Vermont Legislature SmartTranscripts:

[Daisy Berbeco (Ranking Member)]: Hi, welcome back everybody. I'm so sorry we're running late. So we're continuing talking about mental health advocacy day and Vermont Care Partners is in. Perfect timing.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: So just wanted to We haven't done kind of an introduction this year on our DAs, SSAs, so

[Daisy Berbeco (Ranking Member)]: take it away.

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: For the record, my name

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: is Simone Rischmeyer. I'm Executive Director of Vermont Care Partners. I'm Amy Johnson, and I am the Director of Legislative Affairs and Policy for Vermont Care Partners.

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: Now I'm Kelsey Staffseth. I'm the Executive Director for North Houston Community Human Services and Co President of the Chronic Care Partners Board. So thank you for the opportunity to speak today.

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: Really appreciate the committee's attention to mental health in Vermont and especially its interest in better understanding what the designated specialized service agencies do here. Our system, the mental health system is at large, as I think you all know, is under extraordinary pressure and strain with workforce shortages, rising acuity, housing instability, and growing demand across all ages and populations. We're all talking about it. We all understand a lot of what that is. But in focusing on what's strained and broken, it's easy to lose sight of what's also working. And what is unique about Vermont's approach, which we will talk about today, and what will be extraordinarily difficult and possibly to rebuild if we lose it. Vermont's not alone in facing a mental health crisis, but our challenges are amplified. They're amplified by our geography, by our age and population, housing shortages, and a limited workforce pipeline. Across the state, we're seeing an increased demand for services across the lifespan, including children, especially children, youth, adults, older providers. Higher acuity and complexity with more people experiencing co occurring mental health and substance use and intellectual and developmental disabilities. And persistent workforce shortages that affect not only clinicians but also direct support professionals, case managers, peers, nurses and supervisors, and most importantly, the people that we support. These pressures show up everywhere in emergency rooms, schools, law enforcement, families and communities. And while it may feel at times as if we can't do enough, because it does, the reality is more nuanced. Much of what we are seeing is a result of a community based system absorbing pressures that other states would fall to institutions, correctional facilities, or out of state placements. So that brings me to the importance of our designated specialized service agencies. Vermont's designated specialized service agencies are backbone of our publicly funded system. They are state contracted, not state employees, but state contracted nonprofit organizations. And they are your community based experts in mental health, substance use, and intellectual and developmental disabilities. They are geographically rooted in the communities they serve. They're accountable to state standards and public oversight through designation. And they're responsible for providing or coordinating a comprehensive array of services for defined populations. The agencies provide ongoing community based mental health, substance use, and developmental disability services that extend far beyond the short term interactions, ensuring critical support for Vermonters and partners. The partners are intentional. They're our primary care offices, our hospitals, schools, our first responders, and we really can't support individuals and families alone. The agencies serve as Vermont's essential safety net, ensuring access to regardless of insurance status or ability to pay. And they often maintain sustained care coordination across months or years, filling the gap between acute hospital treatment and routine medical care. We serve individuals regardless of complexity, acuity, risk, or ability to pay, and work closely with our community partners. We provide services twenty four hours a day, seven days, three sixty five days a year, because when people have needs, it doesn't fit neatly into that nine to five model. And that is a unique difference between our agencies and many other organizations. So the next slide shows the 16 network agencies, and you'll see who's who and which county. Our network includes both designated and specialized service agencies, which you'll see here. The designated agencies provide an array of services, mental health, substance use, and intellectual disabilities. And the specialized service agencies can be anywhere in the state, and they provide more targeted services, whether it's for children, youth, and mental health or intellectual development and disability services. What's important is that while each agency is locally governed and responsive to its community, between designation and Vermont Care Partners, they operate as a coordinated system. That means shared standards, sharing in best practice, problem solving, and the ability to implement statewide reforms, which we'll talk about too, but like crisis response and conflict of interest and now CCBHCs as well. From a legislative perspective, this network structure is what makes large scale transformation possible. It allows innovation to happen locally while alignment and consistency happens statewide. And that's essential no matter where people live. Go into the next one. This is a lot. We were trying to give a history of and limited like each one probably has about 12 more of those, but we tried to rein it a little bit. What's most important to understand here is that our system isn't an accident of history. Vermont made an intentional policy choice decades ago to build a system based on community care rather than institutional care and on public accountability rather than fragmented contracting. It was built over generations, as you see, shaped by a steady commitment for services to be rooted in communities so people can thrive where they live. In institutional, but even then, Vermont began forming the locally governed agencies that would eventually become the designated agencies in the backbone of our system. By the 1960s and 70s, with the Federal Community Mental Health Act and the establishment of designated agencies, Vermont made another clear choice, a policy choice, that care should be delivered close to home by community based organizations that were accountable to their communities and their regions. The 80s and 90s marked a deeper commitment to deinstitutionalization. We had the closing of the Brandon Training School, the passage of the Developmental Disabilities Act, and the implementation of Success Beyond six. Reflecting Vermont's belief that people belong in their communities with the rights of trust. During this period, provider agencies expanded their roles even more, and that's when we started having even more intellectual and developmental disability supports in the communities. And federal reforms began to reinforce the direction. When we got to the 02/2010, which seems like a strange thing to say, but 2010, Vermont began focusing on building a modern and more integrated system. While the Vermont Council and Vermont Care Network had been around for quite a while, we formed Vermont Care Partners in 2014. Peer support became more formalized. Agency designation rules were established, and reforms such as the Blueprint for Health and Hub and Spoke emphasized even more integration. Mental health payment reform began during that period as well, recognizing the need for aligned financing. So what we're seeing now is the continuation of that trajectory. We have enhanced mobile crisis, mental health urgent care, certified community based integrated health centers, conflict of interest free case management, and developmental service payment reform. They're not departures from Vermont's values. They are efforts to modernize the system that we've been building for decades, very intentionally. So I think the lesson from this history is that Vermont succeeds when vision, implementation, and investment go together. This moment is about refining and strengthening a community based system that Vermonters have committed to for generations. We do have worries about a lot of the reforms. We can get into that later or another time, but we really wanna make sure that we're equipped to meet today's realities and our future needs. So we have system reform. There's a lot going on. I think you all know we have the certified community based integrated health centers. We have conflict of interest free case management. All the things that are on the slide, I keep looking over here, but I know you're seeing it up there. We're in the period of an important period of transformation. And what makes this moment notable is not any single reform, but the fact that multiple interrelated changes are happening at the same time across policy, across payment, and service delivery. Conflict of interest free case management, it's a federal mandate. It's also one that reflects Vermont's commitment to person centered care, transparency, and choice, assuming that it's implemented well. We're definitely learning in real time how role and policy clarity, staffing levels, and regional supports are needed to make this model function. We have grave concerns about the impact on housing, especially with the aging population, and on the implementation itself, but we are absolutely committed to making it work. Similarly, developmental services payment reform is a necessary step away from outdated rate structures. The transition has highlighted how sensitive payment changes are to accessible services, workforce ability, and service acuity, and it underscores the importance of continued refinement to ensure the stability of the individuals and families that we support and the providers. Without flexibility, we can't meet the holistic needs of the people that we support, including their mental health challenges. We just recently finished or collated, I should say, our developmental services crisis survey, and it shows that forty three percent have a co occurring mental health challenge, and forty two percent of the people that we support with IDD have a history of trauma and abuse. And then there's the crisis continuum in which we're making great strides, we'll talk about that later as well, but great strides in terms of access and integration. Expansion of the crisis continuum, including the enhancement of crisis, 09/1988, and alternatives to emergency departments has already demonstrated a lot of really positive results, especially where capacity is well resourced. Where that occurs, we're really seeing quicker responses and fewer unnecessary hospitalizations. CCBHC. CCBHC really builds on our focus of integration. We started talking about it trial and say in 2015, aligning with the blueprint and really providing parity between FQHCs and CCBHCs, as well as focusing on a cost reimbursed model. We're finally there. And it sets clear standards for access, integration, and accountability. As Vermont moves forward with this model, there's an opportunity to ensure that payment levels are there, that implementation supports are fully aligned with the expectations being placed on community providers. The expectations are much greater than they are now, and that alignment is essential to make it successful. All of these efforts are being coordinated through the agency of human services, their transformation work, and hopefully supported by the Rural Health Transformation Grant. We have a lot of recommendations, they ask for recommendations, Many into the hopper there. But lasting reform really depends on alignment across systems rather than isolated initiatives. And that's going to be essential as we roll out all of these and we invest a lot of these federal dollars. The systems transformation is not a single decision point. It's an ongoing partnership between the legislature, the state, the people that we support, families, providers, communities. And if we center people and pay close attention to the impact of the policy, the implementation of the financing, and truly listen to

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: the

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: feedback, I think we can make this successful. But it's a lot all at once. And it has the potential to either really enable our system to thrive or to destabilize it.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: I

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: just want to echo what Simone was saying that the designated agency system was intentionally built with the legislature, with the state and with private entities. And I like to think about the designated agencies as specialty providers. And I think that's really meant to highlight our expertise and we're often looked to do the hardest, most difficult things in the community. And so we're the last stop before inpatient, before hospitals, before seeking a higher level of care. And I think that's important. We'll talk a little bit about who refers to us, but we are networked with all the other agencies that provide services to Vermonters like first responders, law enforcement, EMS, hospitals, primary care, they seek us out specifically to provide care that they cannot. And so, again, we provide a gamut and spectrum of services, which is really about prevention and upstream supports. We support people across the lifespan from the itty bitty to end of life. And that looks different based on people's needs. But we have a wide spectrum touching on many of the things that Simone talked about. One of the things that I want to highlight is when people think about mental health, think they'd say, oh, therapy. And I think that's kind of where it can end. I think that designated agencies would provide what we call wraparound supports that are personalized. And so that can include psychiatric support. We employ psychiatrists, APRNs, we have therapists, case managers, peers, care coordinators, and that touches on mental health, substance use, developmental services, but so much more than that. As you know, lives are complex and the many needs we have can exacerbate mental health or substance use issues. That speaks to the holistic supports and then the community crisis response. So we've talked about the crisis continuum a lot, but the designated agencies run the nine ninety eight lifeline. That's So split between two agencies and KHS does nights and weekends and NCSS does weekdays with a little flexibility in there. We have mobile crisis, which every designated agency runs. HCRS is the lead agency, but that is deployed across the state. We have the Vermont State Police Embedded Program, which has been well received mostly, well, we think it's a great program and it's also well received by Vermont State Police, really stoked barracks managed in our area saying this one of best things the state has done to support that because what happens, they get calls to everything. You call 911, they respond. It's a great system. But what law enforcement would say is that they often get taken away from criminal work and saying, we want to support people, but we can't stay. This isn't a criminal matter. What can we do? And so mobile crisis helps fill that void to not even call law enforcement. But then when we do have to respond to a community issue, we have embedded folks that respond collaboratively. And then the last part of the continuum is the community based urgent cares, so mental health co occurring, and there are multiple across the state. But the state has committed to that in partnership with the designated agencies to fulfill Sandra's best practice of the crisis continuum, which is really about keeping people out of institutions, keeping people out of the hospital emergency departments and serving them in their communities, which has a big impact on people. But is also, I want to talk about the designated agencies as part of healthcare reform and part of the answer to the healthcare issues based in the state, which also is talking about how do we manage resources and saying if we can keep people out of the emergency department, which is one of the most expensive places you can go, we can provide better care and reduce expenses.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: Daisy?

[Daisy Berbeco (Ranking Member)]: Can you, on your last slide, there's three buckets. Could you just ballpark what percentage of your resources go into each of those buckets? I know it's But I'm just curious. Okay, like your services. What percent of your services are for prevention stabilization, for intervention, and then for crisis response?

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: I I would say that the first two are pretty intertwined. And so a lot of the work we do with case management, care coordination, therapy, we get referrals. And so often that's saying, hey, we've got a more intensive situation, you support a kiddo, can you support a dog, can you support their family? But the idea is when we collect data too is saying, look, we're not only doing interventions to support folks who need it, but then we're giving them the skills and ability to step down. And so the early intervention work, would say fits into prevention and intervention, but the idea is that we're always working people down to the level of care that they need. And some of our data, when we look at CAMS data, is saying like that eighteen month to twenty four month is really saying like you see the most impact over that time with kids that have the most intensive needs and then it plateaus. I think that's just saying, look, we've done what we need to do. We've developed good supports, but now we're ready to step down so we can take on somebody else. And I think that's really, we're not here to support people forever. I don't think that's the purpose of this system. And so we're getting better through data that's saying, you might need an intervention, we can wrap you and then we can scale it down until we're ready to discharge you back to lower level of care. So I didn't really answer your question, but I think it's really hard to say like they are day to day based on the need. We're practicing skills that I would say go into upstream prevention. We do a lot of work on the social determinants. As an example, last year, staffing KHS drove almost 2,000,000 miles to get people where they need to go, to work, to doctor's appointments. And so I would say that's preventative work, getting people around where they need to go to important appointments, to jobs, to foster relationships. And so Simona touched on geography. And so that's just one agency. And so we do a lot of work that helps people achieve their goals. And so I would say that fits into the upstream supports and then the intervention. So I guess that would be the biggest bucket, those two together. Then the crisis continuum is a smaller sliver, although an important one for getting people in.

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: And I guess I would just add, I'm not gonna guess. We could probably get you some better information afterwards about that though.

[Daisy Berbeco (Ranking Member)]: Don't take the time, it's okay.

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: Just But have the I think what you're hitting on is something I think about a lot, which is we've had a heightened focus on the crisis response for good reason. And we needed to build that out in the way it's being built out. But it takes away from the discussion and the infusion of resources as well into the prevention and early intervention piece of it. But so much of that occurs, I would agree. I think the community crisis response is a smaller sliver, but it's talked about a lot more, especially now and over the past few years.

[Daisy Berbeco (Ranking Member)]: Yeah, and Kelsey said earlier that we're kind of the last stop before level one. And so I'm just left with this idea of where are folks going to find the therapist? The back of Psychology Today, that's where I went. But are we leaving private providers out of this system too much? It just left me with that idea. If you all are serving the folks with a more intensive need, is everybody else going to the ER? Can you orient them? We have

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: a slide on that. Of course you

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: do also.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: It's an

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: important conversation.

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: And I don't think private therapists are like that. I mean, referral sources come from private therapists too. It's not a skip that phase. I think often we are working with private therapists who need support saying, can't support this person in my practice or like other referral sources, I think private practitioners have a scope of work that they feel comfortable with and then it becomes something outside their scope and they will refer to the DAs. I think they would say like, we wish the DAs could do more. And so Simone talked about CCBHC, current, this is having a conversation with the school district about like, can we get more home and community based? And so I think the general census is that the DAs are doing enough to support people. In the model we have, it capitates how many people we can see. And then beyond that, we can see more people, but we don't get paid anymore to see more folks. So actually for us, we're over serving children, but in the community, there's a desperate need for more of that. And so we're capped at the number we're paid for. CCBHC will change that. So that's good movement there. So that's meant to increase access. If we serve more, we should get paid more money. I think how it gets implemented will be a really important piece of that. So that's a good thing. We should be able to improve access if we can find people to do the work. But that change should alleviate some attention in my opinion, and help with some of the capacity that is needed.

[Daisy Berbeco (Ranking Member)]: I don't want to get into the weeds, but if anybody's listening that has thoughts on potential salary cap through the CCBHC, please reach out to me because I'd like to learn more about

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: that. Any other questions?

[Unidentified Committee Member]: Well, I have a question, and I went through your slides, and I don't if we only have ten minutes of what our schedule is, or are

[Daisy Berbeco (Ranking Member)]: you thinking we started a little late, so I don't

[Unidentified Committee Member]: want to divert you from your cause my question is totally not addressed. I don't On want to

[Brian Cina (Member)]: paper we have ten more minutes.

[Unidentified Committee Member]: Yeah. Can ask that, I'll pass later.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: Go ahead.

[Unidentified Committee Member]: This is financial. We've been hearing a lot from hospitals, days cash on hand and all those, the margins. And I see that you haven't included any of your financial analysis of the 16 agencies. And I worry about that because I know about your payer mix, is problematic at best. So I'm just wondering about the stability of the designated agencies and how do we think about that?

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: Really quickly, so we wanted to give an overview and kind of lay of the land for mental health. We have access to all of that information, so can pull it and very happily will share it, especially when we're talking about our budgetary ask for this session. So that is information that we can get you. In terms of financial stability, I will toss it over folks want

[Unidentified Committee Member]: Well, let me try just say your budgetary ask is coming through you in the future. Yeah. Because you don't need to take time now if it's coming, you

[Daisy Berbeco (Ranking Member)]: No, could just send me some no, no, anyone else that might

[Unidentified Committee Member]: be interested in some information on the stability of your system. Absolutely. That's what

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: I care about. Absolutely. Other questions? Do you have more?

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: We'll go quickly through our So just as an overview, so the target population that were under state statute, SMI, serious mental illness, adults, and then SED, severe emotional disturbance, those are outdated language, but SAMHSA uses that. So slightly different here. We use different language when we talk about it internally, but that is statutory we're supporting. And so again, talked about zero birth to death. We're gonna see you, we're gonna work with you, we're gonna figure it out. And then the crisis continue with an individual disabilities. Thank you, Amy. I want us to wrap along here. So one of the things, you know, we always talk about the scope, which is like, ideally, can you just do this? And the reality says in our communities across the state, the DAs have the infrastructure to do many things beyond their initial scope, which I think is good. It's connected. We're often the first to be reached out to by the state. A good example of that was when the hotel vouchers changed, we were asked to send case managers to hotels to help people transition effectively. That was an unfunded mandate and we always want to do goodwill and good faith work, But I think sometimes there's the constraints on resources saying the DA should focus on their scope and then there's the reality of saying, how do we support Vermonters? And I will say that I think the DA's and SSA's are well positioned to be flexible and meet people where they're at, which includes a much broader spectrum than the SMI and SED, and I think we do that well. So we talked about this, I won't go over it again, but ninety day mobile crisis, VSP, alternative CEDs, those have come online. I think they're really effective. We're getting some good data we'll be back to talk about, but this has been an effective approach to keep people in the community and keep people out of institutions and the emergency department.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: And I wanted to, you've seen this slide a lot. And one of the reasons why I put it in here again, because this is a really important part of the system of care and it's a needed part of the system of care. We have identified who does what. So the DAs are running many of these parts of the system. So it's important to note that we are doing that work, in collaboration with DMH. The other piece that I want to talk about, because I know what the next slide is, because I made the slide deck. The other piece that I want to talk about is this is such a critical part of the system of care. We're always going to need it. And we are always going to have people hitting this part of the system of care if we are not investing upstream. So we want to move people from the ledge, down the stairs, out of the building, up the hill, and we need to plug them in to services and supports that can help provide that care. And that is a gap. That's where we're seeing that home and community based care being eroded by our underfunding. So while this is critically important and we want to keep investing, that upstream preventative care is critical. So that's why this slide is in here. There is so much to be able to talk about with the DAs and SSAs and the work that we do. And so this slide deck could have been 6,000 slides, but I didn't think we had time for that. But one of the things that we don't talk about very often, and I know it's hard to read this slide, there's a lot of things on here, but we do preventative care and that means a lot. But the other piece that we do a lot of connected to prevention care, and early intervention is our prenatal to aid services. So this is a list of all the things that the agencies, and I'm not saying every single agency does all of these, but our agencies are doing all of this work in the prenatal to AIDS services land. So when you see me in this committee and we're talking about doulas and you're like, why is Vermont Care Partners talking about doulas? We have several agencies that are providing perinatal supports, perinatal clinicians in the home, and doulas in the home. So you can see this is a wide range. We have embedded folks in pediatrics and OB. We're running Dulce programs. We have one DA that's a parent child center. Several agencies run therapeutic child cares. We have a DA that's a head start where many are participating in children's integrated services, food shelves, food access, early childhood school based care, and the list goes on. You can read it here. But I think that it's really important that we are doing the crisis work, we're doing the home and community based work, we're doing the upstream work. And this is a part of the work that doesn't get talked about as often. I think it's really important for people to know that the DAs and SSAs are also doing this work. Anybody want to add? I had to put it in. I had to. I was so glad that you're back in the room. I know when you left, I was worried. Need the crisis iceberg. So a few years ago when I developed this, I didn't develop the iceberg. It's a thing that exists in nature. But when I had this slide in a previous iteration of my work here, it was here's where we are, here's where we're headed. I believe that this is where we are. These high end parts of the system are really important. Inpatient care, law enforcement, ED, crisis services, that's where we're at though. That's where a lot of the funding is going. That's where a lot of people are hitting the system because again, upstream, early intervention, early identification, social determinants or social drivers of health, that's where things are being eroded and it continues to be eroded. So you can barely see what those words are. And I thought about making them bigger, but I thought, no, like this work, we continue to do it. We continue to hold onto it. It continues to be important, but right now we're growing that iceberg and that is playing into the high costs of care, the high costs of insurance in our state, and part of the reason why we have the highest insurance costs, healthcare costs in the country. So here's where we are. So what are we doing differently that can flip this iceberg around? I don't know if anybody wants to add anything. This is my favorite slide. We work with many partners. Talk about This is my least favorite slide because of what it looks like. But, you can see we work with everybody, faith based, FQHCs, private practitioners, hospitals, criminal justice. We're working with everybody. We partner with everybody. It's really important for us to be able to do the promotion prevention, early intervention, treatment and recovery work in collaboration with our community partners. That's a critical part of being able to serve everybody. And so we get a lot of referrals. Not only are we working in collaboration, but that collaboration often looks like referrals. So we put in our top referral sources for our adult services and our child services. So you can see self referral. The primary care is a big partner. We'll talk about in thirty seconds in the next slide. We'll talk about how primary care is providing integrated mental health supports and that short term mental health services, it's necessary, it's wonderful. And primary care is often referring to us with folks that they cannot serve in that role. You'll see hospitals and a lot of folks that are on this next slide. Anyone want to add anything? Because I know we're

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: No, for us, but 55% of our referrals come from primary care and 70% come from primary care and hospitals combined. So it's a significant part of our partnership and referral source are those two entities.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: So this is not anybody watching who's going to get mad at me because you're not on here, the mental health landscape. These are a lot of folks that are in your committee that you talk to often. This is a snapshot of who provides mental health care in our state. We really encourage you to have folks in and talk more about what their mental health care looks like. The bullets you'll see, this is non exhaustive. We're just trying to simplify it so you can see who does what and why all these pieces are important. We're going to talk about this together. If you'll give us like two or three extra minutes, because you take as much time as you need because I'll slow down then. We have the time and also because I was not here to start at your appropriate time. We are here at your pleasure. Oh, thank you. So we really wanted to highlight who's doing mental health, how they're doing it, and why all of the pieces matter. I think that it can get confusing. If I go to my primary care for mental health services, why do we need DAs and SSAs? We're providing different things and we're also interconnected, working in tandem, referring to each other. I'm gonna toss it over to the people that can speak more eloquently to these supports and services, but we really wanted to provide you with this kind of landscape of who's doing what and why it matters.

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: I think I'll just say one quick thing and then pass it over to you, but I think there's enough need out there for everybody to be providing mental health services in the different scopes. I used to work with the FQHCs, and we talked a lot about, at the time it was the four quadrant model. But the bottom line is it's about acuity and it's about the skill sets you have and the services you have in each place and how you can together support individuals, how you access services. You might go to primary care and they see you and they do an assessment for mental health and then realize, you know what, actually, you'll be better off supported by a designated agency and let's make that referral. And so it's really about the skill sets, the access points, and how we collaborate and refer together and coordinate those services. CCBHC will include an aspect or does include, I should say, it's already happening, does include an aspect of primary care screening and coordination similar to how primary care focuses on mental health screening and coordination. So there's a lot of overlap there.

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: I think there's two sides of the coin when we talk about oversight. We often talk about the admin burden, but I would say that in the mental health landscape, the oversight and scrutiny that we have from the state and from our regulating bodies is high. I think that produces a high quality of service. I think we've also been emphasizing better data collection. I think we'll be back with more specifics about are people better off? I think we focus on some of the easier metrics, which is how many people do we see, which is great. And how often do we see them and what does it mean? But how do we know if people are better off? Are they transitioning from one level of care to the other? And I think we have really been pressed to do that. I think we're rising to that occasion with some specialty skills to be able to analyze data and saying, yeah, we are seeing that. We are seeing that kids are better off. We are seeing that the most intensive acute situations around depressive disorders get better over time, over the first thirty days, ninety days. And so I think that how the DAs are situated allows them to be uniquely positioned to address a lot of the needs here. Another one I would highlight is school Success Beyond six, there's big changes. I think the agency of education is focused on that and saying Success Beyond six is a mental health program. We wanna make sure that as the models change or regionalization or the approach that that's not lost. I know that again, workforce can be stressful, but having the designated agencies in schools provides that oversight supervision in the continuum of care that's really important. And so one of the things that I get a little worried about is when everybody does a piece of this, you lose the effectiveness of the holistic approach. And so one of the pressures we get sometimes is saying, well, I can just provide therapy, but can the VA just do psych? And you're like, maybe, but that's also the most expensive service that we lose money on, but we are required to provide. And so we want to make sure people have everything that they need, but when you get a fragmented system, it does become hard. I think one of the best things that the DAs offer is that there's a total continuum internally that we can provide that supports all of these providers here as well. And so we work really closely with all of them as partners, but just want to advocate that the strength of the TA system and the benefits come from the continuum and sustained investment to provide good services to people that need it. Daisy?

[Daisy Berbeco (Ranking Member)]: SB6 is federal, part state funding. And I'm wondering why you have two separate boxes for schools. One is SB6 schools,

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: one is

[Daisy Berbeco (Ranking Member)]: schools. How many What's the split like? Do we have a lot of schools that aren't taking SB6?

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: So we have schools No,

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: you go first.

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: Think this is like the mental health landscape, which is like some schools hire their own clinicians. Some schools have their own social emotional programs internally, and then some contract for some supports from VAs. Some have whole collaboratives that are built into schools. So we have a couple of those in our area where we run that collaborative program with the special education program, we provide the social emotional therapeutic sports internally for kiddos. So I think this is outline saying there's both currently in the system and schools will employ their own

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: staff. I don't want to leave them out because there are some schools that aren't necessarily participating in Success Beyond six that are running their own internal programs. So, I wanted to capture that. I do believe the next slide might have some statistics on how many schools we're in, but that's why you see two different boxes. But as Kelsey said, I think it's really important. Some schools are doing Success Beyond six and working with a designated agency. Some have some in house folks and Success Beyond six. So really that menu of options is really helpful for schools to serve the whole school population.

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: Yeah, I think it's really important not to think about it as one or the other, but what are the needs of that school and where are the resources that exist in the community?

[Unidentified Committee Member]: Does that mean that money's being left on the table because of not getting access to payroll money? We have an idea of

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: what the split is now between schools. I mean, it's an ever changing landscape.

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: Yeah, we can probably get that to you. I think the challenge is that there are the contracts work in different ways. Some contracts work through the supervisory union and then the supervisory union decides where the staffing will go and some go directly to the schools. And so it's pretty nuanced in terms of the numbers, but we can at least tell you how many schools we're in, but we can't necessarily tell you where there are also other, where you're not. Yeah.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: So busy slide, lots going on. So this is just VCP by the numbers. We don't have an, our impact report available yet. But we did pull together some statistics here. I didn't put in the number of schools. We can get that for you for Success Beyond six, but you can see 3,800 students in Success Beyond six. But this is really just demonstrating we do really good work. And so here is kind of a snapshot of our outcomes, for fiscal year twenty five. Happy to speak to or toss it over to these two to speak to any of these, but we just wanted to include some, outcomes to kind of leave you with. We do have this as a one pager on the backside is our budget request for this year. Conveniently, they're in the card room and I can bring them up here. Yeah, that

[Unidentified Committee Member]: would be helpful.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: So we can give those to you. But if you have any questions, this is our last slide to close out. I don't know if I

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: I'll just say what struck me when we were looking at the numbers, I only have six, here are some, was the number of people served daily when we were looking at that. We often look at how many people do meet unique individuals. This is how many unique people we'd see over the year, it has actually increased. The number of people per day that rely on the system of care is pretty No words like somewhere between scary and also essential, right? Like the fact that that many people are struggling on a daily basis and the supports that we're here to provide that support and provide the specialty skill sets necessary is critical and it's critical for all of our communities.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: And I think about if we were to close our doors for one day, that's 5,260 people on that one day that we get supports and services. And that's significant. Yeah. I

[Unidentified Committee Member]: don't expect you want to answer this today, but once again, I'm curious. We heard from you many times about your workforce struggles and that kind of piece. So you haven't mentioned that yet or where you stand with that piece. That, of course, is huge.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: Yeah. In terms of our vacancy and turnover data and what it looks like in aggregate and also by department, we have that information. And that will definitely be part of our next slide deck. We'd like

[Simone Rueschmeyer (Executive Director, Vermont Care Partners)]: that in iceberg form.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: I will try.

[Daisy Berbeco (Ranking Member)]: I'm just looking over these numbers and want to say congratulations and thank you. Good work. You guys are doing it. And often it's kind of I don't want to say thankless job, but you're not compensated barely. I recognize the value of what you're all doing and you're saving lives. And I appreciate you all. And beautiful slides, You by the always have the best slides. They're colorful. Colorful.

[Unidentified Committee Member]: It was

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: a late night.

[Brian Cina (Member)]: Want to say I appreciate this last slide a lot because it helps us quantify, even though the qualitative to me is more important, people do ask about numbers. Then one little fun fact is I'm going to share that there were 3,725 mobile crisis responses with my coworkers, because I think that means I responded to 1% of the mobile crises in the state or something. Know what mean? Like 37 people. So then we can all be like, we did this portion, we did that portion. So it's fun to play with numbers sometimes when you feel overwhelmed and sad and like in a system that's failing, you know?

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: I'm really glad that you said that because there's a lot of DASSA staff in the room. And I think this is a real nod to all those folks in the room who do this work. And this hasn't necessarily been shared out with everybody, but the people in this room are doing this work and these statistics are you. So thank you for saying that and thank you for everybody in the room who contributes to this work every single day.

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: And I appreciate Brian too, just threading it together. When we think about the DASSA system and Vermont Care Partners, it's a unique body and saying we have 30 different committees that meet every month to talk about best practice to support each other across the state. So one of the strengths of the network is the network and it is unique in the way that it comes together and supports each other. And so, we may be focused on the NEK, but we come together every month with different staff that talk about how can we support our partners in Edmonton or Lemoyle or Franklin Grand Isle. And so I think that is one of the best things about care partners, the expertise across the state of health functions.

[Daisy Berbeco (Ranking Member)]: Thank you.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: Thank you for coming in.

[Kelsey Stafseth (Executive Director, likely Northeast Kingdom Human Services; Co-President, Vermont Care Partners Board)]: Thanks for

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: your time.

[Daisy Berbeco (Ranking Member)]: We're going to take a ten minute break. We'll be back here at 02:10, and that'll bring us to 03:30.

[Amy Johnson (Director of Legislative Affairs and Policy, Vermont Care Partners)]: Seems like the best time for a break.