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?

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

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

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?

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?

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 t

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,

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 t

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 ar

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

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

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.

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

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

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.

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 inte

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 he

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

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.

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

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

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.

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.

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 housi

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 Ag

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'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 pot

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 o

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,

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.

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 oppo

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.

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

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

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 wh

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 w

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

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 i

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 buildi

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 unde

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.

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

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 c

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 m

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 t

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?

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 stat

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 be

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

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.

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. 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?

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

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 be

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