Assembly Select Committee on Youth Mental Health and Treatment Accessibility

Thank you everyone for joining. We're going to go ahead and get started. Thank you everyone for being with us. Good afternoon and welcome to this formal hearing of the California State Assembly Select Committee on Youth Mental Health and Treatment Access. Thank you all for joining us today, whether you're here in person or watching online.

I want to begin by thanking the North Inland livewell Center for hosting us today and by recognizing our panelists and community leaders, educators, youth advocates, county partners, organizational representatives and students who have taken time for their busy schedules to participate in this discussion.

I also want to express my deep appreciation to my staff, the Legislative Analyst's Office, and the Assembly Office of Policy and Research, whose preparation and coordination made today's hearing possible. Thank you also to my Assembly colleague, Assemblymember Laurie Davies.

I will offer my Assembly colleagues an opportunity to make opening remarks once I get through the housekeeping items and my remarks as for reviewing housekeeping items so that everyone knows how the hearing will proceed, we will hear from four panel segments today.

Panel 1, Panel 2A, Panel 2B, and Panel 3 each will have five to seven minutes for their remarks, and we ask that all comments be directed towards the Committee rather than to the audience. Following each panel's presentations, Committee Members will have the opportunity for questions and answers.

After all panelists conclude, we will open the floor for public comment. Public comment will last 30 minutes, with each speaker receiving up to two minutes, time permitting. If you would like to speak, please submit a comment card to our staff Members who will raise their hands in the back.

There they are back there, Tracy and Caleb, and you will be able to line up at the end of the panel sessions to put in your public comment. Today's hearing is being recorded, transcribed and televised, and all testimony becomes part of the public record.

To ensure that every voice can be heard clearly, we ask that the audience refrain from interruptions or loud reactions during testimony.

As chair of this Select Committee, I convene today's hearing because youth mental health in California is at a critical inflection point statewide and national data show that behavioral health needs among children and young people remain significantly elevated above pre pandemic levels.

According to the Legislative Analyst Office or the lao, the share of youth experience serious psychological distress rose from 19% in 2018 to nearly 30% in 2024. We also know that far too many young people reach crisis points before receiving help.

In 2023, youth ages 15 to 24 had the highest rate of emergency Department visits and hospitalizations related to self harm harm. Although those numbers have declined slightly from their pandemic peak, they remain well above pre pandemic levels. Even when young people are ready to seek help, they often cannot access it.

In 2023, more than half of California's children reported difficulty obtaining mental health treatment and only 29% received the level of care that they believe they needed. Additionally, these needs are not evenly distributed. Data show persistent and deeply concerning disparities, with historically underserved students continuing to face significant gaps in access to mental health support.

Workforce shortages remain one of the largest structural barriers. California currently faces a 30% shortfall in behavioral health providers trained to serve children and adolescents, a gap projected to grow to nearly 38% by 2033. Youth serving specialists, school based providers, and child and adolescent psychiatrists are in critically short supply across many counties in California.

While these challenges are significant, the state has also made historic investments to improve youth behavioral health.

Beginning in 2021, California initiated allocation of more than $4 billion for $4 billion over a five year period through the California and Youth Behavioral Health Initiative to ensure young people can access mental health and substance use support where, when, and in the way they need it most. That was the intention.

The state also invested nearly 1.4 billion across the last three fiscal years in school based mental health services and more than 700 youth wellness coaches were set certified in 2024 alone, helping expand the workforce in school and community settings.

These efforts represent meaningful progress, but significant implementation challenges remain, including uneven regional capacity, workforce constraints, and sustainability concerns for programs funded with one time dollars. Here in San Diego, county, the statewide trends are acutely felt. San Diego has one of the largest populations of youth with serious emotional disturbances in the state.

The LAO identifies San Diego, along with Los Angeles and Riverside, as having some of the highest numbers of youth experiencing significant behavioral health needs. The LAO also found that San Diego historically received fewer behavioral health infrastructure awards than its modeled need would suggest.

In other words, the scale of youth mental health needs in San Diego has not always been matched with proportional investments from the state. San Diego's size and diversity make it a unique case within California.

With more than half a million children and youth spread across urban, suburban and rural communities, the county must balance geographical, cultural, and linguistic factors that influence access to timely and appropriate behavioral health care.

These county specific challenges mirror statewide landscape, high and rising youth mental health needs, difficulty accessing care, and persistent workforce shortages that limit the availability of specialized services for children and adolescents.

This underscores the importance of today's hearing and the need for sustained investment, coordination, and policy attention to support youth mental health in both the San Diego region and across the state.

The structure of today's hearing is designed to build a comprehensive understanding of this issue from multiple critical perspectives from our system leaders to providers on the ground and most importantly, to the students themselves. Panel 1 Our opening panel will provide a system level view.

This panel will offer insight into how our county and school systems are implementing these state initiatives and confronting the daily realities of student needs. Panel 2, including 2A and 2b, will be the provider and community provider perspective.

This panel will offer on the ground perspective of service delivery and illuminate real world challenges in workforce capacity, treatment access and community engagement. And we will conclude with Panel three, the Lived Experience. Finally, and most critically, we will hear directly from middle and high school students from our local districts as well as one recent graduate.

Their testimony provides the essential, unified, the essential unfiltered view into navigating mental health challenges and attempting to access a system that all too often was not built with their needs in mind.

We are here today to better understand these realities from those on the front lines as we work towards policy, budget and administrative solutions that meet the needs of California's young people. This Committee is not here to simply listen.

We are here to act and we're here to learn from the lived experiences, elevate the realities of our youth and families, and shape solutions that strengthen access, prevention, coordination and care across California.

I want to welcome Assemblymember Laurie Davies, who's here with us, to the hearing and I now open the floor for you to make some opening remarks if you would like.

Good afternoon everyone. I appreciate it and I want to thank everyone that's here. Obviously we have incredible experts. You are working, you are living the information that we need. Our job right now is we are in the district and our job is to learn from you.

And when we go back in January, we start the budget and also we talk about legislation that will be going forward. And so it's really important because we get our legislation from you. You know what the concerns are, you know what the problems are and you're best at letting us know.

And our job is to hopefully fulfill that and move forward. And I can tell you I've had the opportunity to serve since 2020 up in the state and my district is both south Orange County and North San Diego. So I'm just grateful to the Assembly women here for partnering and bringing up such an important subject.

It's something I've dealt with when I was on City Council for eight years and did a lot with fentanyl, did a lot with parents that have lost their kids to suicide as well as drug overdose. And so I was up in Sacramento during COVID and obviously we really saw what was happening to our kids.

I was getting calls from my friends saying, I don't know what to do. The kids don't want to go back. They can't learn. They're staying in their clothes all day long. There's no motivation. And I don't think people realize, you do, how much damage that had on them and their self esteem along with their social skills.

And so when we had $100 billion surplus in 2020, I was really disappointed. The fact that we got very little and we fought for that, saying if there was ever any time that we need this money to not only bring in more health care providers to bring more into the schools, it's now.

So I can tell you, very, very frustrated with that. And the other thing is, every year because of our budget now, as it stands, everyone comes up and it's a one time funding and that is not appropriate, not when you have issues like this. This isn't putting on a nice, you know, nonprofit program that is great.

But we're talking mental health, we're talking the lives of our teens.

And so you have to have the security of knowing that not only do you have a job, but how are you going to get people to want to get into this industry if you're waiting every year until June to find out if we've actually given you funding?

I mean, to me it's ridiculous and it's frustrating and I'm sorry for your hearing, but this is the way I just kind of say it as it is. But know that we are fighting for you. And so whatever we can do, we will be your strong audience, we will be your voice up there.

And I would love to have all of you come up there for a day so that we can do little advocacy with the other Members so they can understand, especially those that are on budget and health budget, so that we can really let them know this is important.

Thank you. Thank you for your comments. We will now move on to panel one. So we have today Nadia Pravara, Mara Madrigalwees, Christine Frias and Carol Ochoa. And we will start with Nadia.

Thank you. And I have.

Is it working?

Okay, there we go. And I have a couple of my colleagues too. So Dr. Laura Vlegels and then Yale Koenig from County Behavioral Health. So thank you all for having us here today. I so appreciate you two for saying that one time funding should not be used for services and treatment. It is, it is very true.

And we struggle on, on the daily to make it work, knowing that people need these things long term. And we're expected to sort of just figure it out after the funding runs out. So I really appreciate that. So you can go to the next slide.

So County Behavioral Health, just to level set, is responsible for providing specialty, specialty mental health and substance use care for people who are medi Cal eligible with serious mental illness or serious emotional disturbance.

And so there's sort of the large population of San Diego, there's the medi Cal population and we are the specialty provider for both children, adults, everybody of all ages. So there's a lot of change happening in this space, not only for other medical providers, but us.

If anybody's read the news or seen any of the things happening, there are many changes occurring simultaneously for us. So I'm just going to highlight a couple because they're really opportunities for us. But even though these are sort of coming around, we still need more opportunities. As the Assembly Members were speaking to.

So we implemented payment reform in 2023, which is not probably very exciting for many people, but for us it's very exciting. This changes the way we reimburse providers. And so it changes from sort of a line item budget where you kind of pick and choose every little dollar and you get reimbursed to a rate for each item.

Sorry. For each service. And it's going to allow both simplification for providers across our children and adult networks, but also it's going to be bringing more money into our network. So this allows us to reinvest to grow our services for children's programs as well as do things like incentive payments related to health care.

So it's really important for us to be able to grow our network to be able to meet the need and regionally distribute services across our county. Payment reform is going to be a big opportunity. We're already seeing some of the impacts and we are going to continue to grow.

The other thing is BH Connect, which is also a waiver. We opted in. Some counties aren't doing it. We opted in. It's going to be very big for us. So in June of this year, this allows us to again improve the care that we're providing.

We will be implementing new evidence based practices, but also on the reimbursement side. So as you can tell, I'm sort of always on the finance side thinking about how we can grow things. On the reimbursement side, it's going to allow us to receive reimbursement in several of our hospitals which could not prior to this receive reimbursement.

They were considered institutions of mental disease that had more than 16 beds. So we have many, many bed days in those hospitals and we could not, it was all county funded. This allows us to now receive reimbursement for us which is going to then free up money for us to reinvest into our system.

So really, really big deal for us. We're also with all these new opportunities, reinvesting, redesigning our services to make them reimbursable.

So there's a lot of new opportunity where, you know, it could have been county funded or MHSA funded where we're redesigning services to align them with medi Cal reimbursable services and we then are able to then sustain them and then grow our system.

So on the other side, in terms of the one time funds, our county has been awarded a lot of funding recently for related to like the bond infrastructure grant, funding to grow community, community based care, things like that within children's services. Specifically we were awarded funding to.

We are going to be building the first children's crisis residential facility around in the Kearney Mesa area where Polinski is. So within an empty site in there, 16 bed facility which is going to establish new children's crisis services for our continuum.

So we know it's a service that we need and I think as both of them were speaking, there's many children, children in crisis. So this will offer a new pathway for those children to come in and receive care and then get connected to longer term care.

We also, one of our local providers, local partners, was awarded $20 million to build a psychiatric residential treatment facility up here in North County in San Marcos.

And so we'll be partnering with them as they move along on that facility to partner with them to again have another location, a new service for us where children have better access to care. One other thing that they both highlighted is the mental health workforce needs.

So in 2022 there was this report that came out that we participated in noting that San Diego County needs about 17,000 new behavioral health workers. Which is like mind blown. You think about how many is that? Like twice as many as we currently have.

So one of the things we are doing is investing in recruiting, retaining and advancing, sort of allowing folks to move up the ladder, if you will, within the mental health system. So $15 million a year has been allocated.

We are working with the Policy and Innovation center, who's the administrator and then a lot of the local universities, community college districts and other CBOs where folks can, can. There's a range of things.

So it could be from apprenticeships for peer support workers or substance use counselors, all the way up to, you know, training for psychiatry, getting your clinical hours, stipends for folks who need hours where they're not going to get compensated. Like who can work for free in San Diego? Nobody can.

So we are going to come in and fill the gap for those folks. And in fact, it launched in September, the first cohort. And many of the students that are participating couldn't believe that there are not many strings attached to it. It's really meant to complement any other sort of resources that they might get.

And then in turn, they either pay back their loan or their loans are forgiven through working for one of our local CBOs for five years. So it's a really nice partnership where we grow our network, but also gives opportunity. Next slide forward. So this is, I think, on everybody's mind right now, the Behavioral Health Services Act.

This is a huge, as I was speaking to policy changes. So it does. It will start July 1st. It's going to shift prevention funds. Many of our children's programs right now are funded through prevention funds. It's going to shift the funding to the State of California Department of Public Health. So it means it's eliminated locally.

So we're walking through that process right now, which has been very challenging with our CBOs. It's probably the least favorite part of the work that we do is having to really look at what sort of meets specialty care and what's eligible for BHSA and what is not any longer.

We are also in the midst of the community program planning. This is gathering community input, feedback through different engagement opportunities to inform our integrated plan. And with the focus on children's services, there's many different cohorts of folks that we will need to focus on. So we invite you all to participate in that process as well.

And then, as you can see, the integrated plan is going to be due as a draft in March and then due in June, the final one. And then lastly, I'd like to highlight before I hand it off to Yale, we're developing an optimal care pathways model.

And so we've done two models of this previously for mental health and substance use. This is really meant to develop a framework for our children's system where we all partner together. What are the capacity of services we need, what are obtainable sort of levels of service that we can actually achieve through reimbursement.

And it really is going to allow us a frame framework to help give us concrete goals over the next five years to work towards and be able to sustain financially. So I'll hand it off to Yale right now. Go ahead.

Thank you so much, Nadia. So we're very focused on the need, but I just want to briefly start with some information from the CDC where they offer indicators of positive mental health for kids. And they really call out with data on how kids are flourishing.

So for example, for young kids, they talk about how smiling and laughter are indicators, how connecting and showing affection to a caregiver is something that we see in most of our kids. How when they are faced with frustrating moments, they're able to recover and move forward. For older kids, they're curious, they're interested in learning.

When they're challenged, they're also able to calmly move through that challenge again. So many positive indicators that are also taking place for our kids. And when they do face adversities, they also show a lot of resilience, which is so important because it's those protective factors that helps them move forward in life.

They help all of us move forward in life. The CDC also of course offers rates around anxiety, depression, suicide, ideation and thoughts, which is of course something that we've all become so much more aware of since the pandemic in California.

There is the California Healthy Kids data, the CHICKS data, and the CHICKS data is really looking at our local students for us and showing us that there are still rates of feeling hopeless and persistent sadness, isolation, suicidal thoughts. But we're starting to see some trending down in that data, which is really encouraging and hopeful.

There was mention around access to care and it is absolutely something that we are aware of and needing to address together. Access to care can take on different forms. Sometimes it's about not having funding for services, and sometimes it's about not having the workforce to do the work.

Even when the funding is there are kids in General and the generation is comfortable with mental health. Typically they know the language, they know how to ask for help. But there's still stigma and people are still facing and needing to address stigma. And it does prevent some people from gaining access to services.

Sometimes access is impacted because people don't know where to go or what to ask for, what to get. And as again was mentioned, not everybody is impacted about access equally. There are communities that face additional barriers and there are subgroups within our communities that struggle with access even more.

I think Nadia mentioned the county behavioral health target population for kids. Mental health is being the specialty mental health provider. So the kids that have Medi Cal, we are responsible to provide their services. Kids with Medi Cal that have mild or moderate needs can access those services through through their managed care plan.

And there's four of those in San Diego. So it's not an easy landscape. The county is also the safety net. So we are also there to provide services for those who are unfunded or underinsured. And that's certainly important for us to attend to.

And the landscape is complicated and there is so much that is available, but needing to navigate all of it is difficult even when you're in it and helping families navigate through it.

One of the things that again was mentioned is the Children Youth Behavioral Health Initiative or cybhi and that is something that is relatively new to the landscape. It's about four years in, but it is a tremendous influx of resources and funding that has been made available for kids and families in California.

So for example, under that umbrella there are digital platforms like Saluna and Bright Life for Kids, which are apps directly available for kids to use to support their mental health. There's also various campaigns that were launched under the umbrella of cybhi like It's Never a Bother, which is focused on suicide prevention and workforce.

There's so many different ways in which CYBHI is addressing short term and long term strategies strategies. And there is the fee schedule. This is the school based fee schedule where school districts that opt in are able to, with considerable investment in work able to directly provide mild and moderate mental health services to all students.

So regardless of payer. So again, the landscape is always shifting and we all always have to be working together and know what's happening over here so we can adjust over here as well. So let's take a minute and dive in into the county behavioral health continuum of care.

We have roughly 350,000 kids with Medi Cal in San Diego. And again, we are the specialty mental health provider for those kids. We have roughly 100 contracts that we Fund to do this work.

So community based organizations that we partner with and they are the ones that serve roughly 12,000 kids annually, providing them with specialty mental health services. So on the one end of the continuum we do a lot of population health work. So for example, the county has the it's up to Us campaign.

This is a media campaign that is local and is really about creating awareness around mental health. We also have the. Suicide Prevention Council where we bring together leaders throughout the county and collectively we work towards zero suicides moving down the continuum.

We have early intervention services, things like Friday Night Live and Club Life where we focus with students on school campuses to really build their leadership skills and again going towards building that resiliency and protective factors. Outpatient clinics. We have clinics throughout the county with so many access points for families to come in.

And there they would meet with a multidisciplinary team of Clinicians that can offer individual family group work. Psychiatrists that when medications are needed, that can be offered. Case manager, peer support specialist. All of that can happen in an outpatient outpatient clinic. We also have school based programs.

There's about 25 contractors that deploy Clinicians to about 400 of the schools in San Diego. And those Clinicians are able to work one on one or in group setting with students on those campuses. It's about half of the campuses in San Diego. We also have sports specialty programs.

So for example, we know that in our community there are kids who've been commercially sexually exploited. We have programs that are specifically focused on being able to support those children. We have intensive services. This is one of our newest level of care. Intensive outpatient and partial hospitalization.

For many years that was available in the community for commercial insurance, but Medi Cal system was not able to offer it. We've recently, due to some changes at the state level, have been able to stand up an IOP and a PHP with community based organization. We also have our residential treatment.

You may have heard of strtps or short term residential therapeutic programs where we're able to care for children. And we have an array of crisis services. We have crisis stabilization units. We have pert where a clinician and a law enforcement officer can deploy to the community when there is a psychiatric crisis.

And more recently the NCRT or Mobile Crisis Response Team. And in the PATH year, in partnerships with county office of Ed and school districts, we've been able to actually launch a component of MCRT that's focused on deploying support on school campuses for those students that are experiencing a crisis.

And then all the way up to acute care services. We are very fortunate in San Diego. We actually are very rich Wood resources. We can always do more. There's always need for new levels of care. Things are always changing.

But there are three local psychiatric hospitals that we partner with to ensure that kids get the care that they need. And with that I'd love to turn it over to Dr. Vlegels.

I do need to remark that we are running significantly over time for our panel. So. So please keep your. It was supposed to be five minutes per panelist. So I just wanna make sure we keep on our time.

Thank you, Dr. Patel. I am going to pass it off to our next panelist. I came prepared today with three clinical vignettes. I am more than happy to share kids stories with you, either if we have additional time or if guests here want to connect with me afterwards. But I'll pass it, I think, to Mara. Next.

Thank you. Could we just queue up the slides, please? Please. Thank you so much.

Thank you. I appreciate that.

Yeah.

Thank you, Dr. Vlegels.

All right, I'm just going to go ahead and go through. I'll skip around. There's additional slides for more information, so just feel free to review those. I am going to highlight the cybhi, a couple of programs through CYBHI just to really highlight what's going on in San Diego. County.

And the two that I want to highlight are the capacity building grant and the multi payer fee schedule. And I want to start with just the acknowledgement that schools are not just places of learning, they are community hubs where children spend a third of their waking hours and where trusting relationships with adults and peers can form.

Which really makes schools places that are powerful and practical for early identification and support. Integrating mental health services on campus helps lower barriers like transportation, time and stigma. And more importantly, it promotes more equitable access for services, especially for those who might otherwise fall through the cracks.

And this is why for the San Diego County Office of Education, it was really important for us to lift this capacity building grant. Especially we put out invitations for all 43 of our schools, school districts and all of our charters across the county.

And very excited to note that there was a total of 173 eligible LEAs in our county for the capacity grant. And right off we had 87 who participated, which is one of the better rates across the state. So that really is just speaking to the level of trust that our LEAs have in wanting to partner on this.

It's not to say that we won't have more. We are currently looking at how we can engage our other LEAs to build their capacity in preparation for the multi payer schedule. And that's essentially what that capacity building grant was. It was to get them ready to be able to swiftly move over to the multi payer fee schedule.

So we're really excited. We are in the middle of this process now. And what this is going to allow us to do is the following. If I can switch slides, oops, I'm going backwards. Okay, so these are the options. This is a technical assistance that the San Diego County office offers.

But the fee schedule provides sustainable reimbursement for school linked behavioral health services. So there's no out of pocket cost for our families. It enhances behavioral health services and school hours for California students, for all students across California. And so it really does allow for students to receive care at school sites. So again, it goes to that thing.

Oftentimes some of the barriers where parents didn't have time to take their students go to a place of where they would receive services, but it's now happening at their school site. So so many different things that it really allows the access is just so more readily available on school sites.

Some of the services that are eligible for providers to be able to account for is psychoeducation, including classrooms wide social, emotional learning, screenings, assessments, treatment counseling, case management. And then the practitioners, it's licensed psychologists, marriage and family therapists, our PPs, school counselors, nurses, community health workers, physicians, nurse practitioners.

And now of course we've talked about this, it's been mentioned before, our certified wellness coaches. The real important message here is that what we tell our schools is that you're able to now Bill for services that you already do. It's not new. And this was the real important message because our schools were already tapped.

Our staff are tired going through the pandemic. Everything that brought on the needs that our students had, it also affects the staff. Our staff have children too. They're going through it as well. There's so much happening. And so to say here's one more thing. And we're saying it's not one more thing.

You're already doing this and now we can Bill for your time and your services. So it's really the messaging and we go slow to go, right? That's how we do this. And we walk them, you know, we really hold their hand through the way.

So while the state was having, you know, changing deadlines on us, reports are due here now, they're due next. I mean, it really was challenging, but we pushed back and we communicated very clearly. Your due dates for these reports are when schools are out. They're due in July. That's not going to happen.

So there's a lot of communication. We're really trying to integrate two very different systems with two very different languages. And so it's slow go, but it's going to start coming together. It's starting to come together. It's not going to start. It's starting to come together. And it's all because it's about students first.

And we keep that message going forward. We partner with county behavioral health all the time. We're constantly talking about how can we do this better. And so that really helps because we have a unified message not only here in San Diego, county, but that transfers up to the state. So that's just really important to know as well.

So other things that I wanted to share with you about this is keep going. I just need to read the sign. So. Not even raining still. The other thing is we also, what was really important is as we engaged Our districts was we provided sample crosswalks. So as a sample. And again, this is just an example.

So for things that they're already doing. So for example, a suicide risk screening, we looked at the reimbursable amounts that the state provided, and then we showed them. So these are dollar amounts for things, again, that you're already doing. Safety plans, parent information sharing. And this was just a sample so they could see your time.

This is what we start to be able to Bill for, again, for things already done. So we provided things like this, not just for suicide risk screening, but also for social emotional learning classes, what their time would look like and how much the reimbursement would be.

So as an example, again, average day of a PPS school counselor, assuming if they're doing an SEL presentation, this is the amount that they could get back. Suicide screening, individual counseling. And again, it was just a sample so that they could see, you know, yes, it's not more.

I mean, they're putting into platforms, but this, again, is additional dollars that could be bringing back. And what's phenomenal about this is that it could be used toward any programming that they want at their school site. So it could pay for a counselor's time? Yes, it could pay for another school member's time.

It could pay for peer programming. We've invested a lot of dollars in peer programming in our schools because one thing we do know, and it was mentioned before, that our students are very much invested in their own mental health and they want to do more peer programming.

They've often said to us, don't do it to us and for us, but really give us the information because we're talking to one another. And. And they are the future of the workforce. They're very much involved.

And they also say, I want people who look like me, who understand who I am, who, you know, really understand my life experiences. And so they are the future of our mental health force. And so more peer programming around mental health is so critically important. And these dollars could go towards funding more peer programming, which is phenomenal.

So these are some of the cohorts that we have going on now. These are cohorts. Cohorts within our county. So, as you can see, we started with two cohorts, which are different LEAs. Moving into the different cohorts that go. We. We had a slow go. Two in the beginning, then nine.

Our last cohort, which was five, we had 28 new LEAs coming on board. They just opened up cohort six. And we're hoping to see more than the 28. So we're really excited about this. There's a large, extensive cohort onboarding progress, so it's not easily done.

But the fact that we have more cohort, more LEAs coming on board with each cohort, again, is really excited. And I think it just speaks to the team that we have.

We have expert consultants, our SDCOE team, and then we have a strong vendor that has been working with us that really gets our LEAs comfortable with the process. So these are currently who's in our cohorts. And we have highlighted Santee and La Mesa, Spring Valley, because again, just like the process is long, so is the reimbursements.

But those are two of our districts that have been successfully reimbursed. Hopefully we'll see more coming along. So very excited about that. And then charters as well. So this is eligible for all districts and every single charter in our county. So we just wanted to highlight that we support our charters, of course, as well.

And this is across the state. We are seeing that the PPS staff Members who are most billing and most reimbursed are licensed clinical social workers, marriage family therapists and our pupil personnel counselors. And these are different categories that are most billed for. Just wanted to share that with you.

Treatment, and there's a whole many different treatment is defined a whole host of ways and then psychoeducation. So we wanted to share that. And this is across the state. So these are the reimbursed dollars that have been provided across the state so far. So hopefully we'll see that continuing to grow as we go. We stay tuned.

We will have a SDCOE webpage on CYBHI capacity grant and we will have. Oops, sorry. Well, we will have increase. There's an email dedicated just for questions around this that anybody can tap into and we will happily answer your questions. Thank you.

Thank you for that presentation. We can move on to Christine.

Good afternoon and thank you so much for allowing me to be part of this critical conversation. I am super privileged to be the Director of student services for the San Marcos Unified School District. Waiting for my slides. There it is.

All right, so again, Director of student services for the San Marcos Unified School District, where We serve over 18,000 students at 19 schools. My team oversees mental health crisis response, student supports and coordinated health services.

Like many districts, we've seen a dramatic increase in youth mental health since the pandemic, particularly anxiety, depression and significant spikes in suicidal and even homicidal ideation. Schools have become the front line for youth mental health intervention. SMUSD is in Cohort 5 for Cybhi.

As Mara said, we are already providing many of these services intended for reimbursement, but billing has not started. The biggest hurdle we face is the requirement to collect student insurance information. Many families fear government overreach, have privacy concerns or worry about immigration consequences.

Our challenge is that we are already delivering this care, but without insurance data there is no path to reimbursement. This creates a real sustainability issue. CYBHI has enormous potential, but families fears about sharing insurance information must be addressed through clear statewide messaging and supportive policies.

We're hearing from early cohorts that reimbursement is slow, difficult or in some cases not happening at all because without insurance information we simply cannot Bill. Without upfront support, districts bear the full cost of launching CYBHI infrastructure. The administrative burden of preparing for billing with documentation, training and compliance is significant.

Without stable funding, the mental health workforce we've built is at risk. We're incredibly proud of the student support team we have. We have 14 school social workers, 11 of them licensed clinical social workers, 36 school counselors, seven registered nurses. These professionals are the heart of our school district's mental health ecosystem.

Most of these positions are funded through soft or grant dependent sources. Every year many receive layoff notices because their funding is uncertain. The demand for mental health support is rising sharply and without more stable funding structures we cannot meet that need. The acuity of cases on our campuses has changed dramatically.

We're seeing more self harm, more eating disorders, more students presenting with suicidal or homicidal ideation and a dramatic rise in students experience experiencing anxiety and depression. Schools are now functioning as first responders for youth mental health and the needs are continuing to increase.

We rely on strong partnerships with the San Marcos Sheriff's Department, Rady's Children's, Behavioral Health, North County Lifeline, Palomar Health, just to name a few. And we also use the technology that flags concerning content that is typed on any of our district devices and it enables rapid intervention. Additionally, we receive anonymous data from our crisis text line.

One of the most impactful initiatives that we have had was a partnership we had with the City of San Marcos called the let's Face It Together Mental Health Campaign. It received national recognition for innovation and creativity and the goal was simple make mental health support visible, accessible and stigma free. Students could text SMUSD to 741741 for 24.

7 crisis support. We had wellness teams that conducted hundreds of consultations, home visits, referrals and linkages and students came forward who likely would not have before. Unfortunately, despite its success, we could not sustain the program in its entirety due to a lack in funding.

At Mission Hills High School we launched a state funded $1.5 million peer to peer mental health pilot through the Children's Partnership in California. DHCS students complete a formal peer counseling curriculum, then serve as trained, certified and even paid peer counselors working in a wellness center. The center provides a safe, stigma free space.

Peer counselors support students throughout the day and refer immediately to adults when risk is identified. This model is working and it is shifting culture. Our Superintendent's vision is to bring a wellness center just like this to all 19 of our campuses.

To strengthen California's youth mental health systems, we need improved coordinations between schools and county health, streamlined warm handoffs, clearer data pathways and just more joint crisis training between counties and the state. We need unified messaging explaining why the insurance information matters. Families trust schools, but they need to hear from the state as well.

And most importantly, we need stable or sustainable funding for mental health staff. We cannot continue depending on grants or one time allocations to maintain the workforce that is keeping our children safe. And in closing, youth mental health needs have reached a crisis point.

We have strong systems, strong partnerships and in San Marcos we have proven programs like the let's Face It Together campaign and our Peer to Peer Wellness Center. But none of this is sustainable without stable funding and practical solutions to CYBHI implementation barriers. Our students need us.

They are asking for our help and with the right support from the state we can continue building a school based mental health system that truly will save lives.

Thank you for that presentation. Next we'll move on to Carol.

Hi, I'm Carol Ochoa and I am a school counselor. I've been a school counselor since 2003 starting my career creating a counseling program from the ground up which was super exciting.

I worked for a K8 San Diego school district that had not had counselors before on its site and they decided to write a grant, a federal grant for three years after a tragedy at a local high school.

So my school counselor colleagues and I were able to create a mental health support program systems to address social, emotional, academic and post secondary exploration needs with systems and supports that are still used to date. In 2006 I started in the Poway Unified School District and was hired under an Educational Assembly Bill called AB 1802.

There was an emphasis at that time for individual parents, students and counselors to meet at Grade 7 and 10 with the making sure we were making an impact on students passing the California High School exit exam.

At the point that I was hired, each middle school in our district was given two and a half counselors per site regardless of enrollment size of the school. During my time in pusd, I have seen tremendous changes in counselor ratios over the years as the state budget fluctuates.

At my school we have a student enrollment of over 1500 kids and before I started there were two counselors. It's varied from two and a half counselors to our lowest at one and a half counselors. We remained at two counselors for years and my partner and I had a caseload at 1.0 of 770 each.

For reference, the national standard for counselor to student ratio is 250. With COVID funds we were able to increase to three counselors five years ago and we are now up to four counselors at my school site. As our district is now staffing counselors based on enrollment versus every school gets the same.

We have middle schools ranging from 900 plus to 1500 plus. So now our caseloads are more comparable to one another. Currently at my site our student counselor ratio is 375, so it's still above the national standard.

School counselors play a tremendous role in early mental health identification and as links to additional community resources for students needing more intensive supports. Post Covid, we are fortunate in our district to have contracted with an organization called Mending Matters that provides on site therapy for a limited number of students.

Each secondary campus in our district has one provider and they are a part of our school staff and are there daily with us.

Another important part of our comprehensive school counseling mental health support team are our student support specialists who provide additional support for students in a variety of way with students individually, peer mediation groups as well as whole school programming.

Again, another critical member of our staff post Covid School counselors in PUSD have received district supported universal screeners which allow us to survey all students to make data informed decision on what student need supports and what and who we are able to support.

And so this way we're able to capture a lot more students that may have gone unidentified. We also utilize research based social emotional learning curriculum. Counselors at our sites use them for classroom lessons or targeted group interventions based on universal screening. Your data.

School counselors pay an irreplaceable role as first responders to students who may have thoughts of suicide. Students sometimes self refer friends or family may refer them or teachers may notice cues in their writings or comments in class that warrants counselors to do an assessment to determine level of risk and follow protocols for best next steps.

Each case is unique and delicate and can sometimes take multiple hours to adequately address the student needs. Moving forward in the last two years, school counselors in our district now have an important role in threat assessments.

If a student has been deemed a potential threat through words, writing or Internet searches, counselors collaborate with administrators to determine level of risk and follow protocols for next best steps.

With more counselors, we have been able to focus on aligning our program with the asca, which is the American School Counselor Association, which are the national standards set for counselors and we are able to analyze student needs through data to be more reflective and create proactive, intentional work supports and intervention.

Our site has been able to become a recognized ASKA Model Program or RAMP Certified School which shows that our program aligns with standards based on counseling practices and uses data informed decisions to drive our programming.

This is a huge accomplishment for our district and Bernardo Heights Middle School became the fifth school in San Diego to receive this recognition. One area of youth mental health that is particularly near and dear to my heart is the Mental Health Awareness Club that I advise on my campus. In 2018 I had a student approach me.

Her name was Lauren and she saw a need within our school community. She said she had a diagnosis of depression and anxiety and had a rough summer.

She knew statistically there were many others on campus who had mental health issues or kids who have family or friends with mental health concerns and she wanted to provide a space to openly talk about mental health issues and supports.

It was important to Lauren to have the word mental health in the title of her club to bring awareness forward and to reduce the stigma around mental health. Our students take a climate survey through our Mending Matters provider annually since 2021 which focus on a variety of mental health topics.

While the mental health awareness club can't take all the credit, we feel that through school wide activities and purposeful use of advertising mental health we've helped reduce the stigma at our school site.

When the students first took the survey in 202149% of students stated that they did not seek mental health support when they needed it because of the stigma around mental health. It was the number one reason students cited for not seeking support.

Seeing that number, the club became more intentional with having the word mental health awareness as a norm on our campus. Since the original survey, that statistic went down from 49% to 30% of students feeling this way and it went down from the number one reason to the number nine reason.

Lower counselor ratios have allowed us the opportunity to showcase our work and teach other professionals about the work we are doing on my campus Focused on Youth Mental health.

My co club advisor and I have presented at the San Diego County Office Equity Conference the last two years and we were proudly the only school counselors at the conference.

Our presentation was titled Reducing the Stigma of Mental Health in Schools and focused on data, results and activities regarding the club as well as step by step on how to duplicate this club on other campuses. This is just one of many ways school counselors can positively impact mental health on campuses.

I am proud of the significant daily impact school counselors have on students, academically, social, emotionally and in college and career preparation. While we continue to champion mental health and learning, greater resources are necessary to ensure that we can effectively and efficiently serve every student.

As I have mentioned, many of these new systems, programs and staffing were put in place post Covid and those funds have since gone away. But the needs have not. Last spring our district had to make hard decisions of how to cut budgetary funds. This is an unfortunate familiar cycle in the world of education.

Unfortunately, mental health supports and school counselors are considered line items when looking to reduce a school budget. We are still currently facing budgetary cuts for the upcoming school year. We cannot as a community afford to lose any more school counselors or mental health supports in our school. We are the front line.

We spend six and a half hours a day, five days a week, we with these students, with our youth and kids and they know that we are the trusted adults and they will they know that we are there to support them and their friends.

We need to be well staffed, well trained and well equipped with up to date screeners and curriculum so that we can support each and every student on our campus. We need the funds to reflect the national standard of 250 to 1 school counselors to student ratio.

California student to student counselor ratio is consistently among the highest in the Nation and in 2324 California was the 42nd ranked school counselor to student ratio.

We need to improve this statistic so that school counselors can expand on our supports for all students and continue to do the good work we passionately deliver to our students on a daily basis. I appreciate you taking the time to listen to my journey as a school counselor and I welcome any opportunity to continue the conversation.

I appreciate your dedication for our youth and your support for their overall well being and mental health supports. Thank you.

Thank you so much for your presentations. It's given us so much to think about. I have several questions but I'd first like to offer it up to my colleague.

I'm not sure if there's enough time.

We do have three more panels.

I'll be quick. You talk about the stigma for youth. How much of it is?

So, on our school site, we can talk to students, you know, without, without having parent permission initially. So, we go out to every single classroom. We do this in every 6th, 7th, and 8th grade homeroom, and introduce ourselves as school counselors, our mending matters provider, our student support specialists.

And we talk about the whole variety of reasons that students may see a counselor all the way from schedule to organization, you know, to talking to a teacher, to friends, to parents, to mental health, and bigger concerns. And so, we do try to be that friendly face out on campus.

We do supervision, so we're there before school, after school, or they're at lunch. So, it's a very, you know, casual opportunity for students to approach us and see us as staff that, you know, they feel safe with.

So, I'm hoping that that helps to reduce knowing that we are those staff members that are there and are safe to talk to, regardless of what, you know, they may be hearing at home.

I would just add that I think—am I on? Okay. Sorry. I think that post pandemic, just in general, there is a reduced stigma around how, how exacerbated the mental health needs are. I think as adults, we feel that. And so, I believe that where we were pre pandemic was we were in a lot—it was a lot more difficult to get parents to engage in that conversation.

I think we have a big opportunity now because people are more willing to hear it. That's why within San Marcos, we did the campaign we did to help people understand that help was available on our campuses.

I do believe, though, that there is still a lot of stigma for the adults because they don't want people to believe. And it spans the socioeconomic gamut. It is not just one or the other. It is all throughout. We don't want people to know what's going on in our home. That's not happening to us.

We can take care of that. The school doesn't need to know about what we're dealing with.

And so, while I think people are far more open to that conversation when they have trusted folks on campus that they've built that relationship with, I do believe we still have some work to do with our parents to help them understand why it is critical for their kids to be able to access this care at school. What we hear a lot is, well, we didn't need that when I was in school, so why do they need it now?

We had to go outside for that. And the world has changed. And so, that's kind of an ongoing conversation that we continue to have about whole child wellness, and for them to be academically ready, they have to be socially, emotionally ready as well.

So, yes, there is still a segment of folks that I believe there's some work to be done with.

Thank you. And I'll just ask one more question. We talk about the reimbursement. What is the timeline on there, if you actually get it?

So, it just really—it's depending right about now. It takes—we only have two districts of all the cohorts that have built because it takes such a while to amp up to that. So, depending on, both districts have received it within months. So, it's about that long.

It's not years, it's within months, but it's the ramp up to that that's taking the longer amount of time.

And we would love—not today—we would love to see how we could streamline that for us. Again, this is policy that we can actually put together and discussing auditing to see where the money's actually going, why isn't it being refunded when it should be at a certain time?

But basically, what can we do to make it easier for you? Thank you. I appreciate all of your comments.

Can I just comment, too, on reimbursement? So, we receive reimbursement different way, but it's also an incredibly tedious process that. I mean, there were points where it's like six months behind. We had several of our hospital providers who were supposed to get reimbursed in, like, June. They finally just got reimbursement like, two weeks ago.

So, they could not—one of them could barely make payroll. It's just—it's wild. They've provided the service. It's expensive. Yeah. So, thank you.

When we talk about June to now, those are two different budget cycles. And so, it also makes it difficult for our entities to budget appropriately and to stay on budget. So, very interested in your comments, in looking at what can we do to streamline the process.

Do we need to call for an audit in order to get to that? Those are definitely questions that are out there. Looking at Carillon as a reimbursement partner, I have heard anecdotally that there has been some struggle with receiving training on filing those reimbursement requests.

And that could be leading to why about 50% of them are being rejected, it looked like from your own slide. And do you have any thoughts around improvements to that reimbursement process or what we can do to lower the administrative cost of the school districts having to, you know, file that reimbursement paperwork?

Yeah, Mara.

So, I think it's gotten better from where we were, I think from what we've heard and the feedback that they got, because the initial, those first districts that were going for reimbursement, there was a lot of everybody was hearing how it was not running smoothly.

And I think there was an outcry from the districts, like, you're not making it easy. We've been sitting here, you know, on the runway for a very long time. And so, there were discussions with DHCS and Carillon, and so, now there is ongoing training, like it, it's on a frequent basis, so you can jump right in.

And so, the trainings, they have changed the pattern. It is much more readily available. Now, vendors are even getting trained. There's ongoing communications between the vendors and Carillon, who are—and the vendors are the ones who are working directly with the districts. So, it has changed.

And now, again, though, it's still the process of amping up to get ready so now, but it has become more streamlined. It's just still slow going to get into the cohorts.

But I've understood that there is a better process that Carillon has heard loud and clear that it needs to move because of the outcry that happened initially. So, where we were, from where we are, has changed. So, I want to be clear with that.

That, that's great to hear. That's the kind of progress we want to hear so that we know that the system is working. As I said in the opening, $4 billion is a lot of money. Our taxpayers want to know where their money is going and that it's actually delivering the care that they want to deliver.

The taxpayers voted for Prop 1. We want—the voters voted for Prop 1. We want to see our young people and our people in general receive the care that they need.

We just want to make sure it's going to the right place and that it's not creating new systems of bureaucracy and administrative cost that isn't covered in those reimbursement costs. Specific question to Nadia—is there an opportunity for open dialogue on what meets the standard of care that the state will reimburse?

Because from what I heard in your opening, or in your statement, that there seems to be some back and forth onto what is covered, what is not covered, what qualifies. Are you able to provide feedback and open the door to expand what is covered?

So, are you speaking to, like, the specialty care versus others? So, I think, you know, several folks have talked about how complicated the system is, so everybody has their piece. But I think the complexity is how those pieces work together and people bounce around between those things.

So, you could be mild to moderate, then you're bouncing into specialty care, then you're back out. We don't have data across all those, so we see when somebody's in our system that we don't see what happens when they're out. There's also, you know, this sort of crossover often with justice and we don't see their data necessarily either.

So, I think, you know, it's all driven by funding streams right now and rather than what is the best need to wrap around a child or a youth, it's about where the funding is and who gets reimbursed for those things.

So, I think, you know, this is just my humble opinion, until we figure out a way where we can serve the person, both mind, body, physically whole and provide reimbursement that serves that person versus, you know, you get a piece, you get a piece and then you guys all have to figure it out and let the, you know, every parent's own adventure when they're trying to navigate the system, it's going to remain challenging.

And certainly inefficient, it sounds like. Right? People aren't getting the care they need quickly. There's redundancies in billing. It seems like there's a huge opportunity, if there was better coordinated efforts, as you all have touched upon, that maybe we could deliver care a little bit more effectively.

But it sounds like that coordinated effort between agencies and levels of provider, maybe something that we need to work on going forward. Huge undertaking. State of California is doing a huge undertaking here. So, definitely. And then, a question about, Christine, for screening tools. Is that something that's reimbursable?

Do you know? You mentioned that there are screening tools on the Internet. I know former school district, I was part of Powell Unified, we had those similar screening tools that would capture trigger words.

So, my understanding is for that particular system that is highlighting the, the concern, we wouldn't be able to bill for that. But once we bring that child in to assess what's going on that is billable. So, if it is a, if a, if a student types in something about self-harm, they would then be—it'll initiate a counselor or social worker to calm them down. They would then do the Columbia risk assessment with them and that is billable.

Okay, thank you. I mean, like my colleague said, there's so many things that I would love to chat with you about, but we do have to stick to time and respect our other panelists. Thank you for your presentations, presentations today. Appreciate it.

I look forward to working with you in the future as we look at what we can do better for the State of California. Thank you. Next up is our provider perspective. Panel 2A will be Dr. Scott Kane, Pyle Beam, and Susan Ryder—Dr. Susan Ryder.

And we will just go in order that you are listed on the agenda. So, Dr. King, you're first up.

Good afternoon, Dr. Patel.

Can you guys hear me? Okay, push the button. That always works. All right, thank you, Dr. Patel. Thank you so much for inviting me. It's really an honor to be here. Thank you to all the government agency folks who gave that wonderful discussion of the work they do.

We really rely on many of those programs, and it makes a big difference to have those programs so fully funded. I want to talk a little bit about my background. I'm a child and adolescent psychiatrist. I've been doing child and adolescent psychiatry about 25 years. Most of that was with the Navy.

Before I went to medical school, I was a high school teacher for two years. So, a shout out to our educators. I am currently working at Sharp Mesa Vista Hospital as their Director of Outpatient and Intake Services. Sharp Mesa Vista has about 150 beds across all the age groups. We have about 20 beds for adolescents and children.

We also have six different programs—intensive outpatient, partial hospitalization programs. We can talk about those a little bit later because those represent discrepancy in health care because they're not often eligible for Medi Cal patients to see. I worked in the corrections facility at Donovan State Hospital for about six months. Very interesting experience doing that.

And then, currently, I'm on the board of directors for NAMI San Diego, National Alliance for Mental Illness. They have like over 600 affiliations across the nation, and San Diego has the largest affiliation, which I'm really proud of, the work they do. They work in 15 different locations, 36 different programs.

And then, I'm also the father of three who have graduated from Poway Unified School District, ages 19 to 25. Gives me an interesting perspective on what our kids get to go through. And then as a parent, I was fortunate to set up a parent wellness program. We call it the Mental Wellness Committee at Westview High School.

That's still going on now. It really aims at parent support as well as teacher and student education. So, again, thank you for letting me talk here. I was thinking about what perspective to bring. I really want to get away from what happens on the individual patient basis.

Actually, I don't know that we need a lot of support on that—the medications and the therapy. There's a lot of research and interest in that. I'd be happy to talk about that.

Instead, I wanted to talk about this question I think we all have, which is how do we go from the one patient model at a time to really managing mental health for our youth across the entire county. That's really a huge challenge.

And I thought I would start filling in where Dr. Vogels said she was going to give a little bit of a vignette. So, I'm going to take you through what an experience is like being a child and adolescent psychiatrist. So, seeing a teenager in the emergency room, this is more of an amalgam of patients, not one patient in particular.

But a typical patient I might get called to see in the emergency room—it's a very busy place. A 14-year-old girl who was in high school, went to the counselor's office, said she was cutting the night before and was having suicidal thoughts. That usually triggers a necessary evaluation.

The school typically will call 911. Typically, there will be a police response. It may or may not be PERT. In those cases, they typically will bring the patient to the hospital. The parents may or may not be called at that moment. Typically, the patient is transported in handcuffs in a police squad car.

And then, they come to this really busy emergency room. We try to reach the parents; they come frantically to see us. And that patient typically talks about having some depression and some anxiety. They'll typically talk about some parental conflict going on. They'll talk about maybe being bullied by peers on social media.

They may have some uncertainty about gender identity. I might suspect that they're using substances. They may be evasive about any kind of sexual assault history. And you can imagine that's not the environment where they're going to just open up and start talking to you.

They're really wanting to not give information to me that's just going to turn around and go right to their parents. That dynamic has a lot to do with why they're presenting in a crisis. They're feeling isolated from friends and honestly oftentimes never seen a therapist or a psychiatrist before.

And you would think—now, my job in the emergency room is to put all that back together like Humpty Dumpty, right? But the reality is that my main decision factor there is do I admit them to an inpatient psychiatric unit, or do I discharge them back to these overwhelmed parents?

And I just want to emphasize how inadequate those two choices are. And they're basically all I get at this really critical time for this young person. So, what's the problem with acute inpatient stay? It's wonderful. It guarantees the patient will be safe for typically 72 hour period, but it's a scary time.

It, as a result, can be traumatic. Parents are usually not allowed to visit except maybe one or two hours during the day. It's traumatic for the parents and it raises the question, well, what happens at the end of that 72 hours or week long process?

Because we know that all those issues I raised are not going to get fixed in such a short amount of time. We could start medications. They typically take weeks to really have a benefit. And then, in 72 hours, what are we doing with therapy? So, let's look at the other option, discharging the patient.

Well, what message does that send? This kid who was brought to the hospital and we gave their whole story that they didn't want to tell anybody and we say, well, okay, you can go now. And here is a six page handout with all the resources that you can look up. There's no warm handoff in that.

The other thing that's just an awful experience for me as a parent is to look those parents in the eye and try to explain all the issues that are going on while protecting their child's confidentiality and explaining, well, what's really going to help is if this person develops a therapeutic alliance with this person you don't even know.

Right? It's just more than they can really manage. And so, that really led to a lot of my thoughts about how we could do better in that circumstance. One common thing is they'll get referred back to primary care.

And I know in other states, we do have, other states will put together a network of consultants to talk to pediatricians, right?

So, when they are in their office and they have somebody there and they feel overwhelmed, they can activate this consultation service that's paid for by the state and it is a program that would be, I think, really useful for us to do. The next thing is, of course, we talked about access to outpatient therapy.

It's almost impossible to get that coming out of the emergency room.

So, if, in the old days when I was in training, that was a requirement, they came into the emergency room, they didn't leave the emergency room unless you had a therapy appointment within seven days, preferably the next day, and then, there's really no connection back to the school.

This is the system that identified the patient and sent them to us. Now, that would be unacceptable—if it was a therapist who was sending a patient to me, I would call the therapist and explain what's going on to close the loop.

But the school system, we just don't have any partnership because there's so much anxiety about confidentiality, despite us all knowing the critical emergency nature of the situation. So, I think there's a lot we could do better and hopefully not taking up too much of your time.

I'm going to go through a couple of my visions for how we could do that better. And it really does start in the high school. So, first of all, this probably started back before high school even started.

And I really think a lot of the anxiety that the kids feel has to do with how to transition to high school, so we could do a better job and I know a lot of the schools do a nice job of orienting from 8th grade into the freshman year.

I think schools should dedicate some time and space to student wellness. I have school systems where they actually will have wellness days, and these are college students who now say that really made a difference to my well being after leaving the school. So, I think that's worth thinking about. We've talked about counselors, teacher.

I love the peer support programs that were identified. This is teaching people the language that we need for our young people to feel comfortable talking within their own space as opposed to waiting to come to an emergency room and talk to a total stranger.

I think we really want to encourage the testimony of our parents, teachers, coaches, peers, about their mental wellness experience, and so, it takes courage, right? I'm fine to say in public that I've done my own therapy; I've gone through taking medications.

You want to feel comfortable standing up as leaders to say this is okay, this works, doesn't have to be the way forward, but we all need some kind of connections. We all need to make some special effort. And so, there's no exceptions to that. Everybody's going to be involved in connecting with other people feeling down.

We've got to make sure that they hear that message, that this happens to everybody at all age levels. I think also we need to, and you guys know this, we need to encourage connectedness over social media. Lots of times, kids think they're connected because they're on social media.

And this is an old school concept, but I call it empty calories. Right? It's like eating celery. You're not getting any energy out of that. The connectedness really depends on physical presence, connection with another human being, and we need to really emphasize that.

So, in school counseling and parent education, collaboration with the county, other not for profit organizations—I mentioned NAMI for example—one program, I know Aaron's going to talk a little bit late about this, mental health first aid for youth and parents. Right?

We all are familiar with CPR and yet nobody does mental health training which is going to be able to—all of us would be able to utilize that in our own lives. So, I think that should be part of the educational curriculum on some level. I love the county's mobile crisis response team. What a new vision.

Instead of calling 911 and getting police, you get therapists to come and they talk to you. When I was working at the Palomar Crisis Stabilization Unit, they told me that it was about for every 10 calls they got, they would bring us maybe one or two. And I was always impressed by that number.

They're doing therapeutic interventions at the person's home. I think most of the community doesn't understand that that's available simply by calling 988. I'm amazed that, you know, half the patients and families I talk to have never heard of 988. Right? So, I think we can do a better job advertising that and encouraging that.

And people will learn more about it and it'll get better over time. I'd like us to see if we can somehow expand the Youth Crisis Stabilization Program. Right now, I think we only have the one, and it's such a wonderful model. There may need to be some tweaks done.

But other locations around the county would help avoid needing to do that whole emergency evaluation. Timely assessments that allows for the development of the therapeutic alliance. So, the way I teach my residents is the most important thing you're doing when you're doing assessment is safety.

But the second most important thing you're doing is you're connecting with that person in front of you. You know this. That takes time, that takes listening, that takes acknowledgement, and that comes back to resources. So, the more people that are familiar with how to develop a therapeutic alliance, the more effective we're going to be as a community.

And we can leave our top end level providers to deal with the severe mental illness as opposed to all of the community's anxieties in different areas. I tried to get at this before. I think we just need to collaborate with parents and schools, especially the counselors, on a regular basis. These are experts.

They know about the kids and what they're going through. They need to hear what we think. I know there's an issue about confidentiality. It just does not make sense to me when we have such a mental health crisis among our youth that we don't have a mechanism to communicate.

Perhaps there's a way for parents to consent to that from the beginning. Perhaps it could be on like the student card, like an organ donor card. Right? Just something where we are okay to do what we know is important and what any small town community would be doing to communicate because the enemy is isolation and loneliness. Right?

It's not the privacy of the kids—that's important, don't get me wrong—but we've got to make sure they walk away knowing that the people in the community know about them, care about them, and value them. I think we have—I did want to talk a little bit about intensive outpatient programs.

I'm sure a lot of our experts understand this. It's a much better model for care after a crisis than an acute inpatient stay. So, I went through what it's like on an acute inpatient unit. Intensive outpatient program is just as it sounds like.

You're going 3-4 days a week, maybe half a day, but at the end of the day, you're maybe going back to school, you're going home at night, and you sleep in your bed, you sleep on the weekends, and you come back, you're dealing with real world problems.

And what you're doing is you're practicing what you were guided to do the day before and you come back the next day and say, well, that didn't work. I need another strategy. When you're on the inpatient unit, you're not practicing any of that. You're just worried about what you're going to do when you get out.

The issue is we're so worried about safety, we tend not to refer out of these crises to an outpatient, intensive outpatient, or partial hospitalization program. At Sharp Mesa Vista, I've been amazed. One of the things they do is a lot of means restriction with parents at night.

And they do a wonderful job and have phenomenal results with keeping kids out of the acute inpatient unit and into some of these other programs. So, I think that's another piece that we could be trying to emphasize. Partnerships for other organizations and the in peer—sorry, the in-school peer support model.

I want you to think a little bit more about what that means. These are kids who feel the need to reach out and connect with others who are struggling.

If we can connect kids in need with these ones, be able to reach out, not only does that make the connection, but it models for them how to do it for the next person. It's a pay it forward model.

And instead of trying to create always a safety net where you need our support, if we can show the kids that they actually can do this themselves for the next person, that's more empowering than anything. So, I'd love to see us continue to encourage that. All right, so thank you for listening to all of my spiel.

I've got more ideas that we could talk about. But, you know, when I think about this, I mentioned the safety net concept. My vision is for us to change that to more like an engagement trampoline. Right? Kids come in, we engage with them, and then we send them back out to succeed and develop.

They don't all need psychiatrists and therapists and medication. Some do, but not all. Thank you.

Thank you so much. Yep, go ahead. Thank you.

Okay, can everyone hear me? Oh, thank you. Yes, I do have slides. I think I'm the only one on this panel who did. So, my name is Payal Beam. I have the privilege of serving as the Vice President for Mental, Behavioral, and Developmental Services at Rady Children's Hospital, San Diego. Rady Children's has been around since 1954.

It is a large safety net for many of the children, probably over 90% of the children in our community. And so, that's not right. S, I just, I wanted to share a little bit about who we are, what we do. Do I have my—hold on? Okay, no problem. I can get started, though.

So, we are, like I said, we serve over 90% of the children in our community. And let's see. It's not forwarding. There we go. Okay. As you can see, we have over 2,000 staff, over 900 patient beds. This is combining our recent merger with Orange County. And we are in six different counties, over 12,000 employees.

So, we're a very large network of inpatient and outpatient level services, including the two trauma centers in Southern California. That's—here we go.

So, in 2015, our board really set out on this vision to look at the whole child care, not separate, you know, physical health from behavioral health, mental health, and really look at the whole child as—and the reason for that was the strong belief that there is no health without mental health.

And so, this is something we strongly believe in. We've been working towards that for a very long time. Back in, you know, the driving force behind it, I mean, I know we talked a little bit about COVID numbers and beyond, but between 2012 and 2022, we saw over a 1,200% increase in behavioral health issues in our emergency room. 1,200% increase. 2022 was the peak, but the numbers, it's been continuing for a lot longer for the previous decade.

And so, we really started out at that point. You know, our board decided we have to do something about it. This next slide is more a continuum. That was our conversation about what we're going to do and what we're not going do as an organization.

But since 2016, we've been adding on to the levels of services, the layers that we've been providing. And so, in 2016, we started depression screenings across our continuum, so whether you go in for a neurology visit or primary care or physical therapy, like we really started those across the board.

And I think since 2020, we've done over 1.3 million depression screenings so far. After that, we added a behavioral health urgent care in mid-city that was funded by Price Philanthropies and now it's running independently. Also, we added a psych emergency department, so six bays connected to—in our main hospital.

And so, children can actually go there and either get admitted to inpatient or they can be released home or to other community providers. We also added, during the COVID 19 Pandemic, we added mental health integration programs. So, we have mental health therapists embedded within our primary care practices across the county.

Actually, this goes from Hemet all the way to Chula Vista. And it's been an incredible program, with its challenges, but we trained over 200 primary care physicians in addressing some of the low level issues. So, depression, anxiety, ADHD, everyone's coming in with that.

So, our primary care doctors now have more confidence and competence in addressing these issues in house. And they can also connect with the in-house therapist and also refer to psychiatry as needed.

And so, in 2025, January of this year, we brought all of these services together under one single umbrella, forming the Mental Behavioral Health Institute, which now rolls up to me, so that's how my job became available. These are a lot of the programs that we currently have.

And again, you know, we were talking about prevention and early intervention. The early intervention piece is really what we're seeing in our primary care integration and healthy steps programs. We're doing those depression screenings I mentioned. We have a lot of partnerships. No one can do it by themselves.

We really need to be working with our community partners, our county partners, like Nadia was mentioning earlier. Right? Like whether it's the Regional Center or justice involved, I mean we should be collaborating so we know what's happening so we can make adjustments, because no one needs to be doing everything. We don't have that kind of bandwidth.

And so, we have this continuum of entry like outpatient programs, emergency services, acute care, and also education and training because workforce has already been talked about quite a bit. Where I want to spend some time is our systemic barriers. So, early identification and access are critical. We continue to have such long wait times across the board.

I mentioned our mental health integration program. It's an amazing program because you go to your primary care physician, there's no stigma. Everyone goes to their primary care doctor. You can see a therapist right there. The challenge with us is you can only go to that provider as long as that person's embedded within your primary care doctor's office.

Right? You can't just go. It's not something that everyone has available. And so, that's a barrier. Whether it's age, geography, insurance, you know, these are all barriers that we experience on a daily basis, and I think everyone in this room can attest to that. Mental health parity has been the law.

But in reality, the reimbursements continue to be ridiculously low. We talked about the timeliness of reimbursement. You know, large organization like ours, we can sustain a few months, but smaller organizations, they're struggling to make payroll.

And so, when you know you have the qualified provider, when you know you have the service that's been delivered, what are the reasons for it to take 90 to 120 days? Especially because on the flip side, access is an issue.

And so, when we know that an access continues to get delayed because we're not getting reimbursed in an accurate or timely manner—someone else had a slide earlier about the 50% denial rate. That's unacceptable. If you're doing everything to be a qualified provider, you shouldn't be having denials at that rate. Mental health services.

There was a question earlier about stigma with children or parents. Children don't have the stigma anymore. Our kids are asking for the help. They are very comfortable asking for help. Our parents are getting more and more on board. But I don't know that our insurers are necessarily valuing mental health services or the complexity of it.

You know, we still have the same reimbursement model from, I don't know how long ago. But when you're looking at outpatient level, you know, weekly therapy versus psychiatry, those are reimbursed at different rates. But what about integrated models? Are those reimbursed, you know, the same way by the minute?

And if you're looking at, you know, meeting your payroll because people have to bill so many minutes to get that much reimbursement, that's not necessarily—you're not necessarily looking at the value. Right? And so, just the different levels of services that we do have, we do continue to add them.

But we're also really reliant on how we're getting reimbursed and the sustainability of it. Many, many, many of our services continue to be supported through philanthropy, through short term grants.

And like someone said earlier in the school panel, you know, having to serve notices, I mean, of course that's going to add to the workforce shortage because people are looking for stability. If you're planning to stay in San Diego, you know, you got to have a job, you're not going to be able to do it for free.

And then, the administrative burden, so even building up billing in any of these programs, the administrative burden, because not only is mental health reimbursed at a lower rate, you have the burden of the—it's more complex.

So, someone who can bill physical health services, I don't know, maybe they can Bill 100, 150 encounters a da. For mental health, they're probably able to build 35 encounters a day. And so, those are all of the things that they're really worth talking about when we look at systemic barriers.

So, my personal stance needs to be more transparency in how people can bill for services and how we can sustain those programs, because if we have transparency and you know, this is what your reimbursement is going to look like, then it's a whole lot easier to make those services happen.

Workforce shortage is very much directed to reimbursement because when we have new graduates working with severe populations, the more complex, these are the folks we should have people with 8, 10, 20 years of experience working with and we have instead brand new graduates who are being traumatized working through this.

So, and that adds to the administrative burden because you have to do it differently depending on the payer, because payers don't necessarily want the same information before they reject your claim. So, just a little bit on systemic barriers. But that being said, we are continuing to provide more services because we know there's a need.

I'm very excited about this. We are building a new campus and that's going to be coming up in about three years. It's going to increase our capacity, inpatient capacity, to 48 beds. It's going to increase our crisis stabilization from 6 to 24. We are adding intensive outpatient and partial hospitalization programs which we don't currently have.

We'll have 20 slots for those. And you know, continuing to partner with our partners just in the community so we can serve our children together because we just can't leave them hanging. Thank you.

Thank you for bringing forward that insightful information. We'll definitely take it with us. I have so many questions, but we do have one more panelist for this section, Dr. Reiter.

So, thank you for having me today. I'm Dr. Susan Reiter. I am the Director of Business Development and Psychoeducation for Aurora Behavioral Health.

So, we are probably, in this room, one of the only private for-profit health care programs, which actually puts us in a very interesting and unique position because despite the fact that we are private and for profit, we still see as many underserved patients in high priority areas in high priority communities as everyone else in this room.

And yet, our ability to get reimbursed and the ability, the effect that it has on workforce and is tremendously different. So, I want to kind of speak to that a little bit.

Dr. Kane did an amazing job of talking about what it looks like when someone comes into an emergency room and how short the length of stay is for acute care. 20 years ago, when I started in this role, acute care was longer for youth.

It was about 10 days length of stay and 20 years prior to that, it was 30 days. Essentially, it was residential treatment.

And so, the parental expectation that my child is going to go into your services, they're going to feel better when they come out, was a realistic expectation because we know that, for example, an antidepressant takes four to six weeks to kick in.

Well, if they're with us for 72 hours with the likelihood that that antidepressant has kicked in, we know what their side effects are. We don't even know if it's the appropriate therapeutic level. Unfortunately, our, like, our definition of medical necessity for acute care has shrunk.

But the societal expectation of what our level of care is supposed to do has changed, has not changed. I can't tell you how many parents I meet with who are like, well, you must have just gotten so much better at your job. What you used to do in 30 days you can now do in three.

I'm like, no, we can still only do it in 30 days, we just only have your child for three. So, imagine being a parent or being a child, a youth, a student who is at the premier crisis point in their life. They're at their lowest point and they are finally reaching out for help.

They've not reached out previously, they've not sought other services and they're like, I'm going inpatient. This is, I mean, I'm at the bottom. I have hit rock bottom. And then, three days later, they don't feel that much better than when they started.

What they do is they lose faith in the healthcare system altogether because they feel like, well, it didn't help. If this is supposed to be the best level of care, this is supposed to be the highest level of care.

And three days later, I still feel horrible, and families are still in a whirlwind, and we're trying to piece together, in this very siloed system, after care for the individual. It becomes a tremendous barrier for the families because they're like, well, inpatient didn't help. Oh, and wait a minute.

I don't have the right insurance in order to access intensive outpatient programming. I mean, ideally it would go inpatient, partial hospitalization, intensive outpatient programming, and then, once a week, therapeutic care with an outpatient provider. Or if, if individuals need a higher level after inpatient, they would go to residential and then PHP and then IOP.

Well, unfortunately, not all providers cover PHP or IOP and there are very limited resources for our Medi Cal kiddos with regard to IOP. We have our first IOP level of care at San Diego Center for Children here in San Diego, but their slots are highly limited, and the wait list for that is beyond measure.

So, we have kids who have this need, and we tell parents, this is the best step down for you, and they go, well, but I can't get them in. And the schools are then left to fill that gap and fill that burden. When I started 20 years ago, counselors did academic counseling.

Now, they are tasked with behavioral health counseling. They are supposed to be substance use counselors, mental health counselors, sex ed counselors, HIV counselors, gender identity counselors, you name it.

They're supposed to pick up every social, emotional, learning component of a child's life that was previously covered in a village that surrounded our youth, often in faith communities, often in large congregational families and extended families. And it's now being kind of dumped on the schools. And the schools have stepped up in a massive, massive way.

Unfortunately, there is that gap between inpatient care and the school in terms of us being able to get information to them.

All too frequently, I will have a family admit their child on a Friday night, knowing that they will discharge on a Sunday, and then tell us we will not sign a release of information because we don't want the school knowing that our kid was there.

Because the stigma is very real still when it comes to our level of care, when it comes to inpatient acute care. The assumption is that other parents are going to go, oh, that apple didn't fall far from that tree, and if that kid has problems, it's the parent's fault, and it's a lack of parental guidance or maybe the parents have drug use or maybe the parents have mental health issues, and we're not going to talk about that.

And so, as opposed to talking about and normalizing mental health and mental illness as a normative medical issue and not judging it the way that we do currently, we don't judge someone who has diabetes and whose family has diabetes, but we judge plenty of people who have depression.

And it's genetic and it's heritable throughout the ages or any sort of substance use the same way because we don't understand them as brain diseases. One of the things I'm always saying to family members is, for a long time, we didn't understand dementia and Alzheimer's on the other end of the spectrum.

But today, we would never consider saying to someone who has Alzheimer's or dementia, why don't you remember who I am? How come you can't remember my name? Why don't you remember the history that we had? And we don't go through that and then blame the patient and then blame the family for the loved one having Alzheimer's disease.

But when it comes to depression, anxiety, schizophrenia, bipolar disorder, ADHD, spectrum disorder, any eating disorder, any disorder that's in the DSM other than the dementia diagnoses and other neurocognitive disorders, we tend to blame the family and blame the patient. Well, why can't you just pick yourself up and get out of bed and go to school?

Well, I can barely remember to brush my teeth. Right? We expect them to make these huge gains when they get to acute care. They don't make the huge gains.

They don't have the option to go to partial or IOP or if they do, it's so stigmatized because, well, what is my kid going to do if they go to your IOP program? Then they're not going to be able to school them and then they're going to fall back in school.

And just having that conversation with families when they're in crisis and their frontal lobe is not activated because they are in fight, flight, freeze, fawn, and fold.

You have a family in crisis and you're trying to go through the litany of resources and all of these options with them and have them understand logically and rationally what this looks like when they're just trying to make sure their kid is still alive. It's really, really, really hard.

It also doesn't help that, for the last 10 years, we've associated the term active shooter with mental illness. What it has done is made families really shy away from wanting to talk about mental illness, because, uh oh, now my kid's an active shooter. No, your kid has mental illness.

They have depression, they have anxiety, they have eating disorder. You know, a very small percentage of individuals who have mental health diagnoses then go on to become active shooters. Right? And so, we have this gap in parental awareness, parental understanding, as well as within the system itself.

One of the things I would love to see is, you know, parents to become more aware of early warning signs. All too frequently it's coming to the school's attention because the parents don't know the warning signs.

Because contrary to popular belief, unlike the driving test, we don't get a manual when kids are born that tell us what warning signs to look for.

And I can guarantee if you got it at the time the kid was born, by the time the time the kid is a teenager, it's going to be outdated and it would probably be written like Ikea instructions anyhow, and no one would know how to use it. So, we focus so much on reactivity as opposed to proactivity.

And if we took a more proactive approach to making sure that parents saw those early warning signs so that they could get their child into mental health services so that they're not stigmatized, so that they haven't had to wait to crisis and then be let down by the system, I think it would really, really create an opportunity for our families.

The last piece that I want to speak to is workforce. One of the things that hasn't been brought up in this Committee has to do with the PSLF grants. So, PSLF is a student loan reimbursement and forgiveness program that is for individuals who are in health care fields.

But the only individuals who are eligible for that are people that work for nonprofits or governmental organizations. So, I'm in a for profit hospital. Over 50% of my kids that come in to see me are Medi Cal recipients, tribal kids from the reservations, or dependents for Tricare.

And yet, none of my staff are eligible for loan forgiveness because we're considered a for profit agency. And so, therefore they're not eligible for this forgiveness because theoretically we don't serve underserved populations.

This is a huge problem because it creates a workforce problem in all of the private hospitals because unless we're willing to pay double, they're not willing to stay. They'll cut their teeth at the for profit organizations, whether it's a hospital or another organization, an agency in the community.

And then they realize, wait a minute, If I work 10 years at a nonprofit, I can get my loans for my six-figure mind mortgage forgiven. But if I stay here, even though I really like it, I'm not going to have that happen. Well, in San Diego, that's a very simple calculus.

And unless you come from an affluent family or you have a heart of gold, you leave the for profit organization, which leads to increased turnover, which leads to poorer outcomes because you don't have the ability to have the continuity of care, even within your own staff.

Because as, you know, Dr. Kane talked about, we have to build rapport and that takes time, and part of that is learning from one another and learning from seasoned professionals in the field. If we don't have those seasoned professionals because they're flying away, it creates a huge problem. And this is, in some ways, a very simple solution.

Right? And I would be—it would not be in my interest to point out that if we could fix these problems, my hospital would be obsolete. Right? My CEO often says to me, don't, don't, don't push the, you know, your business development. You're supposed to make sure we have patients in the hospital.

And my goal is to keep people out of the hospital and not needing my services. Because at the end of the day, there are always going to be crises, right?

There are going to be circumstances where we don't see warning signs, where the kid has hidden this, where there's been so much stigma in the family system or so much hatred or retribution or denial, especially for like our trans kids, for, for example, where they need crisis intervention.

But from a clinical perspective, my heart breaks for these families that could avoid seeking crisis services because they would be able to seek services at a lower level of care that just aren't available to them.

Thank you, panel, for your remarks. I will open it up to questions. Assemblymember Davies, I'll let you go first.

Really great information, all of you. I really appreciate it and I really like the information you were telling us. What can we do, because that's really what we're here, we're problem solvers. And so, that's what we want to do, is tell us what we can do at a state level.

And so, obviously, I'm not going to go down and ask question after question, but I would love to see if we can get follow up information from you.

And you know, it's so true when you're talking about the loan forgiveness because a lot of different medical associations, you know, you can sit there and work your loan off and there's no reason why, just because you're a private hospital for profit, it should change.

We need to have professionals that are everywhere with that and the opportunity and the more places that we offer it, the more people that would actually go into the business, I believe, and into the industry. So, it'll be interesting to see what we can do. And have you looked at a federal level at all on that?

We have. I know that San Diego Psych Association and a lot of the other, like BBS and a lot of the other organizations, have as well, to talk to our congressmen and women and state senators or state senators at the congressional level, but it's a hard sell, especially when there's a lot of pushback around forgiveness at all.

It's been a rough handful of years with regard to forgiveness because there's still often a belief system that, oh, so you want to not have to pay for the work that for what you received. Right?

As opposed to an awareness that like, for example, I could become a lawyer and make four times my pay and pay off my student loan very easily. But I chose to go into this work not because I was going to become wealthy, but it would be nice if I didn't become homeless in the process.

And I mean that very literally. We have students who move out of the field of mental health because they cannot afford their apartment in San Diego, they cannot afford housing in California. So, if we're looking to workforce, we have to find a way to support them.

And loan forgiveness is a great way because it encourages them to stay in the field.

Maybe what we need to do is label the field and that's, you know, then exactly what the job is or the private part is, you know, if you're doing something in mental illness, you know, whatever it may be, this is then going into that category. Thank you.

While we're waiting for Assemblymember Boerner to come back, I'll throw in some questions. Payal, you talked a little bit about integrated models and how the reimbursement rates are different.

And I know it's come up to me before by a member who's sitting, a constituent who's sitting in the office here today, who spoke with me at length about reimbursement rates and then insurance clawing back reimbursements that have already been issued and that causing some instability for professionals to practice and even accept insurance in general, whether, you know, they're in private practice or with an institution.

Do you have any—and I'm asking a lot—solutions that you might be willing to offer approaches that we could use to correct some of that?

I think going back to just that transparency on reimbursements, right. When you're looking at, I mean like the dyadic care code, you know, it's something. But I remember we had to spend a lot of time educating the payers on, you know; yes, this is approved; yes, this is law; yes, this is what we did.

And so that adds to the administrative burden. And so when you're looking at like small, smaller organizations being able to apply for reimbursement, it's that administrative burden that keeps adding to it. You know, oftentimes we get an auth approved for treatment but not for evaluation, or we get approval for evaluation but not treatment.

Silliness like that "delays". Exactly, it adds time, you know, and also when you're looking at, if you're billing by the minute, you need to have your teams, your patient facing providers booked for a certain number of hours in a day in order to be sustainable.

So what does that do for the people that need to walk in, because you need to have that availability. And so I think really just looking at impact, and I don't have a single soundbite answer, but I think there's definitely more to speak on the transparency of that, you know, what are the delays, what are the denials.

Because if you're doing everything up front to be credentialed, then it should be a no brainer. I mean, like, you know, you go buy a tire, you know how much it costs, you walk out with a new tire. You don't have to figure out like, so not to simplify, you know, mental health services to that level.

But if you have done the work up front, you should get your reimbursement without those challenges.

Well, and certainly I appreciate that it's a very complex issue and not really expecting you to have an answer, but I do want to tackle this. I think there's an absolute need, it's our obligation, our responsibility as legislators to look at this very seriously.

I'm wholeheartedly in agreement with you that mental health and physical health are a continuum of the same body. We are one body. And mental health issues create physical health issues which create new mental health issues.

It's cyclical because we are one person and I frankly don't understand why health, mental health reimbursement rates are so different from physical health reimbursement rates. And with the billing to the minutes, again, I'm not fully understanding why we don't have more time to see patients.

Because if a patient presents with a crisis and you're in a billable by minute situation, you might want to push that patient out because it's a perverse incentive at that point.

Correct. And oftentimes you're, you know, spending as much time doing the documentation as you are providing services.

And so they're just, I mean, the administrative burden is real and it's significant and it impacts our access and, you know, so all the solutions we're looking at we really focus on, you know, how can we provide more face to face time, how can we see more kids, how can we do more of that.

But it's the noise of the administrative burden that keeps us from doing more.

Yep, understood. Dr. Kane, quick question for you. This is something that had come up when I was a school board Trustee with those 51/50 calls. Our students being taken out in a police vehicle with handcuffs is a very tragic situation. They're already feeling they're at their bottom, their worst.

And then we're adding to the stigma of that by handling our children this way, especially in their most vulnerable state. Have you seen an opportunity for us to do that differently with an MCRT or something like that.

Well, yes, thank you for the question. It's not done this way in every county and every state. And I understand the need for our first responders to maintain a level of safety and that this is outside of their experience.

But I do think the Mobile Crisis Response Team really does give us an opportunity to see a different way to tackle the problem. Those guys go out with therapists who are trained to have the discussion. We call it motivational interviewing.

Right where you are, you're talking to the person, they're complaining about what's bothering them and you sort of pivot all that energy into, well, let's go get you some help. That takes some experience and training. I would not expect our police force to know how to do that. I call them for other reasons.

So we're going the fact that nationally and California and here in San Diego has a parallel program, right. From 988, the mobile crisis response team to the CSUs. I think it's underutilized, but it's mostly aimed at the adult population.

So if you're looking for an opportunity, there's an opportunity to expand how we think of those three programs, 988, the Mobile Crisis Response Team and the CSU's, to a youth or a transitional age youth program that I think could be very effective.

That sounds great. Thank you, Assembly Member Boerner.

Yeah, I think both my colleagues covered a lot of what I want I was going to ask. I want to thank you for. First of all, I didn't say opening remarks. I'm Assembly Member Tasha Burner. I represent the Coast. So we basically have all of North County here accounted for.

And I want to thank Assembly Member Dr. Patel for putting this together. I have two teenagers myself, and I think somebody mentioned, I can't remember which one of the women mentioned. Normalizing mental health, last year was my worst mental health year of my life, and this year it's my best mental health year of my life.

And I tell that to people. People are always shocked. It was like, yeah, life is hard. Perimenopause is the worst. We thought puberty was bad. Then you get perimenopause and you're like, never ends. But I'm on the, you know, not quite on the other side, but I'm in a good place now, unfortunately. It's awesome.

See, we all represent the spectrum. It's all a spectrum. But I think normalizing it is really hard. And what you were saying about the interactions with schools really hit home. You saw I only cry about children and the planet. Those are the two things I cry about.

And, you know, you brought tears to my eyes thinking about that kid in crisis and the fact that we don't have 30 day stays and I can't. I was just imagining if my kids were in crisis, how would I handle that. And I still have a job and I still have to put food on the table.

I still have to cook for the other one. And how do you do with this. You know, we have what I see in the mental health space and this, I've probably served the longest in the state Legislature. So I was pre Covid, Covid, post Covid. I've seen it all.

And we had a problem pre Covid with mental health, and that was when I had the southern part of what's now, Laurie Davies District and really people who have multiple access to barriers, barriers to access on mental health issues and how to get it to them.

And you have these layers of government and we give money at layers of government and we expect them to work together and. And they don't work together. And then we expect different hospital systems to come in.

And I don't think, you know, I have advanced degrees and I don't think I barely could, you know, sign up my kids for high school because that takes a PhD in education.

But to bring that together with a family in need, what is it that we could do that would Streamline and integrate both the private sector, the public sector, the different layers of government we have, you know, in Vista, we had school districts, we had the county, we had private providers, we had health clinics.

You have all these things. It's not a navigable system, you know, and that's the barrier that we can solve. That's the barrier we can solve. There are lots of things we can't solve, but the coordination we could solve.

How do, what would your advice be, each of the panelists on how do we like remove those barriers of coordination so that we. Cause I think often we think of government in terms of like how we do budgeting. The county gets this much money. This gets this much money.

This is how we do medical, Medicare, reimbursements, whatever. That's not how a person experiences a system. So we don't do it from a person centered perspective. So how do we change that so that we're integrating the services.

And before the pandemic, we were actually at the cusp of doing this with Vista unified, the City of Vista and the county. And the pandemic happened and blew everything up on multiple levels. But I would love to hear your perspective.

Happy to go. I had to struggle with this when I was in the Navy up at Camp Pendleton. I was Director of mental health. So 50,000 Marines and their families. And when I was up there, found that there was a multitude of resources, all funded through disparate ways.

And as I went around the community, I found out that each of the commanding officers had found one or two of them. And so that was their go to program. And what happened is if a person didn't fit into that program, they would educate the commanding officers.

Well, if it's this kind of a problem, you go to that program. If it's that kind of this one. And so the commanding officers were keeping track of a huge diagram of where to go for different programs. And so it wasn't my idea. We took it from another base. But the idea was no wrong door, right.

So it was to reverse the education process. So we went to all the commanding officers. We started by going to all the different agencies and said, let's partner, let's tell all the commanding officers. It doesn't matter which program you go to, because we all have the same goal in mind.

And, and we will work behind the scenes to streamline all the communication and passing out. You're in this zip code, you're at this stage, we'll sort it out. And that is so reassuring to recognize. We have all these programs, but it doesn't matter which one I go to, I'm going to be able to access it.

So how do you do that. What you need is, and we have a model here based on domestic violence, the one safe place. If you haven't been to that organization, you should go. It was funded by our DA, Stephan Sommers. And what it is, is all the organizations come into one place, all part of that program.

And we know in North County if you need access for domestic violence, you go there and you'll get referred to the correct place. You don't have to know all 80 different programs. You mentioned navigation, right. When I started working at Palomar Health in the ed we had substance use navigators.

I'd never heard of that before, became incredibly effective. We're using them all the time. I can't solve your opioid problem, but this substance use navigator can create a path for you to go.

So if we had a mental health navigator, a youth mental health navigator who just plugs into that one organization that gets all the resources and quickly links you to the right place, you would have something that's very effective. The other secret for you to understand is mental health is a build it and they will come model. Right.

In other words, we all think we need more mental health and more mental health. It's an anxiety. When I was in the navy, we built a mental health walk in clinic. And I know we have them in the county, but we didn't have something like that in the local navy.

And people thought I was crazy because they're like, you're gonna have like 100 people lined outside the door. But this is a secret to access. If you don't think you have access, you're banging on doors because you think you have to to get in.

If it's going to take me seven weeks to get in, I better start now. Everybody's banging. We opened the walk in center and you know, we had 10 people in line and we took care of them. What happens is once people know they can get in, they don't actually want to come see me.

They just want to know they can in the middle of the night when they really need to. And so that's why it's so critical to have a 988 program. You know, I mentioned NAMI. We have, we locally have the contract for the Warmline. It's a California program.

It's an example of programs that are getting defunded because we're losing money. But to me it's an example of easy access to gain connection to navigate system that just doesn't cost very much money. So again, to address these issues, we need straightforward, easy places to go where people know how to navigate.

And you know, the other thing you do is you just ask somebody on the phone, is this a today problem or like a two day problem or like a two week problem. And again, if they're panicked, they're not thinking that. But if you're just asking that question, I could wait two weeks. Awesome, outpatient mental health.

You just triaged to the right place. I can wait two days. That's an IOP level problem. So we sometimes get carried away with needing to do this really fancy triage process when people just need to know that when they need it, they can get care. Again, I'm sorry for talking too long.

Good stuff there. I would completely agree with the no wrong door process because that's what we need. We should be able to, it shouldn't be up to the patient, family who's in crisis to navigate the age, the geography, the insurance. You should be able to go anywhere and then we figure it out at the back end.

And I think one of the things I've seen now in San Diego for 15 years is we tend to be a very collaborative community. And so, you know, I mean, I walked in, it's like, yeah, I know half the people here.

And because for that reason, right, because we work together and say, like, this is at my level, this should be at your level.

I mean, as a hospital, if it's not meeting the complexity or acuity, we shouldn't be having kids to come to us, you know, and I'll say that openly and anywhere, whether it's with my leadership or, you know, with our community partners, like, we should be supporting each other in being successful so we can serve the needs of all the kids.

I think one of the things that we've seen historically is that it's not no wrong door, it's all wrong door in our county. You're not in this zip code. You were in this zip code for this program, but you're still in that zip code. But this program doesn't cover that zip code.

We have such fragmentation in the way that our RFPs go out and our contracts go out that, you know, families don't know how to navigate that. And they also don't know how to navigate when they go from one payer to another.

We have patients that had been in a managed care program and now they're in a Different managed care program, or maybe now they're in the county, or maybe they started an FQHC which had integrated care on site, where you had primary care and you had a navigator and you had a mental health clinician right on site.

And they just said, you're having a, let me have you walk over here. And now they're in a siloed system where you need to get a referral in order to go see someone to do an assessment. And it's six weeks out to get that assessment.

And then by the time you get that assessment, you've either forgotten about it, resolved it yourself, or gotten to a crisis and you've now landed in a hospital. Right. So we don't do a very good job on the preventative side by doing that real integrative model. And the FQHC's do an amazing job of that. Right.

Because it is an integrated model. It literally is. Let me walk you down here and you can talk to the mental health clinician. And it normalizes mental health, right. We also need to talk about it in terms of mental health as opposed to only talking about it in terms of mental illness.

And we also need to include our partners at the Regional Center and our folks that work with developmental disabilities and spectrum disorders, because I know that all of us are seeing more and more what we used to call years ago, dual diagnosis, which was before we called dual diagnosis, you know, having substance use and mental health issues.

It was individuals that had intellectual disability or developmental delay as well as mental health, psychiatric issues. More and more we're seeing kids, especially coming in who are on the spectrum and also have psychiatric illness or they're coming in for behavioral issues as a result of their spectrum diagnosis. That's not psychiatric.

Psychotropic medication is not going to help them. Right. They need ADA, they need to have therapy. One of the things that I think is really, really imperative in the context of mental health is for us to recognize that both of my fellow panelists have talked about the fact that this is not a short term fix.

And all too frequently we think of mental health and mental illness as acute in nature as opposed to chronic. And the thing that's interesting about chronic illness is that we forget there's something called remission. We assume that if someone has a chronic illness that they're always going to be symptomatic, they're always going to have to manage everything.

Every day is going to be a burden, as opposed to reminding them that chronic illness has periods of remission.

But we need to stay on top of it with whole body wellness, with looking at mind body integrated care, with being able to address those warning signs early on and having a no wrong door, where if you go to your primary care physician, they know, you know what, this is outside of my scope, but I know who to refer you to.

And it doesn't have to be the hospital, right. It can be a clinician in the community or IOP or PHP, but all too frequently they don't even know that they can refer to IOP or therapists don't know that they can refer to IOP and still keep their patient.

They're like, if they go to IOP, I lose my patient for eight weeks. No, that's not true. And so, you know, when we look at graduate education as well, the education's on the clinical side, but not the business side of the house.

You know, I can't tell you how many new grads don't even know what 988 is. New grads, they don't know what 211 is. So they're not learning this in graduate school. Right.

And that's a problem because if our new graduates don't know what 988 and 211 are, how can they educate their patients and the communities that they serve with that information to find that no wrong door. Because the beauty of the access and crisis line is they have those connections, they can pull it up.

It would be lovely if we had that rubric right, where we all know and luckily with the relationships that we have, we can do that.

I just wish it wasn't so difficult because one of the things that also happens with the siloing process is Medi-Cal patients have to be seen in Medi-Cal clinics and managed care patients can be seen in managed care clinics. So you see fragmentation outside of hospital and emergency care.

This fragmentation where, if you're going to see this type of patient, you have to be in this physical setting and if you're going to see this patient, you have to be in this type of physical setting. And yet the two patients are identical in presentation, but we're treating them very differently just because of their payer stream.

And that's a problem. And that is something that can get addressed at, you know, at a state level with regard to, you know, being able to see these medi-Cal patients at the same time that they can be seen in a managed care situation, not just in a hospital or a crisis situation.

I've gotten permission from Dr. Patel to ask one question, but you have to answer in one sentence less than 10 words. What can the state do to address the issue with mental health stigma? 10 words, 1 sentence.

Remind people that mental health is not a characterological flaw.

Along those lines it impacts everyone. Everyone has every single person family has been touched by mental illness or mental disease mental illness and needs support at some point in their life.

Help teachers, parents, school systems understand that their kids are going to be okay and that they can do this and encourage them as opposed to finding flaws.

Thank you for closing out this panel with some optimism. Appreciate that heavy topic. I'm pretty sure we all have a thousand things we could have asked you in addition so you will be having follow up from us. Thank you.

And we will have our panel 2B panelists please come up. Thank you.

Oh, you are? Yep. Okay, here we are. Here we are. We're all together first, right? Yes.

Thanks, Caleb.

Thank you. We will go in order of the agenda. Karen, you can go first.

Thank you for being here. Yes. I'm Karen Ogden and my husband and I have a nonprofit and it's Solifex. It's a youth leadership and wellness organization. So 30 years I've spent as a teacher and my husband 36, working mostly as a school principal. Can you hear me? Okay? Okay.

Who now works in the charter world working with dropout recovery students. You can find most of our information on our website. So if I don't cover what you want, most of it is there.

So year after year, we'd witnessed the growing social emotional challenges our kids were facing a lot dealing with unrealistic performance, pressure creating anxiety, depression, and suicidal ideation. So when learning that there were seven suicides in four years at our local high school and those are the ones we heard about, I knew I needed to do something.

Our community in Poway formed what I Wish my parents knew, a Committee with a lot of leaders in the community, and I was a part of that. But what I really wanted to address is what is our community doing for prevention? How are our students getting to this point? Right. So in 2013, it's been a while.

I retired early so that I could devote myself full time to youth mental well being and began doing research with mostly Cal State San Marcos teams, healthcare professionals and a suicide prevention specialist. So our nonprofit, Soul Effects stands for Step Out, Lead Every Day and the effects it has on our lives and others.

And it was launched in 2015. Our mission is to empower youth to become confident, purpose driven leaders. I'm assuming I go here? Whoops. There we go. For three years, we worked with high school focus groups led by college students.

Then for eight years, our team took 25 to 30 college interns into Powell Unified School District middle and high schools as they mentored students over 91 hour sessions every spring.

With the guidance and direction of our team of professionals, these interns, through trial and error of different strategies and methods, together we came up with best practices for the greatest impact. I'd like to say pickleball would be the answer to everything, but there is. There was so much that we learned.

So we created a Youth Our solopex Journey program, which we refer to as a Youth Leadership and Wellness. I think I mentioned that and you can understand it much better on our website. What an adventure. We don't use the word lesson looks like. And what it entails.

We have clear evidence that near peers have most of the answers. With a constantly changing world of media, our youth listen to them as they share their own personal challenges and strategies on how they overcame these. Dr. Patel attended our sessions in the high schools and was always very, very supportive of our work.

As I was telling Tiffany Campbell, she was always in the weeds and I just really respected that about Dr. Patel. Because organizations saw that lives were not only being changed and several lives saved, many came alongside us.

We received 36 grants over the years and the most impactful have been RV Sunrise, Rotary Assembly Member Kristen Gaspar, Joel Anderson and our last grant provided us with a half $1.0 million, which is Brian Maienschein Assembly. Brian Maienschein is a huge proponent of youth mental health and we'll be forever grateful for his work.

Brian wanted to ensure that our program was going to not only significantly impact hundreds of thousands more students, but it would truly be life changing for each of them and that he wanted to see sustainability. So right here it shows the numbers, I believe. Sorry. Sorry.

Right here it shows the numbers and that top is actually doubled since then. So I'm going to go back to right, right here. Because of Brian's support, we created 10 very impactful videos. We hired a producer, Director and a diverse team of five online college influencers who we knew would be extremely positive role models for students.

These influencers are the ones who teach the lessons and provide specific strategies for each of the lessons you can see here and achieving our goal of making it as easy as possible for teachers and for implementers.

We never thought we could replace in person mentoring from college students, but we have a training for peer students to be the guides or the mentors.

That actually has been more impactful because they used to try to want to impress the college students and now they're working with their peers and who step who are stepping up and leading their small teams of students in discussions. So students are able to set goals each week. Their team provides accountability and support from them.

This funding of Brian's allowed US to impact 7,500 high school students in Poway Unified, Escondido Union High School and San Marcos Unified. So and I could not believe there's paid counselors, peer counselors in San Marcos. I was just so amazed with that, learned so much here.

So in 20221 of the largest and most successful educational organizations in our country, AVID was very interested in our program at that time. Following the social and emotional impact Covid had on students, they were looking to create exactly what we have in our Journey program.

So we met with avid's Vice President, their curricular team and business team, and they ended up acquiring our program. They have taken our journey to their seventh and 10th grade students nationwide, as well as Canada and Australia. So we're thrilled about that, especially as retirees. Today.

SOL Effects is able to provide our program to any youth organization outside of all K12 public and private schools because of AVID owning that Cal State University has implemented. Cal State San Marcus has implemented our program and their leadership programs for three years now. And it's relevant for seventh grade through young adults.

So so many students would come to us and say, we're so tired of people coming in and lecturing to us and telling us what to do. We know what to do and we just need to be able to talk.

And, and that's what they said was different about SOL Effects is that they could have conversations, honest conversations with each other in small groups, realizing that they are not alone.

So we're firm believers that all students are in need of communities, safe places like we all do, where they feel they're not the only ones with their challenges, but a place they can express themselves and feel that they belong. And our SoloFX journey is meeting this need. Thank you.

Christa, go ahead.

Hi. Thanks so much for having us. I'm Krista Esquivel. I'm Vice President at the YMCA here in San Diego County and I'm a social worker. I've been a social worker for 20 years. I'm here with my colleague Kristina Halmai, who's a therapist. And number one, we're very happy to be here.

Number two, the YMCA sits in a very unique place here in San Diego. County. We have the opportunity to serve lots of children, families through our child care, amazing enrichment programs. But we also have a continuum of clinical treatment programs here in San Diego at ry.

And we have the enjoyment of being funded by the County of San Diego Behavioral Health Services, also cybhi, also samhsa at the federal level, also fee based, also Medi Cal.

So we really see the gamut of the challenges that exist and that Ms. Pravara, with the county Behavioral Health brought up in terms of the interconnectedness but also the disconnection between these funding sources. And I think you said it very well, Assemblymember.

When our families and our children, they don't know what they're funded by and they're seeking services and as a provider who has to use multiple lines of funding to do that with a family and to make it feel seamless is almost impossible.

And we see that, you know, young people and families have multiple barriers to accessing mental health. There's long wait times for clinical care, there's inequities for under resourced communities and populations. And of course, as everyone has already talked about, the demand is outpacing the workforce.

But like I said, we have a really unique perspective as the YMCA because we are serving families. We have infants to older young people, right. Transition age youth.

And this led us to think about mental health in a different way and to try something different and new in our community based on the fact that we have this really again unique perspective, this very unique geographic so sort of spread in the county as well.

And so we are evaluating a positive youth development based model embedding mental health promotion into everyday environments like our sports, our camps, our after school programs.

Again, like many of the panelists have already talked about, really thinking about how we can connect mental health into these touch points that help build wellness, but more specifically how we're helping to build stress tolerance in kids and how we're helping them develop those skills. They were described as protective factors.

But to second Dr. Kane's comments and Dr. Reiter's comments and Dr. Beam's, keeping kids out of intensive treatment options is our goal. It's our goal to not have residential facilities. It's our goal to not have children.

Have to be in these very high intensity traumatic experiences and have families experience what happens in situations like what Dr. Kane described. And that does happen. We see that happen. It is. I also didn't know I'm a parent. I have the most spirited and wonderful nine year old who I'm extremely worried about.

She's going to be okay and I've got to pay attention. And I feel so lucky to have the perspective that I have. But it also makes me just as worried as every single parent here in San Diego. County.

The most recent community needs assessments out of our nonprofit hospitals have all settled again on the same same worry that parents have about their kids. And it's mental health and it's, it's, it's a really important and reasonable concern.

So thinking about how we can really continue from the state level and the local level, continue to think about how we scale investment in prevention oriented models alongside clinical care. So I believe.

Doctor Weiss from the office of the San Diego County Office of Education and a couple of our other colleagues on the panels before talking about these integrated approaches. So something that we've been working on at the Y is really how we Talk about it. And Christina will talk a little bit more about it as well.

Democratizing therapeutic and clinical care and putting it in the hands of the people who are closest to our kids, who our kids feel most comfortable with. Their coaches, their teachers, their after school counselors at the Y, the swimming coach that they have, the folks that they're spending the most time with and really helping to upskill those folks.

Not to necessarily provide clinical treatment, obviously, but to be with kids and families in a way that's truly building those protective factors and building those stress tolerance skills so that young people have the skills they need to navigate the world the way that it is. The world is hard. It's difficult, it's scary.

And when we have our ability to tolerate stress and recover is like the most important definition of positive mental health. It's not about being happy all the time. It's not about waking up in a good mood every single day. It's our ability to meet the natural obstacles that we are all going to face.

Unfortunately, some of us will face more difficult ones than others. But facing those obstacles, being able to navigate them and being able to recover, those are the skills we want to teach our kids.

Those are the things we want our villages to be helping support our kids with, whether it's at school, whether it's in after school programs, whether it's in sports programs, wherever it is.

So if we can start to spread these more preventive practices in and alongside clinical programs and clinical services, we're going to be able to use those resources in such a highly effective way. I do want to also second a couple of the logistic issues that our colleagues before us on the panel presented.

We're also developing a nature informed IOP and partial hospitalization program. We have invested almost $1.0 million in that particular development of that program from philanthropy, from other sources, getting that money to invest in that. And we're not there. We are not there.

So the challenges that have to be overcome to build capacity to even start to think about creating more services, they're astronomical. They're astronomical. What you have done, Amazing. It's amazing. When community based organizations or hospitals even are able to stand these things up. We take them for granted. We think that they're easy.

We think it's easy to just get on a panel, an insurance panel, and start billing for your 30 minutes. It's not easy. Our friends at Radies are definitely like, no way. It is not an easy thing to do. It is very, very difficult. You need a PhD to read billing codes. This stuff is hard.

It is very hard. And you're under reimbursed, you're undervalued for how difficult those things are. So I just want to second all of that. And it is a really difficult thing to do.

So if it's possible for us to invest in capacity building in those areas as well, that would frankly take some of the burden and the pressure off of some of our institutions, be it our school settings, our community based organizations, our hospitals even, to be able to have some breathing room, some space to figure out the logistics of this and get through the bureaucracy and the administrative burden to make some progress in those areas.

And then the again the increasing our ability to have naturally occurring supports for children in more organic ways. Kristina will talk further about that and what young people are asking for. Dr. Patel, you talked about meeting young people where they are in a way that works for them.

That's what we need to do and we need to be able to have funding for that. Not our traditional and please don't get me wrong, evidence based practices are extremely important, but the ones that are on the clearinghouse are typically ones that were tested rigorously 2030 years ago with very specific populations.

And we need to have some more flexibility in how we can use our funds to be able to have access to community defined interventions and also more innovative interventions that aren't just pilots that last for 18 months, though it takes, like I said, it takes probably 17 months to get through the papers and then you have the one month where you can provide the service and then the program's over.

These are all very real things. They're very challenging and we've got to be able to get through some of those policy barriers to get us anywhere. And Christina will talk a little bit about what we've heard from young people, specifically about how they want us to show up in clinical settings.

Hello. Hi. Hi. I'm Kristina Halmai-Gillan. I am a licensed marriage and family therapist and serving in the role as Director of Service Innovation with YMCA here in San Diego. Everybody has really covered so much that is valid and true and urgent.

I won't say much and I certainly won't steal from the young people that I know are going to speak. But I would like to really raise up that we need innovative practices. Young people are asking for innovative practices. In one line.

Youth want mental health access that feels relational, culturally relevant, activity based and embedded in safe places within their communities, not just in clinical offices. There is a time and place and need for that, but that is not for everybody.

They identify as a generation and a generation who quite frankly, has experienced things that we have not all grown up with yet. We are still resorting to the things that we know that have worked in the past, particularly social media. There are strengths and deficits within social media. I also am a parent of teens.

I'm not fighting against, I'm fighting with. But I have a real concern around the amount of young people who are resorting to AI for mental health support. We've heard the horror stories.

So, you know, I won't go there, but I do think we need to really be talking about it and talking with them about it and getting ahead of it because it's dangerous to become reliant on that.

We know that, you know, because there's so much screen time that there's less time outdoors and there's less time in person and they have lost access to community places. Right.

I mean, frankly, there's a lot of adults who have perspectives and attitudes towards youth that are not friendly and when they congregate and they're in person, they get shushed away when those kinds of things are important and to have access to each other and to a park or to a parking lot even, or to a sports field or court or what have you.

Those are all really important things that we need to prioritize and put up front just as much as we do the clinics and the offices and the higher levels of care. Also, as everybody else has said and Krista was getting to, none of those things are reimbursable. Field trips are not reimbursable.

Week long, two week long IOP programs that are outdoors at a beach or in the mountains are not reimbursable. Currently.

If we can figure out how to reimburse for those types of activities, I think we could really, you know, shine a light on what's possible and really, you know, kind of navigate what mental health, what mental well being and what mental health care looks like going forward. I'll be done now.

Yeah, thank you for that. And our final panelist, Erin.

Hi. I just wanted to make sure I was close enough to it. Hi, I'm Erin Langs and I am the founder of CARES Advocacy.

I am a certified mental health first aid instructor through the National Council on Mental Wellness of Washington D.C. my CARES advocacy organization also has mental health education curriculum that I developed after unfortunately in the spring, the National Council removed several groups out of my curriculum that I still currently teach on public school campuses.

My experience since being on four different high school campuses here in San Diego in the past 14 months is my first school was Westview and I was actually introduced to the parent wellness group at Westview High School through Scott Keane and a couple other individuals here in this meeting.

And they were my first mental health first aid class. So mental health first aid. I will echo a lot of what you said because you've obviously had mental health first aid or you know about it. Mental health first aid on high school campuses is teen mental health first aid.

And what the teens are informed and taught is how to safely identify and support each other in challenges and even crisis. But what we do talk about are challenges don't always have to turn in to a crisis if we start paying attention early. The National Council only has this curriculum through 9 through 12th grade.

So 14 to 18 years old. They have not addressed, unfortunately, elementary or middle school. I think we need to focus on education much earlier around this. It not only is helpful for the students, but it is helpful for families. It's helpful for parents. I do have.

There is a student who will be on the panel after us who was in one of my classes at Torrey Pines High. I also have another student. I believe he's coming for the next to watch the next panel and give feedback. He was in my class two weeks ago at Scripps Ranch High.

I've also taught at Canyon Crest Academy and I'm drawing a blank what my other Torrey, Westview, Canyon Crest and Scripps Ranch High. I've also trained at multiple nonprofits in San Diego, county, both for youth and adult students. If you walk away from this, the one thing I want you to remember me saying, students are craving this information.

I cannot tell you how many young women and young men come up to me after each class wanting to just talk. I have students personally asking to have an in person meeting or a FaceTime with me because they don't want to be on Zoom. They don't want to talk on the phone to me.

They want to see my face and they want to be right here. So FaceTime on an iPhone is much better for them. They don't want to be online learning this. They don't want therapy online. I mean, I'm gonna. The feedback I keep getting.

I was at the behavioral health tech conference downtown two weeks ago for three days and there was a student panel there. And there were five students who kept talking about how terrible AI is for mental health support and how much they can't stand it. And they do want things in person.

So this education at the school level, at school, I just I can't stress it enough. We talk a lot about stigma and again I'm going to echo what has been said before these students. I have students, first day of class will talk about their own personal self harm to an entire class of students.

They don't know all of them. At Scripps Ranch High School it was grades nine through 12 that were allowed to sign up for this class. They didn't all know each other and they are being vulnerable and sharing in a room because they feel safe.

And then we talk about how this young person evolved and got over it or maybe they're still struggling with it. So I just keep going back to this is a community concern. We have to circle around our families, we have to circle around these students and the earlier the better.

I am the mother to a 24 year old and a 21 year old, both boys. I've been to the emergency room with both my boys suicidal.

My first time was with my son when he was in fifth grade and he told me how he was going to slit his throat because he was being tortured at school for being chubby. We didn't know he'd been in a fight. School never called us. I have lived experience with this.

So I know what it's like to walk into an emergency room. They put a security guard right on you. If nobody here has been to the hospital with a student, a security guard's with you the second you walk in and you say my son just told me how he's going to kill himself.

So we need this, we need this community support. It needs to be earlier. I'd like to speak to the 988 and the crisis response team that we are so lucky to have here in San Diego. I bring that up at every single school.

I train teachers on these campuses before I'm allowed to teach teen mental health first aid. And I will tell you most of the teachers aren't aware that there is this crisis response team. These students, before they walk out of my last class, they all are able to answer to me, what do you do?

What do you do in a crisis when you call 911? What do you say if they call 911? Each one says to me before they walk out of the room, I ask for mental health support with the response team because how beautiful is that?

I've met two families who lost their sons to suicide because their sons were arrested and put in police cars. And they went and we're checked on a 5150 and they thought if this is what's going to happen to me when I'm having mental health crisis or challenge? I don't want to be here and they're not here.

So that response, I talk about that constantly. It should be in every single high school. On a poster. 988,911Ask for mental health support on a 911 call in San Diego. County. We're so fortunate to have it. So it's a privilege for me to be here. Thank you.

And it's a privilege for me to share what I am hearing. Boots on the ground from these students. They are craving this and every single student should be able to have this education. I've educated probably about 150 students in county because each school I go to the maximum that could sign up for the class.

30 kids, 30 students. Because it was paid for through like foundation, Money Cares Advocacy. My organization. It's privately funded by me. I can't, I can't apply for federal grants because then they're going to tell me I have to exclude people out of my curriculum and I refuse to do that.

My 24 year old is incredibly high functioning neurodiverse. Graduated from Vanderbilt University, works in wealth management in San Francisco. He is extremely neurodiverse. I'm well educated in this. My degree is from UC San Diego Ravel College and psychology, specializing in autism. I'm not a therapist.

I tell students I'm not a mandated reporter oftentimes, which is why they want to come to me and say, how do I talk to my mom about getting some help, those kinds of things. But the students are craving this and they should all have it. It's going to help all of us if we start early.

Thanks. Thank you for your insightful comments. Once again, I think when we bring in our nonprofits, we can see what breaking down barriers and breaking down stigma looks like because that's what our nonprofits do. They come into the community, they work directly with our students, they build up capacity within our young people.

And I definitely applaud your work and would love to find ways to make it more sustainable. The funding models definitely make it challenging on, off, up, down.