Behavioral Health Advisory Board - Regular Meeting

Board for May 27th to order. Madam Clerk, can you please call the roll and announce the presence of a quorum?

Thank you, through the Chair.

Yes, I'm sorry, I was looking over there. I apologize.

No, no, please go ahead, sir.

Thank you. Through the Chair, we have Ms. Miriam Stewart.

Present.

Dr. Tiffany Amrich.

Present.

Heather Winters. Karen Annunziato. Present. Senator Garcia.

Present.

Victoria Millet.

Present.

Carlos Martinez. Present. Present through a designee. Laura Naredo.

Thank you.

Lauren Robito. Christopher Wing. Present. Dr. Janitza De Jesus. Lieutenant Elio Perez. Lourdes Dorado. Claudio Perez. Present. William, I have Delaincy here. William Delaincy or William Delaney? Apologies. Thank you. Alfredo Hernandez. Michelle Fernandez. Susan Holtzman. Carolyn Acosta. Maria E Verde Yanez. Present. Through designee, Dr. Joseph Potier. Gustavo Cruz. And Luis Espinoza. Mr. Chair, you have a quorum.

Thank you, Matthew. Can we please rise for an invocation led by Claudio and the pledge by Lourdes?

Father, we just thank you. What a blessed opportunity to come and advise on how to better serve this wonderful city that you've given us, Lord. We're just thankful. We are thankful as we look back to Memorial Day and all that has made this possible. Those sacrifices, we pray, as we continue to study and deliberate here, that we would honor you in all that we do by providing the best level of care for our city and those that are hurting. We're thankful. In your name we pray.

Amen. Amen. Prayer. Lord, listen.

I pledge allegiance to the Father, and to the United States of America,

I think Amanda's running a little behind schedule. I think she was at a meeting, so we will just continue with the agenda. We are now, let's see, roll call. We got the reasonable opportunity to be heard. Anyone from the audience who would like to speak? Don't worry about it. We have other opportunities to speak, whatever items we have. We have some new members. Mateo, do you want to introduce the new members?

Yes, Mr. Chair. We have a new designee from the Fire Rescue Department. That is the Lieutenant Elio Perez. And then we also have a new designee from the Corrections Department with Dr. Janitza de Jesus. Is Elio here?

No. elia is not here at this moment mr chair okay okay perfect and then we have um yes would you like to say a couple of words i'm just grateful for this opportunity to join this board i'm looking forward to working with you all perfect thank you welcome thank you for for your time to this point we really appreciate it's a lot of good work that we need to do on here all right so now we have special presentations uh let's move on to the community needs assessment by thriving minds Do we have any presentations, any community presentations?

No.

All right, perfect. Let's just go on. When I was asking that, we had some community partners that were doing a presentation. But since we don't, we'll go right into, Renee, just stick to the agenda. So let's go to community needs assessment tool by Thriving Minds. I think the next mission for us is to come up with some community assessments to figure out what the need assessments are for our community. And I know Thriving Minds, you have a lot of this information. But I want us to be very attentive to this because I think it's going to be the crux of what we as a board are chartered to do is to make sure that we identify where these gaps may exist and figure out how we provide services as we move forward. So, um, that's where you're on.

Good morning. Can you guys hear me? Yeah. Um, so good morning, everyone. Some of you may have heard this presentation before, because we did present it at the collaborative meeting back in October November. Um, but I know Amanda reached out for us to share it as part of, uh, this, uh, work group. So it was part of your presentation. So please feel free to follow along. So contractually, Thriving Mind is required every three years through our contract with the department to do a community needs assessment to see what we're seeing as our community needs for that three-year cycle. As a reminder, Thriving Mind serves the safety net population, so it's the uninsured or underinsured. give that caveat and while some of these needs might also be specific to the populations that have insurance or have income for their care we do specialize on the safety net so just keep that in mind as we're going through the recommendations It's a three year process. This last three year process, we did contract with one of our partners, Behavioral Health Research Institute, BSRI, to help us through the needs assessment. And BSRI serves as our evaluation provider on various projects that we do at Thriving Mind, our prevention system, our care, our ROMs, our recovery oriented system assessments. So they have extensive experience working, evaluating our needs. So the methodology is the next slide. We did a extensive review where we did stakeholder surveys, we did provider surveys, we did person served surveys, we also did focus groups, we did community town hall meetings, and we also looked at our data from over the last three years, as well as historical trends, census data, all that kind of good stuff. And then key survey findings and focus group findings. These are kind of the major buckets that we looked at or came up through those various different surveys or meetings or data mining awareness. I don't think any of this is going to surprise you guys because we've been talking about this as a group, right? Awareness and stigma. access and referral care coordination children's services and specific suicide prevention services peer support and behavioral health and housing those were kind of the big bucket areas they're not in any particular order right they're not in any particular order they're not ranked most severe to least severe they're just um laid out and we didn't do a ranking um as part of any of these needs so Drilling down further on the awareness, access, and referral, some strength, there was a low public awareness of non-crisis behavioral health services, so there was some public awareness as to how to access services. There was strong perception of Thriving Mind as a resource and a hub to be able to access services. Some of the barriers, transportation and housing, I don't think that'll surprise anyone in our community. That comes up time and time again as some of the biggest barriers in our community. Cost, insurance, wait lists for various services, the stigma, cultural barriers, and language barriers, and then just general mistrust of institutions. So some of the recommendations that came up from the work groups were, and some of the work that we've actually already been doing on this board, develop accessible resource guides and expand outreach via social media or community events, leverage specific to transportation, leverage rideshare partnerships to address some of the transportation barriers in our community. Those were the general strength barriers and some recommendations in that bucket. The next area that came up was care coordination. Just to quantify or qualify care coordination, there's two levels of care coordination in our system. There's system level care coordination, which is done at the ME level, which we do have care coordinators at Thriving Mind that help navigate system level barrier access issues. And then there's the provider level care coordination. So Thriving Mind does contract with our various community mental health providers to do provider level care coordination. And that care coordination is the direct service with the individual helping them bridge gaps within the continuum and in their care. So some of the strengths identified of the system, strong coordination processes between the providers. So our providers are doing a good job communicating across the provider network to coordinate care. And that Thriving Mind did support good care coordination efforts within the ME. Some of the barriers is it's underfunded. I don't think anyone would be surprised that there is more need in our community than funding. So care coordination is underfunded. There is siloed funding as well, right? Certain dollars come out in certain buckets. So... there is siloed funding for operations there's high staff turnover time and time again i keep hearing from the provider community i think a lot of you know that i stepped into the president's ceo role in january so it's been all of four months and i've been meeting with my network providers and one of the top the top two things that keep coming out in all my provider visits is housing and then staffing staffing and retention so um no surprise that it also came up as part of the needs assessment And then inconsistent communication was the other barrier identified. So some of the recommendations to improve on this need is strengthening cross-agency communication, reducing administrative barriers, and develop shared protocols to help with warm handoffs.

Moving back to the staffing question. Sure. Um, are you hearing like a theme? Is it burnout? Is it, uh, the pain not keeping up with positions?

It's a little bit of everything. Um, definitely. Um, we're actually in process of doing, and I can share it with this group because, um, for those of you who aren't familiar with FBHA, which is the Florida behavioral health association for, um, all behavioral health providers for the state. They recently put out a survey on salaries across the state and we are definitely under in our area. So salary definitely is an area for our community. We are going to take a look at least for our provider network and do a similar analysis for our network providers to see where they stack up statewide and that comparison. So salary is definitely one of them. that we hear time and time again. Certain positions, behavioral health techs are a hard one to find. When you're paying minimum wage for certain salaries in our field in comparison of working retail and getting a similar salary, it's a much less stressful job versus some of the challenges in our field. So salary time and time comes up. And then burnout. Burnout is another big one. Taking care of your staff. It's a high-stress job. It's patient care. So burnout. So definitely looking. Some of the providers tell me, okay, I can get them in the door. The salary, we've adjusted salaries enough where it's attractive enough, but then it's keeping them, right? It's the wellness and the package to make sure they don't burn out. So definitely seeing it on both sides.

Mm-hmm.

Yeah, and I can add to that. It really is a concern, especially for therapists and counselors and so forth, because of the pay. We're under about 5 to 10% of the FBHA, Florida Behavioral Health Association, study. and Miami is at that rate, but our costs are about 5%, almost 10% higher than what it is throughout the state because of living here. So keeping up with those raises and with a comparability study within our county here is very difficult because you have the school system that's hiring, you have all these other entities that are hiring And our staff is subject to that. So they're paying more. And then we need to pay more. And then they pay more. And it's a concern.

And Claudio brought up an excellent point that I forgot to mention is cost of living. Comparatively across the rest of the state, we are significantly higher. I've heard up to 30% higher. I don't know if that's really the right statistic. But definitely significantly higher than other areas. So, you know. A $60,000 case management position, if you're getting that, goes a lot less here in South Florida versus a $60,000 position up in North Florida. That's just the reality of cost of living in our community. And we see that a lot of staff are leaving and exiting the county and moving to other areas of Florida.

Yeah, that's a serious problem. And during, right after COVID, something similar happened to the hospitals.

Yeah.

where they were with the nurses. Nurses were just rotating around and around and just checking up the cost of the salaries. And that could be something that I can see potentially have been happening here as well. And then we're not receiving additional dollars. So how do we manage that? I do have a question on the silo funding. What does that mean? And I know everything is in buckets. My understanding when we rewrote a lot of the behavioral health laws in the legislature was they tried to eliminate some of those silos when it comes to, well, mainly on beds, I guess it was. What do you mean by silo funding?

Even though there's been some work towards moving away from certain buckets, it still very much comes down in buckets. Agape's actually had some great success with piloting a new OCA, which maybe will be the way of the future. What is that? It's a new OCA MSIRT, I believe.

MSIRT.

And then it is actually flexible enough where the dollars follow the individual. So that truly is, and Claudio can speak to this, the most flexible funding source that we have right now because regardless of the person is coming in for mental health needs or coming in for substance use needs or coming into residential care or outpatient care, the funding is not siloed. It literally follows the individual regardless of what category, what population, what service. Not all our dollars are that flexible. And that's actually a brand new OCA that Agape did a great job in advocating for and getting that into their contract. And some of the conversations with the state is looking at getting that level of flexibility across the entire system. but the reality is is that right now for the safety net system it still very much comes down in very specific okas there's very specific okas specific to population so some of our dollars are specific to women's services or children so some are very population specific some dollars are very much service specific where they come in for residential services or they come in for crisis services some of it is into the mental health bucket or the substance abuse bucket. And we can't cross them if you will, unless there's a legislative budget request to shift that. And sometimes that takes quite a bit for those of providers in the room that have to wait for budget shifts at the Tallahassee level know that sometimes that could be months in the making. So yes, Senator, it does still come down in very specific buckets, which make it difficult to- to serve the individual.

And just what she means by the OCA, it's a cost center. So substance abuse, let's say you get a million dollars in substance abuse, a million dollars in mental health, a million dollars for children or residential or outpatient, and then these are different cost centers, right? So OCA, so you bill according to that cost center.

There's many codes.

Yeah, so if you run out of funds here... Then and let's say we have an overage of need. Let's say we have the Super Bowl and you're going to have substance use maybe much more that year. Well, you got a problem because now your dollars that are in mental health. Now you got to change the diagnosis of the individual. So all of that. is a concern and we're moving toward more of a blended type service.

And so by the way, OCA stands for Other Cost Accumulator. Think about it as a funding code, right? And so again, there are some OCA's that are very flexible, which you could use across all the different covered services, across residential, across children, against adults, but then there are some that are very restricted.

Maybe what we can do is, For the next legislative session, take a look at that and and see if we can add that to this board, make a recommendation to the county commission to add that as a priority work on. And I think we might be able to. I understand there's a lot of fraud in the system I get. I understand why these were created to make sure we narrow the narrowly. tailored but maybe now that we exist here in Dade County we might be able we have the state here we have you here we have great providers smart people on this board that may we might be able to craft something that we could try to pilot something here in Dade County so if you can give it some thought with your team or if you can think about how we can try to craft it coming out of here not coming out of the state I get it maybe we might be able to do something to bring some flexibility to that. Very good.

Yes. Also, how does this

Absolutely. As I've been sitting through that data interoperability, some of the very same thoughts that I've been having, and I know Lourdes and I have verbalized some of that to that group as far as making sure to capture that and being aware of, for lack of a better word, the flavor of the dollar and how then that really can integrate across our system because right now we do have some of those restrictions.

All right.

I do, if it's okay, through the chair. I'm going to take this opportunity just to mention that those presentations, the last two have had errors in the information of funding streams through the department that we've asked to correct. The first one they did, but in the second one they were saying that Medicaid dollars flow through the department and the managing entity, and I'm concerned about that. So I was hoping... to volunteer the managing entity in hopefully the October meeting to be able to talk about those funding streams. It kind of sounds like that's one of the things that you're interested in. I would love to also talk about the authority of the department over substance abuse and mental health because that's something that they haven't really captured and we do have some authority over private organizations as well as public.

So this is the goal of this board, and this is why you all pretty much handpicked. So I appreciate, yes, the answer is yes. And I don't think we need an action on the board on that, but we'll get together and do that. That's the whole goal.

I guess moving along on the next area or category, children's services was another area of need that came up. And some of the strengths identified were the schools are key access points for generating awareness, family engagement, and prevention. And the school system has done a lot of work over the last several years embedding behavioral health services within the continuum. And embedded services are actually very valued and utilized. Some of the barriers, lengthy process at times to enroll, limited service for neurodivergent youth. And again, just like we're experiencing on the behavioral health side is staff shortages. so i think no one area is uh not experiencing that um so some of the recommendations in the children's services category is increased parent education enhancing school partnership we've actually i know miriam and i have met and her predecessor sally alion who used to be on this board before miriam sits on our thriving mind board and continues to sit on our thriving mind board and i know miriam and i are continuing to have that dialogue and conversation of how we can continue to collaborate with the school system to make sure services are reaching those youth that need it. So enhancing school partnerships, implementing additional teacher training. I know that the school system has done a lot of teacher training in the identification of mental health. moving on the next area is suicide awareness and prevention so a lot of the system strength is that there's lots of resources that exist we have 988 we have 211 we have the mrt so definitely a lot of resources in this space and a lot of uh growth that we've done over the last few years and a lot of marketing right you guys have seen some of the advertisement for 988 and MRT. But some of the gaps, no surprise, I think we would all agree as far as the public awareness. I was actually very excited and proud to see the work of this board and moving forward some of that education and messaging to bridge those needs and gaps. Gaps in peer-specific outreach and significant underfunding for suicide prevention. When you actually look at the actual dollars that go into suicide prevention compared to the rest of the system, it's not a heck of a lot. So looking at some of the recommendations is identifying gaps in the public awareness and increased peer-specific outreach. Work to identify additional funding sources to specifically enhance suicide prevention. The next area that came up as part of our needs assessment was peer support. Some of the strengths that were identified, highly valued approach for continuity of care. I don't see Mitch here today, but she would tell you just what a big advocate she is for the peer support in our community and just all the great work that our peer specialists are doing and what an added value they bring to engaging individuals into the behavioral health system. Some of the barriers, roles and responsibilities for peers are not always clear or consistent, so there's more work to be done to make sure that the role is defined. Oftentimes they're underutilized, and there's still stigma associated just across the entire system, but then also associated with peer services and peer organizations. So some of the recommendations in the peer space is standardizing training, supervision, defining roles, addressing stigma, and ensuring that our peers are equitably compensated.

Let me add to that, if I may, is that they are one of the most powerful influencers of treatment, you know, and transformation. It's really, and it's very difficult to hire them as their records and so forth keep them from being hired. So that is another area that if we You know, we need to help in that process, even though they have the ability to go to DCF and challenge the concern, it's still very difficult for them. And they are very effective, very, I mean, cost effective, and also truly effective in the whole system. So that's an area that there's a great need for. And this kind of, without silo, like a value-based care type thing where you don't have such specific siloed buckets, as she say, that allows you to give that individual the best treatment they need. So they may need a peer instead of a psychologist in that particular treatment plan for that person. But again, when you have that freedom in your funding, then you're able to use certain type of individuals. And peers are very important, and they're not used as well as they could be, for sure, especially in outpatient, too.

Absolutely. What are the rules for peers?

To become certified, you mean? The Florida Certification Board has a curriculum and a test. So there is a written exam. And then there's a certain amount of hours. I think it's 500 hours of field service. That's a lot. So, yeah.

It's it's highly regulated like any other professional credential. Um, and yeah, I couldn't tell you exactly what the hours are or all the coursework. Um, but yeah, if you go to the Florida certification board, it'll lay it out like it does for clinical social worker or any other credentialed.

I mean, can we add that to a conversation piece for the next meeting on peer specialist? I guess our peer. Counselors because. Especially when someone with the addiction side, I would think, and maybe not so much as behavioral health, and I don't know, correct me if I'm wrong, but having someone who's gone through it is very meaningful and impactful, but to see that we have to do 500 hours for someone to be able to talk about my own experiences, and this is how, I'm not here to be a therapist, I'm here to tell you this is how I went through it, it has to be hard to get peer specialists to sign into this. Is that I'm asking you the question, tell me.

Yeah, I think the 500 hours is the least of the concerns. There's a lot of other issues. And I do agree with Claudio, the background check is quite an issue. Even though several years back, Florida Statute 397, the Marchman Act, is what includes peer specialists. And there were some exemptions placed in statute. But the process is still backed up.

I'm going to put that on your bucket to do. Can you figure out how we can streamline that process and what changes need to be done? Or someone.

No, I can help whoever wants to do that.

I agree 100% as a clinician and as a patient and as a parent of someone who has a mental illness. I think that this is one of the biggest bang for your buck, if you may. I don't know what metrics we have about the impact that they do have, but I think it's

Talking to the mic. Guys, we're up here talking to the mics that you have, so the people watching TV can- Mr.

Chair, I nominate Ludlis to come up with some good recommendations on what the biggest barrier is with backgrounds. Because that's probably 50% of their problems, because they're peers. They've been through it. They do have the record. Most of them have a record and misdemeanors and

I'm not sure I would say most of them have a record, a lot of them don't.

But yes, I can work with- And I understand 100% and let me tell you as a clinician also, I'm a convicted felon because of my substance abuse problem. I did get arrested for a $10 bag of cocaine back in the days. And I had to jump all the hoops of getting my civil rights restated, DCF, all of the background screening exemption that we have to go through as a clinician. So this is something that speaks to my heart as well. So I know for them, a lot of them, they do want to help. They have the skills. They have the knowledge and understanding. But we need to just help screening a little bit better and easier for them to be available to provide the help. All right. Thank you.

If I can make a comment also about peers for the court system, we utilize peers in the diversionary court system and we see the transformative effect on the participants that come into diversionary court. Yes, they're a resource, but they are when we go into chambers and I know the judge, she would share this sentiment as well. We see the reliance and the community that it builds for the people that are in treatment. And with respect to exemptions and on the DCF side of things, you know, I'd be happy to work with Lourdes and discuss, you know, some of those barriers.

That's something I see a little subcommittee here. All right. So it'll be it'll be you guys if you can help us with that. And again, there's no, no, nothing in concrete that this is going to happen, but at least we can start having conversations with our friends. In Tallahassee, so we can try to maybe figure out a way that we can either get an exemption for day county as we. Clearly have a trying to get a robust system here together, or try to do a pilot for Miami-Dade county. So there's ways we can craft that drop in this pencil, I guess.

One last thing, Mr. Chair. If you all can look at the cost of being reinstated of all their courts, all the issues that they went through, they have to pay all of that up. And that is almost prohibited. That is almost that knocks out so many so we may look at somehow you know how to pay for that their cost of being reinstated with all there.

You know it's waving fees are saving something or something to allow for some because that is another challenge because even if you jump through the hoops of getting the charges, you know exempted them to your point Claudia there's all the fees that have that you have to get paid.

All right. So through the chair, so that would be focusing on Miami-Dade County though, right? Like maybe there's something that could be done with the 11 judicial circuit, not statewide.

I personally would love to see something statewide, but now in this role that we have, we could try to push that and then just maybe focus it to Dade County. I think it would be an easier sell for the rest of the state for some of the professional boards and so forth that we try to mess around with some of their crediting systems that we just make it for Dade County.

absolutely one more thing mr chair the the last one the i'm on that board on the fbha board the florida board And they do have a lot of resources and, you know, contacts up there, obviously. They are very involved, and every day they're much more influential. So depending on what it could be agreed upon on the statewide or local, because, you know, that's something to look at. We may get a lot of support. If it's something that makes a lot of sense, we can push it through Tallahassee easier for everybody than just for Miami. So we'll look at that.

All right, let's do that. Yeah.

hello sure continuing on the next area was behavioral health and housing which again i don't think is going to surprise anyone that housing is a huge need in our community some of the strengths were identified where you know thriving mind is able to support some housing incidentals and also relationships with housing entities like the homeless trust and individuals so those are some of the strengths in our system some of the barriers is unlicensed or unregulated housing environments Systematic eligibility challenges, high costs of just housing in Miami-Dade County, and limited supportive housing options in our community. So some of the priorities and recommendations talked about as part of some of the work groups was expand affordable housing and supportive housing, improve ILFs and ALFs oversight, integrate behavioral health needs into housing eligibility, That was the major buckets. Some of the specific town hall feedback was, again, housing is central to behavioral health needs. Wait lists are concerning in our community. I think you guys are aware that we have wait lists for all our residential services, at least the ones funded through Thriving Mind for the safety net. We've talked about this throughout our conversation is the role of peer specialists and how sometimes they're undervalued or underutilized. Stronger interagency collaboration is needed. Some of the areas of disagreement that was found in the town hall meetings is data is underestimating housing issues. That was some disagreement. Some people felt that it was appropriately estimating housing needs. Some people said it was still underestimating issues. And data is overstating youth service capacity. Some people felt that there is still even more need in the youth area. Again, some of the recommendations should be no surprise. We've been talking about it all along throughout the presentation is expansion of housing service, navigation support, family engagement, peer specialists elevating that role, emphasizing system-wide care coordination, And again, this is kind of what we've already talked about, but the key summary, the awareness and stigma, the access and referral, care coordination, children's services, suicide prevention, peer support, and behavioral health and housing. And that was it. I don't know if there's any more questions or discussion that you guys want to have.

Is there any other questions? Great job. You talked about the standardizing protocols for handoffs. What do you mean by that?

So right now, I don't know that there is a specific protocol or process for when referrals are going, being handed off from agency to agency. So if someone at Jackson ends up in their CSU and that are getting referred over to Agape for residential, I don't know that there's like a standardized process that it says, you know, we should be contacting this individual and this basic information should be transmitted over I don't know that right now it's it's just personalized whatever care coordinator discharge planner over at Jackson has whatever relationship with the intake department over at Agape and those warm handoffs are happening but it's not in a very standardized fashion across providers or across the system right so

those of you that are providers is that I mean I'm assuming it's true I know it's true talk to you Lord is can we all we can when we with we are the board and we'll bring it back to the Commission can we come up with some protocols for take County on these handoffs?

Yeah, we can certainly make certain recommendations as far as these, this would be the basic standard of care, right? The person should be, and I think a lot of what we're trying to do in the data interoperability work group, right? So making sure that that Intake, biopsychosocial, regardless of where it's originated from, follows the individual and making sure that there's basic standards, if you will, when a person is going from one provider to another. Definitely, I think it's certainly something that we could explore to standardize and determine what that standard protocol should be.

I think we can do it. Sure, we can. And we can make that as part of an ordinance in Miami-Dade County. I don't think there's anything that precludes us. We'll figure it out when we get to that point with the attorneys. If you don't mind, start talking to our attorneys. Figure out how we can do that. I don't think that we can. And if not, we'll just try to encourage all of our providers to set up some type of standards. So, Bill, do you want to work on that?

I'd be happy to.

I'm wondering if the standardization in your mind is just the collection of standard elements across the system or systems. I think part of the standardization and the warm handoff issue is data sharing. So I'm not sure that the hospitals, the homeless system, Thriving Mind, the individual providers who do community mental health, there's not a data warehouse that we can all see in real time. And we've experienced this in real life. We'll have to do a stagnant share of who's in my system, who's in your system, who's in the criminal justice system in order to understand which households are potentially costing us the most. It's a manual process at a point in time rather than a continuous flow of data feeding into an algorithm that tells us we really need to coordinate more or redouble our efforts on a particular individual.

Yeah, to Vicky's point, I think it's both Vicky, right? I think there's the basic standards of what should follow that individual, but we definitely, and that's part of what I'm excited with the data interoperability work group, is that when we get to that point and those recommendations of how data can truly be shared within our system, That is going to be game changing for us because right now it's a very, like you said, manual process where I'm having to pull data from thriving mind. You're having to pull data from HMIS. We have to pull data from other hospital systems that are not within our network. So it does become a very fractured process to be able to data share. So I think it's both. I think it's a yes. What standard data, pieces of paper, if you will, we need on each individual, but then how can we get it in an integrated fashion to be able to share

Through the chair. Another challenge we have is some individuals are covered by managed care as a homeless system. And I know this isn't a homeless system specific conversation. We don't have an easy way to find out who's on what plan. And those plans oftentimes are willing to contribute toward startup housing costs with cash that we could leverage with existing resources, both yours and ours. unpacking who's on what plan, and people don't often know what managed care plan they're covered by if they're covered, and that can change, and there's not a real-time way for us on this end to do that, but these are some of the clients with the most serious mental illness and substance use disorders who we can't quickly identify who has what coverage and how we leverage, and I think the managed care agencies... have been the most reticent to share. We have much better luck working with Jackson and our hospital system to share data, but managed care once can see in real time that the work we're doing is helping their clients stay Prevent and end their homelessness or stay out of hospital systems, but they're not willing to reciprocate data to us so that we know, you know, we can't track outcomes for them. They can track outcomes for their clients, if that makes sense.

Vicki, so how do, give me, what is the recommendation? Is there a recommendation? I mean, because I know that's a lot. How do we get this information?

No, I think you're on the right track through the chair. Having standard warm handoff procedures and then talking about interoperability on data, that needs to move into some sort of pilot, I think, where we're actually sharing the data. And then I think that's another hurdle to cross, like how do we get managed care to be comfortable with this interoperability because it only benefits them as well.

Mr. Chair, that is one of the integral parts of interoperability. This is one of the biggest issues that continuum of care and transitions of care and now we also have care risk involved and that has posed other barriers. Even though it may seem like it's an easier process, it has become, to the hospitals and other referral sources, something that sometimes they don't want to do. And therefore, it creates a problem with where that list is, who truly is on the waiting list. Are they really wanting beds? And then that stops others from getting beds or treatment, whatever it may be, wherever our lines are. So care risk has to be a part of this conversation. uh as far as where the referrals are going to and how does that um how to efficient referrals are able to be provided now this this inter operability is a great uh process that is helping to identify that but we're on the right track by saying that we want to have the right you know policy procedures that are consistent because you're right there's all all across the board everybody does it different

Through you, Chair. Yes, sir. If I may really quick, having experience as a clinical director of a community mental health center, the referrals, there are standard of practice where we're supposed to provide at least three options for the clients. Each agency has a different form, and that is, I think, the point that we want to focus on. So that can be a standard way of providing what is the data that we're going to provide on that form for the other agency for that handoff. I think that that's something that we could probably make some progress on. The other part of it, it really depends on what level of care they're referring from and Is it a residential, is it a PHP program, is it coming from outpatient? So that is really going to be different because they have lists of providers that they normally, they have good relationships with. But standard practice is three referrals. And then again, the other point of it is, the handoff happens if the client agrees to it. Because you might give them the three referrals and they say, let me think about it, they walk out the door and nothing happens because you don't send that referral to the other agency. So it's a little bit of a complex. Topic here.

All right, so then we'll come back with some recommendations so we can put this but to Apply it to Miami-Dade County.

So if you all can Have a conversation and talk about it that would truly appreciate that could be an action item that we can take to the board relatively quickly if I may sir, um the last Medicaid procurement the contract spoke to the relationship between the health plans and the managing entities and Now, since that's gone through and they've selected the major plans, especially in Dade County, I think there's a golden opportunity for the managing entity to work with the health plans here, and especially in Dade County. I think to do it statewide would be more challenging, but there's an opportunity to share data, to share information, and share some resources as well. Care coordination is something that the plans have begun to utilize just as Thriving Minds does, and I think that there's really, there's a contractual responsibility now

there is and it's been put on both contracts on the mma plan side as well as the managing entity side and we are definitely pursuing those uh relationships and we've gotten some agreement signed but as you can imagine some mma plans have been more reluctant than others to to partner but we are definitely exploring those options with those new contract requirements

Laura, why don't we do this? If you get stuck with any of these agreements, please call me. You have friends all over Miami-Dade County that will be willing to pick up the phone and make some phone calls.

Appreciate that.

Because they all need some help in other areas. Sounds good. So you could try to put the... Listen, guys, this is the pressure here. We have this board, then we have the county commission, then we have our legislative friends, and we need to use them if we're going to really transform the system. It's not going to happen with one of us alone. so thanks bill that's uh that's a good way to look at it and you're absolutely right about that all right i think we're good right for me thank you all right so we got a couple action items out of this all right we have um i'm going to try to standardize the um the protocols for handoffs and we're also going to look at the conversation with the health plans to try to maximize the the funding and resource and information sharing right with um with the managing entity because we always we can't forget we have i mean you're on our board but we have you you're the managing entity for the and we could do all these things through through you as well um Think I don't think we need any action on any of those that's just things that are going to happen in the wall The action items will be when we come back at the next meeting. So we have some time to get that done I do have one question on the needs assessment overview You said that we look at a lot of the safety net What's what's out there in the safe for there are safety nets and I know we work with privates as well, but do we ever take a look at the private organizations that are out there? And if not, how do we really do a community assessment? More comprehensive. Okay, there you go. Thank you for the word. I appreciate it.

That's a great question because, again, that's why I always do my caveat of thriving mind focuses on the safety net. So when we do our town hall meetings, we don't. you know, refuse anyone to come in. So if it comes from a private provider, we're getting their feedback. Um, but predominantly it's coming from, from our network service providers that are the safety net, um, the individual serve that are surveyed. And part of that are people that received services through our safety net funding. So it's a great question as far as how do you elicit a system-wide needs assessment. I don't know that I have the answer to that. It could be a matter of some of the same language that we have in our ME contract, in our managing entity contract, speaking to our partners at ACCA and the commercial insurances to see about them doing a needs assessment every three years. Because between the insurance plans doing a needs assessment and then the managing entity, you'll have needs assessment from the entire community. I don't know that I have the best answer to that.

When we look at the state and we look at private organizations, they're all licensed, correct? No.

Yes, so it depends. So if we're talking about a hospital, they're licensed through ACCA. If we're talking about substance use facilities, they're licensed through us. Doctors would be Department of Health. So a lot of times, to get a physician in a room and do a needs assessment with them, that we do have a lot of difficulties getting them to the table. But we have some.

It's a multi-agency needs assessment that needs to be tried to coordinate all this. Okay. All right, Amanda, I think we'll talk later to see how we can try to do a comprehensive, I mean, using what Thriving Minds already started off with, because this is obviously it's a really good work product. But figure out a way that we can try to do a comprehensive and more comprehensive approach and we do have some funds available. That's what those funds are there for too. So we'll come back and if you guys have any thoughts, ideas or suggestions, please or. Entities that can do this. I think that's where we start, figure out this is exactly what we have, and then how we connect all the dots, if you guys feel comfortable with that. That's okay?

Yeah, Baptist has a big needs assessment, too, that they do, I think, every two years. It's a great needs assessment, too, very similar.

All right, let's reach out to Baptist as well. Let's try to reach out to some of the providers, the bigger, I guess, the hospital groups. I'm going to close their services already, but... We'll talk. All right. And you guys have any thoughts or ideas, please talk to Amanda.

I would just like to make a comment through the chair. I know from my own personal experience with my young children, Nicholas, it's very challenging to navigate. And I'm a person that has navigated the system, the safety net system through my professional roles. But from a perspective of dealing with a private institution, I think their care is great. I just know that they experience the same capacity issues. And in terms of handoff, care coordination, I think they strive and aspire for that. But they are an entity that, you know, should be brought to the table because it is interrelated to what we're doing here. Absolutely.

All right. Perfect. Thank you. Okay. Now we are, where are we on the agenda? We're on old business. I know we had approval of minutes. Folks, we sent out the, I hope we did, right? I'm assuming we did. We sent out the minutes for the last meeting. Hope you all had an opportunity to review them. If you have any amendments, any questions? Seeing none, Louie moves the minutes. Second. All in favor of approval of minutes, say aye. Aye. All opposed, like sign. We are now in old business where we have community needs assessment. We went through that already. We have the opioid settlement discussion.

Thank you, through the chair. At the last quarterly meeting, we talked a little bit about this board providing some oversight to the Miami Center, Recovery Center for, I always forget the name, the Leifman Building. is where I tend to go. Sorry about that. So because they are receiving or it's the plan that they do receive a good amount of Florida opioid settlement dollars and because our Substance abuse and mental health DCF regional office is identified by DCF and the opioid settlement as the subject matter expert. We provide technical assistance to counties and municipalities on the opioid settlement. I did request and it was approved to go ahead and talk a little bit about the expectations of the opioid settlement. So I'm going to start with just a little background on it. And I don't know, Amanda, if you could pull up the website that I sent you, because I think it'll help for people to look at that. So basically, you keep hearing the word settlement associated with these dollars because it was a... Give me a second.

Amanda?

So through the board, there is in your packets the exhibit that you provided. I did provide copies. It was a little bit difficult to bring it up to projection, but I can, during the meeting, resend the link.

We have it. You guys can look at it while there's a presentation. That would be great. So if you have any questions. So thank you. Thank you, Amanda.

Sure. So that's just a small part. I'm not even going to go into those. Those are the approved uses that I wanted to make sure everybody had that. But the website... The link is on the email that I sent, so I just kind of wanted to walk through it since I didn't have a PowerPoint, but that's fine. So the settlement agreement with the National and Florida Settlement Agreement includes multiple pharmacies and pharmaceutical companies that were found to be overprescribing And when people hear out in the community what is an opioid, they think of specific drugs. But what we're talking about here is the overprescription of drugs like Oxycontin and fentanyl. People were becoming addicted to those medications. And then there were some oversight placed on prescribers for those drugs. So from there, individuals who could not obtain those types of drugs anymore with the prescription, they started turning to street drugs. And so unfortunately, you can watch a lot of documentaries on it. There's a lot of different perspectives on how the epidemic came about. So I'm not really going to go into whose fault what is. However, for the state of Florida, there are $3 billion to the state of Florida, and they will be distributed over a span of 18 years. The first payment to the counties was in 2024. And the payments were back to 2022. So there's already quite a few dollars in the county bucket. There are multiple through the Attorney General's office. There are multiple buckets where dollars go down. So you may have heard in the data inoperability presentation, some of those dollars do trickle through DCF and the managing entities. But the majority of the dollars that are coming to Miami-Dade County came directly not through DCF came directly to the County. Um, so while we provide technical assistance, we meaning the office of substance abuse and mental health, um, to the counties, we do not provide oversight per se. So there's no approval of plans that needs to be done by the department, which is why I think it's really important that this board exists and that this work will be done through the board. Um, So if you look at the exhibits that were passed out, it lists out in pretty much detail a good chunk of what the approved uses of the dollars is. But overall, it really focuses on expanding evidence-based treatment, community prevention, and justice system diversion. The dollars cannot be used as general revenue, so not to keep the lights on or The elevator's running. It's for use for treatment. There is a council that was set up through the agreement and in statute 397 called the statewide council on opioid abatement. The website that's been shared with all of you and will be shared again does talk about those meetings. They are recorded. They review the plans that are submitted by the counties. They provide an annual report with recommendations on what the next year should focus on. And the whole goal, really, of the council is to make sure that opioid use is abated. So reduced use, reduced deaths due to opioid use. When you look at the website, you're also going to see a section where plans are uploaded by the counties. And there is what's called, we call it ODMS, but it's Opioid Data Management System, where those plans are uploaded, where also there is, for example, EMS is a part of this, Emergency Management Services throughout the state, where it feeds in data. They feed data directly into the ODMS system so that we know how many calls are coming, not only in Miami-Dade County, this is statewide. You will see when you look at that website that Miami-Dade's plan has not been uploaded. That's because it hasn't been approved yet. So we're waiting, and I know we'll get an update at the end of the meeting on the building, so I'm not going to go into that, but uh eventually the plan will be uploaded there and once a year the plan needs to be if it needs to be updated it's updated and the expenditures are also reported through so it's a fully transparent process so everybody can just log in there from the public and be able to see the plan and the expenditures there are some cities in miami that have already uploaded plans and they're already putting in for example um south miami has a contract with one of our recovery community organizations, New Hope, and they even do some street outreach, and they pay directly through the opioid dollars that are going to South Miami. So I encourage you to go to that website and look at that. It's very interesting. Some of the items and resources that you'll find in the resource tab of the website are, for example, the state of Florida does provide Narcan for free supplies through our quite a few locations. That website is called I Save Florida. So you'll see a link to that in the website resources page. So free Narcan to law enforcement, to any members of the public, to fire department are supplied for free. And you can look at the website and visit any of the locations for assistance with that. And then that's about it. If anybody has any questions, I just wanted to make sure to put that out there and to make sure that everybody's aware that we do offer the technical assistance. We receive emails all the time and we provide guidance to the public, anybody that's interested in these dollars.

Really appreciate you taking for that presentation. It's very insightful for the board to understand these dollars. The opioid dollars because we keep on hearing that. And I don't hide behind it. I think you guys know where my position has been in the last kind of commission meeting. I did say. I did talk a little bit about the use of those opioid dollars for the funding of the building itself. That wasn't the biggest fan, but this is where we are right now. So, um. But. We need to make sure we keep our eye on that. So I think Kathy's going to come up and give us a brief in a bit on the building itself where we are. It's really political. I mean, I don't know what more you have to present, but is there any questions on the use of the opioid dollars, the presentation the lawyers just gave?

I would just like to make a comment through the chair. Um, something that was clarified and I've been discussing with Lourdes is the Co occurring the fact that these dollars can be used for Co occurring disorders with substance use disorder and mental health. And I think that that's an important point because. Sometimes we see that existing in individuals with both. And also specific to, and Lourdes, you could probably do this more eloquently than myself, but when we're talking about opioid use disorder, it's not just limited to opioid, right? It's also stimulants. And so that affects, my understanding, a larger population in Miami-Dade County.

No, listen, and I think that's how the county has been able to use those dollars because it does, you know, when you look at the population and the diversion programs, you look at their mental and physical state that will really apply, meet the requirements of the law, meet the requirements of the law. Harvard think this money would always have been better spent in the community with providers, but that's just me. That's just one guy. Yeah.

Just to add extra clarity to what Karen and Lourdes was saying, it's not just co-occurring, but at risk of substance use, which I think is also part of how the dollars have been allowed to be used for the diversion facility. They're that flexible is my understanding.

Mr. Chair, if I can add? Yes, please. I spoke with Judge Verde yesterday, and she wanted us to make a pitch for the use of these dollars for outpatient substance use treatment. I mean, Miami-Dade County, we invented drug court here. It was the first drug court in the nation. We don't have outpatient services to refer those folks to. Since the closure of the DAP program, there's a critical need for that. And unfortunately, we've got one of the model programs for diversion, but the question is diversion to what? And what's there, there's just not ample capacity for what is needed.

And can we add that to the call for next meeting as well, please? That's exactly a great point that we as a board can need to start exploring together with the opening of this building. If we've talked about it before and Kathy knows exactly where I'm coming from, we need to be more than just diversion. We and this is going to be our charge. You know, we start there and then we keep on continue to grow and expand. So it needs to be more than just that. Okay. Is there any other question on, um, on the, where were we on the opioid sediment? Okay. B I'm sorry. Follow the agenda. All right. Amanda, can you give us an up to give you a minute, Kathy? I'm sorry. Can you give us an update on the public awareness campaign?

Yeah. Sorry. Through the board. Yeah. So with the public awareness campaign, there was a resolution passed 1184, which on May 5th, which the Board of County Commissioners authorized the $70,000 to be utilized for the communications and information. Technology department for the services for this campaign. There have been numerous events in May. A lot of us. I have seen many of you at the events through the NAMI walk. That was a big launch as well as the recent collaboration with the mayor on the. the press release conference as well as your segment with Jackson Health System. So we are working a lot with the community and a lot of the different events. There has been a lot of social media online through Instagram. A lot of you do follow the page, which is Behavioral Health MDC. We currently have around 150 followers. It's only been, I want to say, two weeks that we have launched this initiative, as well as the main webpage where individuals come to the site. CITD has tremendously done a great performance with the graphics. When individuals reach to our page, they see They go in and then there's the four main resources. So we have our 211, our directory, they have WestCare with the mobile response, and they have also the NAMI page as well, which pop up and take individuals to those resources, as well as all the pages, like all the different elements of the webpage that we have previously approved. So people are going, people are clicking, there is more involvement, they're reposting, resharing a lot of the stuff that we share, as well as the collaborations that we've done with all of various board members. Thank you very much, Mr. Alfredo, with your support, as well as explaining to the Hispanic community in Spanish what this board means and what it does. We've been reposting that as well. So if any of the board members would like to collaborate with this specific Instagram or Facebook page, please feel free to reach out to me so that we can continue to amplify the message of this board to the community.

You say collaborate because I discovered that sometime late last year with the social media world. Collaboration means that you put their name. on your post and then it appears on your page as well. So this is important for us to give whoever wants to collaborate, I think we all should be collaborating now through this time, through the different agencies and departments and personal, you know, personal and both providers, collaborating with the campaign itself so we can try to amplify it through all of our channels. If you guys feel comfortable with, please let Amanda know to add you to the collaboration so we can, and you still have to click, right? I still have to click and accept yes, right?

yes so if there is a potential collaboration from any of our board members you if you know if let's say that i'm the one um assisting the board through that posting i would send you a request for that collaboration and you would have to ex your entity would have to accept it whoever manages that you still have to look at it and say okay i'm okay with that because you you may not be okay with all the collaborations you know so yeah but uh through the the board i do want to burn on that before that's why i know i i did want to say thank you very much to also christopher wing with the networking and the ability to get us on the jackson segment which was very wonderful to have that collaboration so i i do see a lot of um different board members reaching out And moving this forward, we do have Judge Verde will be doing a community resource fair after this meeting. I believe it's from 2 to 4 PM this afternoon. 2 to 4 PM. And we do have other individuals and providers that provide services in the community that will also be there as well. So these are great opportunities to connect and be able to communicate what resources are available for our community.

right through the chair yes um so great job to amanda and her team for all the social media i know that we're following and we're sharing and collaborating and it's been a great month and and all the providers actually know may is mental health month and everybody's been full force press getting um their programs and campaigns out there and i hope that we continue it throughout the year, that it's just not May's mental health. Jackson had a fabulous one with the care coordination team doing a whole little music segment. It was fabulous. It was actually when we re-shared it, it was one of the most viewed little segments. i will put in a plug as far as i do get nervous with us now having all these pages and the new website um resources right so mrt is exclusively funded through the safety net 988 is predominantly funded through the safety net as well um as this becomes more aware and people are aware of these resources i can tell you that mrt is already getting to that capacity where it's getting so the the contract measure for mrt is that they're out within the community mobile response team sorry it's the mobile response team uh it's the mobile response teams through us care right so they were already getting close to that capacity and the contract requirement is that they're out within 60 minutes within the hour and they've often have been much less than the hour but as we are advertising them even more so i start getting nervous that we're not going to be meeting that measure because more people are going to be aware of the resources which is a great resource but we need to then start talking about additional funding right so are we looking at county funding are we looking at school system funding and other resources for us to be able not just for mrt not just for mobile response team but any of our you know system where which will feel the impact of these campaigns so so that those are my comments

If I if I mean the coordination of funding is a big deal because if we can't get it from the state we have to look at we have to take care of our own and maybe through and I know everyone is trapped to get that but I think if we pull some of our resources we might be able to continue to meet that need so.

Through the chair. Um, I feel like this is a good time for me to mention that in three 94 statute, that's the mental health statute. There is a requirement for local match from all of the providers that receive state dollars. Um, and it's 25%. So the department covers 75 and then there's supposed to be a local match of 25%. Um, and I know that there there's the ability of having in kind, there's some, you know, flexibilities there. Um, and the managing entity does, uh, keep tabs on that. But it is difficult, more and more difficult to to meet that match requirement. So I don't know if that's the topic that we want to pick up here. I do think that it's something that we're going to be between the department and the managing entity talking about more.

Can you do me a favor and talk about that amongst yourselves and then bring that back to the board next week if you guys are okay with it. It's important to have that conversation and figure out where we go from from there. So okay. Um, all right. So I think data interoperability, I think we had a conversation about, is there an update on that or Amanda?

So through the board, there is a closeout session. Approximately, it's coming close on June 4th. They did mention a lot of the findings, and a lot of our board members were in those meetings. We did receive some feedback, and I know that some of the board members are now in communication with Rebecca and the HealthSpirian group to clear out any confusion or any misunderstandings in any of the information or data that they've gathered. But they will be coming back into town and providing us with a finalized project overview of what they oversee the ecosystem of services are in this community and their recommendations for how to do the private and public partnerships.

Is there any questions?

Unfortunately, I won't be here. On June 4 and will not be able to take anybody. We have visit Tallahassee. So I do have some concerns about those final recommendations, especially since I can't be present. I did ask to have a meeting with them. in advance of that, because for obvious reasons, they agreed, they agreed, but they only gave a half hour. So that's not enough. So from there, I communicated with Amanda and crew that, that we needed to do a presentation for this group on the funding stream. And that's where I kind of like just threw in Laura.

And I appreciate some of those conversations back and forth. So I appreciate you being being attentive. And this is why, again, it goes back to the point that we all have different levels of expertise and knowledge and come from different points. And we have to pull together and make this happen. So we will make sure that I will follow up with them today. Now, we will follow up with them today. Make sure that they do give us a full presentation to the board and make sure that they bring you information. Bring you up to speed as to exactly where everything is. This can't happen without the state either. So there'll be fools not to. All right. Interoperability. Kathy, you're on. This is an update on the mental health facility.

Through the chair. First of all, congratulations, Senator Garcia, for your campaign. at your press conference i'm super proud of the work that amanda dominguez matias eddie lauren dr ambridge it's an entire department that's behind you supporting this work and if i can address through the chair some of the conversations that we've been having when it comes to the opiates funding I just want to make sure, Sands, we've been working so long on the mental health facility that back in September of not last year but the year before, we did have an item that was passed over at the Board of County Commission that directed us to use all opiates-related funding for the mental health facility so i just wanted to mention that to the group that it's a direction that was given to us to the administration by the entire board of county commissioners so wanted to put that piece out there um senator garcia and members board members when it comes to the mental health facility i think we've all been watching um there's been a lot of really great conversation about the facility i was fortunate enough and the mayor asked me to present i gave a very brief presentation at the committee of the whole on the facts and what i mean by the facts is what is included in the item and what the model looks like. And I'm glad that we were able to hear the perspective from our judge, Judge Verde, and I would like to put on the record, and if you can relay the message to her, that this model does include 24 beds in the space of substance abuse. So in the space, sorry about that, of substance use. There are 24 beds that are included from our new direction, our county's new direction program. So just wanted to put that out there. But we're excited about the work continuing to move forward. Thank you, Senator Garcia and board members for continuing to advocate for a population that that for so long has needed services. And I know that that's why we do this work day in and day out, because we believe that the most vulnerable individuals locally need services and need wraparound services, which I'm happy to report, that are directly linked to the core strategies that are included in the opiates funding. So my staff and I continue to be excited about this work. I get the question many times on what does it feel like to work on the mental health facility? Our mayor continues to really share with us, her staff. We run social services locally, but sharing her passion and ensuring that our residents get services here in Miami-Dade County. How's that senator is there is perfect Kathy.

Thank you so much. And yes, it's hopefully it'll go before the board. We're waiting for. Analysis from, I believe from Jackson is doing some type of analysis and then it'll go before the board and maybe sometime in August often August. Right? I don't know what I'm not going to handicap this. We'll see what happens. Kathy, thank you for the work that you're doing on this. We've had some disagreements and you know that. I just think I was going to say, I think funding should be used a little bit differently. But I know that there's nothing illegal or unethical with the way that the monies are being used. i always stand behind my position that i do believe we need to have a robust system not just a diversionary program in place and this is why we all come together to make sure that we do have that this could be the beginning and then we figure out where we go forward for this so i just want to appreciate the work that you're doing and and obviously this board will when this board when this building becomes when open when it comes open the oversight of the actually And board, I mean, building will be falls on this committee. So it's extremely important that we all stay attentive and pay attention and be involved. So I appreciate that, Kathy. Thank you so much.

Senator, can I emphasize, underscore something that you've stated? I know that many individuals connect this work through the advocacy of Judge Leifman. But I think that what makes this model um so unique it's the comprehensive approach right in coming together and there's so many of you around the table i've been in the field now for 30 years or so as a licensed clinician and so many of you providing those wraparound services it will take a village to implement this model so thank you you started when you were 10. Yes, Senator Garcia.

That's awesome. Before I forget, thank you, Kathy. You know, I really do appreciate the work you've done. Amanda, one thing that I did see here that I want to bring for the next meeting, the $70,000 that we appropriated for the campaign, can we break that down in cost so everyone can see exactly, even me, to see how that money is being spent and where it's going? I mean, I think that's just in the eyes of transparency to make sure that these are taxpayer dollars, so I want to make sure that it all gets accounted for. Anything else to come before the board? Any announcements? Oh, okay. The next behavior. Let me read this. Okay. The next behavior health advisory board meetings on Wednesday, August 26th, 2026 at 10 a.m. at the Stephen B. Clark building, which is this building right here. And we will have action for progress data interoperability project blueprints report June 4th. Okay. So on June 4th, we'll have the June 4th meeting that we talked about that you're not going to be able to attend. Lord is, um, Action for Progress will be here with us and giving us their presentation.

Mr. Chair. Yes, sir. Is there any way to give Lourdes some type of access? Are you able to? Able? Or do you want to?

I'm fortunate.

You're on vacation. You're on vacation.

No, no, no. I'll be in Tallahassee. I'll be in Tallahassee. Okay. Yeah. And I saw that it's like four hours. And we're going to be having some pretty intense meetings over there.

We'll do. We'll make sure. I'll make sure that the... They get together with with the state with you together with the state and we'll know we need a representative.

It could be somebody else as well or something that will be there.

I'm sure none of you all might all my regional leaders leadership is going to be in Tallahassee and I just found out about the June 4 meeting like the day of the last meeting because we didn't even have it in our calendars and I'm I'm when I say we I mean Laura. So but Laura will be there. Yeah.

That's it works. It works. We'll make it. We'll, we'll figure something out. There's not worried about it. Um, all right.

So through the chair, yes, please.

Any announcements to come from the boards?

It's actually not an announcement, but just an FYI. The next meeting actually falls on the week of the annual conference, behavioral health conference in Orlando. So just FYI, a lot of us, we won't be here. A lot of us may not be here.

All right. So can we come up with another date?

Through the board, I can definitely look at the week prior to this. Is there a specific date that you will be gone for the conference with all the providers?

Literally that week. It's the week of.

I think it's better the week after.

The week after the 20s. Okay. We can push for the week after that Wednesday for the following.

It's literally the 26th to the 28th. Okay.

We'll push it for the week after.

All right, I think we're fine. And I guess anything else that comes before the board? And before we adjourn, I just want to thank NAMI for the amazing mental health walk. I was shocked to see how many people were there. We do have to congratulate the executive director for the work she's doing. She's doing a phenomenal job. But it just tells you how many people in our community believe that we can do better. And people are not only looking to NAMI, but looking to us to make sure that we provide resources for them. Because it is something that's plaguing this community, and we can do so much better. But I just want to congratulate Ms. Halsman and NAMI for the work that they did, because I think that was the largest walk I've seen. And I want to thank Marlins Park. Oh, it's on Marlins Park.

I actually heard from Susan that it was actually larger than New York and LA this year.

And I was, listen, I was on that stage, and when I looked back, when I looked out into that crowd and seeing all the different teams there, it just really warmed my heart to think that people are starting, the work that you all have been doing for so long, people are starting to pay attention and say we can do better. So I appreciate every single one of you and those of you that participated at the walk. So Susan, God bless you and thank you so much. And with that, Amanda, you'll give us a new date for a meeting. and then you guys continue to work on your subgroups or whatever so we have right now so make sure we come back with uh some information so we can have an action items by next meeting so all right so with that vicky moves we rise thank you all thank you very much