Vermont Legislature SmartTranscripts:

[Liz Cinau (Emergency Nurses Association)]: We're going to talk about really accessible to you guys.

[Alyssa Black (Chair)]: Everybody, let's go ahead and finish the pain solution. We got a handout card with a QR code on it, and we're technologizing. Back, everyone. The Vermont nurse practitioners in today, because it's their legislative day as well. We're looking forward to hearing from you and great work that you do for Vermonters.

[Kate McFaun Williams (ANA Vermont Secretary)]: Thank you. I'm Kate McFaun Williams. I'm ANA Vermont Secretary. I'm also the delegate to ANA membership I'll be going down in DC. I'm an RN case manager in a trauma level one medical center. I work over at Dartmouth Hitchcock. I've also been a school nurse at Waits River Valley School, and I've worked in community care over at Heter Road Primary Care as well. And I love healthcare. I love designing policy, crazy about nurses. And mostly what motivates me is my family. And over 32 of my family members get care here in the Connecticut River Valley and in Central Vermont. So I'm interested in shaping policy to help bring the nurse's best to the patient's side. So we've got a few things we'd like to discuss with you today. With five eighty five, right out of the gate, an act related to health insurance reform. And my colleagues will share a little bit about that. I know we've got fifteen minutes, right? So I'm going to try to be quick. The biggest piece on this legislation that I'm concerned about, that our coalition is concerned about, is we're urging legislation to strike Section 11 and retain existing law enacted under H31 Act brief. So we all know how difficult it is to get prior authorization, It will take away from patient care and increase burden. So this has big effects on how we're going to work with throughput and taking care of our patients. So we would like to have that strike that section 11. Any other big comments on this?

[Alyssa Black (Chair)]: No. Okay.

[Brian Cina (Member)]: So that was the prior authorization section, right? Yes, that's

[Kate McFaun Williams (ANA Vermont Secretary)]: on H585, It's five eighty five. It's not related to health insurance report. And the biggest piece that I would like to have you take away today is that nurses need to be at the table. They need to be helped designing hospital governance as well as healthcare governance. Please ask us, those that are patient facing, an RN or APM to be part of the committee. Currently what's working, and I'll just step out of the coalition for a minute, Currently what we're doing isn't working. And I think it's because you don't have a patient facing clinical nurse at the table, an RN or APN, who has the skills to work at the board level and on committees. And I think that we can help solve some of these problems. And I know it always takes money, but we can be clever with that. And we know how to identify problems, make an assessment, a diagnosis within our scope, and we know how to make a plan and evaluate it. And part of our expertise with this is Act nine. Thank you so much. Last year we passed, we helped design that law and got how prevent workplace violence. And so now we're building the toolkit and we're going through the state of Vermont to get all the hospitals back to bed. So we put in the work and we follow-up and we do an evaluation. So that's what we're working for. And very quickly, we know we had Act 24, which said you can't harm a health care worker. We know we have that law, but this law that we helped do last year is going to help prevent that. And so we can make things happen. So we need to be at the table. H573, an act relating to the first certification of an emergency room examination. Liz will be our expert on that.

[Liz Cinau (Emergency Nurses Association)]: So Liz Cinau, I work for the Emergency Nurse Association. I'm one of the directors as well as the government affairs committee chair. And this is really important to align the verbiage of what is actually happening in emergency departments to ensure that patients are getting timely access to care in an emergency crisis situation. So currently, right now, across the state, a lot of emergency departments are staffed only by PAs, especially on off hours. So any patient that comes in during off hours where there is not an APRN or a doctor that can complete this, their care and access to the treatment that they need is significantly delayed. And that is directly related to escalation and decompensation on their part. And as a nurse, really realigning the verbiage to ensure that there is protection for those patients getting equal access rather than delaying their access based on how it's currently being done throughout the state. UBM has PAs that see them to complete these under an agreement. But again, to just ensure that everyone coming into emergency departments across the state can ensure that they have that timely access to care. I think it's really important to understand that this does not decrease the level of care that these individuals get. The qualification process to ensure that you are completing an emergency evaluation is equal no matter who is completing it, whether it is a doctor, an MP, or a PA. So they have the appropriate education and the appropriate qualifications to do this. It is just aligning to ensure that those individuals get access appropriately and timely so we can get them to where they need to be for their care.

[Kate McFaun Williams (ANA Vermont Secretary)]: And I think we'll move on to I know

[Alyssa Black (Chair)]: we have 15, so I wanted

[Unidentified Nurse Practitioner coalition representative]: to take So currently, there's a bill sitting in the Senate Health S-one 163 that representative Goldman was so kind as to have a companion age five sixty nine for. It started over in the Senate. It's going to be moving its way out of there very shortly. But what I wanted to bring to you folks ahead of time for this, this is not a change in scope of practice. This is a language cleanup. All we are trying to do is modernize the language so that it reflects the scope of our practice and reflects what's actually happening in most of the rural hospitals in the state at this time. It's no change in scope or clinical practice. And I said that three times intentionally because as an educator, I learned you

[Alyssa Black (Chair)]: have to say something before

[Liz Cinau (Emergency Nurses Association)]: it sticks.

[Alyssa Black (Chair)]: She got three more. Yeah, yeah. Boy, all right. But this is just

[Unidentified Nurse Practitioner coalition representative]: simply about clarification and language cleanup. And it's been being discussed with both BOSS and BMS. And I believe it's going to come over to you guys in a very nice tied up package.

[Kate McFaun Williams (ANA Vermont Secretary)]: Right. So, and then we'll jump into a real complicated one, but HR one, Rural Health Transformation. So our statement is that the Vermont Nursing and Nurse Practitioner Coalition is a resource to be included in work groups, committees, and for operational guidance to implement the award of 195,000,000 annually for five years. And we know after five years, it could be problematic. It's difficult now as well. We have the necessary expertise in care delivery and nursing and nurse practitioner scope of practice that is necessary to ensure our communities have access to high quality asking to be appointed to committees and participate in how we're going shape this healthcare. We have some ideas, we have some solutions, and we're willing to do the hard work. And I think we've proven how committed we are and successful we are.

[Unidentified Nurse Practitioner coalition representative]: And I want to say tagged on to that, Act 68 last year did appoint some nurses and nurse practitioners to some committees for rural health transformation. Bridget here sits on the primary care committee and is bringing forward ideas from boots on the ground providers to that committee. I'm sitting on one of the committees as well. And so what we're saying is please continue to do that because we are now being able to get our voice heard where it was never being heard before. And what we're bringing forward is what the real barriers are to being able to provide cost effective, safe care for our patients.

[Kate McFaun Williams (ANA Vermont Secretary)]: And the last couple of bills that we're concerned about, S-two zero eight and S-two zero nine, an act relating to standards for law enforcement identification and an act relating to prohibiting civil arrest in sensitive locations. So currently, law enforcement can't go into a patient's room or into locked areas. We'd like to see that extended to the lobby and the hallway because we can't have this kind of distraction taking us away from patient care. That needs to happen outside of a hospital clinic and home health agency, outside of those walls. We ought to be able to see the person who's coming in. We all believe in masks, high defies, not a problem with that, and identification as well. And so that's a bill that's with the Senate. We were going to meet with them today, but they were tied up with their judicial nominations. And so that's what we've presented today. The QR code will give you more information about our positions and which bills we are following. Yes? I was just wondering, are there any hospital boards on which nurses are presently represented? I don't know. Should ask.

[Liz Cinau (Emergency Nurses Association)]: 188 is another bill that we've really tried to emphasize the importance of ensuring that if you're appointing people, you're finding the middle ground, who are the right people to be appointed onto that board? We've had a discussion about how each board is managed differently or selected differently across the state and whether or not that's currently working. We would really like to participate in how that is better outlined to ensure that maybe somebody who practiced years ago is currently speaking as a nurse, but isn't currently speaking out of our national organizations that help direct care. Nurses are known for balancing the whole picture. We balance the financial responsibility with the quality of care and the resources. There is no prioritization of how we're going to make this financially profitable. But instead, what do we have in front of us with what resources? And I think when we talk about being at the table, making sure that we are putting those people and appointing those people that are best qualified to have transparent conversations about what decisions are being made to support our health care facilities and our communities. And again, when we say, we want to help you, we've been in this committee, we enjoy working with you, we enjoy these conversations even when they're challenging. But at the end of the day, if we're implementing decisions on how health care should be done and we haven't integrated someone or asked someone, can this be possible? A lot of the times, we're finding that that silence of who did we talk to is unfortunately leading to gaps in how it's implemented and the success of that. So we do really want to ensure that when we talk about what does this look like, it's not, yes, we support this, no, we don't. How do we carve this out to really ensure that it is meaningful and it gets at what it's going to? Because I think that there are uncomfortable conversations to be had around it. But again, we're all here to figure out how we're going to continue health care reform in the right direction.

[Kate McFaun Williams (ANA Vermont Secretary)]: Yeah. And the nurse is best at the patient's side. We are there for people's and family's best days and worst days. We know how to have incredibly difficult conversations. We're good at that. So we're good at that on committees. So that's our appeal. Leslie? I come from the southern part of

[Leslie Goldman (Member)]: the state, Windham County. And Brattleboro, and I get this from the newspaper, has had a lot of challenges. And one of the reasons nurses were not invited to be on the board or involved in this was because of conflict with the elected bargaining agreement. And I don't know if you guys have come across that. And I was just looking for some help with understanding that issue.

[Kate McFaun Williams (ANA Vermont Secretary)]: Yeah, there are some restrictions with expert at it, but we will find somebody to answer that question for you, particularly since we've had some healthcare facilities in the state that have union representation. As an association, we're not a collective bargaining agent. So that would be a pool to think of. But we'll get back to you on that. But I'm sure there are some restrictions.

[Alyssa Black (Chair)]: I was hoping push back on it.

[Liz Cinau (Emergency Nurses Association)]: It's for more clarification and more conversation.

[Eviana Ryder (Student witness, GIV Health & Medicine alum)]: At the

[Liz Cinau (Emergency Nurses Association)]: end of that, that's really just a blanket statement about understanding how unions work. I, as a leader, work really well with my union, as well as work really hard to ensure that our relationship from administration to the direct care nurses is cohesive and collaborative. So I think that, again, as we continue to have the conversations and narrow down what we're actually getting to at that, it doesn't necessarily need to be a union nurse that's direct care from a union. So there are a bunch of people, 130 people here today out of the American Nurses Association, that would really be great representation from where they come from that have the qualification background. And again, I think that is a part of the further conversation. That's the question.

[Brian Cina (Member)]: Thank you.

[Alyssa Black (Chair)]: Daisy? Thank you so much for coming here. When I see the nurses taking over this building, I feel like we're in the presence of something great, and I just want you all to know how much it makes a difference to say that. Saying Am

[Kate McFaun Williams (ANA Vermont Secretary)]: I my father's daughter? Also say that you're in a fairly safe space. We've got all

[Daisy Berbeco (Ranking Member)]: these nurses here around, we're all from safe space. And I wanted to point out that there are still bills being introduced, so there's a couple that I want to put on your radar. One is H H850, and I'm not going go into describing them right now, the other is H836. One has to do with arrests in sensitive places or something, and the other one, age eight thirty six, is requiring hospital board meetings to follow public open meeting laws. We've reviewed

[Liz Cinau (Emergency Nurses Association)]: that a little bit. And again, it's a lot, right? So a lot of us generally are in direct care with full time jobs, and we're trying to keep a pulse in here in our spare time. And those conversations where somebody reaches out and says, Hey, have you seen this? Could you review it? What do you think of this? And to say, yeah, you're going in the right direction. Or this seems fine without you don't have the direct care need. But it is so helpful if you guys, again, you say like Flagging a point. Yes, did we reach out? Did we have this conversation? We have a question. We're just as accessible as you guys have been made to be our voice. We want to be here to be our organization's voice.

[Unidentified Nurse Practitioner coalition representative]: Yeah. Also have Gail Zatt from Zatt and Renfrew, employing too. So, certainly she's an avenue that's in the State House all the time and can reach out

[Alyssa Black (Chair)]: to us all the time.

[Francis McFaun (Vice Chair)]: I think Liz touched on H573. Were you okay with it as written or were you looking for some changes? It's Daisy's bill, by

[Liz Cinau (Emergency Nurses Association)]: the know, I know. Daisy might have thought, and again, full transparency, she reached out and said, what is a barrier? And I said, access and what we're actually doing. And I'm curious. I've been curious to see where conversations would go with this. It does have a little more than just a PA and how those conversations could again, I don't want to say I approve it in completion before we have conversations with everyone that is touched by that. But I do want to participate in the conversation to ensure that you guys put out a meaningful bill that allows appropriate access to the situations that we have.

[Francis McFaun (Vice Chair)]: I'd like your input.

[Liz Cinau (Emergency Nurses Association)]: Oh, lost my input. I'm not. I'm not

[Francis McFaun (Vice Chair)]: too good to take it off the ball.

[Liz Cinau (Emergency Nurses Association)]: Yeah, I think, again, is nothing that I felt that when we gave the leave behinds that I really strongly felt about. Again, I think that this bill is going in a great direction around providing access to that care. I do want to acknowledge that we should always be careful how expansive that gets with who else has access to that. And that is just a really important part of the conversation when it does come off the wall. I think it's really interesting.

[Kate McFaun Williams (ANA Vermont Secretary)]: I think it's important. We support this, but let's ask the PAs too.

[Alyssa Black (Chair)]: I Yeah. They're in support.

[Unidentified Nurse Practitioner coalition representative]: They're very much in support. But I would also just remind people, and I am sorry, don't have the exact year, but it's within the last three years that APRNs was just added to this. So, APRNs have only been able to do this within the last several years, and that was because we also asked for a rules change. And at that time, the PAs were a little busy with other things, but we should have included them at that time. And so, we certainly support them. And it's definitely within their scope of practice. Last question, Brian?

[Brian Cina (Member)]: It's a two part question. The first is, can you remind us of the National Association of Professional Association with which your profession is affiliated?

[Unidentified Nurse Practitioner coalition representative]: Nurse practitioners or the American Association of Nurse Practitioners?

[Henry Gogo (Student witness, GIV Health & Medicine alum)]: The AAMP? Correct.

[Brian Cina (Member)]: Does the AAMP have any clinical guidelines or policy recommendations regarding the emergence of artificial intelligence in healthcare? There are So can you briefly tell us because we only have a minute?

[Unidentified Nurse Practitioner coalition representative]: Yeah, actually, I'm going to do is tell you there are some statements. I don't have them in front of me, I'm happy to get them to you.

[Brian Cina (Member)]: So we could always tap on you as a witness if we look at the issue? Absolutely.

[Liz Cinau (Emergency Nurses Association)]: Yes, and so he is here specifically as the American Nurse Association, which is national. This is our Vermont doctor. And I represent the Emergency Nurse Association, which is also national. So we all have had we come together because these priorities and these conversations come up for all of us. And it's so much more beneficial for us to collaborate and come together on our position statement and how we want to guide our state in these situations. But we're directly pulling them from national guidelines. Yeah, that's what

[Brian Cina (Member)]: I figured, thank you. I know that AFT nurses came to the Progressive Caucus to talk about their concerns about AI replacing nurses in a way that endangers patients, but that's only one of the many uses. So it would be interesting at some point if we look at the issue to hear your national perspective as well as the local. So thank you for offering.

[Kate McFaun Williams (ANA Vermont Secretary)]: Our ANA president, Jennifer Mensick Kennedy, ANA president, had just came out to say they didn't have it ready yet, but we are all

[Brian Cina (Member)]: Just did.

[Alyssa Black (Chair)]: Just did. We were preparing for this.

[Liz Cinau (Emergency Nurses Association)]: Yeah, yeah. It's a big conversation, right? So what does an AI triage kiosk look like to replace a triage nurse in an emergency department? That is very different when you can come in and check a box for chest pain versus what my response is looking at you immediately to know sick, not sick, chest pain for the last seven years in regards to an ingrown hair. Again, that is something that it's true. You can't replace us. And I think there's a place for AI, and I think there's not a place for AI.

[Francis McFaun (Vice Chair)]: We'll look

[Brian Cina (Member)]: forward to the discussion.

[Alyssa Black (Chair)]: Thank you. Thank you so much. Thank you. Thank so much. From the Governor's Institute, and we have Nathan MacIntyre with us.

[Kate McFaun Williams (ANA Vermont Secretary)]: Do want to come up and look at us? And

[Alyssa Black (Chair)]: you guys, do you all want to come up together? It's going be great. Perfect. Awesome. And we have one other person who will come up faster. Hi, welcome. Happy to have you in today. Tell us about what you are working on and how your experience has been. Thank you for having us. Do we still have twenty minutes or are we crunching? We do. You have until 02:45. Okay, great. Wonderful. My name is Elizabeth Frascoia.

[Elizabeth Frascoia (Executive Director, Governors Institutes of Vermont)]: I'm the executive director of Governors Institutes of Vermont. And we're really pleased to be in front of your committee. I don't know that we've ever been in this committee before, but we're really excited to talk to you about what we're working on. And so I am going to give you a quick overview of what GIV is and how I think it fits into the work that you are thinking about. And I'll turn it over to our students to give you a fresh perspective on the Health and Medicine Institute specifically. And then I have another older alum and board member to offer his perspective. So thank you again for having us. So the Governors Institutes is the mission is to inspire our Vermont young people to do meaningful things with their lives. We do that through these intensive summer programs that take place on college campuses across the state. They last from one to two weeks long. Students come, it's their first sort of collegiate experience in many cases. They live with a roommate, they eat in a dining hall, They attend classes and workshops and often are getting a lot of choice in how to spend their time, so kind of learning to navigate an independent college postsecondary experience. We offer these in topics, many topics. We have eight this year, from the arts to technology, AI. We just did a day on AI and cybersecurity and thinking about those issues. But what I wanted to focus on in this committee was our Health Medicine Institute, which has grown in popularity and demand over the last eight years since we've been offering it. We began it. It's always been in partnership with the AHEC network. I'm sure you are in contact with those folks. They're wonderful partners for us. And they help us deliver that. They bring expertise. They help us give a really broad spectrum of pathway expertise for young people, whether they want to be nurses, whether they want to be respiratory therapists, or they have never heard of respiratory therapy. We're trying to open a lot of doors and say, there's a lot of ways that you could participate in the health care sphere as a professional. So we started with 35 students. We doubled to 70 students. We doubled again to 140 in two different sessions, which we've been doing for a few years now. This year, I'm very excited to say that a little bit of the materials I sent you are centered around our move that's happening to UVM. So we have been at Vermont State University at two different campuses. We're going to be able to bring all 140 students together this year in one place for a really exciting it's four days virtual and then seven days actually on the UVM campus. We're going to be in partnership with the health center, in partnership with the College of Medicine and the College of Nursing and Health Sciences to try to really bring together a lot of components of health care. And we hope to build that relationship over time. We are a nonprofit organization. We were founded by Governor Snelling back in the early '80s in concert with the Agency of Education and, at that time, the Arts Council. It started with the Arts Institute but have grown to many other topics. A couple of important things to know. I know that you had a little bit of information background just to refer later. But one of the crucial things that we do is make sure that students can access this opportunity no matter what their financial situation may be. So about 90% of our students receive some amount of financial aid to attend the institute. There is a tuition fee, but it's on a sliding scale based on your family's income. So 90% of people get aid. 55% of students in the last two years were low income. So that's just a really important thing I wanted to say. And I'll turn it over to you all in just a second because we don't have too much time together. But that need has increased significantly. And so I'm not here to ask you all with a money ask, but we do have a money ask in front of the education committees that will go to appropriations. We are doing a lot with a little. We leverage the money that we get from the state appropriation. It's about 20% of our budget. And it's just under $400,000 We'd like to see that go a little bit north of $400,000 We have a specific ask in front of them. So if you see that coming through and you can be supportive of that, I appreciate it. Let me see if there's anything I want to tell you before that. Oh, the other thing is that really in partnership with the Vermont schools, But we're also not only looking at educational pathways, but career pathways so that students are working with working professionals. People volunteer their time to show up. Last year, we had a whole team from UDM's pathology research. They are normally in a basement alone, I guess. But they were so excited to come and talk. They spent two full days with us, one at each session, just sharing really passionate excitement for what they do and how important that research work is. Boy, they were really excited to get our own basement. I know that. Yeah, maybe Maybe both. So I'd love to turn it over. Is that my phone ringing? I'm so sorry. It's telling me to pick up my children.

[Alyssa Black (Chair)]: Leslie, but what age? This is for high school students specifically. So we're looking at early by ninth, tenth, eleventh. Yes. So Go ahead, Leslie. So I'm wondering if the AHEAD funding got reduced, how would that affect this? Significantly. And I know that they were not included in the governor's budget this year, which is quite concerning to me. My understanding of that is that their Department of Health funding specifically funds early pipeline. So they provide in kind support, expertise, and it would be very devastating to us.

[Elizabeth Frascoia (Executive Director, Governors Institutes of Vermont)]: I don't know what we would do without them. For this program or all of it? This program specifically. I could just say one other thing, which is that beyond those 140 students, we're still turning away at least 100 more. We'd love to grow this program, continue to grow it. We can only do that with continued sustainable support from AHEC and our partners. My

[Henry Gogo (Student witness, GIV Health & Medicine alum)]: name is Henry Gogo. I graduated Rice last year. I'm currently taking a gap year, but I'm going to attend UVM this fall. And I am a 2024 MS alum. I'll touch base on my experience with GIV and how it helped me understand more about what I want to do in the future. Think Derby's really, really helpful just to expand young people's understanding of what they want to do within a certain subject. I know that I knew that I wanted to get into the health medicine related subjects, but I didn't know what exactly I wanted to do. And after going to GIV, I was exposed to many different career paths and steps to how to get there. But not only that, just all the hands on learning that we did with not only our peers, but with the professionals that are really passionate about doing their jobs. It just really helps because I personally really learn better with hands on learning. I feel like a lot of people do better or learn better by just doing the work and just repetition. And I think it helped me a lot and helped me gain confidence with life skills, like CPR and stop to bleed. I think the confidence that I gained from GIV helped me get into more health related stuff. That's why I feel more confident when I joined. I now attend the EMT courses at Sam Mike's at the moment, and I don't think I would have felt comfortable doing that without the training I did at GIV. And all the connections you make with your peers and professionals, and they can just help you out with the future.

[Eviana Ryder (Student witness, GIV Health & Medicine alum)]: My name is Eviana Ryder. I am a senior in high school in Vermont Commons, but I live in Burlington. I would like to talk about my experience at DIP and how I view it. The technical skills you learn there are just fundamental to life. I have had experiences in my past where somebody needed emergent care and did not receive that because nobody was trained in CPR and a life was lost. After GIV, I am confident that if I went back in that situation now, that life would not be lost. If somebody was to drop right now, I could save you because of GIV. I've got a bunch of stuff. I made so many friends. It was great. I go to a tiny school. I don't have a broad community. So I was able to make friends from all around Vermont. GIV draws from every corner. Furthermore, it gives you connections into career pathways, especially health and medicine. I think I just met about half the EMTs at UBM right now. My mentor Kevin is part of APAC. He was here earlier at the GIP table, if anybody met him. He's wonderful. He taught me everything I know. But as we all know, that is especially vital right now, making connections into health care. My dad is a doctor at UVM. I have grown up fully aware of every issue, administration issues, patient issues, staffing issues. And GIV is where that junction is. It's going to create retention in Vermont. Why should anybody go outside Vermont if they have the pathway in their career built in, if they have those connections already. He is taking an EMT course. I have a friend who got his Viper. He's now working as a ski patroller at Sugarbush. He doesn't need to go anywhere else because his career is already laid out for him after GIV. It's just a really wonderful experience and it's so helpful. Health and medicine was amazing. Not only did we get EMT certifications, well, did you get prepared for EMT certifications, but you also got to experience sheep brain dissections, sheep heart dissections. She brought up respiratory therapy because that's something that was offered to us. I took a little course in that while I was there. It's just a wide variety that you're introduced to. If that's pathways that you want to experience, that's pathways you get to explore at GIP. And that has really helped me and so many of my friends and peers get into this field. I have a friend who now is going to go shadow at UVM to see if she wants to become a nurse because GIV has inspired her to do so. It's really important, especially with our health care system as it is right now.

[Brian Cina (Member)]: Are

[Alyssa Black (Chair)]: you graduating this year? I actually kind

[Eviana Ryder (Student witness, GIV Health & Medicine alum)]: of just graduated. Graduated early.

[Kate McFaun Williams (ANA Vermont Secretary)]: Where are you going to?

[Alyssa Black (Chair)]: Do you know where you're going to go?

[Eviana Ryder (Student witness, GIV Health & Medicine alum)]: Yeah, I'm about to do a semester abroad, and then I will be going to University of Denver.

[Brian Cina (Member)]: So you talked a bit about your interests and your goals, but could you just reframe it, each of you, and just say, before this program, what was your interest, and now what is your goal? If you haven't, because I still don't know it's okay.

[Henry Gogo (Student witness, GIV Health & Medicine alum)]: For me, didn't really have a particular goal in mind. I wanted to experience what it's like to be in this field so I can see if I want to be part of it. And afterwards, I still don't know what exactly I want to do in that field, but I've taken even more interest into that field. So I think it just really helps me at least focus on what I want from that.

[Brian Cina (Member)]: So it was a chance for you to explore an area of interest and confirm that it's a pathway you want to stay on. Yes. And then what about you?

[Eviana Ryder (Student witness, GIV Health & Medicine alum)]: It's quite similar for me, I a little bit know I'm interested in international relations. That's what I am studying in college. My major is confirmed already. However, I did health and medicine at GIV because I find it deeply interesting. My dad inspired me to do so, and it has confirmed for me that if I don't like international relations, it is a pathway that I intend to pursue as a paramedic or an EMT.

[Brian Cina (Member)]: You said if you don't, I missed, I heard the path, the paramedic or EMT, what is the first thing you said?

[Eviana Ryder (Student witness, GIV Health & Medicine alum)]: If you It's don't, international relations ends up not being my jam.

[Brian Cina (Member)]: I see. Do you see yourself being an international EMT?

[Alyssa Black (Chair)]: I'm really open to anything. Would love that. Space EMT.

[Brian Cina (Member)]: Well, thank you for highlighting what it did for you, because it sounds like a great program to help people explore an interest and that it could be a viable way to recruit people into certain professions where we need more support.

[Henry Gogo (Student witness, GIV Health & Medicine alum)]: Thank you.

[Alyssa Black (Chair)]: You. Jeremiah, did you want to

[Jeremiah Breer (Board Member, GIV; CFO, Vermont State Treasury – speaking in personal/board capacity)]: Yes, of course. So nothing I'm going to say is going to be as interesting as these But I am Jeremiah Breer. I'm a 2007 graduate of the Asian Cultures Institute and the Governor's Institute. And I am currently a board member. And I want to emphasize that my speaking to you today is in that capacity and not in my professional capacity as Chief Financial Officer of the Vermont State Treasury. So a couple of things that I would emphasize to you. One is that GIV is investing in young people, right? And it's helping them explore different opportunities and resources and avenues. And I'm sure that I don't have to sell to you that Vermont has some demographic challenges. And anything that we can do to invest in young people and make their futures here brighter is of benefit, not just to the health care space, but to the state as a whole. And GIV, of course, has a very specific, as you have heard, health care institute, which is very impactful in that area. In my case, in particular, as an alum of the program, so I grew up in Cabot, Vermont in a double wide trailer with a single mother and a very blue collar background. We didn't really have a whole lot of resources and not a lot of opportunities came my way. And my role was very small, you might say. That's not actually a bad thing. I actually love that about my upbringing. That's a very beautiful and wonderful thing that I was absorbed in this very local, rural network. But what GIV did for me was it gave me a whole new perspective. Because I went to UVM for one year. It was a two year institute. So the first year we went to UVM and I met all these new people from around the state. And then the second year we actually traveled to China itself and went around for three weeks in various different places. I saw all the landmarks and that really widened my horizons. I had never been really out of the country except for maybe a little bit into Canada. And I saw different people and heard different languages and in different foods. And it gave me this different view of the world that I never would have had. And so now I'm an executive level finance professional in Vermont state government as it happens. And you might think that the link from the Asian Cultures Institute to that is like a lot of dots. But the link is that this made me open to new experiences. It made me open to new ideas. It made me have the confidence to take risks and it helps me to grow socially. So that I think just without that, I never would have been able to become the person that I am today and I would not have the mindset of like a global citizen. And so not only does GIV help us with addressing Vermont's demographic issues, but when we talk about investing in young people and keeping people here, it's not just about keeping people here. It's about the quality of those people's lives and the ability of them to contribute and perspectives that they have. And so GIV really contributes in both of those ways, I think very powerfully. So that's the first thing. And then the second thing that I will emphasize is that as we are asking you for funding, right? So as I mentioned, I'm the CFO of the treasury. I have fifteen years in financial management. I'm trained as an accountant. I am a certified public accountant. And in addition to my professional capacity, I've been involved with many different nonprofits and many different budgets and organizational structures. And what I can tell you about GIV is that it is especially well run organization. They will steward every dollar that you give them to the utmost. They will not waste any money. Anything that you give them will be used in the most efficient way to manage their impact and to further their mission. And so I just want to plug you that as state dollars are scarce and you're allocating among resources, I would just, both as someone personally impacted by this and so involved in it and as a financial professional, I would say that this is one of the best and most impactful sources of dollars that you could allocate anywhere. So that's what I have to share for you today.

[Alyssa Black (Chair)]: Thank you. Go ahead, Leslie. As a proud parent of a GIV grad in the late early 2000s, I guess, everything they say is true. That it opened his eyes, he went into the Arts Institute, it opened his eyes beyond his own and our expectation. So yes, I really want to say thank you for that work and that it's all true.

[Brian Cina (Member)]: While we have young people here, this strays a little bit from the topic,

[Francis McFaun (Vice Chair)]: but Is

[Alyssa Black (Chair)]: this going to be AI?

[Brian Cina (Member)]: No. I did already hear from them that they And studied if you wanna be a witness, if we talk about that issue, that would be great. But Jeremiah, you just said that you mentioned the demographic issue and about young people staying in Vermont, and we rarely get young people as witnesses. What would make young people stay in Vermont? It strays a little bit from the topic, but this is like using your GIV opportunity to influence us.

[Eviana Ryder (Student witness, GIV Health & Medicine alum)]: It's the cost of living. Young people are moving out because they have no place to stay. It's very much a housing issue. It's very much a cost of living. The price of groceries is insane right now. If I was not living with my parents, I would be able to afford cheap ramen every day. That's not quality living. That's not something that people want, which is why they're moving away. There's not enough job opportunities for what they want to go into, which is why GIV is so important. We need to encourage them to stay here and provide them with those job opportunities, provide them with the career interests that they want and give it to them young so that they understand that is an opportunity they are provided here in Vermont.

[Brian Cina (Member)]: I like to summarize to make sure I heard. I'm not saying exactly what you said, but housing was an area, affordability especially I was hearing food and work opportunities that align with their interests and passions. Those are three main areas we could focus on that

[Henry Gogo (Student witness, GIV Health & Medicine alum)]: would retain young. That is my belief. Okay, thank you.

[Brian Cina (Member)]: Do you wanna weigh in or? I'm always glad it's still later.

[Jeremiah Breer (Board Member, GIV; CFO, Vermont State Treasury – speaking in personal/board capacity)]: Madam Chair, if I might just highlight the fact that we're one of the few organizations that is bringing young people into building, I think, actually a powerful argument for the effectiveness That's of why I

[Brian Cina (Member)]: was like, we should take advantage of using the investments maximum by asking the young people everything we can while we have your time. So

[Liz Cinau (Emergency Nurses Association)]: thank you.

[Brian Cina (Member)]: We are

[Alyssa Black (Chair)]: happy to connect you with other young people if you're looking for witnesses.

[Francis McFaun (Vice Chair)]: Thank you.

[Alyssa Black (Chair)]: Great. Thank you. Go ahead. Do you have any data that shows, for instance, Henry, I was glad to hear that because of GIV, you chose to do the EN2 approach. Do you have any data that talks about the kids who go through the program, specifically this one?

[Elizabeth Frascoia (Executive Director, Governors Institutes of Vermont)]: Yes, so thank you for the question. This has been a really challenging thing for GIV overall. We're a small organization, trying to track everybody is really tricky. Because of AHEC, you asked about AHEC's involvement, they have more capacity to track this, and they have been tracking this. And so in the document that I shared with the committee, there's some more data. I'll give you a couple points, which is that post secondary enrollment in Vermont is very low compared to the graduation rate from high school. But for GIV students, it's quite high. And many of those folks are going to a Vermont college, and of the folks going to college, many of them are choosing health related degrees. Thank you. Appreciate that.

[Alyssa Black (Chair)]: Yeah, thanks for the question. Any other questions? Well, thanks so much for coming in. Thank you.

[Henry Gogo (Student witness, GIV Health & Medicine alum)]: Thank you for your time. Thank you so much.

[Brian Cina (Member)]: Do you think of anything else we can do to keep young people in Vermont being tough?