Senate Standing Committee on Health

You seconds for our Vice Chair to arrive, but thank you to panelists for being here so prompt to not appear awkward. We'll get going. The Senate Health Committee will come to order. Good afternoon, and as we continue to take precautions to manage ongoing Covid-19 Risk, the Senate continues to welcome the public and has provided access to both in person and teleconference participation for public comment.

For individuals wishing to provide public comment via the teleconference service, the participant toll free number and access code is posted on the Committee website, and I will announce it now. Today's participant number is 877-226-8163 and the access code is 736-2834 the number, phone number and access code are also displayed on the screen. We will maintain decorum during the hearing as is customary, and any individual who is disruptive may be removed from the hearing room.

For today's hearing, we will be hearing all of the panels on the agenda prior to taking any public comment. Once we have heard from all panelists, we'll have a public comment period for those who wish to comment on the topic of today's agenda.

Okay, so we want to begin the hearing, and I would just like to say in the last few years we have certainly focused a lot on trying to enhance our behavioral infrastructure, behavioral health infrastructure, as well as kind of reimagine how we treat our young people, especially as it relates to behavioral health issues.

So today's hearing will do an overview of two initiatives authorized in that budget, the California Children and Youth Behavioral Health Initiative and the Behavioral Health Continuum Infrastructure program, which was a 2.2 billion, whereas the California and Youth Behavioral Initiative was a 4.4 billion. And these are all multidepartments. As we try to continue to break down the silos, we've spread out.

And so, of course, I'm really interested in how that is working because sometimes in our ability to break down silos, I think we can create compression, if you will, and understanding of how things work.

This hearing will include representatives from the California Health and Human Services Agency, the Department of Healthcare Services, and the Department of Healthcare Access and Information, who will provide updates as to how the funding is being spent, as well as provide detail on what improvements have been achieved in these behavioral health services or what outcomes are targeted in the future. County and community partners and providers will also share their perspectives as participants in the initiatives, along with their perspectives of the child advocacy group.

Just to see if my Vice Chair would like to make any opening comments. She would not. So we'll begin with our first panel, and we're going to hear from our first panelists, Melissa Stafford Jones of the Children and Youth Behavioral Health Initiative. Welcome.

Good afternoon, chair Eggman and Members of the Committee. I'm Melissa Stafford Jones of the Director of the Children Youth Behavioral Health Initiative at the California Health and Human Services Agency. Thank you for inviting CaLHS today and for the opportunity to provide you an overview and status update on work underway as part of the Children and Youth Behavioral Health Initiative, or CyBHI. Behavioral Health continues to be a top priority for this Administration and CalHHs.

We are fully committed to accomplishing our transformational goals to improve the mental health well being services and ongoing supports for all Californians, including our children and youth who we know are struggling. This is a commitment we know we share with all of you and with so many of the dedicated system and implementation partners and stakeholders that we have been working with, including those that will be testifying before you today.

And we really appreciate the leadership of the Legislature on this very critical issue of our children's well being. As was stated, the CyBHI is a $4.4 billion initiative with an additional 300 million added in last year's budget for a total of 4.7 billion, working to reimagine and transform the system supporting behavioral health and well being of children and youth into a more coordinated, youth centered, equitable and prevention and well being oriented ecosystem of services and support.

And the CybHi is really at the core of the governor's master plan for kids'mental health, which takes an all of the above cross system, cross sector, systems change approach to improving Kids'well being and their access to the supports and services they need, including meeting children and families where they are, which in addition to home.

We know the other place where kids spend the most time is at school and we know the need continues to be significant and urgent with children and youth continuing to struggle as they have over the last decade. But also we've seen with increasing mental health challenges. I know we've all seen the most recent data from the CDC that in particular identified increasing sadness, increased levels of violence, and increased risk of suicide for both teen girls and our LGBTQ plus youth.

The Legislature's and the governor's recent budget investments and actions underscore our shared commitment to solutions. Much of the work of the CybHI is oriented toward longer term systems change and capacity building that is really needed to achieve the transformation goals of the CyBHI and improve access and outcomes. We recognize the immediacy and the intensity of the behavioral health needs, though, of California's children and youth.

And we are really working to act with urgency on making those critical systems changes, as well as taking a number of steps thinking about nearer term action and support for youth.

And at the same time, we have heard loud and clear from our partners in our work over the last 18 months as we've been working to implement the CyBHI, that simply doing more of the same of how systems and services work today is not good enough and will not be effective in building the systems and services youth and families need for mental health and well being.

Partners have emphasized the need for fundamental transformational change, and we recognize that these systemic changes that need to be made, breaking down silos as the chair talked about, coordinating across systems in ways that truly center children and what their needs are, reducing stigma and discrimination, all in the context of historic underresourcing, cannot be addressed overnight. But the need for this work is universally acknowledged amongst all of us, and I know we are all committed to that work.

And we have particularly heard this directly from our youth who have really challenged us to do several things, including redefining treatment, to not only define it as clinical services, but they also have named as part of what they see as treatment for their mental health as the arts, various activities, mindfulness, access to safe parks and green space, access to peer services and relationships with caring adults. Youth have also emphasized that culture and culturally relevant practices must be part of healing.

Youth have told us they need systems to stop waiting until they are in crisis to support them.

They want to get the supports and services they need earlier that they want and need a behavioral health workforce that looks like them, speaks their language, comes from their community, understands their Lyft experience, and they've told us that the harm systems have caused to mental health and well being of youth and communities in the past must be recognized in order for them to trust that the systems we are working to build now will actually be there for them.

Specifically, Cybhi over the last 18 months has been progressing with research, planning and design, and we are now actively moving into the implementation phase with many of the Cybhi's 20 component work streams. And that work is very much guided by what I was just describing, which is what we are hearing directly from youth and families and communities.

And we summarize those findings in a report called youth at the center in terms of what we have heard from youth and families and are really using that as a guiding document for our work ahead.

As of December 2022, we have engaged over 1000 organizations in our efforts to include sectors of health, behavioral health, counties, sister state agencies, education at all levels, early childhood k through 12, higher education, community based organizations, youth and family advocates, subject matter experts conducting almost 400 listening sessions and expert and stakeholder interviews, about 75 roundtables and focus group sessions and we've held almost 50 events with youth and parents, and cross sector collaboration and centering.

What youth and families want and need is really central to our work. The inputs, the insight, the experiences that are coming from that partner engagement. We are using those for our plans and for our implementation of the cybhi that's underway. I'm just going to put up this slide.

I promise not to go through every box on this slide, but the work of the cybhi really falls into these four main categories that you can see across the top a focus on workforce training and capacity building, the behavioral health ecosystem infrastructure that we need coverage and a focus on public awareness and reducing stigma.

All of the efforts that you see on this slide, these different work stream components that are a part of the cybhi are led and coordinated across multiple departments within Cal HHS and you will be hearing from my colleagues in both DHCs and HKAI about their work under the cybhi.

Things such as the new dietic services benefit that's available under medical starting in January of this year the development of a new virtual services platform to increase access to services that will go live in January of 2024 grants that are underway to support the scaling of proven practices that are effective to improving access racial disparities grant awards made in December of 2022 to really focus on increasing the brick and mortar capacity for children and youth behavioral health services multiple efforts underway that you will hear about for supporting school linked behavioral health services and multiple strategies to build the workforce that we need and the more diverse workforce that we need as well.

The CybHI also includes targeted efforts to reduce stigma and raise public awareness, youth suicide prevention efforts and supporting the capacity of educators and school staff with traumainformed training. We hear directly from youth that stigma, particularly with families and communities and the adults in their life, remains a barrier for youth getting help. So CybHI includes campaigns to reduce stigma, raise public awareness about youth behavioral health aces and toxic stress, and support youth getting connected to the services and supports they need.

The CDPH, the California Department of Public Health Stigma Reduction campaign, released a $33 million RFP for a communication partner in January, and later this spring will be releasing a $15 million RFP for community based partners to support that work at the on the ground level there are also two components underway related to suicide prevention at CDPH, a targeted youth suicide prevention campaign that will focus on youth who are at greatest risk of suicide, and that includes both partnering with community based organizations later this spring.

They have a partner in place who will be working on grants to trusted partners in those high risk communities, as well as a communications campaign as well as an evaluation of that effort. And efforts are also underway to implement the $50 million youth Suicide Reporting and crisis response pilot program that was approved in the budget last year.

This pilot program will develop and test models for making youth suicide and attempted suicide reportable events, and the pilot will also support models for rapidly and comprehensively responding to these events by providing crisis services and follow up in schools and in the community where it's appropriate in that instance. Also, the new trauma informed training for educators that our California office of the Surgeon General is developing will go into beta testing this spring and will be available publicly to all educators and school staff this summer.

And these highlights and more in terms of our work to date is summarized in a recent report we did a public progress report that we released in January of 2023 that I think we provided a link to as well. And I'll just close by emphasizing really the centrality of schools and the health education partnerships that are a part of the work of the cybhi. As I said earlier, meeting kids where they are is at the core of this effort, and as are our partnerships with schools.

And we are working closely with education partners across the field.

Right now, we are working particularly closely with the State Board of Education and the California Department of Education on several matters, including thinking about linkages between our workforce efforts, things like career technical education that happens in the k through 12 school system, and what we are doing in terms of workforce efforts, as well as really thinking about how can we better integrate and coordinate the work of community schools and the cybHi, which have a lot in common in terms of a whole child approach, deeply focused on equity and on really supporting our children to thrive.

I will note just two last things for the initiative. Overall, Calhs has selected Mathematica as our evaluation partner, so we are conducting a formal evaluation of the cybhi. We'll be forming an evaluation advisory group. We are working with them to finalize our outcomes goals. We will have a public dashboard in place in the coming months as we continue that work.

And then lastly, spending plans of over $2 billion for the work underway in the CyBHi are in place for 2122 and 2223 combined with an additional approximately 750,000,000 planned spending in 2324 and then additional funds will be spent as they become available in the out years of the initiative. Thank you so much for the opportunity to present this update.

Thank you very much, Director. Now we're going to move on to Director Autumn Boylan of the Department of Office of Strategic Partnerships, Department of Health Services good afternoon.

Thank you. As you said, my name is Autumn Boylan. I'm with the Department of Healthcare Services and I have the pleasure of working with Melissa and Elizabeth to implement this very innovative and important initiative. The Department of Healthcare Services has made significant progress and taken important steps to implement the key provisions of the children and youth Behavioral Health Initiative, for which we oversee responsibility and really aimed at improving access to critical behavioral health services and supports for children, youth and families across the state.

As Melissa said, in addition to joining the many stakeholder engagement activities headed up by the California Health and Human Services Agency, along with our colleagues and other departments, DHCS has also extensively engaged with over a thousand unique and diverse stakeholders on key implementation partnerships across the state, including hearing directly from youth.

As Melissa said, we do aim to keep youth at the center and we have engaged with over 300 youth in various focus groups, advisory bodies and surveys, and other opportunities to hear from young people where they're at. As Melissa said, we have also engaged extensively with the local education agencies, the healthcare providers and payers in our medical and commercial behavioral health delivery systems, behavioral health experts and community based organizations, among others.

We have, as a part of this process, stood up two separate expert panel think tanks to obtain information and guidance from experts in the field, both from within California and nationally. And we also have managed two separate stakeholder workgroups to help inform the work of the CyBHI that DHCS is leading.

Throughout this engagement, we've sought to engage with diverse populations, regions, age groups, including individuals from BIPOC communities from Latinx, Asian American and LGBTQI plus communities, as well as other historically underserved populations, including making sure that we're speaking with young people from rural communities, families experiencing homelessness, justice involved youth, and foster youth. All of this foundational stakeholder engagement work informs our implementation strategies for the 12 distinct work streams in the cybhi that DHCs is leading.

As Melissa said a moment ago, in January of 2023, DHCs implemented a new medical dietic services and dietic caregiver services benefits. Dietic services integrate physical and behavioral health screening and services for the whole family during a visit for the child, and not just the child being the identified patient. Dietic services involve simultaneous treatment for the child and the parent and caregiver, with studies showing significant improvements in child behavior issues and increases in positive child parent attachment.

Dietic care is centered on the needs and priorities of children and families, and it leverages the Wellchild visit to screen and identify areas of needed intervention. It also provides an opportunity to address the social determinants of health that may pose barriers to optimal mental health, family dynamics, and healthy development. Adding dietic services as a medical benefit offers sustainable funding to create and maintain this infrastructure for integrated care for children, creating seamless access to behavioral health assessments and connections to other locally available services as needed.

We are also, as Melissa said, implementing a digital behavioral health platform starting in January of 2024. This will be a new technology solution for all children, youth and families in California ages zero to 25 that will improve access by offering youth, parents and caregivers a new way to assess behavioral health needs and receive support. The platform will provide support and resources such as interactive digital education, self monitoring tools, app based games, mindfulness exercises, and access to free on demand, one on one coaching and counseling supports.

It'll be delivered through a downloadable smartphone application, available as a web portal application, and also available by telephone. To date, DHCs vetted over 450 different types of platforms to understand what we can do and envision a future for California's digital behavioral health platform and content. This was done through an extensive market scan, a request for information and numerous vendor demonstrations.

Through this process, we have sought to deliver a best in class solution that will integrate multiple partners into a seamless user experience and also provide tailored services for children ages zero to 1213 to 25 and parents and caregivers.

We are getting very close to making an announcement about a selected partner to lead this effort and we will, as a part of the build up to the launch in January of 2024, continue to conduct with our partner extensive user testing to obtain youth input, as well as input from families, parents and caregivers about the design, content creation and functionality of the platform to make sure that it meets the needs of California's youth.

These activities will continue prior to and post go live and we continue to keep youth at the center. We also will be engaging with our primary partners, additional partnerships with key implementation partners in the community such as schools, primary care providers, behavioral health experts across the state to help drive awareness and adoption of the platform. Prior to and upon launch.

The platform will help to alleviate pressure on the public behavioral health delivery system by offering an upstream option for getting help and reduce the overall need for services delivered in emergency departments and psychiatric hospitals, as well as reduce the need for crisis services by providing that on demand touch and somebody to talk to when a child is feeling lonely or they need additional support.

DHCS is also working with potential vendors to provide a statewide e consult service for pediatric and primary care providers to connect with behavioral health providers. This effort will strengthen the workforce and improve capacity of primary care providers and pediatricians to be able to provide behavioral health treatment to children, youth and young adults. And to date, we've engaged extensively with leading experts on e consult services, and in the coming weeks, we'll be launching an additional stakeholder engagement process to help inform the design of the statewide solution.

We are also, as Melissa mentioned, scaling evidence based and community defined evidence practices through a series of grant initiatives, and we conducted an extensive stakeholder engagement process to identify the practices that will be scaled through this grant effort. The practices are based on robust evidence for effectiveness, impact on racial equity and sustainability. Through this grant initiative, we aim to improve access to critical behavioral health interventions, including those focused on prevention and early intervention, and resiliency and recovery for children, youth and families.

We published a grant strategy document last fall outlining the approach DHCS has taken to scaling these practices, including our distinct priority areas for funding and for funding of this initiative. And to date, we have released funding announcements for two out of six rounds of grant funding and anticipate releasing the other four rounds of funding in the current year. The practices include those focused on parent and caregiver support and training programs, traumainformed practices and programs, early intervention and wraparound programs, as well as community defined evidence practices.

In addition, as part of the 2022 Budget act, the Legislature authorized additional funding to address the urgent needs and emergent issues for children, youth and families. DHCs is leveraging existing partnerships and leading experts to build tools, resources and programs, including contracting with the Childmind Institute to develop next generation digital supports for children, youth and families, and behavioral health providers, as well as a video series for parents and caregivers to educate them about behavioral health conditions impacting their children and youth.

We are also contracting with the children's partnership to pilot and develop statewide standards for high school peer to peer demonstration programs. And that's one thing that we've heard extensively from youth, is that they really would like to see an additional investment in peer to peer programming. They want to learn and be encouraged and inspire each other in their health and wellness journeys.

We are also contracting with the Sacramento County Office of Education to disseminate wellness and mindfulness grant dollars in all k through 12 districts across the state and in all 58 counties in terms of school based behavioral health services. As part of the Master plan and Cybhi, DHCS is leading a number of initiatives to expand access to outpatient mental health and substance use disorder supports through schools.

For many people, schools are a relatively safe place where they can build trusted relationships with teachers and staff, and it's an important vehicle for identifying and responding to behavioral health concerns. This is true both for the k through 12 school system here in California, as well as the California community colleges, the University of California systems and the California State universities.

In collaboration with the Department of Managed Healthcare, we are working to develop and implement a school linked statewide all payer fee schedule that will provide for reimbursement of these outpatient services to students under the age of 26 at all public school campuses across the state, and this fee schedule will launch beginning in January 2024 and will be implemented across this d. As I said, the goal is to simplify the reimbursement processes and administrative burdens for schools, school districts and their partners organizations including cbos, county behavioral health providers and behavioral health providers at large to obtain reimbursement from the medical delivery system and commercial health plan providers for behavioral health services provided to students at or near a school site.

We work regularly and closely with our colleagues at the Department of Education, the State Board of Education, the California Community Colleges, CSU and UC systems, as well as with our LEA partners across the state to design and implement this statewide fee schedule and we have collaborated with DMHC to launch a cross sector workgroup to help inform this work and address all of the complicated policy and operational issues that it takes to merge these two worlds of health and education.

The workgroup is made up of leas, education sector associations, union representatives, our County Office of Education colleagues, county behavioral health departments and health plans across the state, both from commercial and medical delivery systems. We are also working closely with LEAs and institutions for higher education, as well as other key partners, to design a $550,000,000 school linked partnership and capacity grant program that will help to provide direct grants to the LEAs to build operational readiness for implementing this new statewide all payer fee schedule.

So there's a lot of lift that it takes and these dollars will help to support the operational needs, including building capacity, establishing partnerships, and creating the infrastructure necessary to build these health plans for the services.

In addition to all of this work, DHCs also in January of 2022 launched a student behavioral health incentive program, or SB Hip, which provides incentive payments totaling $389,000,000 over a three year period to medical managed care plans for the purpose of building sustainable partnerships and infrastructure between the medical managed care plans and the local education agencies to improve coordination of student behavioral health services between the plans and schools to increase preventative and early intervention behavioral health services for transitional kindergarten through twelveth grade students, to increase mental health services at or near school campuses and to increase access to behavioral health services at our near campuses or through school affiliated behavioral health providers.

Furthermore, we also are managing the Calhope Student Support initiative at DHCS and through partners including Sacramento County Office of Education and all of the County Office of Education. Partners establish a statewide social and emotional learning community of practice which aims to provide resources, training and support to LEAs for implementing social emotional learning programming in schools and to date there are over 6000 Members of the communities of practice statewide.

As a part of this effort, DHCs and partners launched Calhopeschools.org, which is a website that coalesces resources on social emotional learning and development across in one site available statewide and it includes resources developed through the Calho program such as Angst and trusted space which provide important tools and resources for schools to implement SEL programming. And I think with that I will yield thank.

Thank you very much for your presentation and just the way my brain's working. So, Deputy Director Boland. Deborah Jones Right. So you're like, what we're going to do? You're saying how we're going to do it, and now you're going to tell us who's going to do it for us.

Absolutely. Thank you very much, Madam Chair. Madam Chair and members, Elizabeth Landsberg, the Director of HCAI, the Department of Healthcare Access and Information. I'm really happy to be here today to talk about our investments in trying to build the healthcare workforce on the behavioral health side that California needs. So I'll be focusing, all of the initiatives that I'll be talking about are absolutely funded through the Children and Youth Behavioral Health Initiative. And we do have some other sources of funding. So foundational for HCAI. Every one of our healthcare workforce programs has three main goals. To develop a healthcare workforce that is representative of California's diversity in terms of racial and linguistic diversity, really working to increase the diversity. Building a workforce that serves medically underserved areas and then developing a workforce that serves the medical population. And we're working across the continuum from pipeline all the way through graduate medical education. And I'll talk about some specifics. So we know that we need to bring more people into the healthcare workforce and that we need to diversify those folks. So we're doing everything from health careers exploration program, which supports folks going into high schools, doing career fairs and the like. We in the fall announced more than $40 million in grants to 20 organizations that are again doing everything from outreach and support to bring young people into the healthcare workforce, providing paid summer internships, as well as almost 200 grantees with one year post undergraduate fellowships. So supporting bringing more people in. And then we absolutely want to be supporting the institutions to train more people, if possible, train them faster and increase the capacity there. So we have a psychiatric education capacity expansion program supporting the growth of new and expanding psychiatry residency and psychiatric mental health nurse practitioner programs. So in the most recent set of awards, we supported three new psychiatry residency programs, six expanding on the psychiatric mental health nurse practitioner side, three new programs and four expanding programs. We're particularly proud to have helped support the establishment of several new psychiatric residency programs, including one in Butte County. So that's just an example of trying to get into areas that didn't previously have training programs. We know there's a great interest in increasing social work training capacity, so we have launched our social work education capacity expansion grant and just completed a few months ago our first cycle awarded seven new programs establishing either a BSW or an MSW program, 16 programs expanding the capacity of their MSW programs, and 14 of those programs have accelerated four plus one programs to help folks get to an MSW in five years. So we're very pleased with that. We're also providing support for peer personnel training and placement. And then I believe Autumn talked about this, it's not just about having more behavioral health providers, but also helping primary care providers have the tools to provide psychiatric and behavioral health care services. So we're pleased to be funding a couple of programs at UC Irvine, the primary care psychiatry fellowship program designed to improve provider expertise, knowledge and comfort level in primary care based psychiatry, and also supporting a new primary care training and education in addiction medicine. So we think that's a key component. Yes, we need more behavioral health specialists, but we also need to give primary care providers the expertise to provide these services, both to do the assessments and early intervention. So bringing more people in, supporting the institutions and then supporting the individuals, and what do we need to do to help build this workforce? So we operate several loan repayment programs, scholarship programs, and more recently, stipend and earn and learn apprenticeship programs for a wide range of behavioral health professionals, from peer support specialists to psychiatrists. And all of them have a service obligation to serve in an underserved area or in an underserved facility. Given wealth disparities, including the racial wealth gap, we know not everyone can take out a loan, so loan repayments aren't enough and we're looking more to do scholarships and stipends to diversify the workforce. Through the WET, the Workforce and Education Training Program, funded by a combination of General Fund and MHSA Mental Health Services act funds. HCAI awarded $40 million to five WET County regional partnerships, and counties have used those funds to provide scholarship, stipends, loan repayment awards to public mental health system staff in their regions. They're also using funding to support pipeline and retention activities. So the county had counties, the regional partnerships had broad discretion to decide what were the most important recruitment and retention activities for them. We're very pleased to be working in the substance use disorder space, so mental health is important. We have a new substance use disorder earn and learn program to support organizations providing education and paid job experience for those becoming substance use disorder counselors. We also know that we need to support the community based organizations, many of which may contract with the counties or with schools or be providing services in the counties. So we have a program to support CBO's to recruit and retain behavioral health personnel and provide loan repayment scholarships. Similar strategies, but specifically focused on CBOs, and we will be announcing those grant awards in the next couple of weeks very soon. We're also very excited to be relaunching the social work stipend program, and that will happen this fall to support MSW students completing their advanced degrees and obtaining licensure. So those are HCAI's basic approaches. And the state has invested heavily in all three types of programs to address California's major health workforce shortfall. We're also working to develop some new professions where there are gaps, including wellness coaches, to serve California's youth. So this is a major part of the youth initiative, was to develop these new behavioral health coaches. Youth told us, unsurprisingly, that behavioral health wasn't the sexiest name, so we're calling them wellness coaches. So under the youth initiative, we were charged with designing and building this new wellness coach workforce, really with multiple goals in mind, to increase overall capacity to address increased youth behavioral health needs that we've all talked about, but very much also to help build the diverse workforce. Again, we're all listening to youth. Youth have told us loud and clear that they want peer support, special peer support, and to both be the givers of that and the receivers, but also that they want some near peer support. So to have a young, diverse workforce that reflects all of their diversity in terms of race, ethnicity, language, LGBTQ plus. The wellness coach role, we also think fills some of the workforce gaps that exist today. There is the peer support specialist. There's folks who have msws. There aren't a lot of folks with an AA or a BA. So we have a wellness coach, one position that will have an associate degree, the wellness coach two will have a bachelor's. So we really are trying to think through the workforce ladder or workforce lattice. What are opportunities? We want the wellness coach to be a wonderful position for people to be in it if they want, but also if they want to be a wellness coach for a while and then go and get their master's or become a licensed therapist, they could do that as well. So really trying to listen to youth. Many school districts are doing this already. They've recognized the value of a workforce like the coach. They may call them advocates or liaisons, but we're seeing schools doing this. So we think we are on the right track. So we have a lot of steps to go through to implement this wellness coach certification process moving forward. In terms of next step and strategies, HCAI convenes and supports the California Health Workforce Education and Training council. One of the recommendations of the Future Workforce Commission report was there needs to be someone, a body looking at statewide at the strategic health care needs of the state. So we convene this 18 person body. We've had a couple of folks here have given us presentations. We're really looking, again holistically at the state's needs. Some themes that have emerged are we've got to do more to support the clinical supervision of providers. We cannot train staff, so we're really looking at what we can do to support faculty and to support the clinical supervision. So obviously we're hearing people can make more money in the field than they can necessarily as educators. So we're looking to how can we use some of our funds specifically for clinical training and to address those faculty shortages. We also know it's essential to support students throughout their education process. We can't recruit folks to be part of this workforce and not support them along the way. So we're looking holistically at what kind of mentorship programs. Yes, the financial piece is important, but how do we also provide students with the emotional support that they need? It's been great to hear training programs talk about wellness and including wellness as part of their training curricula. We're also talking to them about what pieces of their curricula are addressing implicit bias and addressing cultural humility. So those are some of the approaches that HCAI has adopted. And we also have a new health workforce research data center to better understand the data. So we came out with our first report, pleased to see that that's already being used. We need to better understand both the supply and demand side, but we have at least a better sense of who's in the profession as we work to build out the system. So all told, we estimate 25,000 additional behavioral health professionals will be supported in their training and 16,000 young people will have an opportunity to explore careers in behavioral health as a result of these investments. So there's a lot more that I could say about our behavioral health workforce investments. But happy to take any questions. Thank you.

Thank you very much. And thank you all very much. And thank you for all the work you've been doing in a pretty compressed time frame. I know we're all eager to get to work, but you've been laying the groundwork. Can you, Ms. Lansberg, to talk a little bit more about the new social work stipend program? Is it going to be like MHSA like we had previously?

It's going to be very similar. We frankly increased the dollar amounts, because we were still paying 18,500, which we've been doing for years. So this will be 25,000, but it will be very similar.

Okay. And can you talk a little bit more about the wellness coaches and the criteria for that? I've heard from providers and folks that don't make the criteria too difficult so that you can't find the unicorn to fit it.

Right. Well, I mean, it's been interesting, and we have had a very robust stakeholder engagement process to decide on the wellness coach. What are the core competencies, what are the qualifications? So, frankly, we have those who think we haven't put enough qualifications or training in, and we have those who think there's too much. So we think we got it about right. So we're looking at requiring for a wellness coach one, an associate degree and a number of clinical hours, 400 hours. We had more initially, but we really want to get folks into the schools, but we've got to provide them with the support. So we have a list of core competencies. We've been meeting with the community colleges to talk to them about the training program and have been pleased with those conversations.

Good. And then on the issue of supervision, which we all continue to hear is a massive issue, do you work, then with Ms. Boland's office to be able to find those, like somebody in the VA system? You just need to have more people to be able to provide supervision to more trainees.

I think we have to do every strategy available. Yes. We are looking at places even like state hospitals. We haven't previously been funding folks at Department of State Hospitals, and we are starting to do that. So, yeah, we've got to use every strategy possible to address the supervision issues.

Okay. Do we think it's a good idea to take back some of the money for workforce development?

Well, I do want to say that none of the children youth behavioral health initiative dollars are proposed for delays, but there are, as you know, dollars that proposed for delay around some of the social work dollars as well as some of the psychiatry focused dollars. And I know that's an important conversation with the Legislature.

Okay. Thank you. Ms. Stafford Jones, can you talk a little bit more about the evaluation process that you're setting up? It sounds know, because first I'm thinking, why don't we have our evaluation set up before we develop our programs? But it sounds like you did a whole bunch of listening tours to try to figure out not what we wanted, but what the students and the professionals wanted. So tell me a little bit more now about your evaluation process that you're going to set up.

Yeah, thanks very much. Yes, we were operating in parallel. So part of the engagement we did with youth families, also our stakeholder partners with professional experience and communities was really asking them what were the outcomes they thought were important to change, what needed to be different about the system, and what outcomes did we want to prioritize and see differently for our children and youth if we were successful in transforming the behavioral health ecosystem for children and youth? So that's what we were gathering through all of this work. And at the same time, then we did do a competitive RFP selection process where we chose mathematica. And our approach to the evaluation has actually got multiple components to it. So one aspect of it is looking specifically at systems change. So much of this work is really thinking about how do we have a more coordinated system across sectors? And so looking at are we making progress? What are some of the markers of knowing when you are having a more coordinated, integrated system, which I think we all know is often a 10 year plus endeavor when you look at different collective impact models. But what are the indicators we can see along the way to know if, in fact, systems are working together in new and better ways? The second is really a policy evaluation component. So looking at both the policies themselves, did they add up to the outcomes that we hoped for? Having Mathematica help us understand that, and hopefully that will provide insights to all of you and policymakers in the future about how to build on the work of the children and youth behavioral health initiative. But also looking at our implementation. How did we do in terms of implementation? What were some of the accelerants? Maybe what were some of the barriers? How did that affect how we evaluate the policy changes that were put in place? We're also looking at a population health and program level implementation. So we're looking at specific outcomes goals in terms of, for example, looking at how will we know if we've increased access to behavioral health services, how will we know if youth and families are having an easier time navigating to the services that they need? Because sometimes what we hear from families is we know the services are out there, but we don't know how to get to them. We're also looking, for example, to have some shared outcomes measures with education. One of the things we've heard, particularly from our education partners, is that related to attendance and absenteeism, has a lot of intersection with behavioral health and mental health. So thinking about how can we use a metric that today education already use and include that as part of our outcomes goals for CYBHI. And then the fourth approach to the evaluation is what we're calling rapid cycle evaluation, which is we really do not want to have an evaluation that just tells us after the five years are over, what we might learn. We are really looking for opportunities to learn along the way. How can we look at the work we're doing along the way, look at leading indicators and make adjustments where that's possible to actually get to the outcomes goals that we have? A really also key aspect of the evaluation approach is deeply centering equity, not only in terms of the outcomes goals, but even in terms of our process of evaluation. I'm sure you're all familiar with some of the critiques of a more traditional evaluation that really may miss some critical issues related to equity. So that will be a core focus of the evaluation advisory group that we are setting up. And actually, we have a CYBHI equity working group now that has a data Committee that's already meeting with Mathematica to help inform the work we're doing, to set up the evaluation to really think about both from a process perspective. So, for example, how do we gather information from youth and families about how do they think we're doing in terms of progress we're making? Not only what sort of quantitative data tells us, but what are their experiences, and are those changing over time? So incorporating really multiple modalities for gathering information to inform the evaluation?

And are we doing separate evaluations for the public awareness campaigns?

Yes, all of the work streams are also collecting data for the specific goals and objectives they have for their individual work streams. And then we are working to really align that work with the evaluation that mathematica is doing is more focused on the goals overall for the initiative. So sort of, when you add everything up, have we moved the needle the way we want to? But each work stream is also collecting data about the impact of its work. So, for example. Yes. In each of the public awareness campaigns, there's an evaluation component built into it. Okay.

So we know if we're actually.

Yes.

Okay. Ms. Boylan, can you talk a little bit more just about the fee schedule development? I know that's been a big area for concern and how we bring in the commercial folks as well.

Yeah, I'm happy to. It is a very complex bit of policy and implementation. There are a lot of open questions that we are working closely with our implementation partners to address. Ultimately, where we want to get to starting in January 2024 is a core set of policy documents and understanding about how to build services to the managed care plans on the MediCal side, as well as to commercial health plans. Some infrastructure for doing that to really, like I said earlier, facilitate and remove some of the administrative burdens of figuring that out. So the statute very specifically allows for reimbursement without the contract needing to be in place. This takes the burden off of the schools to negotiate with the plans around the rates because the rates will be established and published as part of the published fee schedule. The commercial plans are obligated also by statute to reimburse providers in accordance with this same fee schedule. So the rates are the same across all of the delivery systems. And the health and safety code pertaining to the commercial plans further specifies that they cannot impose any utilization controls, such as prior authorization or things like that, to control who gets the services and who doesn't. So basically what we're working with stakeholders to do is identify the scope of the services that will be included in the fee schedule, identify the rates, develop the policy that backs it, and we'll be issuing extensive guidance and providing technical assistance both to the schools and the LEAs, but also to the health plans, the counties, and the commercial payers as well.

But I thought we were not going to ask the schools to do the actual billing though, right? It'll be whoever the provider was, if the school has a provider or CBO or the county.

Yeah, that is one of the things that we are working to address. That is probably the billing infrastructure is the most complicated part of the implementation, truthfully. We are working through some different models for how the billing can happen. There are many districts that participate in billing of the LEA BOP program today, and so they have some third party billing infrastructure and entities that are doing billing for medical services today. And so working through some of the complexities around that. But we would agree with you, and that is what we're aiming for, is to not have the schools have to figure it out directly. There are school based providers that are employed by the school. And so thinking through some of the challenges around when the school is the provider and it's not a partner organization like a CBO or a behavioral health provider that already has experience doing the billing, how do we accomplish kind of the billing infrastructure for the schools directly who will be providing services that are reimbursable under this fee schedule using the pupil personnel services, credentialed providers at every school?

Okay. And before I turn over to my Vice Chair, Director Landsberg, do we know the number that's needed of more mental health workers across the spectrum?

We do know. We've gathered a fair amount of information about who is out there. We have not done a full needs assessment. There have been the CBHDA that's here. There have been various assessments done, but I can't give you one set number.

Okay. It's good to know what we're shooting for.

Yes.

Okay. Senator Nguyen.

I just have a few questions to Elizabeth. You mentioned that you're working with different institutions. Are they nonprofit? Are there Cal State system, community colleges, USC system? Who are you working with to getting these students?

All of the above. So if, for example, as we're funding training programs, psychiatric, mental health, nurse practitioner programs are going with UCs and CSUs, but we do also fund some private institutions. So we have criteria, again, focusing on our diversity needs, focusing on serving medically underserved areas, but we don't only provide funding to public institutions.

So from the many professionals that we need, how long are we looking at to get these people certified and onto the workforce?

Well, I think it's a great question, and it's so important to both have short term strategies and long term strategies because obviously it takes a lot longer to train a psychiatrist than it does a peer sports specialist or a wellness coach. So we really are working at every single level, again, from peer sports specialists to psychiatrists. And we need to be doing that as well as recruiting literally folks who are in high school who we hope will move along that ladder. So we're targeting all of the professions in mental health and also substance use disorder counselors that are so important.

So since you've been doing this so far, have you seen any excitement of students wanting to get into the field? I mean, are they now, like, flocking in or we're still at where we have been?

Well, it's a great question, and you'll have other panelists that may be a little closer to it than I. As a state handing out grants to community based organizations, we're not necessarily hearing directly from the trainees that we're supporting that. We do have some of those case stories. So I think there is some excitement out there, though, and it's really important for us to keep building that in the state.

Yeah. Because the way for me is the measurement is that, okay, we're spending all these money to try to get people excited. Are they getting excited or we just keep on talking about something that we're hoping people get excited to go into?

Well, we know that many of the programs are impacted. Right. There are many more people who want to go to a social work school than can. There are many more people who want to go through any of these training programs that can. So our focus is really on increasing capacity and again, where there can be accelerated programs to support accelerated programs.

Thank you.

Thank you.

Heard today, my Alma mater has a cohort cap of 12 for an MSW program. We're not getting anywhere fast with that. Senator Roth.

Thank you, Madam Chair. First, I want to commend you on your efforts, specifically the efforts to link healthcare plans, health plans, with school districts and LEAs. We've been talking, we spoke a lot about that over the two years that I had the education finance Subcommitee, and I think it's a noble effort and certainly one that's long overdue. So I look forward to watching that progress, specifically. I come from a county, Riverside County, that has only about 77 acute care psychiatric public acute care psychiatric beds and no pediatric acute care psychiatric beds to service about 2.5 million county residents. And as you probably know, at about the same time, they say we have about 31 child and adolescent psychiatrists to service, I guess something over 614,000 residents. Now, down where I come from, they say that's a problem. I recognize we're talking about a continuum of care here, from prevention and outpatient mental health services to intensive outpatient services and then inpatient. But in order to try to get a handle on and to assess, I guess, the seriousness of the apparent lack of inpatient bed capacity, do we have a handle on the percentage of youth behavioral health cases that require inpatient services? In other words, we're talking about the youth population. What percentage of those with behavioral health situations require inpatient care? Do we know?

Not off the top of my head. I don't know if some of our colleagues today will have some of that data that they can share, but it's something that we can certainly take back and share with you following the hearing.

I think it would be important for us to know, because, of course, I get the anecdotal information from hospital CEOs and others in the healthcare area in the community that so and so 10 year old or so and so, a 14 year old spent five days in the emergency department in acute mental distress because there were no beds. And the stories just sort of mount. But I don't have a handle on what that means in terms of the total population, total youth population, with serious mental health issues. And so I think that would be instructive and might inform how we allocate and appropriate our resources.

And I think we're going to hear from our colleague at DHCS, who will talk about some of the infrastructure investments specifically related to children and youth, as well as the broader population.

Good, because it's certainly an interest of mine, that particular piece, in particular on infrastructure. Thank you, Madam Chair.

Thank you, Senator Rubio.

Thank you, Madam Chair. And thank you for the information. I read all the data, the statistics that you shared, and it's not really surprising, but you always hope that the numbers are lower. One that caught my eye in particular was that children in California with anxiety or depression rose 70% from 2016 to 2020. And like I said, you kind of know it's out there, but you keep hearing the data, and it's really just shocking to see. But I want to just focus on something else. I think my colleagues asked the questions that I wanted to address, but in particular, right now, I've created a Select Committee on School climate and student safety just because I was a teacher for 17 years, vice principal. And the issues we're dealing with right now, we've always somewhat dealt with them, but just the numbers are increasing as it pertains to bullying, as it pertains to just the Internet and what our children are doing in the Internet. And some of the cases that I've heard of depression coming from some of the bullying that's going on in the Internet and social media, and not only that, but suicide. And that's increasing. And so I wanted to see, and I think, Melissa, I don't know if you have any information on this in particular. If you can share. Is there anything specifically targeting the use of social media platforms? What's coming out of it? Information, data, statistics specifically to address that? Whoever wants to answer that, I would appreciate it. Thank you.

Thank you for your question. As part of our contract with the Childmind Institute, we're doing some work to look at the impacts of use of social media on children and youth. They've already done a significant amount of work in this area, but are working with parents and caregivers, as well as experts across the state to inform some strategies for how we might mitigate some of the harmful effects of social media. I think as we are also thinking about the digital behavioral health platform that we're launching as part of the Children in Youth Behavioral Health Initiative, it will provide an opportunity for young people to engage in healthy and productive relationships and interactions through an online portal. And I don't know my own kids as an example, but kids that we hear from across the street, kids these days see the world through their phones, unfortunately. And so building out some tools and resources through this effort to help mitigate some of the things that you're talking about by providing a tool that will give them positive information, educational resources, access to coaches and forums where youth can learn from and inspire each other is one way that we're addressing that. And then again, like I said, through all of the work that we are doing with the Child Mind Institute, with our school partners, through the CalHOPE program, we are building out a community of individuals in California who are really focused on social and emotional learning and support, including mitigating the impacts of social media, mitigating the impacts on social school climate. These are all things that we are intensely focused on in the work that we're doing through these various efforts.

I'm sorry, I was just going to share. You just said that you've done a lot of work in terms of gathering data. Do you mind sharing either with the chair and sending it to all of us or directly to me? I'd like to get deeper into the numbers and. I'm sorry, I think I interrupted you.

I was just going to add that. And yes, we're happy to share some more of the data that we track. I was just going to add that we've also been looking at some of the research about the importance of really focusing on positive mental health and how certain of those kinds of strategies are also an antidote to some of the negative impacts of technology or social media, and some of the research around things like a sense of purpose, whether that's through volunteer opportunities or a job, human connection, whether it's with peers or caring adults, whether that's through a mentorship program. Something Autumn and I have talked about, the literature is actually very clear right around sleep for all of us, but particularly for young people. And the connection between good sleep, hygiene and mental health is very profound. So how can we, we are also trying to think about through, I think of the work streams in the CYBHI as tools we have in our toolbox. What are some of the opportunities we have with some of those tools to also provide these sort of antidote pieces that also really help build the positive mental health and resilience of our young people. And that is something in all of our conversations and work with youth through different youth engagement partners in different sessions. They have really raised with us. They want us to focus on their well being as well as on their clinical mental health needs.

Thank you. And I just want to point out in particular that recently I heard something. There's so many school districts that are trying to deal with this issue in so many different ways, and I've heard so many of schools just in different areas, they've actually, to collectively, as a community, have decided that they were going to be a social media free zone. And parents have jumped on board and they all sort of help each other stay accountable where their children are only using their phones certain hours of the day, or they're capping it to one or two. I'm trying to think out loud in the sense that I've been dealing with students all my life. I mean, that's been my profession for years. And I go back to the time when we used to role play with students to show them what's appropriate behavior and what's not, how to treat each other and what's bullying, what's not. And I just cannot wrap my head around the fact that now we have to figure out how to teach that through the Internet. How do we specifically role play and show students how not to treat each other? It's just completely a different world. And in my mind, I was just considering pursuing maybe funding to incentivize some of these schools to continue to pursue that on their own, whether it's through a school district or individual schools just being an Internet free zone, at least during school hours. And parents have jumped on board to the point that even after hours, they only allow their students to use it for 1 hour. And all parents are held accountable. And I think that we also are creating a society where kids are not really knowing how to behave with one another because they're not seeing each other face to face, as opposed to some of us that are a little older, that we literally had to go knock on a door to talk to our neighbors. Right. But just thinking out loud, maybe at some point pursue some funding to incentivize school communities to join forces to minimize of it, because I think that just having our kids talk to each other really forcing the conversations, which I know it's so outdated the way I'm thinking, but being a teacher, I know what works, and that's that interaction face to face and knowing how to behave with one another. And I also think it leads to inadequate behavior in the workforce later on. How do you interview if you're not used to being in front of people, but just want to point out that those schools are doing some great work, the kids are learning how to focus just on social relationships versus the Internet. But thank you for that, and I appreciate, and I look forward to the data that you'll be providing so I can read. Thank you so much.

Thank you, Senator, and for your decades of experience. Senator Nguyen had one more question, and then we're going to go to Senator Menjivar.

Thank you. Thank you, Madam Chair. So I've been meeting a lot with my schools, and of course, with the budget deficit, funding issues have come in the forefront of all the, and one of the things that I heard many, many times now is that they're afraid that if there's any budget cuts, it's going to end up being the mental health side. And that one time funding they got during COVID or surrounding Covid, they have that staff in place and et cetera. And if funding starts getting cut, that's the first one to go. It might be addressed later by Children Now, but is there any ongoing efforts to help, or are you evaluating it, looking at making sure that we do this as a long goal. It's not just the problems today. We'll fix it today. And we think that's never going to happen again tomorrow. And so that's one. And then the other part is, as Autumn, you mentioned, the stakeholders that you're meeting with, do they include parents? Okay. Because as a mom who has two boys, one in elementary, one in middle school, I would like to be at those conversation. Right. I want to know what's provided by the school, what my children can consent to with or without me. I mean, a 10 year old and a 12 year old. And so those kind of things that I think we, as parents don't like surprises. We want to be informed. We want to know what is being engaged by these professionals in the schools and what are the opportunities for the children as well, because we definitely don't want to harm our children in any way. If they need the help, we want them there to get the help. But we also want to know.

Also, yes, engaging parents and caregivers and families is a part of our overall partner engagement process across all of the work of the CYBHI. And then we do have an ongoing engine of funding support. I'll let autumn talk about that. And part of the work of DHCs and DMHC.

Yeah. So thank you. And thank you for the question. I would also agree and echo that we have attempted in all of our stakeholder engagement efforts to be very intentional about including parents and caregivers. We also bring our own perspectives to that work. But, yes, echoing what Melissa said. We do see the all payer fee schedule that I spoke about earlier as a future forward, sustainable path to fund mental health and substance use disorder services at schools. The MediCal managed care plans and the commercial plans have obligations in their contracts with the state. So I'll speak to MediCal for a second. But from a MediCal perspective, behavioral health services are provided through the Medicaid program, which is an entitlement program and a sustainable source of funding. Commercial plans, obviously, are also under the Mental Health Parity and Addiction Equity act, required to provide mental health and substance use disorder treatment to their enrolled members as well. And so we do see and have heard similar concerns about one time funding efforts. And there are many of those within the CYBHI. There are the grant programs that are part of it, and that's why we're structuring the grants to help set up that infrastructure for future success. But there are permanent features of the children and youth behavioral health initiative as well, including the all payer fee schedule for school based services and reimbursement to the schools, as well as the digital behavioral health platform. As well.

Thank you very much. Wrangling them all together. Get them all together. Senator Menjivar.

Thank you so much, ma'am. Chair, two questions for me. Don't know who can answer this. Could you speak a little bit more about, I see that HCAI began developing training for youth in our justice system. I see that we have a workforce pipeline for the youth coming out, but I'm also seeing training for non clinicians within, if I read that correctly, within our juvenile halls. I'm not sure if this is the mental health first aid training, if this is what we're focusing on. Just love to hear a little bit more of what that training looks like.

Just going to my Deputy Director, my HCAI workforce Deputy Director is going to come up and help answer a little bit more. So, yes, one of the workforce funding streams is specifically focused on justice and system involved youth. And so, Karen, if you can just address a little bit more specifically what we're doing with that. Thank you. Senator Menjivar.

Welcome.

Thank you. Good afternoon. Caryn Rizel. Yes, this has been an important partnership that we're developing. And so we're doing two things. One, we're looking at how do we reach out to and encourage justice and system involved youth to be part of the behavioral health pipeline. So that's something that we're working towards. We're also working, we have an RFI out now, a request for information for organizations to help us develop that training to be able to work with, as we talked about, non clinicians to be able to better serve justice and system involved youth.

So it's still in the works. Nothing tangible yet.

No. We put out a request for information for potential partners to work with us on that.

Perfect. I'll definitely be following up on that. I appreciate it. And my second question is, you put together these stakeholder groups to learn more. You don't have to throw out any more stats, but particularly with our LGBTQ plus youth. And just like those stats have just gotten, it's just through the roof there. I don't know if you have a percentage, but what do your stakeholders and youth look like? Do we have predominantly women, girls, LGBTQ, black boys? What does that look like? Were we able to achieve a really diverse group?

Thank you for the question. I'll start, and then maybe my colleagues will want to add. I do think one of the strategies we used, and this actually came at the suggestion of some of our youth and family engagement partners, was some of this work we've done directly as state staff, talking with different of our partners and stakeholders, including youth and families. But some of it we've really done through trusted partner organizations, working at the local level and through that strategy, that is how we have really been able to engage a very diverse group of youth across all of the dimensions of identity and more that you are mentioning. So, because this is what some of the youth and family engagement partners told us, which is, Melissa, people are not going to really reveal to you what they are thinking and needing. And so we've really worked through partner organizations who are already trusted and working with youth of color, working with LGBTQ plus youth, working with youth across the state, rural youth, lots of different identities. So that's what we've done, is to partner to make sure that we are really getting a deep cross section of youth, including system involved youth, immigrant youth. And so that has been an intentional strategy as part of how we've engaged both youth and families.

I would echo that in the work that DHCS has done. We've also aimed to be very inclusive and have talked with a lot of folks across the state through partners and otherwise. We are also trying to be very intentional in the way that we're writing contracts for vendors in terms of expectations for the engagement that they are also required to do in doing this work to make sure that we're thinking through the needs of those populations and many more, as Melissa said, as part of the ongoing work. So not just the work that we are responsible for, but that our implementing partners are responsible for to make sure that we're very thoughtful about the needs of black boys, of Latinx populations, of non English speakers, of LGBTQ plus. And also, I spoke earlier about some of this work around the digital behavioral health platform in schools and how important it is to establish partnerships with trusted community partner organizations. And that's very much a part of the actual delivery model for the digital behavioral health platform as well as the school based services and all of the other work that we're doing. We've also made a concerted effort in selecting and scaling evidence based and community defined evidence practices to make sure that we are inclusive in the selection of practices to address the needs of those populations specifically. And it's kind of rooted in the strategy that we are implementing.

Chair, will you indulge me one more question here?

Go ahead.

Thank you. So I see one of the stakeholders were education stakeholders from early childhood. I don't see anything specific to the ECE world here, and I'm wondering, there's a section on asus, and I'm wondering in looking at the wellness coach model, if any pipeline can go into our care systems. Yeah.

You want to talk about ECE engagement?

I can talk a little bit, and then maybe Caryn, if you want to talk about, because HCAI has envisioned that over time, the wellness coach could be in an early care and learning setting. So appreciate that question, and Caryn may want to speak to that. I'll also note. Another, I think, important place where there's a focus on early care and learning settings is the trauma informed training for educators that the Office of the California Surgeon General is developing. That training has different modules, including a set of modules that are specific for our early care and learning providers to think about that work and also the acus and toxic stress campaign awareness that they're developing. They'll also be thinking about certain population groups as well. But that trauma informed training for educators does specifically include a focus on early care and learning settings.

Thank you. And thank you to our panelists very much. I think this may be the first time I've seen most of you in person. Okay, next we're going to hear from stakeholders. We're going to have Michelle Corbera, Executive Director, Behavioral Health Directors Association, Leandra Clark Harvey, Chief Executive Officer for the California Council of Community Behavioral Health Agencies, Adrian Sheldon, the Director of public policy and strategy for the California alliance of Children and Family, and leshon Francis, senior Director of behavioral health Children NOW. Welcome, all of you. I think we have you kicking to this off Ms. Cabrera.

Thank you.

Thing to work here. And I would say we would ask for the former panelists to hang around if you possibly can, in case we have more questions for you. Thank you.

Thank you so much and good afternoon, Madam Chair Members. Michelle Cabrera with the County Behavioral Health Directors Association. First, we want to thank and commend the Legislature and the Administration for your foresight in allocating one time funding to build out our behavioral health treatment capacity. As we know that demand for behavioral health services for young people and their families far exceeds what's out there. So what's out there? The perspective of county behavioral health is unique and informed by decades worth of partnerships with and in schools.

Prior to Cybhi, 85% of county behavioral health agencies already had some form of established school based services largely funded through MHSA and medical, so a combination of both insurance reimbursed and some of those more wellness oriented activities that are outside of insurance. When I asked our Members why they had invested so extensively already in school based services, they said that the answer was simple. We are looking for our kids.

Historically, our challenge with building and expanding school based services has come down to the fact that building partnerships requires investment and time. Schools often lacked the physical space to accommodate our services, and we had major funding gaps when it came to the delivery of what we call non specialty mental health under Medi Cal and to students with private insurance, which can be up to half or more of the student population, depending on the campus.

Calam has helped us to address some of the funding gaps for medi Cal students in that we can now build down and draw federal match for those who don't qualify for specialty services. But funding gaps for privately insured students remain our schools do not choose which students to serve based on their insurance status, and they didn't want us to for the most part, either.

However, schools do have legal and financial responsibility for educationally related mental health services or irms, so managing those lines of payment and legal responsibility across schools, public and private insurance has been part of the heavy lift of getting ourselves to where the kids are.

While Medi Cal managed care plans and private insurance plans may have had some payer responsibility to serve children and youth, their services tend to be much more medical model and so clinic or hospital based rather than out in the community, under Cybhi, our existing relationships to schools will be fundamentally altered. But we're concerned that unless we dedicate additional time to understand what we're dismantling and how we're putting it back together, it won't lead to the positive outcomes we're all hoping for.

First, while the fee schedule will bring Medi Cal managed care and private insurance dollars to the table in a meaningful way for the first time, it will also alter the county's relationship with schools from an on site, all in payer partner, excuse me, to a pass through payer.

And the fee schedule is designed today is considered by the state, as we heard, to be budget neutral, meaning that no new state funding are currently earmarked to pay for these expanded services, a policy magic trick that assumes that all the plans have an existing set aside for these kids that adds up to a whole. There are key differences, however, in how plans could offset new costs. Private plans will undoubtedly raise premiums. Medi Cal managed care plans will likely get their capitated rates adjusted.

Until recently, we knew relatively little about what services the state was considering for the fee schedule. We now know that they propose to focus county behavioral health payments on substance use disorder services, which are desperately needed. Our question, with no dedicated funding, is whether it is assumed that county behavioral health plans will make it work within existing resources. Funding for county behavioral health substance use disorder services overall is notoriously sparse.

As we have fewer dedicated funding sources for SUD services, we believe that the state has an obligation to pay counties for any new services above our existing networks. Without this, we'll need to cut other programs to pay for this new pass through payer responsibility, where we'll have little or no input on quality and from an oversight perspective.

Already with the investment of new funding into schools for school based mental health during the pandemic, we've seen a massive lift and shift of our children's behavioral health specialists out of county behavioral health to work for schools with higher pay and summers off. These labor market shifts have been compounded by new job opportunities for our kids specialists to work from home delivering app based telebehavioral health services. There are only so many humans who are today qualified to do this work.

Most of them already work with us or our contracted providers. Without an expansion of the workforce, we will simply double down on shifting our existing highly qualified workforce from one sector into another, where those specialized skills may not be maximized and leave holes in other parts of the safety net. These workforce and payer responsibility shifts are also essential considerations in the buildout of the proposed virtual services platform.

An essential function of the platform will be to provide children and families with primary and primary care with access to clinicians. But from our vantage point, we are concerned that without changing the pool of qualified professionals working at the top of their license in the places where kids are parents and kids will be left with the same frustrating conditions they face today. Only it will be a computer generated ghost list rather than the one they get over the phone today.

We need a workforce Reserve to preserve our progress, and this should be front loaded to stop the emptying out of our behavioral health safety net workforce. Our questions and concerns regarding cybhai initiatives are not just about how we'll pay for the services and who will perform the work. We have significant concerns based on decades of experience about program integrity and quality of care. Protecting students privacy around sud matters is not the same as it is for adults.

42 CFR is complicated enough, but when you add to the mix that students can be suspended or even face criminal charges for engaging in anything related to alcohol or drugs, the stakes around getting it right are much higher. Lea privacy FERPA is also a potential barrier as school districts are often not able to share information with us.

We urge the state to take the time necessary to make sure that it is not trying to address the crisis as we knew it three years ago so that we don't unintentionally create a new one. We thank you for the opportunity to speak to some of our concerns, and we look forward to continued engagement with you and the Administration on the important work underway and how we can reform our system to deliver the care that young people want and need.

Thank you very much. Dr. Clark Harvey.

Good afternoon. Chair Eggman and Members thank you for the opportunity to share feedback regarding CybHi on behalf of CBHA's Member agencies providing vital behavioral health services to diverse communities across our state. Our Members are mission focused to provide high quality behavioral health services to the lifespan. From programs supporting mothers and infants to older adults, outreach programs to homeless to residential treatment for adolescents, mobile crisis services, mental health first aid, as was named earlier. You name it, our Members do it all.

Our children, youth and family providers are hopeful about Cybhi and its promise for a more equitable ecosystem, and grateful for our governor's incredible and unprecedented investment in this behavioral health system of care. But with this much opportunity comes responsibility and a responsibility for all of the stakeholders to engage and ensure that CybhI is on track to meeting its mission.

This is especially so when we look at the statistics that tell us that one in five children live with a mental health diagnosis, and it's the chief ranking reason why children under seven years old are hospitalized. So it's no surprise to any of you here today, but the first issue that we want to talk about is the need of an adequate workforce in order to carry out the objectives of the cybhi.

We all know that we've been operating at a deficit for years and the pandemic only exacerbated our workforce shortage. Now, the Cybhi is ambitious and we look forward to learning about how the cybhi will plan to encourage more providers to enter the workforce in order to carry out the work that has to be done. Providers are also concerned about how school based services will be reimbursed.

Traditionally, providers have had difficulty providing services on school campuses because of administrative barriers around who can get reimbursed within these settings and requirements to obtain a PPS certificate and school counselors and personnel do a great job, but they are overburdened and typically do not provide services outside of the school hours or during the summer break. Whatever flexibility cybhi can promise around payment structures for providers within schools and incentivizing schools to contract with providers in the community is absolutely critical, especially via the school linked services.

Additionally, the process for providing services should be constructed in a fashion that does not create administrative burden. For example, in the current systems that our providers operate in, they spend too much time completing paperwork versus seeing clients. And with this opportunity to shape Cybhi, we should avoid replicating this existing issue.

Now CBHA is proud to have participated on the evidencebased practice work group for cybhI. Over 40% of our Member agencies are BIPOC led and serving organizations, so the conversations related to ensuring not just evidence space, but community defined and culturally specific practices are invested in was an important one to contribute to. And we encourage flexibility in how we conceptualize evidence because the lived, cultural specific experience of so many Californians who utilize services is just as important as the research that academics do on University campuses.

We also appreciate the recent Cal HHS publication that acknowledges youth from Low income and marginalized communities face greater needs and higher barriers to accessible and responsive support. So our Members are doing God's work, as I call it, many operating on a shoestring budget and working to diversify funding to provide critically needed services. And Cybhi can be an answer to their plight. We look forward to continued work with the Administration as it is implemented. Thank you for the opportunity to reflect the sentiment of our Members.

Thank you very much, Ms. Shilton.

Thank you Senator Eggman and honorable Members of the Senate Health Committee. I'm Adrienne Shelton. I'm with the California alliance of Child and Family Services. We are a statewide Association of a 160 nationally accredited nonprofit organizations serving kids and youth and families in the safety net in all of the 58 counties, our Members are the school and county contracted providers of behavioral health services for vulnerable youth in our state's medical program and their families. Thank you so much for including us in this important hearing today.

The administration's new investments in children and youth behavioral health couldn't come at a more critical time. We can't say this enough, our youth are in crisis. I wanted to give a couple of examples about what our Members work looks like in the field. So children come into our Members program often having experienced profound physical and emotional abuse. Stabilizing these kids that are in crisis, working to rebuild their trust with the goal of reunification, is a profound responsibility, intensely emotional work, and requires specialized training as well.

Youth may be referred into our Members programs through schools, and our Members then provide essential support services that support the kids emotional health, which is critical to academic health. And then also our Members are providers of mental health care for youth covered by all systems of care. So public medical, managed care, private insurance, and also school districts. So again, our focus, though, is on youth, primarily from underserved groups and youth with the greatest needs.

So the administration's focus on children and youth behavioral health is exactly the right approach, considering that 50% of all lifetime mental illness begins by age 14 and 75% by the age of 24. So this early intervention can make a lifetime of difference. And so from our standpoint as frontline providers, the children youth Behavioral Health Initiative offers several important opportunities to transform care for our most vulnerable youth. So I wanted to name a couple of those.

First, and this has been talked about today, but can't emphasize this enough, expanding and diversifying our behavioral health workforce. So the grants that are going to be provided by HKI specifically for community based organizations are really important, and these grants are going to support the recruitment and retention efforts of community based organizations. And Director Lansberg had mentioned this program specifically. And then second, I wanted to mention the BCHIP program.

So the BCHIP initiative grants, this is the infrastructure grants are going to provide a literal lifeline for youth and families that are facing behavioral health crises. And several of the California alliance Members were awarded funding to develop and strengthen our children's crisis residential children's crisis stabilization services. At the time when we're hearing from, to your point, Senator Roth from the California Children's hospitals, that they're simply overwhelmed by the number of crises among our youth and safe places and the appropriate places for youth to stabilize.

And on the next panel, you're going to hear from one of our California alliance Members, San Diego Center for Children about how they are deploying the beachhip grant, and even more maybe importantly, how it's connected to the broader continuum of care efforts that they're making, that we are trying to strengthen as an Association as well. And so, again, these investments come at a time when children and youth and families and the communities that are serving them are really at a breaking point.

And so we are looking forward to working with the Administration, the Legislature to build out these programs and more that are really desperately needed in our state.

And then at the same time, we also think it's important for the Committee to understand that while we sort of expand the limits of our system from, on one hand, the far reaches of early prevention to, at the other end, to serve youth with the most acute needs, we also need to focus on the entire continuum and save that, the core of our continuum, from collapse.

So from the standpoint of our Members that are doing this life saving work in community, the challenges are literally growing by the day. And at the core of these challenges, we would say, is the outdated and burdensome reimbursement rate structure that we have in California. So the community based organizations are often caught between the Low payment rates in contracts and then, for example, surging housing prices and other costs that make recruiting and retaining staff extremely difficult for the nonprofits.

So while we are appreciative and support all of the investments made by HKI and this Administration, really any long term workforce plan must also address this issue. So we definitely wanted to put that out there. And then also, my colleague mentioned this, but we continue to have burdensome documentation requirements. So as long as providers are spending more time on paperwork than treating the kids, we're also going to continue to have a workforce crisis and a behavioral health crisis.

And so we are working to address this with a legislative proposal this year. We're also working with the Administration, we've worked with Senator Lamone in the past on a Bill related to this issue, but this must be addressed, and then also to achieve our state's goals of equity and responsiveness to the needs of our most marginalized communities.

California is going to be even more reliant on these community based organizations that are rooted in diverse, you know, the communities that our Members serve often, almost always lack transportation or have a good reason to mistrust institutions. So our Members succeed by going to the streets, going into homes, going into schools, going into the most rural, underserved parts of the counties, Riverside counties, some of the most rural parts of the state. And so any payment model that sort of takes.

This one size all approach, which is a clinic based model of care, is going to drive these unique and culturally responsive cbos out of business. And worse, the outcomes are going to reflect that. And so all of this to say is that if we don't get payment reform right under Calim and effectively address the workforce crisis that we are experiencing, all of these investments that are welcome and needed are essentially putting more rooms on a house with a crumbling foundation.

And so I really want to thank the Committee for this Critical and important hearing today. I know individually you were all working on legislative proposals to address the behavioral health crisis, and so we're grateful for your leadership. And so please consider the alliance and the frontline service providers, 160 of them and nearly every part of the state, as resources to you as we are trying to problem solve and address the difficult challenges facing our state's children and youth. Thank you.

Thank you. And I got out to visit a couple of programs during a break and really doing God's work. Next, we have Lishaun Francis with behavioral health Children Now. And thank you for the very nice report you made for us, too.

I'm really glad that you got a chance to take a look at it. Thank you. Madam Chair and Members, my name is Lishaun Francis. I'm with Children Now. We are a statewide research, policy and advocacy organization focused on the whole child. Our goal is just to sound the alarm of how kids are doing in our state and on issues of mental health and addiction. You know, the reason why we're here is not well.

In 2021, several of the organizations at this table and Children Now wrote a letter to the Governor asking for him to declare a State of emergency for California's youth. The reasons for this were clear. In 2020, almost every other age group suicidality rate went down, with the exception of 10 to 18 year olds. Black youth in particular, experienced an increase in suicidality that doubled from 2014. The deaths of young people between the ages of 15 and 24 due to overdose, tripled from 2015 to 2020.

Our organizations knew that in order to make headway, we needed to tackle this problem with the same urgency we tackled the Covid-19 pandemic. We essentially needed policymakers and stakeholders to literally huddle and explore which rules, which regulations should be suspended in the short term to address the hospital bed crisis, the workforce crisis, and any other structural issues many of my colleagues brought up today and then explore the resources needed to address those issues.

I bring this up because a declaration was not declared that we were in a mental health crisis and we still have those same issues. While we're here today to talk about Cybhi, I really want to stress that the results from CybhI won't be seen for quite some time. This is a long term strategy. Children Now is very invested in making sure that this program goes well. We believe in its principles and we believe in its goals.

As a reminder, the Administration stated the intent of the initiative was to be cross sectional payer agnostic, include the zero to 26 age range, address substance abuse disorders, and be a program steeped in equity. We agree with these tenants. Unfortunately, to date, we aren't sure the Administration will be able to address the principles it set for itself on the issue of cross sectionality. Someone mentioned it earlier.

We're hearing from school administrations, we're hearing from schools because of the impact cybhi will have on schools, which makes sense given how much time young people spend in school. And we know how important it is for schools to have counselors, nurses, caring adults on campus, et cetera. But we are hearing from school administrators that there are so many different funding streams right now that speaking to mental health, and it's unprecedented the amount of money Cybhi is not the only initiative. We have community schools.

We have the Mental Health Student Services act. We have the many different streams of cybhi. We also have federal dollars that we aren't even going to talk about. But the point is, there is a way to think about sustainability and making sure these dollars worked. If they had received technical assistance on braiding and blending this funding, which they did not. In addition, from the youth perspective, there are some foundational issues within the school setting.

So while education policy is out of the scope of Health Committee, it can literally derail any school behavioral health efforts. It tries to deploy. Confusion around minor consent, privacy and confidentiality, combined with the school climate that often works to punish instead of support, can discourage students from seeking help on campus. How comfortable are they talking about their issues with an adult on campus about, say, drug use if they fear that information can be relayed to a school resource officer? Bibach youth have been clear.

As long as there isn't clarity around how their information can be used and whether or not punitive practices on campus exist, they won't feel comfortable getting help at school. We talked a lot about including commercial insurance into the structure and fabric of school mental health services. It is about time that we do so. However, our biggest issue has always been about accountability when it comes to health plans. Historically, the state has not done a great job when it comes to holding health plans accountable.

So we would really like to see some accountability metrics built into how health plans are operating within the school system. Cybhi's intent is to focus on the zero to 26 age range. However, we've noticed very little focus on the bookend populations, and what we mean by that are both our zero to five populations and our transition age youth. Oftentimes when we actually examine the definition or our definitions of children and youth, we're really focused on school age children, which we know is important.

But infants and toddlers as well as our tape populations both have unique brain development stages, which means we need to invest in those programs that support where they are in their brain development. Cybhi has also stated its intent to address substance abuse. To date, the conversation around addiction has been light. This is really a missed opportunity. It's important that we remember that mental health disorders and addiction have a bidirectional relationship.

Young people are using because they're sad, and they're sad because they're using a comprehensive plan on youth addiction within the cybhi is needed. Finally, equity can't happen within a vacuum, and HHS isn't solely responsible for it. However, the most important part of the equity conversation is ensuring we are aligning our policy recommendations with that of the needs of marginalized communities. Simply stated, we need to be asking ourselves two questions. Who? Which specific marginalized groups asked for this policy?

And are those people being engaged early and often in the creation, design, and deployment of this policy? Equity is when we can answer yes to both of these questions. The good news is, I believe we can get this right. To that end, we implore the Legislature to think about the State of California as a regulator. Not just where will these dollars be spent, but do we have the right policies in place to support the goals of the initiative?

Where do we need to add, if anything, and sometimes what existing policies are actually harmful to our goals? Having clarity around what foundational changes need to be made will ensure our young people get the support they need. Happy to answer any questions.

Thank you all very much. I guess I would just start off with for all of you, just because billing and fee structure and documentation is a consistent theme. And as we heard from our state panelists, they're working on all this and they're having stakeholder groups and getting input. Do you feel like your input has been invited and welcomed and processed?

I would say that for both the alliance and CBHA, we've worked with partners in the Legislature as well as others through the state group that they created a work group documentation reform workgroup that they created a couple of years ago. And that was a great process. There were all types of people at the table, our county partners plans, and everyone contributing to what we would hope would be a set of standards that would be adopted, hopefully uniformly across counties.

And so the state did do some really good work. They did come up with some recommendations to streamline processes. The problem is, when we've pulled our Members recently, only one of 70 organizations that responded to a survey said that they've seen changes that are in the positive direction around documentation reform. And so we are still asking for more. That's why we're back before you all with legislation this year, joint legislation, to really discuss this issue further.

So I do want to credit the state with their efforts to bring together the stakeholders and have lots of conversation and make some early changes. But there's still work to be done for.

Thank you.

Just going to add that I think we feel that we're involved in every single workgroup of the state. I feel like our feedback is welcomed, is welcomed by the state and the departments involved in the CYBHI. And I would say even the vision within CalAIM as an example about documentation, I feel like we're aligned, and the vision and how it's rolling out is just not playing out how we thought, which was sort of less time on documenting. It's not happening in the field. While we are providing input, it's welcome. I feel like when the rubber hits the road, we're not quite aligned.

If I may just add, I think that there are actually two or three conversations in the mix here. So one is how do we Bill for MediCal specialty behavioral health services today under MediCal? How will we be billing for them tomorrow post payment reform? And then how will we be billing for school based services under the fee schedule when that eventually hits? And I agree with Adrian and Leandra that the state has been really great about engaging.

And I think part of what we feel some anxiety about is that there's talk of the fee schedule going live January 2024. And there are so many outstanding questions that cross over these massive, very intricate systems of payment documentation requirements and legal responsibility. And what we don't have a good sense for right now is that we're on track to meet that January 2024 goal. And we know that there's a lot of intensity and pressure around needing to get something to kids fast.

But there are unintended consequences if we move the wrong way. And we're trying to signal that we're sitting on top of a very precarious moment to begin with from a systems perspective, and that when we look out on the horizon, we don't see that there's like a reservoir of great children's specialists just waiting to jump into these roles.

So we're saying, let's make sure that how we design documentation requirements, for example, under the fee schedule, make sense and align, and that if we allow for certain administrative barriers to be removed when it comes to the delivery of MediCal services on school campuses, well, we should be removing those documentation burdens outside of schools, too, so that providers and health plans can deliver services without that burden elsewhere. And we don't unduly privilege school based services, which are wonderful, but just one slice of the broader continuum.

Okay, thank you very much. My other colleagues have any questions at this point. Okay. We really thank you for. Oh, yes, Senator Limon, thank you.

And I appreciate the conversation. And certainly this has been a conversation that's been happening for years. And I think our chair really also highlighted some of the pieces in regards to documentation and certainly was a multi year effort in terms of the Bill that did not make it out, in part because we heard from our state agencies that they were actively working to think about how it was going to.

I think our state agencies believe that they were in or are in the process of making those changes. And listening very closely to you, I think from my perspective as a Legislator, certainly we think about a lot of issues.

And after a period of time, you start to hear themes and repetitions, and that's when I think red flags are raised, and not because there's ill intention, but just because it's like, look, it's been four or five years, and so I really appreciate the last comments about our roles in thinking about what foundations work and which ones maybe limit us. And I do just want to highlight that this piece, in terms of the process, the documentation, the payment, is still very real.

And while there is a lot of effort being put in to resolve it, the truth is I'm not convinced it's resolved for 58 counties. Perhaps we have some best practices in some places, but we are still a 58 county state. And so I want to just thank you for being at the table, to thank our state agencies for having you at the table, but also recognize that we're not there yet. And so if it's not a piece of legislation that's going to move it forward.

Certainly we're looking at intent and interest, but I don't think a piece of legislation is out of the realm of possibility. I mean, I ask myself, how many years do we wait and how many more individuals and youth don't get seen? Because how do we go to our constituents and say, well, there was some county paperwork issue. Right. And not to blame the county, but there was some paperwork issue. And that is the reason that is so hard to sit on.

And so it's also not easy to solve. So I will say that had it been easy to solve, we would have already solved it. But at least on that piece, and that was a very specific piece that I've worked on, on a multi year effort. And I'm not sure we've been as successful as we want, but I want to thank everybody for being on board. And just think your final comments in terms of what's needed in the foundations to make it work.

Senator, if I may. I'll just note one thing, which is that right now, today, in March 2023, we are still required to document services to the minute in specialty behavioral health, which is a very unusual requirement, an outlier in healthcare, broadly writ. Once we make the payment reform transition, that documentation requirement goes away and so does the requirement to settle to costs for counties, which has a multi year reconciliation where we carry a significant amount of audit risk along with our providers.

So we share in that risk. I will say that we've also, as part of this work group process with DHCs, identified multiple places where there may be either accreditation bodies or even federal laws that conflict with the goals of CalAIM and still require additional documentation to be added in in certain places. And the state's been, I think, a really tremendous partner along with our provider associations.

I know the alliance has gone to some of the accreditation bodies to say we want change because we want to move the whole country in a direction where behavioral health is not, again, an outlier and being required to do things that other sectors are not, that don't serve the interests of the client. And so I think all of that is to say, yes, change has been slow. And part of that, I think, is because we are now identifying, aside from payment reform, there are some other things that still need to be addressed before we can fully get over the hump.

Thank you all very much. Thank you. And thanks for the work that you do every day. Thank you. Our next panel coming up is going to be more stakeholders focused on the Behavioral Health Continuum Infrastructure Program we're going to have Marlies Perez. Oh, I'm sorry, Senator Rubio. Okay, I'm sorry. Chief of Community Service Division, Department of Healthcare Services.

Moises Baron, President and CEO of San Diego Center for Children. Phoebe Bell, Behavioral Health Director, Nevada County immediate past President, California Behavioral Health Director Association and an alum of my doctoral alum, Portland State, and Al Rowlett, President, California Council of Community Behavioral Health Agencies and Chief Executive Officer, Turning Point, who was a partner at Sac State. And I had his daughter in my class. Welcome all. Let's start with Marlies Perez.

There we go. Wonderful. Thank you. So I'm going to be speaking about the department's efforts, the Department of Healthcare Services around the Behavioral Health Continuum Infrastructure Program that I call BCHIP. And so, to date, DHCS has awarded a total of 1.1 billion through four rounds of BCHIP grant funding. Each round of grant funding is designed to target key gaps in the state's behavioral health facility infrastructure. So think about bricks and mortars.

All BCHIP resources ensure care can be provided in the least restrictive settings by creating a wide range of options and services and supports. Although we are pleased with the level of interest to participate in the program, we have been challenged with difficult decisions in funding awards. The statewide demands for Behavioral Health Continuum Infrastructure expansion, as described in DHCS's 2022 Behavioral Health Needs Assessment report, and as demonstrated by the volume of BCHIP grant requests, exceed the available funding authorized under BCHIP.

So now I just want to walk through some of the rounds and give you some updates. So in round one, DHCs awarded more than 163,000,000 to 49 county, city and tribal entities, which has directly supported 245 new or enhanced mobile crisis response teams throughout California. So this is infrastructure dollars and some service dollars that we had from the Federal Government. So as of December of 2022, there's a total of 161 teams that are delivering services.

The most common staffing models are one clinician and one peer, and also one clinician and one paraprofessional. Of the 28 grantees reporting, nine are delivering services which provide 24/7 care, while eight grantees provide 80 hours plus a week and 1140 to 8 hours, 40 to 80 hours. Referral sources for dispatched calls were predominantly from 911, behavioral health, homeless and other service providers.

Individuals aged 25 to 44 represent nearly 30% of the service population, and then nearly 60% of those receiving services since July of 2022 report being stably housed. At the time of service, 14% were unhoused or at risk of homelessness and 25% were unknown.

A total of 54,000 different service types were reported provided to individuals since April of 2022, and nearly 60% of those receiving services after dispatch since July of 22 were stabilized in the community, while 22% were put on a 5150 or 5585 hold. Those stabilized in the community include those receiving warm handoffs to behavioral health, medical and other community based services. So in round two, DHCs awarded $7 million to support 50 planning grants, consisting of 18 tribes and 32 counties in B Chip.

Round three, DHCs awarded 518,000,000 to 43 launch ready projects to build or expand behavioral health care facilities. Overall, this creates 36 new inpatient and residential facility sites that offer 1174 new behavioral health treatment beds and 40 outpatient facilities to offer 126,000 new annual behavioral health treatment slots.

In round four, DHCs awarded 480.5 million in grant funding to 54 projects focused on facilities that provide care for children and youth ages 25 and younger, including pregnant postpartum women and their children, transition age youth ages 18 to 25 and their families. These funds will support 29 new inpatient and residential facility sites to offer 498 new treatment beds and 48 outpatient facilities to offer over 74,000 new annual treatment slots.

So between round three and round four grant funding, it's going to support a total of 153 behavioral health facilities. And I'm going to run through this list really quick because I think it's important for you to see just the type of facilities and how diverse they are. I also just want to state while round four was focused on children and youth, we also funded other children youth facilities through round three, and we'll continue to do so with round 5 and 6.

So we've funded with this 1.1 billion 17 adult SUD residential, three that are specific to the transition age youth population seven perinatal SUD residential three adolescent SUD residential nine children's crisis residential programs known as CCRPs, which are currently not available in California. These will be brand new facilities for this licensing type. Eight acute psychiatric hospitals and four of these are for children.

One general acute care hospital three mental health rehabilitation centers two peer respites, five psychiatric health facilities four are dedicated for children two recovery residences four short-term residential therapeutic programs four social rehabilitation programs 11 community mental health outpatient clinics 17 community wellness and youth prevention centers 12 crisis stabilization units one hospital-based outpatient treatment detox facility five intensive outpatient, two narcotic treatment programs 12 office based outpatient eight SUD outpatient, 13 behavioral health integrated outpatient which are mental health and or SUD outpatient services integrated with community wellness and prevention centers, three partial hospitalization programs, two school-linked health centers, and two sobering centers.

This spring, DHCs will announce is that. All new construction, those are all new beds, or that's the continuation or the continued funding of some. So these are all new beds, whether it's new construction or a rehab of a current facility, but these are all new beds and new slots. This spring, DHCs will announce grant funding awards for round five, which will address significant crisis care gaps with consideration for funding priority to those that provide crisis services to individuals in need.

And then the 6th round of BCHIP funding focused on unmet needs is currently in the planning phase with an anticipated release in the fiscal year 202425 and fiscal year 2526 as proposed in the Governor's Budget. DHCs does not anticipate that the delays in round six will impact the goals of the cybhi and other efforts underway to expand the behavioral health continuum of care, including the California Behavioral health community based continuum demonstration.

The additional time will allow DHCs to analyze the gaps remaining after awarding the round five is complete, along with looking at the other rounds as well. Thank you.

Thank you very much. Next we'll hear from Moisés Barón, President CEO of San Diego Center for Children.

Good afternoon and thank you very much for the invitation to be here today as a provider. I wanted to reiterate that we are experiencing, we're seeing a triple crisis in pediatric mental health. On the one hand, we're seeing more youth being impacted. Something that also we need to point out is that the severity of the problems that we're seeing is increasing. And as you've been hearing time and time again, significant workforce shortages that are creating a problem with access to care.

To answer your question from earlier about numbers in San Diego, we conducted a very comprehensive study directed by the Board of Supervisors, and we found that in 11 occupations of mental health, behavioral health occupations, we had a shortage of 8000. That's just one county. So I think that when we started thinking about the state, that's an important area to be thinking about. We believe that early identification and intervention of mental health, behavioral health problems is key.

So all the efforts to try to do more in the schools, to do more in integrated care are important. However, once you identify this youth, you need to have in place a comprehensive continuum of services. And if I may call attention to the screen, although it looks kind of small for you, you need to have really a true continuum of services. And Senator Roth, you were speaking to that a few minutes ago.

You need to have prevention collaborative care outpatient, in home wraparound, you need to have also intensive clinical services. You need to have residential inpatient crisis stabilization. When we look at the different payers, what we see is that commercial insurance accounts for about 47% of youth in California, managed care medical, 50% plus, and the mental health plans, about 4.55%.

And when we look at especially managed care medical, we see that by design, today, there are structural problems, systemic problems, with many of the youth covered by managed care medical do not have access to the continuum of care, as you can see there, or you can barely see there. Some of these youth can access these services if they meet criteria for specialty mental health, but that can vary from county to county.

So one of the concerns that we have is, like, if we don't look at this and we make sure that communities have the full continuum of services, and we remove the barriers to access that exist, we may be able to identify many more that need the help, but again, they need to be provided the appropriate level of care to be able to address their concerns or their problems. There's also work that needs to be done to remove barriers to care.

So, for example, with regard to access to IOP and PHP, intensive outpatient and partial hospitalization for medical youth, there were a number of barriers that prevented that from happening. We at the San Diego Center for Children, in partnership with Rady Children's Hospital, developed a pilot program. We used philanthropy dollars to be able to show how an integrated program could be effective. And it worked.

And actually, we were able to use that data to advocate, in partnership with others, with the Department of Healthcare Services, to be able to make some changes to the regulations that would allow that to happen. So now it's in the hands of counties to be able to implement this. And likewise, you passed maybe 20317 to allow them now the creation of the PRTFs that you were referring to. But now we're awaiting those regulations to be able to happen.

So we need to be working at it from a number of different perspectives and in partnership to be able to ensure that we have these things in place. So at the San Diego Center for Children, we are the oldest nonprofit serving children in San Diego and providing a range of services, serving about 1000 individuals every day. And we are fortunate to have been one of the organizations that was able to receive two of the BICHOP grants.

And I want to bring you to our main campus in central San Diego to show you what we have done and what we're planning to do with those resources. We were primarily in our main campus. We have short term residential treatment beds. We have license 80 capacity for about 72. With the changes happening that have happened with Families First Prevention Services act, there was a cap of 16 otherwise would be considered to be an institutional mental disorder.

We also had a therapeutic on public school and a wraparound programs in our main facility. So what we have done is convert some of the sTRTP bits to group homes so that we can continue to serve commercial insurance and educational referrals. And we are using the bitch dollars to be able to create an IOP PHP hub.

So we're going to be the first provider in San Diego County and one of the first, maybe in the state that's going to be able to serve medical, youth, child welfare, youth and others covered by medical, providing these intensive clinical services that are much needed. With regard to the next phase, with the second grant that we received, we're planning to create one of the nonexistent today, PRTF psychiatric residential treatment facilities.

And we hope that it will be possible to be able to have the regulations in place so that we can then not only finish the construction, but be able to implement this. So we believe that having continuums of care are important so that we can provide the appropriate level of care to the youth. And to your question, Senator Rod we don't know today what percentage of youth experiencing problems need intensive health services or need inpatient. We don't have that data.

But we do know that we need the continuum so be able to identify exactly what the needs are and how to be able to develop it. So what we are working on is to really create a continuum, to be able to use the resources that you have made available. And we are very appreciative of that, to be able to give access to the youth, regardless of whether their insurance coverage is, which is something that we need to work or to the appropriate level of care.

And we're thankful for that. We're going to continue to work that. And hopefully this could serve as a model for other communities to be thinking about the continuum of care that we need to have in place to then be appropriately able to serve the youth that we identify in schools or in integrated practices. Thank you.

Where's your initial point of contact with kids?

We get referrals from all over. Some of them contact directly. Some of them are county contracts, some of them we are in many schools, families contact us. So there is many ways in which families come in contact with us.

Thank you very much. Next we'll hear from Director Phebe Bell.

Hi. Good afternoon, Madam Chair and Members. Thanks so much. My name is Phebe Bell. I'm the County Behavioral Health Director for Nevada County, past President of CBHDA and a proud social worker. It's an honor to be here today to represent my behavioral health colleagues in discussing the historic investments made by the Legislature and the state through the BCHIP program. BCHIP was designed to support the state's calam goals of pursuing an IMD demonstration waiver in order to expand outpatient access rather than just treatment in IMDs.

Around the same time, counties invested in a gaps analysis of inpatient beds and the needs throughout the state, and this study really underscored the importance of infrastructure investment as well.

The study, conducted by RAND, looked at the question of capacity through not only limited inpatient access, but, to my colleague's point, as a part of a continuum, along with the step-down capacity that's necessary to move people out of acute levels of care when their treatment is done, and mostly to ensure that people have access to the right level of care for the right amount of time.

And I know from our work in Nevada county that when our team has various treatment levels accessible from outpatient to intensive, outpatient to acute care, and then back down again, that we can deliver life changing recovery oriented services that significantly limit the number of clients who will need inpatient levels of care, including conservatorship. And in our county, we often do this in partnership with turning point and our friends there.

Throughout the state, counties were able to use the RAND analysis to inform what projects we most needed and where along the continuum, which has been super helpful, and the gaps are significant. At the time, RAND estimated that California was in need of 4800 acute and subacute beds and roughly 3000 community residential beds.

The RAND report also looked at regional variation and found that some of the most severe adult bed shortages were in the Central Valley and the superior region, which are also hampered by severe workforce shortages, as we've certainly heard a lot about. These are estimates only for the adult population, and as all of us are also aware, in the children's behavioral health world, the need for children's acute and residential capacity is even more dire.

Because county behavioral health reimbursement has historically been limited to cost, we've had to rely almost entirely on unique grant funding opportunities to support infrastructure investments, and we often braid our sources together creatively to make it work.

BCHIP has helped with that tremendously and to share some success stories from my county, we've been awarded funding in three different rounds of BChip a mobile crisis grant, a planning grant which we used to identify gaps in our county system of care and then round three funding for a shovel ready project last year. This one we're particularly excited about. It's for a wellness center focused on making behavioral health services more accessible to our community Members experiencing homelessness.

And in rural counties particularly, we find that finding appropriate facilities available to purchase that we can turn into a treatment facility, is really hard. And so when you have such a facility and a willing seller and a funding stream at the same moment, it's something to be celebrated and we're really excited about it. Overall, counties comprise just under a quarter of the grantees for the competitive rounds and received just under half of the dollars.

Our grants will expand capacity to treat children and youth with mental health and sud needs, as we've heard, and also to address the outpatient and more acute care needs of millions of primarily Low income Californians. While we're extremely grateful for this opportunity to make significant investments in our treatment capacity, we have learned a lot about this process to date and would love to offer some key points of consideration for the state moving forward.

First, and super importantly, the BCHIP funding is not building housing for our clients and should not be confused as a build out of housing infrastructure. Treatment and housing together can be powerful in our clients recovery, but they're different functions. BCHIP is about expanding treatment capacity, also important, but different.

Second, we need to consider the impact of a competitive grants process on a safety net system more broadly, but in particular for small and rural counties, which often lack the administrative capacity to take on writing grants and managing grants on top of our core duties. Nevada County is lucky because we're a big small county, but often a rural. Set aside is a way to handle that kind of inequity that's built into competitive processes.

But even larger counties have a hard time finding the staff capacity in this current workforce shortage to go through the process of applying for grants that painfully may not even come to be. In addition, long and difficult contracting processes and significant reporting requirements tied to the BCHIP have been real challenges that we can and should learn from moving forward, and many of the counties who are not awarded BCHIP funds have additional projects that were denied.

They're awaiting another opportunity to apply, and so we really very much hope that the round six funding is able to move forward quickly. Last point I'll raise is that beachf comes at a cost to county behavioral health agencies in the long run. Without an increased funding for services, counties will have to contract with all the grantees to some degree in order to ensure the 30 year medical commitment attached to the funding.

And in some cases we didn't know about these projects or didn't necessarily have them as part of our contracted providers. And so committing to that for the long haul is a new commitment for us. In closing, we urge the state to continue with its final round, six rounds, and to do it without delay, but with an eye towards streamlining and simplifying the grants process and reporting.

Ultimately, despite the hurdles, we continue to believe that BCHIP will lead to a meaningful expansion of treatment capacity at a time of significant need across all communities and levels of care, particularly places where county is partnering with our providers to make this historic change happen.

Thank you very much. Thank you for bringing the rural voice. Mr. Rowlett good afternoon.

Good afternoon Dr. Eggman and Health Committee Members. I'm Al Rowlett, President of the California Council of the Community Behavioral Health Agencies. I'm also a Commissioner with the Mental Health Services Act OAC. I would be remiss before starting without saying Dr. Eggman is still my daughter's favorite professor.

Extra points.

I was looking for those. I am pleased to be joined by the fellow panelists to discuss BCHIP and how agencies like the one I have run have experienced the application process and early implementation. As you all know, BCHIP was established to target and fix the various gaps in the state's behavioral health facility's infrastructure, and providers are grateful for the investment.

I'd be remiss if I didn't point out that oftentimes funding does not specifically call out CBOs as eligible applicants, but this was not the case for BCHIP and we're grateful. And while turning point, the agency that I've been privileged to have oversight for 40 years has not received BCHIP funding. I will reflect on the comments of those CBHA agencies that have. Several agencies shared that they have experienced the application as process as slightly cumbersome.

Others indicated that they did not feel the application was publicized well enough and that it was not targeted towards BIPOC serving or small CBOs who often require additional TA. Multiple agencies noted that only programs awarded in their county were large programs that did not serve diverse communities as cited by all the previous presenters. One agency reported that they had received the award notice before the holidays, but they have not received the scope of work and contract template for the round.

Another reflected a number of unexplained delays and again, understanding that but wanting to again advise and potentially assist in remedying that for the next round of applicants. Some reported issues with delays of their contracts which led to stop-work orders or two agencies having to temporarily stop their construction projects. Diversity of award populations one applicant noted that of the Shovel Ready and Kids Awards, only 20 to their understanding, were for children and youth programs and providers.

Some reflected success with consultants, while others noted challenges with communication and the lack of responsiveness and again, emphasizing the need to get consultants to assist with the process.

The example I will share is from an agency that after nine months of again, providing documentation and emails around submission and resubmission, and multiple issues associated with portals, something that oftentimes CBOs are occasionally plagued with, that they received two statements of work for work just days ago and were provided only 10 business days to respond and asked to make revisions during that 10 business day period.

Again, they noted that with the assistance again of consultants and others, they were able to respond, but had not had that, it would have created some unique challenges for them. There are successes and I want to note that one round three BCHIP recipient praised the ease and support of the program. They are in the final stages of a two year construction project, are finally able to break ground due in part to the program's funding.

Another agency praised BCHIP for helping them level the playing field and allow organizations to create physical, brick and mortar anchors in their community. In closing, the vision of CBHA is that the people of California deserve a comprehensive community behavioral health system that is adequately funded, as my colleague just said, and serve those in need.

And though the process is not perfect, the fact that DHCS can acknowledge that there is gaps in California's behavioral health system and create a program like BCHIP to rectify them gives all of us hope that our members will continue to be a voice for the voiceless and help countless people to a road, a recovery, and mental health wellness.

Thank you, thank you and thank you all very much. So just kind of summing what you all said, it's good, but it could be better and so much money. It makes things very difficult and complicated. Ms. Burtz, can you respond to people having trouble with the application for the funding and then again the braiding of services that needs to take place in order for things to be used to their full effectiveness?

Definitely. So with our round three funding, with the launch ready, we definitely had some. It was our first putting out of the RFA through a specialized portal. We were using some real estate experts. It really didn't--and to everyone's point--there were some bumps. Some of them were plot holes. So much so that we changed the platform to make it more streamlined and easier. And we did find that in the further rounds.

And I'll admit we're learning along the way, this is very fast money. With round three, all of it has to be expended by June of 2026, and then with the other rounds by June of 2027. And to be able to get permits to build in this day and age, with all the issues of the economy and not being able to have the supplies.

There has been some pushing on some of this to we don't want to lose a cent of this and we really want to ensure that once the grantees are awarded, they can start construction, they can bill back to their award date. I just recently heard there's some confusion around that, so I'm going to take care of that when I get back to the office.

But we are, really, I think what you've heard, too, from some of the testimonies is, like I'd mentioned, for round three, we had $2 billion in requests. Same with round four and round five, or even more. So there are entities that aren't being able to be awarded, which can be frustrating in a grant process. We are going to be looking at everybody that's applied, all the gaps every time we make the awards. We look at where our current facilities, where are they physically located?

We have it mapped out. What are all the disparities from the needs assessment, from the work done by CBHCA. We look at all of that and compile it. What populations are they serving? I am a little surprised about the round four not serving kids. All of those facilities are licensed and or certified facilities for kids. So some of this is just challenging because it's moving so quickly and just a lot of information out there, and I hear a lot of myths all the time.

That is a part of a very fast process. So I do want to acknowledge that. I want to acknowledge the bumps, and I do also want to acknowledge the incredible partners we have had through the process, helping, informing us and letting us know when there's been an issue and just encourage that with the grantees and for the applicants that haven't been awarded.

And you've also heard people say they really hope the next round is not postponed. I guess you can just nod.

We have heard that, yes.

Okay. All right.

Just add one piece to that. I think both by the quantity of requests to the opportunity for the RFP, as well as by the studies that we were commissioning and that THCs was commissioning, the pent up demand for infrastructure investment is massive in the public behavioral health system, and it really is a reflection of that payment system, the cost-based reimbursement system, where there's no capacity to generate the revenue to do it yourself, and so there's significant deferred investment that has to be caught up with to be able to get to a place of meeting existing needs, let alone expanded demands.

Yeah, no, and I think Senator Roth and I have both been beating on that, but, yes, and thank you for pointing that out, Senator Roth.

Thank you, Madam Chair. Thank you for the presentation. I'm very concerned about funding and capacity and staffing, really, across the spectrum. Looks like we're making. It sounds like we're making progress as we move through that continuum. I spend time thinking about and being concerned about inpatient capacity, because not being a healthcare provider not being in your business in any way.

But I have served on hospital boards for many, many years, off and on, before I came up here, and I remember the conversations about folks in the emergency department and not being able to find beds. I mentioned earlier about the young people that anecdotally I've been told about over the last few months. I remember when I was on a hospital board years ago, and we took a patient in through the emergency department who attempted to, as I recall, commit suicide by drinking antifreeze.

They were able to stabilize the patient, severe mental situation, acute mental distress at that point in time. There were no beds in the county to transfer the patient to. The patient was placed in a room under the watch, the 24 hours watch that then was required. I assume it is today, in an upper floor. We had the patient in the hospital for at least a week, maybe more, maybe two weeks. Can't remember exactly.

But what I do remember is at one point in time, the patient was able to slide out of the room, hit the fire escape, and do the job that the antifreeze didn't do, all because there was not a bed in a licensed psychiatric facility to transfer the patient to, so the care and treatment could be started immediately and not whenever.

Now, the problem is, the solution to the capacity issue in the inpatient arena is hugely expensive, as you know, and I'm not sure that even when you have people like me talking about it all the time, an administration that's obviously responsive through this program and others, that we'll ever have enough money to lay enough capacity in the inpatient arena down on the ground to make a real difference. And I'm concerned about that.

So perhaps we need to incentivize the private, non-public sector, both the nonprofits and the profits, the profits particularly, to climb into this space and do something. I seem to recall that there's some 16 bid limitation on hospitals. Maybe we need, if we haven't already, we need to finish the job and pursue the waiver. Maybe we need to figure out how to increase Medi-Cal reimbursements in the mental health area to a level where at least a commercial operator could come close to breaking even.

And perhaps at that level, the commercial operator would then see, as one of my friends in the hospital business calls it, the opportunity loss or opportunity cost, and go for that, to add behavioral health beds, to move people out of the general acute care beds and out of the emergency department rapidly to treatment, even though it's just simply a break, even because of the loss of business in the other areas, those in the for profit industry who think like that.

But we need to do something to increase our inpatient capacity. State General Fund, when we have it, incentivized the commercial sector to add capacity that we don't pay for. They do, but they see the benefit of doing so to try to address this shortage, apparent shortage of inpatient beds across our system. So I'm going to continue to talk about it and continue to work on it. And I thank you all for working on all the aspects across the continuum and trying to solve our behavioral health crisis in this state. Thank you.

If I may just say something in regarding to that, I really appreciate you bringing that up. I think that one component that we can work on to be able to address the problem that you're referring to is not only the need for more inpatient beds, but also to provide options as to where these youth can go once they are ready to be released.

And that has been a serious problem as we are able to create more intensive clinical services, like intensive outpatient partial hospitalization, that now can be reimbursed by Medi-Cal thanks to the work that has been done. We need to have counties really understand that and be able to put that in place.

As an example, with the work that we did in San Diego, of the cohort of 45 youth that first started with the intensive outpatient, most of the Medi-Cal youth that we were able to Fund with philanthropy, we found that that cohort of 45 had had 60 hospitalizations in the previous year while being in the program, there were two.

So we know that there are effective services that we can put in place in the continuum, and we can fund and make sure that the regulations allow for that to happen, like intensive outpatient partial hospitalization will be helpful. Another piece of the puzzle of the equation that we have really close to be able to implement is psychiatric residential treatment facilities. So you passed the bill last year, has been signed.

We need to make sure that the Department of Healthcare Services puts the regulation in place as quickly as possible, because we're getting some resources to build them. But we need the regulations to be ready so that we can create even more opportunities to treat these youth with severe challenges and difficulties and create opportunities for hospitals and emergency departments to have places where they can refer these kids so that they are not stuck for two weeks in a room without the appropriate care. So there are options that we can implement right now to be able to make that work.

Let me just ask, you said part time or partial hospitalization?

Yeah.

How does that work?

Partial hospitalization, intensive outpatient services will be three afternoons a week for 3 hours or so. And this is aimed for you that are being discharged frequently from the hospital to prevent them from going there, and that can last for several weeks, and they're very effective. Partial hospitalization will be 5 hours plus a day where the youth still goes home, but they're getting intensive treatment for 2, 3 weeks.

And then the PRTF, the psychiatric residential treatment facilities, which is a brand new category in the state for which we need those regulations that we were talking about, allow all youth, including Medi-Cal youth, to be 30 days plus receiving the appropriate level of care. So it's a step down from inpatient. So if we can put these things in place, we will have the continuum that we need to remove some of the pressure that inpatient units are being experiencing, especially emergency departments. So it's there. We just need to make it happen, and we need to implement and try to speed it up.

And integrate it.

Yes.

In Sacramento County, we've had the unique privilege of partnering with Sacramento County to operate a behavioral health urgent care clinic, and the same principles as with the healthcare urgent care clinic. That 24 hours, seven day a week clinic provides people with an opportunity, and it serves the entire age spectrum, to come into the clinic anytime that they might be experiencing a crisis in order to receive services.

And that includes psychiatry to ameliorate the crisis prior to perhaps being sent to an acute psychiatric health facility or placed in a facility where they would need long term care.

And what we understand about community-based interventions is that if we can ameliorate the dilemmas before they become such a crisis, that inpatient hospitalization is indicated, that oftentimes it is more cost effective and the individual receiving their services experiences them as more resiliency-based and recovery affirming versus, again, sometimes some of the unique stigma associated, especially for underserved and communities of color associated with going into an acute facility for a long period.

In Sacramento, are the transport services authorized to divert to you as opposed to an emergency department?

We accept individuals or citizens from Sacramento County from anyone. And so in your specifically answering your question, if a police officer brought a person to our clinic, we absolutely would see the person, triage the person, and make a determination regarding what would be appropriate level of care.

And more often than not, and the data would support this, that we are able to support the person with returning to a community based or their own resident in domicile to get ongoing support from a community based provider versus going into an inpatient facility.

I assume law enforcement can do that I'm just not sure EMS can do that. And that's why I was asking if your protocols in Sacramento County allow EMS to divert an obvious acute mental distress situation away from an emergency ED to you.

We have a relationship with the emergency departments, and yes, they not only do they divert, oftentimes they divert, and it's a fascinating conversation afterwards, but they do divert individuals to our mental health urgent care clinic.

Excellent. Thank you. Thank you, Madam Chair.

Turning point runs out, Mr. Rowlett?

Yes.

That's great.

In collaboration, and I would be remiss, Ryan Quist is here with Sacramento County.

Okay, thank you very much. Thank you to all our panelists, and we really appreciate the work you do every day. And to the point. Senator Roth and I, we talk a lot about beds, but we understand that improving the entire continuum of care will reduce the amount of beds that we'll need. Right now, we just have a crisis out of control. And so more people need to be in a facility than in the community.

Which is the optimum place for people to be treated is in their community by people who look like them, talk like them, and love them. So we thank you very much for your presentations today.

Thank you.

Okay, now is the time for public comments. So I would invite anybody in the room to come up to the mic right here to make a public comment. Seeing none, we can go to our phone lines. Do I frighten somebody? All right. Then, Moderator, go to that caller please. Welcome, caller.

Thank you. If you have public comment, you may press one and then zero. That is one and then zero. And we will go to line 57. Your line is open.

Madam Chair, Members of the Committee, I'm Toni Trigueiro on behalf of the California Teachers Association. My remarks are specific to the approximately $5 billion invested in the Children and Youth Behavioral Health Initiative and the $4 billion invested in Community Schools, both of which have been funded with one time dollars. Regarding the CYBHI and its programs that intersect or interact with LEAs, we suggest the expenditure timelines authorized in 2020 to 2022 be extended to later years so these programs guarantee sustainability criteria.

Regarding HCAI's workforce expansion, we request HCAI expand their workforce efforts to increase the number of behavioral health workers by including pupil services personnel who are credentialed school nurses, social workers, psychologists, and counselors with CTC issued credentials. HCAI, for example, currently funds scholarships, loan repayments, and grants for nurse anesthesists and psychiatric nurses, but not for school behavioral health workers. CTA continues to express concerns around the viability of wellness coaches 1 and 2, and the expectation they will be on school sides.

But without an answer to the key question, how are the positions sustained going forward without ongoing funding? We've also expressed apprehensions around the new behavioral health fee schedule, given the current difficulties LEAs experience in the local education Association Medi-Cal billing option, the LEA BOP. It's difficult to comprehend how LEAs will adjust to a second fee schedule in the current environment. One suggestion has been to pilot the fee schedule at existing and future community schools rather than rolling out statewide.

If community schools are able to spotlight difficulties, it would enhance the opportunity for participation for others. Sixty percent of our student population are Medi-Cal eligible, and we must do better in providing them both physical and behavioral health services. Without guaranteeing the sustainability for the LEA related initiative programs, including its intersection with community schools, we will have lost a once in a lifetime opportunity to provide ongoing physical and behavioral health services to our students. We look forward to working with the Committee on these critical issues. Thank you.

Thank you very much for your call. Any other callers on the line, Moderator?

We have no one else in queue at this time.

Okay. Why thank you very much. Okay. Well, we thank all the presenters today for your ongoing work and for your presentations today. It is greatly appreciated. And with that, this hearing is adjourned.