Good morning everyone. This is Thursday October 17th and we are going to convene our county's health and human services committee meeting this morning today. We are going to continue part two of our conversation with the review of boards committees and commissions. I am so happy to be joined once again by from important community advocates, volunteers, leaders who will share their perspective regarding their specific areas of focus. I want to begin by acknowledging and thanking all of you for your commitment and leadership, your work matters, especially now, with all the challenges that we are facing as a community. And I learned a heck of a long time ago, and I know my colleagues will agree, that none of us can do any of this by ourselves. And so we had wonderful and important testimony yesterday that we look forward to hearing more from this morning. So what we're going to do is we are going to bring up three panels at a time. Some will be joining in person, some will be joining virtually. Each representative will have approximately four minutes or so to give their presentation. And after all three presentations have been heard, my colleagues and I will then pause to ask questions, make comments, and then once the session is complete the next committee will go. And we have three panels that we will be hearing from this morning. So kicking us off this morning is Dr. Nguyen representing the Asian American Health Initiative, Shen Kweta Anderson from the Victim Services Advisory Board, and Wayne Swan from the Montgomery Care Advisory Board and Wayne Swan from the Montgomery Care Advisory Board. For those of you that are in person from the first panel, if you could come forward, that would be great. And I know Dr. Nguyen, you have to head out early this morning and so you will be kicking us off. Once you get settled, you can begin. Good morning, Council Member Arbonus, Council Member Sales and Council Member Luke. Thank you for the opportunity to be here today to share with you about the priority of the Asian American Health Initiative Program, as well as the Student Committees represent for the Asian American Committees here in 2025. My name is Winwin, and I am the past year of the Asian American Student Committees. And on behalf of my colleagues in the Student Committees, I will share with you two main priorities that will focus on 2025. Our first priority is to focus on capacity building for our community organization, especially the community base and face-based organization, so that they have the resource needed to serve the Asian American community, especially on the behavioral health and senior wellness program. As you know, that Asian American community have many diverse subgroups. And within Montgomery County itself, we have over 15 subgroup up Asian American As much as that diversity contribute to the diverse culture and the economic up the County of that, I suppose the challenge for the county to provide effective Service to customize to each of the community, especially the most vulnerable people in those community, because they have different languages and culture. What we have learned through the pandemic and the best way for us to deliver those service, the health service needed, is through the partnership with the nonprofit organization, and we have proven that it worked well through the pandemic. Therefore, I was doing committee at Xamarin.strategy and we want to double down on that strategy in 2025. We continue to advocate for the investment in building the capacity for these nonprofit organization in the county. And we also asking and we want to spend that concept. We're asking ourselves, how can we build effective coalition among the Asian American community organization so that they can share lesson learned as well as be more efficient in their resource. We are thinking about bringing the group together to the funding share program also to share the resource and have communication among the leadership among Asian American group. We do so because we valued investment the resource that the council have given to our Asian American community. And let me just give you, I mean what that I just want you to thank the Council for the support that the Investment Council have made in our Asian American community. And I want to share a few numbers. In the past three years, with the Investment Council to our grain program, start with COVID- relief fund, and now the healthy community fund, we have to buy over 250,000 services to individuals out of county residents. And over 1,500 community events, which have placed two various community and subgroups in our Asian American community. And that spread out to 23 different community organizations and each of them specializing in different area and different community. And I think that that is the best investment I will argue that the county have made so that you have infrastructure needed when and not a public health crisis might happen. We don't want to, but we know someday we'll come again. So that's our first priority and that we want to continue focus on in 2025. Our second priority is to build on what the first one, but on the end goal update how we can we have the evidence and data needed so that we can provide a service to our community. This is, therefore, we focus on data collection and data analysis. The challenge that we have with Asian American data is that all the data usually aggregated. You have all the group together. We acknowledge that some Asian American subgroup do a bit better than others. And then if you have put all the data together, you cover the need of a smaller subgroup. Therefore, we highly advocate for the level of this irrigated data. Therefore we know exactly where the need are and where the where the need are and and how we can better address those need. What tool we need to address don't need and and our approach to get to those better data collection is two four. Number one we want to work more closely with the county agency throughout healthy Montgomery coalition that we have so that we work with agency to ensure that the county agency collect appropriate level of data and analysis. And secondly, is to our partnership with our RURI, NGO partner, Huerri Rukin, with us throughout funding programs so that they have the capacity to collect the data and analyze and share the data. So we believe that the both approach is critical for us so that we have the data as well as infrastructure to deliver the service to our resident. In conclusion, I want to thank you again for the council support in the past year and the continuous support now for our Asian American community. And I just want to say a few words about the partnership that we have from Asian American colleagues in the Latino Health Initiative Sting Committee as well as African American Health Program and Secretary of the Committee. So we are working closely with each other and we strongly hand in hand support with each other. The need of our brother and sister and other community is there and we are there for them. And what that we also recognize the different, the need are diverged in the what we do. And the best way for us to address the need about up minority communities here is to through the equity lines. And I think that's is critical that we are tech that's approach so that we can provide the effective and customized solution to the community in our county. With that, I will close. I'm happy to take any question. Thank you, Dr. Nguyen. Sit tight. We'll hear from two other committees and then we'll come back with questions. Next, we will hear from Ms. Shank-Weneta Anderson representing the Victim Services Advisory Board. And I believe they are virtual. I'm going to start with the The Toronto Services received homicide referrals provide help to individual surviving for the family members. One of our policy issues is more victim advocates are needed to meet community needs. The HHS Toronto Services program continues to step to meet community needs. The HHS trauma services program continues to step to meet staff assistance to keep up with the rising crime rates over the last years and course fund community demands. Although this has been a priority for the victim service advisory board for the past few years, the specifics have changed each year. Specifically, and as the HHS community knows, trauma services is staffed with therapists and victim assistance. The therapist's scope of work includes clinical intake, therapy and case management for crime victims in the county. Therapists also train and monitor volunteers who assist sexual assault and IPV intimate partner violence victims at hospitals. Each of the last few years, the victim service advisory board has requested additional therapists to staff to provide needed therapy and to build up intake units with the belief that these investments would allow trauma services to better design programs that were more crisis focused, deliver trauma services more quickly, and overall do a better job admitting the evolving needs in our community. Thankfully for these investments have paid off, and trauma services now advise that it is current therapy staff is generally sufficient to meet community needs in the post pandemic period. With that said, trauma services continue to need substantial assistance with its victim advocates program. Victim advocates are independent of the justice system and play a vital role in helping crime victims navigate both criminal and civil justice systems in the community. Specifically, victim advocates assist crime victims in filing peace and protective orders. They hold court school to educate victims about what to expect in the court accompany victims during criminal trials, helps the victims with impact statements and requests for family emergency maintenance. A 10 show calls hearings for IPV offenders and connect victims to need community resources and also programs in the community. One of the second issues that we've been looking at over the time is an increase to access in the housing for intimate partner victims. Bridge and long-term housing for IPv victims has been a type priority for the victim service advisory board since FY 2014. The Betty Ann Crank shelter generally allows IP victims IPv victims to say 60 days but studies show that IPv victims need 12 to 18 months of independence to become self-sufficient survivors. Further, recent staffing losses at the BAK again apparently driven by a combination of the county's strong job market and the fact that the BAK staff pays pay has not kept up with the market. Has made it nearly impossible for the BAK itself to fully utilize its capacity. As a result of all this, there are few housing options for IPv victims, fleeing their abusers and leaving the BAK. More and more IPv victims are being sheltered in hotels at a great expense to the county. Simply put, county needs to establish a plan to ensure safe 12 to 18 month bridge housing to in homelessness for IPv victims so that they can become self-sufficient survivors. This 12 to 18-month transition program can help break the cycle of violence and dependency. It will afford the victims to build life skills, get their GED, other educational and vocational training, and parenting classes. It will provide the victim increased trauma, recovery and empowerment and give survivors time to secure appropriate long-term housing. This can be done through several mechanisms. The first one, IPv victims leaving the BAK often do not qualify or receive priority for transitional and permanent low-cost housing or rapid rehousing services. This may be due to lack of stable employment, poor credit or prior criminal record. Moreover, when using the vulnerability index, a widely recognized tool for demanding the need for housing assistance, IPv victims receive just a one-point priority. Vickham Service Advisory Board strongly supports the SEPH working to alter how the VI SPDET system is implemented in the county in order to grant IPv victims increased priority. This would help close some of the service gaps between those discharge from BAK and those that qualify for county housing assistance. Second, over the last few years, the county was awarded at Housing and Urban Development Continuum of Care, bonus funding to expand rapid housing for IPv victims. However, necessary case management services were not always provided despite the funding being available for that use. Increase awareness of the grant writing process and qualification requirements would help service providers obtain these funds in the future. Training should be offered to potential providers in a timely manner to prepare them for HUD application processes. And third, and lastly, victim service advisory board continues to support methods to provide better transportation options for IPV victim traveling to and from the crisis center, which is often deterrent in their independence. Thank you for allowing us to testify on the victim service advisory board behalf. If there are any questions, please feel free to ask them. Thanks, Ms. Anderson. We'll next, just stay on the line. We'll hear one more presentation and then get back to questions for this first panel. Next we will hear from Mr. Wayne Swan on behalf of the Montgomery Cares Advisory Board who is also joining us virtually. Good morning Chairman Albin Nodz, Council members, staff and I'm guests. The Montgomery Cares Advisory Board provides guidance to the County Executive and County Council, which financially and operationally support the health care safety net for uninsured low income residents of Montgomery County. The Montgomery Care Advisory Board has identified specific priorities for each program. However, there are two overarching goals that will guide the board in FY25. The first priority relates to the Montgomery Care's program, which supports primary care for all owe income under insured and uninsured adult county residents. MKAB would like to continue to build, toward paying health centers, a reasonably competitive rate by increasing the fee for service reimbursement to $175 per encounter. The safety net providers are currently reimbursed and only about 41% of the average actual cost of care, even as many clinics that have already leveraged volunteers and donated services. Our second priority relates to DHHS dental collaborative. MGAB will work to support the collaborative roadmap which aims to transform my company County Safety Net Dental Assistant to a value-based care model and enhance the safety of that dental services available to Montgomery County residents. This year, M.Can members will participate in a work group of community members of Montgomery County stakeholders, regarding the health insurance qualified resident enrollment program, also known as Access to Care Act. The legislative legislation will provide undocumented immigrants without opportunity to apply for health benefits to the Maryland health benefit exchange and will have a significant impact on the health care for the uninsured programs. The work group will assess the possible effects of the legislation as well as develop recommendations for county council and the health effects of the legislation as well as develop recommendations for county council and the health care for the county council. We look forward to working with the county executive, county council, department of health and human services, and strengthening the impact of our public private partnership for delivering health and dental services to county residents. Thank you. Thank you very much. I enjoyed coming to the Montgomery Cares Advisory Board meeting, retreat a couple of weeks ago, appreciate your all's leadership. We're gonna start with our lead for addressing public health disparities among minority communities, Council Member Sales, followed by Council Member Luki, and then I will get in the queue and ask my questions and make my comments. Council Member Sales followed by Council Member Luki and then I will get in the queue and ask my questions and make my comments. Council Member Sales. All right. Thank you again to everyone for your presentations and updates. Starting with our first speaker, Mr. Nguyen. Thank you so much for sharing the updates. I see that given the ongoing commitment to these priorities highlight all the hard work that you and the committee are undertaking to ensure the continued support and engagement of our Asian American community. And just wanted to see if you can share your progress in the last year on these specific priorities since you last testified. Sure, yes. I'm happy to share with you the progress that we made and happy to also follow up with more detailed number and report data because we have, record a lot of that and we can request the staff from H.I. to fill up with that specific data with your office as well. But all of all in terms of the investment that the Council have made to the care to the program in the past year, we were able to issue an additional grain and a span our funding program to for other organization who before have not yet working closely with Asian American community. Okay. And for that, that I think that's critical because we want to ensure that other organization who have familiar with the county have that capacity as well as have the familiar already with the culture and the language that that Asian American community needs so that they can help and respond. And with that some of the number we have included here that even though this is in the past three years, but we saw the increased number of service and 354,000 service, because even though it's duplicative, meaning people coming back, we have a high level of return community member to the service that our NGO provide, because they have that trust. They have that trust level so they can come back, follow through and engage so that when information is distributed or service distributed by the county, they listen. And that is the bridge that we really hope to build between the county and the community. Okay. Thank you. Have you seen any trends in the grants that you're awarding any of the issues or the challenges that the community is facing where you are awarding more grants for a particular issue or group. Yes. About five years ago we have met that hypothesis that that the need in a county more focused on mental health and senior wellness. And the trends as you refer to, I think, more confirmed by the data we collected now is those two are still the most common health need in our county. Mental health among Asian American communities is rising? What many different factor among the youth and out of senior? We have we know that Asian American is the highest percentage of senior among the minority group in the county And what what that rising population of Asian senior that pose a new Opportunity and challenges. Yes, definitely. All right. Thank you so much, sir. Thank you. All right. And the Victim Services Board, Ms. Anderson, are you still with us? Yes, ma'am. Thank you. Yes, ma'am. Okay. Thank you again for all of the updates. Can you share how many people are currently employed with the Health and Human Services trauma services? How many more people are needed to meet the community's needs and how many cases are currently being managed. As FY 24, they're currently over 15, 100 service requests. And it's an increase, increase of course from FY 23. We are working on a currently working on our annual report that's gonna come out in November. And so the numbers will be actually more specified and we're actually going through that analysis currently as we speak. Also with trauma services, they've actually received pretty much over 50 homicide referrals and they provide help to over, they provided help to over 50 individuals surviving family members. Okay, thank you. Given the constraints and additional burdens you face, are there other organizations, agencies, or groups that you're considering partnering with or have reached out to to enhance the victim services support? Yes. So there are other organizations that we're looking at that's actually providing support for victims that are currently in need. One of them is Women Give Back out of Virginia. That was an organization that I brought to the table a couple of months ago that do help victims of survivors of domestic violence. And they provide clothing, resources, movement, and they have some We're actually are also looking at another pardoning organization. That's a nonprofit that provides small housing. It's not large housing at the moment. But we're looking at trying to see in ways that we can do that. But one of the things that would be very, very helpful is going to be the bridge housing that we've been trying to implement since 2014. And we continue to testify and reference to that so that we can have bridge housing for victims of domestic violence. Some of the priorities that we continue to try to address are going to be the these have maintains that the following goals addressing in these priorities are established is to establish a plant to ensure safe one-year bridge housing to enhance homelessness for domestic violence of victims so that they can become sufficient survivors. Also to increase the permanent housing to include providing vulnerable index for the point system for domestic violence victims. It does take them about 12 to 18 months to maintain some type of security for their families receiving educational, and things so they can go out and get jobs. Because what we found happened, if they don't secure that kind of housing, that is why the victims tend to actually go back into that domestic balance situation, which is why bridge housing is very big. I know I've also sat in on a few meetings and brought the information back to the board in reference to a, they're looking at a bridge housing somewhere in Wheaton. At the upcoming project they had, they're developing in Wheaton, Silver Spring, Maryland. So those are things that we're looking at and trying to see if we can partner with those agencies further down the road, if those partnerships do pan out in the competition. All right. Thank you for sharing those updates. And you preempted the last question I was going to ask about the bridge housing. And I know that that's probably what research is saying. Are there other models across the nation that the committee has. Yes. So one of our. Yes. So there are other models across the state. One of our members has a sister. I believe it's out of Iowa. And they have a bridge housing program that we're trying to find out what they're doing and see if we can develop something similar to that. In Montgomery County, but again, the issue's gonna be funding. So those are things that we actually are looking at modeling after some of the ones, but none are actually in Montgomery County where finding the biggest issue and getting bridge housing here. All right, thank you for that. And lastly, our Montgomery Care Advisory Board. Is he still here? Okay. All right. Thank you. I just wanted to ask about the emergency room services and if you've been following the impact of our residents who are using the emergency room and any disparities that you're seeing with folks who don't have access to a primary care provider. Are you seeing a correlation between those who don't have primary care and those utilizing the emergency room? We've just been seeing an uptick in our emergency room wait times. A lot of our colleagues across the state are looking at ways to alleviate the emergency room wait times since Montgomery County has some of the worst wait times and so just wanted to Yeah, the issue of avoid time and it worries you over something that we do need to look into further. It's something that it's and as it's kind of catches by surprise, we don't expect to have it. A lengthy way to bring period is no real rationale for it. But essentially, I have having strong primary care services, we can hopefully keep people from going to the emergency room that don't need to go. We have some people that consistently choose to use the emergency room because it's faster. And in fact, it is for that purpose. But we're trying to funnel those people back through the system to receive direct primary care services through one of our 10 clinics. OK. Thank you for sharing that. And there's going to be more work underway in the coming months about the emergency room wait times and how we can improve them here. And just one last question. Well, more so a comment. I know that the dental collaborative came up with a roadmap. He's not here, but I do want to thank Dr. Rogers with the Health and Human Services for spearheading this effort and recruiting all of the stakeholders that contributed to its creation and look forward to its implementation. Thank you. Thank you. That's what we're looking. Thank you. And I'll go in reverse order since that way, you don't have to wonder when to push your button. So Mr. Swan, yes, as council member sales reference, I am looking forward to reading the final report that the task force with the Maryland Institute for Emergency Medical System Services, Maryland Hospital Association, and folks are putting together on our ER wait times. I think there's a lot of work to be done there and certainly you surfaced the need for effective primary care services and and we are going to continue to have gaps regardless of the Access to Care Act. And so my question for you is you know while the act just passed and so this is all still fresh and the logistics are still being worked out. We know that there will still always be a time period even for those who are able to subsequently get coverage through the Maryland Health Exchange where they don't have coverage. And so my question for you is how long do you think it will be based on what you're aware of, where we start to see a reduction in the number of people needing those gap services, if you will, based on this new law? I'm not sure we actually experienced a gap in this, because someone can sign up immediately and start receiving services to the primary care process with the clinics that are available. So someone presents themselves at one of their clinics. They're allowed to immediately start receiving services. Right, sir. I'm saying with the new law that passed so that those who are not citizens are able to obtain health care coverage through the Maryland Health Exchange. So you serve a high number of individuals who don't have health insurance, right? And the Access to Care Act is to help expand insurance coverage for those who have not traditionally been eligible for it, which we have a significant number of residents here in Montgomery County who fit that description, right? And so even though the law passed, there is a significant runway of time before that will be in place allowing that population to obtain that insurance coverage. And so my question is for you within Montgomery Cares, how are you budgeting or looking toward the future in understanding the impact of that and how that may shift your service delivery model? model. Well, the order group doesn't have to be established. It's supposed to be looking at that impact in fact. So I hope is that the stakeholders that will be involved in the work group will be able to do their work quickly enough to be able to move things forward and to address the specific issues that you just outlined. Okay, thank you. And Ms. Anderson, thank you for elevating the work of your group. It's incredibly important. I know we have a member of your body who also serves with me on the Criminal Justice Coordinating Commission. For the Victim Advocates Program, those are, program. Those are are they volunteers or are they paid? Oh, did we lose Miss Anderson? Oh, I know there was a delay a bit of a yeah. Okay, we can I can follow up with you separately Miss Anderson and I do have questions about that but but thank you for all that you and your group do. Dr. Nguyen, you raised some really great points about disaggregation of data. And one of the huge challenges in that area is public health data itself is only collected in bigger buckets, right? And the agencies like the Department of Health and Human Services have to do their own reporting up and the federal government also uses those bigger buckets, which stakeholders. Are they able to engage in that more micro-level data collection directly themselves to assist with your analysis and how best to target folks? Thank you for the question council members. The answer to your question is yes and that's the effort that we are pushing forward is working with those Non-profit partner so that they are beginning to collect and they have also have the capacity and The skill set so that they collect the right level of data so that we can utilize Right and also help them to to Analyze them those data because they also need to be informed by that data, so they can customize their service better. But to touch on the first point that you bring up is how can the agency, HHS particularly, can better collect the data and use those data for other programs. And I've been involved closely with Health Immongamory correlation, and that is what I see this one up there. The big initiative to drive the data part for the county, especially on health and human services. And I think if we are intentional, intentional, the key word, and also willing to put the effort and to collect the data, we are able to, I mean, we help with the community health needs assessment in the past cycle. And through that effort, we have worked with the department as an MC, how can we actually put in some effort to reach out to certain groups and have to collect data in this more dis-accurricated manner? And that provides tremendous insight for what we want to do. Have in the conversations that you've been having about that in terms of breaking things down into more disaggregated buckets. Is there a threshold number at which you've been told they can't disaggregate below? Yes. I would say that we are still very early in the process, right? In term of what is the the threshold that we can reach, right? And what the county can do with the resources that the county have, right? Right. So I think but we are begin to strategize how we get there and how we begin to, how can we look into those bucket and allocated resource accordingly. So I think if we are pursuing this direction in the next three to five years, we will still have the data that that inform us on our next decision. Right. And I know I know it can be tough because you might be able to disaggregate by language spoken or country of origin or of what have you. But then if you're also trying to drill down into that by gender, by age group, etc. Then you get into some much smaller numbers that may not be able to be disaggregated down to. but there's a lot of ways to sort it that could help in what you're doing and I really appreciate your very targeted lens on trying to make sure you're reaching each of those communities in the way they need to be reached. So thank you for what you do and thank you for collaboration with the African American Health Program and our Latino Health Initiative and for elevating that to us because that's really important. There's lessons to be learned in terms of strategies and tools that the other groups have also tried in terms of reaching people and particularly on the mental and behavioral health piece which thank you again for raising that as a priority for your group. Thank you. Thank you so much. So I'll try to be brief to get us back on track. I know those were phenomenal questions and great responses by our board's commissions and committees. So, Mr. Swan, I want to start with you. So I know to respond from my perspective to the Councilmember Lukis question, which was a good one, I think the sense that I'm getting from some of the clinics are that they're not entirely sure exactly how it's going to all shake out now that the state has passed legislation, which everyone agrees is a phenomenal thing. So they actually have questions of HHS. And so that it'll take a while for that to sort itself out, but it's important. I do want to stress something that Mr. Swan mentioned though. So the two deepest regrets, well, three, but the two of the deepest regrets that I had that of things we were not able to fund in the 2025 budget, one of them was increasing the reimbursement rates through Montgomery Cares for our clinics, because sadly, we are already starting to see evidence where several of those clinics have already had to let staff go. The Mary Center being a good example of that. And that's a huge problem because to Council Member Sales' point, if these clinics don't have the staffing infrastructure necessary and patients are then not able to make appointments or be able to be seen fully they're going to go back to the emergency room. And so it's all connected and something that we're going to have to I think make a very high priority for the FY26 budget. The second thing of course was not being able to fully fund the food programs that we have that are out there, but we'll discuss those at a later time. But thank you very much, Mr. Swan, for your leadership. I do want to highlight, and this is on the, I guess, it's not really good news, it's news. But the Victim Services Advisory Board has been advocating for years, and I mean years, to increase the fund of reimbursement for victims here in Montgomery County. And we were able to fund that increase in the FY25 budget. So for those advocates from boards and commissions that have been asking for line items for years, we may not get to them when we'd like to, but they're because of your advocacy and push. We do get there eventually. So I want to thank them for that. And I also want to uplift, and this is just a comment. And I don't think Miss Anderson is with us anymore. But we saw in the first two years, I'm going to say this over and over again over the next few weeks, and hopefully I'll never have to say it again. But over the first two years, I'm going to say this over and over again over the next few weeks and hopefully I'll never have to say it again. But over the first two years of the Trump administration, there was clear evidence that people were not reporting crime, particularly with in immigrant communities. And they were also not accessing government services, which they were absolutely entitled to at low numbers. And so we have to be cognizant of that. That's something we all have to work on collectively. Oh, Miss Anderson, you are there. Sorry about that. So I wonder if you could just comment on that. I know it's on your all's radar screen, but any concern you have, things we can do to make sure that we prepare ourselves as best we can in the event that this awful toxic rhetoric targeted to immigrant communities both legal and undocumented may have a cascading effect on people's reporting Yes, so some of the worries, some of the worries that we have seen in, um, in and around our office has been the factor of the und... like you said, the undocumented, um, people that are here, that are victims of crimes. So the reason it goes that unreported is because they were... they are in fear of being sent back to their country in which they're trying to, they're in our country trying to get a better, have a better life. And so in that, we're just looking at like if they are survivors, them being just that in whatever type of assistance and programs that are available for them, that would be very helpful. But that's why we're seeing the low reporting for that because they don't want to be sent back. And then also some of the other things being targeted, if they are also, if they have committed a crime or they're gonna be prosecuted, that's another thing and why some victims are not, or survivors are not reporting. So that's what we are seeing. Thank you, Ms. Anderson. I appreciate that. I'm going to get in mind and then also with yes, the worries. Thank you so much. So I do think that we'll have to continue to uplift that our local law enforcement does not enforce federal immigration laws. We have an executive order that prevents that from happening, but it's something we'll have to unfortunately potentially have to continue to talk about. And then finally, Dr. Nguyen, thank you. I have mentioned this several times over the last couple of years, but I have been tremendously impressed at how you all were able to stand up as quickly as you did. A very thoughtful, a very methodical process by which we could identify nonprofits doing great work that may not have been in the county's radar screen. And so we're up against time because we wanna hear from the other panels, but I would love to follow up with you and Missy Ow if we can formally submit this question. If you can identify the nonprofits that you were able to fund but also the ones you you were able to fund, but also the ones you were not able to fund, that are doing good work, that you wanna make sure the county is aware of, that are reaching populations in a way that the county has not been able to in the past. If you could let us know that information in a written form, that would be very helpful, and that can help inform the committee moving forward on and the executive branch on which organizations we should be supporting further. So thank you all very much. We will now hear from our next panel and we have Ms. Elizabeth Nielis representing the Mental Health Advisory Committee. Then we have Marcella Campoli from the Latino Health Steering Committee and Mr. Diego Riburu, also from the Latino Health Steering Committee and Mr. Diego Riburu also from the Latino Health Steering Committee. And we have Mr. Jeff Goldman from the Interagency Commission on Homelessness. And Miss Neillis, once you get settled in there, you will be first up. And again, each of you have approximately four minutes or so. We'll hear from all three groups. And then my colleagues and I will ask questions and make comments. Hi. Good morning. Yes. I'm Elizabeth Nielis with the Mental Health Advisory Committee. And thank you so much for this opportunity to present our priorities before the Health and Human Services Committee. Thank you to Chairman Alburnas and Council members Lickie and Sales for funding so many of our critical programs and services in the county. The following are our top priorities for fiscal year 26. Some of these have implications for the county's budget and others are simply our advocacy recommendations that we will continue to elevate throughout our subcommittee work. The Mental Health Advisory Committee monitors reviews and evaluates the allocation and adequacy of publicly funded mental health services within the county. We seek to remain apprised of the latest research guidance, best practices and model programs to support and improve our county's mental and health and behavioral health services and programs. Our first priority this year is to finance increases directed to community-based peer-led organizations. The Substance Abuse and Mental Health Services Administration has issued guidance regarding benefits of peer support and inclusion of the peer workforce throughout the behavioral health continuum. The same sub-brief expanding peer support and supporting peer workforce in the mental health highlights the current standards and best practices for including peer support workers as an essential component of services delivery for mental health and co-occurring disorders. Peers increase a patient's activation, compliance and sustained engagement and treatment, decrease patient hospitalization, and reduce stigma within clinical and public safety settings. Family peer specialists work with parents and other primary caregivers who have children youth and young adults with mental health challenges. They have lived experience raising children with these behavioral health challenges, they have lived experience raising children with these behavioral health challenges. Adult peers are individuals who have lived experience and are trained to provide support to individuals and their treatment in their treatment recovery from mental health substance use and co-occurring challenges. And youth peers have lived experience with mental health substance abuse and challenges to provide support and advocacy for other children in youth with similar needs. Montgomery County has several family and peer support peer family and adult peer led community organizations funded by the Department of Health and Human Services Behavioral Health and Crisis Service, which provide peer support services and offer training to leading to national and state certification. Family and adult peer specialists can be deployed to work in multiple settings, emergency departments with law enforcement in court, Jail's crisis stabilization, health settings at clinics and in other environments. Across the country, family peer specialists help parents and other primary caregivers navigate youth, serving systems and social service agencies and access much needed services and supports. They help caregivers and individuals progress on their journey towards self-avocacy and self-efficacy through the acquisition of skills, knowledge, and a network of resources and supports. Unfortunately, there is inequitable pay and health benefit inequity that hurts family and adult peer organizations and their staff. The Mental Health Advisory Committee is requesting that Montgomery County Council fund additional financial support to family and adult peer-led organizations and wellness centers funded by the Department of Health and Human Services, Behavioral Health and Crisis Services to promote pay and health benefit equity and support their infrastructure needs. This will allow family and adult peers to have equitable salaries and benefits. In many instances, family and adult peers who often need to work on frontline and in difficult environments are only making minimum wage. Contracts with family and adult peer-led organizations, funded by the behavioral health and crisis services, have not kept pace with the cost of living, nor have allowed for maintaining adequate infrastructure needs. The estimated cost for this request is $603,000. Our second priority is to better utilize our advocacy council. The Mental Health Advisory Committee would appreciate the opportunity to actively and effectively serve as an advisory body to county leaders. Our committee is composed of frontline community providers, parents with lived and families with lived experience raising children with behavioral health challenges, individuals with lived experience, and other representatives of those who are directly impacted. We are critical stakeholders in our state and local behavioral health systems, and we seek more active participation in the decision making process of how our county allocates these resources. The duties of the Mental Health Advisory Committee are to monitor review, comment, and evaluate the allocation and adequacy of publicly funded mental health services within our county and participate in the development of local mental health plans and local mental health budget. We are eager to do as we have traditionally done in the past, we ask that our knowledge, experience, and involvement in the committee be valued by our county leaders. And our voices be heard and our views be adequately considered by the office of intergovernment relations for approval rather than disregarded. Our third priority is regarding crisis response and intervention services, particularly with the bed registry and the sequential intercept model. In an ongoing effort to improve access to behavioral mental health and behavioral and mental health care, especially for individuals in crisis, Maryland has begun utilizing a behavioral health hospital coordination dashboard or an active bed registry. Mental Health Advisory Committee has been involved in the planning of the county's sequential intercept model, in which having an active and effective hospital coordination dashboard is a critical priority. We want to continue to support the county in developing a plan to utilize and expand this bed registry and improve our crisis response systems. Lastly, the Mental Health Advisory Committee will continue to advocate for Medicaid coverage for mental health services in schools and communities, including through crisis response and recovery. The Mental Health Advisory Committee urges the county council to support and communities, including through crisis response and recovery. The Mental Health Advisory Committee urges the County Council to support and pursue the available opportunities to expand Medicaid reimbursement for mental health services provided by schools and through crisis response and recovery. The Centers for Medicare and Medicaid Services have been issuing guidance for the last decade since 2014 on how states can expand their use of Medicaid, specifically in schools and in communities. In 2023, the most updated guidance to state Medicaid directors on implementing expanded Medicaid coverage included the ability for state certified school psychologists to build for Medicaid services. The state of Maryland is working to implement changes to the State's Medicaid plan. And Mental Health Advisory Committee will continue its advocacy efforts to support Medicaid State Plan amendments to expand coverage and access to care. We ask that our county leaders work with us in expediting this expanded coverage through Medicaid. Thank you for allowing us this opportunity to share our recommendations and I look forward to answering your questions regarding these recommendations. Thank you very much, Sitzite. We'll get back to those questions. Next we're going to hear from our Latino Health during committee. Good morning, Chairman Abonos and Council Member Siles and Lutki, I'm here with my colleague Marcela Campoli. And she will begin. Good morning. Thank you for having us here. We extend our gratitude for the opportunity to present the Latino Health Steering Committee policies priorities for fiscal year 2026. Our mission is to advocate for initiatives that enhance the well-being of Latinos in Montgomery County and today we are here to share our top three legislative priorities that align with the needs of our community. So the first priority is the expansion of prevention and intervention services for young people. As you heard me testify in other occasions, the level of crisis that are young people, all young people, but particularly black and brown, our facing is unprecedented, fueled by an unaddressed mental health crisis. We're seeing skyrocketing rates of violence, bullying, absenteeism, and substance use, no? Fentanyl being one of them. The county has hundreds of programs but they seem to be isolated islands. We do not have a shared plan where all of us can align behind and then do their work. And I mean HHS, MCPS, recreation and all the nonprofits that support those services. So we highly encourage the expansion of both prevention and intervention services for our young people, but not doing it as isolated programs, but really we really need leadership to really combine all these efforts towards one particular purpose so that all county entities speak the same language to all young people from all different backgrounds, particularly minority young people. The second priority aligns with Mr. Swan's priority about more adequately reversing our Montgomery characteristics, we need to be able to sustain these clinics over time. And if we do not reimburse them at an adequate rate, 40% or 41% is not a way that would sustain their services. We know that they leverage tremendous amount of volunteers, et cetera, but it would be a lot better for those who use it to ensure that these clinics are here over time. And the last of the priorities is ensuring that the funding for newcomers, that the Council approved last year, was a one-year allocation of funding and we are requesting that these funds be put into the base budget to ensure continuity of services over time also. Additionally, we want to bring to your attention the importance to promoting continuity sustainability and community sustainability by reminding you of two successful initiatives that contribute to community sustainability. By reminding you of two successful initiatives that contribute to community resilience, the Latino Health Initiative, via the Lasalud Community Health Worker Certification Program, which trains participants to promote health and improve access to resources in underserved communities, and the Welcome Back Center, which supports internationally trained healthcare professionals in obtaining licensure to re-enter the Maryland workforce, addressing workforce shortages and enhancing healthcare access. Both initiative are essential for fostering long-term community health and require ongoing funding to sustain their impact. In closing, these priorities are not only addressing immediate needs, but also lay a foundation for sustainable long-term solutions that will lead to healthier and more equitable Montgomery County. But by investing in these initiatives, we ensure that all residents, especially the most vulnerable, have the opportunity to thrive. As our colleague from the Asian-American initiative mentioned, we also share our priorities with the African-American and the Asian-American initiatives. And we all share the appreciation in your equity-based approach to ensuring that each community receives a tailored resource bulk needed to thrive across the country. Thank you for your attention to these priorities. We look forward to continue collaboration to support the wellbeing of our communities. Thank you very much. Good tag team. Next we will hear from the Interagency Commission on Homelessness. I don't believe Mr. Goldman is here. Okay. He's not. Okay, got it. All right. Then why don't we just start with the questions of this two committees and then we will we will go from there and kicking us out this time will be Councilmember Luki. Thank you. I just want to thank you so so much for elevating the Medicaid reimbursement issue. Maryland has been way behind on this for a really long time and this was a discussion that was going on while I was at the state and over and over and over again and highlighting all these other jurisdictions who are doing it and doing it effectively and why Maryland chooses to leave money on the table is beyond me, right? So thank you for that, thank you for continuing to push on that, thank you for elevating the CMMS guidance that's been ongoing. We got to do better. I also want to thank you for elevating the family and adult peer-led programming workers, folks, so desperately needed here. And I think you know that the sequential intercept model is something that is near and dear to me. And if we are to do our best job in making sure that we are keeping folks in need in intercept zero, then we need to increase our peer support. Right. And I'm going to reemphasize this because we did just recently have a hearing, joint hearing with public safety about this, but to be clear, sequential intercept model is an analytical tool. It is not a service delivery model. It is not a program delivery model. It is just to help our folks like you all and our other providers and the entire ecosystem know what resources are available, what's working, what's not, and how to best collaborate together for the best possible outcomes. And I know that we used to have an on-er-own site in Montgomery County and we had gotten a constituent letter about it not too long ago in that it stopped running before the pandemic. And I wanted to know if you could speak to that and whether we are able to get another similar, if not called on our own, but or not affiliated with the on our own program, center service up and running again, because that serves as an ongoing community touch point for those who need that. Oh, push button. Sorry. I am not able to speak to that and it's definitely something that I will bring back to the committee I want to be sure that we are looking at that and enhancing whatever we can do especially that is something that the county had been Successful and implementing before and I apologize that I'm not prepared to answer that question That's okay, but we back to you. Yeah, it gives us something to definitely talk about and look towards Yeah, and I I'd be happy to talk with you separately about that some other time. And thank you for elevating the active bed registry issue as well. That was something that I believe the initial ask for within the state's behavioral health administration so that it works kind of akin to the way the system works for EMS providers now to divert to hospitals and how you know who's got trauma beds open, who's ER is overflowing, if somebody's on mini disaster, what have you, that we would have that for our mental behavioral health beds as well. That ask was in 2014. It's 10 years later and we still don't have it. It is not functioning yet. And so thank you for your advocacy. I will keep advocating for that as well. But that's a huge deal. And you did say that you requested that our intergovernmental relations team listen more to you. Can you be a little more specific about a particular issue? Because here's the challenge. And, you know, I serve on boards. We all do on board committees and commissions as a result of our roles. And so sometimes what the county's position is on a thing might be different than what my position is or what someone else who serving with me is. And so I choose to speak as myself as an individual and I on this committee, but you're not speaking on behalf of the committee. So can you talk a little bit about what it was in particular that where that might have arisen? Well, so when I first came to the Mental Advisory Committee, we had a very active legislative subcommittee. And we would regularly monitor the state legislation and we wanted to learn more about what other jurisdictions were doing, other counties, again, so we could elevate best practices. We had been working under resolution 3615, which allowed us to write testimony in letters with approval. We had worked on up to 11 letters in FY 24 and didn't get maybe two of them then went all the way to the state leaders. We were not clear on what the conflict was. As you said, if there was a position that wasn't aligned with the county, absolutely, that would be something that we would like to understand more, so we could advocate more effectively within the county. We were not given any understanding on any of the particular issues. We were just given an outright updated no more advocacy that it's not in our charter and even though other boards have these advocacy opportunities at the state level, we have been told that ours is not, not at all, and that we've been either interpreting resolution 36, 15, or that it is just incorrect. And so we would like to be able to better understand what those issues are. If we're advocating for something on the state level, and it's not right, or there are issues in Montgomery County, that's exactly what we would like to understand so that then we can better work within our county and with our county leaders. Right. I think, yes, certainly the time to have that discussion with our intergovernmental relations team is now, you know, before mid-December. And, you know, again, to the extent that that is not something that is assigned to this group via the resolution, it still, you still can, as individuals, do what you need to do. Absolutely. And we are promoting to our individual members that they continue to advocate on these issues, and we will continue to remain apprised and updated on what the pending mental health issues are through our state legislator. Thank you. And for our folks here at thank you Diego, thank you Marcella. I think you know I'm a huge fan of your community health worker certification program And I will continue to champion that program because it's vitally important to our community, to our county and to the workforce. It's huge. I could not agree with you more on your request for not having such a fragmented plan. As a whole, we need to do a lot better about that in terms of coordinating between different groups. The more you can coordinate and concentrate, the better the overall outcomes, both in advocacy and in services. So thank you for elevating that and highlighting the fentanyl issue. Again, I, along with Council Member Fanny Gonzalez, I'm supporting state legislative changes for this upcoming session to enhance the penalties for fentanyl distribution. People should not get a pass for profiting off of the death of another and to expand the ability to do inter jurisdictional prosecutions in order to facilitate that since we have some legal hiccups there and we want to make sure we're giving the judiciary and our state's attorney's office is the appropriate tools to address this epidemic. Thank you. Thank you. Before I turn over to Councilmember Seals, just really quick, administratively. Miss Yow, if we could get some clarity for all the boards and commissions on what they can and can't do in terms of advocacy, I've been around a while. That's the first time hearing that you all have been stopped from doing something. There's ways that if there were some concern and I'm not familiar with all the details, you don't have to advocate for a specific position, but your knowledge is really important. And so without saying vote up or vote down, you can provide points for consideration at a minimum. But I do believe that passports and commissions have taken positions on various issues, particularly at the state level. So that's your job, is to help advise us and us as elected officials and policy makers. So if we could get some clarity on that, that would be great. Sure. And depending on the charter of each of the Board's committee's commissions, it lays out whether they can directly advocate or not, but we can certainly compile that and make sure that we're working with the Board's commissions to get their input. Thank you, Miss Allen. Just to be clear, that's an executive rank function, but we're all a team. So we want to help them help you and work together. But but I yield now to council member sales. Thank you, Mr. Chair. Good point to raise with the upcoming session. Okay. So miss Niels, thank you. We recently confirmed a Miss Monica Martin who is the acting director to the current chief of behavioral health and crisis services in the Department of Health and Human Services. And she mentioned during our one-on-one and during her confirmation hearing that one of her priorities is the sequential intercept model. Has the committee been in touch with her and invited her to any of the upcoming meetings to discuss this? Yes, actually Ms. Martinez and the other folks at the local behavioral health authority have been very great at being our partners, attending our meetings and we've had many conversations with them. So we are working with them and looking forward to that ongoing partnership. Very good. Okay. Looking forward to hearing updates about that. And then you shared the need for increases in peer support resources and we've heard really positive feedback about that program. But I'm looking at the fiscal note request and just wanted to know if you could share more about what the workday is for a family and adult peer specialist. Is it a full-time position? And then how many staff will this $600,000 cover? I don't have that exact number for you again. I apologize, but I do know that the regular work times, many full-time, many part-time, but their pay just remains at the minimum wage level. So I think that they're looking at the current group of the number of our nonprofit peer led organizations and adjusting those salaries up to par with what other providers and with what the national standard is. So how many are currently employed now? That is a good question and I will be sure that we can get that back to you. All right. Yes, please. Thank you. And now I lead Tino Health, a steering committee. Thank you. Always a pleasure to see you at Diego. And you as well, my Celia. Thank you for the updates. I know that you have been so busy in looking into interventions regarding those who are dealing with substance abuse and addiction. And all of the contributing factors that impact their lives. And so I first want to commend your efforts in partnership with the steering committee in helping our immigrants, our asylum seekers and refugees, you know, acclimate to the community, get connected with the resources that they need, and contribute to our future workforce needs. We know that Montgomery County has four of the most diverse cities in the country. But if we don't create a welcoming community for our immigrants, new arrivals who are fleeing violence and horrible conditions, they won't stay. And so these investments are so important to ensuring that we maintain a welcoming environment for our immigrants who decide to settle here in the county. And just wanted to know if there's any specific prevention and intervention efforts that the committee wants to see expanded. Yes, the committee submitted a proposal to the county executive a few months ago. Okay. Basically it's an array of services that involves working with the young people. A study was done with, I think there was 17 focus groups reaching 100 plus youth and parents and misinformation regarding fentanyl is a huge issue. The majority of folks rely on social media and the parents feelequipped and not processing the knowledge to support the children. So they use fear tactics that don't work. They stated that they want to hear information from trusted adults in the community. So it's an array of services that involves prosocial activities, like recreation, after school activities, et cetera, information for both young people and parents, because both of them stated that they did not have information, particularly regarding fentanyl, and specific support to the parents in terms of skills building as to how they could best Support their children both on the prevention side and on the intervention side And again the other thing that I want to mention is that The county desperate needs a shared vision for everyone who touches the lives of our young people Yes, and that is lacking Again, we are very good at finding this and that. The other thing that is important is we do not have prevention services for substance use, countywide and the intervention services that we have are just for Wheaton Glenmont and Aspen Hill. And we are getting requests from other parts of the county of parents who still didn't deal with the same issues. Again, and this is not just an issue pertaining to Latino community, but all young people, particularly Black and Brown, those are the most affected. So I'm not sure where we are with that, with the request that was made. Yes, if you are able to share that report with Miss Yowl so the committee can review it as well. On the focus group, yes, we'll do. Yes, yes, please. And thank you for your continued work and look forward to seeing what the county executive will recommend. Thank you. Thank you. Thank you both very much. I'll start with our Latino Health Serenity. Thank you both. I, you know, obviously we're all huge fans of your guys' work. It's really extraordinary the way that this committee in particular has coordinated and organized and gone well above and beyond the charter to really make some lasting impact. So it's obviously critical. And I always say this every year but I'm always struck by the crossover in the between the issues. They're all interconnected, and I always very much appreciate when boards and commissions advocate for what other boards and commissions are advocating for. So I think in stressing the importance for enhancing the reimbursement rates for our clinics is obviously very important as well. So just underscores why I, and I know a lot of my colleagues are gonna make that a big priority in the next budget. But I wanted to talk briefly about, and Diego, you were a lot of hats. I know the work with the Black and Brown Coalition, and in particular with MCPS is very important. It was very unfortunate, very unfortunate that MCPS let go of the public health infrastructure and that they had been able to establish in their own version of public health officer position. Can you talk a little bit about any concerns you have or maybe some hope over the possible collaboration and partnership with MCPS. We've had a long standing challenge with communication, but I fear it's gonna get worse now that that position has been eliminated. Thank you for the nice question. Sorry. I had a meeting with Dr. Taylor yesterday. One of the biggest challenges from my perspective regarding MCPS and anything that they intend to do is a lack of cultural understanding and responsiveness, particularly with the most effective communities that tend to be Black, brown, Asian, American. He is aware of that. I believe him when he says that he is going to focus on those issues. He understands that the $3.3 billion that they receive to not have the internet impacts when they cannot successfully connect with our communities on anything, no, on educational supports, but also on the issues that we talked about. I am not sure whether the plans will be, but I think that we all need to push MCPS to become more responsive to the needs of its constituents or all of our constituents. I mentioned to him that particularly within the Latino community, one of the main concerns apart from the educational and gap is bullying. And the levels of absenteeism are skyrocketing and we used to worry about absenteeism rates in high school but now those are very high in military school and we have spoken with parents who choose not to send their children to school because they are afraid of bullying and the lack of response. One of the things that I shared with him yesterday was a recommendation that the Black and Brown coalition provided to Superintendent Mc Knight at her request at least of recommendations as to how MCPS could be become more culturally responsive and less racist. One of those recommendations was the creation of a public-private partnership for the creation of a constituent support office that could be outside of MCPS, where as I shared with MCPS as a million dollars by many of those doors lead nowhere. Sometimes because people don't have the knowledge, sometimes because people don't respond and sometimes because people choose not to support something in communities that tend not to complain. If you don't understand how the system works, you tend not to get what you need. So he took note of that. Again, he asked me to share the report with him. And I think that if he hears from all of us, he said that he was interested in that. He asked me to send in the reports, so I did. So we'll see what they do. But it's extremely concerning because the school is not just about education. It is, education is the priority, but it's hard to educate young people. If they go to their Hungary, if they're sick, and most importantly if they're afraid, and if their families are afraid of them being in schools. Yeah, that's a great idea. So this whole concept of community school model, it's important, but I think we're not, we're just scratching the surface, and because it is the focal point for so many different families. And as you know, there's, the central office can only do so much than if it's not implemented or executed at the school level effectively, and there's inconsistency. I'll just put that nicely and how some of this is disseminated at the school level. I really like the idea of a constituent services office or something like that that could help support schools. I'd like to follow up with you on that. I think that's great. Just FYI, last year, we had a meeting with JCRC with obviously the Black and Brown coalition. We thought about the Muslim community also and others. This would be to serve everyone, but the beauty will be to support the families that call, but also to document what the issues are, what is, how does MCPS respond to the needs, but we have a lot more data about issues and what happens because this quicky wheel gets the oil and the communities that I just mentioned tend not to get the oil which means services. Anyway, so happy to share with the three of you the recommendations that we sent to the school system two years ago and Have any conversations you you want thank you and just last thing I'll mention this is just a comment But you know all my colleagues and I were shaking our heads when you said we need a collective vision We had one at one point as you know, but we got to come back to that, because I think that's really important. And Ms. Neillis, thank you so much for your leadership. So I want to thank you also for your uplifting, the importance of enhancing our peer support workforce, because we know that even if we had all the money in the world, we would not be able to hire enough clinical specialists to address the need that's out there. And so we need this more holistic model. And that's something that is more capable of. We've done it through our health promoter model, those promotores model, we can tackle this. And so that is something that I'd like for us to explore working more definitively with you and the commission on moving forward because we know that works very important. And as I've said many times, my colleagues have said also been saying this, behavioral health mental health was the number one in chief concern raised by our residents in the most recent public health survey conducted by the Health and Human Services Department that's done every few years. So it's people are aware of it. We have to continue to break through the stigma and encouraging people to get the care that they need and then helping those that are taking care of people find respite services. There's just a lot in this space. And we do want to follow up with you once we get an answer on what you can and can't do in terms of advocating at the state level, because let's all be singing from the same sheet of music on that, and collectively use our influence as best we can. Thank you. All right, thank you all very much. We're going to now hear from our final panel, and we're going to hear from Dr. Gaudiera Limous from the Commission on Health and Dr. Elise Grossman from the alcohol and other drug addiction advisory council who is joining us virtually. And we have not been able to track down Ms. Jacqueline Williams from the African American Health program. She's not here. Hopefully she will be here either in person or virtually soon. If not, we can certainly follow up with Ms. Williams. We're obviously always very impressed by the work of the African American Health Program. But we will start with Dr. Lemus from the Commission on Health. I'm trying to get that. OK, I'm unmuted. Good morning, Chair Adornoz and Council Members, Litgy and Sales. I'm Dr. Gabri Lelemos, Chair of the Montgomery County Commission on Health. I want to recognize the Commission's Vice Chair Marcella Campoli, whom you just heard speak on behalf of the Latino Health Initiative. The primary mission of the Montgomery County Commission on Health is to advise the County Executive and the County Council on Public Health Issues, program services in the allocation of funds devoted to public health needs, and to monitor and assess the priorities of the Montgomery County Health Department and Human Services. Thank you for the opportunity to share with you the Commission's key priorities for FY 2025, which we believe are critical in proving the health and well-being of our community. So we've had extensive discussions. And for 2025, FY 2025, the Commission endorses the following three priorities. The first is the establishment of a health clinic manager. The second is continuous focus and additional resources for maternal health and child health. And reallocating funds for mental health and substance abuse. As you said, this has been very important in the reporting community health needs that we've seen from the county. So the commission on health believes that health clinic manager plays a vital role in ensuring the efficient operation and high quality health care services across Montgomery County's clinics by providing leadership, standardizing practices, managing staff effectively, and overseeing administrative and billing processes to optimize patient care and financial stability. So with the recent expansion and Medicaid coverage, the health clinic manager will address the growing demand for integrated health services and ensure a smoother billing process, especially for clinics that have recently started in this process of Medicaid building. We believe that this role will enhance Montgomery County's capacity to deliver consistent patient-centered care, which we've all just, you know, really focused on internally at the commission, resulting in better health outcomes, higher patient satisfaction and more efficient resource allocation. A health clinic manager will play a vital role in reducing health disparities, ensuring equitable care for all patients, particularly those from underserved communities that we've spoken of today. Regarding maternal and child health, the Commission on Health is concerned about the alarming disparities in maternal health, particularly for Black African-American and Latino women, who face higher rates of infant mortality, higher maternal morbidity rates than white women, and adverse birth outcomes. County data from 2022 indicate that black women were three times more likely to die from a pregnancy related cause than white women. We believe that maternal and infant health is at the heart of building a healthy future for our community. The health and well-being of mothers and their babies not only shapes the next generation, but also serve as a key indicator of our broader public health landscape. Specifically, we are concerned about the ongoing funding challenges that limit the babies born healthy programs' ability to serve all referred clients with only 60% typically able to enroll in the program. On the Commission on Health recommends expanding the Paranatal Workforce and funding interdisciplinary teams for home-based care. Like you said, Chair, Alvernos, a lot of this work is very intersectional. We believe that this approach will address the comprehensive needs of pregnant mothers, including behavioral health, social support, and breastfeeding assistance, which leads to much healthier birth outcomes. It's a preventative type of way to ensure our mothers, especially African-American and Latinas, have better outcomes. While we're proud that our county outperforms state and national averages on many health indicators, we must acknowledge and address the disparities that do exist. So county data reveals troubling differences in pregnancy-related outcomes, as I said, among racial and ethnic groups with non-Hispanic and black women facing significantly higher risks. Regarding mental health and substance abuse, this topic comes up again and again, and the Commission on Health is advocating for a reallocation of funds to programs directly addressing the mental health and substance use crisis, prioritizing outcome based initiatives, and the Commission wants to emphasize the need for behavioral health care providers. The Commissional Alliance very much with and supports the Mental Health Advisory Committee's recommendation to fund the peer workforce for mental health and substance use services utilizing the SAMHSA peer support model. The commission also believes that we must continue to address the shortage of beds in behavioral health facilities and promote the use of the behavioral health hospital coordination dashboard for real time bed availability to improve patient care and hospital efficiency. And lastly, the Commission on Health and Courage at Support for Project Echo to enhance clinician expertise in treating mental health and substance use disorders, particularly in community health settings and community settings period. So I'll stop here. I want to thank you all for listening to us and I'm happy to answer any questions. Thank you Dr. Lemus stay on and we'll get to those questions shortly. Next we will hear from Dr. Grossman from representing the alcohol and other drug addiction advisory council. Thank you. Good morning. Thank you for the opportunity to address this committee today, and I'm sorry that I cannot be there in person. My name is Elise Grossman, and I'm the chair of Montgomery County Alcohol and other drug addiction advisory council, known as AODAQ. I'm a public health attorney at the National Institute on Drug Abuse with over 20 years of experience working in the public health sphere. But statements here did not represent any agency or group other than AODA. AODAx mission is to provide guidance to the County Executive and the County Council by identifying alcohol and other drug prevention and treatment needs and reviewing the county's efforts in addressing those needs. We're comprised of experts in prevention and treatment and have representatives from the legal business and medical communities. As we've heard today, substance use is an area that impacts everyone in this room today. It affects all races, ethnicities, and ages, and often co-occurs with other health issues and leads to many broader problems. Therefore, it was exciting when yesterday the CDC reported a 15% decrease in total fatal drug overdoses between June 2023 and May 2024. However, this good news is tempered by the fact that rates were at a historic high during COVID-19 and are still higher than they were in 2019. So although it's decreased, this means there's still total fatal overdoses of 260 deaths per day. That's as if a Boeing 747 crashed every other day. And prior to COVID-19, we were looking at 186 deaths per day, which is still too high. Additionally, this number from the CDC only applies to adults as youth rates of fatal overdoses continue to increase. In Maryland, there was almost almost 2500 overdose deaths statewide in 2023 with the majority of those being from fentanyl. 138 of them occurred here in Montgomery County. Opioids caused 73% of fatal overdoses in the county but they are not the only substance. The remaining deaths occurred from cocaine, alcohol, heroin, and other substances. AODAQ has two main priorities for fiscal year 2025. Our first priority is to continue examining issues facing youth in our county and provide recommendations to the county executive and the county council to improve the situation. Research shows that childhood and early adolescence is a time when people are most likely to begin using drugs, including tobacco, alcohol, and illegal prescription drugs. Youth who start using these substances earlier in life have worse trajectories, greater consequences, and are more likely to develop an alcohol or substance use disorder when they are older. Given this, we agree with the Latino Health Commission that there needs to be a comprehensive county-wide strategy that both prevents and reduces use substance use and provides harm reduction, treatment, and recovery surfaces for those who do use. Some of the issues that AODAQ will work on to address this year are vaping among youth, substance use in schools, and underage drinking. AODAQ will examine and document these issues throughout the county and will work towards procuring and distributing resources, educating and partnering with parents and caregivers, and partnering with other BCCs such as Latino Health and Commission on Health we hope that are already working on these issues. Council Member Albinas, you mentioned the loss of the MPF, CPS Chief Medical Officer. That was a huge loss and something that we wrote a letter to both the County Council and County Executive on. Prior to having the Chief Medical Officer, we were losing a student a week, primarily to overdose and suicide. That was eliminated due to the effort of the Chief Medical Officer and her staff and we cannot go back. Our second priority is to continue to work to address the issue of stigma related to substance use, misuse, and addiction in our county. Once again, Calvin council member Albiners, you mentioned this issue of stigma. It is so important. Stigma is defined as an attitude, discrimination, or prejudice directed towards an individual or a group, and it can prevent a person from seeking or accepting proper care, support and treatment. A really important issue when addressing stigma is to monitor our language. And this occurs when we're discussing those with about and with those with substance use, misuse and addiction issues. Potential ways that the AODAC will continue to work the address to address the issue of stigma in the county, include holding trainings, advocating for changes in stigmatizing language and official county laws, policies, and other consumer facing information as we did with Montgomery County County Code, and partnering with other organizations. Lastly, I want to highlight two issues that have been affecting AODAQ and probably other VCCs as well. It's been very hard to get new members and fill empty seats as it's been hard to get available positions publicly posted as there appears to be a severe backup in the office and charge of posting these. As a result, there were times where we could barely function or didn't even have a quorum. This obviously impacts our ability to do what we're appointed to do. We would encourage this community to ensure that the office has the necessary staff and funding to do their work to get these positions posted so that we can continue to do our work as well. And lastly, I'd like to reiterate what M. Hack Mental Health Advisory Council has discussed about the issues with the office of Intergovernmental Relations Office that's been a problem for us as well. In the past, we were able to write testimony and give statements, and I know it depends on the charter, but the bill that she mentioned changed our charter and M.H.X. charter so that we can testify at the state level if approved by the Office of Intergovernmental Relations, and used to get approved and as of now they've just stopped approving anything. So I really appreciate any help you all can provide with that. Obviously we don't want to testify something against the Montgomery County's position, the County's position, but I think we have so much expertise and knowledge among us that having our hands tied in this way makes it very, very difficult. Thank you for letting me present our priorities today and I'm happy to answer any questions. Thank you very much. We're going to start with Council Member Sales. Is the AHP still not here? I don't believe so. Okay. All right. Thank you, Mr. President, Mr. Chair. Starting with Ms. Lemus. Thank you again for your presentation. When I first became a council member, the first report I requested from the Office of Legislative Oversity was on Black Maternal health given the alarming disparities. And they're still working on that report and it should be released this fall later on this fall. And they're looking at national trends of where we're seeing improvements and potential policy recommendations that we can implement here. So thank you for raising that issue. We know that the disparities between Black birthing people. So looking forward to seeing what the report recommends in the next few months and look forward to your collaboration as well. I think this is such an important committee. As we're talking about which boards, committees, and commissions should be partnering with each other. Looking forward to partnering with our minority initiatives, including this commission to implement some of those recommendations. So thank you. And then, so no questions. Just wanted to commend you on your ongoing work and efforts. And Ms. Grossman. I'm still here. All right. Thank you. Ms. Grossman, thank you for sharing your two priorities and your intention to partner with others. I just wanted to know if you had any specifics on which boards committees and commissions you are interested in partnering with and how we can support or facilitate those connections. Yeah, so AODAQ and M-HAC work very closely together. We have liaisons that sit on each other's boards and we put forth a spring form every year. Every year I come to this priorities meeting, it's very exciting because I hear priorities from other councils and commissions, and I'm like, great, that's something we want to work on. So I'm hoping, as I said, we can work more with the Commission on Health, we'll see no health community, because this issue of substance use is very broad and affects everyone. The other thing that would be helpful is there are different groups, the Office of Overdose Review. I don't know, ORT, and I don't know all the acronyms, but I feel like we have so much expertise and experience on AODAQ, and we're not always called on to either serve or be a part of these different commissions and councils and meetings and boards. And so if there are other groups that are discussing substance use issues that are making decisions about funding for the opioid awareness funds, you know, the jewel funding, we would love to be a part of that because we have so much knowledge and experience and background in this area. And I feel like we're not always called upon when we're needed or should be needed. No, I, I too enjoy these sessions because I'm learning about all the incredible work that's going on that isn't often read about. And so we appreciate this time of the year to reflect and just wanted to follow up with the one final question. How many training sessions have you held this past year and how many do you plan to hold in the upcoming year? We'd love to put a place hold on my calendar to attend an upcoming training and raise awareness about these opportunities. Yes, so we did a session last year. I think there were three parts discussing substance use. I will put your name down and make sure we contact you. We've been working with Shatterproof in the past to does stigma trainings. A big part of what we're looking at is not necessarily doing the entire training ourselves, but getting the organization to get the right people to the right places at the right time. One of the trainings that we're looking for this year is we'd love to have a training with judicial staff um in the court system because they're as I said there's so much issues of stigma even the word abuse is that is abuse and addicts are not words that are used anymore because this is a disease this is something someone suffers from so it's substance misuse and addiction and a person who uses substances. So I think language is just so important. So I will make sure that when we have the next training we invite you because I think that would be fantastic and that's something that we're looking forward to doing. Thank you and I'm glad you brought up the judicial system. We learned late last year that the youth, I don't know if it's the truancy court or the youth drug court is no longer in operation. So we'll want to get more information about that because this is such a prevalent issue. We may need to look into what efforts are needed to bring it back to operation. I would be remiss if I didn't say that the 20th anniversary of the drug court is coming up this year. The full drug court that is happening November 13th at 4pm, so this will celebrate its 20th anniversary. And as you know, it provides sort of long-term courts to provide treatment for individuals who substance use disorders. So that's very exciting. If anyone has not attended a drug court graduation, they are amazing and very uplifting and emotional. And 20th anniversary is fantastic. So I know people would yell at me if I did not mention in plug that. Thank you so much for mentioning that we will certainly be there to support this incredible initiative. Thank you. Thank you. Thank you, Councillor Murloughi. Thank you and yes I've already got it on my calendar. I will be there. And I just wanted to clarify. So the State's attorney's office still does run a true NC prevention program that they do in conjunction with MCPS who provides them with the students with whom they can work on that and families. And they have graduations for that too. I invite my colleagues to attend. It's a really great program and a great way to work with youth early on. It's primarily at middle schools. There are two high schools who are also participants in that. And, and thank you for mentioning that you, DeSherry, we do have some fairly robust diversion court programs across the state. And not every jurisdiction has exactly the same programs. And for example, one of the programs that we do have with respect to DUIs, one of my questions with that is we have folks who end up with a DUI where the DUI happens in Montgomery County, but they don't live in Montgomery County, but we also want to make sure that if they may be eligible or meet the criteria for a diversion program of some kind, that they're able to get it, and that requires cross jurisdictional collaboration, but since it's at the district court and the district court is a unified court, what can we do better to help with that with the Maryland Judiciary? So I just wanted to flag that for you as something that I think your organization is really well-suited to help address. And thank you for flagging the MCPS, Office of Chief Medical Officer issue. That was an incredibly hard thing to swallow because that was an office that was working really well. Working really, really well and doing very good things in our community and that was beyond a head scratcher to me. And thank you for your making sure we're not just focused on FATNOL, FATNOL is a biggie, but it's not the only thing that we have wrong. And particularly over the past five, six years or so, we've had a number of calls for service for EMS providers at our schools across the state that are related to students experiencing tachycardia because they're vaping THC in the bathroom. People forget and for some reason you, you know, people start to look at that at THC or the other cannibals as less harmful or less risky when really we do have significant issues with that and they are truly affecting our young people. So I do know that the memo that you all did on cannabis and youth did come over to us today. Thank you. It's incredible. Thank you for the hard work on that. And as we discussed with some of the other groups finding good ways to have peers be the ambassadors of that how to be healthy message because if you're thinking about not just the impacts of fentanyl or tobacco or alcohol or cannabis but you're thinking about how to empower our young people to make positive choices and to say without worry or fear or stigma, something's going on and I need help. Because at the end of the day, there is a lot of that co-existing thing where one thing gets the other thing or the other choice because there's unwellness and they need to be able to know that they can get help and wellness without worry about stigma or punishment of some kind that this isn't about being punitive, that this is about getting someone services that they need and caring for them in that person-centered way. So thank you for that. And I think that I'd love to see what we are able to do and again to, and Diego's not here anymore, but to that whole coordinated approach piece. How can we use our youth to be the ambassadors, but better for this message? There's a very good program through HHS, which is like, see the one and the best of us. There are programs with youth, but 100% agree. We need more peers. There are peer programs a lot for adults, but as Mental Health Advisory Council said, supporting peers is very important. And family peers, like how do you help a family mental health advisor council said supporting peers is very important. And family peers, like how do you help a family where they are dealing with these situations and they don't have, I mean, one would not expect that most families have a therapist or a clinician within their ranks to help address this. And yet it's very highly technical things and you want to make sure you're doing the best and that peer support for our families can really be of immense benefit. We're also very excited that Mountain Manor Treatment Center just opened adolescents. It's in Baltimore but it's the first treatment center for adolescents so it doesn't help on the peer side but it's something for you that wasn't there before. Yes. It wasn't really pushing for that for a while. It's something where there's been a long nothing. And we can celebrate that small victory, but everybody's got to push really a lot harder to make sure we're expanding that. Because we don't want these to be things that are unaddressed and then you're an adult and then it's harder. And then the consequences of things are much more challenging. So thank you. And Ms. Liena, with respect to the maternal and infant health and women's health in general. And I appreciate all the different programs we have that are helping to expand and target what we can do for our maternal infant health, our breastfeeding support, and the huge proponent of that. And I'm wondering what we can do to expand what we're doing particularly for our women of color and our young women of color who in the pre-maternal health phase that's helping our young folks and helping our young women to understand how best to help themselves and do that pre-education and pre-expansion of services there so that you're meeting them before they are pregnant too and then they have continuum of support and understand how best to help manage that. How we can expand. Yes, for, yeah, yeah, for, you know, in the pre-pregnancy phase of life and how, you know, to me, education is empowerment and that's really important. And I think that actually is a really critical point to raise. And I think as well that as the Latino Health Initiative, Diableti Woodo suggested this idea of cross-sictoral collaboration and sort of, I don't want to call it coalition building because it's more bringing everybody together and having those conversations because I do believe there are resources in place, but we have to connect them better to the folks who are on the ground, where cultural competency and language access on the Latino side, but also destigmatizing. A lot of the things we just said about behavioral health and mental health and substance abuse are very similar for all of these issues. It's really about everybody kind of getting on the same message and as a community, as commissions, of course, and commission members, but as we do this work that we also engage with the nonprofit sector and have them be our ambassadors as well. I think that I mentioned peer-to-peer work as well, and at least you mentioned the ambassadors. And that is also a key space. I know that there could be maternal health ambassadors, for example. Now this is my, we haven't discussed this in the commission, but these are things that I've been talking with different folks on the ground, on the in the nonprofit sector as I do different types of asset mapping for my work personally. We believe that these are really good solutions and they're really not as expensive as one would think. But again, it's about focusing those resources and the allocation of funds in such a way that those programs that are really showing good outcomes are highlighted, raised up, and possibly expanded. And beyond just, I think, Latino Health Initiative mentioned, like Glenmont or various. It really does need to be expanded. So it's a lot of work. But only if we collaborate and coalesce will we get further. Yeah. Thank you. Thank you both. I don't have a lot to add. That was really well done. Excellent presentations. I appreciate your leadership, doctors, lemus and gross men. Please extend our deepest appreciation to both the commission and the council for your work. And I will just say generally speaking, I think we all could including this committee and we'll continue to work on this and I really appreciate your leadership and putting all this together Miss Yao I know it's a heavy lift coordinating the logistics and providing all of the necessary background but as a matter of practice we should I think we do in some instances but make it more consistent just let the boards and commissions and committees know when we're going to be discussing an issue and committee that crosses over into their work to at a minimum give them an opportunity to tune in maybe give them a heads up so they can submit questions or comments or thoughts. I think that would help all of us uplift our work and further take advantage of their tremendous dedication and public service. So with that, we're going to end on time this morning. Thank you all so much for your dedication and leadership. We will follow up with our good friends at the African-American Health Program to get their update at a later time. But thank you all so much. We are adjourned.