Vermont Legislature SmartTranscripts:

[Theresa Wood (Chair)]: Okay, good afternoon, everyone. It's nice to have so many people in the room. You all look a little bit older than the previous people who were sitting around the room. We had students from around the state, and it was maybe even more packed than it is right now. So thank you all for being here. So this afternoon, we're going to pick up the topic of substance misuse prevention and what's happening in prevention coalitions around the state, what the Department of Health is doing. We're going to hear from a number of witnesses. We have Doctor. Hilfbranner starting us off. Thank you so much. I don't even we're gonna make paper copies.

[Commissioner Hildebrand (Vermont Department of Health)]: Full service organization, you know.

[Theresa Wood (Chair)]: Oh, there's a problem with the link, apparently. Our technology has been causing us problems all day. So thank you for being here, Doctor. Hildebrand. Thank you for having me. Floor is yours.

[Commissioner Hildebrand (Vermont Department of Health)]: All right. For the record, I'm Hildebrand, commissioner for the Department of Health, and good afternoon. Today, I am here with some of my colleagues. I'm here with Emily Truter, our director of the health department's Division of Substance Programs, and leaders from two of our Vermont prevention lead organizations, PPLOs, Amy Carmola, who's the Chief Impact Officer of United Way, and Marianne Morris, who is the executive director of the Collaborative. So prevention works. It's frankly one of the reasons I'm in this job. I saw time and time again that I was healing with the consequences of problems that should have been prevented in the first place. It's cost effective at a time when health care costs are astronomical. And we have a strong and specific Vermont evidence to show how much of an impact it has made in our food. It's an investment in our communities, led by our communities. And sustaining and supporting consistent funding from the Substance Misuse Prevention Fund is critical for this work. We employ a comprehensive approach to substance use disorder prevention, programming that addresses the individual, the environmental, and the societal factors to improve the health of our communities. We use proven strategies such as school programs and policy change to prevent initial use, to reduce misuse, and to enhance protective effects than individuals. We support our community based decision making model, which empowers schools and the VPLOs to use local data to determine what is the best path forward for the community.

[Theresa Wood (Chair)]: The PLO, just not everybody in the room.

[Commissioner Hildebrand (Vermont Department of Health)]: The Vermont prevention lead organizations. Thank you. And this is critical because we need to listen to our communities. They are the best source of information to know what's going on on the ground. We need to give them the ability to do the work, to address the concerns they identify, rather than implementing a top down approach, which doesn't always work in this scenario. It can leave us detached from what's really happening. So I'm gonna hand it over to Emily Trudor, who's gonna give you a lot more detail about how our program is structured. I can go ahead. Unless there's any questions.

[Theresa Wood (Chair)]: Was just wondering, so not on the overall thing, and this may be something that somebody needs to get back to us on, but I'm just I'm just wondering, McGill, did you have a question about this is going get very specific about grants that are out there.

[Rep. Jubilee McGill (Member)]: Specific to prevention, but for our Turning Point

[Theresa Wood (Chair)]: Recovery centers. So I'm just wondering who maybe we could follow-up with Emily afterwards.

[Commissioner Hildebrand (Vermont Department of Health)]: Emily is probably better suited to answer that.

[Theresa Wood (Chair)]: Okay, just want to make sure we've had some concerns raised.

[Commissioner Hildebrand (Vermont Department of Health)]: And if we don't get to it, we'll make

[Theresa Wood (Chair)]: sure we get your questions. Okay, thank thank you so much. Musical bench seats. And somebody is welcome to sit in this chair, if you would like to pull that chair out and sit, that's fine. Yeah, yeah, you probably shouldn't sit half the table, but you can sit in the chair. Although we did have a middle schooler joining that many Welcome, Emily.

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: Thank you. For the record, my name is Emily Trueger. I am the division director for the Health department's division of substance use programs. Just before I begin today, today is prevention day at the State House. Obviously, a lot of partners here today. It is also where Knee Deep and Alcohol Awareness Month, and it's gorgeous outside. A quick shout out to my mother who's turning 75 this weekend. She's very excited. That picture of her front lawn is on the cover of this presentation. There she is. So the so I'm gonna go through several things here. My goal is to make it tangible, be able to feel what prevention feels like on the ground. We have two wonderful presentations that'll be coming after me to really give you that flavor. Our goal is to give you a little bit of the nouns and verbs, as well as some of the process information as we go through it. So the first part we're going to start with is why is substance misuse prevention important? It's compelling. Ninety percent of individuals with substance use disorder had their first use prior to the age of 18. The adolescent brain is more vulnerable, as we know even under the age of 25, to alcoholic drugs than the adult brain. Early use can disrupt brain development, increase the risk of developing substance use disorder, and that ninety percent is compelling and that's a national statistic. We next move on to defining prevention. Substance misuse prevention reduces the harmful effects of tobacco, alcohol, and other drugs, and stops addiction before it starts. And we sort of use two strategies for that, increasing protective factors and reducing risk factors, as well as delaying the onset of first use. To the right of this slide, hot off the presses from the Substance Abuse and Mental Health Services Administration. They've, released a new report that speaks to the long term positive outcomes of prevention. It promotes early substance use disorder identification and timely intervention, reduces the risk for binge drinking and substance use disorder, enhances overall physical and mental health, improves occupational and or academic performance, and lowers school dropout rates and reduces disciplinary issues among adolescents. This is an interactive slide deck, the one that's available there, if you would like to be able to hop out to the larger reports. So you'll see a

[Unidentified Committee Member (addressed as “Peggy”)]: lot of links as part of the presentation.

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: A lot of spaces, you know, what does the investment look like? So, the Substance Abuse and Mental Health Services Administration, they have several reports on this. We do provide the link at the bottom of the graphic. That $1 invested in prevention saves $18 in other spaces. Investments could include school based prevention, community strategies, substance use messaging and policy initiatives. The savings can sit in spaces like chronic disease care, treatment and recovery services, future healthcare costs, criminal justice system expenses, etcetera. We're going to go through a brief snapshot of how we fund prevention services in the state of Vermont. I do want to open specifically with the Substance Misuse Prevention Fund. This slide represents our FY '27 budget proposal. The General Assembly did establish this fund and dedicated 30% of the regulated cannabis sales excise tax for substance misuse prevention. For FY '27, we're proposing that 5,000,000 be aligned with the Vermont prevention lead organizations, 3,000,000 with school based prevention services, and then a little over 1,500,000.0 for field based prevention staff in the field. The next slide probably would take a deeper dive on different date just because it's so detailed, but we did want to give you a snapshot of the overall Department of Health prevention budget, which is a little over 18,000,000 proposed for FY '27. Emily,

[Theresa Wood (Chair)]: I was asked on the previous slide, on the school based prevention services, out

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: of our, whatever it is, 100

[Theresa Wood (Chair)]: and some odd different school districts, what's the reach on that school base? Right now,

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: we're currently serving 64% of middle and high schoolers across the state. I do have a slide a little bit later that does show a map.

[Theresa Wood (Chair)]: So you

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: can see sort of the the areas that definitely need services at all, let alone other areas. There's no area of the state that I'll never say anybody has enough, but there's clear gap areas across the state. We have a slide specific to that.

[Theresa Wood (Chair)]: Okay, thank you. You're welcome.

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: In the slide that has the four graphs to the left, you'll see it sort of laid out in a few different areas. We have community based services, school based services, the tobacco control program, and other prevention activities. We do right now have six different funding sources that do support prevention related activities. Two of them are tied to the Substance Abuse and Mental Health Services Administration, both our block grant and a large strategic prevention framework funding source. Obviously, Substance Misuse Prevention Fund, the Evidence Based Education Fund, General Fund, Global Commitment, and the Tobacco Fund. I

[Theresa Wood (Chair)]: remember when we were doing the vaping bill, the tobacco bill, we heard testimony from the Agency of Education and their, I guess you might call them prevention specialists. How do you link up with the agency of education and the resources that they put into this? There's a variety of areas where

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: we have regular communication with them that also happens at the local level. I think that it'd probably be helpful if I provided a little bit more information in written format post this. But there are lots of conversations in different places. There's still more work to do there. Whether it be policy building, whether we talk about funding, whether things are happening at the local level, or we're talking about school based services, there's lots of connections in that space. But as far as actual alignment of budget, I think it'd be helpful if we took that back and provided you with something more comprehensive.

[Theresa Wood (Chair)]: Okay, that would be helpful to get an idea, which obviously, particularly around school based, where we have gaps, I think at the time, and granted this was three to four years ago, I think we were seeing at AOE, it was a little bit problematic. I'm just going to say, in terms of how they were handling substances, and it was just literally only focused on tobacco. And hopefully that's changed in the meantime. But I don't know if it has. If you have information about your collaboration with AOE, that would

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: be helpful. We will provide. Thank you. Okay. Next, we're going to dive into the meaty parts. I think that a lot of individuals are looking for. So how do we approach prevention in the state of Vermont? We do have a Vermont prevention model. It is a comprehensive, multi pronged approach that includes, different types of interventions and, policy work. So it includes something at the personal level, social, organizational, community, and systems. You'll hear a lot about that from the, subsequent presentations as well. It is grounded in the understanding that prevention strategies are most likely to succeed if they reach people holistically in all environments. Work through each of those systems and how they interact. The next slide is a matrix that is a really small subset of all the wonderful work that's happening across the community, but wanted to give you sort of a matrix that gave you a sample set with some outcomes. Again, the top columns are tied to the prevention model strategies. And then on the side, we have what it is, who it serves, some examples of outcomes, and some examples of work done. In that space, for example, under personal and social, you'll talk a little bit about what it is. It seeks to serve all the long term. It is population level prevention. Some examples of the outcomes include, we've reduced access to 18,000 pounds of medication through the drug disposal program in 2024, and that we had, for example, 51,300,000 impressions for three paid media campaigns, Pairing Up, which educates parents on how to talk to their children about substance misuse. Let's talk cannabis, something specific about cannabis, especially in the world we are today, and Outlast. You'll see some one of my favorite examples, because it is Alcohol Awareness Month, our current One Less campaign is focused, you know, how about Just One More? Think of the inverse. Just One Less is a campaign focused and targeted towards adults and alcohol consumption that we're very excited about. In the organizational space, one example we have in here is about our school based services. It seeks to serve K through 12 school age Vermonters. The statistic I gave previously was specifically about middle school and high school students. That 64% did not include either the K-five or K-six, depending on the school district or supervisory union. A student learns about the harmful effects of vaping as part of the Stanford Tobacco Prevention Toolkit. In the community space, I'm not going to give a ton of specifics because I want the VPLOs to be able to speak for themselves today as part of that.

[Mary Anne Morse, Executive Director, The Collaborative; VPLO Lead for Region 4]: They have a lot

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: of wonderful information to share, but we have the VPLOs. The RPP is a large SAMHSA grant focused on cannabis and alcohol for youth and young adults. And then we have our prevention consultant system, the 11 field based staff. We have some of them in the room with us today. I've been with the division since 1996. My first job was actually as an admin for the prevention consultants across the state, and the wonderful work they do, and really were our first approach statewide ness, and we had that going for us before we tried to leverage additional federal and state funds. An example in that space is rates of past thirty day alcohol use decreased for youth grades nine through 12 from 2019 through 2033. And you'll see some examples at the bottom about, you know, a family attends forums on youth substance misuse with other families and staff and community members in Burlington. Last but not least, and this is sort of the quiet one that sits in the background, is the policy work. So laws, policies, and regulations seek to reduce access to substances. Eighty two percent of Vermont high school students do not use tobacco. The legal age for tobacco use has raised to twice. Next the subsequent slides give you a little bit deeper dive into each of those pieces just to give you a flavor. So for personal and social, as part of the prevention model, talk about our drug disposal program. We talk about some specialized programming, everything from One More Conversation, which is targeted towards pregnant and breastfeeding individuals, and talking about substance misuse and use. We have our nurturing parent programs, which reaches across the state in a variety of sectors, including within the criminal justice system, and My Time, a program focused on pregnant and parenting people. We have numerous campaigns again this month, I think the one to target most because of Alcohol Awareness Month is our new one less campaign.

[Theresa Wood (Chair)]: Can I just ask a question in general? I sort of get the diagram that shows the personal up through the systems. I guess one of the things that, I mean, obviously, we've had some questions in relationship to the Opioid Abatement Settlement Fund and the Substance Misuse Prevention Fund and how those two intersect and correlate. And what is starting to cross my mind is a couple of things. So how do, when we get to the community level and organizations, I guess it would be both of those organizations and community. How do local organizations break through this already established hierarchy that you have? If they have a concept in their local community that, or an organization in their local community that, I don't know, is looking to support a teen center, is looking to support other activities. How do they make themselves known to access resources from the VPLOs? And now I'm even starting to wonder whether or not we should say that prevention activities are not covered under the Opioid Settlement Abatement Fund. Because, well, I see people shaking their heads, but the reality is that that's a declining amount of revenue. This is an increasing amount of revenue in this fund up to a certain point. And we may need to prioritize it for treatment and other activities. So I'm just, we have this sort of, I guess we're butting heads a little bit about what funds should be used for what, do you know? So I'm just, yeah, I know we've had community based organizations doing prevention work that have applied to the opioid abatement fund. And the department has been reluctant to utilize prevention funds for that very prevention work, because you already have established things? And how do you break through those established things to look at different organizations?

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: Great question. I think that there's a couple spaces there. I guess my lovely commissioner can kick me under the table as part of this. But the, I think that the, I don't think you can spend enough on prevention. I will start with that as a general statement. It's long term outcomes and impacts are exponential across generations. I think that the for the VPLO space, which we do have a slide in here that talks about it, they have a a data gathering component that brings their communities together. They look at data about need in that space. They have competitive processes for applying for funds. You know, that Any organization in one of those communities, when those RFPs come out, can apply for new activities as part of that work. Similar to what's gone in the past with the opioid abatement settlement, where organizations could also put in an application to propose a new idea. So that still exists in the VPLO space. So it's not a top down approach. It really is a community bringing everybody together to talk about what your communities need as far

[Theresa Wood (Chair)]: as investments. So would you be suggesting or are you saying that maybe I'm just wondering if the opioid abatement settlement advisory committee should really be asking the question, have you applied? When they see prevention activities, have you applied to your local VLTL or have you applied for substance misuse prevention funds? Do you think that that's something that they should consider? It's something that I've seen as part of

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: the conversation in the committee meetings I attend. Would defer to our current chairs as part of that process, but we do have a representative in the room. Yes. Sorry. Part of that. So I've I've been in the room where they've had conversations about that piece, so I don't I don't know if it's formalized in the process. I'd have to go back and take a look about the best part of the application process. It's a common conversation in any space that we're in, whether we're talking about the you know, looking at the whole package of funding for an organization from everything from fundraising to federal funds to grants to contracts, whatever that may be. So I think those conversations are happening. How formalized, I'd

[Unidentified Committee Member (addressed as “Peggy”)]: have to take that back. Thanks.

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: Next, we're just moving on to organizational, speaking specifically about school districts and supervisory unions receiving funds for substance abuse prevention services. This slide includes the map to the right that you can see some significant areas that do not currently have service funding from the health department for school based substance misuse services. The work there includes screens students and hold support groups, integrate prevention and school health, provide training to school staff, training peer leaders, which I think is a really cool part of the mix in there, and following evidence based curriculum. What

[Theresa Wood (Chair)]: do they do for folks? Providing training peer leaders, providing training to school staff, what happens when they identify issues for students? What happens on the treatment end of things? How is the connection made to treatment for youth? Our treatment programs, so the preferred provider network in and of itself, which is supported by

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: the department, has strong connections with our schools, screening intervention, the screening component could lead to referrals as part of that mix, they could end up in, for example, either one of our specialty programs or the designated agencies as part of that work. Some of the schools have resources in house. So it's a little organic depending on what district you're talking about as far as that. But the purpose of the screening is whatever it identifies is to get the individual to where they need to be and at least make their resources available in partnership with talking with their parents.

[Commissioner Hildebrand (Vermont Department of Health)]: Representative Chen?

[Unidentified Committee Member]: Looking at the map in the 29 unions and districts, as you said, there's a lot of areas in the state that are not in green. What might be happening in those unions and districts? Is it nothing, or are they identifying funds elsewhere for prevention?

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: I think a variety of things. I think that's a big reason why our prevention consultant system is so important. They do have a large reach within our school systems, so 11 positions across the state. Definitely the agency of education schools also, you know, could come up with their own resources and things like that. So there are we at the state level also do provide education and materials as part of that. But the one of my largest goals, and you'll see that in here at the end of the document is one of our 2,030 goals is to get services into each of the school districts and supervising needs, supervising needs across the state. I'm going to, if it's okay, speed up a little bit only because the other presentations on me are. We do have a slide in here that speaks specifically to the school based health and talks about some of that, some pictures of the work happening across the state. We are actively looking to standardize this student assistance professional role across the state. That's not the only type of service that can be purchased with those dollars. A lot of schools use the funding for a variety of activities, but it's an allowable cost within that. The Vermont Prevention Model community highlights. So you'll see three boxes at the bottom. One shows the VPLO regions. We have two of them with us here today. The Regional Prevention Partnership is that large federal grant supported by the SAMHSA that focuses on alcohol and cannabis, and then again, our prevention consultants. I'm going to skip over the VPLO highlight slide because you have two individuals here to talk specifically about that, but here's some examples on that slide. The one thing I do want to talk about, which we touched on a little bit earlier, was the process for the VPFOs. This slide lays that out a little bit, talks about the data gathering component, that five year strategic, hosting a competitive funding process as part of the mix to allow their community partners to advocate for their ideas and programming, and then putting together a board that oversees that work that is balanced and looks across the system. Next is the Regional Prevention Partnership to some areas of focus there and demonstrate some of our partners, including the Department of Liquor and Lottery, the Department of Public Safety, the DEA, working on community education and media. We have a slide about our wonderful prevention consultants. Three of them are with us here today. And the work they do across, they really fill in gaps. They make connections. They bring communities together to talk about different topics and are an integral part of the work we do. Policy level, I think is a really important piece. It's again, it's that quiet thing that you don't even realize maybe in your communities. It could be anything from retailer density. You may not realize in your community, you may have policies and procedures, so you only could have so many of something in your community. The Vermont Prescription Monitoring System and the Vermont Pain Rules in and of themselves, how they change the landscape of prescription drug misuse and substance use disorder. Again, tobacco 20 '1 being one of the most recent things that are part of that. We do have a slide in here that talks about the Substance Misuse Prevention Oversight and Advisory Council and their work. And again, they are policy advisors. They talk about their purpose. They provide recommendations to all different parts of government and communities. And then the next section, we're just moving into some of what the impacts look on the ground. In a lot of spaces, we're looking for outcomes and sort of what the actual reach looks like. This is the slide that demonstrates that 64% of middle and high school students are receiving school based. When I started in 1996, we had prevention consultants across the state, and we had three coalitions. We now have 67 active sub grantees in addition to the VPLOs across the state. So just building that capacity over time has been incredible, and we have a lot more creative partners to work with. We've had 300,000 Vermonters reached via marketing campaigns across the state, and we have had a 2.7% decrease in binge drinking for Vermonters aged 12.

[Theresa Wood (Chair)]: I'm sorry, okay, go ahead.

[Unidentified Committee Member]: The 64% middle and high school students receiving, is that through the state funding?

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: Through the health department's funding, yes.

[Unidentified Committee Member (addressed as “Peggy”)]: Okay, just curious, not related to this slide, but just generally, does the health department work with municipalities on the money that they get directly from the opioid settlement funds? We do at their request. When it happens, do

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: at their request. So we've done a little bit of coordination with Burlington. Right now, there's been some conversations with South Burlington and other spaces. So it's been more of a at a request based space. But, you know, again, our prevention consultants are anywhere and everywhere within our communities. So that reach is happening out there, but we would certainly any conversations that anybody's looking for as far as technical assistance.

[Theresa Wood (Chair)]: I have a question on the the 64% of middle school students receiving school based prevention services. So what do we see in there? Maybe you have it in here. I saw you had, I think, link to the youth risk behavior survey. Are we seeing an impact in decreasing numbers of students

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: accessing substances? In certain areas, yes.

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: In other areas, work to do across the board. So I'm not going to say that there's not. But I think that the two point seven percent decrease in binge drinking is a very big deal. We know that ninety five percent of our youth have not used prescription drugs in the last thirty days. So there are definitely positive movements out there. We are coming out of the pandemic, the impacts and what happened in social isolation and all those different types of things that are out there, so we're starting to see things trend back in a better direction post pandemic. But we definitely have goals to increase, for example, the number of youth that do not use alcohol or cannabis in the last thirty days, for example. So we should have targets to meet, but we are starting to see some positive impacts on the other side of COVID.

[Theresa Wood (Chair)]: Yeah. I mean, it's great to see, of course, increasing numbers of percentage. Can't even really call it engagement receiving. But I mean, the outcomes on the other, I wouldn't call that an outcome. Guess, three

[Unidentified Committee Member (addressed as “Peggy”)]: is yes. It's process. Yeah. Okay.

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: Okay. I think the next slide is for me the most compelling in regards to why prevention funding is so important, especially sustained funding over time. You'll see here that the percentage decrease in high school students reporting past thirty day alcohol use was double in regions where there was funding provided versus regions where there were not. And to me, that in and of itself speaks volumes. I always have to talk about data collection and evaluation because prevention, how do you talk about what you can't see? Data collection and evaluation are some of the most critical work that we do as far as being able to describe the reach, describe and figure out where we're headed. So I do include a slide in here that talks about federal and local data collection that we use to inform the work we do. And then quickly moving to looking ahead, this is just a small subset of the goals we have for 2030. We did recently release our strategic plan and community based needs assessment. And here, again, we talk about outreach and engagement services, serves 100% of middle and high school students. Know, 2035 and beyond, I'd like to get to all K-twelve. As part of that, we're looking to increase the number of high school students that don't use cannabis or alcohol, increase the number of adults age 21 plus that don't binge drink. And the next one has a lot of words in it, but perception of risk is a big deal in the space when we're talking about risk factors. So increase the number of adults age 15 plus who perceive a great risk from using, essentially, using cocaine as part of that. Because we focus on alcohol, cannabis, stimulants, opioid use disorder, the full, and tobacco. We have numerous others that include alcohol, tobacco, and other drugs, as well as just moving into that co occurring space and including mental health as part of that. Just as far as a key takeaway, our largest goal is to stop addiction before it starts. It is the way to win the race in the end. We have wonderful program across our continuum that I believe in full hearted, but this upstream work is what's going to change the landscape of home.

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: Sam Noyes.

[Unidentified Committee Member]: Thank you so much. There's a

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: lot focused on youth. Can you talk about some work you're doing with older Vermonters? I can. You're gonna hear great things from the next presentation. So for one example I'm gonna talk about, but I'll give briefly and I don't wanna steal any thunder. It's, example, older Vermonters and mixing prescription drugs for example, without and things like that. So we have a lot of our campaigns again, our new One Less campaign is geared towards adults and potentially considering reducing their alcohol consumption. It talks about hydration between drinks and things like that. So there's a lot of work going on there, and there's some wonderful examples that

[Commissioner Hildebrand (Vermont Department of Health)]: are coming.

[Unidentified Committee Member]: Thank you.

[Unidentified Committee Member (addressed as “Peggy”)]: I have one last question. Sorry. Can you talk a little bit about, especially for youth, activities that are targeted towards increasing protective factors? I can, I think that the next ones are going give you really wonderful examples that

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: I think that you're going to be excited about? I get teary eyed when I hear some of them, so Sorry,

[Unidentified Committee Member]: I had another, just quick question. You talked about the number of 18 year olds perceive a great risk from cocaine once per month. What's the amount of fentanyl that's in a cocaine? Do you know, isn't it, I heard it was all fentanyl. Fentanyl.

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: Everything's out there, I would say, is that no substance consumption is good. As part of that, we do have drug checking initiatives that are happening across the state. We do have campaigns, and there's national campaigns that talk about how to monitor the use of of what you do there. I think that you do I think people like to talk off, and I get why because it's out there, fentanyl and other things out there. But traditional, the straight up cocaine is still out there too and things like that. So I right now operate, and when I'm talking to my own children, I'm talking about that the drug supply is contaminated or whatever that may be, at the same time, understanding the stimulants in and of themselves so they don't they get some of the attention that they need, it's not all evolving into opioids. Thank you, Emily. Thank you very much. I appreciate it very much. Amy?

[Mary Anne Morse, Executive Director, The Collaborative; VPLO Lead for Region 4]: So I am Mary Anne Morse, Executive Director of the Collaborative Assistance Misuse Prevention Organization in Southern Vermont, and I'm also the Vermont Prevention Lead for Region 4. I am a certified prevention specialist and a member of the Substance Abuse Prevention Council for Vermont. Just going to give you a heads up. Yeah, thank you. What's great about the VPRO structure is that it can keep the funding right where it belongs, close to the people who know those areas, the need, know the people who have the need, and know the local priorities. And the prevention work isn't happening in a vacuum. We team up with all of our professionals at Vermont Department of Health through the DSU and our local networks and partners of prevention on the ground also. You can see here where PL4 includes health districts of Bennington, Springfield, Brattleboro, and White River Junction. And my organization lives right in the crook of that arm there in the middle of the mountains. But we've had ties to these health districts for at least ten years through our prevention work. And we were part of the planning team for the Vermont Prevention Lead Project. And so that's we feel close to our little network there. So having worked in prevention for so long, I can tell you that you get used to the ideas of inconsistencies in funding and frequently your work is turned towards how do I find the funds to continue the work that I do when I know the need is on the ground? The prevention lead project actually helps to increase the sustainability of that work and the organizations so that you can do that work that's in front of you and have a little bit less time having to think about it. I get to think about it a little bit, but all the other organizations that we partner with don't have as much of that stress through this project. And we start with a disparity impact statement, furthering our partners, and then we had to do a logic model, of course, to get things started. And then finally, we worked on our strategic plan together. We gathered funded partners, some of them are here, unfunded partners, what we refer to as untapped partners, the partners that we don't know are with us yet, our regional advisory committee and our prevention coordination team together to think about how we can be innovative in our work down in our region. And after bringing all those minds together, presenting the problems of substance misuse in our area and those challenges, we've come up with these five priority areas or goals, foster belonging and well-being, combat loneliness and cultivate connection, increase understanding of prevention and the community's health, increase awareness of resources, connections to care, and utilize collective impact for community transformation. And we determined that by working on these priority areas, we would achieve the overarching goals of reducing substance misuse over time. Where am I now? Yeah, the organizational structure. So to provide high level feedback for the strategies and making funding decisions, the regional advisory committees are made up of office of local health directors, C suite members from the hospitals, regional planning physician members, and soon we'll be bringing in some school based members too, because we're doing more and more work in that area. Unique to the PL4 district is that there were already eight well established organizations who were doing work in our health districts. And so we've connected with them, brought some of them on board to form our prevention coordination team. And we use this kind of ladder of structure to make sure that we're understanding what's happening in the communities so that we can think about what's best for the region and everyone can do their work locally as needed. Go ahead. So I might have gone through all of that.

[Theresa Wood (Chair)]: Yeah, you can do that.

[Mary Anne Morse, Executive Director, The Collaborative; VPLO Lead for Region 4]: Did that, did that. So it's great that we have these three years of funded partners increases the sustainability. Right now we're in the middle of what the first year of funding our partners at a couple of different levels. One is organizationally for those established coalitions that have been working in prevention so that they don't have to worry about keeping the lights on, that they can just get out and do the work that's coming up in front of them. And then we have some mini grants that happen also that could bring on new partners more easily. And so this is a little breakdown of where our funded partners come from. You can see some of them are working throughout the entire region. Some of them are working specifically in a health district. So that's the breakdown there. But they're all also asked to choose two or three of the goals that we've identified that they want to work towards. And so this is kind of how that broke out. And we're happy to see that there's a little bit in each of those areas. Other than that, you've seen this model before, and it can be easy to get prevention wrong in the community. And that's why we rely on tools like the Vermont Prevention Model. This works best, as Emily spoke about, when there's a little bit of work going on in all of the different areas. And so this is a breakdown in Region 4 about where people are doing their work. Really great substance misuse prevention does have work going on in all of these areas. And it might not be state level policy, but it might be local or school based policy work that folks are working on in their communities. We provide technical support on this to our funded partners. And so over time, we have noted that the depth and the breadth of the work that people are doing across the Vermont prevention model has increased. So, PL4 is, we've sort of imagined this area where we're not speaking to the rest of our local communities about this is what you should do, but we're trying to make sure that it's a more leveled leadership style. And so we've created this image that we're really the planter, the structure that holds things together, the collaborative and the PL4 leads, gives the system its shape, provides the stability and the support that allow the interconnected prevention efforts to take root and grow across Southern Vermont. And these supports include strategies that fill gap areas and provide connecting opportunities, communication and training opportunities. So the design highlights the three connected layers partners, networks, and PL4 leads. So you've heard me speak a little bit about those partners and networks. It's so important that we keep those communications tight and together, it's really been an asset in this world. Together, the layers convey a story of a shared purpose, people collaborating so that the communities can thrive, the blossom. Then, next slide, please. So, in addition to the work that each of our funded partners does, they propose that they want to do a project. We say, okay, we have those pieces. The prevention lead also has to do some work to launch the strategic plan out. One of the things that we focus on is evaluation, which is another tool in the prevention toolbox for evidence based work. And we have provided technical assistance on evaluation, and our results so far with our funded partners has been bright, with 82% of those funded partners reporting that they have an increased understanding of program evaluation and how to embed it in the work. And that's a real key piece of that. So let's take a look at how our funded partners connect to our priority areas in PL4. This is the fund part, hopefully. So the investment that Remote Meals and Prevention directly impacts our youth, whether it's creating safe spaces after school together, empowering youth voices, participating in healthy alternatives, cultivating leaders throughout the PL4 region. Many of these projects are benefiting young people. PL funds youth projects in each of the health districts and the PL leads kind of connect those projects together and provide that technical assistance to make it work as best as possible. So, for example, one of our gap areas is the Chester community. And two years ago, there was no Chester Teen Center at all. And as a matter of fact, they're in a town that had a little bit of strain happening because another town school closed. And so there was new students coming over the mountain pass to get to Chester. And then the lack of things to do if you weren't into sports, quite frankly. And so there was a group of people who really wanted to open up some supports and they did their assessment and found out that a Chester Teen Center was needed. Two years ago, there was nothing. Now they average 30 people a day and have ski and bike events and adventures. They paint murals and participants are asked all the time to participate in their local towns events. Chester's a town with a lot of local little fun fairs and things like that. And those people, those young people are out into the community. My favorite quote here is about when I turn 21, I want to come back and work here. And that's just it's because that's how I felt as a summer camp kid. And then I went back and I worked at my camp and I stayed in youth work and that led me to what I'm doing today. So it really resonates with me. We're making the leaders of today. And in the Brattleboro District, next one, the youth work looks a little bit different, and it's school based. These young people, they might not get much attention or have a voice in other aspects of their the places of their lives, but no one made them work in a garden or create a hygiene closet. Those are ideas that came from them. They started them, they work in them, and they keep them moving forward, empowering these youth at the source and connecting them to the resources that they need to thrive. And then in Bennington, we have a choice team who really wanted to improve school climate and increase healthy behaviors. And there wasn't really much to do to hold them back. They really took charge of it. They presented to the town select board, and they started a town youth council also, the third in the state. They create and hand out calm down boxes in the schools, in both the classrooms and in the public spaces, so that when young people are needing a little bit of focus in their day, they have easily accessible things to help get that together for them. Then in Brattleboro, the youth are the leaders in the school and in the community, leading meetings and analyzing data and using their voices to work towards a better, safer, more connected community. And they actually are the first Vermont Youth Council. And those are the leaders that Vermont needs. And then we have in Windsor, the next one is a story about the Youth Substance Awareness Safety Program provides an alternative to civil courts. And so, there's a lot of these programs, we fund the Valley Court Diversion, and they take it a step beyond really having some small groups and working intensively with the young people who have gotten a civil violation in that way. And what speaks to me here is that when you have young people who have literally been mandated to do a program for something that they got caught doing something wrong, saying that it was great and they learned something, it's gotta be impactful, a lesson that will last a little bit of time. In Bennington and Springfield, resiliency through understanding makes an impact. This out of school time activity is five educational and skill building events. They provide educational and tools that build resilience with young people. They're caring adults. Their trusted adults are asked to attend two events. They're required to attend the two events and they do. It's an incentive based program. And if they are successful in these completions, they get a season pass to our local Downhill Mountain, Stratton Mountain or Magic Mountain, or a Nordic season pass, or a Dorset Theater season pass, providing that incentive to them to be parts of these programs, to be connecting in that way. The next slides. The project has a wide intergenerational aspect. So it educates and works on collective impact by wrapping around the young people and their families, the volunteers in the community, the schools are a part of it, and business partners are all a part of supporting our young people through this program, showing that collective impact of working towards a common goal. So you've heard us talk a little bit about evaluation, both at the state level and with our grants, we are evaluating our funded projects. We use results based accountability, which is as simple as it can be. You'll be asking, how much are you doing? How many trainings? How many events? How many things are you doing? How many pieces of paper did you create? How well did you do? Excuse me, did you do it? And is anyone better off? And so we have worked really closely with our funded partners to get past the jargon of evaluation and get to these types of numbers and be it, and have it based off of the goals that we have established. And right now, we just have the first two results from our funded partners in this year, the how much did you do? And is anyone better off? Will come in the next couple of quarters. But for the one goal of belonging, fostering belonging, we're doing pretty well with people collecting the data so that we can begin to shine a light on how well the whole region is working towards our goals. So thank you. I'll let you know, I'm not by myself doing this work. I have Thomas and Samantha, who you may have seen, and James, who just started with us walking around today, making up the team. We are energized. We love the ability to work with our partners at this level and think regionally for the state and work with our partners Vermont Department of Health. The economic and social benefits of investing in the VPLO and prevention are really clear. Prevention substance misuse before it begins saves lives and reduce costs. And by sustaining and expanding prevention programs, Vermont will be healthier and more vibrant into the future. So thanks so much for your time. Thank you. Do have any questions?

[Theresa Wood (Chair)]: I do actually. I think up on some noise question from before and coming back to the beginning part of your presentation. And substance misuse is one of the fastest growing sectors in older Vermonters. I see a gigantic focus on youth, which is great. But I guess I am wondering what we are doing in our state about prevention of substance misuse for older Vermonters. And when I say older, I'm not talking about people in their 90s necessarily. It's really not only middle aged adults, but it Yeah. So I'm grateful that we're doing all this for youth, but I'm just wondering about what we're doing for older individuals.

[Mary Anne Morse, Executive Director, The Collaborative; VPLO Lead for Region 4]: Yeah, it's cool. I've accepted I'm a part of the older Vermantras too.

[Theresa Wood (Chair)]: It's

[Mary Anne Morse, Executive Director, The Collaborative; VPLO Lead for Region 4]: fine. I took out a slide for this one to be a little bit more timely, but one of them is some communication. So we definitely also have our own. I think that Amy will speak to that as well. We have some communication tools, partnering with places like Senior Solutions and the people who are seeing seniors every day and providing some supports for them. I'll say as an organization and as an ideal for the Vermont Prevention Lead for Region 4, the ideal for us is to change the community norms around alcohol and substances, and that takes time. And so by connecting and by bringing people together towards a bit of a common vision, I hope to get there. But as part of the plan for the resiliency through understanding, by including caring adults, we're kind of everybody up, hopefully, and creating a community that can support substance free areas by working with some We have some hospitals, both on our regional advisory committee and as a funded partner, some small projects. And so I hope that that work can advance over time and that we can begin to norm not alcohol as a reason to relax, but the healthy alternatives as a reason to relax. So I think that we're just given permission more recently to think in that broad view. And I'm really open to hearing what some ideas is of how we can advance it. But those are our solutions right now, and some messaging, some coordinating, and some supporting of our funded partners in the work.

[Theresa Wood (Chair)]: Yeah, I mean, I think what you're hearing from us is needing to think more broadly. And I'm saying this to the department as well, maybe to think more broadly about prevention, because obviously we naturally go to youth. And I think that even older Vermonters don't even necessarily think of themselves as misusing substances. And so that communication, and even when you're doing needs assessments, what kind of outreach are you doing to adults and the senior centers or the local housing situations. So I'm just encouraging us to have a broader view of prevention. Representative Noyes.

[Rep. Daniel Noyes (Clerk)]: I used to have a person who worked at the Department of Health whose full time job was Charlie.

[Mary Anne Morse, Executive Director, The Collaborative; VPLO Lead for Region 4]: Charlie,

[Rep. Daniel Noyes (Clerk)]: I can't remember his name. Does that position still exist?

[Theresa Wood (Chair)]: Yeah, go ahead.

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: That position does not still exist. It was actually

[Unidentified Committee Member (addressed as “Peggy”)]: a shared position between ourselves and the Department of Disabilities, but the work was that it was still within the

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: current staffing pattern. That work does.

[Mary Anne Morse, Executive Director, The Collaborative; VPLO Lead for Region 4]: And we did develop our own messaging campaign for older Vermonters that was geared not just towards the 80 year old, but towards the many people in the middle who are taking care of of both ends. And we used Charlie's papers and work to help build that and and use those to guide in the presentations that he would do to our local organizations that help guide, where do we go to find out what we don't know about the different generations and what their needs are for use. So that's the stage that we're in right now, but I hope that next time we come, we can talk about more things.

[Rep. Daniel Noyes (Clerk)]: Great.

[Mary Anne Morse, Executive Director, The Collaborative; VPLO Lead for Region 4]: Anything else?

[Theresa Wood (Chair)]: Thank you so much, Other questions? Thank you very much.

[Mary Anne Morse, Executive Director, The Collaborative; VPLO Lead for Region 4]: Thank you, appreciate you.

[Theresa Wood (Chair)]: Okay, now we're gonna have Amy.

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: Good afternoon. Thank you for giving me time to talk with you today. I'm Amy Carmola. I'm the Chief Impact Officer at United Way of Northwest Vermont, I'm excited to share some highlights around the state's investment in substance misuse prevention. A lot of what I would love to talk about has been covered already. So I'm going to try and move quickly and share that United Way acts as the lead prevention organization for Region 1, which means we are working with all communities in the Barrie, Burlington and St. Albans health districts. And we have been partnering with the state for about six years, leading prevention strategy in our region. We've developed the regional plans. We convene a regional network of people and organizations. And we allocate state prevention funds. I want to talk about just a few points. One, the importance of the state's investment, not just how much, but how the work is being done. I want to give you a couple of examples from Region 1 and speak to the issue of the span of ages and look ahead to how we are focusing to build on the success so far. So I want to emphasize that Vermont's commitment to investing in substance misuse prevention is ensuring that we have quality work, consistency, and greatly expanded access. I think a lot of the examples you're hearing today are around how we're making sure that resources and opportunities are showing up in areas that otherwise did not have it, where there were significant gaps. We have a good history of substance misuse prevention in the state with some really great pockets of work and some good periods of time, but large gaps and inconsistency over time. The work that's happening now in each region is driven by the needs and opportunities. It's tailored to fit the communities. And we are helping as the lead prevention organizations and as a statewide system, helping coordinate across the region, however that makes sense for the communities. I won't speak to all of the additional work that we do as the lead prevention organization, because I think you've heard about that today, the technical assistance, the trainings, the tools, the convening, the backbone, the funding, all of the work that we do to leverage additional resources. But I wanna emphasize that in about twenty five years of my doing this kind of work, this is the way to do it. This is what I've wanted to see. I give huge kudos to the state for designing it this way. This is the way that it should be happening in terms of the way that it's set up with regional focus, deep engagement in community, expansion across all age groups. This is great. So I'm a huge fan of the system and really proud to be part of it. I'm going to skip past the priorities that our regional funding committee put together and the priority populations. Happy to share any of these details later. Share that we are a big part of the work, but not all of the work, is the multi year funding that we provide to community organizations. We are funding 17 organizations that are collectively serving people of all ages and serving every town in our region. That's not our aspiration. That's what's happening already. Also skip past the fact that our programs, similar to all of the other regions in the state, are investing in work that spans all levels of the prevention model. But I want to emphasize that that multiyear funding is just one part of what we do. We also provide funding, support, leadership, and participation and resources for a lot of projects, activities, pilots based on what our community wants, what's needed, and what's possible. I'm going to skip past talking about the broad engagement that we have across the region, but do want to just emphasize that we have the way that the DPLO system is set up, we have the opportunity to really engage with partners, not just connecting with other partners, but we are actively working with the State Department of Health, the Vermont National Guard. We have an amazing partnership with the Vermont National Guard that started in Region 1 and has spread across the state. We're working with regional planning commissions, the medical centers, Larner College of Medicine. So this is not prevention in isolation. It's really in partnership with shared goals and resources across sectors. I'll point to three of the amazing things that are happening in our region, just three. First one, Ennisburg Cafe. This is another story of a community that didn't have what they wanted and needed to support youth. With this funding, a group of people in Ennisburg opened the cafe, which is providing activities for youth grades six to 12. Over 75 youth participated in the pass border. All sorts of great work happening with organizations and people, adults and youth coming in to support youth development and engagement in the community. We say in our United Way, every community needs a cafe, just like what Chester needed, and we're excited to say that with this funding, the cafe is now expanding to Richford. So that's just a pocket of some of the work that's been made possible that wasn't there before. The second example I want to share is around addressing unmet needs for two specific populations and kind of doing that simultaneously. One is older adults, and the other is people who speak languages other than English. We worked with Charlie and with the Department of Health to really try and make sure that the information older adults need is available and accessible, making sure that all the great materials and information and learning opportunities were getting out to people in community. And we worked with the Vermont Language Justice Project to create two videos that are available in 18 languages about how medicines and alcohol affect you as you get older, and also one about the legal and health consequences of using drugs and alcohol. Our funding committee in Region 1 is, as many other communities are, really focused on the needs of older adults and looking at how we can build out our portfolio and build out our partnership around that age group. And again, prior funding really focused on youth, but the beauty of this VPLO system is that it's saying, let's do all ages. So we're putting a lot of attention into how to build that out there. Last example I want to share is our employee guide, sorry, employer guide to substance misuse. And I've got copies with me if anybody's interested. This was a project that was inspired by the experience of an employer in Washington County dealing with devastating impacts of substance misuse for employees at the work site and in their home lives. We were hearing from many other employers who wanted to support their employees and their families. They wanted to create safe and healthy workplace cultures and, again, provide opportunity for people to get the resources and supports they needed. So we worked with United Way's Working Bridges Program with Prevention Works Vermont, and we pulled together a work group of Vermont employers and community organizations to create this guide that addresses the needs and concerns of employers, but also uses the workplace as a platform to connect with working Vermonters and adults of all ages to get the resources they need. So those are three examples I wanted to share of work that is based on community need, community priorities, opportunities, leveraging what exists already, and really building out collaboration to improve access to prevention. As we're looking ahead, we are focusing on investing in what works and in what's needed in Region 1. We have a lot more to do. We will continue to fund the portfolio of programs that we monitor throughout the year, and our funding committee renews that funding based on evaluation each year. Creating that stability feels really important. And we're focusing on training and workforce development to support the people who are doing the work of prevention. Prevention is for and is made possible by people, and we really want to sustain and elevate the people who do that work. We're excited to expand our cross sector collaboration, really excited to be working with schools. If you think about the opportunity to work with community based organizations and schools and healthcare and business, imagine what we could do to sort of align all of our work together towards these shared goals. And we're working on aligning and collaborating with other areas of prevention around mental health, around domestic and sexual violence, health promotion in general. So much of what we want to do and provide for people in the community really can help in all of those areas. So how can we line that up together? I'm going to stop there. I could talk forever about all the stuff that's happening. I've brought materials I can leave with you, our annual report. I have information about the language videos that we've created, copies of our employer guide. Just want to end by saying I'm really proud to be associated with this work and to do it on behalf of the communities and with the communities in Region 1 and in partnership with the other lead prevention organizations. We're all really proud of it, and I hope that all of you in the state feel proud as well with the vision and investment that you've brought to the work.

[Unidentified Committee Member (addressed as “Peggy”)]: Thank you. Awesome. Yeah, we have a few questions. Go ahead. Thank you. I'm really interested, first of all, you for the great information, in the employer toolkit. And so I learned about New Hampshire has a recovery friendly workplace initiative, and it's a statewide initiative. And this kind of struck me. It resonated as similar to that, but a smaller scale. So I was curious, is this only happening in Region 1? And then two, how do employers engage with this? How do they find out about it? And how many are involved in this initiative and are utilizing the tool kit?

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: Great question. I'll share a couple of points there. One is that love the recovery centered workplaces. Our Working Bridges team, which is at United Way Northwest Vermont and Green Mountain United Way, has leaned really heavily into that whole model of supporting recovery in workplaces. All of the team on the Working Bridges team are certified recovery coaches. And they were working with the employer in Washington County who said, really, we're just completely overwhelmed with the tragedy that's happening for our employees and for their families. And so we drew on work that's happened in the past around bringing recovery models to workplaces. We had HR professionals and different leadership from local employers in Region 1, and they did a lot of research on what's available locally and nationally. So I think a lot of what you'll see that's cited in the guide is references of resources that employers could draw on to bring in, both, again, locally and beyond Vermont. This is available to any employer in Vermont and to any employer anywhere. Most of the references are Vermont focused. So that's it is really tailored to Vermont, but we've pushed it out through SHRM, the State Human Resource, oh, how embarrassing, management, the national and local association of human resource professionals. We've pushed that through our Working Bridges program. And I know that in the first six to ten months, the toolkit was downloaded about, I think, 1,500 times. So we pushed it out throughout all of the areas of Vermont, even though it was created by a team in our region. We have just great collaboration across all the regions. So if there's something that's of interest that one of us has done that the others can use, we put it out that way.

[Theresa Wood (Chair)]: I'm wondering, you and the previous witness talk about the priorities for your local areas, your local regions. And I'm just wondering, how does a needs assessment process work? How often do you do it? And is there some consistency from region to region and the kinds of questions that are asked and how it's done? Or is it that totally unique to each region?

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: I think there's both consistency and areas of unique engagement in regions. I think we all pull on tools like the community health needs assessments, the regional plans that are available in community. We look at the same data from the Youth Risk Behavior Survey and the Behavioral Risk Factors Surveillance System, whatever the preface is, we all look at the same data statewide. And I think we all use very similar platforms in our regions to share the same types of data that we're all looking at around rates of use and risk factors and protective factors at all ages. And then I think it's really tailored by the community partners that come together to look at those data and say, what other information do we want? How do we want to engage with our communities to understand what we want to prioritize? And then that assessment both leads into a multi year strategic plan for each region, and each region's funding committee looks at the data each refresh. We set these priorities. Has anything changed? Do we want to focus additional resources somewhere else? What else do we need to understand? So our funding committee did that process, the original process, and then each year have come back and said, let's reassess and see if we should. I think there are a lot of similarities in the priorities that raise up in any of the regions. There are things around disparities, things around access, things around holistic approach, really building community, not just saying what's the prevention specific pockets that we can do, priorities around all ages. Sorry, I could talk about this forever. But the framing of the approach also sets some very specific priorities. It says, we really want you to invest across the prevention model. We want you to be using best practices. So we have that initial framing, and then each community works with their local data and local priorities to figure that out. Okay,

[Theresa Wood (Chair)]: thank you. Yeah, go ahead, Representative Bishop.

[Unidentified Committee Member]: Hello, Peggy.

[Unidentified Committee Member (addressed as “Peggy”)]: Hi.

[Rep. Doug Bishop (Member)]: I don't know if I missed this earlier, but is this in the first three year cycle for the prevention lead organizations?

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: We are in our second round of funding. I mix my numbers up because we say what year we are in for our region, but then what year we are in for the overall state approach. So we are in our second round of funding from the state. Prior to that, we had some funding as a prevention center of excellence to really build up the capacity within our region to do this kind of work. But yes, did that answer your question? We're entering year two of the second

[Rep. Doug Bishop (Member)]: It strikes me as it seems like it's relatively new in the scheme of things, but to have stood up quickly. And maybe it's because of partnerships that already existed between different agencies for it and formalized. I

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: think that, and I also think the support that we had for a number of years to start to build this up, we did our five year regional plan, and we started to build our network that has been bringing people together for about six years now before the formal implementation of the VPLO structure. And that was really intentional to help Northwest Vermont, in particular, to start to build out some of those connections across the region. There had been really small pockets or strong pockets of work happening, but it was not aligned and collected. So for the first number of years for us, it was really focused on that. Like, how do we bring people together? How do we understand what's good? How do we do some projects together? How do we test some things out? As we were funding work that was happening.

[Rep. Doug Bishop (Member)]: A question specific to the work with schools. We saw a map earlier with respect to the unions and districts that are receiving state funding for prevention. Yes. The schools in regions are different schools districts. Is that the same grouping or are there different districts and supervisory unions that you may be working with that are not on that path?

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: So we are now working with all of the supervisory unions and we have support and funding this year, both to connect with the schools that have been receiving this pool of dollars from the state and to reach out to the, I think it's six Sorry if I'm getting the number wrong. Districts within our region, it might be nine, that weren't receiving the funding. And we have some initial funding to help them build up their capacity and readiness and prioritize what would they want to do with the state funding with the assumption that we will be able to bring funding to every school district in all of those regions. So again, I want to applaud the planning that the state has done to say, you need to get ready, you need to help those districts understand how they could access these resources, how they could use them. And so that's what we're really busy doing right now in anticipation. We also have an evaluator reaching out to every school district, and I know this is happening in other regions as well, just to understand how have they been using the money, what would their priorities be, what kind of technical assistance could we provide for them. So that's been exciting because it's been really hard to connect with schools outside of that formal opportunity. They're so stretched that I don't need to tell you that. Other questions from committee members?

[Theresa Wood (Chair)]: I have a question that's maybe more for the department. How do you determine the allocation for each of the four districts?

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: It's a two part approach. So there is

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: a base allocation that every VPLO gets and

[Unidentified Committee Member (addressed as “Peggy”)]: a balance that is then spread by the size of the population of the Ketronerian. So everybody needs a foundational base, there's commonalities across, but obviously some regions have a much larger population than others, so it's multi tiered. Other questions? Anybody else have any questions? Thank

[Theresa Wood (Chair)]: you very much. Thank you for Thanks for taking time. I appreciate it. Thank you to the department for organizing the testimony today. And I think it's been helpful to hear about the B. I always want to reverse the P and the L, but PLO organizations and to understand that they're relatively new, but they've been built off from a foundation of things that existed in the communities previously. I'm surmising that knowing that you had cannabis prevention funds coming, that you were thinking about how to organize in the best way to utilize those funds in a way that made sense for the whole state. I'm just surmising that. We've been

[Emily Trueger, Division Director, Division of Substance Use Programs (VDH)]: waiting for thirty years, by the the funding has come from the Feds

[Unidentified Committee Member (addressed as “Peggy”)]: has been very, very prescriptive. I love about Vermont when I talk to other states how fortunate we are to have the research we have.

[Theresa Wood (Chair)]: We can wait to invade

[Unidentified Committee Member (addressed as “Peggy”)]: the breadth of many respects and health ideas that they were able to hit the ground running second this opportunity.

[Theresa Wood (Chair)]: And just so, because other than Dan and I, I don't think anybody else was here when it was this committee who designated those funds out of the cannabis for prevention work. So you can see how the evolution happens this always nice, right? It is actually nice to see, years later, some of us are still here and we can see the impact of those, the impact of that. So that's great. Any other questions? Yes, go ahead. I share one thing I forgot to share,

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: which is today is prevention day at the State House and from four to six we have

[Theresa Wood (Chair)]: ice cream shop downstairs, yes of course.

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont; VPLO Lead for Region 1]: Have to share reminders of that here, but we would love the chance to have, we've got partners from each of the regions here, partners who are in the community doing the work, as well as others from the DPMOs, I'd love to have a chance to talk with Penny and anyone and everyone. Please go by. That's great. Great

[Unidentified Committee Member (addressed as “Peggy”)]: day for ice cream.

[Theresa Wood (Chair)]: I know, all of a sudden it got very warm in this room. So thank you, thank you for reminding us of that. I appreciate that. Okay. Committee, I think that this is going to end our testimony for this afternoon. I do just want to touch base with Emily a little bit. Representative McGill had to leave, but it's about the Turning Point grant. So just wanted to touch base quickly. So anybody have any other questions for VDH or the partners around the table? All good. All right. Thank you, Laurie. I think

[Commissioner Hildebrand (Vermont Department of Health)]: we're good.