Public Health, Welfare and Labor Committee- House & Senate

members if you have questions I think even if you're not on the committee at this point in the room you have a question just press a button will try to recognize you at we talked about whether the whole questions to the end or just having as they go I think for the flow of conversation happen is that goes fine with fine with us and find with the DHS so if you if you do have a question is we're going long process but let me know will recognize you and once appropriate let you ask questions so with that would recognize it once you can ask your names and introduce yourselves and we'll go from there. Thank you and good afternoon I'm Janet man and the deputy of health and the Medicaid director for DHS. Hi Melissa whether ten I'm the division director for developmental disabilities services. Hi I'm Paula stone I work for DHS for both Division of Medical Services and Division of aging adult and behavioral health services focusing on children's behavior. And I'm trash can on the deputy director division of aging adult beer all that services focusing on behalf of health for adults. I'm just a quick note of the change on the agenda got house was going to be here and help us president and they've been one of our partners on this journey that due to weather and they we think they got out otherwise they're sitting at the airport listening to us so we're going to do the presentation free all. Seven four we dive into the power point we just wanted to give a little and background on kind of what population we're talking about why we're here presenting this and where the funding came from to actually do this analysis so. The who in this presentation so we are trying to build a system that will be available to every our cans and those who are on Medicaid those are on Medicare those from private insurance so regardless of whether you're a child you have intellectual disability and you have behavioral health only needs if you're having and behavior acute crisis episode out in the community which could be your home or your school or anywhere else in the community this would be the system that will connect you to a mobile crisis team so the what it's mobile crisis response teams that we're trying to build that will go to all of these places and the Y. E. is because we have learned over the last several years and it's become really am really transparent that we don't have what we need in place to I'm a sass and stable as people in their homes we we have nine one one people go to jail people are taken to emergency rooms and then once those two things occur their stock so we are not providing the appropriate treatment for them and then the how is what we're going to show you in this presentation so before we jump right into and what we're thinking and get your feedback on it. I want to tell you that there's two types and you'll probably know this but just to be clear there's two types of American rescue plan funding so we call it internally and this is not the word but we call it the big are okay and that's the money that the state of Arkansas gas that's the money that governor Sanders and now is I'm going to do and give out and under her control we have another funding source within Medicaid and it was M. it was available to us through the center for Medicare and Medicaid where states can apply we applied for the spending back and and twenty one and we had to send in a really detailed proposal on what we would use the funding for we referred to that is our ninety eight seventeen because that's the federal statute that this falls under and it's very specific on how we can use the money so we can't use that for renovations we can't use it for construction we couldn't raise rates with that it's one time funding and it can only be used to expand or enhance home and community based services here in Arkansas so we have a lot of initiatives that we are building with about a hundred and fifty one million dollars we were awarded so and I think I've talked to you guys before out of that a hundred and fifty one million we gave a hundred and fifteen million directly to providers so they could recruit and retain their staff said the remainder of the money we are using to build a variety of programs and this today is just one of those initiatives where we are utilizing that and that federal funding stream under the ninety eight seventeen fines so any questions there and if not I'll start the presentation. Okay we do have some questions or a question. We do or don't I pressed a button we don't have a question on the let me see come over here Senator Irvin run this thing should look over my shoulder make sure on that when there's some that a lot now right proceed. Okay so you guys can write that on the screen but for those you don't have in front of you what we're planning to do today is the we want to go through kind of the goals of what we're doing and a background of how we got here and then open discussion and get your feedback on what we've done so far. So the background on this so and as and at a deputies are deputy. What is the title. What. Right what what makes me and am mentioned earlier but we have been utilizing guide house as a vendor to help us build a prototype essentially and best practices from other states so we're going to review and access that they've uncovered through sept for many many stakeholder interviews there we're going to talk about these deployment of these crisis teams funding sources are population needs and provider capacity and I turn it over to Mr. So we started the project with the vision and I think molesters cover that that vision being community based crisis so services delivered in communities are to stabilize people as much as possible and having those services those community response services coordinated and as coordinator because first responders social service professionals in clinical staff so we can have everybody responding to make sure that we're getting people to the right place to do that we wanted to make sure that we have a centralized system to connect everyone with that mental health intervention and treatment once they're stabilized to build that capacity amongst providers to assess and then triage and stabilize triage is the word that we use a lot in the emergency departments when people come in also on the battlefield we use triage but definitely in community settings triage means you know what do they need immediately what we do to keep everyone safe and then hopefully stabilizing people the more people we can stabilize in their home or in their school or in in a community setting the fewer people we have that are moving into higher levels of care we want to have that centralized hub because we have a lot of these kinds of services going on around the state with different providers in different funding sources and we wanted to centralize that want to collect the data to see exactly who needs the services where people are going but also to get that cooperation across the stakeholders we also need to build technology solutions to support that I'm in those clothes with notification so ensuring that once somebody makes a call and then someone goes out that that is that they're going out and that that there's the situation is resolved as well as what's needed the next day so a lot of times people get stabilized even if they don't go to emerge. As the apartment or another location and then they don't get that follow up here the next day so we really wanna make sure that warm handoffs I and then that crisis response teams and the teams means not just professionals with a clinical background but also pair professionals or peers sometimes are used particularly for adults with mental illness but also the individuals that can be trained to address all of the needs so Melissa mentioned that we have people with behavioral health needs that also are either young children or they may be adults with serious mental illness but they also may be individuals with intellectual disability the need to be a little bit different approach and so if we train these teams to address all of those issues or be able to assess for all those issues and say what's going on here so from young children to elderly individuals and communities that we want to make sure that we have those teams ready for that and then I as with any project is to look for the sustainable funding so we add one to start the project we want to build that infrastructure but we look towards a number of different vendors to sustain that funding across. Representative Ladyman you have a question yeah I hope is appropriate time thank you Mr chairman to ask this question but in developing the vision goals and objectives what input or involvement did the providers have been this so we did many levels our partners got house went out and did many levels of interviews and so we wanted to make sure so we started with internal interviews that DHS because we from our different perspectives you know we all have a perspective on our population that we work with closely and so we know that even like the Division of Children and Family Services so people who have you know working with those children in foster care are Division of you service are and this is sad but there are division of child care and early childhood education I mean there's lots of things that come along with four year olds and it it is and so we started there interviewed are on staff said from your perspective adult protective services so we interviewed everybody and then we took it to. Like state level partners so Department health big big providers like UAMS people that are running call centers and then we also met with a group of providers down at that level as well so we tried to interview providers that are providing these types of services or treating individuals who need those services so we try to make sure across all that we didn't a pretty weak the set of interviews I think it's probably three or four months for us to for god has to cancel you tried to involve certain individuals or groups from each type of service provider. I would say on mostly what and that in the next five said this shows this but it was really trying to figure out which providers which entities are touching people while they're in crisis right so it's not so it's a little bit different than what you're asking so there may be there was certain provider types that maybe were interviewed during that this phase because they don't they don't go out when someone's having a behavioral health crisis or they don't get calls on this people. Thank you. Other questions. So this is our current crisis landscape you can see all of the entities involved in this and so we started out with it's called when there's a crisis and that's where we started our interviews and started mapping this was and you can see that a lot of people call nine one one the National Association for The second for a mental illness. Ninety nine is also has a support line that we we support through data there's the mental health I'm a glasses and we didn't know how the diction support line there is UAMS had a grant to do A. R. connect instead they built a call line nine eight eight is the the suicide prevention call line and as the mental health call line that was instituted federal way for people to call their directly instead of calling nine one one if they're aware of that and the Department of Health runs that we also have the twelve community mental health centers and part of their contracts are to provide That kind of assessment and be on call twenty four seven so we have all of that group in the crisis contact and then we have services that are being delivered in the community and again we we tried to talk to each of them and look at that so we have obviously the EMTs and the first responders again the community mental health centers we have behavioral health providers we have passed the passes have pilot programs for this population or for the population that they serve the local police departments do a lot of this we have all of this crisis services people that are going out and then we also put together who's actually stabilizing the crisis in providing an intervention or service so we know that general hospitals with adult psychiatric units within those hospitals we have some of those across the state we have our four crisis stabilization units we have psychiatric hospitals freestanding psychiatric hospitals that accept people that are in crisis and then we added Medicaid. Added something called acute crisis unit bads FOR hospitals and allow that to be billable service and so we have two of those that have been done and and those both have been for children and so those are are places where we can stabilize services and so as you can see there's a lot of activity in a lot of things going on at the community of lots of different people that are involved in that and all round the bottom along the bottom you see all of those different outside stakeholder groups that are interacting with people that have a crisis. Represent Ladyman you're recognized for a question I'm sorry but I have another question. can you expand on it and the what what is the passes pilot programs can you expand on that a little bit. You know the passes were have community investment dollars that they can use to build out some community investments and so several of them built out specific programs I know one of them built out a program to address and brought in a company from out of state that specializes in treating individuals with intellectual depth and developmental disabilities and also have you have a health conditions and so they started a project there where they had teams just like we're talking about they can go out and either go into an IDT setting where somebody is being treated and having some crisis they could go into hospitals they can go into any place that will allow them and so it's been a really a great project is indeed very well because of if we talk about sustainability that provider became an enrolled Arkansas Medicaid provider. I'm last week I think and so now they're gonna be able to use Medicaid funds and pay them directly so that's one is there another one that I'm missing that big one I remember another represent Ladyman might recognize the name said that when she's talking about and in the company's called benchmark and we've had really good success with our clients going and helping waiver providers and they descend rolled so we were really excited about that. Can I ask a quick question just. If you don't mind I think. I think it's important for us to discuss exactly the different types of behavioral things that were seen that constitute a crisis so if we could just go back to that side because you have there's there's this encompasses so much so if you can just try to let's just talk about exactly who these people are exactly what the what is happening and what we're experiencing and different examples of this type of a crisis behavioral health You you know how this is occur I mean we all we we we know some of the things right that we that are something that we come to the top of the head like like suicide and things like that but there's a lot of others so can we just take a second and just kind of talk about what we are experiencing in the State of Arkansas and it relates to crisis behavioral health. And that's can be different for children's Committee for teenagers and for adults yeah so you know we have so many calls that come our way that where we see where that crisis started and then we probably get in on this and we do K. staff things and so I you know I think about the ones that are most recent that that we're still working on the cases in that can be so one that we we talked about actually on the phone today we're preparing for this five year old five year old who came into DCFS custody and was having some pretty significant behavior problems and I want to give a lot of identifying information but you know had been exposed had had had had some I think neonatal exposure to substances that and come back to the family and then there are some additional exposure and had gone into foster care and really was having some extreme behaviors once we found out about it and it was identified as a mental health crisis we also then looked down and saw what was her and developmental age might developmentally and she was her receptive and expressive language is that about on a two year old level but what we did is identified with the have a health issue because their behaviors are so extreme but our approach should really just be it looking as an occasional health condition and we need to treat that looking at that whole person in so because we didn't have any sort of cross train crisis response somebody did what they need to do which is take her to a psychiatric hospital where she got admitted so we've got that with young children and that happens a lot with children that you know have have experienced trauma going to foster care sometimes it's cannot tell you how many calls we get from grandmothers raising grandchildren the parents are not there. and and they're doing their best and and those children just have some significant anger and in those kinds of behaviors with adolescents you know it can range anywhere from self harming behaviors that did as identified at school or they come to school and they talk about you know what's happened to them or they get into fights and they become very aggressive and so for a lot of those also as you start digging down you say you know it's been labeled a mental health condition but there's also some underlying delays because they may have moved ten times through their elementary school years and just not gotten some consistent education and then they get to a junior high that missed so much school they're angry they are probably board and not understand what's going on the classroom and they really act out and so you know we get those calls all the time and for children and again as young as four that the are division of child care and early childhood education are actually has a hotline for day care centers to call for children that are acting out that are three four and five years old so pretty extreme behaviors and we're trying to approach that and at a specific way but you know when parents or foster parents or grandparents or whoever or school officials See some pretty frightening behaviors what they're gonna do generally is called please call an ambulance or put him in the car and taken to a hospital and so if we have a lot of that and we're we've even gotten this children where they've been in an emergency room and have been there for days because there's no place for them to be transported to so I would say that's the big piece of the children okay and then the adults I know my big we've just seen such a rise and domestic violence an incidence as it relates to domestic violence and and some I just know in speaking with sheriff local of officials that the incredibly dangerous those calls are incredibly dangerous for a law enforcement officers to take in response to but I can that I'm there's they have just seen a dramatic increase and those types of calls and so that that is really a whole level of training that I'm not sure everybody's equipped to have an or that they have and to be able to keep themselves safe and all the people involved in that situation say so just quickly talk about the adult. Sure thank you I'm of course where you talked about is those individuals who are experiencing suicidality or if they are experiencing homicidal ideation stage here either part of their mental illness or for whatever reason we have a group of individuals that are just gravely disabled there psychotic they suffer from schizophrenia or a state Kotick disorder and some of those that's controlled somewhat with medications that they take those medications as directed but for some even with medications they still continue to experience some pretty serious mental health some sense symptoms including psychosis and then as often complicated by substance use and substance use disorders and so you're you're going to have those two things together and they're often get it and be homeless there some homelessness in individuals with homelessness are suffering that they're not getting get access to care they're not getting good access to treatment and they tend to come into contact with law enforcement and quite frequently I am like I said those individuals who are not medication compliant they don't take their masks or they are not able to get access to or go and get their injectables if they're on injectables for those disorders we really get a lot of phone calls around traumatic brain injuries and situations that occur due to traumatic brain injuries in the behaviors that come from that in our veterans experiencing PTSD and experiencing other disorders related to veterans services and just going to speak briefly before I turn it over to Melissa about the dual diagnosis and and those are individuals who have a serious mental illness but they also have some intellectual disabilities developmental delays and said those individuals and have a very unique kind of need where there's an understanding and I think Paula talked about that earlier there really needs to be a good understanding of the. Where those to come together and the specific interventions that need to happen with that population. I think we've talked about this before I mean it's just more and more prevalent we're seeing people with intellectual disabilities have or or developmental delays have since significant behavioral health problems and there's really no way for them to go and I mean we're trying to build out those programs in addition to this right I mean that's all those are whole other initiatives we're working on is setting up hopefully specific wings in a in acute hospitals for IDT and then and setting up step down programs because right now I mean a you guys know this I get referrals to the billable human development center the war and human development center for kids the Conway human development center because there's really no other game in town right now that will take clients with intellectual disabilities who have behavioral health crises and we really weren't designed for that type of deal care right and so we've been having to have it and make sure my staff are trained but they still need more training I mean we just were not equipped for that we're getting there but we need some other options because those are institutions and then once we get and it's really hard sometimes if they want to go back on the community to go back out in the community so we're trying to build community based but I mean I'm sure you all of I mean there was a lot on social media about a young man who ended up taking of them all and have you and represented maybe and I talked about Herman and I talked to his mom now all the time he's doing really well It amble but he was paid in an ER room along with that for weeks on a mattress without a sheet and I mean it was awful and and we were trying really hard to get someone to take him while I waited on an opening at the mobile HTC but you only have so many beds and they were always full so and that's where you need to go and he again he's done really well there but he is definitely his intellectually disabled but he has some really significant behavioral health needs right so it's it's not that And it's hard to mix sometimes the peer group with with my facilities and because you can it can't be we can't put them in a house or people are vulnerable right we can't put him next to people that don't have and that our allies savvy right he's very savvy and but I am C. has been a big and that mother has been a big advocate of how Google has really and save tire and saved into he was on the waiver program and they had built in my home and he lived next door to them and have staff coming in but he was really an aggressive and dangerous to the staff and again her only option was to call nine one one every time that would happen one area of town she lived in the ambulance quit going right they turned around when they knew what house they were going to because there was no place once they got into the hospital that was appropriate to take care of them so they just quit picking them up so I mean we we definitely are seeing this overwhelming need an on a weekly basis where where we that we are at a loss in like policy I'd like with this little five year old who we said today we're going to go get ourselves since I mean breaks my heart my child has an learning disabilities the exact same lines and some Warren and it's run this that we're treating her for mental illness but that well being said I lost my train of thought I got what what's up I'm not. I mean you all go back to your site presentation and I would so much appreciated I just think it's so important share that because we have to humanize us you know in a lot of times will look at these fights will talk about their needs I love the smell of what we're doing it is so important for us really humanizes and understand the real impact that's happening right now to these people in our state so thank you I you can go back to and I appreciate your passion for the sin and sharing that with us it's very important before you go back to your program let me. Make a comment here and I think what you do what you all are talking about here shows that and and I know I hear all the time people say well we want to put our money out in the community and that's great I want everybody to be at their level that they're capable of functioning at that's what the goal is but some time certain people they don't see the need for some of these people like the ones you're just talking about they they may not be able to go to a community or going to the family or when they do go to the family you made a good example there I mean the family tries. But it just don't work so everybody cannot go into a community or a waiver program we we have to have other levels of service for some people thank you all have shown that right there so I'll stop let's get back to pro one represent Ladyman you know I mean course we're huge supporters of the HTC's and and we keep a fall and but like in the case we were talking about what was inside is if we have something like this in place then we could have sent out a mobile team to help stabilize and that young man while he waited to get into mumble because we're right it probably was at the point where he probably needed something more regardless but the the sad thing was is that he just sat we he was in the ER room for that long right not getting appropriate care so even if eventually the end result is you need a higher level this would be a stopgap to not take people to jail in hospitals while we try to stabilize them at their houses. Just just one note on the side right here PCPs are stakeholders and so much of this is happening and clinics and identified in clinics particularly with children and adolescents and adults specially. You know that adult to adult protective services sometimes has been called in if it's not all schizophrenic that beating up a family member or relative so lot of those things that are they are dealt with at the PCP levels and so that's a huge stake holder that needs to be included I realize god has to this or not you all that. In the completely agree I think we've been having some of the side conversation so when we went out and started talking about those acute crisis unit beds in hospitals no one of the things that the hospitals said or actually talk to the pediatricians at the pediatrician group is they said you know if we can bring in clinicians and we can provide this counseling services were still gonna need somebody to call or some place to send them right when they have when they're coming in because we feel like we're at least you know where it was cents and we're willing to treat but we need some support and so and and they even said you know some sauce bill said and we'll take them back into our PCP clinics and treat them in which the one of things we want to happen if there's a place for them to go and somebody help us stabilize because we're not equipped for it like crisis stabilization we can do some small stuff so yes you're you're exactly right and and I think that's also the goal I think this is the whole continuum because the more people we catch on that front in. As reducing screenings we have a whole screenings which were now Medicaid pays for someone we're doing that kind of stuff then our system is not getting clogged with all of those people waiting and waiting waiting for services and then they can't do home community based services because they're too it's too far we've let it go way too far and then we don't have as many. That is in human development centers and other places where people need to go and so I think a lot of this is trying to catch people early because it's amazing how many people and I didn't know this happened until like probably this last two years but people who've been managing somebody with a pretty significant issue at home that they may have been removed from school and I've been I've been home schooling them and then they get really large you know there's large young strong young men and the family has not had anyone to reach out to really they haven't really been keeping up And so they show up at the emergency department so I can't do this any longer and if we caught them much earlier and then our only choices and the families like I cannot do this this is too much or too large and separate copy of our lawyers I think it's trying to come back in that on that front end well and just adds we talk about this all the time it's like we say we did they come from right like they were never on our radar we don't have any case on and we look at all of our systems where do they come from and there and she's right there showing up often times fourteen fifteen sixteen we've never served to them and we were trying to put its act together her that like we're catching on too late right like we get and try and just trying to back that up in in like policy said backing it up by putting passing the rules to put clinicians under the supervision of PCPs and doctors right where you can supervising them and then this would back it up significantly they never get to one of those places where we have to wrestle them out at because once they're labeled at some of these places then they then the file starts building. And just to talk a little bit about first episodes psychosis because we have sinned set aside funding that comes from our federal partners around first episodes psychosis and those are our young individuals who are beginning to have this first signs of the psychotic disorders such as schizophrenia and the earlier that we can catch them in the earlier we can get them on appropriate medications in an appropriate treatment the better the outcome is for those individuals so it's really really important as part of this integrated across the system that we're grabbing them and sometimes those are the individuals that have private insurance and if you look rate we're taking this across everything their private insurance and that's why we don't get them we don't get the mental it's gotten to the point where they are very very ill and the chances of that really good recovery outcome is gone down somewhat. And I'm not represent the let me just make a comment real quick about what you just said about what you know where they come from and you know I I feel for many many many years that we don't know how big this problem is and I've often wondered how how many people do we have in the State of Arkansas that needs these type of services I know there's a whole broad range of services but but because you know we took our son to ball games or the the things and and I I I I never can forget this we would take him to his brother's ball games. Do you know that after about three games another family showed up they had a child like ours. And talk to them in a civil we saw you all bring your son here so we thought we'd bring our they weren't on any kind of program they didn't know they had no idea that there were programs like that and I've seen it over and over and over again I don't know how you find those people I really don't but but they are out there like you said and and it's it's people trying to take care of their adults or there may not be there to their sons or daughters it might be a niece or somebody and they're trying to the best they can and they do it until it gets to the point where they just can't do it. And they wind up holding him down called the police and and that's where you go when I was separate plan and enforce the certified sex with some of this money with this ninety eight seventeen one of the bill that's for doing is a huge educational campaign and by no means I don't want to think I'm out we're out trying to and get more people on Medicaid but for some of these clients we're going to get an eventually and we need to catch him earlier and so right because if we could do more prevention type services and then get him back out off of Medicaid we would be a lot better off and they would as well so we are and using some of those funds to a to a big educational campaign on the Medicaid services and what we have to offer because we agree with you we're not doing a good job of and even on our website of showing what's available working with community partners that they can help total what's available so unless it's when you guys you know that we do and knows to tell them to call me or call one of them and I think a lot of people are at a loss. So I think this was a great leader in because I think we can identify individuals and I think that we can do early intervention and early treatment and that we can get individuals into the appropriate levels of care and we can get them what's needed but in order to do that then I really think that we worry need to guy was this community based crisis response system a crisis response system is an organized set of structures and processes and services that are in place to address those urgent and emergent behavioral health crisis and that is whether it's substance use that's whether it's mental health that's whether it's an intellectual you know someone with behaviors related to an intellectual disability or developmental delay. and it needs a defense that this is a defined population and we need to act as soon as possible and we need to act as long as necessary in order to stabilize that situation so the components of that since system can be twenty four hour crisis call centers are Collins crisis response teams which have as Paul said a variety of individuals who participate in those teens who have special trainings across the stabilization units in a crime an acute crisis beds we've already got a few acute crisis that's for children but we certainly need more acute crisis pads where individuals are getting that care barrel health urgent care so those are kind of the systems in the system goals that we want to look at it over time. The mobile the models of mobile crisis team deployment include a mobile require skews me a mobile crisis response team deployment options such as statewide call centers regionally based call centers or provider specific call centers so those are some of the models around which and process mobile crisis teams are deployed. What we've been asking god has today because we talked about this before as well but you know the past model is really our highest needs clients within Medicaid and of course this model is for all Arkansans but if you're just looking at our pass clientele with behavioral health in ID D. we have how many children we have thirty five thousand children right so we're really serving the hardest of the hard in terms of kids under the past model and we need to build a model that this would work for children okay is that's what we're seeing over and over and we also had to build it for clients with intellectual disability because that's what we're seeing as well and time and time again each week so god has really research to states who were doing that type of mobile crisis for specifically those populations are included in their mobile crisis and so to really good miles I've been looking at our the Georgia model in the Arizona model. And then we also we're trying to figure out the the working with them on background is how all day and how they tight end their nine eight eight systems and then how they tie in their nine one one I think we all probably on the same page of we don't want another phone number out there right and there's there's too many phone numbers that we do know we need a way where it regardless of where it comes three we can connect it said this statewide hub and immobilize and teams so on slide nine this is just talking about the difference between kind of what we're trying to do versus what Georgia and the Arizona models are doing. And again in essence of Tom and you know we pick some and keep things that we light as you can see like Georgia has the centralized hub model which we really like we think that would work well here in Arkansas we think we need one that can do local deployments and keep up with all of our data so that we can utilize our data to see what's going on and and then Arizona does this cool thing like we're talking about where they link all of these lines together so we're taking pieces what we're what we're presenting and are moving hoping to move forward with is taking pieces the best pieces we think from the Georgia and the Arizona my models to make our own. These are designing key considerations and so we talked about this thank you senator Ervin for asking us about the overall population so who needs this what areas of the state are we having significant need are some areas face more challenges that others What is our current provider capacity and and do we have workforce gaps and so we've talked a lot about that I know with our behavioral health task force that we've been working with there's been a lot of conversations about capacity workforce capacity what's the technology necessary to operate this and then he's going to be on that mobile crisis team because we're asking a lot of this mobile crisis teams is we want them to serve all populations all the populations in need and then the last is what is our sustainable funding so we know that we are expanding funding from you know from Medicaid from our of our state general revenue in our different divisions some of our block grant dollars and how how do we bring all of that together and look at sustainable funding across and as Melissa mentioned earlier also if we're gonna talk about all our Kansans then we are talking about commercial insurances as well. And so part of what we can do is look at an example of a crisis resource need calculator that's the ability to provide to feed information again and then it provides estimates of community based crisis response system capacity and associated funding that's needed based on that data input so this is kind of an example we don't yet have the Arkansas numbers so it's an example of this tool and how we would gauge population needs. When you say we don't have the numbers to we have the ability to get the numbers for the day and sometimes I just wonder you know what we're tracking for tracking that we definitely have the capacity to look at our own claims and what we're paying where were struggling to just be honest as were struggling to identify who's sitting in local jails. But we don't know right and what their diagnosis wiser S. that's where we're really struggling. Yeah we had somebody in the service the county jail for how long was that every year. I think it was over a year waiting of that at the state hospital I mean just finally you know we're gonna moved that. There there's just there's no real time tracking system which is why we need the technology. And then again just based on and this is that kind but just an example of potential cost savings based on this model or the models that we are looking at and that's diverting away from inpatient emergency rooms and there's some significant cost savings we actually get people that they care they need in the community rather than the more high cost alternatives to this. Naptime. Madge's adds that once we get the the data and some additional data to run the model on the example on twelve then we can complete a more reasonable cost savings just because I can't guarantee that we're gonna say this amount of money. Yes. No I grades and it's like oh what you're taking those numbers off at thirteen AM. I think I meant here this is just an example and so no this is just of them putting into this national national type calculator on what other states have achieved in savings when they diverted people out of these high cost outings but again we're working to get our claims and if debate has an act any ideas about how we get local jail figures you can get then we can add that end because I think that is a significant crisis that we're not capturing on our side of the house at all. Someone fired fourteen and just upcoming discussion points so what we're really pitching here through this and presentation is this state wide hub so one entity that would operate for the entire state of Arkansas they we would link the numbers together so the M. it would be routed to this high up and then they would deploy a local and mobile crisis response teams M. we discussed internally doing a pilot of three regions and in selecting those regions that with they had different types of make up right some that maybe have an acute a cute capacity in their in their county and then some that down because we're really trying to pilot to see what what what can work and what's not gonna work and then how do we tweak that before we do a state wide deployment and in the model would include these integrated models where we would take the good things we live out of Georgia and they get things we like out Arizona and we would test those as well through the pilot to see if we can operationalize it and if we need to make any tweaks and then as far as training technology data analysis again we have no visibility on a lot of these things currently writing and and so it trying to start gathering that centralized hub for data collection so we can see who these people are how many times are they calling where they going who's following up so that we actually can see some trends and then make changes to a statewide program so we would do all of those items through these three pilots. And then the last two pages are just if you want to learn more about and kind of deep dive into how Georgia works and then how the state of Arizona works but as far as our presentation we are finished and happy to answer questions. The president Ladyman you're recognized I mean I don't really have a question did you talk about you don't know how many people out there in the jails I understand we don't but I can give you personal examples but I think. L. what a lot of times in cities and counties the these police departments and sheriff's departments no things but they're not really reported and I mean I give you an example old town where I was mayor there is couple people that would show up every day and they just be on the street they weren't really homeless they had a home but they didn't have adequate care so I'd college if you take him home well you can't do the put those police resources every day taking that individual home so after a while we dead taking the jail will that's not really recorded anywhere that I know of but I mean that that's the connection that we need is with these local police enforcement units to somehow report and get it into your data system because I guarantee of these police chief these fire chiefs in these mayors and judges sure of slain they know these numbers and they know where these people live but how do you get that in the database that's the that's the question so. Thank you just to kind of speak we recently had a case where I started digging deeper into our forensics case so we know that we get requests for forensic evaluations so I'm rather curious clinician and I went back to look at the number of crisis contacts that we had in our system and we had multiple crisis contacts that were in our system prior to this individual ending up incarcerated with the forensic evaluation so I think it's really important this this to me as a continuum and it's a system that's going to address a lot of these issues and part of the issue on the adult side that I would love to address is can we grab these people early on first contacts before we get to that they were stuck in jail Blake and like Senator side and we're waiting for them to get into that at the Arkansas State Hospital so just my my idea about this continuum is that we're gonna grab adults earlier again intervene early get them into appropriate treatment deferred away from them. Represent Mayberry of questions. Thank you so I appreciate the information what do you need from us what we need to do what's the next step is this something that you can do by rules that you can just automatically do without legislative help do you need us to tell us. I met their goal for today was just to tell you we were working on something right and because there's so much spending right now especially during legislative session and I know you all have and ideas being thrown at you on on things to draft and and bills to run and just maybe just hoping that you will think okay they are working on this someone comes to you and it fits into what we're doing reach out to us so we can stay on track and we just we didn't want you all to think that there was no plan. Right because we know you are Vaught being bombarded probably with ideas. You okay German other questions so you don't need anything legislatively yes. Yeah okay question is when. We're working on it okay and and working on it as fast as we can okay and. So I can't give you a complete timeline among all the other things that we're asking you to do because I know I have other topics I've talked to you about and you know what they're doing is taking out of a fire hose I know at least one a day I don't think any of those ways your shy about approaching so I'm sure was they have information press listen a representative let me have another common question well one thing is I think you're going to have to come to us for and I had this question we were looking at this you know these are projects and this is an initial funding mechanism and. If this works you know how do we sustainably fund it. And that's that funding is not there right now that I don't think hope I'm wrong but I don't think it's that of so I think that's something that you're going to we're going to have to address and hopefully it'll be a successful program in and will be able to find it somewhere in the future but as a as a as a representative said there may be some things you need now and if you do I come back to us I don't think we're ready to ask you for anything right now but you're right I mean of M. starting up a pilot yes it is something that we talked about money wise but I think the end goal because we are kind of spending money on it behavioral health and on this population across through contract dollars three Medicaid dollars through Medicare dollars through private insurance dollars in if the savings or anything like the national motto says this we think this will be a fully sustainable program without any further request and maybe even I don't want to say save money. Right. Well I think there's some structure money that we're going to need right I mean there's that you're talking about some technology to link the systems and and some data tracking technology and you know there's two ways to get that you can buy you can buy to build it and probably buying it is probably better most of the time so I know there's gonna be some infrastructure issues but then yeah hopefully this is the kind of thing where once we get it set up the savings results in enough costs value to allow us to run this assembly on its own and and I guess my question would be from the step wise I understand yes stay tuned way the concept of the polit The Hobbit. Is the hub of the first step I mean what's what's the first step in the process is it linking the calls is it creating the busy creating a physical call center and then the pilots what's what's the order you'll see that happening in. So I think it's it's almost like you have to have the infrastructure there but you want once you put the infrastructure in place you want to be able to roll with the mobile crisis teams very quickly because nobody's going to want to send calls there unless you know when they can start collecting data and less there's somebody to launch so you know ideally what you'd be doing is building out that high up with the technology pieces while finding the team's recruiting teams in training communities because back to what what you were talking about we you know it's it's it's going to be delivered in communities and it's going to be delivered by the people that are already living in those communities and working with people and so I think you need to do it it's almost like it's the different groups are doing this but it all has to come together so when you launch it the teams are ready to go ready collect that data. We're ready accept phone calls from all those different you know call lines that we're looking at and I would say in terms of next steps what we are planning on doing the guide house and all the correct me I mean I think they are going to put together that strategy for us on how to implement that all the same time right I mean because that's what we would have to do you can't turn on a piecemeal at or is not going to work that's also why I want to start with three pilots and not go statewide route the gate. The more questions. Yep. Thank you thank you I just wanna say that I mean this is great this is something that's been needed for many many years and it's it's a challenge I really I know that it's a big challenge and hopefully like you say the savings will pay for it but we don't know that yet but this is something I think we really needed to address for a long long time and I think you will go out into other areas where we're spending money that we don't need to so thank you all for doing this. One thank you for your committee on the mayor's so we're still doing and we're still doing surveys and I don't think we had thought that through but it I think that might be good to reach out to. I just wrap up just to say thank you again you know you we do really have a trained team here which I'm really proud of you guys I mean you all dug into this for a long time I've been talking about this for a little bit as well because of what we've just personally experienced and my husband kept saying we have a tropical system why do we not have a tropical system for people that are in need. That are dealing with mental illnesses behavioral health issues we can't find this for these individuals and they are it's it's not safe for their family members it's not safe for them so you know it this is this is something that's just incredibly important and it's hard when you're an emergency room doctor and you're faced with the situation trying to get somebody helping you cannot find a place and time in the entire state of Arkansas to help the person so it's incredibly frustrating for those folks but I just I appreciate this I'm excited about where we're going and we're going to get there and also to the members that are here. So important you're here to listen to this spread it amongst our colleagues it's very important that they understand and know we are entering into like a strategic planning phase you know that's really comprehensive and state what I would say all over DHS in Medicaid as a whole and we're working towards that and you know that started on our journey with with representative Ladyman and representative Johnson representative Michelle gray and Cecile Bledsoe and we have we've really been starting this along a while and then working on in a while so I just appreciate my colleagues just being passionate about this and digging into this and and representative garner with early childhood and we've talked about this specifically and how it's you know just. You would have to be integrated or just not going to solve the problems so just appreciate all of my colleagues here and and represent Johnson for set all this up. You may be able to comment. Yes it's actually just a little request I know you have that packet in printed form but can it be emailed to maybe someone that could then email it out to other members who are not here because this was really good information and there's only a few of us here I think it's got things here at the C. for that to be sent out in the you know the good news about the streaming is this all be on video and we can encourage people watch you get the information and and hopefully there's somebody watching home right now I know the weather made to tend to slow the topics really important I think there's that everyone agrees and and I'm optimistic you know I I think it's great that we're we're sort of on the front edge of this mobile crisis idea they were seeing other places in the state and some of the things we're doing with can you paramedics and other things are sort of laying the groundwork for these front line workers they can go and have these crisis we just have to get all the resources organized have a good plan for mobilizing the resources and it feels like we have in the right direction on that to see some changes so of thanks again for spending the time on the snowy icy afternoon everybody be safe going home and that will get the information out the anybody that was here I think we have a list people here will make sure the other committee members get as well so thank you appreciate it.