Vermont Legislature SmartTranscripts:

[Sen. Virginia "Ginny" Lyons (Chair)]: You're live. All right, good morning. This is Senate Health and Welfare. It is Friday, March 20, the day before the Fertile Equinox. How about that? We can't be close. So, this morning we've asked the Department of Health to come in and others to come in and talk about prevention and prevention generally and what's going on in the state and what we have. I'm not gonna describe it any further because they're gonna describe it for us. During the next few weeks while we're looking at our bills and going through budget stuff, and there'll be some bills that are relevant to prevention. I just kinda like us to pay attention to prevention efforts and what we can do overall to move forward as much as possible. We have a great partner in the Department of Health and we appreciate you being here. So Doctor. Hildebrandt, welcome and why don't you introduce yourself for the record?

[Rick Hildebrandt, Commissioner, Vermont Department of Health]: You for having me. Rick Hildebrandt, Commissioner for the Department of Health. And thank you for letting me talk a little bit about prevention. I'm here today with three of my partners, Emily Trigger, who's the Director of the Health Department's Division of Substance Use Programs, and leaders from two of our Vermont Prevention Lead Organizations, or APLOs, Amy Carmola, the Chief Impact Officer of the United Way Northwest Vermont, and Marion Morris, the Executive Director of the Collector. Prevention works. It's frankly one of the reasons I took this job. It's cost effective at a time when our healthcare spending has asthma problems. We have strong and specific Vermont evidence to show that it has a significant impact and it's made a significant impact in our city. It's an investment in our communities and it's led by our communities. Sustaining and supporting consistent funding from the Substance Use Prevention Fund for this work is critical. We employ a comprehensive approach to substance use prevention, and we have programming that addresses individual, environmental, societal factors to improve the health of our communities. We use proven strategies such as school programming and policy change to prevent initial use, to reduce misuse, and to hand and hand protective factors. And we support the decision making in this, empowering schools, the VPLOs to use local data to determine what's best for their communities. This is critical because we need to listen to our communities and give them the ability to do the work to address concerns they identify rather than implementing that top down approach, and that are detached from what's happening on the ground. I'm gonna hand it over to Emily, who's gonna give the bulk of our presentation, and then I'll close this out of that in the end.

[Sen. Virginia "Ginny" Lyons (Chair)]: Well, we have a hard copy in front of us, and we also don't send it online. So what what so what I'm gonna suggest while Emily gets settled is that we listen and then maybe hold our conversation till after we because sometimes our questions are all are the next steps. So they know what you're cool with. Good morning. For the record, my name is Emily Trudor.

[Emily Trudor, Director, Division of Substance Use Programs, Vermont Department of Health]: I am the division director for the Health Parents Conditional Substance Use Programming. Historically, is my thirtieth year in division. I began the prevention programming, but my life of prevention began in my teen years. At the age of 16, I joined the first prevention coalition that I had had experience with in South Carolina. We're gonna open this morning with why prevention is important. You'll see a tagline at the bottom of our presentation, listed in a lot of places. Prevention works, treatment is effective, people refer. We wanna open with some pretty powerful statistics. Ninety percent of individuals with substance use disorder began their first use under the age of 18. The adolescent brain is more vulnerable than the adult brain. The science tells us that our brain's not fully developed until the age of 25. Early use can disrupt brain development in general and increases the risk of developing issues and substance use disorder related to life. As far as defining prevention, there's actually been a recent publication that just came out of the Substance Abuse Mental Health Services Administration, which is

[Emily Trudor, Director, Division of Substance Use Programs, Vermont Department of Health]: our primary federal under.

[Emily Trudor, Director, Division of Substance Use Programs, Vermont Department of Health]: There's a couple pieces of information on this slide. Substance abuse prevention reduces the harmful effects of tobacco, alcohol, and other drugs, and stops addiction before it starts. Using two approaches. First, increasing protective factors and reducing risk factors, and then obviously delaying onset of first use. The table or chart to the right in the presentation is one that recently came from the SAMHSA publication and talks about the long term positive effects of investing in prevention services. It promotes early substance use disorder identification and ties to intervention. It reduces the risk of binge drinking and substance use disorder. It enhances overall physical and mental health. It improves occupational and academic performance and lowers school dropout rates and reduces disciplinary issues among adolescents. This one I think has been asked a couple times. Prevention is a smart ambassador. That was good. I'll apply the statistic later when we're talking about but the Substance Abuse and Mental Health Services Administration did do a formal study on the financial impacts of prevention. $1 invested is worth $18 saved. I don't know, there's a lot of other It went up $5 It's inflation. Investments could include school based prevention, community strategies, substance use messaging, things like media campaigns, and policy initiatives, and we'll talk about some of those a little bit later. The savings fall in categories broader than these, but some of them would include chronic disease, treatment services, the criminal justice system expenses, hospital and emergency department costs, recovery services, and future healthcare costs. I think also of note in that, that prevention serves our full population. Our other wealth of intervention serves us up 70. So not only is it a dollar worth the 18 in savings, but also just the breadth of the launcher service is much larger. We're next going to move into what we are currently funding. That's a common question. How do you talk about something that didn't happen? Do you, if we could talk about what we're actually buying with those investments? We're going to move into the budget section here next. I am going to open with the Substance Abuse Prevention Fund, which was a result of the cannabis excise tax. Our proposal for FY '27 is a $5,000,000 investment in our Vermont Prevention Lead Organization structure, a $3,000,000 investment in school based health, and a $1,500,000 investment in field based prevention staff throughout the state. This is the budget. This is one piece of the budget. That's specific to the Substance Use Prevention Fund on that proposal for the folks on the side. The next slide, is a little busy, because the prevention investments across the state are a little bit like a patchwork quote. I do have six funding sources that are articulated in this. I apologize for the small font, but because there's so many investments, it's hard to get it into one space. We did sort it out into four buckets: community based services, school based services, the tobacco control program, as well as other prevention, because there's sort of a subset of other things in there, for a total proposed budget of a little over $18,000,000 for FY '27. If you apply the statistic on the previous slide, that $18,000,000 will save $340 and that would cost Is there, go ahead, no. Go ahead. Awesome.

[Rick Hildebrandt, Commissioner, Vermont Department of Health]: On No, I'm talking about what I'm saying.

[Emily Trudor, Director, Division of Substance Use Programs, Vermont Department of Health]: I just violated my social self. No, I won't ask it now, but Next we'll move into how we approach prevention in Vermont. We opened with the Vermont Prevention Model. I've seen the Evolution of Prevention Services in the state over the last three decades. We have come to a place of a very comprehensive integrated system that uses a multi pronged approach to tackle this work. The Vermont Prevention Model is grounded in the understanding that prevention strategies are most likely to succeed if they reach people holistically and fall in virus. Individual, family, school, community and your state level policies. We have a lovely visual for chemistry. The next slide, I realize has a lot of information, but we did want to provide a matrix with examples in each of those prevention model categories. On the left hand side, you'll see it has a definition of what it is, who it serves, some outcomes, and examples, tangible examples of what that work looks like. This is a very small subset of the activities happening out there, but we wanted to give people a flavor of what that looks like. The personal and social space, I'm going talk a little bit about, we collected £18,000 through our drug disposal program back in 2024. A parent can order a free nail bag envelope and dispose of extra oxycodone prescribed after a surgery. People can take things to their local pharmacy. You'll see them potentially in your grocery stores and the pharmacies that sit there. We had 51,300,000 impressions for the three past media campaigns. That includes Parent Up, Let's Talk Canvas, and Outlast. And a lot of that is geared towards educating parents on how to talk to their kids about different types of things they're doing. We have a we are though the first day of spring, maybe tomorrow, our Hollow Awareness Month is next month, this month of April, we are very excited about our new One Less campaign. You may have heard the old adage, just one more. Our One Less campaign is focused on harm reduction for alcohol use and is focused on adults in the state of In the organizational space, sixty four percent of our students are supported through school based health services primarily in the state of Vermont. We'll talk a little bit more about that later in the presentation. In that work, a student could learn about the harmful effects of vaping as part of the standard tobacco prevention tool. In our communities, we have rates of past thirty day alcohol use decreased for youth in high school from 2019 to 2023 in all RPP funded regions. A family may attend forums on youth substance misuse with other families, staff, and community members as part of that work. At the systems level, eighty two percent of Vermont high school students do not use tobacco. The legal age for tobacco has moved to the total court. Does that include vapes? Just want to clarify. Yes. Let me say tobacco, okay. ABT and selling tobacco to people 21 is subject to a civil penalty. That's the name of spot question. A little bit of a deeper dive, we're gonna have a couple of examples in each of the prevention model categories. The next section we're moving to is personal and social highlights. In this space, again, have our statewide drug disposal program. We have some specialized programs focused on different populations. We have a space on One Part Conversation, helping provide skills to individuals who are able to talk to a member of their community or family about their substance use. We fund a large swath in partnership with other parts of the Agency of Human Services, parent programs. Then we have a new program that has been revamped called My Tide, which is for pregnant and parenting. We have a large campaign portfolio right now that reaches numerous demographics. Is a much more complicated space than the 80s. We have large mass campaigns across the movement. We've all seen the Ryan Pannen. We've seen Nancy Ray Ginny, the war on drugs. The world doesn't communicate that way anymore. We don't all watch ABC, NBC and CBS anymore. And social media changed the game tremendously, so we have very targeted campaigns focused on groups in need that are at all times across the same. The next we're going to move into organizational. This is where we're going talk a little bit about school based health. We have 29 supervisory unions and school districts that are currently receiving funding. There is a map to the right that does show every area shaded in green is currently receiving funding. They do have some significant areas of the state that do not currently receive funding as part of that work. That work could include screening students and holding support groups. That would include integrating prevention into school based health classroom activities, providing training to school staff at large, training peer leaders and champions within the school population, and implementing evidence based curriculum or programming for students. To go a little bit further on school based because it's a large area of focus for us, we did want to give some examples of what some of that would look like. So we do have standardized screening tools, like the GAIN as part of that work. We have capacity building with our students, a lot of staff training, and again, educational support groups. One thing that's often spoken of is our student assistance professionals, or known as SAPs, they often coordinate those activities in schools. We do, with this funding, a school can choose to purchase SAP capacity within their school. They may do something different depending on what their needs are in a given space. We are looking ahead to standardize the goal of this analysis. Next, moving on to the community, and I'm not going to steal a lot of thunder here because we have some wonderful partners who'll be able to dive into the work they do at the community level. But we support Vermont Prevention Lead Organizations, which provide statewide support to Vermonters. We have something called the Regional Prevention Partnership. That is a federal grant that is focused on alcohol and cannabis. And we have our prevention consultants. We have 11 prevention consultants across the state who provide direct technical assistance, and essentially they're everywhere. They're doing either in their schools or in their communities. They're going be through select boards. If you are familiar with things like One Rail Hurrow or Project Benjamin in other parts of the state, They recently helped facilitate our community forums that we did last in October throughout the state, so they're moving and shaping out there. I do have a next slide that has some VPLO highlights by region. Actually going to defer to them for their presentation as part of that, and I did want you to have that as part of the slide deck. We did want to give some specific examples of some the tangible things that are happening to us, and again, these are just a small subset. The VPLOs themselves empower communities to implement substance misuse prevention initiatives that meet their needs based on regional data. There's a four part approach to this. The first piece includes working together to gather data that they review, they take a look at evidence based practices, and they engage their local partners. From there, they're going develop a five year strategic plan that is focused on regional priorities. There is definitely commonalities across all the VTLL's, but there are also very unique things depending on the country. They then facilitate an RFP process that is competitive to provide subgrants to the region to engage partners. Its goal is to address disparities in geographic equity. There is then board allocation. There's a regional funding advisory board that allocates the funds. That board has to have diverse representation and has to utilize a balanced funding approach across the preventionals. The Regional Prevention Partnership, again, is a federal grant from the Substance Abuse and Mental Health Services Administration. I wanted to give a highlight of some of the partners that we work with as part of that. We work with our partners at the Department of the Friction Lottery. We work with the Department of Public Safety and the DEA. We collaborate with municipalities in zoning as part of that. So, see an example of a drug free zone. We engage with local media as part of that. They may do op eds, they may do spotlight stories based on what's happening in the community, and there's a lot of community education and engagement. Again, our VP is focused primarily on alcohol abuse units. We did want to provide a slide on our prevention consultant system across the state. Again, they're everywhere. They help prevent presentations to schools about their youth risk behavior survey data. We do have a survey that happens every other year for eighth grade through senior and high school as part of that work, and they help understand the data that they're working with, which then enforce those strategic plans and those funding efforts. They provide trainees on the Vermont Prevention Model, they present community forums, and they facilitate school and community events. Quality assistance level stuff, is, a lot of this happens at the state and legislative level when we meet the governor. There's a lot of work that happens here. Things like the alcohol beverage tax, you have tobacco and alcohol retail dent fees, how much, many vendors can be in a particular geographic area. We have Tobacco 21, which is in the last few years. One big thing that, in my opinion, changed a lot of what's happened, especially 95% have argued do not use prescription drugs. A lot of different policies and things helped implement that. Not only the coalition work happening on the ground, the working schools, but some of the policy setting, which included the Vermont prescription monitoring system and the Vermont hangovers. How doctors prescribe medication as well as how we monitor that behavior, and just recognizing how different things interact has made a tremendous impact on that one. Some highlights in the assistance space. We also have the Substance Abuse Prevention Oversight and Advisory Council, known as the SMPC, which brought together, three groups that brought together the Opioid Coordinating Council, the Governor's Council for Substance Use, as well as the Tobacco Evaluation Review Board. It focuses on all substances. It provides advice to the governor, the general assembly, and the health department. Its purpose is to ensure that population prevention measures are at the forefront of all policy determinations, and its goals are to, and we talked to people in the beginning, increase protective factors, reduce risks, increase efficiency and collaboration on prevention through a collaborative holistic approach. We do facilitate from the health department side, but that has representation from across the state. Next we're gonna just move into a section about some of the impacts of what's happening on the web. The next one, via the numbers, we have sixty four percent of our students in middle and high school are receiving school based prevention services. We have 67 active sub grantees supporting the BKLO funding. So when I first started, we had three. Granted, that was the 90, a lot of times gone by, but just the number of partners that are actively working with us, as well as receiving funding, has grown exponentially. 300,000 Vermonters reached via RPP and media strategies and campaigns, and recent data coming out of NISDA, which is at the national and federal level, we had a 2.7% decrease in binge ranking for Vermonters H-twelve loss. The next slide, it really speaks to the power of evaluation. I do like to talk about evaluation wherever we are. If you are implementing strategies, no matter what the program is, it doesn't have to be substance use, The evaluation piece allows us to take a look at what's happening. Do we need to pass it down? Do we need to try something different? We did fund a evaluation through the Pacific Institute for Research and Evaluation in regards to some of our school based funding, and you'll see the difference in this graph. This is the percentage decrease in high school students reporting alcohol use in the past thirty days. In non funded regions, there was a seven percent decrease. In funded regions, it was doubled. So the investment is working and working in a very statistically significant

[Rick Hildebrandt, Commissioner, Vermont Department of Health]: That's powerful.

[Emily Trudor, Director, Division of Substance Use Programs, Vermont Department of Health]: I love this topic. Not paper. Range thirty years. So recent data also shows regions in Vermont receiving multiple sources of funding outperform regions only receiving a single source of funding. So, Jim, you have a path for funding across the state. Substance abuse prevention funding, its power sits in its long term, sustainable, single source. You're not answering to federal funds come with a bunch of different things and some other things. That sustainable base really is a game changer in our future. I have a slide that I won't go through. Just the power of data collection and evaluation, especially in a space where the idea of prevention is if something has to happen, is a critical part of the work we do. We have a lot of different things like that, both at the state and federal level as part of that. Surveys are a big part of what we do, so the Youth Risk Behavior Survey. We have a young adult survey that is for calling change, 18 to 25 year olds, so we have a lot of good things to work with. Looking ahead, we right now have set some twenty, thirty goals. The first is that for outreach and education services, 100% of our middle school and high school students receive those services. Again, we have 64% right now. Our goal is to get to 100%. That map that was on the previous slide does show you where we definitely have some large gap areas in that space. We are looking to increase the number of high school students that don't use alcohol or cannabis. We're looking to increase the number of adults, age 21, of course, that don't bench drink. This next one is perception of risk. Whether or somebody thinks something could be dangerous for them, or if they were to engage in, that's an area that we focus in prevention. We're looking to increase the number of adults aged 18 plus receive a great risk from cooking these. So again, multiple substances, but definitely the world of stigmatizes is out there. And again, continued stable funding will support these. When you're constantly in a space where you're always having to apply and work with the peer, you're always working to do that as opposed to working on the important work that's on the company. So I can't stress enough how much we appreciate that continued support. Just as far as the key takeaway, I'd like to end with the prevention model. The Tagalog Prevention Works, we have the data to show it. We have wonderful community partners here. We'll talk a lot about them, what they're seeing in their regions, and how much I appreciate you guiding me to the field today. I'm looking forward to all students. Terrific. You've put so much in here. Thank you.

[Sen. Virginia "Ginny" Lyons (Chair)]: It's great. I'm gonna suggest that we move right along to Amy and then, unless a question is to understand it was I do have one question I'm gonna ask and then we'll go ahead. You indicate how critical it is to have sustainable funding and at some point we'll ask everyone who's testifying today what your recommendations are for our help in improving that sustainability because we have different prevention funds in here. So that's one of the goals that I would have in understanding how to consolidate or make more permanent and sustainable those sources without having all the different conditions placed in bits and pieces. So that's a question for everyone. You have any, if you have a comment at this point? It's something we're incredibly interested in. I think that for me, making sure there's consistent funding statewide, geographic equity is a big thing. I think school based health is a huge place of focus for us. We're looking to coordinate our services for school based health and our VPLOs and have those come together. So we're looking at a comprehensive package across the state. With the proposed up right now that is in the FY27 recommend, it would allow us to expand to up to 12 supervisory units and school districts across the state. That still doesn't get us there. That's the additional million dollars in that particular space. I don't have a specific number, for example, like that, but as far as strategy wise, bringing school based health BKillows together to have a comprehensive, every adult, and every older homeowner is receiving the same services or has them available to them. And again, that ounce of prevention is worth that kind of treatment. Yeah. They will be. Good. I know, you're talking, I think about the, there are a lot of us who have been very protective of the tobacco fund and a lot of people are very protective of this fund. And what benefit could there be realized if the Department of Health had some recommendations about consolidation of those funds and then specific uses to make sure that we have a systemic approach. That I We look more into that conversation. Yeah. So this is this will be important and I know it'll be important in here, obviously it'll inform the budget and the appropriations process, but I think it's something that we could, we as a committee, as a policy committee need to understand and then get the message out. Yeah, I know there are people in the room who will say, oh golly dad, don't do that. But we need to understand the benefit of doing it. Maybe it doesn't work, it does. Thank you. Thank you very much. Alright, so we'll move on

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: to

[Sen. Virginia "Ginny" Lyons (Chair)]: Amy Carmola, United Red Northwest Vermont. Welcome. Thank you. Good morning. You know what? We should introduce ourselves once because there are some folks in the room who haven't had the opportunity to meet all of us. So, I'm going to start with you.

[Sen. John Morley III (Member)]: Senator John Morley, Orleans. Next week. John Benson from Orange District.

[Sen. Virginia "Ginny" Lyons (Chair)]: Ginny Lyons, Chittenden Southeast. Martine Larocque Ginny Michigan Central and Cummings right here. Welcome. Thank you. Thanks for being here. Thank you for the opportunity to speak with you today. I'm excited to share some of the highlights of the state's investment in prevention in our region, which is Northwest And Central Vermont, give you a sense of what that means for our region and then also what it means for the state overall. I am the Chief Impact Officer for United Way of Northwest Vermont, and I'm here today with my colleague, Mahat Abdulahi, who is our Prevention Network Manager for all of Region 1. Mahat works with United Way through a really innovative partnership with the Vermont National Guards Counter Drug Program, and we're really proud of that. Okay, great.

[Amy Carmola, Chief Impact Officer, United Way of Northwest Vermont]: Thank you. We act as the lead prevention organization for Region 1, which means that we are serving all communities in three of the state's health districts: Barrie, Burlington, and St. Albans, which is covering Grand Isle County, Franklin County, Chittenden County, and Washington County. Our United Way has partnered with DSU for about six years, acting as the regional lead for prevention strategy and helping build out the system that we now have. In that role, United Way worked with local partners to develop a regional plan for prevention, a five year plan. We have created a really robust regional network of people and organizations that come together on a regular basis. People who share interests and goals around preventing substance misuse and promoting health and well-being. We allocate state prevention funds to advance the priorities and the plans that were developed with and for our region. And we were part of the planning team that the Vermont Department of Health's Division of Substance Use Programs put together to design the current statewide system of prevention, which was a really great opportunity, and I'm really excited about what they've put together. So, I have a lot of things I'd like to share, but I'm going to focus my comments on the importance of the state's investment in prevention, both in terms of the funding, but also in terms of how it's being implemented and what the system is accomplishing. I'd like to give a little glimpse at the reach and the scope of this investment in Region 1, Northwest And Central Vermont, give a couple of examples of great work happening in our region, and then point to what we're looking at coming up, how we're continuing to build on this success and realize the full potential of this statewide system. I'm creeping into my chair, excuse me. I want to start by speaking to the significance of the state's investment, which was based on the intention and the vision of the Vermont State Legislature and the Department of Health Division of Substance Use Programs. It was an incredible vision. This commitment to prevention and the system that's been built to deliver it is ensuring that we have quality work happening. Work that is driven by data, informed by best practices, that is focusing on workforce development, community engagement, all of the right elements. It's providing consistency in resource and programming, which is essential. And it's providing, it's allowing us in our regions to increase access for everybody. Without this investment and without the system, the approach that comes with it, what we end up with is patchy investment, some really great instances and pockets of great work happening, periods of time where some great things are happening, but there are large gaps and there's inconsistency that really makes it hard to improve or to sustain or to realize the long term impact. The work that's happening in each of the four regions and each community within those regions is driven by community need and opportunity. Sometimes that's similar across a county, sometimes it's really different. And it's important that we tailor the work to fit the community. And our role is to help coordinate that work across the region, however it makes sense to be more effective. One of the things I love most about this system is that it is set up to ensure that we are providing resources and opportunities beyond the check. It's about so much more than the money. We know that's best practice in any kind of funding. As a lead prevention organization, we provide technical assistance, training, professional development, tools and resources. We have a website with a regularly updated set of 54 community indicators for each of our counties, calendar of events, toolkits, those sorts of things. We convene the regional network that I talked to you about. We have monthly meetings of the network. We have a monthly newsletter that's just jammed full of information, opportunities, stories. We have an annual summit where people from across our region come together to review data, assess needs, set priorities, learn together, and connect to each other. It was one of the greatest areas of interest and need in our region. And then we provide coordination or sort of backbone support for the sorts of projects and efforts and initiatives that are important and wanted by partners in our region, but are beyond what a single organization could or should do. So we're really fostering that collaboration. And finally, we focus on leveraging other resources, volunteers, interns, AmeriCorps VISTA materials, examples from other communities, and additional funding. So, I've been with United Way for about twenty three years, which is sort of a long time, but also not a long time. I've done a lot of work through United Way around community investment, creating change, strengthening community, and addressing complex challenges. And I have to say that this system, this Vermont prevention system, is how work should be done. This is what it really takes. This combination of statewide and regional, combination of funding and capacity and consistency of all of that is what it takes to make things better for our communities. This is what it takes for investments to pay off, and we're seeing immediate, and we know we're going to see continued return on this investment. So I'm really proud to be part of this work on behalf of our communities in Region 1, and in partnership with the other leading prevention organizations. So I'll just give you a few details to give you a sense of the scope and the reach of some of our work. I'm focusing here on the programs that are funded with state prevention dollars through our regional funding committee. That group spent months, they meet year round, and they spent months reviewing data and input and needs assessments, and they set some broad priorities for how they wanted to allocate the funds. That's focusing on reducing disparities in access, supporting a holistic model that really builds community, and addressing risk and protective factors. And they identified some specific priority populations based on data from our region to show who is experiencing greater risk, poor outcomes, and those priority populations are people who identify as LGBTQ plus people who identify as black, indigenous, or person of color, and people from households with limited financial means. So this is the framing that our regional funding committee put together and then had a process of requesting proposals and reviewing those proposals and putting together a portfolio for multi year funding for a set of 17 organizations. Those organizations are serving all towns in Region 1. I've listed here the number of the 17 that provide service in each of the health districts. It adds up to more than 17 because many of them provide services in more than one health district. This portfolio of programs is serving all ages, and in this past year we've had over 5,000 people directly served in these programs, and a much broader reach of close to 50,000 people reached through the data coming through the efforts of those programs. So all ages, all towns. That's not just our aspiration, that's actually happening now, and that feels really good. This portfolio of programs where we're providing multi year funding spans all levels of the Vermont prevention model. You can see the numbers along the bottom say how many of the organizations we're funding are working in that space, in that level of the model. There are fewer that are doing work at the systems level, and that means that our funding community dedicated some of the additional funds specifically for some collaborative and regional projects at that level. So they're really balancing out the different ways we fund. So that's some data on the programs that we fund. I want to just give you a quick glimpse of the broader engagement that we have. We have regularly participating with us, about 53 organizations, 102 people engaging with us through our monthly meetings, our annual summit. And then we have a number of partners that are working with us, deliberately contributing to, or supporting, or leading some of our regional projects, and I've listed those there. The state, obviously, the Vermont National Guard, Serve Vermont, AmeriCorps VISTA, etcetera. So this isn't prevention in isolation, this is really happening in collaboration. So I wanna give you three glimpses into our work, and I'm gonna highlight one of the 17 funded partners that we have, and that is the CAFE in Emmis Earth. A few years ago, a group of after school professionals and students and community partners came together in Ennisburg around the goal of empowering community, empowering youth. And after a lot of effort, and with state prevention funding, these dollars made it possible for them to open the cafe, which provides activities and space for youth in grades six through 12. They worked with local partners to bring in, and a lot of volunteers to bring in specialized programming, opportunities for connection, creating the experience of community and belonging. And the cafe is growing. They will be expanding to Richford. They're bringing in more specialized programming. They're starting a dad parent group. They're providing opportunities for youth development. For example, a peer group that's focused on exploring difficult conversations. So, Amosburg really needed and wanted this, and now they have it. And as one of my colleagues likes to say, every community needs a habit like this. I agree. Yeah. I remember when this started, there was an article, I think, in the news, or I read about it somewhere. It was great. Two other things I'll just point to briefly. We have outside of the funding that we provide, some of our collaborative projects have included developing an employer guide to substance misuse. Read this came out of a need that we were hearing from employers, particularly an employer in Washington County, who was just experiencing a lot of impacts of substance misuse for their employees, their employees' families. They had lost family members, and the employer wanted to know what can we do to support our workforce and their families. And so we collaborated with our Working Bridges program and Prevention Works Vermont, and a group of Vermont employers and community organizations, and put together this guide that helps employers address the needs and concerns for themselves to have a healthy and safe and supportive workplace, and uses the workplace as a platform for helping working Vermonters access needs and supports around substance use. And finally, project I want to highlight is information for older adults that we're making available as part of a larger project in translating prevention content. So we've worked with the Vermont Language Justice Project to put together two videos that are available in 18 languages that share general information about substance use and sort of the health impacts and legal impacts of that. And then one that focuses specifically on what older adults need to know about substances and how things change. Thank you. That's one of the reasons I asked my aunt to come. Okay, so we're looking ahead. We are focusing on keeping investing in what works. We have a lot more to do, and we want to continue to provide that stability. We're expanding our cross sector collaboration, working this year, starting to really work more closely with schools. Very excited about that. Continuing to align in other areas of prevention, and continuing to hold that cycle of planning, implementation, evaluation, and continuity. I'm going to stop there. I did bring some things that I'll leave afterwards. I brought in our employer guide for substance misuse, an annual report, and information about our language videos.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. What I'm really glad about is that you mentioned employers. I was going to ask that question. I know EAPs are so important but sometimes having that connection is all yours. Thank you for the time. Thank you. And we have Mary Ann Morris who's the executive director of the collaborative on screen. Welcome. You're muted.

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: Okay, sorry about that. I couldn't unmute myself and still do the other things. Hi, thank you very much for welcoming me into your room. I am Maryann Morris.

[Sen. Virginia "Ginny" Lyons (Chair)]: Maryann, you've got an email or something up in front, maybe push your little red button with the little one with the there you go. We got it. Thank you. Yep. We're perfect now. Alright. Wait a

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: second till I'm perfect.

[Sen. Virginia "Ginny" Lyons (Chair)]: You so much. Now you're imperfect. Is

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: that you're seeing the the speaker now?

[Sen. Virginia "Ginny" Lyons (Chair)]: We are. I think if you go over and hit that little red button on the top of that one, and then click on the collaborative. Just click on the collaborative. It'll come forward. Yeah. Now you can

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: Alright. Cool. Thank you.

[Rick Hildebrandt, Commissioner, Vermont Department of Health]: Thank you. So

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: thanks for welcoming me. And so I'm happy to be here and talking about our work for for Region 4. I have been working in prevention with the collaborative for

[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, maybe Ann, just a little tweak here. The move the collaborative screen over, and now we can see it. Good. You can

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: see That's cool. I can't see my notes, though, so I'm going

[Sen. Virginia "Ginny" Lyons (Chair)]: be Okay. That's good. Know what I want. Oh, see. You need to see your notes.

[Rick Hildebrandt, Commissioner, Vermont Department of Health]: Yeah. Senator, we can present. So she'll give her notes and then Okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: You can just turn your screen off, take your screen down, look at your notes, and then the Department of Health will be projecting your slides.

[Sen. Martine Larocque Gulick (Vice Chair)]: Okay.

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: Zoom is not my first language, so

[Sen. Virginia "Ginny" Lyons (Chair)]: I'm gonna need picture right there. There we go. There. So as soon as it's up, we'll let you know.

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: Okay. And there might be some slides on there that will be slightly different from mine, but we will manage that.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. We'll we'll

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: Oh, I think they're actually the same.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. The slides are up.

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: Okay. So thank you for inviting me here today. I am the executive director of the Collaborative, and I've been working in prevention for over twenty years and for the last fifteen as the executive director of the collaborative. I am a member of the SNPC and I am a certified prevention specialist. And on the next slide, so you can see here, the little blue pop out is our region. Those are the health districts of Brattleboro and Bennington, Springfield and White River Junction. It's a very rural community kind of spread out and our organization kind of sits right in the middle of that L down in the bottom. Go ahead. So having worked in prevention for so long, I can tell you that you get used to the idea of the inconsistencies of funding and the attention had to be has to be paid to the work of making sure that you've got funding to continue the project, which takes you away from doing the work that you want to do in front of you. And the VPLO system has strengthened that prevention infrastructure and leveled the playing field for all prevention professionals and organizations. And I hear this from my cohorts of coalitions in our area a lot. It allows longtime organizations to have consistency and sustainability. What's great about the setup is that it keeps the funding right where it belongs, close to the people who know their communities, know the needs, know the people, and know what the local priorities should be. And this prevention work doesn't happen all by itself. It's a team effort. It's coordinated from the Vermont Department of Health and DSU down through the VPLOs, right down to the local projects on the ground. And it really has been just a bright spot for me to be working with this system, because we have eight different long time prevention coalitions in our area, which is kind of unique. And it was a hard shift for them, but I see things settling for them. They're realizing that this gives them the freedom to do the work that they really want to be doing in their communities based on the need in their assessment. You can go ahead and flip for me. Thank you. So, to provide high level feedback and strategy and make those funding decisions, our Regional Advisory is made up of local district directors, Office of Local Health District Directors, hospital C suite representatives, regional commission members. And as I said, there's eight of these well established coalitions that are really skilled in evidence based work, and we're able to advance and deepen those prevention relationships and skills using them. They make up members on our prevention coordination team, which represent each of the districts along with our prevention consultants in the area. And we meet and communicate regularly to hear what's happening in the districts and locally, and also to share what's happening regionally and with the state so that we can keep that communication and interaction and transparency going. They help to work on the strategic plan and execute it and plan for the future of the PL. Go ahead. So, to do our strategic planning, we gathered funded, unfunded, untapped partners across the region, the regional advisory, the prevention coordination team to talk about the needs in our area and create our strategic plan. We reviewed disparity impact statement and our logic model, and then we asked these groups to come up with some creative out of the box ideas and evidence based ideas to help address the gaps and the needs in our area. And we came up with these five priority areas: foster belonging, well-being, combat loneliness, cultivate connection, increase understanding of prevention and the community's health, increase awareness of our resources and connect people to care and utilize collective impact for community transformation. We determine that by working on these priority areas, we would achieve the overarching goals of reducing substance misuse over time. Go ahead. And so I think we've heard a bit about it takes a combination of acts of actions sustained over time to prevent and reduce substance misuse, and it takes partners that are trained and working towards common goals that they really believe in. And that's why the funding is so important, because we can confidently offer our partners a longer term of security and support. And that three years that we're offering our partners in PL4 also allows the prevention lead in our area time to bring them into the fold of the infrastructure that we're creating for misuse prevention and create a place and a value for them there, sharing the data and trainings, networking and other opportunities. Go ahead. Thanks. So you'll see here kind of the spread of our prevention partners, that we funded throughout the four different districts. And we do have some of our partners who work with multiple districts or within all of the districts. And then also the spread of where they are working across our priority areas. We ask each of our funded partners to select up to three areas on our priority areas that they're going to be doing their work in an effort to improve these priority areas. Thanks. So again, this prevention model, it's actually kind of easy to get prevention wrong while also really having the best intentions at heart. And this is one of the tools of prevention model and the toolkit that helps everybody kind of stay on the right track. And so this is a representative of where our funded partners are working across the model. And we are staying close to our funded partners and helping them understand these different tools and toolkits. And over time, our partners are actually understanding and advancing where they work at the different levels of the prevention model. As some insight, our systems number is a little bit higher probably than you saw Amy's and Mahat's, and that's not a brag. That's just because we do have the eight already established coalitions who had been experienced in doing that kind of work over time for quite some time. Okay, go ahead. So, we provide support to our funded partners through open office hours, one on one meetings, site visits, group meetings, trainings, and we help connect them to the support or tools or partner that they need in that moment. And we require things from our funded partners that increase the region's impact. They build collaboration and fill gap areas and share common messaging. So, and we try to measure how we're doing with that through our quarterly reporting. Go ahead. So evaluation is one of our primary tools in the prevention science toolkit, and we measure how we're doing with providing that technical assistance. And our results so far have been bright, with 82% of our funded partners reporting that they have an increased understanding of program evaluation and how to embed it into their work. Go ahead. And then through assessments at the start of this project, we found gaps in clear and consistent communications across the region. There's so much to do when you're working locally that sometimes these tasks of communication can fall by the wayside. And then another gap was our work with older Vermonters. This was the first time that we had been given the breadth to be able to include across the lifespan, and we recognized that there was that gap. We prioritized communication as a regional tool, providing as many tools and toolkits to help our partners to advance that. Because applied correctly, targeting to a specific audience and using the appropriate media, this can help fill gap areas and also be a powerful tool for health. Monthly, we provide a newsletter to our funded and unfunded partners that helps them to plan communications for the month ahead, providing tips, campaign toolkits, how to use them and making sure everybody knows about upcoming national awareness campaign. And through our site visits, we hear that this has been a valuable tool. And then one of the ways that we address older Vermonters was to create a comprehensive older Vermonter educational campaign with an audience of both the older Vermonter and the people who surround them with care. And that really opens up the age group to down into families with children of themselves. It provides information about prescription drugs, cannabis and alcohol that's unique to this age group. Thanks. So I'm going to take a dive and show you about the work happening on the ground in our area. It's very exciting, and we'll try to connect it a little bit to how their work is actually impacting the goals of our region. Go ahead to the next one. So, the investment that Vermont makes in prevention directly impacts our youth, whether it's creating safe spaces after school to gather, empowering youth voices, participating in healthy alternatives, providing education, and cultivating leaders. And throughout PL4, many of these projects are benefiting our young people. Go ahead. PL funds youth project in each of the we fund youth project in each of the different health districts, and the prevention leads provide technical assistance, connects them to each other, connects them to the tools that can help make their projects bigger and brighter as time goes on. Go ahead to the next one. So in Springfield Health District, Chester is an interesting town. A couple of years ago, the school in Ludlow had to close nearby Ludlow had to close and their young people went to Chester for school. It's a bit of a ride, a bit of a challenge for the Chester community, a bit of a challenge for the Ludlow community. And there was an idea to create a Chester Teen Center. And without this funding, the Chester Teen Center wouldn't exist. It was a big gap area for the region. Now there is an average of 30 young people a day, and they have ski and bike adventures, paint murals, and are participants in many of the town's activities. It's a really neat thing. Like they're always tapped in. Chester's a very like town fair kind of a town. They're always tapped in for those things. And this small space in town, they've created connections for a variety of young people. And so, and for me, my favorite quote here is that when I turned 21, I'm coming back to work here. Because I, as a young person, that's how I felt about my summer camp. And I did go back to work and I worked with youth for a very long time. And that's how I'm still in my position today. That's how I got started. So that sings for me. Next one. In the Brattleboro District, youth work looks a little bit different. It's school based, and these young people might not get much attention at home or have a voice in other places in their lives, but they do here. No one made them work in the garden. These projects, including the hygiene closet, came from them and are managed by them, empowering our youth at the source and connecting them to the resources that they need to thrive. Go ahead. So this choice team wanting to improve school climate, increase healthy behaviors, they've got a lot of ideas, it's really hard to hold them back. Not that we'd want to, but they presented to the town select board. They started a town council. It's only the third in the state. They also did a project where they're handing out calm down boxes, which sounds like a funny thing, but it's got the fidgets and the other toys and focusing tools that young people need to keep calm and focused throughout the school day. They distribute them throughout the school's classrooms and in the common areas. They're fostering belonging by showing up for their peers and community.

[Sen. Virginia "Ginny" Lyons (Chair)]: Go ahead.

[Maryann Morris, Executive Director, The Collaborative (Region 4 VPLO)]: In Brattleboro, youth are the leaders in the school and the community. And they have been for a while. They were the first youth council in the state of Vermont. They lead meetings, analyze data and use their voices to work towards better, safer and a more connected community. And these are the future leaders that Vermont needs. So the Youth Substance Awareness Safety program is actually an alternative to civil court processes. And, this program in Windsor County actually takes it a bit further. They have clinicians who meet as a group and with individuals as they go through the process of getting their tickets expunged. And you don't really expect that when you're sent to a program because you did something wrong that you'll get good reviews. But these guys are getting good reviews pretty consistently from the young people that are coming to the classes, and that's very hopeful. It shows that when young people do feel that they matter when they have someone to connect to. Go ahead. So in Bennington and the Springfield districts, Resiliency Through Understanding is making an impact. This program has five different educational and skill building events that provide the tools and education to build resilience for young people and their caring adults. And yes, the caring adult is required to go to two of the activities. The project is incentive based, and many partners and participants in good standing get the incentive of their choice, which could be a season pass for Downhill or Nordic or tickets to plays all summer long. Go ahead for the next slide. The project has wide intergenerational impact because it educates and works on collective impact by wrapping together young people, their families, schools, third spaces, businesses, teachers and community volunteers towards this common goal. Thanks. Next slide. So you've heard that we really value evaluation as a tool to ensure our work is evidence based. We use the results based accountability model. It's relatively quick and easy. We ask our funded partners to tell us how much did you do, how well did you do it, and is anyone better off. We work as a group on RBA instruction, and then we provide tools so that they don't get lost in the jargon or technical language. And we provide one on one support to complete each funded partner's evaluation table example of the tables here. The next slide shows that where we track that on a collective a clear impact dashboard. And so, we're eight months into this funding cycle right now. And so, we just have two quarters of information, but that first top part of the slide shows our one strategy, increase access to community building event or excuse me, the goal is foster belonging, and the one strategy increase access to community building events. And those are our results so far for two quarters. In the next couple of quarters, we imagine that the community outcomes, the Is anyone better off? Part, will begin to roll in. And lastly, I want you to know that I don't sit in my office alone doing this work, thankfully. It takes a team across the regions and the PL4 lead team pictured here, some of them, Thomas with our friend, Ballant, Samantha at the podium, and then a team of RPL4 partners. And James Coleman is starting next week on our team. And of course, not mentioned here is our finance person, Jackie Barela. We have a lot of ideas, too many most of the time, energy and hope for the future of this project because we know that the economic and social benefits of investing in this VPLO and prevention are really clear. So, thanks very much. I appreciate your time.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. It's a lot of good work. Thank you very much for sharing that with us. We appreciate it. So committee, Commissioner Hildebrand, do you want to back up?

[Rick Hildebrandt, Commissioner, Vermont Department of Health]: Yeah, I was just going to give some brief final remarks.

[Sen. Virginia "Ginny" Lyons (Chair)]: That would be terrific.

[Rick Hildebrandt, Commissioner, Vermont Department of Health]: I just wanted to thank you all for having us here today to talk about our substance misuse programs. And to your question earlier, you know, talking about funding, really the main ask that we have is around the Substance Use prevention fund. That is the main and primary source of our funding for this work, and consistent funding is really important so that we can ensure the viability of these programs. Just again, as some highlights, ninety percent of individuals who start using drugs and other substances start before the age of 18. Investment in this is effective. Dollars 1 invested is preventing $18 in future potential costs. And we use data from strategies and partner with local organizations to ensure that we have a really great program that supports all of Vermont. Consistency matters. We need to sustain initiatives over time to see them pay off. We may be sustained and targeted investments to see real results for pension workers.

[Sen. Virginia "Ginny" Lyons (Chair)]: So, it will be helpful that this is everything that you folks are doing is just amazing. To reach every corner of the state is unbelievable. And it is the cornerstone for having public health improvement overall. We're really appreciative of what's going on. And in terms of the substance use prevention funds, we'll have you back on that one and try to understand what the criteria are right now for utilizing that fund and what constraints those criteria offer or what better could be put in place to have your work continue. I just have one

[Sen. Martine Larocque Gulick (Vice Chair)]: looks like you're concerned. With

[Sen. Virginia "Ginny" Lyons (Chair)]: all the work that you're doing, and I know that there are opportunities for doing PSAs, and what how is that going? I mean are you considering more, fewer, what is the effect of having those public service announcements overall? Do you see them as valuable?

[Rick Hildebrandt, Commissioner, Vermont Department of Health]: What more do we need or not? And I can have Emily speak to this a little bit more, but a lot of that is through social media. Our main venues of reaching the folks that we need to reach. Again, the landscape has changed. It's not, you know, television as much. Use targeted advertising and announcements in that manner. But I don't know, Annabel, if you have any more to say about But

[Sen. Virginia "Ginny" Lyons (Chair)]: at the in particular, I think one of the areas we've been successful are stories, to be quite honest, in different news outlets. For example, Seven Days has been a popular place where I've done things, and having real world examples and experience out there, I think, has been more effective than that big thing that we used to do at least the anxiety. So I think our strategies, we'll work with external partners to help consult us in regards to the strategies, in regards to social media is its own space. You'll still see things in movie theaters. You'll see occasional things on TV. You'll see things on websites and in magazines. So we're using a multi pronged approach in trying to cover all substances across the continuum of care. It's a large area of focus for us. Good. Whenever I see that, whether it's online or on TV, say, Oh, that's so great. Yeah, that's great. And it feels like it has an effect. And then in terms of the organizations that are here, so working in the South and working in the North, do you and you have an annual meeting. It sounds like you get together on a regular basis, is that true or false? Does Northwest get along with Absolutely. The I think one of the things we love about it is this connection to the other regions. We're inspired by the work that we see there. We're working on projects together. We meet monthly to connect with the other VPLOs, and it's great. All right, well this is just the tip of the iceberg, I know that, and I very much appreciate the time you've taken to put all this information together, but I think it's probably helpful for everybody, including you, and so going forward, it will be terrific to hear about what the challenges are. And I know one of the challenges is funding, but the other challenge is keeping people engaged and how that happens and the whole communication system of communication. Committee, any questions that you would have at this point?

[Rick Hildebrandt, Commissioner, Vermont Department of Health]: I just there's so many different types of products out there right now that I'm terribly confused. All of you go to some of these stores and types of cruelty and the types of nicotine and the types of just different things and I'm just targeting youth as far as I'm concerned. I guess if you look at the flavors, the types of products, so that just obviously gives me some concerns, but what they're doing is absolutely fantastic. Right, it's not a static field. We always have to be changing to the environment, you know, whether it's vapes and a smart device or, you know, concentrated nicotine pouches or some other marijuana product, you know, there's the landscape changes constantly. So that's why frankly having people on the ground who know those things and see it every day is really, really helpful. It can't all come from centralized. Kind of basically in partnership with them. Thank you.

[Sen. Martine Larocque Gulick (Vice Chair)]: That's great. Thank you, chairwives. So much gratitude for this. This is amazing and so appreciated. Our point that Emily that he took us through was fantastic. I believe that SAPs are really critical piece of this. Kids learn best when they have relationships with adults and the SAPs that are in the schools building those relationships are incredibly powerful. My understanding, just copying the school from my district, is that there aren't quite enough of them. They're playing the whack a mole as Yeah. You referred to. And they're, guess I'm just concerned that given the there's just so much talk about trying to decrease education spending when we actually really need those SATs more than them. I'm just concerned about that conflict, and I'm hoping that you continue to advocate for for those folks. Just like I really think that's where that's where it really happens. Kids spend a big chunk of their days in schools. Sure. And

[Rick Hildebrandt, Commissioner, Vermont Department of Health]: Yeah. I've got I've got two kids in schools, and relationships that they can make with their educators and the folks in the school can make it a great kid. Right? Exactly. When you have a great relationship, the kid can grow and learn so much, and when they don't, it doesn't. And you're absolutely right. Having the the right folks in that space is critically important.

[Sen. Virginia "Ginny" Lyons (Chair)]: Good question. Any other question? Oh, it feels like we could talk, But, you know, I'm going to resist doing that. And I'm appreciating, Mary Ann, you're being here with us on Zoom. And we're really, this is our first step. Any of will come back, it's closer for you, right? But, thank you.

[Rick Hildebrandt, Commissioner, Vermont Department of Health]: Thank you for

[Sen. Virginia "Ginny" Lyons (Chair)]: having us. We've got challenges in front of us, not the least of which is a perception of where prevention fits in the whole scheme of treatment and recovery and prescription drugs and hospitalization and putting in a center or residence. We'll keep looking at it. Thank you. You very much. We're you very gonna take a quick break. So we're gonna go up live. Yes, Ann. Sorry. I just wanted to make a plug for prevention advocacy day, is April 9. We'll all of us be back at the State House, an opportunity to to talk with folks from any of the four regions. So we'll share more information. Oh, April 9. Maybe we'll try to target some testimony that day. Callista will remind me, and you remind me, you will remind me. Want to get all of you in here of what would be a critical piece for testimony to help us as we move along in with