Good morning everyone. This is a joint committee session of our health and human services and public safety committees. We have a number of esteemed colleagues and experts in the field that we are about to discuss before us today. We thank you for your continued leadership. We are going to break up this morning's conversation in two components. First we are going to be receiving an update on our crisis response services and Discuss a little bit about the situation that is on the ground and then second we will pick back up A bill led by our colleague and friend council member Luky bill 4323 crisis intervention team as Established but we will let the first part of this Conversation dictate how the second part of the conversation is going to go. But up front and I was just discussing this with Council Member Lutke and Chair Katz as we were about to get started. I just want to repeat my appreciation to her for choosing this critical issue for her to serve as the lead on on behalf of this body. She obviously has years, decades of experience in addressing this issue from multiple angles. And your leadership, I think, has led to many great things. And we'll hear some of those updates here this morning. I also want to acknowledge Miss Monica Martin, who had a fantastic interview with the council earlier this week. We do look forward to formally moving forward as a body and ensuring that you become the permanent division chief or behavioral health services here in Montgomery County. And also want to thank our providers in the field and of course our friends in law enforcement. We know the partnership and synergy and this work is critical with life or death consequences. So I will turn it over to Ms. Yao and Ms. Farag just to tee up the first part of our conversation. But before I do that, I want to give the opportunity to my friend and colleague, Council Member Katz, as this is a co-chaired committee session to say a few words. Thank you very much, Mr. Chair. And I too appreciate Council Member Luki bringing this forward. And I also wanted to very publicly thank Ms. Yalam for wrong for once again doing a terrific packet for us. It's always as much as you think you know about a topic when you get a packet like this, it reminds you of what you really should have known. And mental health has always been a great concern for all of us, and some families have never mentioned, and now of course it is, thank goodness. But the opening line in your package says that HHS has operated a crisis center for more than 20 years. So we've been on a front for this for many, many years, and that means we can always do better. Thank you very much. Thank you, Mr. Chair. Awesome. We are joined by our colleague and friend, Council Member Sales. Thank you so much, Council Member Sales. We are just getting started. So we've been waiting for you. She got so many of us got stuck in that traffic in 2.70 this morning. But we yield to you, Miss Yown as for us. Good morning. The Joint Committee will hear several presentations this morning. The first is going to be from the Department of Health and Human Services. And they will provide an update on the crisis center as well as the integrated crisis system in the county that includes crisis call center, mobile crisis response and stabilization facilities. We'll also hear from every mind. They will provide an update on the 98 National Suicide Lifeline and MC hotline as well as issues and trends of concern. And we'll hear from the police department on crisis intervention teams and their mental health first aid and other crisis related training efforts. Finally, DHHS staff will also provide an overview on the recently released sequential intercept model mapping report from Montgomery County. After that, the committee will have a chance to ask questions and discuss various issues. There are potential questions that maybe have concern listed on page 14 of your packet. Thank you so much, Ms. Yanagas. Dr. Stardard, we will start with you. And then if everybody on this wonderful panel could introduce themselves starting with Dr. Stardard. Dr. Stardard, Assistant Chief Administrative Officer, Officer of the County Executive, I have both the Public Safety portfolio, but also work with Ms. Martin and her team on behavioral health and crisis services as well. Good morning Monica Martin, acting chief of behavioral health and crisis services with the Department of Health and Human Services. Sarah Rose, director of the local behavioral health authority with behavioral health and crisis services in HHS. Assistant Chief Dave McBain, Field Services Bureau with Montgomery County Police Department. Jordan Stensky, Captain, Community Engagement Division, work for ACVP. And Chris Meshach, Chief Program Officer at Every Mind. Great. All right, Dr. Stoddard. Yeah, I want to first of all thank the members of the joint committee. This is an incredibly important issue. I know we spent a lot of time in my current county talking about a whole host of really critical issues from transportation to affordable housing. I don't think there's any issue facing the county that's more important today than the crisis of mental health and behavioral health substance use within our communities. We've seen a proliferation that, you know, the pandemic provided jet fuel to what was already an emerging crisis, both amongst our adults and our juveniles. And so the efforts that have been undertaken that are really countywide, you have the partners here and the nonprofit partners that aren't here, as well as a whole host of other partners. We have our Department of Corrections and Relocation represented here, Fire Rescue Services. This is really a whole of community, a whole of government response to this emerging crisis. And I don't want to, you know, we're doing a lot of effort to expand those efforts, but I want to start from the place that as Council Member Katz alluded to, we've been doing this for a very long time. And so we are building on the shoulders of those who came before us, but doing so in a way that's being informed by what others around the country who are facing these same challenges have learned through their expansion efforts. And so there is a place for police in our response, there is a place for mental health, there is a place for substance use. This really is going to be a continuum in Montgomery County that serves everyone and where they are. We're going to talk a lot about crisis response today, but I just want to briefly say that, an effective mental health system should aim to prevent not just address crisis. And so while what you'll hear today is largely focused on our crisis response, if we're doing a really good job in the space, we are reducing the number of crises that we have to respond to. And so I think that's a really important recognition that you will not hear a lot about today, but just understand that that is at the forefront of our mind as well today. So thank you. Thank you. Would Mr. Martindu, would you want to make a few comments as we get started? Sure, absolutely. I just really appreciate Dr. Stoddard, laying out that context around the partnerships about the work we've been doing, about the fact that this is always going to be on a continuum that we just need to keep doing better with and better buy our residents for and that we never forget these conversations that we need to resource our prevention partnerships and strategies as much as if not more than our crisis response. So really appreciate that context. There are some slides that I have provided that may or may not be showing on the screen. Is that right? No. Okay. There they are. Thank you. All right. So I had the great honor yesterday of we had a meeting we scheduled months ago of hosting a kind of a crisis now work groups reboot session with some of those that have been participating in work groups related to the implementation of a crisis now like model here in Montgomery County just yesterday. So I'm borrowing from some of the work that we did yesterday to give you a little bit of a status update. And in doing so, next slide please. I just want to make sure that we're keeping to give you a little bit of a status update. And in doing so, next slide, please. I just want to make sure that we're keeping top of mind, even though many of you have seen this, what an ideal system is, what we're striving to in terms of the ideal in that continuum. So it's a system that every individual family with behavioral health issues can receive services that are helpful and effective quickly and easily for as long and as intensively as needed to achieve the best possible results for a successful meaningful life. It is as you all well know more than a single crisis program, right? It needs to be an organized set of structures, processes and services that are in place to meet all types of urgent and emergent behavioral health crisis needs and I'll highlight again emergent so we're not always reacting right with the highest risk of community cases. But you know, in our community here effectively and efficiently and well-known system, we reach this ultimate ideal, although that is our challenge. The aspirational goal really is that every person receives the right service in the right place every single time. So, all the one to continue that is exactly what we are striving for. These are quotes from the Committee on Psychiatry and the Community for the Group of Advancement of Psychiatry from just a few years ago. This next slide is a graphic I think many of you have seen before comes directly from the crisis now. Framework, but I just highlight it here because it's a great visual for really all of our residents and stakeholders to wrap their minds around in terms of what we're trying to stand up. And in short, that we always have someone for folks to talk to, someone to respond in a place to go, in any state of behavioral health crisis. Yesterday, part of what we did is had a very quick dipstick assessment of what our group program says looked like in relation to SAMHSA's national guidelines for crisis care and the essential elements of a no-wronged or integrated crisis system. Again, this is just more detail on the kind of three main branches of that in terms of the Regional Crisis Call Center, updates that you're going to receive from every mind, and those that are already in place, 9-1-1, and through the Crisis Center's crisis hotline. The crisis mobile response teams work, of course crisis receiving and stabilization facilities to divert from hospitals being the only place that folks can go to in a crisis situation What needs to be baked in to the system at every? Every aspect of it is that it must address recovery needs It must be an integrated behavioral health model that we need significant use of peers. And this is something we heard over and over again, how much more we need to amplify that yesterday, in particular with stakeholders in the room, that all of the care must be trauma informed, that it must follow a suicide safer care model in terms of training around those evidence-based practices to prevent suicide, that it has to have safety and security for staff as well as those in crisis at every moment, and that of course, at law enforcement and EMS collaborate in every step of the way. A just a reflection on the RI International Report recommendations that were issued in 2020 that were specific to Montgomery County. It did speak to the crisis system integration and coordination needs. At that time, the assessment was that our current crisis system was isolated and in multiple silos. And that we had to create structures to support the integrated system in order for providers to work together in a seamless fashion. It did call for a contract to enhance a regional crisis call center, which we're going to hear a lot more about today. We've got the experts here to do that. And of course, increase the actual capacity of the mobile crisis outreach teams. Additional recommendations were to establish two crisis receiving centers specifically for high acuity levels of care with a no-round door approach. Again, to focus on prevention and post-crisis services, a theme we heard earlier here, but that we should be shifting focus towards crisis prevention and post intervention supports wherever possible like the use of a sort of community treatment teams and the peer-led navigation services and again highlighting the need for peer workforce growth and specifically certified peer recovery specialists. So I provide that reflection so that we can kind of see where we are today. So the crisis call centers work group, original purposes is listed here. One thing that was talked about quite a bit is that of course we're not at the ideal place of it operating as an air traffic control hub if you will. But we've made progress towards coordination, warm handoffs in between the different access points for folks to call in when they're in crisis. Again, I'm not, I'm going to let our partners speak to a lot of that here today. But you know, 988 was launched in July of 2022 and the following slide shows the graphic that was created by all the entities involved in our integrated crisis call centers work. This is a visual that I learned yesterday that there's a gentleman in the community that has on their hat. Yeah, and I need to meet that gentleman. So if you're listening today, please call me. But there was a recommitment to making sure that this graphic is displayed broadly. We learned about some of our aging residents saying to the best way that they can utilize this information is to make sure they get large paper copies at home. You know, we haven't done that yet. I actually have one of these here with me. So if you're missing one, make sure to take one. So we are going to do a lot of work, because this is our existing framework, and this is the best way to succinctly explain and direct folks to the proper number for the support that they need. And it may seem simple, but I will tell you we did get a lot of accolades from the state and other jurisdictions were having come up with that infographic. In terms of our crisis outreach teams work group there you see the original purpose of this group. Obviously you're aware that the commentary on dispatch protocol was implemented in 2022 in July of 22 specifically. And so since then the percentage of MCOT responses dispatch with police have reduced to the the 100% that they were at that point in time. Actually, sorry, let me word that differently. Instead of 100% being dispatched with police, 36% are now dispatched without police. We do have our MCOT teams expanding to maximum of five being operational starting next week here in October of 2024 and we will get to the seven that have been funded for this fiscal year 25 before the end of the year. We have satellite sites running in collaboration with the City of Tacoma Park and the City of Rockville and with the SAMHSA grant funded peer positions that were made permanent in this year fiscal year's budget, we now have peers dispatched in about 50% of our MCOT calls. Collaboration with the police department to conduct CIT 40-hour training continues and occurs many times per year. We did have the identification yesterday of having steer as one of our peer organizations join that effort together. So that's something we're going to be looking for to integrating in the future. And we did get Medicaid reimbursement approved for and caught responses with behavioral health personnel on those teams. In terms of the stabilization centers, work group, I feel like I could turn to our expert here at Dr. Stoddard to give you a much better update here. But there's been a lot of progress, so committed engagement conducted in 2022 to 23 to address the seven locks of Lions concerns around standing up the formerly known restoration center now called Diversion Center and having a frequently asked questions document published to ensure we have transparency with all of our neighbors and stakeholders around what we need to do there. Our team has conducted site visits to various locations to learn about their crisis stabilization facilities, models and Delaware and St. Mary's County and Washington DC, Baltimore and Delaware and St. Mary's County and Washington, DC, Baltimore and Prince George's County as well, with the most recent opening of the dire care center down there. Dr. Staudd has established and continues to facilitate a monthly workgroup with representatives from HHS with police, the seven-locks of lines and other key stakeholders to inform facility plans. And the SAMHSA funded stabilization room opened in September of 2023 with four recliners for adults. We're happy to report that Montgomery County Fire Rescue Services did start doing drop-offs directly at the stabilization unit rather than hospitals in February of 2024. That was started as a pilot primarily in the area of Rockville. But there's been over 40 drop-offs to date. And procedures and protocols haven't really refined by our crisis center and fire and rescue leaders. And we have a plan to roll that out to the entire county, actually, also starting in October of 2024. Medicaid reimbursement was approved for 23-hour crisis stabilization. Those come on regular regulations where we live. also starting in October of 2024. Medicaid reimbursement was approved for 23-hour crisis stabilization. Those come on regular regulations were released in May. And we're also happy to report that we did receive a grant from the state to fund expanded operations to support four more recliners to serve youth and provide lifespan services, but also to make sure we have all the staffing and operations in place that we need to be able to build Medicaid for sustainable revenue moving forward. Our diversion centers, you will know, is currently in the design phase and architect has been hired and our goal is to release an RFP for an operator for that center by the end of this fiscal year to have that awarded in FY 25 and to start operations the following year. The last slide here that I will just highlight is a crisis now crosswalk. Next slide please. Yeah. And so, you know, at the beginning of this work, if you looked at that right column about what our status is in Montgomery County relation to these best practices in terms of what should be in place, you would have seen mostly nose in that column. And now here we are, and we do have about five yeses and a partial. We've got some ways to go. But this is part of what we'll be continuing to look at in a simple format around what we're striving towards. You also have information in your packet around other crisis center services, figures, and I don't want to take up much more time right now though and just opening this up around basic updates. So, happy to entertain questions later. Thank you. I think we can go to the presentations and then ask her questions in the end. Thank you for having me. I'm excited to share some updates about 988. So before I get into my trends and noteworthy issues, I wanted to just give you a quick overview that in fiscal year 24 our hotline call center answered nearly 55,000 text calls and chats and we had a little over a 90% answer rate and we're able to answer every call within 20 seconds. And I wanted to also share that of those nearly 55,000 calls, texts and chats that we answered, we're able to de-escalate slightly more than 96% of the visitors contacting us. And so less than 4% need to be escalated. We're escalated to either Montgomery County Crisis Outreach Team or the Crisis Center or to 911. So we're excited to share those successes two years into 988. Along those lines, I wanted to share that we're excited that geo-routing has been implemented, at least with two call carriers so far, T-Mobile and Verizon, and every mind actually was the first center in the nation to receive a geo-routed call to the 988 networks, so very exciting. We, and just so you know too, that geo-orouting is only for calls right now, not for text. Okay. And wanted to share that vibrant, who was the national administrator for, for 988. They have done an impact analysis on data from July and August of this year to predict what centers across the state of Maryland will see in terms of call volume. Right now, they've predicted that there will be like between a seven and 13% drop in call volume for call centers across the state of Maryland with the exception of the Baltimore call center where they're predicting a 14% increase. So now we're in communication with SAMHSA and Vibrant to better understand the methodology behind how they got to those numbers. And so we'll keep you abreast of what the demand projections look like as we know more. As Monica, so aptly stated earlier, we're working also in partnership with our 918-911 and Montgomery County Crisis Center partners around 988-911 collaboration. SAMHSA, BHA at the state level and the crisis response community, as you know, are really intent on focusing and ensuring that visitors to 988 are connected to the most appropriate support, which is a huge priority. And so our first focus is really to establish standards and criteria to really divert calls from 911 to-1-2 either 9-8-8 or the crisis center. And so in some jurisdictions in Maryland, the mobile crisis team is really housed under the same entity as the 9-8-8 call center. Of course, in Montgomery County, it's distinct and that we have a crisis center for mobile crisis outreach every month for 9-8-8 for 988 and then 911 for emergency response. So sharing that because there's going to be potential opportunities at the state level for funding to really support this crisis response and coordination. As you all know last year the state legislation passed a 988 telecon fee in the general assembly and that will go into effect in fiscal year 26. The projection is that that funding will raise about 20 to 25 million dollars in revenue for 988 services across the state. What is underway now is determining how those funds will get distributed across the state to the call centers. What BHA has shared is that the centers will be asked to provide budgets based on projected call volume and what we need. And then any remaining funds could potentially be used for services across the crisis care continuum. And what every mind is doing is really advocating that this funding also be for text and chat because we know that text and chat is really the the wave of communication of the future. We know that at every mind our text and chat visitors more than 50% are youth under the age of 24. So really critical that the funding is available for text and chat as much as call volume because call volume alone is really an incomplete metric for determining fund allocation. Another just issue challenge I wanted to raise is that in fiscal year 25 so far we have about nearly $2 million in funding that contracted to Montgomery County by BHA that is currently held up at the state through the state process. It's awaiting a letter of award and an approved budget and then we know that after those funds come through the state and they'll need to go through the county approval process as well. And we've been working very collaboratively with our LBHA and our BHA partners to get these funds moving forward, but we have not had any progress yet. So that is the challenge I wanted to raise. And just to share that in fiscal year 25, there was a little more than half a million dollars that was awarded by the State to Montgomery County for 98 implementation. But those awards actually never made it through the county approval process. And so just sharing some of those highlights and challenges that we're also experiencing. We are excited to share that with our 988, in this fiscal year, every mind was going to establish two substance use care and avigator positions that will connect with visitors who disclose the need for support with substance use to additional services. This will require the visitors consent because as you all know, 988 services are confidential until they can't be confidential. And so our care will have two care navigators that will follow up to understand specific needs and help individuals build a service plan and gain access to resources. And that we're also just working on ongoing data improvement since the launch of 98. We're improving our data collection, our data accuracy, and data capacity using new technology. And in fiscal year 25, we have, you know, we're going to focus on supporting our staff and team wellness to prevent burnout, to prevent compassion fatigue and compassion satisfaction. So those are some critical priorities for us as we embarked on a model that has fully transitioned from a volunteer-based model to full-time staff doing this work and ensuring that they are taken care of and we prevent their burnout. So I will pause there and we'll be ready to answer questions whenever you. Thank you. I guess the next presentation. That's it. Thank you very much, Council. So in my new role as the Assistant Chief Field Services, Chris's intervention and engagement with the community falls under my responsibilities and I work with the Cam Satinsky and a lot of these issues. But what's interesting is that a lot of what I'm going to speak of today for my perspective is a lot of things I was doing in the third district and some of the things that I recognized with a huge mental health issue in downtown Silver Spring specifically. Over three years ago we were in a crime summit where we were talking about staffing and running calls for service and focusing on violent crime. And at that time I said, I embrace this whole of reimagining, reimagination of police work, where we could focus on those things and turn over mental health to other stakeholders like HHS and private entities. The reality is what we recognize was that we could not get out of mental health crisis situations altogether. And I think that we developed a strong working relationship where we increasingly developed this strong relationship with HHS to address mental health issues. I liken it to a stoplight. And we're actually talking about it a little bit three years ago this way. But the green light would be where HHS did not need police. The red light would be, the police did not need police. The red light would be the police absolutely need to be involved in this. And then the yellow light was something where we could coordinate and collaborate together for positive outcome and crisis intervention and mental health issues. I think we've only grown better at what we're doing and I think that the relationship we developed with H doing and I think that the relationship we've developed with HHS and the things that are going to be talked about today and the training and the collaboration that we're working on together is a successful program and can be done successfully for positive outcomes in the community. And then I will also say that crisis intervention or CIT teams, you know, most of our time was spent in a reactive response to people in crisis, but the development of the behavioral assessment unit is our way of getting in the game of prevention. I think it was already said here before, that the goal here is not to just always deal with people in crisis, but to prevent the crisis from continuing to occur. And Councilmember Alvin, as you said, it's all about partnership and synergy, and I think we're there, and we're working very well, and very hard at a successful outcome with HHS and other stakeholders To prevent crisis from occurring in our community Thank you Good morning. He took most of my lines. All right He read it in you He's allowed to so we're done Good morning, Jordan Stensky-Captain for the Community Engagement Division I want to touch on something that AC McVain said in Acting Chief Martin. Basically, the collaboration part. That's key to this whole thing. We can't do any of this without it. We are just like the R.I. report stated from what Acting Chief Martin said. We're silent. HHS is silent. The police department is silent. Like, we're trying to break down these walls. We started that breaking down of walls 10 years ago with the Family Justice Center where we started to break those walls down and realize we could work together and we're doing the same thing now again in the mental health sphere. Our mental health response just like we said earlier started about 20 years ago with one officer who was basically taking in and collating information and sending that out to HHS for follow-ups. It grew to HHS providing us with a therapist in 2019 and we had two officers reactively responding to high-end utilizers. That collaboration was limited. Officers had to notify them. They had to search our computer dispatch system to find these individuals or commanders chiefs, whomever would call them and say, hey, I need you three to go out and handle this. We've been there 800 times, I don't know why. I'm using a wild example, but that's the example. In 2023, without asking from you or the county executive office for any extra positions, we reorganized the county, the community engagement division to address this problem in a more proactive response. We took some positions within the division and changed them into centralized CIT officers. We have five of those. They're assigned to all the districts across the county. One of them is assigned to both 1D and 60 because of the way the Rockville City currently handles 1D and our calls are serviced and there's a therapist assigned to Rockville City as well. In our original inception of this, we just have them down in the third and fourth district, responding to 911 calls where people were potentially violent, trying to harm themselves or others, potentially in suicidal ideations. And we found that when these officers came and responded, the result was different. Yes, we had people that were petitioned, absolutely, they were sent to the hospital, but now they're being held. And they're not coming back out again. And we're taking a burden off the constituency that's down there. We're getting the help for the people who were there. And in our collaborations with HHS, they're able to take those people and those information and get them into better services. So we don't see these repeat actions. When we created the behavioral assessment unit, that was made as more of the investigative arm of CIT. So when you have someone who continually repeats and is becoming a problem in an area and needs services because they can't get them for whatever reason, the behavioral assessment work in collaboration with HHS to make sure that HHS can get them the right services. And we use any other private and public partner we can find. We've been reaching out asking everyone in this table here what you see really is that collaboration so much so that some folks at the state level have gotten a little annoyed with us because we keep putting people in a position to get petitioned to get mental health services. And that's not because we're trying to annoy the state that's because they don't need the medical side. I'm sorry they don't need the forensic side the jail side. I don't want to put them with direct or stevenses at DOCR. None of them do. They need other places. They need mental health. They need therapy. They have long-term care. Look, MCOTS, absolutely. We need them. Those therapists only response. Totally for it. It's got to happen. Not a question. And I think it's what I think to be 30 when Dr. Santiago was here with us, which is good. That also lends to the collaboration and understanding because we're starting to understand each other's roles and how we come at this and how we help these people. Look, this situation, how this affects people, mental health, it doesn't know a beat, it doesn't know a road, it doesn't know an economic class, anything. It's all over the place. And sometimes these people, they are violent, they have knives. And for someone like me, I sit in an office all day. So it's a very different situation. The officers behind me, the ones who are actually doing this work, and Monica's folks, I'm sorry, acting chief Martin's folks, who have to go out and do this. to place sometimes where they, their lives are at risk. Social workers in a lot of times, especially when I worked with the APS folks I found out, we're going out to homes by themselves of that police assistance. Sometimes when they knew these folks from violent, acting to use Martin's folks to the same thing sometimes. I can't put those folks in harm's way. It's not their job. Their job is to help. We're there to help as well and we will continue to help. We're there to help deescalate and we will lean on them and make them the primary as many times as we can. Having this unit we've seen I will tell you I don't do that many use of force reviews. I know there are other places to do but when it comes to mental health I don't see a lot of them and if I do it's I was had to help the person up off the ground. I had to help them move them someplace. They're not knocked down for agout fights that are memorialized on TV or in movies. It's a very different response. So to that end, this system, while still in some way of an infancy, even though it's 20 plus years old, and we're still learning and we're still evolving because that's responsible government and that's responsible leadership and that's responsible things we have to do for our constituency, we will continue to evolve in the collaboration part. It's what we need and the information sharing. It's paramount to make in this work to make sure we can help our folks. Thank you. So I had the honor to be on the planning committee for Montgomery County sequential intercept model mapping workshop which was held in May of 2024. We had a great turnout of a variety of stakeholders, including behavioral health service providers, law enforcement, courts. We had county leadership there and a wide variety of folks representing the very services across the intercepts. On the screen, this is an overview sample of what a mapping, a SIM mapping looks like, and it includes the, essentially, it's a framework that's used to outline how individuals with mental health, substance use, or co-occurring disorders come into contact with and move throughout the criminal justice system. And SIM helps to identify local resources as well as gaps in services across each intercept. The intercepts are behavioral health and community services, law enforcement and emergency services, initial detention and initial court hearings, jails and courts, reentry and community services and community corrections. So one of the goals is to increase collaboration across the intercepts and to improve the linkages to services to ensure that individuals are receiving supports and services that they need to avoid further involvement in the criminal justice system. And then another goal is to develop the priorities for next steps on how we as a community can enhance responses to individuals and improve outcomes and reduce recidivism. On the next slide, this is our resulting SIM map. So you can tell we have a lot of incredible resources and programs and services throughout the community and we're able to map this out within those couple days at workshop. And this just goes to show how complex of a system we have here across the continuum of care and how important it is to share information and provide the knowledge of these resources with folks in various intercepts across our county. I'm going to focus next on the recommendations that came out of the workshops. And so the top three priorities that were identified, everybody, we brainstormed and talked through after identifying the resources and the gaps in services. We talked a lot about what are the most important aspects that's missing. And we all voted. We were able to, you know, everybody that was participating in the workshop was able to cast votes and these were the top three. So that's enhancing the reentry process was identified as the first priority establishing state the stabilization center was the second and creating multidisciplinary teams was the third. With the reentry process it was identified that a clear and structured reentry process is essential for successful reintegration, including access to critical services such as housing, employment, education, and health care. The next priority, there's a lot of support about the stabilization center that was discussed earlier, the diversion center, and how important that is in our community for hospital and jail diversions. And the third priority that was identified was to create this multi-disciplinary teams. Again, there was a lot of focus on enhancing the communication across intercepts. We know that historically, there's been a lot of information silos, which is presented a lot of that close collaboration and ability to ensure that individuals are accessing all of the services that they may need. Other priorities that were identified including increase behavioral health services across the continuum of care. We know that when people are in need of behavioral health services, the earlier they can get connected to care, the better. And there's also quite a bit of discussion about the need for additional residential services and recoveryidant Recovery Housing. Improving data sharing among agencies. Again, there's the limitations oftentimes across various intercepts and it can create fragmented care and missed opportunities for interventions and supports. Expanding law enforcement's options for diversion was another priority that was discussed, and streamline communication across the intercepts. Again, you'll see a common theme here that's the sharing of information and collaboration identified as so important and key. And then also increasing training opportunities such as trauma-informed care, implicit bias, and anti-stigma, and crisis intervention, as well as integrated behavioral health in primary care. We also were able to take a look at what were the few priorities that was considered to be low-hanging fruit. What are some interventions that we could really jump in quickly and efficiently make it impact quickly for individuals who are experiencing behavioral health concerns that are in the criminal justice system. So, these are the top three that were identified, again, resource sharing, and the LBAJ maintains a resource directory that has a live link, and the QR code to that directory was shared with the work group participants. However, it was determined that because it is very extensive and quite lengthy, that having a brief or quick business card like summary of essential resources would be really helpful. And then resource awareness is just increasing knowledge about the eligibility criteria for community resources. Even just during the workshop, a lot of folks across different intercepts were surprised and interested to hear about services that they hadn't realized exist already in the community. And so it's the availability of resources, but then also enhancing the awareness about who is eligible for which services. And then the last loing fruit that I'll just touch on briefly is just about training, just talking about how important it is for those who are working with individuals with behavioral health concerns to have specialized knowledge and skills to work with people with behavioral health concerns to ensure that they have access to anti-stigma training and to really fully have a good overview of the available resources in the community to best serve them. So that's the brief summary of the report. And this report will be available in the coming weeks on the GEOCPP website. Thank you. Great. Thank you all so much. I'll kick it off. And then colleagues just let me know. I'm sure everybody's going to have questions and thoughts. But I think that fourth or fifth slide that you had with, I just got a new prescription of glasses. I'm glad I did because there's, you know, it really sort of underscores and illustrates the complexity of the system, though, because under each of those bullet points are people, are trainings, and a myriad of different and challenging situations that we find ourselves in. So, but it was a good illustration of that. And I do very much sense that progress is being made and I really appreciate everyone's efforts. So, you mentioned something, Ms. Chef, about the procurements and the resources and the money allocation. I would like to give my colleagues and the executive branch an opportunity to talk about some of those fundings and is that a procurement issue or where's the hold up there and how can we ensure we get the resources to the organizations that need them? Yeah, absolutely. Mr. Chess with referencing money that was made available late into FY24. It was additional funding that was identified by the state that could be utilized by 98. Everyone agreed they could absolutely utilize it. There was close collaboration to kind of get that going. It was about $453,000. Unfortunately, the LBHA did not receive the conditions of award, the statement of work until June 20th of that year. And it was just literally impossible with an expected spend date of June 30th to realize it. I want to make sure you know that we have a very strong advocate and Ally partner with the state here, but also advocate on behalf of our community and our partners. Sarah Rose here, who hopped on right away on this to make sure that this is not something that continues moving forward. We do have outstanding dollars, as Ms. Chath talked about, that have not been awarded yet here in FY25. But we are much earlier in the year, and at least hearing from the state that this is not going to be repeated that pattern. Thank you. I appreciate that. Dr. Satterjamban here. Yeah, I was just going to say so, you know, it's interesting in this space of I've been meeting with Director Stevenson and actually acting chief Martine has recently joined the group with the secretary of the Maryland Department of Health as well as Deputy Secretary Moraz and Deputy Secretary Lord who oversees behavioral health. You know, I have a broad portfolio, but I can't say I have interactions with secretaries and Deputy Secretaries as much as I do in this space at the state. So they are really committed to trying and making improvements. For a number of reasons, obviously, you know, the group started with the Secretary of Focus Dawn, the fact that we have the largest number of persons deemed by judges to be incompetent and need to be remanded to the Maryland Department of Health within our correctional facility. We routinely have 35 plus people sitting in our jails who have been directed by judges to the Maryland Department of Health, but there aren't beds. And so that's how we started our collaboration working with the state. And it's actually broadened to include work around the stabilization centers. There are additional dollars that they are offering to Montgomery County to help them address the problem that they're seeing, but it benefits our residents. And so I think that, you know, as far as I'm concerned, over the last year, we've seen a dramatic improvement in our relationship with the Maryland Department of Health, particularly in the behavioral health and crisis space. And so I'm hopeful that things like every mind experience at the tail end of FY 24 will not repeat themselves moving forward. Thank you. Just a couple of other baseline questions. So staffing, I know in the last conversation that we had almost a year ago, we were still in the process of hiring for some vacant positions. If we could just get a quick update on where that stands and how many vacant positions we still may have. Yeah, absolutely. I believe you have this in page three of your packet. In terms of our crisis center staffing, we have 34 full-time therapist positions. Currently nine of those are vacant. Four of those though are some of the new creations that were created here in FY25. So as you know, it takes us some time to have those positions and pins actually created, but they're under recruitment at this point in time. We have one behavioral health technician that is an MCI eligible professional that also assists with calls. And then we have 14 full-time peer recovery specialists that are just super excited that we have 14 in the milieu. But seven of those positions are currently vacant because of the process of being very classified to make class equity standards across similar positions throughout HHS because we do have peer specialists and other programs as well on behavioral health and crisis services, not just at the crisis center. Thank you. And I know that we've discussed in many ways and this isn't the only division that has a number of vacancies with the HHS and this is a national challenge and problem, but we'll follow up on the strategies you all are using to fill not just these, but all of the other respective positions. And we generally get an annual update on those vacancies from HHS. So I'll hold off until we get those, but thank you. Just a couple of other logistical questions. And then what I'm going to do is just go down the line Starting with chair cats because I know everybody has questions and thoughts, but The geo routing which is great. So walk me through that So does that mean that whether it's coming in through 98 911 the 240 777 4000 or 311 those calls are all being routed to the crisis center? Or no, what does that mean exactly? Sure, no great question. So with G or routing, what that means is that calls coming through 988 will be routed based on their closest cell phone tower ping, not based on the first seven digits of their phone number. So if you have a 917 New York phone number. So if you have a, you know, 917 New York phone number but you live in Montgomery County and you're calling 988, then your call will come to Montgomery County and every month's 988 call center and not go to New York. And right now it's with two carriers, only, T-Mobile and in Verizon. I appreciate that. So, and the concept of no wrong door, so important, so important. And the fact that there are four, at least four, probably more, but four definitive means by which people who are in crisis can contact the county and our various organizations in some way is a good thing. But obviously that initial call, we all know this in preaching to the choir. And whoever takes that call, my goodness. So important to be able to assess and evaluate the circumstances. And how is that going? So the training of those initial call takers, depending on which call they are going through, is obviously the first step. And there's so much that goes in prior to that relationships that are built, you know, sadly, oftentimes these are repeat calls from families who are in crisis for various reasons. And so they may be known to somebody in the system from somewhere. Just could we talk a little bit about that initial call on the training that's going into those four respective call centers. Sure, why can just initially speak to the crisis call phone lines at the crisis center. Those are picked up by crisis center staff. So those are picked up by professionals that already have extensive training and experience in crisis response and specific training around, you know, de-escalation of the phone and evaluation and redirection and warm handoffs and referrals and all of those things. But I also, of course, want every bind to be able to speak further to the training that they have for their call takers in 988. Yeah, so our crisis calloutsers go through an intensive training as well, I believe at 60 plus hours, total of training plus role-playing and also observation time with other experienced call counselors and watching. So there's an intensive four to eight week training process, including how to deescalate calls of crises, but you're absolutely right. Councilman Rolburnos said, including how to de-escalate calls of crises, but you're absolutely right. Council Member Albernos, that when the phone rings, our call counselors don't know what is going to be on the other line of that call, and so they are prepared to answer all types of calls. And I will say with the Montgomery County hotline that the majority of our calls, it's probably close to 90% are first supportive listening. And so for individuals who are just looking for someone to talk to that day who are isolated, depressed lonely, and typically our call counselor might be the only person they'd speak with that day. So our counselors receive training to support all types of calls. Great. I would just add, 9-1-1 integration is a major emphasis. 9-8-9-1 integration is a major emphasis of state-wide this year. There was a conference earlier this year that was held that I attended one day conference talking about that process. Fortunately in Montgomery County, we're the only county in the state that has a one-to-one ratio with our 98-8-2-1-1 call center. Many of the other parts of the state have multiple now-1-1 centers working with a singular 98-8 center, which poses a challenge. There are challenges across the state that are not going to be seen in Montgomery County fortunately, because if you've seen now one-now-1 center, you've seen one-now-1 center. And so trying to have the 99-8 centers across the state integrate is a lot easier for us because obviously it's just just that one to one ratio. And also every mind is providing the text option across the state. So we obviously have the direct conduit there. So we've got a little bit easier road to travel than some of the other state counties across the state. But this is going to be a substantial challenge for a lot of reasons. And what they want to touch on with the the GR routing the LUTU 98, obviously within 911 system we have a lot more information about where the caller is calling from by design. But it's an intentional part of the 98 system to allow for a degree of anonymity essentially to the individual and that's a feature not a bug. But obviously it poses some challenges in the way that you interact with the NIL1 center because if it becomes a NIL1 issue, relaying information can be, can, there can be challenges there because you don't have the same degree of information within the NIL8 system that you have within the NIL1 system. And so I just want to, I raise that to illustrate these are the kinds of things that we're talking through really this year to try and have a much better collaboration moving forward. Thank you. I will now yield the colleagues. We'll start with Chair Katz and we'll go down the line here. Thank you very much, Mr. Chairman. And let me say to you all, and I say this on other topics as well, but thank you for all that you do. I know you never receive enough of that. And candidly and you that are here and the nonprofits that aren't sitting in the room today literally save lives in Montgomery County each and every day. And that is something that we all candidly take for granted and we shouldn't because we need to make sure that you continue to have the resources necessary. You know, many times we use the word crisis. Someone is facing a crisis and we use it as a single term. And of course, every crisis is extremely different in everything that happens. Each crisis is a person and their family is involved and others. It's certainly not a one-size-fits-all. And you all need to help figure out what's the best way to respond, what's the best way to get that person help and their loved ones as well. Many times someone who's facing that excitement, they're excited. They don't know where to turn. So how do we better educate the public to say, this is what we need to do. And if you're facing this, this is what we need to do and how do we do that? Gut reaction is dial 911. I mean, my loved one is having a horrible situation. I'm going to call 911. Well, that might be the thing that you know of. And of course, we have to deal with it. But is there a way that we can figure out, and if someone calls 911, what happens at that point for that crisis? Please. Thank you. I know that he looked at you because you are for him. Yeah, I notice that. Oh, so when calls come into Nimon, one of its and jump in here if I'm saying anything I shouldn't. When calls come into Nimon, one of we determined that it's not a police response word, something that should be transferred over to every mind that there is a system to make that happen much like we do the same thing with the crisis center. As far as marketing the 988 line to get it out for that, I think that's going to be listing sessions or town halls and I think that's going to be marketing and PSAs honestly and another collaborative approach for all of us doing that. I do think in times of crisis, much like we talk about with police, I'm sure you've all heard this. We all fall back on our training that we were trained. We've all been trained since we were this tall that if you have something happen, call 911. So I think it's gonna be something that's ingrained in our society. It's gonna be difficult. Well, I think it's possible, but I do think it has to be more exposure. Because I'll tell you right now, the only time I see 98 commercials, and this is not Montgomery County thing. This is all over the country, is 2 o'clock in the morning. Don't ask why I'm up, but 2 o'clock in the morning. That's it. I mean, and that's just because that's when PSAs were put on. So that I think is something would add is that it's not just building the awareness of 98, right? And I think right now, 98 is also very much marketed as a suicide and crisis lifeline, right? And what we also provide is supportive listening and a lot of prevention, support, and de-escalation so people don't fall into a deeper crisis or need additional more expensive emergency services. So I think there's the piece of not only building awareness of 98 but a true understanding of what 98 is. And you know, Captain is absolutely correct that, you know, 9-1-1 has been around for 50 plus years, right? 988, while the lifeline has been around for more than 20 years, 98 only two. So it's gonna take a lot of coordination, public awareness, building and marketing and campaigning. And I think the other piece that we talked about yesterday in the crisis now work group is 911 giving 988 as a resource as well, right, to then divert people and to help build that awareness. So those individuals who's got instinct and reaction of 50 plus years is to call 911. And 911 is saying, call 988, that's a great pathway to then continue to build that awareness. And I agree with that. I believe though, candidly, 988, and there again, the easiest job in the world is to be a critic. But I believe that 988 needs to market itself in a different way. Somebody's going through a crisis and they say, well, you know, he's not suicidal. So I'm not going to call 988. Well, you should call 988 because they do suicide and other things. And we have to have that ingrained. And I'm going to stop here, too, because you know because my colleagues want to have some other information that they want to ask about. But I guess one of the concerns that I have is when you're in crisis, it's how face can we get there to help? Whatever form it's going to take, how face can we get there to help? And is there, do we have metrics when, if someone is in crisis and we call, and they call, do we have metrics how Faes were able to get there to that issue? For 988, we are, when we are unable to de-escalate. And you said like what percent when you can't which is unbelievable. Yeah, exactly. That goes to either the crisis center or to 911. I'm not sure about how long that transfer potentially takes. Yeah, it would just be a warm handoff. So that actual transfer to get the person's in the next day, we'll only take a minute. Yeah. And then from there, I would defer to my colleagues that I do just to see how long mobile crisis outreach or any other outreach intervention takes. I will just say transparently, this is something we need to do to work on within HHS within the crisis center in terms of better data gathering, better systems to be able to track that. And it's part of crisis now framework to be able to track that. So it's part of our charge. And part of what I don't want to say complicates that it's not really overly complicated is that MCOT response time for example, right, can be variable depending on the actual teams available. For example, it can be variable depending on the actual teams available, but also based on what we're hearing on the availability of deployment of our MCBD partners in those situations where we need to have them with us to ensure staff security. So our system is just not capturing from call to response based on some of those and other variables the response time. And so that is part of our integrated data collection work that we have to do in the back to you. And I said it was last one, this really will be the last one. Is there a certain, is there more, is there a time during the day? I understand Capt. Satinsky is up at two o'clock in the morning, but is there, is there a time that we have more need during the day than other times? For MCOT specifically, it tends to be weekday evenings, like the second shift, 3 to 11 timeframe Monday through Friday. Thank you. I would very, I've done a ride along with the MCOT teams. I would very much encourage members of the council to do that, because I think it's very instruct instructive not just about what the work they're doing is but the way it actually operates and I'll give you an example. I did a Friday night ride along like a like I think I'd rather work five to about midnight or so with the MCOT team and when I arrived they had a list of calls that they knew they weren't have to do already but they said hey if we get something emergent, these are lower acuity, meaning they're not imminent risk calls that were responding to. They were parent, child, interaction issues. They were people, someone with an eating disorder, for example. They were real issues that needed to be where there needed to be an intervention. But if there had been someone who was suicidal or who needed a real direct intervention, they would have diverted. But so the call response time for those initial calls was probably a couple hours from the time the call had been received between them and the MCOT team getting there. But that's not illustrative of when there's a real emerging crisis and how long it takes the MCOT team to get there, which are also variable. But obviously we went from three teams, now we're at five teams, we're gonna go to seven teams. And so we've more than doubled our capacity in a well-known being less than a year. And so I think that we're gonna get a lot better data as we have more teams available, more ships covered and those things as well. And as well as we get a better handle of, what kinds of calls the MCOT team can be most effective in responding to. Thank you. Thank you, Mr. Chair. If I may add on just a little bit more to that, I'm going to be on that theme. And I will look to our senior administrator for the crisis center manager over there to correct me with anything that I'm mistating. But the other thing that has shifted along, you know, establishment of the MCOT teams is we don't define what is a crisis for our residents. They define what is a crisis. So this issue of risk assessment and acuity is very important. It's not in the same place. You know, Dr. Sutter talks about a queue of calls that were in. There was a time where MCOT response was focused on there is a concern about immediate danger and safety, right? Due to behavioral health emergency. But now, as you say, it could be someone with an eating disorder, it may not be very immediate at all, but we're never not going to respond to that. We just might take longer getting to them. Does that make sense? Thank you. Councillor Murloughy. Thank you. A quick question following up on something,member Katz asked for the 4% Of calls that where you do you you aren't able to handle that. What does that translate into in terms of number? It would be, we answered about 55,000 contacts last year, so 4% of it, that's not my jam, but it's not mine either. But I couldn't remember the total number of calls that's 2000. Something to figure out later. Gotcha. Okay, so it's about 2000. Phone to friend or somebody said something under the breath. Okay. Super. is about 2000. Yeah. You phone to friend or somebody said something under the breath. Okay. Um, super. This is what we need. Collaboration. Thank you for doing that. Um, do you know what the call response times are for at the, at the, uh, crisis center because they're wearing multiple hats in the crisis center. What are the call response times there versus 988? Yeah, thank you for asking that. I believe in the last budget cycle, there was a request somewhere along the way for dedicated call takers, and that was specifically to improve the response time. It really all depends on volume coming in, but as you stated and you know well, it's anyone in the crisis center mostly trinklinitions, but who may respond to those calls in the moment. And so we do think that dedicated call takers are needed in order to reduce that immediate response on the line to do that initial assessment and entourage because we, you know, depending on the night and what's happening, all those clinicians could be face-to-face with a number of walk-ins and, you know, we have had residents wait, unfortunately. Obviously, what we're striving is towards is not having, not having anybody wait on the phone, right? We do have nine a day. We have other resources to make sure they're immediately rerouted, but we can't we'll stop away from those more acute crises that might be occurring right in front of them in the center as well. And that includes the peer support folks who you have, they're able to answer calls to as well as going out on the calls, right? Absolutely. Okay, super. And I'm very happy that we were able to have the funding to do that and to bring them on board. And that will help them. And that will help them. Yes, we'll help that. Yes. I know that I'm thankful you guys have the crisis now. Group re-tooled, reworking, re-energized. We're going to use that word. That sounds hopeful on a gray day like today. Re-energized. And a lot of the focus of that group is really what would be on the giant slide that Ms. Rose put up of all the many pieces of the intercept as mapped here. Intercept zero and one. I do want to say, Councilmember Katz came by at the beginning of the start of that two days in mapping session. I was there for the whole first day and a little bit of the second end, and my team was there both days the whole time. And that was really a wonderful thing to see and also to have people have opportunity to hear one another. There were folks who didn't know that we had a CCBHC already designated for the county, right? That's important. And in terms of the forms or ways to be able to share information and I'm glad that the thing I wrote is in the back of their mapping report that they gave. And I don't want the fact that it says active assailant interdisciplinary work group to give anybody pause. I did that while serving as the prevention chair of that work group. So the goal was not about what happens at boom or beyond. It's left of boom. And that's a common term used, I know, in the public safety world. And that is really at the heart of where we're all trying to get and to be is to be in intercept zero most of the time. And most of the work because then that reduces the amount of things happening along the other five intercepts. And I wanted to ask also, sorry, wrote things on different pages. I noted in the packet it talked about the deployment from the Crisis Center for Scissom. And I wanted to explore more what it is that the crisis center does in those situations. We had an incident in my district this week. We did have a community meeting. We did have folks from the crisis center there who were there to support and help. But it was not a facilitated system engagement. And so can you talk a little bit about how that works, how it's decided when it's deployed, and when it is not? So it is really dependent on any community member or stakeholders request. So if we get requests from anyone in our community to do critical and incident stress management, we, again, we let residents and our partners that are calling us drive what they define that they need in that initial encounter and moment. So we have clinicians that go out to respond to critical incidents in the community. It can be anything from natural disaster to, you know, manmade, you know, violent incidents, what have you. So it includes on-site support for individuals in the aftermath of an event or a formal scheduled debriefing of facilitated one as your referencing. So all those options are offered. And as I think we talked about in the last week, you. And information around kind of best practices and these situations, right, from the expertise of the staff in the crisis center is absolutely shared. But we're not in a position, of course, to go in and state this is what we're going to do, right? Depending on who is making the request. And I raise that just because I've been in a situation, not here in Montgomery County, should kind of flag in a situation not here in Montgomery County, should kind of flag that, was not here in Montgomery County, where the group that had been affected by the tragedy was not told that SISM was going to be happening for them. So they all came with zero expectation that that was about to happen. And when they were told, you are now doing this today. It did not go well. Right? You have to be receptive to it. And so it did not go well. But I think it's a highly useful tool that we can deploy needed when wanted and should be used. I heard you talk about how things have evolved and grown in terms of the collaboration and I know you all have been hard at work on these issues for many, many years as have other jurisdictions in trying to find the right fit and balance and what works in your community. Because it is specific to your community and in a community as large, geographically diverse and diverse in every way possible as Montgomery County is, which is a blessing. We have to have a lot of agility in managing that response. I haven't done a ride-along specifically with MCOT. I have done other ride-alongs, but I happen to just do to circumstances involving one of my dogs who had escaped. Don't worry, she has a GPS tracker on her now. But in trying to find her stumbled across an animal service as Van, and I thought, oh no, except in trying to find her stumbled across an animal services van. And I thought, oh no, except that the animal services van was there, but it was a crisis call. And the law enforcement team had arrived first, and then mobile crisis was there too. And this went on for hours, as did my search for said dog. And so I had to keep circling back through there. And what I was able to observe was how fluid, all the constituent parts of the people who had responded to the call were able to work with one another so that the individual in crisis could say, I wanna talk to so and so. And then the other person would leave. And the other, in this case, it was they wanted, they wanted one of the two officers who were there. That was the person they had formed their rapport with and that's who they wanted back in. And so they were continually adjusting and readjusting based on the circumstances that were unfolding. And so I think that speaks volumes about the level of coordination you are already experiencing. But I also appreciate that things need to not stay and get dusty on the shelf. And we also need to always be open to how do we do better. And again, in the sequential intercept model, if you are adjusting services and providing different things at different times, you may then have to adjust certain things at other points in the intercept, the point being that you're never giving up on someone throughout any of those intercepts. And I know that, sorry, look at it, my notes, the recommendations that you reviewed from the mapping session, and I know the report just came out. So it's lengthy. It's a lot to read. I hope everyone here reads it. But the need for multi-disciplinary teams, the need for being able to share data, the need to enhance communications are all what is embodied in that analytical model. And you know, just for my colleagues, to understand that the sequential intercept model is an analytical tool, not a programmatic or a type of care or anything of that sort. It is there to help surface and allow for those discussions amongst the people that have to do that work across the continuum. And I know we had a robust discussion yesterday at the Criminal Justice Coordinating Commission meeting with Director Stevenson. And I know we had a robust discussion yesterday at the Criminal Justice Coordinating Commission meeting with Director Stevenson. I wanna thank you for all that you do. I know that this made the news and Dr. Sotter got some good quotes in in how we are or are not sending more cases with those involved in the criminal justice system who need behavioral health care. And to me it's we're doing a good job of flagging the root causes of problems and and I know everyone here is committed to doing that and continuing to act in the best interest of getting people help no matter where they are on that continuum, including our judiciary. And I know they're not here and they don't typically come before council except during budget hearings when they have to talk about the circuit court budget. But they are a critical piece of this as well, particularly as we move into working through assisted outpatient treatment. And I know the state's going to have some guidance out soon. They're working through that. But you know, in terms of the takeaways you all had from being at that two day mapping session, where do you see next steps going for you based on the state's analysis? Or do we need to come back and talk about that another time? I'll say, I mean, there's, we're at the beginning stages of this, but we've already begun working towards many of those recommendations, increasing the collaborations, and just having more connections and talking through what the needs are and how we can help support one another. I think one of the biggest issues we've all realized and identified is the varying definitions of HIPAA that is from sharing certain levels of information. From the police department side outside of the youth engagement parks, remember the Sim only addressed adults, it did not address the youth, which so that's then entirely different set of circumstances. There are things I'm precluded from sharing with HHS and vice versa. And that ends up, and as well as I'll even bring an MCPS to this point. And that ends up where we have maybe the same child, the same family, the same adult, who, ever getting services from two to three separate entities or a myriad of private subcontractors out of HHS or otherwise, that are all doing the same thing and no one knows it. And everyone thinks they got a handle on it, but maybe this family is going to do the same thing on several levels and we can't discuss it. So we're trying to figure out a way to have that discussion. We're trying to engage the Office of Attorney General to provide us with an opinion on how to share this information, because you'll even get varying definitions of HIPAA from attorneys in our own county attorney's office. And I'm not saying that's wrong, there's just wildly different opinions, so we need something to come down from the State Office to clarify this. And if it says, hey, we can't, then those are the rules. But if it says we can, then great, let's do that. There are carve-outs in the law, especially when it comes to APS and police, whereas long as there is an identified criminal investigation, there are some limits, but we can share information, information, excuse me, it's the lineated in KOMAR, and if we can get something like that, that'd be even better. But until then, which we all know the legislative animal is a little slow, slow. If we can get something from the Attorney General's Office to pinpoint that, that would help us a great deal unless someone has a different feeling on that. The other thing struck me from both the same, but then also we had a workshop that involved Judge Smith and Magistrate Kim, talking about juvenile justice issues from the criminal justice attorney position. And then the full commission meeting that we had yet have yesterday, but also more recently is just the unanimity of recognition. And this was alluded to yesterday at the CDC meeting, the state's attorney and the office of the public defenders office agree on issues around access to beds and care for individuals who are deemed incompetent. This is something they are fighting together to address. That is, I don't want to describe how uncommon it is for a state attorney in a public defenders office to agree on such a centralized issue like that. But I think I've seen this level of unanimity across the board that we need additional resources, more access to beds, and not just total number of beds, but they have to be readily available for people who are in need of them immediately, and not some panacea that might be available six to eight weeks later, so that's not when the person needs the intervention. And people, it's like any other physical ailment, you get worse if not treated. And so, people who are in crisis decompensate or their condition worsens by virtue of lack of timely access to care. And so, it's not just making sure that we have this crisis response system, but it's making sure we have the backstop services available to address the underlying issues so that they don't get worse and you're not just dealing with crisis, you know, when we go to a fire, we don't just, oh, it's down to Embers, we walk away because the fire will restart. Right. You make sure that they're, you address the causal issue of why you had a fire and that's the same thing is true in the space where if someone has an underlying issue, it bubbles up to crisis. You don't just deal with the crisis walk away You have to be able to address those underlying issues. Otherwise, you're going to be back at that same place two three four days later and that's just the reality of the system and what we have to address collectively and so And I think that's what struck me mostly from the interactions that both of the sim but also criminal system. Is this how there's unity irrespective of where you sit at the table or what side of, you know, the interaction at the criminal justice system you sit on that there is absolutely agreement that this needs to be increased capacity in the space. And they think, you know, from the discussions at the Sim mapping session and then again, the summer at the MAKO conference when Mr. Rodin, so James Rodin's the Executive Director of the Crisis Center, Vengeance Center of Excellence within the governor's Office of Crime Prevention and Policy, who led our sim mapping workshop here in Montgomery County along with other members of his team. Did that presentation at MAKO about this issue and about services that GoCap has and programs they have, and they raised the fact that we were trying to formalize having a sequential intercept model body that would then stay and continue to oversee this work. It came up again last week. I was in Connecticut for a couple of days with a couple members of the Maryland Judiciary at the Council for State Governments Symposium on Adolescent and Mental Behavioral Health. And of course, that was the topic, but we moved into other policy areas like adult and needing to have continuity of care. And how are we doing this. And we heard from other states where they had done some mapping exercises too, and they said, and then what? Right? And one of our members of the judiciary who was there said, well, in our county, we're trying to make that permanent. So it's an ongoing, continuous effort to focus on those issues, adjust and readress. And I said, and yes, and tell the legislative body what funding you need in order to make these programs work. Right. And so that is the point of it. But it is never, never to take a type of treatment or method off the table. It is not meant to restrict, it's meant to enhance and specifically to enhance collaboration and cooperation between all the multiple entities that must work together in order for us to overcome the obstacles we now have and do a better job of keeping things within intercept zero. With that, I'll yield. Thank you very much, Council Member Sales. Thank you, Mr. Chair and my colleague for hosting this joint session and for everyone's contributions to really debrief this recent report about the service integration model. Wanted to ask, start with the crisis center updates. Just wanted to ask about the discharge process after individuals are discharged from either the emergency room or holding after reaching their maximum 72 hours day. I know that not everyone adheres to that 72 hours day. Do we know where individuals are discharged to? Are they discharged to family members on their own? If they're an adult, children are they released back to their guardians or? So I can't speak to the hospital discharge process per se. But in terms of the crisis center, it's any and all of those. So I can't speak to the hospital discharge process per se, but in terms of the crisis center, it's any and all of those. I'm happy to get back to you with specific statistics on where they're going. And but as you stated, sometimes the length of stay is increased because there is not the available place and space that is needed for them to step down into. Okay. And for the diversion center, which obviously will not, has an open until, well, hoping 2026, but we all know how the structure projects go. One of the things we've been talking about in the work group is discharge planning starts when arrival. And so really from the person arriving at the center and beginning their care, you're just, you're talking about what the best option for them is in terms of a discharge follow-up services along those lines. And while it says 72 hours, we've discussed in the work group that we're never going to release someone who is still in need of service, who is still actively in crisis at that set. You're not just going to, we've reached some arbitrary 72 hour window, they're leaving no matter what. Now, obviously, in order to keep that bed available for the next person who will be in crisis, you need to focus on addressing the issues and getting them into a better care system long-term if needed. But, you know, there's never going to be an arbitrary cutoff that says, your meter has run out, you're leaving, because we know that just putting them back out in that situation is not going to be good for them, not going to be good for the community. There's no interest served by following the arbitrary timeline. It just, you know, we want to make sure that we're accounting for the metrics because if we're consistently not able to get people out in 72 hours, that has real impacts on the availability of beds for the next person. Thank you for that. Regarding the mobile crisis outreach team, I know that we have, when the crisis team is in the field helping someone within a media crisis. Can you share a bit more about what happens during that encounter when they arrive on the scene? So she's willing. I would love to call up our manager for our crisis MCOTS. To talk about what happens when they arrive on the scene. Thank you. Thank you. Good morning. And I apologize. I was responding to a crisis text from the crisis. No, repeat it. But thank you. Can you state your name for the record? That's Batchic Manager, the crisis center. Okay. And so when a MCOT members dispatched and deployed to the scene, can you walk us through what happens, their interactions with the law enforcement, with the person in crisis? Of course. And of course, it's widely variable depending on the nature of the crisis and the individual specifics of the situation. So the planning in terms of how we're going to respond to the situation occurs before we even dispatched the team. During the initial phone call or triage with the mobile crisis request, or we would be taking information related to the nature of the crisis, any clinical history that would be relevant. The level of interest the individual might have in participating in a crisis assessment, all the different types of information that would be helpful in determining the best response and the best approach in terms of helping to engage the individual. We do have assigned mobile crisis outreach teams on every shift, meaning that staff are assigned to respond to mobile crisis that's their full duty where that is what they're scheduled to do. There's a lot of things that are difficult to do. There's a lot of things that are difficult to do. There's a lot of things that are difficult to do. There's a lot of things that are difficult to do. There's a lot of things that are difficult to do. There's a lot of things that are difficult to do. have a staff person with a particular language skill or area of clinical expertise or area of resource knowledge. This is where our peer recovery specialists have been amazing assets to their crisis center in terms of their broad and expansive knowledge of community resources and treatment resources. We may be flexible in terms of determining which staff would be best to respond. And then we use our triage and dispatch protocol that was configured in 2022 with the assistance of our of McGio and our know, that went through our bargaining process. We use our triage and dispatch part of call to determine the acuity level in regards to law enforcement response. So we would engage if it is a situation where there's some risk of violence, there's been threats of violence or some indication of, you know, concern for weapons on scene, we would reach out to law enforcement by, we do use the telephone we call ECC, request law enforcement, accompaniment for the situation, and listen on the police radio to hear what the estimated time of response might be. And once we get, and we call law enforcement before we engage with the individuals that were able to provide information, we are in the nature of the situation. Oftentimes law enforcement also might have some information that would be relevant. And then we, you know, coordinate with them in terms of how the safest and most appropriate way to respond to the situation. So, you know, and those are situations where law enforcement would be indicated, you know, in other situations where there's a lower cutie or not a risk of, you know, there's not there are not indicators of potential risk for violence or aggression. We would, you know, we would just respond to the, you know, respond to the person's residence. And our response time, it is variable because oftentimes the requester may call and say, you know, respond to the person's residence. And our response time, it is variable because oftentimes the requester may call and say, you know, this is what's going on, but the individuals at school are at work, they're gonna be home as certain times. So we may receive a request, you know, at one point, but then not respond until the requester wants us to. You know, we're client-centered, client-focused. So we're aiming to respond around the best interest of the clientele. Thank you. I'm referencing like the most, I guess, a grigis situation. If a weapon's involved as someone's an eminent danger, how often does an MCOT personnel member interact to assess the situations that 100% of the time or does it very depending on? So it does vary. I mean, we do defer to our law enforcement partners in terms of the safety, you know, the safety components of a scene. So if we have information that suggests that there may be a safety risk, we're going to defer to our law enforcement partners in regards to have us to address that component. They're going to be, we're going to defer to the experts in that area. But there are situations where depending on the nature of the situation, if we know that it might be more effective for us to make initial contact, it really depends on the specific of the situation in conjunction with our law enforcement partners and the information we have available. Generally speaking, law enforcement in those types of higher-cute situations are gonna be the first point of contact. They'll address the situation first, make sure everything is safe, and then our teams will address the situation. And our teams are primary will address the situation. And our teams are primary in terms of the assessment. So the law enforcement's primary in regards to the safety of the situation, but our teams are primary in terms of the assessment of the situation and the engagement of clients or the individuals involved. And so how do you assess the situation? Do you always interact with the client to assess the situation or how does that would be absolutely, of course, ideally we would be interacting with the client. But there are other components that can be helpful in terms of, you know, we try to get information before, as I mentioned before, we even go into situation regards to collateral information from the person who's concerned or the system, you know, we often get requests from property management or shelter partners or what have you. And so we'll try to collect, you know, some of that preliminary information before we even respond. But we do have, you know, our teams do respond in partners. So we often will directly, you know, have one team member directly work with the individual in crisis or, you know, have one team member directly work with the individual in crisis or, you know, the individual who were responding to them while the other partner might be getting the gathering information from those on scene. So, you know, it's apps, of course, the goal would be to, you know, get information directly from the individual who's being impacted. But there's oftentimes, it's important to hear the concerns of the other people who might be involved with the situation. It provides additional information that can be relevant. OK, and how do you debrief after a situation occurs? With law enforcement or with law enforcement, with MCOTs, do you do brief after a call especially in an event where there's a loss of life? So, absolutely. We haven't had, I'm hesitant to say this, we haven't had a mobile crisis intervention that's involved a loss of life. We have been involved in situations in the aftermath where we responded in a critical incident capacity, but we haven't had an outreach that's responded. And a request for an assessment that's resulted in loss of life since, believe the late 90s. So we, the briefing would vary also depending on the nature of the situation this year, in how complex the situation might have been as you're suggesting. We do, as I mentioned, our teams do go out with partners, so they do tend to brief with each other. There's a supervisor on shift or on call that offers a measure of support or debriefing afterwards depending on the complexity of the situation. You know, for more routine situations, it might not be necessary before anything that is unusual or traumatic or complex a shift supervisor on call supervisor being involved. And then it can go to and include a more formal process with myself, with our senior administrator, with our law enforcement partners depending on the nature of the situation. And I don't mean to cut off this process, but I want to appreciate Mr. McNeil for coming to the table and I want to make sure she's available to respond to some other texts that I know are incoming right now. Oh, we're also happy to follow up and writing with additional questions because it seems that she's needed at the moment. Thank you, Thank you. So I don't know who can answer this question, but do you find that residents might be using MCOT as their sole source for crisis intervention or are there other services that residents are accessing? No, I think it seems clear from some of the information presented here today, there is increasing use of our 988 line-in-moments of crisis. There is increased use of MCOTS, and of course we have some increased capacity as well. And there may be, and again, I'd be to follow up with you and check in with the experts back here. There may be some that are at this point, I've been treated to only calling MC Cut. I'm not heard of that per se, um, but it is, it is possible. I would think that that's probably the exception, um, rather than the rule, but, um, they follow up further. After they contact 980, are you referring them to other resources or back to their primary care providers? That also depends, I think, on the individual call, but absolutely we're ensuring their safety and the safety planning steps include all of the resources that are already available to them that might already exist in their life and also the other resources that are available as well. Okay. I noticed from the packet that the county's three crisis centers have different hours was how did we determine which ones would be 24 hours versus limited hours. So we have one crisis center in Rockfoot Picard Drive and you're referring to the satellite offices for our MCOT teams in particular to be deployed from Germantown or Silver Spring. And that is that that's a staffing component in terms of capacity at this point in time. It's also related to the volume of calls and how quickly we can respond to calls across the county. So when the hours that you see are not covered, they're in Germantown and Silver Spring weekends and kind of overnight they are the hours of lower volume of calls, also hours of lower traffic on the road. So that's why we've stopped accordingly. And that may be. And how often do you reassess the needs based on calls for the hours or is it solely based on staffing availability? No, we're constantly looking at the volume of calls and where they're coming from. And again, what I what seems to continually be the case that is that weekday evenings, right into the evening, are consistently the time of the highest volume of calls, which honestly coming into this work and learning the internal operations of the Amcats in the crisis center. I, as a clinician myself, I found surprising, honestly, that there weren't kind of more weekend calls than overnight calls. So it can be variable, but what is consistent are those daytime evening? To that, and that actually tracks the police data as well. Most of our calls for our CIT teams were even our officers related in this space are Monday through Friday between 12 and 10 p.m. And it seems to track geographically as to when people start coming over work. So you'll see some more stuff happening down county, and then it starts to kind of gravitate out, the out of county as people start coming home. And maybe there's a domestic or something else that occurs and it starts to trick or things. And that's kind of where same kind of space. And again, I thought the same thing as Chief Martin, it would be overnight and weekends. That's kind occur, the more wild, notable things occur, but the one and in those and I'm not trying to discount any of that. No. The ones that we interact with on a more regular basis are in that timeframe. Okay. Thank you for that. And then regarding staffing, I noticed that there's a few vacancies. It looks like the five therapy positions are still vacant, are the, and there's four vacancies, four additional vacancies were created. So I just wanted to know what recruitment looks like, where we're at in the hiring process and yeah, sure, I'm happy to share a little bit more detail. Yeah so four of the nine current vacancies are new creations that again are just in the beginning of the recruitment process in this fiscal year so we've experienced challenges when making provisional offers to graduate school students prior to graduation and licensure it is something that we started doing some time ago across a H to just again increase opportunities for recruitment of mental health professionals in general. But when we have a provisional offer that is made it does hold up recruitment on that position because we're securing it for that potential candidate. For sometimes up to six. It's now being capped at six months by human resources. So in the situations where we may have a candidate who does not sit for past license or during that period of time, it has created challenges. It's also created opportunities, right? Some of those past license sure and we've got them on board and we wouldn't have had them on board otherwise. But it is something that we need to look at logistically and kind of mechanically and see if we can have alternatives to having pins held when we have these number of vacancies. In FY25 in particular, we had four candidates in the therapist's school that considered positions of the crisis center. Two offers were made, one person accepted, one canceled the interview the same day due to reconsidering the crisis center schedule and need of hours of operation at that moment in time, and one was not recommended for hire by the interview panel. So that's just, you know, in these first few months of the fiscal year, it can give you a snapshot of what it's looking like. Okay, thank you. And my last question, and I have so many acronyms, the sequential intercept model mapping report, has steps for us to advise us on how to better respond to crises. I see that HHS has so many different entities. We have the crisis center. We have our M-Cods. We have targeted case management services residential respite care. We have 988. We have so many entities and just wanted to better understand if there is a diagram for how everyone works together all these positions will interact with each other. So that will be the work of the collaborative groups and multidisciplinary teams that are pulled together to enact these recommendation. So what the work that has started is to get those groups formalized and moving forward so that we can do exactly that. And there are also some dollars associated with the diversion center to bring a consultant work to. And so there are a number of these models that have been built across the country, New Orleans, sort of Eugene, Oregon. There are a number that are probably half a dozen where they're farther along the Montgomery County are and we're going to rely on them having learned some lessons that we don't need to learn the hard way ourselves. And so obviously there are several people. There are several leaders in this space who offer consulting services that we look to leverage to try and guide us and educate us. We have a lot of the tools, but we want to make sure that those are working in the most synergistic way possible to address the issues. Thank you, Dr. Stodder. I totally agree. We have lots of good tools. And I think Montgomery County has always been a leader in setting the blueprint, creating our own blueprint. And so hopefully with all of these entities and experts right here in Montgomery County, we can create something unique to us that works for our county. Thank you. Thank you. And a letter note sequential intercept would be a good name for an 80s cover band. So, yeah. A lot of synthesizers. Much lighter note. All right, David. Just lighten things up a little bit. Councilmember Mink. How can I follow that? In regards to Councilmember Sales' last question, I'll just note that in the staff packet in a memo that was that I included from our last conversation about this, Circle 66, there's a chart that has a few of those other models that I know are, I know you all have been doing deep dives into that and far more, but for colleagues who are interested, some information, brief information about five of the other models across the country, some of their stats. And then following that is a packet with a 90-day summary from New Orleans, New Mobile Crisis Intervention Unit that I found really, really interesting. They had some great results, a quick turnaround and one of the things that really stood out to me there was their focus on supporting the staff, which was something that Ms. Martin has also mentioned as being a huge priority for us. I think it's incredibly important. And so I'll just note that also and I appreciate your focus on that. Okay, question for every mind. Our local warm line which is used by a number of our older residents and so on. There had been talk of potentially sunsetting that. Is that still happening? What's the status of that conversation? Thank you for raising that. So there is talk of that. However, what we're looking at is one that we need geo-routing fully in place to ensure that then those calls, if we were to forward to 988, they would get routed to our call center. So I think there are several things that need to be in place before we consider sunsetting the 301 warm line. And what we know too is that none of the other warm lines across the state and any of the other call centers are in any path right now towards sun setting as well. So I think that you know we're working with locally with with BHCS and then also at the state level to really determine what that path looks like and you know and ensure that it follows you know proper protocol to effectively sunset and that you have the numbers to show that the call volume is going down. So it's nothing has moved forward in any official capacity. Yeah. And that decision lies with the county, right? Let's totally within our our purview to decide when to sunset that. That's not something that where the state is gonna correct. Correct. Yes. This is something that we're looking at, particularly since we have multiple phone numbers, that that had been one of the conversations about how to simplify and not make it so complicated when there's multiple, multiple hotlines and warm lines and you know, that 988 is able to provide that capacity of the warm line function as well. So just to consolidate and to really make sure that it is clear to our community about which number is going to lead them to the most direct route of services that they need. But there's no rush or urgency or hard deadline. It's just at some point when you're runningrouting is fully up and running and keep it full and we have people doing something. Exactly. And I would just add to that too is the piece of not just geo-routing but also I think to Miss Rose's point how 988 is marked at that point. Because the warm line people are calling and it's primarily supportive listening. And so I think that there's so many factors that need to be in play before we fully sunset that 301 line. And also recognizing that the 301 line is really to your point, Council Member Mink, you know, the resources there for older adults in our community who are there, a homebound isolated lonely and looking for someone to talk to. So I think one of the other things that we've been talking with our partners that at BHCS and LBHA are what are maybe some services we could look at for this population in particular as well to support them differently than a hotline or in addition to the hotline to really help better meet their needs as well. Great. Thank you. Yeah. I mean, I can certainly see by we're not actively promoting that. We want to be actively promoting 988 as Montgomery County's warm line, especially now that we have geo-routing, but also want to make sure that we don't take away that 301 number until folks aren't using it anymore. I'm just trying to imagine, you know, thinking about my old parents and being like, no, no, you're going to call this number now. And you want to make sure that somebody is going to be on the other end of that line, you know, when they're calling until they're not calling anymore. So thank you. It's good to know that that's fully within our purview and that you all have eyes on making sure that we do that for a while and are expanding. But the collaboration, the regular work group meetings, making sure that there's a lot of discussion about how calls are going back and forth, where improvements can be made, having that infrastructure internally is so important and being able to be agile and flexible as you figure out who needs to be part of these work groups who needs to be at the table, where can we expand, what partners can we bring in, really appreciate that that's work that you all are already doing and will continue to do as you continue to bring more folks to the table. I know that you all have looked at metrics around how many calls are we able to transfer from here to there, from there to here, what does that look like, and that we've seen the number of calls, for example, that have been transferred from 9-1-1 to MCOT that you're looking to see those increases and you are seeing those increases. How are we looking at the calls being transferred from 9-1-1-2-98 at this point. Do we have numbers on that yet? Or? I don't have them here. Sorry that I don't have them personally. I can get them for you guys, but I don't have them. I just wanted to add that the public safety committee is having an update on the Emergency Communication Center. And I have asked for that information, which is due Friday, and so I'll distribute distributed when I get it. Great. So consider me author of a book. Noted for the record. The only thing I would add, council member, is that some of this is happening. Frankly, it's a good thing it's happening, organically, meaning officers are actually using their cell phones to directly call over to the crisis center or to the MCOT teams for assistance there, which makes it harder to track. But frankly, I view it as a very positive thing that officers on the ground are thinking that far forward. We just need to figure out how we can try and account for that to have numbers. But again, I view it as a there is greater acceptance of the value of what they refer to as MC44, the MCOT teams in getting them out to more calls. And I think as I think we're going to see with five teams on board starting on Monday and seven teams by the end of this fiscal year, I think the I would anticipate the numbers increasing considerably, just some officers weren't calling for assistance because they knew it wasn't available, but now if they have a confidence that it's more available, I think you're going to see a large preparation in the request for support. Yeah, that's great. I think totally looking at all those numbers are going to be an important, you know, how many calls are we responding to in addition to how many of those calls are being transferred to Kevin Sittonsky, were you going to? Yeah, real quick to add on to what Dr. Statter said, and I didn't reference this too much earlier, but we have now, so Mr. DeBachnik, who was up here earlier, was actually part of that therapy team that she was the therapist back in 2019 that HHS hired and police department paid for with our two CIT officers. It took a little while, but a bunch of us got that position upgraded to a supervisory therapist. We have hired that person and we have seen more referrals over to different services with that person in place with our CIT team because they know what resources are available. The person we have there did work at the Christ Center on their overnight line. So he has a vast knowledge of what's available at the HHS versus what anyone in the police department would ever know. So we are gonna see that increasing as well, just so you know, and we have already seen it at the base level. Yeah, that's great. I mean, and that certainly reflects that as we continue to update our protocols and expand what we have capacity to respond to in all of those things, how important that the training and the education not just to the public but also obviously internally is going to be. So on the 9-1-9-8-8 number I know that obviously we're coming from a place where there were no calls being transferred and we're trying to work towards a place where there are as many calls as possible being transferred and I'll note on that front that when I visited the ECC one of the things that I heard obviously they're so understaffed and overburdened like everyone who's here today. But they got a lot of those calls, those repeat callers where it really was like, clearly they're looking for somebody to interact with. But they weren't transferring them to 988. And so to the point that's being raised here, about making sure that our operators know all the options that are before them and that it's easy for them to do those suicidal, can we talk a little bit about what triggers a dispatch of police if somebody calls 911 and this seems like there's a case of suicidal need? So it really comes down to, well one, how the call comes in, right? If it's coming into 911, it's going to be assessed by one of our dispatchers, our call takers right away and in the dispatcher. And there are national standards that they have to follow to how it comes to us or shoots over to every mind or directly to the crisis center. What we're looking for is, first of all, do they have violent needs? Is there anything immediate? Is there anyone else in danger? They have violent means like do they have a weapon do they have something that can harm themselves or others something Where we're not as I just explained earlier we're not sending our therapists into violent encounters They're not built for that. That's not their job. So if we have something like that that's what we're going to come in first If we determine that that's not the case whether it be through the call or once we get on scene that's when we'll trigger the MCOT teams and see if they're available. Have them come out. So yes, there's a metric forward, excuse me, a way to do that in the beginning. But again, remember, when someone calls 911 or even if they call every mind or crisis center, the call taker or the person getting that call has absolutely no idea what's going on outside of what they're being told. There may be a whole other set of things happening that they can't see or hear and it will take that officer showing up to make that determination. And once they do, oh, it's not as bad as it seemed to be. Okay, we can shift that over to somebody else, deescalate this and move on. The police can go on to the next call. Answer your question. Yeah. Okay. And then if so, thank you. And it seemed like this might be a case where there might be somebody who's suicidal. How does 988 decide whether to send that call over to the police? So it's very similar. We have national protocol that we have to follow as well. And we ask specific questions, one, to assess the level of risk and whether that person or anyone around them is an imminent danger. So whether they, you know, what their thoughts are, if they have a plan, okay, then when are they planning to execute the plan as well as what means do they have and the access to those means to execute a potential plan. So based on the responses to those questions, right? Whether they have access to a gun or medication and what their time frame is, based on all of those things, we assess and then determine whether to call for additional assistance emergency intervention. And 988 is held to the same national standards as, yes, ECC, as who I'm sorry, I'm sorry. I'm sorry, as the 941. Yes, yes, yes. Okay. As who? I'm sorry. I'm sorry. some of those nuance differences. Noting that, you know, the timeline, for example, the timeline of harm, there's a lot of people who, they may have been suicidal or have had suicidal ideation for 25 years. My understanding of the protocol at the ECC is that if somebody has ideations of doing harm to sell for others, an incident that gets sent to dispatch. But again, that may be something that the person has been feeling and been working to talk themselves out of with themselves or with others for many, many years. And so if we're sending, we may be sending somebody, they're dispatching somebody. When really maybe we don't need to, maybe that could even make that person more stressed out, which were less likely to call the next time. And so some of those nuance differences as you are having these, and there's obviously there's an infinite number of variables in cases. But I do think that in some of these cases, especially in some cases of potential for cell harm, that figuring out really what are the exact questions that are being asked and is everybody and how does that, you know, tree look, what are the drop-down menus or whatever the case may be, then making sure that we're really, really aligned so that since everybody is held to the same national standards that there should be a way to do that it sounds like so that the results are coming out consistently wherever, wherever callers come in. The question of weapons is also a really high stakes one and super important. We have to make sure that folks who are on scene are safe. We have that responsibility. We need staff to know that they're going to be safe. And we're also looking for the best possible outcome in all these places for everyone involved, including our staff as well as our residents. And you just, you don't want to get that wrong on either side. And that can feel kind of impossible, you know, to make a perfect judgment every time. And so we just try to get, you know, do the very best we can. Okay, can I just say, obviously the people in the call centers have a limited set of information and they have to make certain decisions around who's getting deployed and how. But then also, once our responders arrive on scene, there's also more information, but there's also still decisions. And so there's going to be things where who develops a rapport with the person. What are you seeing actually in their mannerisms? Not just what they're saying, but how they're saying their tone, their mannerisms. Our goal is to make it as clinician. We talk about, we talk about, there are gonna be times when there's co-responders, but even within those co-response models, there are times when the law enforcement officers are gonna have to step forward and the clinicians got to step back, where the clinician's gonna be right at the forefront and the officer's going to step back. And those are fluid situations that are going to be dictated in large part by what they experience. But our goal was to always have it be as the most clinician-led response that we can possibly achieve safely within those circumstances. But then also the other factor that I noted, it may be the officer who develops the rapport with the person and is having the best interaction in that circumstance. And the clinician may say, let's continue this because it's moving in a positive direction. And you know, the clinician doesn't have to take the lead just because they're the clinician if it's, if there's a report in that specific individual person's case. Sure. Yeah, absolutely. I mean, I don't think that the sure, yes, that's one of one of the potential outcomes. We also want to be able to empower wherever possible and figure out the maximum number of cases possible where the clinician is able to be at the forefront of decision making, balancing that obviously with the safety and the expertise of our of our police. And so and but I think, obviously the report is primary. Yeah, we're even having a conversation now about, you know, obviously the rapport is primary. Yeah, we're even having a conversation now about, you know, obviously we have hostage situations where there's also a mental health component. And those are obviously very difficult where there's a really, there's a, the risk is not just to the individual who's in crisis, it's to others in the space. That doesn't mean necessarily that the clinicians are going to be excluded from that space. It's just we got to figure out the right modality and manner to allow for their feedback input. They bring, you know, we haven't talked a lot about this, but the HHS team obviously has some clinical history that they may be aware of about what has been successful and someone else's past to deescalate them, that the officer is going to have no knowledge about. And so, obviously, even in those situations where there's a hostage situation, there's a Cleo Public Safety Predicate for the officers to be really heavily involved leading because there's a threat to some other person in the space or other, you know, persons. But obviously, even in those cases, there is a clear opportunity for clinical guidance, even to a negotiator. And obviously, Ms. DuBosch, I think understands that very clearly, because she spent a lot of time with the police department in the police department working hand in hand. But those are the spaces, we're actually having meetings over the coming weeks to discuss that very issue to better understand what the role of clinical involvement should be in those kinds of situations. You know, Assistant Chief McBain was out at a recent standoff, and we were talking just as they arrived, and he's like, I'm calling out the MCOT team, because I don't know exactly what I'm dealing with yet, but if it's gonna be a mental health thing, I want them there to consult. And I think that's the right approach that we're moving more towards in the future. I just add, I appreciate you bringing that up, but we've had some recent success with that very same thing. But when you're talking about a loan barricade, it's much easier than when there's a hostage. But something else that we're looking at is the courts have weighed in on one's right to be in their house and take their other tactics that we use but we vacate the area to allow that person to kind of decompress a little bit and we stop the pressure of the law enforcement. And I think that's something that we're going to continue to move forward when not to abandon the person in crisis but to pull back a little bit, reevaluate situation and then address it maybe hours later or a day later. So that's something else that's in our toolbox. Yeah, thank you for that. I mean, that's a good point. And I think that also looking at the protocol for all the stages of a call is so important, including the does somebody even need to be dispatched, for example, in the case of, you know, somebody who may be suicidal and, you know, and talking to, every mind previously, there are, there's a lot of layers that, you know, an operator needs to go through before it comes to let's dispatch the police against somebody's consent a supervisor needs to be alerted to validate whether that intervention is necessary. It's just seen as very, very high stakes because if it's not necessary and if it's without consent that person then is of course less likely to call things could go badly things could go badly, for other reasons. And even the question of, then what does danger mean? What does weapon mean? What does hostage mean? There's a lot of complex layers there where the nuance is matter significantly. And I can't remember if this was in talking to every mine or if this was talking to one of the other jurisdictions that has this kind of civilian forward Approach, but you know if there's a weapon in the room they talked about how near is it to the person? You know is it look in the case of somebody who may be suicidal or who is suicidal? Maybe they have a weapon They own a gun legally and but it's in it's in a different room. It's in a drawer and maybe this person has been You know suicidal for a long time and they call every so often Do you want to send somebody is it better to send somebody in that case or not send that you know and then Are not send somebody in that case and what do our protocols match? That you know if somebody you know has had suicidal ideations involving a knife, and that knife is there in the kitchen, and they're thinking about it, but it's not in their hand. And so those types of nuanced layers, I think that can really make a difference in terms of, if we're giving our operators these different protocols to follow, that it's important that they have that level of detail and that we're consistent across all of our different places that somebody could call. Let's see. Oh, and then also, oh, and I'll note also, the fact that we haven't had an MCOT intervention where there's been loss of life is excellent. Fentany, I mean, that's obviously, that's what we want to see everywhere. And it really speaks to the expertise of our folks doing that hard work on the ground. I'll note, we have had, of course, interventions that, you know, calls, that involve people in behavioral, with behavioral health or mental health crises where there has been a loss of life. Obviously, nobody wants that. And so that's what, right, that's what leads to our questions about what can we be doing differently, what can we be doing better, all the questions that you brought up to Dr. Stoddard around, how can we involve our mental and behavioral health experts in different ways, maybe earlier, maybe more or less on the ground or on the call being the one to vocalize, you know, in the conversation, I know that you're now sending some of our behavioral mental health experts to be trained to be able to be the crisis negotiator if I understand that right in some situations. So I want to make sure we clarify to understand what the police has trained and how they're trained and to be able to serve as a consultant in those situations. That's where we are at this point. Okay, so there would be a consultant then to the... Got it. Alright, thank you. Dr. Sattard, I see your finger. Yeah, this is a space where we've got to figure out the right way to do this. I don't pretend to have all the answers here. I think that this is probably one of the answers. Right. And so and this is just like this is obviously a very high stake space not just for the person in crisis, not for the other person for the you know for the for the responders themselves to be put in this situation too. That's like we've got it. There's got to be some real real hard thought about how how this works because obviously these are very much life-and-death situations that we need to make sure we get right. And so we're definitely asking hard questions about what should that look like and how can it work? And as I said before, we're committed to having the most safe clinically led process we can possibly have. But as you get on that edge, those are gonna be the hardest questions for us to answer. I think that's what we're trying to endeavor to do. Yeah, that'll make sense. And I don't doubt that everybody here wants that has the same goal, you know, and it's not an easy, it's just not an easy one. It would be helpful, I think, to understand what the current protocols for transferring calls from one place to another are as they exist. And I want to acknowledge also that that's a complicated question because due to capacity issues, we are not even going to be able, we have not provided the funding to provide the capacity to be able to follow all of those protocols even as they are. But that said, from the data collection sense and from an understanding of what's on the ground, it would be helpful, I think, for us to be able to have an idea of what are the ideal protocols as they exist or what are we asking our operators and our dispatchers and so on to follow. Now, again, I don't wanna give the, I'm nervous about giving the public a false sense of like, if you meet criteria XYZ, this is definitely going to happen because there are a lot of variables and because we have a lot of capacity issues. But I'll just, I'll just note that maybe internally or it would be helpful for us to kind of have that clear breakdown and to be able to see also where there might be some areas of nuanced difference that you all might be looking at aligning or tweaking as you have those conversations that would be really helpful. And noting also that as we look at speaking of capacity but as we look at other jurisdictions and the types of calls that they are sending their mobile crisis teams to, some of those jurisdictions have really expansive lists. We don't have the capacity even to respond to all the calls under our protocol now. We're getting there and we're adding more. We're going to see big gains with the addition, just this year alone. So that's wonderful, but as we are continuing to look down the line, what else we could bring into the fold, things like disorderly behavior, housing crises, evictions, welfare checks, intoxication, youth truancy, and transport requests are some of the common alleys that I really see across some of those other jurisdictions that it would be great for us to be looking forward to being able to respond quickly to all of those. And so just really encouraging, as I said, in your interview, there's obviously a budget line that comes attached to all of that. And so as you are looking at the potential for expanding those and you're collecting the relevant data, how many types of calls are these? To please keep us informed about if that's the kind of model that we want, the reality of what that budget would look like. Thank you for raising that. I think I bought this with my interview, but I just want to make sure that you're aware that during, I don't want to say there's downtime for our clinical staff at the crisis level. I really don't want to use that term. But when there are times of less demand, it's just been wonderful to learn that again, our crisis and our leadership, our managers and senior administrators are all about being more proactive and preventive whenever possible. And so an example that I will highlight that speaks to situations in which people may be on house or intoxicated, but there's no immediate, necessarily immediate threat I identified, where they may be concerned of the sort of conduct because people are sleeping behind commercial establishments and they're drinking and that kind of thing. We had a peer-led team that responded to a situation in Silver Spring like that and made relationships again during times where they weren't on an acute MCOT response call and were able to connect five residents that were in that situation sleeping behind commercial establishments and clearly using alcohol and other substances to treatment. So again, whenever the capacity is available, yeah, absolutely. We want to be able to be more proactive and preventive in those situations. That's great. Thank you. Are you old? Thank you, all. I think between the five of us, I think that was really great. We covered a lot of bases. Really appreciate the thoughtful questions and comments from colleagues. I just had two quick questions, and then this will help us transition to the second part of our conversation. And just a quick time check. It's quarter to 12. Wanna thank our colleagues so much for being here, for blocking this much time out of your busy schedules. But so the work group, the interdisciplinary group that is meeting, which is great. And that is an update from our last session last year. We had talked about because that group had just begun to convene. How often is that group meeting? And then who chairs those meetings? So it used to be that the three crisis network groups, if you will, were meeting every six weeks and remotely. It may have started off differently, and so I'll look to my colleagues to share if it started off any differently than that, but that's how I came into the fold. At this point in our reboot process, we're having a longer meeting of all the workgroups together with breakout sessions within that meeting quarterly. That's what we started establishing yesterday with the work groups then meeting in between. And then currently we have our integrated crisis call centers work group chaired by newly chaired by co chaired by Sarah Rose here to my right and every mind. And we have our mobile crisis outreach teams work group chaired by Miss Tobaknik and Abital Graves from Fire and Rescue Services and then our stabilization facilities work group co-chaired by Dornay Hill who's our senior administrator for crisis and taken trauma services and our senior treatment administrator for behavioral health and crisis services. We welcome additional partners and stakeholders in those. We are going to be hearing very soon about when those individual work group meetings will be happening in the interim and then have again a whole gathering in mid-December. It's a target for the whole group. I think we're just starting a reentry focus group as well. Yeah. Yeah. And that was part of the, we didn't have quite enough time right with the report to get into every bit of it. But of course, we did talk about the some recommendation reports just briefly yesterday. And there's quite an overlay. And we don't want exhaust all of our partners in every space in terms of meeting overload. So that's part of what we were looking at is there are different purposes that are part of what the charge of the group is going to be established to recommend the same report recommendations are or to implement those rather. But we need to make sure that there's integration across both. So we haven't quite figured that out yet, but we're moving in that direction. That's really helpful. I'll just make two final comments for transitioning. So we brought up a lot of policy issues that are beyond the capacity of anybody in this room. Some of that is state legislation that may be required. Some of it, frankly, might be federal legislation. So I do think that as the work group continues to meet and you all develop recommendations from a policy perspective, you know, we should obviously collaborate and see how we can collectively advocate once the session begins in anapolis in January to see what more we can do to free up some of that information sharing, which is so critical. But I know challenging, but so critical. But I know challenging but so critical. So well thank you all very much. I know many of you staying are staying here for the second part of the conversation and that is to take back up again Bill 4323 the crisis intervention team introduced by our colleague council member Lutke. As I said at the beginning, this was a two-part conversation first to get an update from the folks that are on the ground, which we have accomplished. And that will help provide us with some context for this part of the conversation. As I've shared with Councilmember Lutke, I know that there are still a lot of moving parts. Ms. Martin is still acting and will hopefully be appointed very soon in this permanent position. But we've all seen clear evidence that the work is going on. And so there was a fundamental question raised in our last session on whether this should be focused as an MOU or focused as legislation. And I'm not sure that we are prepared to answer that question right now. But I would like to continue in this context to talk about the bill, but obviously already good things are happening as a result of its introduction. But Ms. Wellens, I will yield to you to provide sort of the legislative background and context and remind us where we are. Certainly, certainly. Thank you, Mr. Chair and thank you, Council members. As you know, this is the second work session on Bill 4323 crisis intervention team established as originally introduced. The bill would have done two main things. One was to kind of codify the establishment of the crisis intervention teams, the collaboration and co-location of MCPD and HHS personnel in terms of responding to crises where there's, you know, a public safety component to them. And then in addition, there's a creation of an advisory group of multiple stakeholders that would help advise on and continue and carry out the sequential intercept mapping model and would also provide an annual report with a lot of some of the data points that you just received a briefing on and others. As I understand it, due to a lot of the ongoing collaborations with the Bill sponsor and other council members with the DHHS and public safety community, that some of the intents and of the bill are evolving and being fine tuned. So I think that's kind of where we are today of, and obviously I want to be respectful of the council members and what motions they may or may not want to move forward about potential amendments to the bill. But my understanding is the focus has really become on that advisory group and what its functions would be, who its members would be, what it would be reporting on. So I think that's where we are. I do in terms of the MOU or potential MOU, I can comment I checked with the office of the county attorney yesterday and they apparently had apparently there's going to be a meeting on October 4th with the county attorney's office and the HHS and MCPD regarding the ongoing work towards an MOU. Terrific thank you for that overview just a of comments and I'm actually going to determine Councillor Mellucci to provide some feedback. So the MOU is obviously critical. We've very clearly, I think, demonstrated what from the council's perspective, what our interest is and seeing what is in that MOU. Obviously you all need to fine tune that, but that will be a critical document that will, in many ways, codify the work that we're doing right now. And that, as I know, Councilmember Lukis intent is that we are ensuring that this work is sustainable. It's great that we're having these efforts now, but how do we make sure it continues when we're all not here? Which is, I know where she's coming from, and I totally 100% get that. So I just thank you for that update. And then it sounded like the work group, the interdisciplinary work group, and what is it called? Does it have a name? It's now. Okay, it is called crisis. I'm not sure. I don't think we landed on the great final new name. Okay, but it's convening again in December. I heard that part. The integrated whole group, yeah, and the individual. Workerbs will be between. You can be between. All right, great. So there's some real structure to that, which I appreciate in respect. So thank you. I just wanted to clarify those two things. Council member Lutke. Thank you. Yes, this has been a goal of mine since I took office was to try to help strengthen things here in Montgomery County based on work I was doing while I was at the state and wanting to see progress here at home. And so in January of 2023 it was actually the first committee session I had as a council member. It was a joint committee session of this fine group assembled here and brought in folks from Anorondale County and from our behavioral health group and from law enforcement to talk about other things happening in other jurisdictions, what's happening here. And to talk about the state's progress in 2020, passing the legislation that Senator Augustine sponsored, creating the Crisis Intervention Team Center of Excellence. And then in 2021, creating the Senator Hester, who represents part of Montgomery County, the Maryland Behavioral Health and Public Safety Center of Excellence, both of which are housed within the governor's Office of Crime Prevention and Policy. And while those were passed in 2020 and 2021, they didn't really sort of become, as I call it, brick and mortar functional until more recently. But they have been running throughout 2023, and I'm looking at Captain Satinsky because he sits on one of those bodies. Did you meet at all in 2022? I didn't get a point in until 2023, so I can't tell you that. Okay. Well, at least someone in the room here has been involved with that since 2023, but I think it may have been late 2022, not entirely sure. I think they were waiting till after the administration changed to really in earnest start that work. So in the bill as introduced, and as you note in the packet, I would like to cut out the whole front end of the bill because it's not necessary. So the language that was there that directed the police department and health and human services to work together on an MOU isn't needed if you are in fact and I know you're real close on the MOU and I want to thank Dr. Bridgers who is not here but you know there are some of those fine-tuning pieces and getting an MOU together and given that was a large part of again my prior life, I totally appreciate that, but they are, you know, to share with colleagues, they are real close to ink on the paper if that makes sense. And it really is some hiccups with understanding information sharing, data sharing, the HIPAA FERPA, uh, two of my least favorite acronyms, because I had to explain them so many times. But they are complex and layered, and we need to do our due diligence to make sure that whatever we're putting in the MOU is accurate. So I certainly appreciate that. But you've also taken critical steps to move towards achieving those goals, like co-locating a Vrompe card drive. And participating in the SIM mapping workshop at the end of May, because in February, when we had our work session on the bill after introduction and public testimony, you know, Judge Bonafant made sure I knew that that was happening and that I should share with everyone. So folks could participate. I know we offered tours so that my colleagues could tour anorundals center to see what it looked like and how it worked and I know council member cats. I believe you attended that Remember but I think okay Must have been a wild time in an around the county and and we've now received a $750,000 federal grant Which I would ask Captain Satinsky and thank Congressman Raskin for that to explain what that is providing for us here in Montgomery County or will provide. So the earmark we put in to get to basically bolster up our services in the CIT world and build out our behavioral assessment unit. So the monies that are there are some of it's going to be used for equipment, sensory deprivation for the vehicles in order when we have, especially for Laurie Reyes' group, the autism IDD group, when we have our autistic sensory folks that need a quiet place to be when we find them out, let's say in the woods, far from home wherever, to calm them down and de-escalate that. The other part of that, there'll be some training involved because the CIT training world is an ever-expanding model and will be upstraining our CIT central officers advanced training and also we're looking for our co-responder model to hire out contract therapists to ride directly with our CIT officers for when those instances are we need to get somewhere quickly we need to assess them quickly and now we have our CIT centralized officer and our therapists right there on the scene to work in tandem to provide the best possible services. So that's what the monies are mainly going to be utilized for. Right. And to be clear, that does not supplant any work of the MCOT team. No, no, no. It is a supplement. It's a complete supplement and I'll be done in concert acting chief Martin and I have been talking about this for a while. And we've done in concert with HHS. And similar to the matter that we have now where the position is housed over at HHS, but I pay for it. Right. Right. And so I worked with Miss Wellens too and with Captain Satinsky and Dornay and Dr. Bridgers. And thank you, Dornay Hill, for being here. To talk through refining that and making sure we could create an advisory body. And again, with much appreciation, and I'm currently serving on a state level one, where there's a lot of people, and they have to do a lot of work in short order. And so very quickly, the lot of people got broken into discrete buckets in order to make those things happen. And so I'm very much viewing what we have here presently happening with the I'll call it work group to be named that is up and going. All right. the 2024 reboot. That that work is very nuts and bolts oriented and that that is very focused on intercept zero and one within SIM. I don't think it contradicts or is in place of meeting to have some oversight, even if it only meets quarterly, but that does still produce an annual report so that you're constantly having a re-evaluation of needs, priorities, and resources so that we don't let the work that was done in May get stale. And so that we have a very focused way for all these constituent parts to provide that information to the county executive and to the council in a meaningful way that allows us to know what we have to do because you all are the subject matter experts. And there are many that need to work in this space together. But we take up and I don't have to, I'm preaching to the choir sitting next to me our chairs when we have to do budget hearings for operating budget for all of these different entities. And having that sort of broader holistic view will allow us to do a better job in prioritizing funding and in understanding what needs there are both within executive branch entities and within our nonprofit provider community as well in order to achieve these goals in an ongoing basis. And I know I think we've kind of exhausted time and I'm not sure what to do today, but I do know that there's a lot to digest, and maybe not everybody has had ample time to digest the report, because it just came out a few days ago, unless you were up at 2am, like Captain Satansky. So perhaps we should come back and you know into the point where Ms. Martian is about to be knock on wood confirmed and no longer acting that we come back and discuss this when everybody can have digested things and have a more thoughtful conversation about it then. I love that. Thank you. That's where I was going as well. By then we'll have an MOU. By then the group will have reconvened in December. I'd like to propose something very new into the new calendar year for us to convene, which will give us some time. But I think this has been very productive. I appreciate all of you very much. I don't want to hold this up any further, Ms. Wellens. So we'll get back together. We'll get the band back together again. The sequential intercept band back together again in January or February when we're back from recess. So thank you all very much. We are adjourned.