Vermont Legislature SmartTranscripts:

[Alyssa Black (Chair)]: Hi, welcome back. It's afternoon, January 14, and we are starting testimony we had walked through earlier from Katie McLennan from the Legislative Council on H270 and we have in with us, I think we're going to start with Lieutenant John Ott or did you guys both want to come up? I think we were with Trevor or or no. I mean, don't have to. I didn't know if we were all open with slides.

[Brian Cina (Member)]: Let's do separate. It's

[Mark McDonough]: okay. Well, thank you for having me. Appreciate appreciate the opportunity to speak to this legislation that we definitely think is pretty important. Do you need to introduce myself? Do already have the other

[Alyssa Black (Chair)]: Introduce yourself and what do your role. Wonderful.

[Mark McDonough]: My name is Mark McDonough. Professionally, I'm a battalion chief for the Burlington Fire Department. Additionally, I reside in Warren, Maderuk Valley, where I volunteer on the Warren Fire Department and also volunteer on the matter with Landscape Control. So pretty, pretty ingrained in the first response community here in the in the state of Vermont. So but today, I'm kinda here in multiple roles. I hope I have an opportunity to speak later on about being a part of a peer support team. But right at the moment, I want to speak kind of representing the Emergency Service Provider Wellness Commission, where I serve as the vice chair of that commission. We are charged with numerous things by the state statute that was created a number of years ago in 2021. One of those things that we really focus on is looking at legislation, either creating on our own that we want to push forward or seeing legislation that exists that we think is really important and supporting it and being vocal about that. That's the case today. We learned last session about H-two 70, a bill that would make peer support interactions and communications between peer support team members and the first responders that they're assisting confidential, which currently does not exist. And before I go off on any tangents, I'll just kind of look at my written words. And so while there have been some cultural improvements in first responders seeking help when their mental health is struggling, unfortunately, the stigma surrounding this still remains a challenge and a barrier for first responders in seeking help. Despite the inherent stressful nature of their work, there's a persistent reluctance among many first responders to seek help as they fear it would be viewed as a sign of weakness or an inability to perform their duties. One of the most successful methods of convincing a member to seek help is to gain their trust and confidence that doing so will remain completely confidential. Peer support programs are recognized as having the lowest barrier for seeking help. So when we think about all the different resources that we have for folks, the first line of defense and the easiest manner for somebody to seek that help is to go and seek a peer. And in the state of Vermont, we have multiple organized peer support teams, some of whom are specifically created to work for their organization, such as the Burlington Fire Department's Peer Support Team or the Vermont State Police Members Assistance Program. And others are designed to support all of Vermont's first responders, such as the EAP First Secure Program, which has over 80 members that are available to support every first responder in the state of Vermont, no matter what type of organization they're a part of. The benefit and the reason why peer support programs are so successful is that they're immediately available. You just pick up the phone and call your peer, right? It's not calling a clinician, making an appointment, seeing if they have availability, do they take your insurance? You just call a friend and they answer the phone right away. It's that relatability because they've shared those lived experiences. They've dealt with those life stresses. They've dealt with the challenges of the shift schedule. They've seen those traumatic calls that we've all been on. And there's a reduced stigma in talking to a peer versus a professional, right? Successful peer support programs provide early intervention and help first responders reduce their stress levels and remain more resilient. There's absolutely no question about that. The backbone of any successful peer support program is trust and confidentiality. If a member of a program were to ever violate this, not only would that member never be successful again in being a peer supporter, but would also significantly compromise the integrity of that team in general. And the success of that team is certainly at risk. That's why it's really common practice for most programs to create their own policies that confidentiality is part of being on that team. Any violation of that is grounds for dismissal from that team. We certainly have that in Burlington and part of the language if you want to join our program. The challenge, though, is that we don't have any legal protections. Think for that's not really the best word to put it. But The Mexican. Yeah. Exactly. To to try to enforce that. Right? And this legislation would add another layer to that of protection and trust so that we can go to the first responders of law and say, if you utilize a peer support program or you you utilize a peer to share what you're going through, you know that not only do we have a policy, but it's state law that we have to maintain confidentiality and you have the protection of like the employer can't come and try to force our hand and threaten us with anything to tell you what we discussed. And we're extremely confident that that level of protection would help break down a barrier that may be preventing somebody from seeking that help. Throughout the country, many other states are taking or have taken the same measures to protect the confidentiality of these communications. In New England, Connecticut, Maine, Massachusetts, and New Hampshire all have some type of confidentiality laws on the books. Elsewhere in the country, Colorado, Florida, Maryland, New York, and South Dakota have laws. Federally, there is a law protecting peer support communications amongst federal law enforcement officers. So this is not something that's unique. In fact, in New England alone, Vermont is one of only two states remaining that hasn't addressed this. I would also be remiss if I didn't point out that Vermont does have a law protecting the confidentiality of peer support for the Department of Corrections only, and it's very specific to their entity. So it's something that's been tackled before. How we didn't hear about it while it was going through the process were unsure, especially because we had a member from the Department of Corrections on the commission. But it did, and and I would certainly want to reference the language that they use as we look at at the bill that you have in front of you. And I do have, in my document that I can share with the clerk, I do have that bill outlined so you guys can reference it so easily.

[Alyssa Black (Chair)]: And if you don't have this, don't worry about it. I can get it elsewhere. But do you happen to have a citation where in statute the Department of Corrections policy is? And do we need to because they're covered under this, should that Does be

[Mark McDonough]: this make sense? If I could just tell you the numbers and numbers. Vermont Section eight, twenty eight BSA, 126.

[Alyssa Black (Chair)]: 126 in 28 BSA? Yep.

[Mark McDonough]: Sorry. I don't have I don't really know what in one

[Brian Cina (Member)]: of those books. Don't I don't

[Alyssa Black (Chair)]: know what chapter the Department of Corrections falls in. We never do anything in there.

[Mark McDonough]: In my head I'm not even gonna try to do that because I was looking at it this morning. Yeah. So I I would strongly encourage you to look at the language of that bill. H two seventy was introduced last year by the Vermont Police Association, if I recall correctly. I do think it's imperative for me to share that the commission is extremely supportive of the intent of the bill. We have significant concerns with some of the language used in the bill and we've expressed that. We expressed that last session, I've shared a draft of what we would say it'd be like the language that we would prefer to see utilized in a bill that may go forward this year, not having the exact understanding of how the process works. But we've we've shared a document with the clerk with that information.

[Alyssa Black (Chair)]: Could you could reshare that document? On the website. It is? Oh, okay.

[Brian Cina (Member)]: I was gonna ask it, and I just looked and I saw it. And I'm reading it.

[Alyssa Black (Chair)]: Well, also our legislative email is purged after six months. So something

[Mark McDonough]: Just sent it on

[Brian Cina (Member)]: Okay. Great.

[Alyssa Black (Chair)]: It's posted. Bad for not looking.

[Brian Cina (Member)]: I some of your additions. Yeah.

[Mark McDonough]: Well, can I mean, you'd like to hear, I can share that some of the primary concerns that we have and and I think we're very understanding of why the folks that introduced the bill have the language they do because it's it's almost verbatim to the federal language, which again is specific to federal law enforcement officers? I'm unfamiliar with the type of peer support programs that they utilize at the federal level or who they bring in to do debriefings or anything like that. And so one of the big things that the terms that they use that are very concerning to us is the term counseling. So it's a peer support counseling session. One of the absolutes that we learn right at the very, very beginning of our trainings is that as a peer supporter, we are not in any way, shape or form counselors. We do not treat people in any way, shape or form. Our job as peers are to be empathetic listeners and to truly hear what it is that our member is saying to us. Because oftentimes just sharing how you're feeling, I think as we all know in just life in general, sharing how you're feeling and what you're going through is all you really need to help process what you're going through. And then the other component of being a peer supporter is that we are the subject matter experts on the resources that are available to our members. So our our job is to just hear them and then hear what it is that they're saying they need. And as if it's just to talk it out, that's easy. If it's, hey, I I think I need this resource instead of them doing any of the legwork, our job is to be able to just make it happen for them. So to use a term counseling session, we're just really uncomfortable with as a commission because we don't want there to ever be any question about what our roles are and what job we can do. I would imagine that clinicians and counselors would have concerns about that language as well-being in that field.

[Alyssa Black (Chair)]: Assuming you don't refer to it in normal conversation as a peer support counseling session.

[Mark McDonough]: Never. Never. No. Communication, peer support communication. Other terms that you may hear us use is a critical incident stress debriefing, where we go and help the crews from an incident debrief over something. But again, that's just us listening. We provide some guidance and some guardrails for the conversation just based off of scientifically proven methods that work. My team in Burlington, that's not something we do. We don't even do debriefings. Our training is just in the listening aspect of things, being active listeners and being subject matter experts. Whereas the security team does do debriefings. And they're for very good reasons that the security team, that's their method and like our fire department's team has our method. There's just enough nuanced differences in how our job works. Have, in the fire department, we have the kitchen table. And so after those tough incidents, we all go back around that kitchen table and sit around together and can discuss those things. And that's where the peer support team can come in and just sit at that kitchen table and be a part of that. Whereas, outside of the professional fire service, there's that doesn't exist. Right? If you think about our volunteers, they go on the call, calls over, they get in their vehicles and go back home. Police officers, they work independently in their cruisers. They don't have that congregate area where they can all gather and be together and discuss things. That's why debriefings work really well for the law enforcement side of things. Same dispatchers are independent. If you think about all the other, groups that that we serve here on the commission, The professional fire service is the only one that has that natural ability to gather and support each other. Yeah. So I just I I guess I just wanna to just leave you with just the Again, the commission is so supportive of the H-two 70 and its intent, but we are very hopeful that we can be a big part of the conversation moving forward as we evaluate the language of this and would strongly emphasize our desire to make some edits to the language as it stands right now.

[Alyssa Black (Chair)]: Can you highlight, because it looks like you've sort of rewritten the bill, other than what you pointed out with the peer support, the counseling session, or not including that, is there anything substantive that is a change

[Mark McDonough]: can highlight for us? Other areas that we made some changes to were what defines a peer support team member.

[Brian Cina (Member)]: What

[Mark McDonough]: defines a peer support team program. We also added in language at the end of the draft that we were proposing that provides some protection from liability to peer support team members because currently there is nothing that's specific about that. And while clinicians and other medical professionals can purchase insurance that protects them from those areas, it'd be pretty cost prohibitive for us to purchase our own. So we added some language in there to that.

[Alyssa Black (Chair)]: I see that, and little g. Brian?

[Brian Cina (Member)]: Yeah, two questions. One is, does say, I noticed in the definition of an emergency service provider, you added in medical examiners and assistant medical examiners. Then it says all of the first responders as defined by the Emergency Service Provider Wellness Commission Act. At first I thought it said by the commission itself, and so I saw that as like the commission could say, Oh, we're missing members, they should be included. But then it said the act, and then I reread the act, and the act actually has less members defined than you do. And so that could just be a discrepancy, but it led me to the question, why would we not include emergency mental health workers? I work for First Call part time, and we go into situations with the police and firefighters and EMTs and see some of the same things sometimes. But we're not considered an emergency service provider under this law. Were literally who people call when they are having a mental health emergency. What are your thoughts about adding that category or any others that we may have missed?

[Mark McDonough]: That leads us down a path to a whole another separate conversation and another piece of legislation that we're very hopeful to be able to bring forward, if not this session and soon, is expanding the definition of first responders in the state of Vermont for exactly what you said.

[Brian Cina (Member)]: We could do that in

[Trevor Whipple]: this bill,

[Brian Cina (Member)]: but could use the bill as a vehicle to do that stuff.

[Alyssa Black (Chair)]: I would say that as this bill is currently configured around confidentiality, you, the first call, would be covered under the confidentiality because Howard is a provider required by federal law for confidentiality.

[Brian Cina (Member)]: Except that. So here, just to talk through this, because they may also have insight into this because of what you said about the employer. Let's say me and other crisis workers form a group, a peer support group, and we're debriefing an incident and the agency wants us to turn over that information to them about what happened, we have to. We can't say that And what this would allow is it allows the peers to So let's say I'm having PTSD and I don't want my boss to know because I'm afraid they're going to punish me or something, because that does I'm not saying Howard does that, but that happens, please. I'm afraid of that. So I'm telling my coworkers and the supervisors, you need to tell me what Brian said in that meeting, there's nothing saying that they can say no to that right now. It doesn't matter if Howard's a HIPAA covered agency. I'm not a client, I'm a worker. And so similarly, I think if the firefighters are talking amongst themselves about something that happened and the mayor comes in and is like, You need to turn over to me. What this person said in the meeting about themselves, how do they protect their own from someone above them trying to come in? And this would say, they would have the right to say to the administration, No, this is protected information. It's about ourselves and about what we went through. You don't have a right to know that. And so similarly, there's no protection that I'm aware of for mental health workers or any healthcare worker against the employer coming in and saying, you have to turn over information about your coworker and their mental health to us. And it's just weird to me too. We have probation officers here, and they're covered. I'm not saying they don't walk into these situations where they go to check on someone and find someone dead, overdosing and these horrible things that are happening every day that we're seeing, but why is a probation officer in there, but not like a mobile crisis, I guess.

[Mark McDonough]: Guess, is there I mean, to be specific on that one, just because they're under the definitions of the Vermont criminal justice.

[Brian Cina (Member)]: Oh, is it because they're a sworn officer? Yeah.

[Mark McDonough]: Because it covers any sworn officer in the state.

[Brian Cina (Member)]: So I'm not saying we should take them out. It's more like why would we not include mobile crisis or other things that maybe recovery coaches are going into situations where they're finding people like, I don't know.

[Alyssa Black (Chair)]: I think it opens up a larger question around, in general, all employee assistance programs for all types of entities regardless of I'm setting that aside

[Brian Cina (Member)]: But this isn't an employee assistance program, right? This has

[Mark McDonough]: appeared. It speaks specifically to peer support communication.

[Alyssa Black (Chair)]: Yeah. How

[Mark McDonough]: that occurs happens in a variety of ways. So specifically, the secure team, which is a group of peers who are trained Yeah. Through specific It's what we're

[Brian Cina (Member)]: gonna do. We

[Mark McDonough]: know in the next category.

[Alyssa Black (Chair)]: Thank you.

[Mark McDonough]: I didn't know if they were trying to add to

[Brian Cina (Member)]: the comment. It was a classic COVID moment.

[Mark McDonough]: Luckily, it wasn't anything embarrassing.

[Brian Cina (Member)]: Yeah. Yeah. Bye. Bye. Go ahead.

[Alyssa Black (Chair)]: Think hold on one second. Let's you wanna see? Yeah. Can we can we mute?

[Brian Cina (Member)]: Sounds good.

[Carrie Mall]: Hi. My name is Carrie Mall. I'm a peer, and I'm also a clinician. I can speak to that for that gentleman. I'm sorry. Didn't catch your name. I'm actually, oh, one second. I'm actually visiting another fire station out of state right now. So if you are an emergency mental health clinician, you are supported and you follow HIPAA. So you actually have a higher level of protection right now. And if your agency is pushing you to do that, that is illegal and you are protected by HIPAA. But I think that's taking away right now from what we have this going on because it's totally separate. I just wanna remind everybody that the majority of these first responders are unpaid. They are volunteer, they're farmers, they're workers, They have nothing, and this is to protect us so we have somebody. So these people will maybe call mobile crisis, but those are a totally separate entity. They have different licenses. When I practice as a LICSW, I have responsibilities. Also as a mandated reporter in Vermont, volunteer firefighters in EMS are not necessarily mandated reporters. That needs to be a totally separate conversation from this legally. If anyone wants to speak to that after this, can. I come from a state originally that has that separation. Four, is very well meaning, I understand to bring it up right now, but it's a very separate situation from what Mark is bringing up because you have protections already federally and within the state. And part of that too is making sure that these agencies are having licensed people to provide those mobile critical care, which I think in Vermont sometimes we're a little lapsed with people having the correct licenses to be providing the care they have. But that's very separate from your firefighter or your we've got a lot of volunteer mobile ski patrol. I also work with those in the prisons. We it's a very broad range, but this is to protect people who are not employed. They don't we don't get stipends for anything. We have we have no professional union. We have nothing. And I think it's important that we stay on track to focus for those. You know? And I I just really needed to speak up to say that because it's a very different situation right now. And that is a very separate thing. Our mental health and those resources in our state is very broken for the community as a whole. And mental health workers do need support, but this is a very different coverage. To expand that would would not do this justice for those moving forward.

[Alyssa Black (Chair)]: Thank you, Carrie, for refocused. Let's let's wait until Carrie testifies, and then we'll

[Brian Cina (Member)]: I'll write it down. Okay. Alright.

[Carrie Mall]: Yeah. I'm all done. I just wanna make sure to bring that up.

[Alyssa Black (Chair)]: Thank you, Mark. You want to continue?

[Mark McDonough]: Yes. I mean, that was pretty much the end of what I had written down. I do think, yeah, as I said, there's other areas that we're certainly very interested in pursuing. And that is a topic that I think is worth discussing is what does define a first responder. It's a complex conversation, right? I mean, and there's a lot of people that are gonna have very strong opinions about that for various reasons. Certainly, there's going to be businesses and industries that are going to have some pretty passionate things about how this could affect workers' comp law or workers' comp costs and so on and so forth. But anyways, yeah, I'm happy to take any questions that you may have about this.

[Alyssa Black (Chair)]: Any questions? Yeah. Go ahead. So I was and and and the bill itself, it does have protection for the employer to not get sued or something. What would you want for first explain this to me. So the peer to peer, it's organized through the Burlington Fire Department. Correct. Are there guidelines to it? Like, I I understand how you wanna be protected.

[Brian Cina (Member)]: Mhmm.

[Alyssa Black (Chair)]: But what is the setup so that we could actually do something to text those that are doing the peer to peer?

[Mark McDonough]: Like the employee, not the employee, but the peer team member?

[Alyssa Black (Chair)]: Yeah, because you've mentioned that you're worried that there's no protection for them.

[Mark McDonough]: Right. And that's what, and maybe we added an R where we meant to leave just ease because the intent of that liability is to protect the employee to the liability is there for the peer support team members because currently there is nothing.

[Daisy Berbeco (Ranking Member)]: There is nothing.

[Mark McDonough]: Right. It gives us

[Alyssa Black (Chair)]: this bill only protects the employer. Right.

[Mark McDonough]: And I'm not sure if you're looking at my draft language.

[Alyssa Black (Chair)]: No, I'm looking at the initial.

[Mark McDonough]: H two seventy? Yeah. So that's very much something that we changed in the draft language that we've created, where there would be protection for the team members from liability and trying to give us some protections if I somebody were to come after mean, obviously, when there's gross negligence, like in anything, But when folks are acting appropriately within their training, if somebody takes issue with that, then we'd like to see our members feel confident that they are acting in people's best interests and have some level of protection, which doesn't exist. Sure.

[Alyssa Black (Chair)]: What's the process for someone to be designated your support team member?

[Mark McDonough]: So it depends on which team you're a member of. The certification is the most common is ICISF. Forgive me, I cannot remember exactly what that stands for, but we can certainly get you that information. The members on the secure team all have that training. The members on the Vermont State Police Members Assistance Program all have that training. The Burlington Fire Department, all of our team members have taken a training that the International Association of Firefighters, which is our national union, has created in conjunction with a behavioral health specialist that's been vetted and put together. And if you look at the curriculum, there are many, many parallels, very few differences. The one big difference that I already spoke to was that our peer support training does not speak to debriefings because of the nature of our position and how we can all come together. Whereas they don't have that luxury in many other first response agencies. But if you look at besides that, it's very, very similar. So in the language we speak to that a peer support team member would have to be somebody part of a recognized team by an entity. And they have successfully completed the training that that entity has deemed as the one that they're gonna follow. But it has to be kind of an established program. It couldn't just be, you know, somebody saying, I'm a peer supporter. Any

[Alyssa Black (Chair)]: other questions? I guess I just have, in advancing h two seventy, do you feel as though it's an important step to support first responders in any profession? Do you think that we should be advancing this as a mechanism for supporting our first responders?

[Mark McDonough]: The commission strongly supports advancing this with changes. With changes? Chances.

[Brian Cina (Member)]: Sorry? And the changes you submitted.

[Mark McDonough]: Correct. I mean, that certainly are

[Brian Cina (Member)]: You could be plural. Like

[Mark McDonough]: The commission.

[Trevor Whipple]: Yeah. Yeah.

[Mark McDonough]: Yeah. No. I mean, it was it was, you know, certainly a collaborative effort. Unfortunately, the primary author is on grandkid duty today, he couldn't join us. But it was a collaborative effort for sure. The person that did most of the editing in this current edition that we have submitted is a retired licensed clinical social worker and has been a peer supporter for decades, doing it long before it was a thing down in Pennsylvania and then moved here and has become a really vital part of our team up here. How

[Brian Cina (Member)]: does that clinical social worker practice as one of these emergency service providers?

[Mark McDonough]: He's retired. That was his profession. He was a volunteer ski patroller.

[Brian Cina (Member)]: He was a volunteer ski patroller who's also a licensed clinical social worker.

[Mark McDonough]: And so when he was acting as a peer supporter, he was acting as a peer supporter, not as a clinician. Yeah. And now does not practice as a social worker, there's no blurred lines. He's always a peer supporter.

[Alyssa Black (Chair)]: This is question that's really not, it's just related as a practical matter of how it works best. Categorically, if you're a firefighter, does your peer come from your immediate group? Is it sometimes better if the peer comes from someplace further away or a problem in terms of variations? What's the best way So for that to

[Mark McDonough]: I think the security team is an excellent way to explain this. When the security team is notified that there was a critical incident and that agency is requesting that we come in and provide a debriefing for them, we seek out peer support team members who are in that section of first response. So if it's a fire department that experienced a critical incident, we're going to try to send fire department peers because they get it, they get the job, they get the lingo, they get the culture because each first response entity, while we're all first responders, as you may imagine, a police officer has a different culture than an EMT or a firefighter or a dispatcher. Right? Yeah.

[Alyssa Black (Chair)]: That part's understood. I was just wondering, like, if you're in the Burlington part. Carrie, would you mind muting? Thank you. Awesome. Is it best to have someone also in that same fire department that's in the category of being the peer counselor or?

[Mark McDonough]: Yes, for the Burlington Fire Department, by and large, our members are seeking out fellow Burlington firefighters.

[Alyssa Black (Chair)]: And then if you're in one of the volunteer fire departments all around the state, is that the state?

[Mark McDonough]: They would most likely be serviced by the security team and they would

[Alyssa Black (Chair)]: In that camp.

[Mark McDonough]: Correct. They would find firefighters from the team that can go and support. So like, which, for example, something that I've done, I'm a member of the security team as well. I've gone out to fire departments that have had tough calls or because I also work as an EMT, I can go help ambulance squads. But they wouldn't send me to go help a police department that went through. Yeah. Yep.

[Alyssa Black (Chair)]: Thank you. Yep. Thank you. And thank you for coming in, especially on short notice. So next we have Trevor.

[Brian Cina (Member)]: Did you used to work for a police department in was it South Carolina?

[Trevor Whipple]: I was the chief of police in South Carolina. And I recognize you.

[Alyssa Black (Chair)]: I bet I bet you. I bet bet

[Trevor Whipple]: talking about confidentiality. Anyway, thank you.

[Brian Cina (Member)]: Guys weren't covered by HIPAA.

[Alyssa Black (Chair)]: I think mugshots are part of the public record, aren't they?

[Brian Cina (Member)]: They are. Yeah. Yeah. For the for the record, it's more likely that we interface in emergencies, not because I committed a clip.

[Alyssa Black (Chair)]: Right. More likely. Very,

[Trevor Whipple]: very much appreciated that interfacing. Anyway, thank you for the invitation to appear before you this afternoon. My name is Trevor Whipple. I am a retired police chief from here in Vermont. Served thirty eight years total. I was in the city of Barrie for a little over twenty three years, and, finished my policing career in South Burlington after twelve years there as the chief. I now work for and am speaking on behalf of not just myself, but the Vermont League of Cities and Towns. I am employed by them, have been for about seven years now as their law enforcement. They call me a law enforcement consultant. I'm a full time VLCT employee who consults out with cities and towns in Vermont, all our members, on policing issues in the risk management sense. So a lot of policies, a lot of training. I am a member of the Emergency Service Provider Wellness Commission. I'm a member of the Vermont Criminal Justice Council, a regular trainer at the Police Academy, and I could go on ad nauseam. I, early in my career, served also as an emergency medical technician and in the town of Barry as a volunteer firefighter for about eight years when I first started my career. I am here on behalf of Hill CT and myself to strongly support, h two seventy, with some of the recommendations or the recommendations that have been, requested or the the modifications that have been requested. My reason for asking to support this and asking VLCT to support this is that, I think from a human standpoint, being a police officer and then a police chief, I was a chief for twenty years total of my career, and having employees that worked for me, officers that worked for me, as well as experiencing it myself, I realized what the, not just the acute stress, but the chronic stress. Not just that you go out, yes, it's bad, you go to a horrific situation and you see trauma, you see people in crisis, that's bad. But frankly, it's the everyday things. It's the, I miss my child's birthday today. I'm late to get home to the Christmas party because I got called out. We're short of help, so I'm working in a twenty hour shift instead of a ten hour shift. And those things creep up and they build and they cause this chronic stress accumulation. So I really cannot overemphasize what I find, what I believe to be the value of peer support. And as a police chief, I experienced some of what representative Cina is talking about, and that is I was the employer. And there were times when I would ask employees to come in under duress and to give me information about potentially other employees and wrongdoing or concerns. And sometimes that's necessary for the betterment and safety of the organization. Sometimes it's necessary for the protection of the employee, but there are times, and I want there to be times where employees can feel free to go to someone who's properly trained and recognized as a peer support individual and vent to them. Maybe they went out and they're having problems with stress, they're having problems with sleeping, and perhaps they've started to drink too much. And so they wanna confide in a peer. It's like, oh my gosh, I can't believe how stupid I was. Last weekend, went out and did X. But if I, as the boss, as the police chief found out about that, I might have to take employment action against them. So I really want these opportunities to present themselves to first responders to be able to confide and support one another without the fear of, and where's it gonna go next? And who's gonna find out? Now, are some safety valves built into this legislation for the things that we should not keep secret. If the employee is expressing self harm or suicidal ideation, that's a hard stop. If they're sharing information that's indicative of a mandatory reporting, child sex abuse or elder abuse, that has to be reported. And there are other things as well. I do want to, not that you don't understand the importance of this, you folks supported, passed out, ultimately was voted into law, the Emergency Service Provider Wellness Commission. You obviously see the importance behind that. But I think that just to paint a little bit of a picture, because I think sometimes we either don't know or lose sight of. And so I pulled off just this morning, it's got a little bit of age to it. I don't think numbers have changed, perhaps they're a little bit worse, but the CDC had a report from the Surgeon General. It's in 2019. But at that point, they were reporting, and I still do believe it true, that law enforcement officers and firefighters were dying more frequently at their own hands than they were in service. So more firefighters and police officers were taking their own lives than were killed fighting a fire or killed by an adversary in a police encounter. EMS providers had one point three nine times more likely to die by suicide. And one thing, and I found even as a police chief, I can't tell you how many times I had to express my apologies, but to our office staff, to our telecommunicators or our dispatchers, they sometimes go forgotten. They're in the office, they're not seen, but they're the first point of contact. They many times are dealing with trauma and stress on the phone. And what this report pointed out, and it was again, a good reminder to me, is that seventeen to twenty four percent of those folks developed PTSD symptoms. Twenty four percent had symptoms of depression. So I think that if we can provide a mechanism to further encourage this peer to peer communication, this don't live with this horrid secret, or don't feel that you can't turn to your fellow peer, and frankly, unload. Sometimes it's just, I just need to vent. I just need to talk to somebody that understands, but I don't want to risk my job or I don't want to risk my family finding out. I just don't want that worry. And this provides protection. And I think that, you know, to speak to your point, and I know there's been a lot of questions, do think that particularly in our rural areas, that sometimes there can't even be a disciplined crossing. I do agree with Mark and that I think that most times cops like talking to cops, firefighters like talking to firefighters. But I think when we get into some of our more rural regions, the first responders are few and far between, or many times they're cross disciplined. You've got a part time sheriff that's also a part time firefighter or an EMT. So, we wanna make sure that it's not discipline specific. This is why it's all first responders. And I think that this would further highlight the importance and the support of peer support systems and encouraging using that. When we talk about, we hear it every day, this recruitment retention challenge, we have the dearth of police officers, firefighters, maybe not so much, but I think probably firefighters have become an issue as well. EMTs, you name it, just community servants that wanna come forward and serve as emergency service folks, the numbers are fewer. And I think anything we can do to help provide mechanisms for them to feel more supported, to have avenues to debrief, to de stress, to feel a little bit better about what they do dealing with the trauma that that might be inflicting upon them.

[Alyssa Black (Chair)]: Go ahead, Daisy.

[Daisy Berbeco (Ranking Member)]: Thank you so much for your years of service to Vermont I'm excellent just so moved by your compassion and recognition of what folks go through when they serve. And especially these days, I know especially law enforcement officers are carrying a lot in terms of what's happening nationally. So I really appreciate that you're able to emphasize the universal care that we all deserve when it comes to dealing with trauma and having someone who understands where we're at to be able to talk to. And as I was sitting here for the last hour, I was thinking, well, why wouldn't these folks just be able to reach out to one of our peer support specialists who we certified, and we could pull out federal dollars for Medicaid and all that. I thought, well, then we would need to train them on the experience of being a first responder, but are we being duplicative in creating this system? And it just dawned on me that you all have organically built the type of system of care within the forces that you all serve. And that's how we're going to get out of the mental health crisis, is by people leadership especially, having the compassion and empathy to take care of those that they serve. So thank you for your leadership on that.

[Trevor Whipple]: Thank you. And we still need to send a message to leaders because I do fear that there are still some potential leaders out there that may not understand the impacts of this trauma. You know, I had an officer who was moments from taking his own life, and he was concerned that he would lose his job. And, you know, I reassigned him full time to taking care of himself and told him that if he went and did what it took to take care of himself and to get healthy again, that his job would be there when he came back. There are entities that don't feel that way that will quickly try to, you know, divorce themselves of an employee that's facing those challenges because I don't I don't know why. I feel that we ask these people to come and provide this service that's inflicting trauma on a daily basis to them and to their families. We deserve to support them. We we need to support them. And that includes our crisis workers on the front. And I would absolutely support because I'm not sure. I don't want to disagree with anyone else that's testified. But I would want to verify somewhere legally that clinician to clinician communication is protected, because I would question that.

[Brian Cina (Member)]: I mean, just to clarify, you, a current consultant and as a former seasoned law enforcement officer, you would include mental health crisis responders in the definition of an emergency provider? Well,

[Trevor Whipple]: within my power, knowing the service they provide. And as I was my final years in South Burlington, we stood up the community outreach program. I really understood the value of that because, frankly, the crisis we're facing today in our downtowns all across the nation, but let's focus on Vermont, there are situations that are exacerbated because we're using the wrong tool. We're sending police officers to deal with mental health crises when we need to send you. Now we don't want to put folks like yourself in danger, and you should either not go to a dangerous situation or pair with someone who can help handle the danger of a situation. But I am not a trained mental health clinician. I've got the skills I've developed on my own, but I want somebody like you with me, or in fact, I want somebody like you to go instead of me if the time is right, because you bring the right tool to the situation. So I'm not good on short answers. The short answer is yes.

[Brian Cina (Member)]: I appreciate it because I've worked with the police since 1998, and as a mental health crisis responder since 2003, and the way we respond has evolved. And it used to be the police would go first and then we would come, and now we go together, or we go with the police hiding around the corner in case we need them and the outcomes are way better. And we also walk into really bad situations together, and we find things that no one should have to find. And so that's why I think we should be treated the same in terms of when we need support from our peers. So I appreciate the support.

[Alyssa Black (Chair)]: I think that we should, since the heart of this bill is around the confidentiality piece, think that we should table this and speak to our legislative council to ensure that there are things in place for you and the people who serve as you.

[Brian Cina (Member)]: Are you saying that you want to hear more from lawyers about HIPAA covers us?

[Alyssa Black (Chair)]: Not necessarily HIPAA, if there are other pieces in statute. Any protections. Any protections. I'm going go Leslie and then Karen. Very quick, and I'm sorry I was a few minutes late. There was a report to the legislature due at the '5 from the commission, and I'm wondering where that stands. I was just trying to catch up on that.

[Brian Cina (Member)]: I think

[Mark McDonough]: it's Oh,

[Alyssa Black (Chair)]: it's still in draft. Okay.

[Trevor Whipple]: I think it's

[Alyssa Black (Chair)]: Oh, and and maybe on our list that's coming in January or was that your

[Mark McDonough]: We're shooting where are we

[Trevor Whipple]: shooting for January 15, Evelyn? Or no? I don't know if we'll make it. But

[Brian Cina (Member)]: Well, we have a We

[Mark McDonough]: a we have a meeting scheduled the February.

[Brian Cina (Member)]: We're Oh, okay. To

[Alyssa Black (Chair)]: Okay. So you're working on the next version. Okay, so if I'm looking at the most up to date is 2024. Yes. Great, thank you. Karen, go ahead. And I just wanted to know, I know you're in the same tradition. Did you have any other statutory recommendations other than the ones pointed out?

[Trevor Whipple]: No. That was, as as Mark said, you know, the gentleman who couldn't be here today was the primary architect, but it it was passed before a number of on the commission, myself included. So any recommendations I had are in what's been posted online by the clerk.

[Alyssa Black (Chair)]: And this question is for either you or Mark. I'm just first of all, putting together a witness list on this bill, I struggled a little bit because I wasn't sure because it's not a topic I'm particularly familiar with. Can you think of anybody who would be in opposition to this bill? And if I'll also throw this out there, if they happen to be listening, if you could please contact us so that we can ensure that everyone's voices are heard. But I just wondered if either one of you, in your experience and as part of the wellness commission, whether or not you can think of anyone who's in opposition to this.

[Trevor Whipple]: I don't know of anyone. Mean, you never know. Mean, there's always somebody opposed to everything. But I can't think of anything. I've tried to think from the first responder mindset, but also from the employer mindset. As a police chief, would I be offended if you pass this and said, Oh, my employees can't even talk to me now. As a police chief, if I had a police officer, a dispatcher that was struggling and wanted to talk to a peer, and that meant I couldn't find out, I've had it. I want them to be healthy and safe.

[Alyssa Black (Chair)]: Thank you. Okay. Yes, well, we're going to get a testimony right there. So thank you.

[Brian Cina (Member)]: Thank for

[Trevor Whipple]: your time and your attention. Thank you.

[Alyssa Black (Chair)]: Sherry, thanks for joining us. Sort of hoping you could tell us as a member of a peer support team, sort of what you do and your thoughts on the bill.

[Carrie Mall]: So I'm an interesting member because I have a private practice. So I am a licensed independent clinical social worker. So I'm also a peer and I have to be very open with everybody and let them know that I can't ever take that LICSW hat off because I'm still a mandated reporter and I still have to follow HIPAA among some other of my licensing requirements. But still, will still come because I am a volunteer firefighter. I'm also a captain at my local fire department. One of the big differences I think that we have that limits our protections from other states is moving here from Massachusetts is the mandated reporter clarification in our state. Mental health providers, police officers, paid employees in Vermont are mandated reporters, which means their protection if a peer comes to them and says they're suicidal and they don't know what to do with that. And they might be worried to report that because they're not a mandated reporter. Because while there's legal obligations for us to report as a mandated reporter, we're also protected by being a mandated reporter. So I do think that's a piece that the state needs to look at as well to help people feel like when they are sorry, I'm at a fire station right now. There's a little bit of noise. Let me know if it's too loud. But so that they feel confident when someone does come to them making the right call that they need to make. Because volunteer EMS, volunteer firefighters are not included as mandated reporters. And I think that's a really important piece that needs to be included in this because that's going to help people. And it's also going to mean that there's an extra level for the peers of knowing the severity. Because I do have some peers that will reach out to me and ask, I'm really worried for this person. What what am I mandated to do? Especially if that person doesn't wanna go any higher. You know, they just wanted to unload. But if they say that they're suicidal because you have to remember, especially with the volunteer forces, which I represent here, we don't have a day off. We don't have a fire a police chief that can say, take care of yourself. We have to go to our job the next day. We have to take care of our families. A lot of us are leaving our jobs. We don't get stipends. We don't, you know, we don't have any kind of financial support. A lot of people are struggling right now. So there's that financial piece too. I'm seeing a lot of volunteer, both in the emergency field and just struggling to pay their bills. So if I go to this call and I lose my time at work and they don't have health insurance, so the secure program is the only way that they're getting support unless myself and some of my other colleagues that provide pro bono services. And just as a reminder for each incident, they only get about five sessions, which as we know, for someone with PTSD is not enough. But unfortunately, that's all we can afford in the state to fund. And we have seen some pretty severe things. I will say that I even asked to support police officers, firefighters, EMS. In our area, we do invite dispatch to come to our crisis debriefings if they can. You have to remember too, we're a large area, so dispatch is servicing a huge area, so sometimes they can't make it. Although they really do try to. But, you know, we're we're when you have a critical incident to grief too in these small areas, you know, out where I am, we I live in Cabot. We don't have a mutual aid service as a paid fire department. So you have to remember, if you have a paid fire department that's your mutual aid, they're gonna be there right away to support you. We require on our neighbors, you know, if we only have three people that can show up, we're really hoping there's maybe another three people from our direct, you know, mutual aid. And that is a huge load on people mentally. What if you can't show up and your neighbor's house burns down? Or you can't help at that lift assist so that person dies? And there's a huge layer that I think people don't think about unless they are a volunteer first responder and the responsibility that that puts on you in the mental load that it takes. You know, I have my own therapist because one, you practice what you preach, but two, you know, we've seen some pretty horrible things. You know? When you show up and your neighbor has blown their head off with a shotgun, you don't get that out of your head. And then you have to turn around and go back to work after that. And, you know, that's just one of the many incidents that we go through regularly. And, you know, we don't have anyone really supporting us. It's all of us going together. And the officers have a certain level of training, but a lot of them are farmers, electricians, plumbers, IT. They just have to turn around and go back to work if work lets them off. And so I think it's really important. I do hope that moving forward with this, reaching out to some of those really rural communities and really asking the first responders themselves, not just the commission. I support the commission wholeheartedly, but I think there's a lot of us that are kind of dealing with this day to day that don't have all the professional supports and mental health. We know there is not a lot of mental health resources out in the rural areas. When there's a call, I often drive down to Southern Vermont. I might go way out to other side of the state. Our peer responders are really trying to meet what we can meet. So that's where I do think it differs from agencies that are sending out mental health workers. They are working for an agency that has insurance. Are working, they have federal and state guidelines. You look them up, they are there that protect them in that role. It does not protect first responders, especially volunteer fire and EMS and ski patrol. So if there's a legal piece that comes up, I'm protected because I pay for my own malpractice insurance and I carry that. In order for me to be a secure clinician too for the state, I have to have my own insurance, making sure I have very comprehensive insurance. So at least the clinicians that work for the secure program, we're protected by ourselves, but there's no protection from the state.

[Alyssa Black (Chair)]: Go ahead, Brian.

[Brian Cina (Member)]: Earlier when you interrupted the other witness, you said that crisis workers were not protected by HIPAA, and you said you're a clinical social worker, so you must be familiar with HIPAA. Can you share which part of the HIPAA law provides protection to mobile crisis workers? Peer support communications?

[Carrie Mall]: Sure. I don't want to say that I interrupted. I was trying to speak. There's no raise your hand or chat on this. I would advise you guys to maybe add that so people could speak because when there is the professional piece to add that, I wanted to make sure there wasn't anything incorrect. So agencies should be having the correctly trained and licensed personnel to go out in global crisis. Those people, and I would ask you to look at some of the surrounding states if you need some help making some better laws around that. But they are a different They're going out specifically for that piece, and they are protected by their agency. They have insurance. They have benefits through their agency. They're an employee. We are not employees. The majority of first responders in Vermont are not employees. Just wanna point that out. So we get no support from anyone, and we have no legal protection.

[Brian Cina (Member)]: I just wanna acknowledge that I hear you that the volunteer workers don't have the protections that paid workers have.

[Carrie Mall]: Yeah, thank you. And I think all mental health, I'm telling you across the board, I think it is sad. I wish you guys would really look at what some of the other states around us are doing. We're about ten years behind protecting frontline mental health workers, you know, and really supporting them. And, you know, to that point, we don't have police departments in most of our towns, So when we show up, I can't tell you how many times we have shown up on a call. Oftentimes calls come in, and I know this happens with mobile crisis too, and you don't have all the information. You just have whatever was called in or if there was a car accident, you don't know, we're a Cary state, you don't know what you're showing up to ever. And so our volunteers, whether it's paid or unpaid, we are all going into some pretty scary situations, which is why I really urge you guys to look at what the states around us have done, because it's working and it's protecting people and it's making people come forward. Because I don't carry a gun. I do know in other areas, are some volunteer first responders that might keep it in their car because we don't know what we're walking into. And VSP, they're wonderful, they're amazing, but they can take forty-forty five minutes to show up. That's a pretty scary thing when you're, I'm four foot ten, I weigh one hundred and thirty pounds, and if I show up on scene by myself, I do, but there's only so much I can do at four foot ten in my turnout gear when there's a dangerous situation. We have a major issue across the board in Vermont. I really hope that you guys you know, acknowledge that there's a problem here. You know, another part of it too is what we're we're reimbursing the people that are treating our first responders. You know, they're doing it because they care and they're not making very much money off of it at all and they do it because they care. And that's all I can say. And then they have to use their own insurance. And then you've got the mobile crisis going out and Mobile crisis is amazing, but it really differs based upon each county, how it goes out. And that's insane. It should be across the board in every county. We should have the same protections for everybody. I really urge you to reach out to the stakeholders, those in the field that are doing it every day and really try to support them because those are the people that are going to keep doing it. We have a shortage of volunteers and part of it is financially and economically. It's really hard to make a living in Vermont. I can't tell you how many days I'm gone without pay just to show up for an emergency because if I don't show up, no one else is gonna show up. Then that mental toll that takes on you at home, you know, I'm very lucky that my partner and I, you know, my husband, he can stay at work and I can I can respond, but there's not a lot of couples like that? So I just really urge you to also speak to the stakeholders. Look at that mandated reporter law for our state. Well, yes, it puts pressure on people legally to have to report an incident. It also protects them so that if they do report something, someone can't sue them. Because we're not reporting these sessions, we're not In a mandated reporter law, it's not you making a justification, it's just giving the evidence that you have and stating that there's a concern. These And programs are so important. They save lives.

[Alyssa Black (Chair)]: This question is for anybody. I'm assuming members of the secure support team, peer support team are paid.

[Carrie Mall]: Only the clinicians. Only the clinicians.

[Alyssa Black (Chair)]: In most cases around the state, those offering peer support services, they're not being paid for that, correct?

[Mark McDonough]: I can tell you my team in Burlington is volunteer.

[Alyssa Black (Chair)]: Volunteer, okay.

[Carrie Mall]: Through the secure program, they're not paid. They don't even get paid for mileage if they're driving really far away. Sometimes when the call comes out, we get the email. It's whoever can show up. We can't find whoever is closest. It's whoever is available to meet.

[Alyssa Black (Chair)]: Go ahead, Brian.

[Brian Cina (Member)]: I'm just a little confused because I'm hearing there's clinicians now, but then I was hearing there was peer support communications, where regardless of what the training of the workers are, they're not each other's clinicians. So are we talking about two different things?

[Carrie Mall]: No, no, no. The secure program has clinicians and peers. There's two levels of support. So the first level of support are trained peers. And the secure program also has clinicians that are contracted to work with them. So in through the EAP process, but secure, they get five sessions if they want with a paid clinician that's paid through the secure program. And when there's

[Alyssa Black (Chair)]: a part of? That's

[Carrie Mall]: part of the secure program.

[Brian Cina (Member)]: But who's that for?

[Mark McDonough]: Carrie, can I just, I think I can clarify a little bit? Invest EAP is private employee assistance program that exists in the state of Vermont. There's an arm and an SDAP that is called EAP first. They solely exist to provide emergency or employee assistance programs to first responders in the state of Vermont. They created the secure program. So the secure program is a team full of peers that anybody can reach out to, any other first responder can reach out to that peer to have a peer to peer communication. When a debriefing occurs following the ICISF model, are multiple peers there to run the debriefing and we also additionally will send at minimum one clinician because the clinician can, and their sole job is to sit in the background and observe, so that if they see any indications of somebody that's experiencing a critical stress injury, they can identify that and deal with it right away, and also just be that immediate available resource if somebody has strong emotional reaction through the debriefing, they can be their system as well. So have added professional credentials to manage, but we've been very understandable, this is their profession and their job and so they're compensated for that to be a clinician in the EAP first program. The peers are doing this on a voluntary basis currently. You recall last year we were requesting for some funds out to support EAP first,

[Alyssa Black (Chair)]: some of

[Mark McDonough]: those funds that we were to to help augment the cost that these volunteers are incurring by, as Kerry stated, driving quite far distances. I've driven from my home in Warren up to Highgate Springs to do a debriefing, know, or without a southern law, So just to help folks with, you know, offsetting those costs.

[Trevor Whipple]: And there may be entities that pay some of their staff when they're doing peer support functions. I think of DOC, they identified a specific position, a peer support coordinator or something, they developed a position that was paid, state police may pay their peer support people, not certain, so it could be a blend.

[Alyssa Black (Chair)]: Are any of the services reimbursable

[Mark McDonough]: Like insurance? Not to the best of my knowledge.

[Carrie Mall]: Sorry, if just up here and they do not hold a clinical license, it's not reimbursable. That person would also have to be able to carry the insurance that that person is seeing. So, for example, let's say they have Medicaid as their insurance and let's say they're meeting with me and I'm a peer and clinician, it's not reimbursable because I don't currently, I'm not board certified with that insurance.

[Mark McDonough]: And it is, I think imperative just since like this is that we have had kind of a broader discussion about

[Brian Cina (Member)]: all of this like

[Mark McDonough]: which is a bit of a divergence from our primary desire which is that the confidentiality from peer to peer communications with a trained peer support team member and a first responder grant.

[Alyssa Black (Chair)]: Thank you, did anyone have any questions for Carrie? Right, well thank you very much. I encourage anybody listening to reach out if they'd like to testify on this, and we will sit down with legislative council and sort of compare drafts and decide where we'd like to go with that from here. So I think we can take a break. Sorry. It's timing. It's timing. We're gonna take a break until 02:30 when we have Nolan and Jen back in. We're gonna discuss budget adjustment and the recommendations we heard so that we can get our recommendations off to the committee on appropriations. Alright, thank you everybody. Thank you for coming in.