREATING MENTAL AND BEHAVIORAL
HEALTH DISORDERS. SCHOOL BASED
HEALTH SYSTEMS MEET SCHOOL
STUDENTS WHERE THEY ARE THEY
ELIMINATE TRANSPORTATION
BARRIERS AND APPROVED BOTH
HEALTH AND EDUCATION OUTCOMES.
CALIFORNIA TOOK A BOLD STEP IN
2021, PROVIDING MILLIONS OF
DOLLARS FOR THE CALIFORNIA
COMMUNITY SCHOOL PARTNERSHIP
PROGRAM. IT'S THE NATION'S
LARGEST INVESTMENT IN STUDENT
MENTAL HEALTH AND UNDERSCORES
THE IMPORTANCE OF A WHOLE CHILD
APPROACH TO SERVING STUDENTS,
WHICH IS A NEW MINDSET, YOU
KNOW, AND 20. I WAS BEEN IN
EDUCATION FOR 40 YEARS AND JUST
GETTING TEACHERS AND
ADMINISTRATORS UNDERSTAND THE
IMPORTANCE OF MENTAL HEALTH HAS
BEEN SO DIFFICULT. I DON'T. I
THINK WE'VE GOTTEN PAST THAT
WOULD SAY THAT WOULD BE THE
UPSIDE IS THAT THEY KNOW THAT IT
IS IMPORTANT NOW. IT'S JUST HOW
DO WE DO IT? AT THIS POINT. UM
ANOTHER THING THAT WE DID AS WE
PASSED A LAW THAT UPDATED OUR ED
CODE FOR SCHOOL COUNSELORS,
WHICH INCLUDES MENTAL HEALTH
WITHIN OUR JOB DESCRIPTION. WE
ALSO HAVE TRAINING STANDARDS NOW
THAT ARE HAVE UPDATED IN 2019
THAT HAS MORE MENTAL HEALTH
SERVICES IN OUR SCHOOLS. AND
BECAUSE OF THAT WE NOW ARE ABLE
TO BUILD FOR MEDICAL SERVICES. A
SCHOOL COUNSELOR. SHE'S ABOUT
15,000 OF US IN THE SCHOOLS AND
BEING ABLE TO BUILD WILL OFFSET
THE COST OF IT. AND I BELIEVE
WE'RE THE FIRST IN THE NATION TO
DO THAT, BECAUSE I'M HEARING
FROM EXECUTIVE DIRECTORS FROM
ALL OVER THE NATION ASKING, HOW
DO WE ARE WE ABLE TO DO THAT?
BUT IT'S REALLY THAT WHOLE WILL
TO MAKE SURE THAT WE HAVE THE
PEOPLE IN OUR SCHOOL CAMPUSES
BECAUSE WE DO HAVE A WORKFORCE
SHORTAGE ALSO UM BUT TO TRY TO
SOLVE THAT CALIFORNIA LAST YEAR
PASSED A BILL AND THEY THEY HAVE
A SCHOLARSHIP PROGRAM NOW THAT
ADDRESSES WORKFORCE SHORTAGES.
SO UM, A PROFESSIONAL SCHOOL
BASED MENTAL HEALTH PROFESSIONAL
LIKE A SCHOOL PSYCHOLOGIST AT
SCHOOL, SOCIAL WORKER OR SCHOOL
COUNSELOR CAN APPLY WHILE
THEY'RE GOING THROUGH THEIR
PROGRAM, AND THEY CAN GET
$20,000. PROVIDED THAT THEY GIVE
FOUR YEARS OF THEIR TIME TO A
HIGH NEEDS SCHOOL WE HAVE HAD
SINCE THAT WAS PASSED IN
SEPTEMBER. WE'VE HAD OVER 3000
PEOPLE THAT HAVE BEEN ABLE TO
GET THAT SCHOLARSHIP IN THE
SCHOOL COUNSELING PROFESSION.
WE'RE VERY EXCITED ABOUT THAT,
AND WE THINK THAT WILL HELP WITH
SOME OF THE WORKFORCE ISSUES WE
HAVE IN OUR SCHOOLS. SO ONE OF
THE BIGGEST FACTORS IN SCHOOL
BASED MENTAL HEALTH SERVICES IS
STRUCTURING COMPREHENSIVE
PROGRAMS THAT DON'T LEAVE ANY
KID OUT OF THE EQUATION. SCHOOLS
ARE FAST PACE, NEVER KNOWING HOW
THE DAY IS GOING TO UNFOLD
ENVIRONMENTS SORT OF LIKE THE
SOUNDS THAT WE'VE BEEN
EXPERIENCING TODAY. YOU KNOW, IT
JUST WAS SO RE MINDFUL OF BEING
ON THE SCHOOL CAMPUS. YOU GET
THESE THINGS GOING ON IN YOUR
TRYING TO WORK WITH ALL THE
THINGS AT ONE GIVEN TIME. THERE
ARE OFTEN THOUSANDS OF STUDENTS
, FACULTY AND PARENTS ASSOCIATED
WITH ONE SCHOOL AND EACH STUDENT
AND THEIR FAMILIES SPRING WITH
THEM THEIR UNIQUENESS. QUITE A
TASK TO MANAGE SCHOOL COUNSELORS
, HOWEVER, KNOW THAT ONE OF THE
FIRST PLACES START IS IN
BUILDING COMPREHENSIVE SUPPORT
ON SCHOOL CAMPUSES IS BUILDING
AND TRUSTING ENVIRONMENT WITHOUT
THAT, YOU DON'T HAVE ANYTHING.
IF A STUDENT IS GOING TO SHARE
THEIR STRUGGLES, THEY MUST KNOW
THAT THE PERSON THEY'RE SPEAKING
WITH CAN BE TRUSTED AND COUNTED
ON. TRUST TRUST, TAKES
CONSISTENCY AND STAFFING AND
PURPOSEFULLY BUILDING PEER TO
PEER. AND STUDENTS TO ADULT
RELATIONSHIPS. THE FRAMEWORK.
MOST SCHOOLS UTILIZES DESIGNED,
UM, AND A PROGRAM CALLED MULTI
TIERED SYSTEM SUPPORT. SOME
PEOPLE HAVE HEARD ABOUT THAT. WE
CALL IT M. T S S. THIS MODEL WAS
ORIGINALLY ADOPTED AS A
FRAMEWORK FOR LEARNING AND
INSTRUCTION, BUT WE HAVE ADOPTED
THAT TO EXPAND TO SOCIAL,
EMOTIONAL LEARNING MENTAL
HEALTH. WITHIN THAT FRAMEWORK.
WHAT IS INCLUDED IS PREVENTION
SERVICES. UH SCHOOL CLIMATE,
UNIVERSAL SCREENINGS, EARLY
INTERVENTIONS AND TREATMENTS. AH
I WILL SHARE BRIEFLY ABOUT A
DISTRICT BECAUSE I THINK THAT
WILL KIND OF CAPSULE IT AS SOME
MY FINAL REMARKS ABOUT HOW A
DISTRICT USES AN MTS S PROGRAM
TO DELIVER THE SERVICES ON A
SCHOOL CAMPUS IS SO I'M GOING TO
FOCUS IN ON CORONA NORCO LIP
PRETTY CLOSE TO WHERE I LIVE IN
RIVERSIDE COUNTY. AND UM, IT'S A
VERY LARGE SCHOOL DISTRICT. AND
THEN THE LAST 5 TO 10 YEARS THEY
HAVE MADE SOME STRATEGIC MOVES
AND INVESTMENTS THAT HAVE BEEN
VERY IMPRESSIVE TO ME AND HOW
THEY ADDRESS THE ISSUES OF
MENTAL HEALTH. UM ONE OF THE
ELEMENTS AS THEY HAVE ONGOING
TRAINING FOR TEACHERS AND TOPICS
SUCH AS MENTAL HEALTH SUPPORT.
SUICIDE PREVENTION, STRESS
MANAGEMENT FOR TEACHERS
THEMSELVES AND EARLY DETECTION.
ANOTHER THING THEY DO, THEY HAVE
DOUBLED THE NUMBER OF SCHOOL
COUNSELORS, INCLUDING
STRENGTHENING THEIR ELEMENTARY
SCHOOL COUNSELING PROGRAM
BECAUSE THAT WAS JUST A DESERT.
IN REGARDS TO THE STATE OF
CALIFORNIA UNTIL ME RECENTLY
WHERE THERE WERE, UH LEGISLATORS
AND OTHERS STARTED FIGURING OUT
THAT THAT'S WHERE A LOT OF TIMES
WHERE THE PROBLEMS BEGIN IS AT
THE ELEMENTARY LEVEL, SO THEY
HAVE STRENGTHEN THAT PROGRAM.
THE SCHOOL COUNSELOR STARTED OFF
AT 600, STUDENTS PER SCHOOL
COUNSELOR. THE RECOMMENDATIONS.
250 WE HAD 1000 AND ONE WE WERE
AT ONE POINT, YOU KNOW, AND I
WAS AS A SOMEONE WHO WAS IN A
MINISTRY FOR OVER OVER SCHOOL
COUNSELORS. I REMEMBER GRAY
SHOSHI MOTO, ONE OF MY HIGH
SCHOOL COUNSELOR SAID THAT WE
HAD 500. I THOUGHT I WAS DOING
PRETTY GOOD TO GET OUR RACIAL
STAND. SHE SAYS. DO YOU KNOW
500? PEOPLE'S NAMES. I SAID, I
DON'T AND SHE AND BUT I
RECOGNIZE WHAT SHE WAS TRYING TO
TELL ME. IT IS SO DIFFICULT TO
MANAGE THAT, UH, SO THEY HAVE
GOTTEN CORONA NORCO HAS GOTTEN
CLOSE TO THAT THEY'RE ABOUT 300
TO 1, WHICH IS, YOU KNOW,
PLAUSIBLE FOR THEM. THEY CREATED
A UNIQUE SYSTEM. UM AND
SOMETHING THAT I HAVEN'T SEEN
QUITE LIKE THIS, BUT THEY HAVE
AT THE HIGH SCHOOL. THEY HAVE
ONE COUNCILOR DESIGNATED AS AN
INTERVENTION COUNSELOR. SO THEY
HAVE THEIR, UH, COUNSELING TEAM
IS DIVIDED BY THE ALPHABET. BUT
THEN THEY HAVE SOMEONE THAT JUST
SPECIALIZES IN MENTAL HEALTH.
BECAUSE AS THIS NOISES WITH AN
ALPHA COUNSELOR. YOU DON'T KNOW
WHAT'S GOING TO HAPPEN AND
YOU'RE MOVING AND YOU'RE TRYING
TO MOVE STUDENTS FAST THROUGH
YOUR OFFICE AND SO HAVING
SOMEONE DESIGNATED SET ASIDE
JUST TO DEAL WITH THE MENTAL
HEALTH ISSUES OF STUDENTS IS
BEEN VERY HELPFUL. AND SO THEY
REFER IN AND THEN SHE MANAGES
ALMOST IN A CASE MANAGEMENT KIND
OF SITUATION, WHICH I THINK IT'S
PRETTY GOOD, BUT SHE ALSO OR HE
IT DEPENDS ON THE SCHOOL. I'M
TALKING ABOUT ONE SCHOOL THAT
I'M AWARE OF GROUPS ARE OFTEN
ORGANIZED AROUND THINGS LIKE
ANGER MANAGEMENT, RESTORATIVE
PRACTICES, GRIEF AND LOSS,
ALCOHOL, OTHER DRUGS, ETCETERA,
WHATEVER THE NEED IS OR
INDIVIDUAL INTERVENTIONS. THEY
ALSO CONTRACT WITH TWO AGENCIES
AND, UM ONE AS WELL AS TOGETHER
THAT PROVIDES LICENSED THERAPIST
ON EVERY CAMPUS. AND SO THAT IS
ALSO A TRIAGE IN TYPE OF
STRUCTURING. THEY ALSO HAVE A
GROUP, ANOTHER ORGANIZATION THAT
THEY THEY CONTRACT WITH CALLED
CARE SALAS. IT ASSISTS FAMILIES
IN MANAGING THEIR MANAGED CARE
SYSTEM TO HELP THEM MAKE SURE
THAT THEY GET TO THE SERVICES
THEY NEED. THE CASE MANAGERS ARE
CAREFULLY MATCHED WITH FAMILIES
TO NAVIGATE THE HEALTHCARE
SYSTEM, BECAUSE SOMETIMES THE
WAIT TIME IS LIKE THREE MONTHS
TO HAVE THE SERVICES. LASTLY
THEY HAVE FAMILIES DINNERS IN
EVERY SCHOOL CAMPUSES, WHICH I
THINK IS ABSOLUTELY WONDERFUL.
SO NEXT WEEK. JUST TO CONCLUDE
IS STUDENT MENTAL HEALTH
AWARENESS WEEK SO THERE IS A
THAT STARTS ON MAY 8TH. IT
CULMINATES ON MAY 12TH WITH A
STUDENT SUMMIT THAT WE'RE
HOSTING IN THE BAY AREA. AND WE
ALSO SPONSOR LEGISLATION.
ASSEMBLY CONCURRENT RESOLUTION
29 THAT RECOGNIZES THIS WEEK AND
THIS IS THE FOURTH TIME WE'VE
DONE THAT. SO UM, A CR 29 IS
AUTHORED BY ASSEMBLYWOMAN KIRK
SILVER, AND THE AIM IS FOR AS
MANY SCHOOLS AS POSSIBLE TO
PARTICIPATE IN THE MYSTIFYING
ISSUES AND STIGMA ASSOCIATED
WITH STUDENT MENTAL HEALTH
ASSOCIATION AS PROVIDING TOKE.
IT'S AND OTHER KINDS OF THANKS
FOR OUR SCHOOL COUNSELOR, SO
THEY WERE ABLE TO POST ON SOCIAL
MEDIA AND REALLY TALK ABOUT
MENTAL HEALTH AND A VERY ROBUST
WAY. SO I URGE YOU, UH, AS A
SUBCOMMITTEE TO PRIORITIZE
MENTAL HEALTH FOR CALIFORNIA
STUDENTS, WE MUST WORK TOGETHER
TO CREATE COMPREHENSIVE
PROGRAMS. UM UNDER AN M. T S S
MODEL. SPECIFICALLY I THINK WE
WOULD BE VERY HELPFUL TO BUILD A
COLLABORATION BETWEEN
STAKEHOLDERS, INCLUDING
EDUCATORS, SCHOOL COUNSELORS,
OTHER MENTAL HEALTH
PROFESSIONALS, COMMUNITY
ORGANIZATIONS AND GOVERNMENT
AGENCIES TO DETERMINE AND
PUBLICIZED DISTRICTS LIKE CORONA
NORCO, WHO CAN USE IT BE AN
EXAMPLE FOR OTHER DISTRICTS TO
FALL IN LINE WITH SOME OF THESE
KINDS OF EFFECTIVE PRACTICES. AH
THERE ARE SCHOOL DISTRICTS ARE
DOING GREAT JOBS. THERE ARE
OTHERS THAT AREN'T AND WE NEED
TO HELP THEM IN EVERY WAY WE CAN
SO WE CAN REACH KIDS EARLY AND
EFFECTIVELY. THANK YOU SO MUCH.
AND THANK YOU. GOOD MORNING,
ASSEMBLYMEMBER'S DR JACKSON AND
MEMBERS. MY NAME IS SARAH
BATCHES. I'M THE DEPUTY DIRECTOR
OF EXTERNAL AND GOVERNMENTAL
AFFAIRS FOR FIRST FIVE
CALIFORNIA I WANTED TO BEGIN BY
THANKING YOU FOR ACKNOWLEDGING
YOUR PERSONAL STORY. THE ONLY
WAY WE REMOVE STIGMA IS BY
PROVIDING SAFE OPEN SPACES. MY
HUSBAND'S AN ELEMENTARY SCHOOL
TEACHER WHO HAD TO PIVOT TO
ONLINE LEARNING, AND I AT THAT
TIME WORKED 16 TO 18 HOURS TO
HELP SCHOOLS OPEN UP STATEWIDE
DURING COVID, AND I DID NOT HAVE
THE OPPORTUNITY. I MISSED IT
WHERE I DIDN'T SEE HIM FADING,
EVEN THOUGH HE WAS SHOWING UP TO
WORK EVERY DAY ON ZOOM HE
PERSONALLY WAS FEEDING BECAUSE
HIS TRAUMA HAD CAUGHT UP TO HIM.
AND SO IT WASN'T UNTIL AUGUST OF
2020 WHEN WE FINALLY CAME TO
HEAD AND HAD HIM A CRISIS AT
HOME THAT WE BUY OURSELVES HAD
TO FIGURE OUT HOW DO WE MOVE
FORWARD OR I OR ALSO, I'LL LOSE
YOU. AND SO THAT RECOGNITION
IT'S IMPORTANT BECAUSE IT'S NOT
VISIBLE. THERE IS NO BAD YOU
CARRY, BUT YET IT'S IN YOUR
HEART. AND IT'S IN YOUR DAILY
PRACTICE AND HOW YOU SHOW UP. SO
I'M VERY PROUD THAT HE SHOWS UP
EVERY DAY AS AN ELEMENTARY
SCHOOL TEACHER, AND HE'S THERE
WITH HIS KIDS, AND HE TELLS THEM
IT IS OKAY TO FEEL YOUR FEELS.
AND SO WITH THAT I AM PROUD TO
NOT WORK FOR FIRST FIVE
CALIFORNIA WE SERVE AS THE STATE
LEADER IN CREATING MEANINGFUL
IMPACT IN THE LIVES OF OUR
YOUNGEST CHILDREN IN THEIR
FAMILIES, OUR COMMITMENT TO
STRONG COLLABORATION WITH STATE
POLICYMAKERS AND PARTNERS HELPS
US TO IMPLEMENT A VISION
CENTERED AROUND THE CONSTRUCT OF
SAFE, STABLE, NURTURING
RELATIONSHIPS AND ENVIRONMENTS,
WHICH IS NEEDED FOR A CHILD'S
HEALTHY BRAIN DEVELOPMENT.
PHYSICAL AND EMOTIONAL
DEVELOPMENT. 90% OF A CHILD'S
BRAIN DEVELOPS IN THE FIRST FIVE
YEARS OF LIFE, MAKING IT THE
MOST CRITICAL YEARS TIME WHEN A
CHILD'S BODY IS RESPONDING TO
STRESS AND DETERMINING HOW BEST
TO COPE WITH THOSE FEELINGS AS
WE EMERGE FROM COVID 19. WE KNOW
FAMILIES AND CHILDREN, AS WAS
STATED HAVE BEEN IMPACTED BY THE
LOST OF LOVED ONES, THE DIRECT
EFFECT OF THE ECONOMY AND
ENVIRONMENTAL INSTABILITIES. WE
HAVE YET TO TALK ABOUT.
WILDFIRES DROUGHTS ALL OF THAT
THIS GENERATION OF CHILDREN HAVE
BEEN THROUGH A LOT, AND SO THOSE
TRAUMATIC EVENTS CAN POTENTIALLY
CAUSE WHAT IS KNOWN AS ADVERSE
CHILDHOOD EXPERIENCES. ACES THAT
OCCURS IN CHILDHOOD BETWEEN
SYRIA AND 17 YEARS OF AGE.
ADDITIONAL EXAMPLES OF THESE
TRAUMATIC EVENTS WHICH WE
CONTINUE TO FACE ON A DAILY
BASIS IS WITNESSING AND
EXPERIENCING VIOLENCE. MASS
SHOOTINGS, ABUSE AND NEGLECT,
WITNESSING RACISM, BULLYING AND
INEQUITIES, HAVING A FAMILY
MEMBER ATTEMPT OR DIE OF
SUICIDE. ALSO INCLUDED ARE
ASPECTS OF A CHILD'S ENVIRONMENT
THAT CAN UNDERMINE THEIR SENSE
OF STABLE SAFETY, STABILITY AND
BONDING, SUCH AS GROWING UP IN A
HOUSEHOLD WITH SUBSTANCE ABUSE
PROBLEMS, MENTAL HEALTH PROBLEMS
AND STABILITY DUE TO PARENTAL
SEPARATION OR HOUSEHOLD MEMBERS
WHO ARE WHO ARE CURRENTLY
INCARCERATED. ADVERSE CHILDHOOD
EXPERIENCES ARE MORE COMMON THAN
ONE MIGHT THINK. NEARLY TWO
MILLION CHILDREN IN CALIFORNIA
ARE AFFECTED AND WE HAVE 9.7
MILLION CHILDREN IN THE STATE,
SO ONE OUT OF FIVE ARE AFFECTED
AND 60% OF ADULTS IN CALIFORNIA
HAVE EXPERIENCED AT LEAST ONE
ACE, AND THERE'S POSSIBLY UP TO
10 ACES. OUR MENTAL HEALTH
CRISIS HAS REQUIRED A COLLECTIVE
RECOGNITION OF THE NEED TO BRING
AWARENESS TO CALIFORNIA PARENTS
AND CAREGIVERS ABOUT TOXIC
STRESS RESPONSE AND CHILDREN,
WHICH IS THE BODY'S RESPONSE TO
LASTING AND SERIOUS STRESS
CAUSED BY ADVERSE CHILDHOOD
EXPERIENCES. THIS MEANS A CHILD
DOES NOT HAVE ENOUGH SUPPORT
FROM THEIR PARENTS OR
CAREGIVERS. TO OVERCOME THESE
DIFFICULT EXPERIENCES. TOXIC
STRESS IS OUR BODY'S RESPONSE TO
PROLONGED EXPOSURE TO TRAUMA AND
CAN BE HARMFUL TO CHILDREN. IF
NOTHING IS DONE TO STOP IT,
BEING IN A CONSTANT STATE OF
STRESS CAN AFFECT A CHILD'S
BRAIN DEVELOPMENT. AND AS I
MENTIONED FIRST FIVE YEARS 90%
OF YOUR BRAIN DEVELOPS. YOUR
IMMUNE SYSTEM AT A TIME WHEN
WE'VE HAD A PANDEMIC WHEN WE'VE
HAD RICE AND FLU, RSV AND
DIFFERENT ILLNESSES, THEIR
BODIES ARE NOT ABLE TO SUSTAIN
ALL OF THIS PROLONGED
EXPERIENCES, WHICH THEN TURNS
AND IMPACTS THEIR ABILITY TO
LEARN TO DEVELOP AND DEVELOP
BEHAVIORAL ISSUES, SUCH AS
DIFFICULTY REGULATING THEIR
EMOTIONS AND FEELINGS, AND THEN
IT AFFECTS THEIR ABILITY TO
RECOVER FROM ILLNESS AND
INFECTION. PHYSICAL SYMPTOMS OF
PROLONGED TOXIC STRESS CAN
PERSIST INTO ADULTHOOD, WHICH
THEN CAN CAN EXHIBIT AS STUNTED
GROWTH. OBESITY ASTHMA, HEALTH
TO SERIOUS DISEASES, HIGH BLOOD
PRESSURE AND DIABETES. ADVERSE
CHILDHOOD EXPERIENCES ARE LINKED
TO CHRONIC HEALTH PROBLEMS,
MENTAL HEALTH AND SUBSTANCE
ABUSE PROBLEMS IN ADOLESCENCE
AND ADULTHOOD. ACES CAN ALSO
NEGATIVELY IMPACT YOUR
EDUCATIONAL ATTAINMENT, YOUR JOB
OPPORTUNITIES AND EARNING
POTENTIAL. SO WE'RE ABOUT
BREAKING THE CYCLE OF POVERTY
LIFTING OF FAMILIES. IF WE DON'T
PREVENT THIS EARLY, IT WILL HAVE
A LIFELONG EFFECT. HOWEVER ACES
CAN BE PREVENTED. AS TRAUMA
INFORMED CARE CONTINUES TO GAIN
TRACTION, MORE AND MORE
PROVIDERS ARE BEING AT THE
BEGINNING TO SCREEN CHILDREN AND
ADULTS FOR EXPOSURE TO ADVERSE
CHILDHOOD EXPERIENCES IN TRAUMA
CASES. SCREENING PROVIDES
PARENTS AND CAREGIVERS THE
NECESSARY INFORMATION TO
UNDERSTAND ACES AND TOXIC STRESS
AND HOW TO MEDICATE IT ITS
EFFECTS. SCREENING INSTRUMENTS
CAN VALIDATE A DELICATE
SITUATION. SOMETIMES IT'S
DIFFICULT FOR PARENTS TO
UNDERSTAND THAT THEIR DIVORCE,
ALTHOUGH THE RIGHT DECISION FOR
THE COUPLE MAY HAVE A LONG
LASTING EFFECT ON THE CHILD, AND
BE USEFUL TOOL FOR EARLY
DETECTION OF COMMON CHILDHOOD
TRAUMAS. THE QUESTION HERE IS A
SIMPLE SCORING SYSTEM THAT
ATTRIBUTES ONE POINT FOR EACH
CATEGORY OF ADVERSE CHILDHOOD
EXPERIENCE. QUESTIONS COVER A
DIFFERENT DOMAIN OF TRAUMA AND
REFERRED TO EXPERIENCES THAT
OCCUR PRIOR TO THE AGE OF 18.
HIGHER SCORES INDICATE INCREASED
EXPOSURE TO TRAUMA, WHICH HAS
BEEN ASSOCIATED WITH A GREATER
RISK OF NEGATIVE CONSEQUENCES.
SCREENING TOOLS CAN BE
ADMINISTERED IN A VARIETY OF
WAYS. WE KNOW THAT SOME
PROVIDERS HAVE OPTED FOR OPEN
ONE, YOU KNOW, FACE TO FACE
SCREENING SUCH AS SOCIAL WORKERS
, SCHOOL COUNSELORS, PHYSICIANS
, COMMUNITY HEALTH WORKERS WHO
ASKED THEIR PATIENTS EACH
QUESTION OF THIS TOOL OTHER
PROVIDERS HAVE BEEN AT HAVE
DECIDED TO ALLOW PATIENTS TO
INDEPENDENTLY FILL OUT THE TOOL.
THAT MADE HIM PROVIDE A LITTLE
BIT MORE COMFORT IN DISCLOSING
INFORMATION IN PRIVATE. THE RISE
IN TOXIC STRESSING YOUNG
CHILDREN HAS LED OUR
ORGANIZATION FIRST FIVE
CALIFORNIA TO EVOLVE FROM OUR
TALK, READ SIGMUND CAMPAIGN AND
HAS GROUNDED US IN THE NEED TO
BUILD A PUBLIC AWARENESS
CAMPAIGN CALLED STRONGER STARTS
CENTERED AROUND EDUCATING
PARENTS AND CAREGIVERS ABOUT THE
LONG TERM EFFECTS OF TOXIC
STRESS ON THEIR CHILDREN. AT
FIRST FIVE CALIFORNIA ARE
FOCUSES ON PREVENTION AND
SUPPORT BUILDING UPSTREAM
SOLUTIONS TO HELP PARENTS
PREVENT ACES AND TOXIC STRESS BY
CREATING SAFE, STABLE, NURTURING
RELATIONSHIPS. ENVIRONMENTS
KNOWN AS S AND R. E S FOR THEIR
CHILDREN, WHICH HELPS MINIMIZE
THE EFFECTS OF ASIS AND TALKS
EXPRESS. PARENTS AND CAREGIVERS
CAN TAKE STEPS TO HELP THEIR
CHILDREN WHO ARE EXPERIENCING
ADVERSITY BY PROVIDING THE
APPROPRIATE SUPPORT, BONDING AND
SAFETY EXAMPLES OF CREATING SAFE
STABLE NURTURING ENVIRONMENTS
AND RELATIONSHIPS INCLUDE
ESTABLISHING DAILY ROUTINES. A
KID WHO WANTS TO KNOW WHAT DO I
EXPECT? WHERE AM I? WAKING UP
TODAY WAS TODAY LOOK LIKE ARE
YOU COMING BACK? AM I GONNA SEE
YOU? CREATING CONSISTENT
POSITIVE RELATIONSHIPS WITH
ADULTS DOING FUN. POSITIVE
ACTIVITIES TO CONNECT AND BONDS
SUCH AS READING TOGETHER AND
GOING ON WALKS AND THEN HELPING
GUIDE YOUR CHILD THROUGH
PROBLEMS BY HELPING THEM BUILD
THEIR ABILITY TO COPE WITH
DIFFICULTIES, SITUATIONS. THE
GOOD NEWS IS THAT IT BY
EMPOWERING PARENTS AND
CAREGIVERS WITH RESOURCES
INFORMATION. THAT TOO, BUT THAT
CAN BUFFER AGAINST THE EFFECTS
OF TOXIC STRESS CAUSED BY ASIS.
WE CAN BEGIN TO ADDRESS THE RICE
AND CHILDREN'S MENTAL AND
BEHAVIORAL HEALTH NEEDS AND
ENSURE THAT EVERY CHILD CAN GROW
UP HEALTHY AND STRONG. WE INVITE
YOU TO LEARN MORE BY VISITING
OUR WEBSITE, FIRST FIVE
CALIFORNIA .COM FOR ADDITIONAL
TOOLS AND RESOURCES, AND WE
THANK YOU PROFUSELY FOR BRINGING
LIGHT TO THE THIS CRITICAL ISSUE
ON BEHALF OF MY MOST VALUABLE
HUMANS ARE CHILDREN. THANK YOU
VERY MUCH QUESTIONS FROM
COMMITTEE MEMBERS AT THIS TIME
OR COMMENTS. I'M DEFINITELY
LEARNING A LOT. THANK YOU SO
MUCH. AND, UM IT'S JUST
DEVASTATING TO ME WHAT'S
HAPPENING WITH OUR CHILDREN
TODAY AND WHAT IS THE BEST I'D
BE LIKE, HOW CAN I MEAN IS IT
RESOURCES? THAT MONEY IS AT WORK
FORCES THAT WHAT ELSE CAN WE DO
TO ELEVATE THIS. I WOULD SAY
STRUCTURE AND ACCOUNTABILITY.
IT'S VERY IMPORTANT. THERE'S
SOME SCHOOL JUST THERE'S SOME
STATES THAT HAVE A MORE
ACCOUNTABLE SYSTEM FOR K 12 OR
GRANTED AND SENT. IF I YOU KNOW
WHERE THERE IS AN ACCOUNTABILITY
MEASURES SHOWING THAT WE'RE
MEETING THE TARGETS THAT THE
GRANT REQUIRES. AND THERE'S
ACTUALLY TECHNICAL SUPPORT ON
THAT. SO YOU HAVE SCHOOL LIKE
UTAH. FOR AN EXAMPLE. IT HAS I
THINK THERE'S 15 PEOPLE ON OUR
STAFF AT THE DEPARTMENT OF
EDUCATION OVERSEAS SCHOOL
COUNSELORS. WE DON'T HAVE ANYONE
IN THE DEPARTMENT OF EDUCATION
OVERSEAS SCHOOL COUNSELOR,
SCHOOL PSYCHOLOGISTS OR SOCIAL
WORKERS AND THE DEPARTMENT OF
EDUCATION. WE'RE SORT OF ON OUR
OWN, SO HAVING THOSE KINDS OF
STRUCTURES, THE TECHNICAL
ASSISTANCE AND ACCOUNTABILITY TO
GET THE MEASURES THAT WE WANT AS
A STATE WOULD BE A GOOD STARTING
POINT FOR THAT. UM YES, I THINK
I WOULD ANSWER YES TO EVERYTHING
YOU BROUGHT UP. WE NEED
RESOURCES WORKFORCE ACCESS RIGHT
NOW. ACCESS TO CHILDREN'S MENTAL
HEALTH SERVICES ARE REALLY NOT
EQUITABLE. AND SO I CAN OFFER
SOME SERVICES TO PEOPLE WITH
MEDICAL AND SOME SERVICES TO
PEOPLE WITH PRIVATE INSURANCE.
THEY'RE NOT ALWAYS THE SAME
SERVICE. UM AND WE NEED TO
REALLY IMPROVE. EQUITABLE ACCESS
TO SERVICES AS WELL AS THE
PROVIDERS WHO CAN PROVIDE THOSE
SERVICES. HOW DO WE RETURN TO
BUILDING A VILLAGE FOR OUR
CHILDREN? AND THAT TAKES ALL OF
US AT THE STATE LEVEL TO COME
TOGETHER INTENTIONALLY AND MAKE
SURE THAT AS WE'RE CRAFTING
POLICIES THAT IT'S CRAFTED WITH
THE MINDSET THAT WE WILL ALL BE
RESPONSIBLE FOR COORDINATING,
CREATING SYSTEMS CHANGE
STRUCTURES THAT UPLIFT AND MOVE
FORWARD POLICIES THAT SUPPORT
ULTIMATELY THAT CHILD WITH THAT
FAMILY? A CHILD DOES NOT COME
ALONE. BUT HOW ARE WE TREATING
THEIR SUPPORT SYSTEM? ARE WE
MAKING IT DIFFICULT FOR MOM TO
HAVE ACCESS TO CHILDCARE
WORKFORCE, TRANSPORTATION,
HOUSING AND FOOD? STABILITY ARE
WE MAKING A CHALLENGING FOR THAT
MOTHER WHO MAYBE IS NOW? IN IN
THE DONUT EFFECT OF RAISING A
CHILD AND CARING FOR AN ELDERLY
PARENT. DO THEY HAVE ACCESS TO
RESOURCES TO ENSURE THAT THAT
THOSE FAMILY MEMBERS ARE BEING
TAKEN CARE OF? AND THEN HOW DO
WE TRANSLATE THAT LOCALLY, WHERE
PEOPLE FEEL CONNECTED TO THEIR
COMMUNITIES THAT THEY'RE SEEN
AND HEARD THAT THERE'S SOMEONE
CHECKING UP USING HOME
VISITATION SYSTEMS? I'M A NEW
MOM. I JUST HAD A BABY DURING
COVID LAST NOVEMBER DURING THE
SPIKE, WHICH MEANS MY FAMILY WAS
NOT ABLE TO COME AND VISIT THE
BABY. BUT MY HUSBAND AND I MADE
A DECISION THAT IN THE MORNING
AND NIGHT WE WOULD BOTH CHECK IN
ON OURSELVES AS I'M GOING
THROUGH MOMMY BLUES, AND HE'S
MAKING SURE HE'S TAKING HIS
LITTLE MAGICAL PILL TO SELF
REGULATE HIS FEELINGS AND
EMOTIONS. ARE WE HOLDING
OURSELVES ACCOUNTABLE AND DO WE
DO ENOUGH AS WE BUILT THAT
SCHOOL SYSTEM THAT TAKES CARE OF
DIRECTLY OF FAMILIES AND
CHILDREN? DO THEY HAVE THE
INFRASTRUCTURE AND THEN AT THE
STATE LEVEL DO WE HAVE THE RIGHT
ACCOUNTABILITY SYSTEMS TO ENSURE
THAT THE POLICIES THAT YOU INPUT
THE U PASS GET IMPLEMENTED?
THANK YOU VERY MUCH FOR THIS
PANEL REALLY APPRECIATE IT AND
WE'LL BE HAVING SOME FOLLOW UP.
THANK YOU. OUR NEXT PANEL IS
IMPROVING. BEHAVIORAL HEALTH
DELIVERY. WANNA WELCOME UP
KIRSTEN BARLOW AND SARAH GAVIN?
AND THEN WE'LL START WITH MISS
BARLOW. AND YOU CAN JUST
INTRODUCE YOURSELF AND WHO YOU
ARE REPRESENTING. AND, UH, WE
HAVE. WE'RE GOING TO HAVE TO DO
FIVE MINUTES EACH FOR YOUR
TESTIMONY. GOOD MORNING OR NOW,
AFTERNOON CHAIR AND MEMBERS. I'M
KIRSTEN BARLOW ON BEHALF OF THE
CALIFORNIA HOSPITAL ASSOCIATION
. WE REPRESENT THE MORE THAN 400
HOSPITALS, INCLUDING EMERGENCY
ROOMS AND HOSPITALS THAT PROVIDE
INPATIENT PSYCHIATRIC CARE IN
CALIFORNIA. UM IN THE INTEREST
OF TIME. I'M GLAD THAT YOU HAD
DR HUANG AND YOUR FIRST PANEL
FROM PROVIDENCE HEALTH, SHE
COVERED QUITE A FEW OF THE
ISSUES AND CHALLENGES THAT
HOSPITALS FACE, SO I'LL BE ABLE
TO SKIP SOME OF THOSE COMMENTS
TODAY ONLY TO SAY THAT WE AGREE
WITH MANY OF THE COMPLEX HINGES
SHE BROUGHT UP PARTICULARLY IN
OUR HOSPITAL ERS, UM, AS YOU ALL
KNOW, AND YOU'VE ALREADY HEARD
ABOUT THE GROWING INFLUX OF
PEOPLE IN A CRISIS TODAY.
OBVIOUSLY WE AGREE THAT LOTS OF
COMMUNITY BASED OPTIONS AND, UM
IN OUR STATE COULD KEEP PEOPLE
OUT OF A CRISIS. BUT IT IS A
CHRONIC DISORDER. SOMETIMES
PEOPLE DO HAVE AN ACUTE EPISODE
. AND WHEN THAT HAPPENS, WE DO
RELY ON OUR HOSPITAL SYSTEMS TO
HELP BE PART OF THAT SAFETY NET.
WHY DON'T I JUST GIVE YOU A FEW
FACTS, FIGURES ABOUT THE ROLE OF
THE HOSPITALS PLAY IN DELIVERING
MENTAL HEALTH CARE AND
CALIFORNIA? UM, IN OUR EMERGENCY
DEPARTMENTS ABOUT 5% OF THE
PATIENTS WE SEE IN ANY GIVEN
YEAR OR THEY'RE PRIMARILY WITH A
MENTAL HEALTH CONCERN. AND I
FOUND THIS SORT OF INTERESTING
THAT THE PRINCIPAL MENTAL HEALTH
DIAGNOSIS ARE CONCERNED THAT
COMES TO OUR EMERGENCY ROOMS IS
ACTUALLY ANXIETY, IN FACT, THE
NUMBER OF VISITS FOR ANXIETY OR
ABOUT 3 TO 3 TIMES HIGHER THAN
VISITS FOR DEPRESSION IN OUR
EMERGENCY ROOMS. AFTER ANXIETY,
THE OTHER PRINCIPAL DIAGNOSIS WE
SEE AN E R PATIENTS ARE SUICIDE
, SCHIZOPHRENIA AND DEPRESSION.
MOST MENTAL HEALTH VISITS TO THE
ER ARE STILL AMONG ADULTS. BUT
ABOUT 10% OF THOSE MENTAL HEALTH
VISITS TO THE ER, OUR
ADOLESCENTS UNDER 18. ABOUT HALF
OF THE PEOPLE WHO SEEK CARE FOR
MENTAL HEALTH NEEDS AND AN
EMERGENCY ROOM ARE COVERED BY
MEDICAL AND LESS THAN 20% OF THE
PEOPLE WHO COME TO OUR ER IN A
MENTAL HEALTH CRISIS HAVE
COMMERCIAL INSURANCE, SO BIG
DISPARITY IN TERMS OF WHERE
SOCIOECONOMICALLY WE SEE PEOPLE
GETTING CARE IN THE ER. WHILE
MOST ER PATIENT VISITS. THE KIND
OF GOLD STANDARD NATIONALLY IS
ABOUT A FOUR HOUR VISIT FOR YOU
TO GET YOUR CARE TAKING CARE OF
PEOPLE IN A MENTAL HEALTH CRISIS
OFTEN SPEND MANY, MANY MORE
HOURS, UM, WAITING FOR THE RIGHT
LEVEL OF TREATMENT TO OPEN UP
AND YOU HEARD A LOT ABOUT THAT
FROM DR WANG. IN TERMS OF
INPATIENT PSYCHIATRIC CARE. OUR
STATE HAS 31 PSYCHIATRIC
HOSPITALS, JUST RESTATING
BUILDINGS THAT THAT'S REALLY THE
PRIMARY TREATMENT THEY OFFER IS
IN PATIENTS LIKE YOU. METRIC
HOSPITAL CARE AND THEN WE HAVE
86 HOSPITALS THROUGHOUT THE
STATE THAT OFFER INPATIENT
PSYCHIATRIC CARE IN A UNIT OF
THEIR BROADER COMMUNITY
HOSPITAL. AGAIN THERE ARE MORE
THAN HALF OF OUR PATIENTS IN OUR
INPATIENT PSYCHIATRIC HOSPITAL.
LEVELS OF CARE IN CALIFORNIA ARE
EITHER COVERED BY MEDICARE OR
MEDIC, AL SO ANOTHER SORT OF
SIGN OF ECONOMIC DISPARITY IN
TERMS OF THE LEVEL OF ACUTE
NEED. WE HAVE SCHIZOPHRENIA,
BIPOLAR DISORDER AND DEPRESSION
ARE THE MOST COMMON DIAGNOSES OF
THOSE WHO ARE CARED FOR IT.
PSYCHIATRIC INPATIENT LEVELS OF
CARE, AND THE AVERAGE LENGTH OF
STAY FOR MEDICAL BENEFICIARIES
IS ABOUT A WEEK. SO WE'RE FAR
FROM THE OLD DAYS OF SEEING
HOSPITAL CARE AS AN INSTITUTION
WHERE PEOPLE GO AND STAY FOR ANY
INDETERMINABLE AMOUNT OF TIME,
OFTEN AGAINST THEIR WILL. REALLY
RIGHT NOW. WE'RE REALLY JUST
LOOKING TO STABILIZE THE PRIMARY
SYMPTOM OF WANTING TO HARM
YOURSELF OR SOMEONE ELSE AND
MOVE YOU INTO THE RIGHT LEVEL OF
CARE FROM THERE. BUT THERE ARE
SOME BIG OUTLIERS FROM THIS ONE
WEEK AVERAGE STAY BECAUSE WE
DON'T HAVE THE SUB ACUTE
PROVIDERS LIKE WE DO IN PRIMARY
CARE WHEN SOMEONE LEAVES READY
TO LEAVE THE HOSPITAL. WE DO
HAVE SEVERAL 1000 INDIVIDUALS IN
CALIFORNIA THAT ARE KIND OF
STUCK IN AN INPATIENT
PSYCHIATRIC HOSPITAL BED BECAUSE
THAT NEXT LEVEL OF CARE ISN'T
READY OR AVAILABLE TO THEM. UM
IN FACT, IN 2020 ALONE, CLOSE TO
2000 ADULT MEDICAL BENEFICIARIES
COLLECTIVELY AMASSED 35,000 DAYS
SITTING IN AN INPATIENT
PSYCHIATRIC HOSPITAL BED WHEN
THEY WERE ACTUALLY READY TO BE
DISCHARGED, BUT THAT NEXT LEVEL
OF CARE WAS SIMPLY NOT AVAILABLE
. SO AS YOU HAVE HEARD, AND YOU
ALL KNOW FROM ALL OF THE
OVERSIGHT HEARINGS, EVEN HEARING
ABOUT THE MANY, MANY INVESTMENTS
THAT WE'RE MAKING IN IN
CALIFORNIA'S INFRASTRUCTURE, ALL
OF THOSE NEEDS CAN'T COME TOO
SOON. CLEARLY THERE'S A CRISIS
NOT ONLY IN THE LEVELS OF CARE
THAT WE DO HAVE BUT PEOPLE
REALLY BEING STUCK IN THE WRONG
LEVEL, AND NOT IN THE LEAST
RESTRICTIVE SETTING. ONE OF THE
AREAS JUST TO HIGHLIGHT IS THAT
AS YOU MIGHT KNOW, WE DO HAVE
DISPARITIES AMONG YOU KNOW WHAT
COMMERCIAL COVERAGE WILL PAY AND
WHAT MEDICAL WILL PAY OR
MEDICARE, BUT WE ALSO HAVE A LOT
OF DISPARITIES ABOUT WHAT'S
BASED ON WHERE YOU LIVE. FRANKLY
JUST GEOGRAPHICALLY, WHAT ACCESS
YOU HAVE. SO EVEN IF THERE'S A
BENEFIT, THAT'S ON YOUR LIST OF
THINGS THAT'S COVERED MERRIMAN
ACTUALLY BE AVAILABLE TO YOU. UM
THAT'S SIMILAR IN THE CASE OF
MEDICAL WHERE WE DO HAVE A WHOLE
HOST OF REALLY, UM RICH BENEFITS
AVAILABLE. BOTH OUTPATIENT
CRISIS SERVICES AND OTHERS.
THERE IS REALLY NO EXPECTATION
FOR MANY OF THOSE SERVICES THAT
WE HAVE AN ADEQUATE AMOUNT OF
THEM IN EVERY COUNTY OF OUR
STATE. SO AS A RESULT, WE DO
HAVE PARTS OF OUR STATE WITH
ABSOLUTELY NO IN PATIENT
PSYCHIATRIC BEDS AVAILABLE FOR
ANYONE, INCLUDING FOR PEOPLE
WITH COMMERCIAL CARE. YOU'D HAVE
TO TRAVEL OUT OF YOUR COUNTY IF
YOU NEEDED THAT LEVEL OF CARE.
MOBILE CRISIS. YOU SAW A MAP
EARLIER, WHICH IS A GREAT MODEL,
ESPECIALLY TO PROVIDE A NON LAW
ENFORCEMENT RESPONSE TO PEOPLE
IN CRISIS AND THEIR FAMILIES
AGAIN NOT AVAILABLE EVERYWHERE.
SO WE REALLY HOPE THAT AS YOU DO
OVERSIGHT AROUND HOW, FOR
EXAMPLE, THE INFRASTRUCTURE
FUNDS THAT WERE LETTING OUT OR
WORKFORCE DEVELOPMENT ALL OF
THESE GREAT PROGRAMS THAT YOU
HAVE IN MIND AND I TO REALLY THE
GEOGRAPHIC DISPARITIES THAT WE
HAVE ABOUT. YOU KNOW, IN TERMS
OF WHERE PEOPLE LIVE AND WHAT
THEY REALLY HAVE ACCESS TO,
BECAUSE WE DO BELIEVE THAT
REALLY SHOULDN'T MATTER WHERE
YOU GET OFF THE BUS THAT
CONTINUUM THAT WE WANT TO MAKE
SURE IS AVAILABLE TO EVERYONE
SHOULD BE AVAILABLE TRULY TO
EVERYONE, REGARDLESS WHERE THEY
LIVE, DESPITE YOU KNOW, OF
COURSE, UNDERSTANDING
DIFFERENCES AND WORKFORCE
AVAILABILITY AND THINGS LIKE
THAT. ONE OF THE OTHER ASPECTS
THAT YOU HEARD A BIT ABOUT
EARLIER FROM THE COUNTIES IS
JUST ONE MORE MINUTE INITIATIVES
TO TRY TO REFORM HOW WE PAY FOR
THE SERVICES THAT WE DELIVER BY
AND LARGE. THE STATE'S PAYMENT
REFORM EFFORTS HAVE IGNORED THE
NEED TO LOOK AT WHAT WE PAY FOR
IN THE ROLE OF THE HOSPITALS
PLAY SO FOR MANY YEARS NOW,
WE'VE REALLY NOT MADE IT CLEAR
HOW HOSPITAL EMERGENCY ROOM
COULD BE FULLY PAID FOR THE COST
OF CARING FOR AN INDIVIDUAL AND
CRISIS SOMETIMES FOR DAYS OR
WEEKS, UM AS THE RESULT. WE'RE
REALLY LEFT WITH NO ADDITIONAL
RESOURCES TO DO THINGS LIKE
HIGHER PEER SUPPORT SPECIALISTS
AND NAVIGATORS AND PSYCHIATRISTS
AND OTHERS WHO REALLY COULD GIVE
PATIENTS AND FAMILY MEMBERS A
BETTER EXPERIENCE WHEN THEY DO
COME TO THE HOSPITAL EMERGENCY
ROOM. SO WE REALLY WANT TO MAKE
SURE THAT WE ARE LOOKING NOT
JUST AT, UM YOU KNOW WHAT WE'RE
MAKING AVAILABLE, BUT HOW WE'RE
PAYING FOR IT AND MAKING SURE
THAT THAT ALL PARTS OF OUR STATE
, UM DELIVERY SYSTEM NOT ONLY
HAVE ADEQUATE LEVELS OF PAYMENT
, BUT THAT IT ACTUALLY OCCURS IN
A STREAMLINED WAY, AND WE'RE
MAKING IT CLEAR WHO'S
RESPONSIBLE. UM AND HOLDING OUR
HEALTH PLANS ACCOUNTABLE FOR THE
PART THAT THEY PLAY. THANK YOU.
THANK YOU, MISS GAVIN. DO HAVE
SLIDES. SLIDES. GREAT. AND ONCE
AGAIN FIVE MINUTES. YES I WILL
MOVE THROUGH THESE QUICKLY.
THANK YOU FOR INVITING ME HERE
FOR ASKING THESE IMPORTANT
QUESTIONS AND FOR SHARING YOUR
STORIES. I'M SARAH GAVIN I'M THE
CHIEF BEHAVIORAL HEALTH OFFICER
AT COMMUNICATING HEALTH CENTERS
. WE ARE A NONPROFIT FEDERALLY
QUALIFIED HEALTH CENTER THAT
PROVIDES CARE FOR 21,000
PATIENTS OVER 100,000 VISITS
LAST YEAR AND YOU'LL OWE COUNTY
WHICH INCLUDES MAJOR CITIES OF
WEST SACRAMENTO, DAVIS AND
WOODLAND. AND ONE THIRD OF OUR
VISITS AT COMMUNICATING HEALTH
CENTERS ARE ATTRIBUTED TO
BEHAVIORAL HEALTH AND SUBSTANCE
USE TREATMENT. I'M ALSO A
LICENSED MARRIAGE AND FAMILY
THERAPIST AND A LICENSED
PROFESSIONAL CLINICAL COUNSELOR
, AND I HAVE WORKED FOR
COMMUNITY CARE FOR OVER 15 YEARS
AND MINISTERING AND PROVIDING
MANY OF THE SERVICES THAT WE'VE
DISCUSSED TODAY UNDER THE
MEDICAL UMBRELLA HERE
REPRESENTING CALIFORNIA PRIMARY
CARE ASSOCIATION. EXT SIDE. LIKE
COMMUNICATE HEALTH CENTERS.
THERE'S 1300 LICENSED COMMUNITY
HEALTH CENTERS IN THE STATE WITH
THE MAJORITY OF BEING FQ HCS.
WHAT THE UMBRELLA TERM HEALTH
CENTERS AND THESE ARE, OF COURSE
MODELS FOR THIS INTEGRATED CARE
THAT PEOPLE HAVE COME TO
APPRECIATE WHAT WE'RE CONNECTING
THE BRAIN WITH THE BODY AND
LOOKING AT PHYSICAL HEALTH AND
MENTAL HEALTH AND SUBSTANCE USE
TREATMENT AND DENTAL SERVICES
HAPPENING UNDER ONE ROOF. AND
WHICH IS CONSERVED THE UNINSURED
AND DO NOT TURN ANYONE AWAY
BASED ON THEIR INABILITY TO PAY
NEXT SLIDE. AND AS YOU CAN SEE,
HEALTH CENTERS PROVIDE CARE FOR
OVER SEVEN MILLION PATIENTS IN
THE STATE AND AS PART OF THE
BEHAVIORAL HEALTH SYSTEM IN
CALIFORNIA, SERVING ONE OUT OF
FIVE CALIFORNIANS AND 11% OF
TOTAL VISITS HAPPENING AT HEALTH
CENTERS IN CALIFORNIA ARE
ATTRIBUTED TO BEHAVIORAL HEALTH.
EXT. LIFE HMM. IN ADDITION TO
HEALTH CENTERS, BEING THE SAFETY
NET PROVIDER IN THE COMMUNITY
FOR PHYSICAL AND BEHAVIORAL
HEALTH SERVICE, I WANTED TO
SHARE AND HIGHLIGHT THAT MANY OF
OUR HEALTH CENTERS NOT ONLY
PARTICIPATE IN HOSTING MEDICAL
MANAGED CARE, BEHAVIORAL HEALTH
SERVICES, BUT ALSO A VARIETY OF
COUNTY LEVEL BEHAVIORAL HEALTH
SERVICES THAT HAVE BEEN
DISCUSSED TODAY. SPECIALTY
MENTAL HEALTH, DRUG, MEDICAL
HEALTH, SUBSTANCE USE TREATMENT.
AND FOR EXAMPLE, COMMUNICATE AIR
WITHIN YOLO COUNTY. WE ARE THE
ONLY OUTPATIENT DRUG MEDICAL
PROVIDER FOR THE ENTIRE COUNTY.
NEXT SLIDE. OUR BEHAVIORAL,
HEALTH AND SUBSTANCE USE
SERVICES, AND OUR SYSTEM IS
COMPLICATED TO NAVIGATE. I HOPE
THAT THAT'S APPRECIATED TODAY
AND HEARING SOME OF OUR SPEAKERS
, AND I WANTED TO SHARE A REAL
EXAMPLE OF WHAT A HEALTH CENTER
COULD PROVIDE AND MEET THE NEEDS
OF THE COMMUNITY AND CREATED
DIGI STIGMATIZE WAY TO RECEIVE
CARE. SO THIS IS AN EXAMPLE OF
OUR ONE OF OUR CLINIC SITES IN
WOODLAND. AND AS YOU CAN SEE,
THIS IS ALL THE SERVICES THAT
HAPPENED UNDER ONE ROOF UNDER
ONE ADDRESS. IN A IN THE
COMMUNITY IN A FAMILIAR SETTING
FOR INDIVIDUALS TO ACCESS, SO
WHEN THEY'RE WALKING INTO OUR
HEALTH CENTER, THEY COULD BE
ACCESSING DENTAL. THEY COULD
ALSO BE ACCESSING SUBSTANCE USE
TREATMENT. UM, SO IT'S A
WONDERFUL DE STIGMATIZE WAY TO
PROVIDE CARE AND ALSO HELP
NAVIGATE SOME OF THESE
COMPLICATED SYSTEMS THAT WE'RE
DISCUSSING. HOWEVER, THERE ARE
CHALLENGES IN PROVIDING THESE
THESE SERVICES AND THERE'S
LIMITS TO WHAT HEALTH CENTERS
ARE ABLE TO DO TO EXPAND, AND
I'LL SHARE SOME OF THOSE TODAY.
NEXT SLIDE. 11 EXAMPLE OF THE
CURRENT CHALLENGE IN PROVIDING
INTEGRATED PRIMARY CARE AND
BEHAVIORAL HEALTH SERVICES IS
ADDED A HEALTH CENTER TODAY WE
CANNOT BUILD FOR MEDICAL AND
BEHAVIORAL HEALTH SERVICES ON
THE SAME DAY, SO D H. D S ALLOWS
US TO BUILD MEDICAL AND DENTAL
SERVICES AND DENTAL AND MENTAL
HEALTH SERVICES, BUT NOT, UM
PHYSICAL HEALTH SERVICES AND
BEHAVIORAL HEALTH SERVICES ON
THE SAME DAY, SO I HOPE YOU CAN
APPRECIATE WHEN WE'RE TALKING
ABOUT INTEGRATED BEHAVIORAL
HEALTH. THIS IS A HUGE BARRIER
FOR US TO BE ABLE TO REALLY
TRULY PROVIDE THE CARE THAT ARE
THAT ARE PATIENT DESERVES AND
ASKING SOMEONE TO WHO WAS IN
CRISIS OR STRUGGLING TO COME
BACK ON A DIFFERENT DAY AND NOT
HAVING BUILT AN ACCESS TO MEET
THE NEEDS FOR THEM RIGHT IN
THERE JUST CREATES FUTURE DELAYS
AND DE STIGMATIZE AND CREATES
STIGMA. AND FOR OUR PATIENTS,
WE'RE ASKING THEM TO COME BACK
OR GO SOMEWHERE ELSE AND
RELATIONSHIP IS KEY TO
BEHAVIORAL, HEALTHCARE AND
ENGAGEMENT AND SO WARM HANDOFFS
AND HAVING SERVICES ON ONE DAY
CREATES MORE RELATIONSHIP AND
TRUST, AND THIS IS A CONCEPT
BUILDING, PHYSICAL HEALTH AND
MENTAL HEALTH ON THE SAME DAY IS
SUPPORTED BY THE FEDERAL
GOVERNMENT. CMS AS WELL AS THE
MAJORITY OF STATES ALLOW MEDICAL
AND BEHAVIORAL HEALTH VISITS ON
THE SAME DAY AND REALLY IS JUST
ONE OF THE EASIEST WAYS TO
IMPROVE BEHAVIORAL HEALTH
DELIVERY. EXCITE. FOR THE SAKE
OF TIME. I WON'T GO INTO THIS,
BUT I HOPE YOU CAN APPRECIATE
WHEN LOOKING AT THIS. HOW
COMPLICATED AND TRY FOR CATERED.
OUR SYSTEMS ARE AND OUR PATIENTS
WHO ARE FACING MULTIPLE BARRIERS
ARE HAVING TO NAVIGATE THIS
EXCELLENT AND AS STATED, SOME OF
OUR HEALTH CENTERS PARTICIPATE
IN THE PROVISION OF COUNTY
MENTAL HEALTH AND SUBSTANCE USE
SERVICES AND MORE WOULD IF
CHANGES WERE MADE. CPC ATTEMPTED
TO BREAK DOWN SOME OF THESE
CHALLENGES, AND SP 3 TO 3 WAS A
PROCESS TO CLARIFY THAT FQ HDS
CAN PARTICIPATE IN DRUG, MEDICAL
AND SPECIALTY MENTAL HEALTH,
WHICH WAS HELPFUL AND I WANT TO
POINT OUT THAT WE HAVE TO RUN
THESE AS TWO SEPARATE LINES OF
BUSINESS WITH A CLEAR SEPARATION
OF WHAT HAPPENS ON THE PHYSICAL
HEALTH SIDE AND WHAT HAPPENS ON
THE DRUG MEDIC HEALTH SPECIAL.
THE MENTAL HEALTH SIDE. WHICH
COMES WITH COMPLICATIONS AND
CHALLENGES, AND SO NOT AND ALSO
NOT ALL COUNTY PARTNERS WITH FQ
HDS IN THE PROVISION OF SERVICES
AND THEIR CHALLENGES WHEN
SERVICES ARE SILOED, ANYTIME WE
HAVE TO REFER A PATIENT OUT TO
ANOTHER SYSTEM, WE RISK LOSING
THEM TO THE SYSTEM AND THE
COMPLICATIONS TO NAVIGATION. SO
ANY TIME WE CAN TAKE CARE OF
THEM UNDER ONE ROOF, IT'S A
BETTER MODEL OF CARE. NEXT
SLIDE. ADDITIONALLY WHILE WE ARE
VERY EXCITED BY SOME OF THE
CHANGES THAT ARE COMING OUT
THERE, CAL AIM WE DO WANT TO
EXPRESS THAT THERE ARE SOME
CHALLENGES WHEN HAVING TO REFER
TO COUNTY LEVEL SERVICES WHEN
THERE ARE WAIT LISTS BECAUSE
PATIENTS AND CLIENTS END UP IN
LIMBO AND FUHS ARE HOLDING ONTO
PATIENTS WAITING FOR A COUNTY
SPOT. UM AND HEALTH CENTERS,
HEALTH CENTER PATIENTS WHO
BELONG AT A HIGHER LEVEL OF CARE
OF STRUGGLING TO HAVE REFERRALS
ACCEPTED BECAUSE OF STAFFING
CONCERNS ARE SILOED SYSTEMS, SO
WE REALLY NEED SOME GUIDANCE AND
SOME CONSISTENT GUIDANCE FROM
COUNTIES AS WELL AS HEALTH
PLANS. EVERYONE SORT OF DOING
THEIR OWN THING TO HAVE IT TO
HAVE A SYSTEM AND A CONSISTENT
INTERAGENCY COMMUNICATION AND
STANDARDS. TO HELP OUR PATIENTS
STEP UP AND STEP DOWN. EXCITED.
MORE CHALLENGES THAT WE'RE
SEEING. THAT'S BEEN EXPRESSED
HERE IS, OF COURSE, WE HAVE AN
INCREASED NEED FOR BEHAVIORAL
HEALTH SERVICES, COUPLED WITH
BEHAVIORAL HEALTH, WORKFORCE
SHORTAGE, AND NONPROFITS, LIKE
QUÊ, HC PROVIDING CARE TO THE
MOST VULNERABLE COMMUNITY
MEMBERS ARE COMPETING WITH
SALARIES WITH BEHAVIORAL HEALTH
CLINICIANS IN A WAY THAT WE HAVE
NEVER SEEN BEFORE. UM, COSTS ARE
INCREASING AND REIMBURSEMENT
ISN'T AND IT'S VERY DIFFICULT TO
COMPETE FOR THOSE WORKFORCE. HMM
ALSO DOCUMENTATION AND
COMPLIANCE STANDARDS FOR
SPECIALTY MENTAL HEALTH AND DRUG
MEDICAL HEALTH FORESTER PASS OR
MANAGED CARE SYSTEM. I HAVE
BUILT THESE SYSTEMS. I CAN SPEAK
IN A TEST THAT THEY ARE
COMPLICATED AND CUMBERSOME. AND
FOR US A COMMUNICATOR. THIS IS
THE NUMBER ONE REASON OUR
BEHAVIORAL HEALTH PROVIDERS WANT
TO CHANGE THEIR ROLE AND GET OUT
OF THE SYSTEM IS BECAUSE OF THE
PAPERWORK AND TO LOSE QUALIFIED
PROVIDERS BECAUSE OF PAPERWORK
TO ME, FEELS TRAGIC. NEXT SLIDE.
WE ALSO NEED EVERYBODY TO DO
THIS WORK. WE NEED DIVERSE
PROVIDERS TO MEET THE BEHAVIORAL
HEALTH NEEDS OF OUR COMMUNITY,
WHICH INCLUDES BEING ABLE TO
BUILD FOR ALL QUALIFIED
PROVIDERS AND STAFF IN OUR
SPECIALTY MENTAL HEALTH SYSTEM
AND DRUG MEDICAL SYSTEMS. WE
HAVE LOTS OF FLEXIBILITY AND
WHAT LICENSES WE CAN BUILD FOR,
AND REGISTRATIONS AND NOT ON THE
FUH SEASIDE, FOR EXAMPLE, WE AT
THE AT AN FUH SEE, WE CAN'T
BUILD FOR LICENSED PROFESSIONAL
CLINICAL COUNSELORS, WHICH IS
ONE OF THE LICENSES I HOLD. BUT
IN THE SPECIAL TEAM IN THE
HEALTH SYSTEM WE CAN UM MAYBE 15
49 IS AN EXAMPLE OF LEGISLATION
THAT WOULD MAKE IT A LITTLE BIT
EASIER TO INTEGRATE DIVERSE
TYPES OF PROVIDERS SUCH AS
COMMUNITY HEALTH WORKERS, FOR
EXAMPLE, ALL OF THE WE'RE
EXCITED FOR THEM TO BE BILLABLE
PROVIDERS THROUGH CALAIS. HDS
ARE NOT INCLUDED IN THAT. UM AND
SO THINKING ABOUT THE RISING
OPERATIONAL COSTS, WANTING TO
SUPPORT INTEGRATED CARE, AND
THAT WE'RE PROVIDING CARE TO 7.2
MILLION PATIENTS IN CALIFORNIA,
WE WOULD REALLY LIKE THE
FLEXIBILITY INTO DOING THIS
IMPORTANT WORK AND THEN
SIGNIFICANT DOCUMENTATION WOULD
ALSO HELP ALLEVIATE SOME OF OUR
CHALLENGES WITH WORKFORCE
EXCITED. AND ONE FINAL
SUGGESTION. UM IS IT IS THE
MAKING FUNDING DIRECTLY
AVAILABLE TO F QHD IS OFTEN
TIMES THEY COME THROUGH THE
COUNTIES OR OTHER SYSTEMS AND
THINKING SPECIFICALLY ABOUT
PROMOTING THE INTERSECTION OF
PHYSICAL HEALTH AND BEHAVIORAL
HEALTH CARE. IT WOULD BE
WONDERFUL FOR US TO HAVE SUPPORT
IN THAT WAY. AND THEN THE NEXT
NEXT SLIDE. JUST IN CONCLUSION.
I HOPE YOU CAN APPRECIATE THAT
CUTIES ROLE IN PROVIDING AND
BEING MODELS FOR INTEGRATED CARE
. WE NEED MORE FLEXIBILITY AND
WHO WE CAN HIRE AND SOME OF THE
REQUIREMENTS THAT PREVENT US
FROM DOING THE GOOD WORK AND CAN
AND TO BE DIRECTLY CONSIDERED
FOR MORE PUBLIC HEALTH FUNDING
OPPORTUNITIES DIRECTLY TO
INTEGRATE PHYSICAL HEALTH AND
MENTAL HEALTH. THANK YOU SO
MUCH. THANK YOU SO MUCH.
COMMITTEE MEMBERS ANY QUESTIONS
OR COMMENTS? THANK YOU VERY MUCH
FOR YOUR INFORMATION. OF COURSE,
AS WE BEGIN TO THINK ABOUT,
CONTINUED, UM UM, SILOS TO
CONTINUE TO BREAK DOWN, RIGHT?
UM. OBVIOUSLY WE'RE GOING TO
NEED ANOTHER ROUND OF
LEGISLATION TO REALLY LOOK AT
SOME OF THOSE SILOS. WE KNOW
THAT DURING COVID 19 ALSO WE
SAID, HEY, WE DON'T HAVE ENOUGH
PEOPLE TO PROVIDE THIS SERVICE
WE MIGHT HAVE TO EXPAND, WHO CAN
PROVIDE DIFFERENT SERVICES RIGHT
UNTIL THE WORKFORCE COMES IN OUR
EFFORTS, SO WE PROBABLY NEED TO
BE THINKING ABOUT. WE DEFINITELY
NEED TO BE THINKING ABOUT THOSE
IDEAS AS WELL. SO PLEASE. BE
READY TO PROVIDE US WITH SOME
LEGISLATIVE SOLUTIONS FOR THAT,
ALL RIGHT? AND WITH THAT, THANK
YOU VERY MUCH FOR THIS PANEL
TIME. THANK YOU. OUR LAST PANEL
OR PERSPECTIVES FROM THE FIELD,
BUT WE ARE LOOKING FORWARD TO
HEARING FROM THOSE WHO ARE ON
THE GROUND, PROVIDING VARIOUS
BEHAVIORAL HEALTH SERVICES. WE
HAVE SOME WHO ARE PARTICIPATING
REMOTELY, AND THEN WE ALSO HAVE
SOMEONE PARTICIPATING HERE IN
PERSON. AND BECAUSE YOU ARE HERE
IN PERSON, OF COURSE YOU GET TO
GO FIRST. UH SO THAT WE CAN MAKE
SURE THAT WE UM, GET YOUR
PERSPECTIVES. UM UH, MISS KAREN
LARSON, CHIEF EXECUTIVE OFFICER
FROM THIS STEINBERG INSTITUTE.
YOU MAY BEGIN. THANK YOU. UH
GOOD MORNING AND GOOD AFTERNOON.
I GUESS I SHOULD SAY NOW, THANK
YOU FOR HAVING ME AND FOR HAVING
THIS IMPORTANT CONVERSATION. MY
NAME IS KAREN LARSON. I'M THE
CEO OF THE STEINBERG INSTITUTE.
I'M ALSO A WOMAN IN RECOVERY,
WHICH I THINK IS IMPORTANT TO
SAY OUT LOUD IN THIS CONTEXT. UM
I'M PROUD TO HAVE WORKED IN THIS
FIELD FOR OVER 30 YEARS NOW,
WHICH IS A LITTLE HARD TO SAY
OUT LOUD, BUT IT'S TRUE. ALL OF
THAT HAS BEEN IN CALIFORNIA. I
STARTED AS AN INDIVIDUAL
THERAPIST AND OVER TIME. UM NOW
I HAVE THIS STATEWIDE
PERSPECTIVE. UM THE STEINBERG
INSTITUTE WAS CREATED WHEN OUR
FOUNDER, MAYOR DARRELL STEINBERG
, LEFT THE SENATE, AND IT KIND
OF LOOKED BEHIND HIMSELF AND
SAID, WELL, FOLKS AREN'T PAYING
THAT MUCH ATTENTION TO MENTAL
HEALTH. AND SO I WANT TO START
THIS NONPROFIT ADVOCACY
ORGANIZATION. FAST FORWARD EIGHT
YEARS AND WE'RE HERE TODAY WITH
THIS REMARKABLE ATTENTION BEING
PAID WITH A BUDGET BEING, UH,
DEDICATED TO BEHAVIORAL HEALTH.
THAT'S MORE THAN DOUBLED OVER
THAT COURSE AT THAT TIME, AND
WITH MORE THAN 200 BILLS THIS
SESSION THAT ARE FOCUSED ON THE
BEHAVIORAL HEALTH SPACE, SO
DEFINITELY IN A DIFFERENT SPOT,
BUT STILL HAVE OUR CHALLENGES.
UM BEFORE I CAME TO THE
STEINBERG INSTITUTE, I WAS THE
HEALTH AND HUMAN SERVICES
DIRECTOR AND YOLO COUNTY JUST
ACROSS THE RIVER. AH SO I
OVERSAW ALL OF THE PUBLIC
HEALTH, ALL OF THE BEHAVIORAL
HEALTH AND ALL THE SOCIAL
SERVICES. I OFTEN REFER TO YOUR
COUNTY AS A GOLDILOCKS SIZE
COUNTY. IT WASN'T TOO BIG. IT
WASN'T TOO SMALL. IT WAS JUST
RIGHT, UM, IT BECAUSE I WAS OVER
ALL OF THOSE SYSTEMS AND BECAUSE
OUR COMMUNITY WAS RELATIVELY
SMALL IN NATURE, I HAD THIS
REALLY UNIQUE PERSPECTIVE. RIGHT
I GOT TO SEE HOW ALL THE SYSTEMS
THE IMPORTANCE OF HAVING ALL THE
SYSTEMS WORK TOGETHER TO AFFECT.
POSITIVE OUTCOMES FOR ARE THE
PEOPLE WE CARED ABOUT, AND I
ALSO HAD THE GIFT OR OR MAYBE IT
WASN'T A GIFT. BUT THIS
OPPORTUNITY TO HAVE TO WATCH
MULTIPLE GENERATIONS OF FOLKS GO
THROUGH OUR SYSTEMS. SO THE VERY
FIRST JOB I HAD IN YOLO COUNTY,
I WORKED IN A PERI NATAL DAY
TREATMENT PROGRAM WHERE WOMEN
WERE INVOLVED WITH CHILD WELFARE
WOULD COME INTO TREATMENT WITH
THEIR LITTLES AND THE MOMS WOULD
BE IN THEIR TREATMENT. THEY DO
PARENT CHILD INTERACTION
THERAPY. IT WAS AMAZING. I WAS
IN YOLO COUNTY LONG ENOUGH TO
WATCH THOSE SAME LITTLE PEOPLE
GROW UP AND ENTER MY JUVENILE
JUSTICE SYSTEM AND THEN GROW UP
A LITTLE MORE, ENTER THE ADULT
CRIMINAL JUSTICE SYSTEM AND GROW
UP EVEN MORE AND HAVE THEIR
CHILDREN INTO OUR CHILD WELFARE
SYSTEM. AND SO THAT'S A GIFT IN
SOME WAYS, BECAUSE IT DEFINITELY
MOTIVATES YOU TO DO BETTER EVERY
DAY. BUT I THINK ONE OF THE
QUESTIONS I WAS ASKED IS HOW WHY
HAVING A STATEWIDE FRAMEWORK FOR
OUTCOMES AND ACCOUNTABILITY IS
IMPORTANT. AND WHAT? HOW THAT
PLAYS OUT ON THE GROUND LEVEL,
AND I THINK THOSE MULTI
GENERATIONAL PATTERNS THAT ARE
PLAYING THEMSELVES OUT IN ALL OF
OUR COMMUNITIES THROUGHOUT
CALIFORNIA THROUGHOUT THE NATION
ARE REALLY WHAT HAPPENS WHEN WE
DON'T PAY PROPER ATTENTION TO
OUTCOMES AND ACCOUNTABILITY AND
HELPING OUR SYSTEMS DO BETTER.
BY THE PEOPLE THAT WERE INTENDED
TO SERVE UM, SO MY PERSPECTIVE
TODAY IS THAT DATA IS KEY TO
TRANSFORMING THE SYSTEMS. YOU'VE
HEARD LOTS OF STATISTICS. I
CROSSED ALL THOSE OFF MY TALKING
POINTS BECAUSE ALL OF EVERYONE
DID A GREAT JOB, SO WE'RE REALLY
GOOD ABOUT TALKING ABOUT THE
HORRIBLE OUTCOMES ASSOCIATED
WITH UM, NOT DOING WHAT WE
SHOULD BE DOING WHAT WE AREN'T
AS GOOD AT AS A STATE AS A
SYSTEM OR A SERIES OF SYSTEMS
SERVING PEOPLE LIVING WITH THESE
CONDITIONS, IS TALKING ABOUT THE
OUTCOMES. THE QUALITY OF LIFE
OUTCOMES ASSOCIATED WITH
ACHIEVING RECOVERY. AND SO WE
THINK THAT'S THE MOST IMPORTANT
FOCUS AT THIS MOMENT. UM WHEN I
BECAME DIRECTOR AND YELLOW
COUNTY. WE UM WE WEREN'T
FOCUSING ON THE RIGHT THINGS.
THERE WAS GREAT GOODWILL TOWARDS
MAKING THESE THINGS BETTER. UM
THERE WAS FINANCIALLY WE HAD.
YOU KNOW, MORE MONEY COMING IN
ON REGULAR BASIS FOR THESE TYPES
OF SERVICES, BUT WE WEREN'T KIND
OF ALL ROWING IN THE SAME
DIRECTION FOCUSED ON THESE LIFE
OUTCOMES. AND SO, UM, WE WERE
LUCKY ENOUGH THAT ARE ELECTED
AND THE LEADERSHIP IN THE COUNTY
REALLY ENCOURAGED US ALL TO
ADOPT AN ACCOUNTABILITY
FRAMEWORK THAT FORCED US ALL TO
KIND OF BE ROWING IN THE SAME
DIRECTION AND FOCUSING ON THE
QUALITY OF LIFE OUTCOMES. UM AS
A RESULT, WE REDUCED
HOMELESSNESS, INCARCERATION,
HOSPITALIZATION AND SEVERAL
OTHER QUALITY OF LIFE KIND OF
OUTCOMES FOR PEOPLE LIVING WITH
BEHAVIORAL HEALTH CONDITIONS AND
REALLY THE LESS MEASURABLE KIND
OF OUTCOMES THAT WE ACHIEVED.
WE'RE WORKING ACROSS SYSTEMS SO
WE HAD, YOU KNOW ALL OF OUR
COMMUNITY CORRECTIONS
PARTNERSHIP WORKING ON THIS
FRAMEWORK. ROLLING IN THE SAME
DIRECTION. LAW ENFORCEMENT
HOSPITALS, EDUCATION. EVERYBODY
WAS KIND OF USING THE SAME
FRAMEWORK TO TELL THE STORY
ABOUT THE OUTCOMES. SO. ANOTHER
PIECE OF THE PROMISE THAT I WAS
ASKED TO TALK ABOUT WAS ACCESS
TO CARE AND WHY IT'S CRITICAL.
AND IT IS. WE BELIEVE THAT EVERY
CALIFORNIAN SHOULD HAVE A RIGHT
TO ACCESSING THE CARE THEY NEED
WHEN THEY NEED IT, WHERE THEY
NEED IT, AND FOR AS LONG AS THEY
NEED IT. UM AND WHAT WE ALSO
KNOW IS THAT OVER THIS PAST
DECADE, OUR RESOURCES IN
BEHAVIORAL HEALTH HAVE MORE THAN
DOUBLED, BUT OUR PENETRATION
RATES HAVEN'T CHANGED AT ALL.
AND SO WE CAN'T CONTINUE TO JUST
TALK ABOUT INFUSING MORE MONEY
INTO THE SYSTEM WITHOUT ALSO
LOOKING AT THESE OTHER OUTCOMES
ABOVE AND BEYOND ACCESS TO CARE,
BECAUSE THE REALITY IS ACCESS TO
CARE IS NOT ENOUGH IF YOU ACCESS
CARE THAT ISN'T HIGH QUALITY.
THEN YOU'RE NOT GOING TO GET
BETTER. AND SO WHAT WE REALLY
ALL CARE ABOUT IS LET'S HELP OUR
FOLKS GET BETTER. LET'S HELP
THEM, YOU KNOW, GET JOBS ENROLL
IN SCHOOL, HAVE MEANINGFUL
RELATIONSHIPS WITH OTHERS AND BE
SUCCESSFUL IN LIFE. I THINK WE,
YOU KNOW, WE'VE HEARD ABOUT ALL
THE CHALLENGES LIKE THERE ARE
LOTS OF REASONS WHY WE AREN'T
ACHIEVING THE OUTCOMES WE ALL
WANT. UM THE PANDEMIC DIDN'T
HELP THIS WORKFORCE SHORTAGES.
UNBELIEVABLE AND, UM, WE'VE BEEN
A PART OF A LOT OF THE
LEGISLATIVE WORK AROUND THOSE
THINGS. WE UM SPONSORED 855 THE
PARODY LAW 89 88. YOU KNOW WE'RE
WORKING ON ALL THESE THINGS AND
WHAT'S REALLY COME TO THE
FOREFRONT FOR US IS THAT WE NEED
TO FOCUS ON OUTCOMES AND REALLY
, UM, MOVE TOWARD A SYSTEM WHERE
WE'RE TRACKING THOSE OUTCOMES
AND TELLING THE STORY ABOUT HOW
TO IMPROVE THE LIVES OF THE
PEOPLE THAT WE ALL LOVE AND CARE
ABOUT. UM AH! I DON'T WANT THE
MESSAGE TO COME OUT OF MY
STATEMENT THAT WE DON'T NEED
MORE MONEY IN THIS SYSTEM. WE
DEFINITELY DO. ONLY THREE CENTS
OF EVERY MEDICAID DOLLAR IN
CALIFORNIA GOES TOWARDS BAY
BEHAVIORAL HEALTH AND AT THIS
MOMENT IN TIME IT'S CRITICAL
THAT WE FOCUS ON THESE OUTCOMES
AND REALLY ENSURE THAT THE
RESOURCES THAT WE ARE INFUSING
INTO OUR SYSTEM ARE BEING
APPLIED AND TO AFFECTIVE
TREATMENT MODALITIES THAT
IMPROVE THE LIVES OF OTHERS. UM
I WILL JUST QUICKLY CALL OUT
THAT WE ARE SPONSORING A BILL
THIS YEAR AROUND OUTCOMES AND
ACCOUNTABILITY AND WE HAVE OTHER
SYSTEMS WITHIN CALIFORNIA
FRAMEWORKS TO GO BY THE, UM THE
CAL OR STATUTE AND THE CHILD
WELFARE INDICATORS PROJECT. BOTH
ARE GREAT EXAMPLES OF PLACES
WHERE OUR STATE WHEN THEY'VE
APPLIED. THIS CONCEPT OF LOOKING
AT OUTCOMES AND ACCOUNTABILITY,
FORCED HEALTHY COMPETITION AMONG
THE PRIVATE AND PUBLIC SYSTEMS
HELPED THEM KIND OF LOOK AT ONE.
ANOTHER LEARN BEST PRACTICES, UM
, RECEIVED TECHNICAL ASSISTANCE
TO, UM, HAVE A QUALITY
IMPROVEMENT KIND OF FRAMEWORK
WITHIN THEIR SYSTEMS AND IMPROVE
THOSE LIFE OUTCOMES. FOR OTHERS,
UM IT'S WORTH NOTING THAT THE
STATE IS DOING A LOT IN THIS
SPACE AS WELL. UM WE THINK
THERE'S MORE THAT CAN BE DONE.
WE HOPE TO. WE LOOK FORWARD TO
SEEING MORE FROM THE
ADMINISTRATION'S MODERNIZING
BEHAVIORAL HEALTH FRAMEWORK.
THEY'VE KIND OF TALKED ABOUT
OUTCOMES AND ACCOUNTABILITY. BUT
WE'D LIKE TO SEE WHAT THAT HOW
THAT ALL PANS OUT. UM SO I THINK
I'LL FINISH JUST BY SAYING
THERE'S A LOT OF HOPE. I MEAN,
THIS IN AND OF ITSELF PROVIDES
SO MUCH HOPE THAT THAT THERE'S
AN INCREASED FOCUS THAT THERE'S
THIS PATH FORWARD THAT
EVERYONE'S KIND OF INTERESTED IN
THE SUBJECT MATTER AND WANTING
TO GET TO SOLUTIONS. AND, UM
WE'RE HAPPY TO BE A PART OF THAT
SOLUTION. HOWEVER, WE CAN AND SO
VERY GRATEFUL FOR YOUR TIME
TODAY. THANK YOU VERY MUCH. NEXT
UP. WE HAVE A REPRESENTATIVE
FROM THE NATIONAL ASSOCIATION OF
SOCIAL WORKERS, CALIFORNIA
CHAPTER. UM. HARMONIES UH,
CINCINATTI. NATTY NATTY.
WONDERFUL YES, WE CAN HEAR YOU.
YOU HAVE FIVE MINUTES. OH GOOD.
OKAY I'LL SPEAK FAST EVENING
GREETINGS, DR JACKSON, AND IT
SEEMED COMMITTEE MEMBERS. THANK
YOU SO MUCH FOR HAVING ME AS
WE'VE BEEN HEARING. WE'RE IN A
CRISIS RIGHT NOW. THE MENTAL
HEALTH WORKFORCE ESPECIALLY IS
IN CRISIS BECAUSE BURNOUT AND
UNTIL WE PROBABLY ADDRESSED THE
WHOLE OF THE BURNOUT, WHAT
HOLISTIC AND SUSTAINABLE
SOLUTIONS AND SUPPORT THE WORK
FOR IT, THE STATUS WILL CONTINUE
TO WORSEN AND OUR COMMUNITIES
WILL CONTINUE TO SUFFER FOR OVER
A DECADE, I WORKED IN THE
BIGGEST MENTAL HEALTH FACILITY
IN GERMINATION TWIN TOWERS
CORRECTIONAL FACILITY IN L. A. I
STARTED AS AN INTERN, AND I'M A
W PROGRAM AT U C L A. AND WHEN I
GRADUATED, I RETURNED WITH THE
COUNTY DEPARTMENT OF MENTAL
HEALTH, PSYCHIATRIC SOCIAL
WORKER PROMOTING TO MENTAL
HEALTH CLINICAL SUPERVISOR UNTIL
I LEFT ALMOST A YEAR AGO, I
WORKED IN NEARLY EVERY PART OF
THE JAIL, OFTEN FOR OVERNIGHTS
AND WEEKENDS IN AN EFFORT TO DO
EVERYTHING POSSIBLE TO LEARN AND
UNDERSTAND THE SYSTEM WHILE
JUGGLING THE DEMANDS OF MY
FAMILY. MOST OF THE TIME I
WORKED ON MINIMUM SUPERVISION
AND SUPPORT, BUT IT WAS THE ONLY
WAY TO MAINTAIN EMPLOYMENT IN
CHILDCARE NEEDS. I GOT TO KNOW
SO MANY OUTSTANDING COLLEAGUES
WHO, DESPITE THE LOVE OF THE
WORK ALSO LEFT, ESPECIALLY IN
RECENT TIMES. WHY ARE SO MANY
LEAVING, ESPECIALLY WITH YEARS
OF INDUSTRIAL KNOWLEDGE? I
RECENTLY CONTRIBUTE TO A STORY
IN THE L A TIMES WITH THIS
PROGRAM WAS EXPLORED WITH THE
FOCUS ON SOCIAL WORKERS IN THE
COUNTY SECTOR. THAT WE COMPRISE
THE MAJORITY OF THE MENTAL
HEALTH WORKFORCE. PROFESSIONALS
REPRESENTING VARIOUS AREAS OF
PROFESSION CONTRIBUTED TO THE
GENERAL CONSENSUS THAT THIS TYPE
OF COUNTY WORK IS SIMPLY TOO
STRESSFUL TO SUSTAIN SOCIAL
WORKERS ARE VALUING QUALITY OF
LIFE AND THEY'RE EITHER LEADING
THE GOVERNMENT SECTOR TO GET
THEIR NEEDS MUCH OR AVOIDING
ENTIRELY. PEOPLE ARE LEAVING. WE
OUGHT TO CONSIDER WHY ALTHOUGH
FINANCIAL INCENTIVES AND
FLEXIBLE WORK SCHEDULE ARE
NECESSARY AND MAY ATTRACT THEM
AS A MEANINGFUL SPIRIT,
ESPECIALLY IN THE EARLY,
UNDERPAID PROFESSION, THEY ARE
NOT ENOUGH TO RETAIN. I'M
PERSONALLY FAMILIAR BECAUSE I
LEFT I DIDN'T WANT TO LEAVE, BUT
I REALIZED IT WAS NO LONGER
SUSTAINABLE AND I WASN'T ALONE
AS A MASS EXODUS OF STAFF
CONTINUES WITH MY FORMER
WORKPLACE BAPTIST 56% OF THE
SHOCK OF THE SITUATION, PEOPLE
OFTEN SAY NEW HIRES ARE ON THE
WAY, BUT THAT ONLY GENERATES
FALSE SENSE OF HOPE AND RELIEF
BECAUSE MORE HIGHLY QUALIFIED
STAFF CONTINUE TO LEAVE FASTER
THAN NEW ONES CAN BE ON BOARDED.
THE DISTINCT BURNOUT THAT COMES
FROM THIS WORK, THEY CAN ONLY BE
UNDERSTOOD WHEN ACTUALLY
EXPERIENCED AFTER BEING ON THE
FRONT LINES TO THE PANDEMIC IN A
PLACE WHERE THERE'S NO SUNLIGHT
OR VENTILATION WHILE SEEING
PATIENTS AND SQUALID CONDITIONS
, AND WE CAN ONLY BE DESCRIBED
AS A HUMAN RIGHTS AND AFTER IT
TOOK ME SEVERAL MONTHS TO BEGIN
TO UNDERSTAND THE WEIGHTLESS
SYSTEM HAD ON MEAT, WHICH I
BELIEVE IS A METAPHOR FOR THE
WAY THIS SYSTEM HAS ON OUR
SOCIETY. WE MUST FUNDAMENTALLY
CHANGED. WE MUST FINALLY CHANGED
HOW WE OPERATE. IF YOU WANT TO
IMPROVE OUR ABILITY TO PROVIDE
SERVICES. IF WE CARE ABOUT THE
PEOPLE WE SERVE, WE MUST CARE
ABOUT THE WORKFORCE TO PROVIDE
THEIR SERVICE. RESEARCH SUPPORTS
WHAT WE'RE SAYING. WELL, MY
WORDS AND OUR ACTIONS THEY ALL
SUPPORT. WE'RE SAYING THAT WE
NEED STRUCTURAL CHANGE, AND I
TRULY BELIEVE IT'S POSSIBLE BUT
THE CHANGE THAT NEEDS TO COME
FIRST. WE DON'T YOU KNOW, LOOK
FAR FOR ANSWERS. THERE'S AMPLE
RESEARCH ON BURNOUT, IN FACT,
REGULARLY TRAINED ON THE TOPIC,
AND WE HAVE EMPLOYEES PROGRAMS
FOR HELP. I ACTUALLY THOUGHT
HELP AND THEN ONE OF MY FIRST
THREE ALLOTTED APPOINTMENTS THAT
THERAPIST RECOMMENDED MEDITATION
ENCOURAGED ME TO CONTINUE
ADVOCATING. LITTLE DID SHE KNOW
THAT I WORKED IN ITALIAN RETORT
RETALIATORY WORKPLACE AND THAT I
WAS ALREADY TOLD BY MY PROGRAM
LEADER, BUT I WOULD NOT BE ABLE
TO PROMOTE WITH THIS
ADMINISTRATION BECAUSE OF MY
ADVOCACY. INCIDENTALLY WHEN I
WENT TO SCHEDULE MY SECOND
APPOINTMENT, BUT WE'RE NOT
AVAILABLE, BUT I NEVER WAVERED
AT THE BURNOUT GOT WORSE, AND I
LEARNED THAT WE OFTEN PUNISHED
THOSE WHO SPEAK OUT. BUT WE
DON'T EFFECTIVELY SUPPORT THOSE
WHO REMAIN SUFFERING IN SILENCE.
ALL OF US PERPETUATE MORE
BURNOUT AND FURTHER CONTRIBUTE
TO THE CRISIS. SO WE NEED
MEANINGFUL CHANGE, NOT A STRESS
BALL AND OCCASIONAL DONUTS FOR
STAFF APPRECIATION, ONE
INCENTIVE TO BE A GAME CHANGER
OR PART TIME POSITIONS WITH FULL
BENEFITS EVERY SECTOR OF
FRONTLINE WORK. THIS WOULD ALLOW
PEOPLE TO HAVE THE OPTION OF
WORK AND SUSTAINABLE WAY FOR
THEM. PEOPLE HAVE SO MANY
REASONS TO PURSUE THIS,
INCLUDING FAMILY, PRIVATE
PRACTICE, ACADEMIA OR OR
ADVOCACY. PEOPLE WOULD HAVE THE
POWER TO CREATE SOMETHING THAT
WILL HELP THEM BE MOST EFFECTIVE
VERSUS BEING FORCED TO A MOLD
THAT IS PROVEN DATED,
INEFFICIENT AND DETRIMENTAL TO
EVERYONE INVOLVED, INCLUDING THE
CLIENTS SERVED ANOTHER REASON WE
CAN SUPPORT PART TIME OPTIONS
BENEFITS BECAUSE WE'D BE
DIRECTLY SUPPORTING WOMEN IN THE
WORKFORCE, ESPECIALLY MOTHERS
AND CAREGIVERS. ALSO WORKING TO
COMPRISE THE MAJORITY OF THE
MENTAL HEALTH WORKFORCE ARE 90%
WOMEN, SO BY THIS ALONE, WE HAVE
A DIRECT IMPACT ON A WOMAN'S
EMPLOYMENT CONSIDERATION. AND
PRODUCERS WHO ARE PARENTS. WOMEN
WITH CHILDREN ABLE TO 18 YEARS
OLD, COMPRISE 71% OF THE GENERAL
WORKFORCE. THIS DOESN'T EVEN
INCLUDE WOMEN WITH NON PARENTAL
CAREGIVING RESPONSIBILITIES ARE
ALSO 75% WOMEN. THE NUMBERS
INDICATE A MAJORITY OF WOMEN
DOING THIS WORK ALSO HAVE
CAREGIVING RESPONSIBILITIES AT
HOME. E ON PAID WORK DEMANDS AND
RESPONSIBILITIES. WORKFORCE WAS
NOT DESIGNED FOR WOMEN. HOW WILL
WE MAKE UP THE MAJORITY OF THIS
WORKFORCE AND WE ARE OVERDUE FOR
ADJUSTMENTS THAT ALLOW US TO DO
THIS WORK SUSTAINABLY AND
EFFECTIVELY BY SUPPORTING WOMEN
AND ANYONE WHO PURSUED THIS
PROFESSION. WE ARE SUPPORTING
THE PEOPLE WE SERVED IN THE
WORKPLACE AND BEYOND. WHEN I
FIRST TOOK MY MATERNITY LEAVE.
MY MOTHER WAS ALSO DYING OF
CANCER. YOU HAVE ONE MORE
MINUTE. OKAY I WAS DOUBLY
RESPONSIBILITY OF CARING FOR HER
WHILE ALSO BECOMING A MOTHER
MYSELF. I KNEW SIX MONTHS WASN'T
ENOUGH. AND LUCKILY MY DIRECTOR
UNDERSTOOD REQUESTED HERE BUT
WAS MOSTLY UNPAID TIME OFF A
PRIVILEGE NO LONGER HONORED.
WHEN I RETURNED. I HOPE THERE
WAS PART TIME POSITION AVAILABLE
FOR ME BECAUSE THEY EXISTED
DEPARTMENT. ALTHOUGH THERE ARE
JUST VERY FEW. INSTEAD, I WAS
OFFERED A 30 HOUR WORKWEEK WAS
SIGNIFICANT DECREASE IN
BENEFITS, WHICH I EVENTUALLY DID
FOR A BIT KNOWING I WAS
PRIVILEGED. WE COULD DO IT AND
THEN HAD TO RETURN FULL TIME.
EXTREME CAUSED ON FAMILIES
SUSTAINED SUSTAINED. WHAT HAS
BECOME IMPOSSIBLE FOR MANY IS
ONLY CAUSING FURTHER HARM TO OUR
SOCIETY. AND I KNOW BECAUSE I
KNOW I'M STRUGGLING TO KEEP UP
WITH THE JUNGLE MYSELF, AND I
WORKED WITH FAMILIES AND
STUDENTS IN OUR SCHOOLS WHO FEEL
THE BRUNT OF THIS WEEK. AGAIN I
WORKED WITH SOCIAL WORKERS. HAVE
YOU THINK SENTIMENT BUT OFTEN
ARE TOO STRETCHED TO DO ANYTHING
WITH THE KEEP GOING. PART TIME
POSITIONS ARE NECESSARY AND
TELEWORK, EVEN IF ONLY A FEW
HOURS A DAY FOR DOCUMENTATION.
IN FACT, IN OUR HANDBOOK AT
CORRECTIONAL HEALTH SERVICES IS
TOUTED AS A BENEFIT, BUT ONLY SO
MUCH STAFF WERE CHOSEN TO USE IT
OFFERED THE POSTAL WORKERS DOING
THE WORK. PLEASE, UH CONCLUDE.
WRAP IT UP, WRAP IT UP AND EVEN
A FEW HOURS A DAY, WRAP IT UP,
ALLOWING THE BENEFITS WILL HELP
THEM UNTIL HEALTH WORKERS LIKE
HE SAID DR TORREY JACKSON AT THE
END W LOBBY DATE, RILEY WE CAN'T
GO BACK TO THE NEW NORMAL. WE
HAVE TO IMAGINE A NEW NORMAL AND
IN DOING SO WE NEED TO TAKE CARE
OF OUR WORKFORCE. I KNOW IT GOES
BEYOND MENTAL HEALTH, AND WE'RE
IN A PERPETUAL STATE OF TRAUMA
AS A SOCIETY, INCLUDING US
TREATING THE TRAUMA AND WE NEED
HELP, TOO. SO THANK YOU. THANK
YOU SO VERY MUCH REALLY
APPRECIATE IT. UM NEXT IS ALEXIS
SIEGEN. WITH THE CALIFORNIA
STATE ASSOCIATION. THAT'S LIKE A
PSYCHIATRIST. HI CAN YOU HEAR
ME? OKAY. YES, WE CAN. OKAY
PERFECT. THANK YOU. MEMBERS OF
COMMITTEE AND THE CHAIR DR
JACKSON FOR HAVING ME HERE TODAY
ON THE LEFT TO SPEAKING IN THE
VICE CHAIR FOR THE CALIFORNIA
STATE ASSOCIATIONS, PSYCHIATRIST
AND THE PSYCHIATRIST OF THE UC
IRVINE MEDICAL CENTER AND ORANGE
COUNTY, WHERE I'M PRIMARILY WORK
AS AN INPATIENT ADULTS ON THE
PATIENT ADULTS PSYCHIATRIC
UNITS. I ALSO PERFORM AND SEE
ADULT OUTPATIENTS. R D C. IRVINE
MEDICAL CENTER IS A SAFETY NET
HOSPITAL AND THE MAJORITY OF THE
INDIVIDUALS WHO SERVER HAVE HAVE
MEDICAL THEIR INSURANCE WANTED
TO ACKNOWLEDGE THE EFFORTS THAT
HAVE BEEN MADE BY THE STATE OF
CALIFORNIA TO PRIORITIZE MENTAL
HEALTH. UM 988 HAS BEEN AN
AMAZING ACCOMPLISHMENT AND HAS
THE POTENTIAL TO HELP PEOPLE IN
CRISIS AND DIRECTING TO THE
SERVICES WE NEED. UM HOW ARE
THEY NEED, HOWEVER, THERE IS
STILL A LOT OF GAPS IN OUR
CRISIS RESPONSE. WE FREQUENTLY
HAVE PEOPLE BROUGHT TO OUR ER
FROM JAIL, AND IT'S UNCLEAR WHY
THEY WERE TAKEN TO JAIL IN THE
FIRST PLACE IF THEY REALLY
NEEDED MENTAL HEALTH CARE. UM WE
NEED MORE EDUCATION FOR FIRST
RESPONDERS. SO THERE'S AND THE
WHITE THE WAIT TIME FOR CRISIS
ASSESSMENT. IT'S HIGH. OFTEN
THEY MAY NOT BE ABLE TO COME
UNTIL THE NEXT DAY, SO IT'S
STILL POLICE THAT ARE COMING. I
HAVE AN INDIVIDUAL WHO HAS
SCHIZOPHRENIA SPECTRUM DISORDER
. HE IS ON A CONSERVATORSHIP AND
IT'S FAMILY. HE HAS ASK THEM TO
CALL THE CALL 911 BECAUSE HE
WASN'T FEELING WELL. HE SAID
SOMETHING WAS WRONG. HE WAS
ASSESSED BY THE POLICE DIDN'T
REALLY KNOW WHAT A
CONSERVATORSHIP MEANT. AND SO
THEY DIDN'T TAKE HIM IN. AND HE
ACTUALLY THEN LATER ON, WENT TO
ASSAULT AND NEIGHBOR THINKING
THAT THEY WERE TRYING TO ABUSE
ABUSE. SOMEBODY AND SO NOW HE'S
IN THE JAIL SYSTEM IN THIS ALL
COULD HAVE BEEN AVOIDED IF HE
HAD JUST BEEN TAKEN TO THE
HOSPITAL IF THE PEOPLE WHO
ASSESSED HIM HAD BETTER
EDUCATION AND THIS CRISIS
ASSESSMENT. THEY'RE ALSO VERY
DISJOINTED BETWEEN CITIES SO
AGAIN, SO IN GENERAL PSYCHIATRY
THERE DEFINITELY LIMITATIONS TO
OUR CURRENT TREATMENTS. BUT
WE'RE PRETTY GOOD AT GETTING
PEOPLE WELL AND AN ACUTE CRISIS.
WHAT WE STRUGGLE WITH IS KEEPING
PEOPLE WELL AND OUT OF CRISIS
AND YOU HAVE A NUMBER OF PEOPLE
HAVE TALKED ABOUT THE DIFFERENT
FACTORS THAT COME INTO THIS
TODAY. AND SO I WANT TO JUST
HIGHLIGHT A COUPLE THAT WE SEE
IN THE WHEN WE'RE IN THE FIELD
THAT ARE SOME OF THE MAJOR
BARRIERS SO WE KNOW OUTPATIENT
CARE IS ESSENTIAL PEOPLE. WELL
HOWEVER, OUR CURRENT MODEL FOR
GETTING ACCESS TO THESE GREAT,
ASSERTIVE COMMUNITY TREATMENT
OUT PROGRAMS THAT YOU HAVE TO
FAIL UPWARDS. IT WOULD BE
HOSPITALIZED A CERTAIN NUMBER OF
TIMES TO MEET CRITERIA TO GET
ACCESS TO THOSE PROGRAMS AND THE
NEED TO HAVE THE CAPABILITY TO
EXPAND THESE PROGRESSIVE PEOPLE
WHO ARE HIGH RISK OF
REHOSPITALIZATION TO REDUCE THE
CHANCE THAT THEY ACTUALLY NEED
TO BE HOSPITALIZED AGAIN, AS
MANY PEOPLE HAVE SAID PROGRAMS
HAVE HIGH STAFF TURN TURNOVERS.
WE ALSO NEED TO HAVE HIGHLY
TRAINED PHYSICIANS WORKING WITH
THESE COMPLEX INDIVIDUALS. WHO
HAVE OFTEN WHO ARE OFTEN ON VERY
COMPLICATED MEDICATION REGIMEN
AND HAVE TRIED AND FAILED
MULTIPLE MULTIPLE MEDICATION. UM
WE ALSO THE TRANSITION OUT OF
THE HOSPITAL, AS MANY PEOPLE
HAVE DISCUSSED KEY OPPORTUNITY
TO ESTABLISH OUTPATIENT
CONNECTIONS, BUT OFTENTIMES OUR
HANDS ARE TIED BY THE LACK OF
AVAILABILITY TO ACCESS COMMUNITY
RESOURCE PROGRAMS. IN ORANGE
COUNTY. ANYBODY WHO WAS MEDICAL
WANTS SUBSTANCE ABUSE TREATMENT
HAS TO BE SEEN IN PERSON OUTSIDE
OF THE HOSPITAL AND PLACED ON A
WAITING LIST CANNOT REFER THEM
FROM INSIDE THE HOSPITAL, AS
NUMEROUS PEOPLE HAVE SAID,
BELIEVE THESE RESIDENTIAL
SUPPORT OF CRISIS SUB ACUTE
STEPPED DOWN TO HELP REDUCE
INPATIENT STAYS, ESPECIALLY
WHILE PEOPLE ARE WAITING FOR
PLACEMENTS FOR DIFFERENT
PROGRAMS AND THEN SOMETHING
THAT'S JUST I WANT TO MENTION
BECAUSE TO ME, IT'S SO EGREGIOUS
AND IN ORANGE COUNTY, THERE'S NO
WAY I CAN OBTAIN AHA. SHELTER
BEDS FOR AN FOR SOMEBODY WHO'S
IN THE HOSPITAL, WHETHER IT'S
MEDICAL OR PSYCHIATRIC UNTIL
THEY'RE ACTUALLY OUT AND ON THE
STREET BECAUSE THAT'S THE WAY
THE ACCESS PROGRAM HAS BEEN
DESIGNED IS THAT PEOPLE HAVE TO
BE ON THE STREET IN ORDER TO GET
SERVICES. AND SO WHEN THEY'RE IN
A HOSPITAL, THEY'RE TECHNICALLY
NOT ON THE STREETS. UM NOW IN
THE LAST COUPLE OF LAST COUPLE
SECONDS. I JUST WANT TO FOCUS ON
HOUSING. PEOPLE CANNOT STAY WELL
WITHOUT SAFE AND AFFORDABLE
HOUSING THAT PROVIDES THE
APPROPRIATE LEVEL OF CARE AND
SUPPORT FOR THEIR ILLNESS. WE
WANT PEOPLE TO BE INDEPENDENT AT
THE LEAST RESTRICTIVE LEVEL OF
CARE, BUT THAT CAN BE THAT CAN
REQUIRE VARIOUS LEVELS OF
SUPPORT THAT PEOPLE WITH SERIOUS
SENDING PEOPLE WITH SEVERE
MENTAL ILLNESS AND TRAUMA. TWO
STREETS IS JUST SETTING THEM UP
TO FAIL. I HAVE MULTIPLE WOMEN
HAVE TOLD ME THAT THEY USED
MESS. IN ORDER TO PREVENT
THEMSELVES FROM BEING ATTACKED
ON THE STREETS AT NIGHT. UM AND
SO, YOU KNOW, WE HAVE THINGS
LIKE FULL SERVICE PARTNERSHIPS
THAT HAVE SOME HOUSING STATEMENT
. BUT REALLY, THEY'RE ONLY
MOVEMENT BOARDS AND OVER LIVING,
WHICH MAY NOT PROVIDE THE
SUPPORT THAT SOME PEOPLE NEED.
UM I WANTED TO HIGHLIGHT ONE
EXAMPLE OF THE PROGRAM END
KELLER IN ORANGE COUNTY, WHICH
IS THE JOHN HENRY FOUNDATION,
WHICH IS A RESIDENTIAL FACILITY
THAT IT'S NOT LOCKED, BUT IT'S
FOR PEOPLE TO GET DIFFERENT
SPECTRUM DISORDER WHERE
MEDICATIONS ARE MINISTERED
PEOPLE THERE ARE PSYCHIATRISTS
THAT COME ON SITE. AND IT'S A
SUPPORTIVE LIVING SITUATION.
PEOPLE ARE SEMI INDEPENDENT
PLACES, BUT IT'S ONLY ONE
FACILITY AND IT'S A WONDERFUL
ONE. IT HAS WAITING LISTS FOR UP
TO A YEAR, AND IT ALSO ISN'T
COVERED BY INSURANCE OR MEDICAL
. WE NEED THESE BRIANTI OF
OPTIONS IN ORDER TO HELP ARE THE
INDIVIDUALS THAT ARE STRUGGLING
WITH WITH DIFFERENT LEVELS OF
CARE TO HELP KEEP THEM
INDEPENDENT. UM I THINK I MADE
IT IN ALMOST A LITTLE OVER FIVE
MINUTES. PHENOMENAL JOB. WHEN I
SEE YOU HAVE A STICKER A
CERTIFICATE WAITING FOR YOU.
THAT IS FANTASTIC. THANK YOU SO
MUCH. AND FOR OUR LAST PERSON,
ABSOLUTELY. AND FOR OUR LAST
PERSON WE HAVE JOY I LOVE I LOVE
FEAR WITH THE CALIFORNIA
ASSOCIATION OF MARRIAGE AND
FAMILY THERAPIST WELCOME. THANK
YOU. AND THANK YOU SO MUCH FOR
HAVING ME. CAN YOU HEAR ME?
OKAY. YES, WE CAN. OKAY ONE WITH
THE BAR HAS BEEN SET, SO I WILL
DO MY BEST THERE FIVE MINUTES OR
LESS. THANK YOU, DR JACKSON FOR
ALLOWING US THE OPPORTUNITY TO
BE HERE TODAY, ALONG WITH THE
ESTEEMED COLLEAGUES AND MEMBERS
OF THE PUBLIC. THE CALIFORNIA
ASSOCIATION, MARRIAGE AND FAMILY
THERAPIST OR CAMP. REPRESENTS
35,000 MEMBERS AND WE ARE
DEDICATED TO MAINTAINING HIGH
STANDARDS AND PROFESSIONAL
ETHICS. UM AND UPHOLDING
QUALIFICATIONS FOR THE
PROFESSION. IN ADDITION,
EXPANDING THE RECOGNITION AND
AWARENESS OF IMPORTANT WORK THAT
M FTS MARRIAGE AND FAMILY
THERAPIST BEYOND COUPLES THERAPY
, SO I LIKE TO SHARE THAT STDS
ARE TRAINED TO DIAGNOSE AND
TREAT INDIVIDUALS, PARTNERS,
FAMILIES AND GROUPS FROM A
VARIETY OF MENTAL HEALTH. FOR A
VARIETY OF MENTAL HEALTH ISSUES
. SO UM THEY TREATING AREAS
INCLUDING PERSONALITY DISORDERS
, BIPOLAR DISEASE, DEPRESSION,
PTSD, THE IN ADDITION TO ANXIETY
AND INTERPERSONAL RELATIONSHIPS
, AND SO BECAUSE OF THIS, YOU'LL
FIND EM FPS IN A VARIETY OF
POPULATIONS, SCHOOLS, HOSPITALS
UM, DIFFERENT MENTAL HEALTH
FACILITIES, AGENCIES AND, OF
COURSE, PRIVATE PRACTICE. UM
I'LL JUST KIND OF GIVE SOME
HIGHLIGHTS HERE, SOME OF WHICH
HAS ALREADY BEEN SET. I WON'T
EMPHASIZE THOSE ITEMS, BUT WHEN
WE LOOK AT AREAS THAT CAN HELP
IMPROVE ACCESS, I WANT TO ECHO
ALEXIS EGAN'S COMMENT THAT I'M
LOOKING AT THE RATES AND BEING
ABLE TO HAVE UH, COMPENSATION
THAT REALLY KEEPS PEOPLE IN THE
FIELD. SO I'M LOOKING
SPECIFICALLY AT MEDICAL AND
LOOKING AT THE INSURANCE RATES.
AND WE REALLY, UM HAVE A DESIRE
FOR THOSE RATES TO BE HIGHER, UM
, TO ATTRACT MORE PROVIDERS TO
PARTICIPATE AND MEDICARE, MANY
OF OUR PRE LICENSED PROVIDERS
GAIN THEIR 3000 HOURS OF WORK
FOR WORKING LOW WAGE OR EVEN FOR
FREE AND SO THEY'RE NEEDING TO
PAY OFF HUGE LOANS. AND UM,
OFTEN, THEY THEN GO INTO PRIVATE
PRACTICE VERSUS STAYING IN THESE
TYPES OF SETTINGS BECAUSE OF THE
COMPENSATION. I ECHO THE PART
TIME WITH BENEFITS. UM SIMILARLY
, GRANTS AND SCHOLARSHIPS SO
REALLY LOOKING AT THE PIPELINE
AT THE OUTSET, AND HOW DO WE
INCREASE THAT OPPORTUNITY? UM
TELEHEALTH HAS BEEN VERY
SIGNIFICANT IN TERMS OF
BROADENING OUR REACH, AND IT'S
STILL IMPORTANT, SO WE HOPE THAT
THAT STAYS AT THE FOREFRONT
FRONT. UM A FEW OTHER THINGS
HERE IS JUST LOOKING AT MAKING
SURE THAT WE ALSO ARE ABLE TO
ATTRACT DIVERSITY AMONGST THE N
A. T SO THAT WE COULD BE
CULTURALLY RESPONSES. TO UM OUR
COMMUNITY SO LOOKING AT WAYS TO
SUPPORT DIFFERENT ORGANIZATIONS
, SUCH AS THE ONES YOU HAVE HERE
IN THEIR PIPELINE OUTREACH TO
DIVERSIFY THE REPRESENTATION IS
APPROPRIATE. UM. YOU KNOW, WE'RE
LOOKING FOR FREEDOM OF CHOICE IN
THE TREATMENT AND PROVIDER
OPTIONS THAT SERVE INDIVIDUALS,
UNIQUE, MENTAL, EMOTIONAL AND
THERAPEUTIC NEEDS, PROVIDING
TEAM BASED AND COLLABORATIVE
CARE MODELS IS ALSO VERY
IMPORTANT TO PROVIDE A RANGE OF
SERVICES TO ENSURE POSITIVE
OUTCOMES. AND YOU KNOW, ALSO
LOOKING AT REMOVING EXISTING
DURING THE JURISDICTIONAL
BARRIERS THAT PREVENT QUALIFIED
PEOPLE FROM BEING ABLE TO RENDER
CONTINUITY OF CARE. SO WE HAVE
SEEN INSTANCES WHERE BECAUSE
SOMEONE RUNS UP AGAINST A
BARRIER THEY NO LONGER CAN SEE A
PROVIDER THAT THEY'VE SEEN FROM
MANY YEARS. SIMILARLY OTHER
TYPES OF BARRIERS REMOVING
PROVIDER PARODY BARRIERS TO
INCREASE ACCESS. SO REALLY
LOOKING AT OPPORTUNITIES TO
SUPPORT QUALIFIED PROVIDER.
VERSUS DEFINING BASED ON
LICENSURE TYPE PREFERENCES, SO
THAT'S REALLY BIG, AND I THINK A
GREAT WAY TO INCREASE
OPPORTUNITIES THERE. AND JUST
REDUCING ADMINISTRATIVE BURDENS.
THAT'S A BIG CHALLENGE FOR OUR
PROFESSIONALS AS WELL. THIS IS
PREVALENT IN THE HEALTH
INSURANCE SYSTEM AND PROGRAMS
THAT DETRACT FROM THE PATIENT
CARE. AND THIS ISN'T THAT AND
THIS INCENTIVIZE PROVIDER
PARTICIPATION. SO UM, YOU KNOW,
I THINK MORE BROADLY, I LOVE
THIS FORM, AND WHAT WE'RE DOING
IS EXACTLY WHAT WE NEED TO BE
DOING. HAVING THESE DISCUSSIONS
LOOKING AT STATEWIDE AND ALSO
LOCAL CAMPAIGN. TO INCREASE THE
LEVEL OF HEALTH AND LITERACY AND
CYCLE EDUCATION AMONGST
CONSUMERS AND TO CONTINUE TO BE
STIGMATIZED MENTAL HEALTH
ILLNESS AMONGST CONSUMERS. AND,
UM, PROVIDING POLICIES THAT
SUPPORT HEALTH EQUITY AND
REDUCED WORKFORCE DISPARITY
BETWEEN WAR. URBAN AREAS. AND
ALSO BETWEEN ORGANIZATIONS AND
FACILITIES AND THEN LASTLY,
FUNDING FOR INVESTMENT THAT
DEVELOP AND SUPPORT HEALTHCARE
TECHNOLOGY, SO RESOURCES AND
SERVICES TO IMPROVE THE QUALITY
OF CARE, LOWER COSTS OF CARE AND
IMPROVED ACCESS TO CARE. SO I
CUT OUT A LOT THAT I HAD. I AM.
UH, THANK YOU AGAIN FOR THIS
OPPORTUNITY, YOU KNOW, BEING
AROUND THEIR TIME AFTERWARDS FOR
QUESTIONS. THANK YOU VERY MUCH.
WE WANNA THANK THIS PANEL FOR
GIVING US A GLIMPSE ON THINGS
THAT ARE HAPPENING ON THE
GROUND. WE HEAR YOU LOUD AND
LOUD AND CLEARLY IN TERMS OF
WORKFORCE. UM AND UNDERSTANDING
THAT WE CANNOT AFFORD TO DELAY
WORKFORCE INVESTMENTS AND WE'RE
GOING TO DO EVERYTHING THAT WE
CAN TO MAKE SURE THAT THAT THAT
PIPELINE CONTINUES TO GROW IN
THE FUNDING THAT COMES WITH IT.
SO THANK YOU VERY MUCH TO THIS
PANEL REALLY APPRECIATE IT. UM
NOW WE WILL GO TO ANY PUBLIC
COMMENT OR IF THERE'S ANYONE IN
THE ROOM THAT WOULD LIKE TO DO
PUBLIC COMMENT, YOU PLEASE COME
ON UP. UM AND THEN WE WILL OPEN
IT UP TO THE PHONE LINES BEFORE
WE ADJOURN. CHERRY JACKSON AND
COMMITTEE MEMBERS. THANK YOU SO
MUCH. FOR REALLY PUTTING SHINING
THE LIGHT ON THIS CRISIS. UM AND
IT IS A CRISIS. I'M CHRIS STONER
MERTZ AND THE CEO OF THE
CALIFORNIA ALLIANCE OF CHILD AND
FAMILY SERVICES. WE HAVE 100 AND
60 NONPROFIT, COMMUNITY BASED
ORGANIZATIONS DOING BEHAVIORAL
HEALTH AS WELL AS OTHER FAMILY
SUPPORT SERVICES TO CHILDREN,
YOUTH AND THEIR FAMILIES.
THROUGHOUT THE STATE. WE AS I
SAID, WE ARE REALLY APPRECIATE
THE ATTENTION YOU'RE BRINGING TO
THIS CRISIS. OUR MEMBERS HAVE
SEEN THE IMPACT OF THIS CRISIS
ON OUR CHILDREN AND YOUTH,
RESULTING IN INCREASED RATES OF
SUICIDE AND HOSPITALIZATIONS,
PARTICULARLY FOR YOUTH OF COLOR
. AND THOSE IN THE LGBTQ PLUS
COMMUNITY. THE INTENSITY OF NEED
FOR MENTAL HEALTH AND SUBSTANCE
USE INTERVENTIONS. WORKFORCE
CRISIS, BURDENSOME DOCUMENTATION
, REQUIREMENTS AND MEDICAL THE
LOSS OF SHORT TERM RESIDENTIAL
THERAPEUTIC PROGRAMS AND
SIGNIFICANT CHANGES TO THE
FINANCE FINANCING STRUCTURES IN
MEDICAL ALL HAPPENING
SIMULTANEOUSLY ARE FURTHER
EXACERBATING, UH, THE ISSUES
THAT PROVIDERS HAVE AROUND
PROVIDING THESE SERVICES
QUICKLY. TIMELY. UM AND ENSURING
THAT THE FULL ARRAY OF SERVICES
ARE AVAILABLE, SO WE DEEPLY
APPRECIATE YOUR LEADERSHIP AND
LOOK FORWARD TO WORKING WITH YOU
AND THE ADMINISTRATION ON
SOLVING THESE ISSUES AS QUICKLY
AS POSSIBLE. THANKS. AND THANK
YOU. UM NEXT, WE WILL GO TO OUR
PHONE LINES. IS THERE ANYONE ON
THE PHONE LINES WHO WISH TO
PROVIDE PUBLIC COMMENT? TO
PROVIDE PUBLIC COMMENT. PLEASE
PRESS 10 ON YOUR TELEPHONE
KEYPAD AT THIS TIME, AND 18 T
SPECIALIST WILL PROVIDE YOU WITH
THE AIRLINE NUMBER BY WHICH WILL
BE IDENTIFIED. WE WILL FIRST GO
TO LINE 15 GO AHEAD, PLEASE.
LINE 15. YOUR LINE IS OPEN. GO
AHEAD, PLEASE. FIND 15. PLEASE
CHECK YOUR MUTE FEATURE OR PICK
UP YOUR HANDSET. WE WILL MOVE ON
ONE MOMENT, PLEASE. MOVE ONTO
LINE 17. GOOD AFTERNOON, MARY
CHRISTIE ON BEHALF OF THE
CHILDREN'S PARTNERSHIP,
COMMENTING ON THE CHILDREN'S
MENTAL HEALTH CRISIS, THE
CHILDREN'S PARTNERSHIP APPLAUDS
THE INVESTMENT AND THE CHILDREN
AND YOUTH BEHAVIORAL INITIATIVES
, IN PARTICULAR THE
PRIORITIZATION OF VINCENT
TODDLERS AND EXISTING
INVESTMENTS LESS FAR. THE
REALITY REMAINS, HOWEVER, THAT
THE VAST MAJORITY OF THE
HISTORIC BBH AYE. INVESTMENTS
ARE GOING TO SCHOOL AGE CHILDREN
AND THE SYSTEMS THAT SERVE THEM
. TCP BELIEVES THAT IN ORDER TO
MEET THE STATE'S GOAL OF
REDUCING A C, E S AND TOXIC
STRESS BY HALF WITHIN ONE
GENERATION AND TO ADVANCE THE
GOVERNOR'S COMMITMENT TO
IMPROVING THE MENTAL HEALTH OF
OUR STATE, CHILDREN AND YOUTH,
AN ADDITIONAL ONE TIME $100
MILLION GENERAL SEND
APPROPRIATION TO SUPPORT INFANT
AND EARLY CHILDHOOD MENTAL
HEALTH SERVICES AND PROVIDES
PROVIDER TRAINING WOULD
SIGNIFICANTLY MOVE OUR STATE TO
GREATER MENTAL HEALTH EQUITY.
BRO CALIFORNIA'S INFANTS AND
TODDLERS, ESPECIALLY THOSE FROM
COMMUNITIES OF COLOR THAT HAS
BEEN HISTORICALLY MARGINALIZED
AND HIT HARDEST IN THE LAST
THREE YEARS, FUNDING DEDICATED
EXCLUSIVELY TO INFANTS AND
TODDLERS IS NECESSARY TO ENSURE
MENTAL HEALTH SYSTEM OF CARE IS
PREPARED TO MEET THE NEEDS OF
ALL CHILDREN AND YOUTH IN
CALIFORNIA. WE LOOK FORWARD TO
WORKING WITH YOU. THE
ADMINISTRATION PARTNERS AND
FAMILIES ACROSS THE STATE TO
ENSURE CHILDREN FROM BIRTH TO 26
ARE PRIORITIZED. THANK YOU FOR
YOUR CONSIDERATION. THANK YOU.
THANK YOU. LINE 16. GOOD
AFTERNOON. MY NAME IS LISA
COLEMAN. I'M THE LEGISLATIVE
DIRECTOR FOR THE CALIFORNIA
COMMISSION ON AGING, AND I JUST
WANT TO START BY SAYING I DID. I
DID SIGN ON A LITTLE LATE, SO IF
I MISSED IT, I APOLOGIZE IN
ADVANCE WHEN I WAS REVIEWING TO,
UM, THE ANNOUNCEMENT OF HIS
HEARING. I WAS VERY EXCITED TO
SEE THAT IT REFERENCED CHILDREN,
ADULTS WITH DISABILITIES FAMILY.
AND OLDER ADULTS, BUT THEN I
DIDN'T HEAR ANYTHING ABOUT OLDER
ADULTS. SO AGAIN IF I MISSED IT
. MY APOLOGIES, BUT I AM CALLING
TO REMIND THIS COMMITTEE AND TO
THANK THEM FOR THIS FOCUS ON
BEHAVIORAL HEALTH AND TO REMIND
US THAT OLDER ADULTS IS THE
FASTEST GROWING SEGMENT OF OUR
POPULATION. EVEN BEFORE COVID
30% OF OLDER ADULTS WERE
DIAGNOSED WITH COGNITIVE
COGNITIVE IMPAIRMENT. ANXIETY OR
DEPRESSION, AND THAT WAS BEFORE
COVID. BUT OF THE 30% THAT HAD A
DIAGNOSIS. 4% OF OLDER ADULTS
UTILIZED LONG TERM SERVICES FOR
BEHAVIORAL HEALTH. OF THEM DON'T
HAVE ACCESS TO IT. I WANT TO
REMIND THIS COMMITTEE OF THE
GROWING IMPACT THAT BEHAVIORAL
HEALTH HAS ON OUR HOMELESS OLDER
ADULTS. IN CALIFORNIA FROM 2017
TO 2021, THE NUMBER OF PEOPLE 55
OVER WHO SOUGHT HOMELESSNESS
SERVICES, BUT THE MAJORITY OF
THEM EXPERIENCED HOMELESSNESS
FOR THE VERY FIRST TIME
INCREASED BY 84. CERTAINLY NOT.
EVERY OLDER ADULTS WHO IS, UM
IT'S FACING HOMELESSNESS. UM HAS
BEHAVIORAL HEALTH ISSUES, BUT
CERTAINLY ALL OF THOSE WHO ARE
NOW HOMELESSNESS HAVE BEHAVIORAL
HEALTH ISSUES. AND SO WE DO IT
FOR, UM, THE. WHAT'S THAT
EXPRESSION? THE CURE IS, UM. OH
I'M GETTING OFF MYSELF ALL
CONFUSED. I THINK YOU KNOW WHAT
I'M TRYING TO SAY. PREVENTION IS
CHEAPER THAN A CURE. AND SO WE
ASK THAT YOU FOCUS SOME OF THESE
INTENTIONS ON OLDER ADULTS.
THANK YOU. THANK YOU VERY MUCH.
THAT'S THE REMINDER IF YOU DO
WOULD LIKE TO COMMENT, PRESSED
ONE THAN ZERO AT THIS TIME.
WE'LL GO NEXT TO LINE 19 GO
AHEAD. GET AFTERNOON. THIS IS
REBECCA GONZALEZ WITH THE
NATIONAL ASSOCIATION OF SOCIAL
WORKERS. CALIFORNIA CHAPTER. UM
I JUST WANTED TO COMMENT VERY
BRIEFLY ABOUT THE PIPELINE. UM
FOR PEOPLE ENTERING THE
PROFESSION OF SOCIAL WORK
RECENTLY, THE ASSOCIATION OF
SOCIAL WORK FORD HAS RELEASED
LONG SOUGHT DATA. ON WHO WAS
PASSING THE NATIONAL EXAM THAT
WE TAKE IN CALIFORNIA FOR PEOPLE
TO BECOME LICENSED CLINICAL
SOCIAL WORKERS AND THE EXAM
DISPARITIES THAT WE HAD
SUSPECTED FOR MANY YEARS WERE
CONFIRMED, UM, BLACK TEST TAKERS
IN PARTICULAR. UM WE'RE NOT
PASSING THE EXAM AT THE SAME
RATE. AND THERE HAS BEEN A LOT
OF DISCUSSION ABOUT THE
CONSTRUCTION OF THE EXAM AND THE
BIAS BUILT INTO THE EXAM. SO I
DO THINK WE NEED TO LOOK AT HOW
WE ARE LICENSING OR PROFESSIONS
, MAKING SURE THAT WE ARE, UM,
MAKING SURE THAT THERE ARE
ENOUGH DIVERSE PROFESSIONALS TO
SERVE OUR DIVERSE COMMUNITIES.
THANK YOU. THANK YOU. WE HAVE NO
FURTHER LINES IN CUBA AT THIS
TIME. OKAY THANK YOU VERY MUCH.
WE WANNA THANK EVERYONE WHO
PARTICIPATED TODAY. ONCE AGAIN.
THIS IS JUST THE FIRST ROUND.
UM, OF HEARINGS. UM, AND OUR
NEXT ONE WILL BE ON TUESDAY. MAY
16TH AND WE'RE LOOKING FORWARD
TO CONTINUE THE DISCUSSION TO
MAKING SURE THAT WE GET THIS
RIGHT AND WE MEET THIS MOMENT
AGAIN. I WOULD LIKE TO THANK MY
COGLEY COLLEAGUE
ASSEMBLYMEMBER'S PELLERIN FOR
HER PARTNERSHIP IN THIS EFFORT.
WE WANT TO THANK THE SERGEANT'S
FOR, UH, ALL THE BEHIND THE
SCENES WORK AND WANT TO THANK MY
STAFF AS WELL WHO I HAVE
STRESSED OUT IMMENSELY, UM, AND
MAKING SURE THAT THIS GOES, UM
GOES, UH, RIGHT. SO THANK YOU
VERY MUCH, AND THIS HEARING IS
ADJOURNED.