Health & Human Needs Committee - Regular Meeting

Call the meeting to order. First, I will have roll call.

Peacock. Here. Campbell. Novitsky. Khalil. Mollery. Here. Middleton. Here. Warwick. Here. Ozayn. Zoller. Here.

Crime. Here.

Triggs is excused. Maxon is coming on as we speak. Jackson?

Present.

Your honor, we have quorum.

Okay. Great. Alright. This is our May meeting. We first are gonna recognize the fact that May is Mental Health Awareness Month.

So as part of that, the Community Justice Council Behavioral Health Subcommittee reaffirms its commitment to addressing complex intersection between behavioral health and the criminal justice system. The work of this committee reflects a growing understanding that meaningful justice reform must include compassionate, coordinated, and evidence informed responses to mental health needs within our community. In alignment with the county executive's directive, for mental health health awareness month, We recognize this month not only for a time for awareness, but also as an opportunity to advance collaborative strategies that strengthen access to care, reduce system gaps, and improve outcomes for some of Dane County's most vulnerable residents. So it is timely that we are meeting today and going to be discussing all of the work that the work groups have been doing between meetings. Alright.

First, let's go to consideration of minutes. Do I have anybody moving to approve those minutes?

I should approve. I'll second.

All in favor?

Aye. Aye.

All opposed? Motion passes. The minutes are approved. Alright. With regard to action items, presentation reports to committees, they're kind of all the same thing today.

I between, last meeting and today, worked on establishing work groups, and, Sharon has been invaluable in making sure that we are getting, some meetings on the calendar for those work groups. Some of I think most of you are in at least one work group, not or, or two or sometimes three if you're, Pete Zeller. And we've been working in between meetings and will continue to work in between meetings on those. We're doing those via Zoom to cut down on time that people are commuting here and making sure that whatever time extra they have for those meetings is in the meetings themselves rather than kind of getting here. In that vein, because most of the work of the committee is going be done through those work groups in the next six months or so, I the next few meetings, I know that we have strongly encouraged, in person participation, and people are welcome to be in person.

I'll probably be in person for these, for the next few. But, to the extent that, you are not easily can get here, Zoom is completely fine. The Zoom is not discouraged. I would rather have people use their extra time, for the work group meetings that we are having, extra on it on top of these committee meetings. Okay.

So with regard to, the reports to the committee, I am on work group one. Work group one is really looking at chapter 51 and the competency process. So the criminal competency process and then the mental commitments under chapter 51, the processes and procedures that we are currently using, and the processes and procedures that we may want to use in the future to kind of fill in some of the gaps to where there might be gaps, and to improve best practices by both looking internally and discussing what we see, but also looking to external sources of people that have already looked at improvements that can be made and taking a look at what we can do and incorporate into our practices here in Dane County. So for purposes of work group number one, the objective with the strategic plan is to explore system level coordination across behavioral health, the courts, and community supervision. And that is with particular emphasis on, like I said, chapter 51 and the competency process.

The primary goals and objectives of the work group is to clarify the roles and responsibilities across agencies to reduce duplication and to make sure gaps in service are covered. The work group also has a goal of improving communication between the courts, behavioral health providers, and supervision agents to identify earlier intervention points where individuals can be diverted prior to deeper system involvement, to ensure that statutory tools are being used consistently and as intended, how chapter 51 is being applied in practice, and whether there are things we can do to improve that. There are decision points where sister where system alignment can be improved. So the work group is working on that as well and improving data sharing. So one of the things, that the group has done is, reached out to add additional members to our group, including Kathleen, Katie Martinez from the State of Wisconsin Department of Health Services who really works, on a lot of these issues, particularly criminal competency, with, counties all around, the state.

And, learning from her what things are in process and what things might be improved here in Dane County. One of the things that she is going to be providing is legislative update. There are some moves in the state here to update some of the statutes with regard to chapter 51 and criminal competency. And so I'm going to work with her on knowing kind of what those changes might look like and who's advocating for them. And then we can discuss as a group whether this subcommittee may want to sign on to some of the legislation if it is something that we think is beneficial.

So, another thing that we're doing, we'll be doing is to review, Brown County's dual track detention system. Chief Wararch was in Brown County before, coming here to Sun Prairie and mentioned that there is this dual track that Brown County might have a good template for us to at least incorporate some of their ideas in. So we're gonna take a look at that. We're reviewing competency diversion models both in Wisconsin and in around the country. Also centralized competency dockets.

Milwaukee right now has one, and I'm gonna be, talking with, the judge that has been running that for the last year and a half or so, Mark Sanders, on what he sees as efficiencies that have been improved and overall how that's been working for them. Also looking at what the best practices are for various either providers or various law enforcement entities that have might have policies on some of these the things that Dane County might not have policies and procedures on yet. The bottom line is we don't want to reinvent the wheel if there is something out there that's working for people. As part of the work group number one, we have participants from kind of all around, the stakeholders' process, somebody from the DA's office, someone from the public defenders. We have, someone from Journey Mental Health.

We have Chief Warrick. We have Corporation Counsel and a number of other players. One of the things that we're doing is talking with those various players in these preliminary meetings and kind of brainstorming, talking to a few people at a time each meeting to see what they think might be things that can be improved in the process. For example, this last meeting that we had for Workgroup One, you know, learning about the legislative changes and learning about some competency issues that might be happening in Dane County, that we could improve on. One of the gaps that we identified was, sometimes when somebody is found not competent and not likely to regain competency, judges can then refer them, or keep them in custody for chapter 51 potential proceedings, so that corporation counsel has time to look at it.

The statute allows, that person to stay in custody for a certain number of hours. And, improving the communication between the courts, the DA's office, incorporation counsel, and the public defenders, to have information available to the judge at the competency hearings so the judge can make an informed decision as to whether, that referral for chapter 51, is appropriate. Because if we can bring a corporation counsel in earlier, then we may have situations where judges aren't ordering chapter 51 because we've already been told by the county that they're not gonna be pursuing 51, and so there's no reason for that person to stay in custody any longer. One of the things that was discussed at this last work group meeting, number one, was developing just a very short order that goes out in competency cases with the hearing notice in cases where the report came back not competent, not likely to regain. And then corporation counsel would be copied on that hearing notice saying there's been this finding of not competent, not likely to regain.

We're gonna have a hearing and corporation counsel is hereby notified and should attend the hearing to let the court know, their position on, whether chapter 51, would be pursued in this case or not. So that's, one tangible thing that has come out of that work group. Now I'm, going to be presenting that to the judges at the next judges meeting. And hopefully most, if not all judges will start to incorporate that notice in their practices with regard to competency cases. All right.

I think that's it for about group number one. If there's anybody in work group one that wants to kind of talk about anything more that I may have missed, the next work group one meeting that we're gonna do is we're gonna just, you know, focus on one of the one or two of the other members of the work group and see if there are particular concrete things that we can do to improve the process overall for competency and for chapter 51. Anything? No? Okay.

Alright. I'm seeing a head shaking here. So that's essentially what chapter 50 or the chapter 51 in the criminal competency group right now is doing, is working on small changes, but also looking at those bigger changes that might improve things and might already be in process somewhere else where we can sign on if appropriate. Okay. Let's go to work group two. I think Peter is going to talk to us about work groups two and three two and four and five. Right. So we'll go to two for him, then I'll come back to three for me, and then he'll talk about four and five.

Okay. Hi. I'm Pete Zollar, Dane County communications nine one one behavioral health call diversion. Gonna be talking about our objective two, which is strengthening the intercept points. Please help me. I'm I was gonna do two, four, and five at the same time, so I'm just gonna pause a little bit as we go. But looking at strengthening intercept points, we've looked at several different systems, and we have coordinated with multiple guest speakers.

Let me interrupt you. If you have it for two, four, and five, just do go ahead and do two, four, and five. Yep.

I love that.

And then I'll I'll do three at the end.

Okay. Great. Thank you for that accommodation. So objective two is strengthening intercept points. Objective four is peer support, integration, and objective five is the countywide service handoffs.

A lot of us are all in the exact same group because there are so many, interwoven pieces to this, so it just made sense to keep all the same brains in the same room having the same conversation, so then we can come, talk to this subgroup. With that, the objective is to develop a comprehensive plan documenting current behavioral health practices and a service delivery system throughout the system mapping. That is a lot. With that, the primary goals and objectives, that will be our service inventory and our system mapping that's developing a comprehensive inventory service providers. So making a list, checking it twice, reducing redundancy and administrative burden on clients, enabling cross provider communication to ensure statutory tools are being used consistently as intended, exploring crisis response pathways and coordination between crisis interventions and care systems, evaluate, the resource desk in the jail, and their current and examine the current provider contacts and contracts, examining, the technology advancements in service delivery, like how can we get that information to people, exploring the medication, continuing from out of the jail, and then talking about warm handoff and procedures.

I'll kind of break that down through parts here. So looking at the reducing the redundancy, we've been talking and exploring about, standardized forms. Just seeing how other systems have done this in our area. I cite the Zero Suicide Coalition. They made a plan where they're using the Columbia.

They're using the the Stanley Brown safety response plan, and it works throughout multiple systems. So we're exploring if that would be something that we could do within these systems, Enabling cross provider communication, this is always that the big dream, but we have seen it starting to happen with familiar faces through Dane County, and that's exploring that standardized release of information form And in different points, when would that form be provided to a person, and where would that form be held if that is something that is something that can happen? Looking at evaluating that resource desk, We're looking at, like, the feasibility of requiring service providers to staff that resource desk. Sounds like it's staffed around three days a week at four, five hours, but we know that people are released at multiple times of the day and and throughout the day. So how can we fix that, or how can we, support, having more resources that way?

Looking at that, having physical people there, that's obviously gonna be a way where somebody could come in, one on one talk, making a plan. Another way, Sharan has been, talking with, 211, and there's the possibility of having a 211 kiosk available. So, again, if somebody isn't there, there is another option available. We're also talking, exploring the ideas of adding a QR code to release paperwork, at the jail. So QR code can be formed through multiple languages, and then it can cut right through, say, two one one resources.

So that person who is being released when if, say, there isn't a kiosk there or when the table isn't there, they would be able to explore in their own options. That would be same for that private person who doesn't want to discuss all this. They would also have just one more option available to them where they could do that on their own. Going with the formal outreach I'm sorry. What what research needed and or subject matter experts?

Well, we talked a lot about the jail there, so we talked, to Sarah Wompole so sorry, Sarah. Majeski. We also talked to lieutenant Dudley, Kelly Splinter, and then there was a formal outreach to Ed Wall at the United Way. We've also had a couple, guest individuals to the meetings, including, the aforementioned and then, Jalil Curry from Office of Justice Reform. What are we looking at for next?

We wanna find out if this kiosk is something that can happen, who needs to approve, who needs to make that decision. Look at the applications, like the two one one applications, if they can be placed on the jail residents' tablets. So residents do have tablets so they can start looking at resources. So can we put some of the options that we know are available to the community available right there for, individuals, seeking the feasibility of requiring service provider staff resource desk? That's a big way of saying, like, is there any place in the contracts already there saying that somebody should be there from a certain agency to staff the desk, or is that something that somebody would be willing to, look into?

So having additional conversations there. We did talk about the standardized, forms, which, again, I know has worked in other agencies. This might be something that could work here exploring standardized, release of information as well. There's a lot of people in, two, four, and five. Was there anybody else that wanted to add anything?

Alright. Do you guys have any questions here? Alright. Thank you for your time.

Thank you. Alright. So work group three, is ensure the work group that is looking at primarily medication issues and looking at what we can do to ensure the continuity of care with regard to medication during intake, incarceration at the jail, and at release, really across the full system of care. One of the things we did in our first meeting was to, really discuss what information we wanted to know in order to improve those systems and brainstorm some of those things. And based upon what we did at our first meeting, for our second meeting, had Tricia Mooney Fogerney from WellPath who join us at that meeting.

She got a list of our questions prior to that meeting and kind of did a presentation for us on what WellPath does both at intake and during the incarceration, and then also what they do when somebody is released. So we are working on understanding how that is working in the jails and how it is being followed. There are a couple of questions that she was unable to answer, so I am hopeful that we'll get some answers relatively soon. One of the biggest questions that wasn't answered is, to what extent are the prescribers going off of the formulary in appropriate cases. Because the contract requires them to in appropriate cases to go past the formulary.

And we are unsure if that's being done or not. She thinks that it is being done, but I don't know what the instance of that is overall. So we're going to take a look at that more, but also take a look at, primarily what can be done on release, for people to have extra medications, once they're released for at least like a two week supply. One of the biggest barriers that the committee members or the work group members identified was people that are released that weren't weren't anticipated releases or nobody from WellPath knew that they were gonna be released. And so what we can do to increase that prior notice to WellPath so that the medications can be provided upon release And there can be more coordinated care to make sure somebody has a follow-up appointment already scheduled once they're released.

I think one of the things, for instance, we're going to take a look at is what defense attorneys might be able to do when anticipate a plea agreement, is going to result in time served. Letting the jail know that so that if somebody's on a medication, they can continue that medication with a supply. Oftentimes, I think that the pleas will come up and they will happen within a week. And then it happens so quickly, nobody has notified WellPath that the person is likely going to be sentenced that day for a time served disposition. So that's one thing to look at is how to have more people in the bucket of WellPath knowing that they're going to be released, or having a good idea that there's a very good chance they're going to be released so that that continuity of care can happen.

And then one of the other next steps are just hearing from other people in the community, particularly Journey Mental Health, and what is happening kind of after people are released and what we can do in that context. For when people are first put in the first incarcerated, one of the things to look at is if there are things that are kind of falling in the gaps of taking a look at what the contract with WellPath is and then talking to people at the jail to make sure that those all of those things are being followed. And what when the contract comes up for renewal, we might want to put in or when I say we, I mean you, because I will not be working on the contract. But corporation counsel might want to put in to make sure that we can improve overall the medication distribution management within the jail population, both at intake and while they're in the jail and then when they're released. One of the other things we're looking at is whether third party providers can be utilized in certain circumstances, particularly if a drug is not on the formulary that somebody's been, working with for a long time and it works for them.

There was an example in one of our meetings about the VA, where can the VA provide medications to the jail for a particular person? So we're looking into the feasibility of third parties providing medications to the extent that WellPath doesn't have a prescribed medication on their formulary. Okay. I'm taking a look at my notes here. And then identifying potential models for same day or rapid access to behavioral health and medication services.

So taking a look at what some of the bigger counties like Milwaukee County might do, They they may be behind where we are. They may be in front of where we are based upon certain aspects of what they're doing. But looking at what their practices are upon release and and seeing if we can mimic those to the extent that we think they might be working better better in Milwaukee County than here or working better in Brown County or some of the bigger counties taking a look at if they're doing things that we're not doing yet and that potentially could be overall improvements. Anybody from work group number three you kinda wanna discuss? Anything else that we have been working on?

No? Okay. Alright. So we have gone over, I think, most of the work groups now with the exception of work group seven. And I'm gonna have, Chloe, talk a little bit about that because I think DHS was, going to take the laboring or in, work group seven given that work group seven isn't, getting a triage center up and running. It is making sure that the public knows what the, current status of the a potential triage center is and, a centralized place that people can go to get what the latest updates are on the creation of the center. So I will, give it to you, Chloe.

Thank you. Yeah. Our update, is pretty straightforward. We have confirmed that human services has the infrastructure to host the public facing website on our web page and to share updates about the proposed triage center. So we, at this point, just need to develop the content and work with our communications director to, make that a reality, and we will make sure to keep everyone in the loop so you all have the access to that website when we have that.

Great.

So pretty straightforward, but moving forward.

Great. Okay. Anything else on the work groups that anybody wants to put out there or discuss? I think, like I said at the beginning of this meeting, a lot of the discussion for these particular work groups are, in the weeds right now. There are some big picture issues, but there are some in the weeds issues that we wanna look at so that we can make some small changes along the way even when we're trying to effectuate big changes.

And so the work group work itself is really where a lot of their discussion is coming in. And here, I'm primarily going to be using the committee as a reporting mechanism so that everybody's knowing what is going on in the work groups and how we're making progress on the strategic initiatives developed by the CJC. Anybody else wanna talk about anything in their work groups? No? Okay.

Alright. So the next meeting date will be July 14. And, again, that'll be in hybrid format. And as I said at the beginning of this, while we have encouraged strongly encouraged participation in the past in person. We are going to, I'm not going to strongly encourage participation in person anymore, particularly for folks that, are spending time commuting here.

I'd rather them spend that time working on the initiatives within the work groups. And given that the work groups themselves are taking more time than just regular attendance at these committee meetings. I wanna make sure that people aren't burnt out on, working with the with the overall group and then working in their subgroup.

Yes? Chair, if I just bring to the chair's attention that we must have in the room, though

Right.

According to Robert Rules of Order. So we can't, we would not be in compliance if any if everyone did not show up.

I I anticipate being in person for everyone. So I think that's enough. There doesn't need to be a certain amount of people in the room.

I I anticipate that's enough, but let me please check on that, and I will give you that information this afternoon.

Alright. And I am seeing a nod from Colleen that as long as I'm in the room, that's fine. Okay. So, if you you're welcome to come in person, as particularly if you are in the building anyway. I'd love to see people, in person and not just talk to a screen. But, I want to be mindful of everybody's time and the extra time that these work groups are creating. Okay. Public comment on items not on the agenda. I don't think we have any public members here. Does anybody on the screen have any comments on anything on the agenda or off the agenda?

No? Okay. Any other business, that people wanna see on the agenda for next time other than just work group updates? I anticipate that every meeting, we're gonna have these work group updates. So, if there can be at least one work group meeting per time in between these, sub subcommittee meetings, preferably about once a month.

I don't wanna do it once every two weeks because people have a lot of meetings, I don't, again, want people to burn out and and, want them to be able to have time to, work through, some of the action points that we develop in the work groups themselves. So I anticipate that work groups will probably meet about every four weeks or so. So hopefully, there are one to two work group meetings in between our subcommittee meetings. Alright. And I think that is it. Do I have a motion to adjourn the meeting?

Motion to adjourn. Seconded.

All in favor?

Aye. All

opposed? Alright. We are adjourned.