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I_ECR_BH_2021A 12/10/2021 09:08:08 AM Committee Summary

PUBLIC
STAFF SUMMARY OF MEETING
INTERIM COMMITTEE  BEHAVIORAL HEALTH TRANSFORMATIONAL TASK FORCE
Date 12/10/2021
Attendance
Amabile X
Michelle Barnes X
Kim Bimestefer X
Bradfield E
Michael Conway X
Kolker X
Michaelson Jenet X
Dianne Primavera X
Priola X
Simpson X
Van Beber E
Robert Werthwein X
Dean Williams X
Winter X
Gonzales-Gutierrez X
Pettersen X
Time 09:08:08 AM to 04:53:40 PM
Place Old State Library
This Meeting was called to order by Pettersen
This Report was prepared by Juliann Jenson
Hearing Items Action Taken
Call to Order, Opening Remarks, and Committee Schedule Committee Discussion Only
Review of Subpanel's Recommendations Committee Discussion Only
Review of Additional Proposals from the Governor's Office Committee Discussion Only
Elevating Transformational Proposals Committee Discussion Only
Next Steps and Timelines Committee Discussion Only
Public Testimony Committee Discussion Only

Call to Order, Opening Remarks, and Committee Schedule - Committee Discussion Only


09:10:37 AM  

Senator Petterson called the meeting to order and provided an overview of the agenda and the process for the committee to complete their work.  She thanked the subpanel for the work they have done to assist the task force.

09:11:50 AM  

Senator Petterson discussed issues facing the behavioral health system that were highlighted in a recent news article and how that has informed the committee. She explained that the committee will discuss this issue later in the meeting.



Review of Subpanel's Recommendations - Committee Discussion Only


09:14:07 AM  

Vincent Atchity, Subpanel Chair, discussed the activities of the subpanel and how the subpanel determined its priorities. He discussed ranking the recommendations.

A list of the subpanel's priorities may be found on the task force website at: https://leg.colorado.gov/sites/default/files/images/committees/2017/bh_supanel_recommendation_summary_1.pdf

 

09:20:32 AM  

Jacob Bornstein, Wellstone Strategies, explained expectations and the recommendation list.

09:21:53 AM  

Marisol Rodriguez, Wellstone Strategies, also explained the process for reviewing recommendations, including question and answers. 

09:23:25 AM  

Committee discussion ensued about the process and how to proceed with the review of the recommendations. 

Senator Pettersen asked the task force members how they would like to proceed with the discussion about the recommendations. Committee discussion followed about how to proceed.

09:34:16 AM  

Lesley Brooks, Subpanel Vice-Chair, presented Recommendation A: Southern Ute Behavioral Health Facility: One-time dollars to support the Southern Ute community in renovating an identified existing facility for inpatient services as well as for establishing transitional housing. Should also serve the Ute Mountain Ute tribe if possible.

Committee members discussed the recommendation and focused on other federal funding available to the tribe. Further discussion about whether the recommendations would fall under the federal guidelines for expending the American Rescue Plan Act (ARPA) funds.

The facilitators asked the committee to show their support for this recommendation by using the fist to five process, with a fist being no support and five fingers as full support. 

09:51:14 AM  
Dr. Atchity discussed
Recommendation B: Youth and Family Residential Care: Invest in youth and
family residential care, ensuring that young people do not need to be sent
out of state and families are able to receive respite across the state
through the following strategies: 1) Youth Neuro-psychiatric capacity for
up to 16 beds, 2) Respite for 10 to 12 centers for children and families
for 60 to 72 beds, 3) Youth Psychiatric Residential Treatment Facility
(PRTF) & Qualified Residential treatment Program (QRTP) ongoing support
through Dec. 2026.  Committee discussion followed. about the type
of respite care that this recommendation would cover.  Committee members
raised questions about the ongoing costs related to the recommendation.
 The facilitators proceeded with the fist to five for this recommendation.
10:08:42 AM  
Dr. Brooks presented
Recommendation C: Adult Residential Care: Invest in adult residential care
in high-need areas across the state that meets gaps for the adult population.
The purpose is to provide integrated step-up and step-down care in transitional
housing, supportive housing, and recovery homes. This should serve people
with intellectual and developmental disabilities, those with co-occurring
conditions, those involved in the criminal justice and competency, people
experiencing or at risk of homelessness, and other populations experiencing
disparities exacerbated by COVID 19. Funding expected to be paired with
the Economic Recovery and Development Task Force to address homelessness.
Facilities should, wherever appropriate address both substance use disorder
and mental health. Committee discussion followed about increasing the amount
of funding dedicated to each of the recommendations. The facilitators proceeded
with the fist to five for this recommendation.
10:19:44 AM  

Dr. Atchity presented Recommendation D: Immediate Life-Saving Activities (including Opioid Response): Invest through the community investment grant in treatment on demand and Medicated-Assisted Treatment in communities with high need, including for those involved with the criminal justice system. Consider focusing on ensuring community MAT providers can service the jails to better ensure smooth transitions. Two direct investments are also requested: Naloxone bulk purchase fund for an additional 5 years, and harm reduction funding through CDPHE ‘s HIV/STI program.

Committee discussion ensued about community investment grants, funding, and the use of current funds allocated for Medication Assisted Treatment for individuals involved in the criminal justice system. The facilitators proceeded with the fist to five for this recommendation. Committee discussion continued about other resources for this recommendation.

10:40:42 AM  

Senator Pettersen recessed the meeting.

10:51:37 AM  

Senator Pettersen reconvened the meeting.

10:51:55 AM  

Dr. Brooks presented recommendation E: Primary and Pediatric Care BH Integrations: Invest in School Based Health Centers.

Committee discussion followed about the implementation of the recommendation. The facilitators proceeded with the fist to five for this recommendation. Committee discussion continued about other resources for this recommendation.

11:14:45 AM  

Dr. Atchity presented recommendation F: Children, Youth, and Families Community Services: Through the community investment grant, ensure there is a youth and family oriented care center within a two-hour drive of every community by investing in eight to ten additional centers. These would support children, youth and families in crisis. These centers are envisioned to build out the hub and spoke model beyond beds. Additional grants may be allocated for expanded caregiver interventions and establishing other evidence-based services, including care navigation and coordination.

Committee discussion followed about supporting existing services and infrastructure. The facilitators proceeded with the fist to five for this recommendation. Committee discussion continued about other specifics. 

11:29:05 AM  

Dr. Brooks presented recommendation G: Crisis Response, Diversion, and Competency: Through the community investment grant, fund communities to develop or expand pre-arrest diversion programs (e.g., STAR, mobile response, co-responder), post arrest diversion through the judicial branch, and intensive community-based services. In addition, allow for judicial districts to apply to add additional competency courts for high-need areas for up to 3 years of funding.

Committee discussion followed about existing state resources and programs related to pre-arrest diversion. Discussion focused on being too prescriptive on how to utilize these grants. The facilitators proceeded with the fist to five for this recommendation. Committee discussion continued about specifics and community grants that are designed to address community needs. 

11:55:25 AM  

Dr. Atchity presented recommendation H: Care Navigation & Coordination: Through the community investment grant, augment existing infrastructure, and develop additional regional centers as needed to support a localized resource navigation system for each region of the state. These should be connected to the navigation hub funded through SB21-137 and an expanded 988 that is also connected to the care navigation database. Separately, enforce current statutes and strengthen language so that anyone who is eligible for Medicaid in the justice system is getting enrolled. Funding for both of these should save money in the long run due to connecting people to care they need.

Committee discussion followed about flexibility for implementation, issues related to care coordination, and limitations related to technology. Concerns were raised that this recommendation may be duplicating efforts. The facilitators proceeded with the fist to five for this recommendation.

The committee took a lunch break. 

12:20:42 PM  

The committee reconvened and wished Madam Chair a happy birthday.

12:50:35 PM  

Dr. Brooks presented recommendation I: Workforce Expansion and Recruitment: Invest in a tiered and expanded workforce that includes clinicians, peer support professionals and other staff. In addition, ensure reciprocity so that people from other states and countries can come to Colorado and fill behavioral health positions, especially when they can serve and/or identify with high-need populations.

The committee discussed different community needs across the state.

12:57:49 PM  

Dr. Atchity presented recommendation J: Workforce Training: Focus on three strategies: 1) Provide funding for established and accredited academic institutions to develop rural behavioral health academic hubs or satellite programs to support virtual licensure-track degree programs, including technology investments. 2) Invest in Crisis Intervention Training for all law enforcement both through funding and policy requirements. 3) Support all safety net providers by 2026 to be a) culturally and linguistically competent and b) serve a set of complex youth needs, including mental health, IDD, autism, SUD, and co-occurring conditions. Incentivize with rating system and consider higher Medicaid rates for certain cases.

 

 

12:58:55 PM  

Dr. Brooks presented recommendation K: Workforce Retention: Allocate funding for workforce retention for direct service. Strategies include short-term salary increases, bonuses, and telehealth investments.

12:59:23 PM  

The committee discussed recommendations J and K. The committee discussed different aspects of community behavioral health aides and peer support services. They talked about the need for training the workforce within Colorado and keeping the workforce in the state.

The members discussed different ways to keep the people providing these services in Colorado, including compensation and benefits.

01:13:27 PM  
Mr. Bornstein spoke
about funding allocation requests and the facilitators proceeded with the
fist to five for this recommendation.
01:22:24 PM  

Dr. Atchity presented recommendation L: Community Investment Grant: Provide funding for the above-mentioned recommendations that can be funded through the grant (totaling about $140m) as well as this additional amount to fund local governments and community-based organizations to address identified behavioral health needs. The Community Investment Grant would provide funding to services along the continuum of behavioral health care that meet regional needs. Specifically, there should be investments in evidence-based programs along the continuum, including prevention, treatment, recovery and diverting people away from the criminal justice system. To effectively implement these investments without further bifurcating the system, there should first be a county or regional level assessment that identifies gaps in the service continuum for that community and areas that need investment should be identified.

The committee spoke about identifying state-wide gaps and needs.

01:24:00 PM  
The committee members
debated the funding in recommendation L. The facilitators proceeded with
the fist to five for this recommendation.



Review of Additional Proposals from the Governor's Office - Committee Discussion Only


01:43:59 PM  
Cristen Bates, Department
of Health Care Policy and Financing (HCPF), presented the recommendations
from the governor's office.  She gave an overview of how their team
will go through the recommendations.
01:45:55 PM  

Ms. Bates first discussed behavioral workforce investments and emphasized workforce shortages across the state.  The recommendations addressed flexibility, enticements, and other investments. 

01:47:46 PM  

Ms. Bates proceeded to the next recommendation regarding behavioral health safety netcapacity building.  She noted that SB19-222 requires the state to have a safety net by January 2024. 

 

01:50:31 PM  

Dr. Werthwein presented a recommendation regarding bed capacity, including competency.   He discussed the demand for competency restoration services and beds. 

 

 

01:53:51 PM  

Dr. Werthwein proceeded to discuss the next recommendation regarding investment in communities via local grants.  He emphasized the importance of grants on the local level to address community needs. 

01:56:18 PM  

Dr. Werthwein continued to the next recommendation about psychiatric services for youth with complex needs.  He discussed youth with co-occurring disorders and the benefits of community-based treatment options. 

01:56:57 PM  

Ms. Bates returned to discuss the the state innovation model, integrated behavioral health.  She stressed the importance of integrating behavioral and physical health services. 

01:58:22 PM  

Ms. Bates discussed the seventh recommendation about immediate life saving activities for substance use.  She explained the benefits of investing in harm reduction and Naloxone.

 

 

02:01:41 PM  

Elisabeth Arenales, Office of Governor Jared Polis, discussed the public safety related investment recommendations, including early intervention, behavioral health information sharing, domestic violence support, and school mental health resources.

02:08:08 PM  

The committee asked questions about and discussed the recommendations.



Elevating Transformational Proposals - Committee Discussion Only


02:21:32 PM  

Mr. Bornstein introduced the Tier 2 recommendations from the subpanel and referred to the previous handout given to the committee. 

The tier 2 recommendations can be viewed here on Page 3:  https://leg.colorado.gov/sites/default/files/images/committees/2017/bh_supanel_recommendation_summary_1.pdf.

02:23:56 PM  

The committee members talked about mental health stigma, holistic care, consistency, and accountability.

02:34:07 PM  

The committee proceeded with the fist to five to gauge whether to continue the discussion around the tier 2 recommendations.

02:40:10 PM  

The facilitators proceeded with the fist to five temperature check to include the tier 2 residential care recommendation in the subpanel's workforce recommendations.

02:44:07 PM  
The committee discussed
funding for school health services and mental health providers in schools.
02:49:31 PM  

The facilitators proceeded with the fist to five temperature check on the tier 2 recommendation related to adding the School Health Professionals Grant program to the safety package proposal.

02:59:27 PM  

The committee continued to debate the tier 2 subpanel recommendations and which recommendations to elevate to tier 1.



Next Steps and Timelines - Committee Discussion Only


03:18:24 PM  

The committee discussed accountability and safety net programs across Colorado.

03:25:17 PM  

The committee continued to discuss how to get care to the sickest people in Colorado.

03:31:51 PM  

The committee discussed the next steps before the committee takes a final vote on the recommendations in January. The facilitators told the committee that they will host office hours for members to ask questions over the next couple of weeks.



Public Testimony - Committee Discussion Only


03:34:45 PM  

Hope Hyatt, representing Colorado Mental Wellness Network, testified.

Frank Cornelia, representing Colorado Behavioral Health Care Centers, testified.

Committee members made comments about the testimony.

03:44:51 PM  

Maree McRae, representing Colorado Heart, Mind, Connect, testified. Jenny Stith, representing WINGS Foundation Inc, testified.

03:52:53 PM  

Elizabeth Newman, representing Colorado Coalition Against Sexual Assault, testified.

03:57:21 PM  

Danielle Felder, representing Colorado Alliance of Boys & Girls Clubs, testified about behavioral health and community support.

Ms. Jennifer Roberts, representing Colorado Cross Disability Coalition, testified about individuals with disabilities.

04:06:52 PM  

Cecilia Martinez, representing Family & Intercultural Resource Center, testified about bi-lingual providers. Mr. Lance Tunick, representing self, testified about his son's experience in Colorado.

04:14:56 PM  

Jenny Loth Hill, representing herself, testified about the mental health system and childhood trauma. She also discussed houselessness.

04:21:36 PM  

Sandra Dummit, representing self, testified about mental health care.

Mr. John Reid, representing Beds, and Funding, testified about residential facilities and therapists of color. Steve Bell, representing self, testified about his personal experience with a behavioral health condition.

04:36:31 PM  

Mr. Ken Coburn, representing self, testified about diversion programs.

Darik Gutvwiller, Arapahoe County Sheriff's Office, accompanied Mr. Coburn.

Mr. Jonathan Cappelli, representing Neighborhood Development Collaborative, testified about permanent supportive housing.

04:49:34 PM  

Commissioner Pelton, subpanel member, discussed a potential audit of the behavioral health system and community mental health centers.


04:53:40 PM   The committee adjourned.