Board of Commissioners - Regular Meeting

Mm hmm.

All right, you're good to go.

All right, stream test for June 15, Health and Human Services Committee.

Well, good morning, everyone. And let's go change. Let's go ahead and get that out to begin with. So I know lots of us will maybe up a little late last night. So thank you all for being on the call this morning. So welcome to our June 15th Health and Human Services Committee meeting. And Ben, did you want to add something to the agenda?

Or do you want me just to go on into it? I just wanted to, I neglected to add the item to approve the minutes of the March 2, 2026 committee meeting. And so, yes, if y'all would approve those minutes, please.

Thank you. Yes. So can I get a motion that we approve the March 2 Health and Human Services Committee meeting minutes, please? Commissioner Evans, are you trying to come off mute?

Yes. Can you hear me?

Yes, I can now. Do I have a motion?

Yes, I'll make a motion to approve the minutes.

Thank you, and I second it. So all in favor say aye. Aye. Okay, and that motion passes. Thank you so much. All right, so we are going to dive in now to our agenda. We have a robust agenda today. So we're going to try to allot about 30 minutes for each presentation, and that includes questions as well. So, Denise, I'm going to turn it over to you first because I think you want to make some opening remarks about behavioral health. So go right ahead and welcome. Great.

Thank you for the opportunity to be with you this morning. We've got two great presentations for you today, but before we begin, I wanted just to briefly discuss the work of the Behavioral Health Department and why these two presentations are relevant to our work. As you all may remember, we have a vision that by 2034, all individuals with in Wake County will have the opportunity to thrive. And achieving that vision requires that any more than any one organization cannot do this alone. And so this work has to be done collaboratively. And that's the work that we do as a department. We bring the partners together. We use our resources to strategically invest in the high priority areas to work to improve how these systems work together. So today's presentations are examples of that work. The Youth and Families Behavioral Health Study is helping us better understand the needs of our children, youth, families in Wake County, and identify opportunities to strengthen the system of care that supports them. And then following that presentation, we have Alliance Health that will provide an update on their work and then investments across Wake County and their role in supporting behavioral health service for residents in Wake. So together, these efforts help us better understand our community's needs and improve how our systems work together to support our residents. And so with that, thank you for your time. I'll turn it over to our consultants with our Youth and Family Behavioral Health Study.

Thank you. Thank you so much, Denise. And thank you everyone for being here and for giving us the opportunity to share a little bit more about this work. So we can start on the next slide. Thank you. Just a really brief agenda for our time together today. We'll start by introducing ourselves, giving you a little bit of background into who we are. Then we'll do a high level overview of the project timeline. and then move into an overview of each of the project phases. And then we'll end with some time for questions that you might have about the project. Next slide, please. Yep, so we'll start with who we are. We can go to the next slide. My name is Eden Griffin. I use she, her pronouns. I am a director at Omni Institute. We are a nonprofit social science consultancy, and our goals are to provide integrated research, evaluation, and capacity building services, all in service of the goal to accelerate positive social change. So our role on this project will be overall project management, We will be leading the strength and needs assessment as well as the national benchmarking that I will speak a little bit more about in a moment. We'll be co-facilitating the strategic planning efforts and leading the strategic plan development and delivery. Next slide.

Thanks, Eden, for the great introduction. Hello, my name is Dr. Rena Dixon. I'm the CEO at Fact Forward. We are a training capacity building organization that serves North and South Carolina. And we envision a world where youth and young adults have the opportunity for a healthy, bright, self-determined future. And we do that through capacity building in communities across South and North Carolina, as well as training. and youth-focused programs. And our role on the project is we're going to be co-leading the youth and family advisory group development. We're going to be co-leading the structured engagement sessions with the Wake County community. And we're going to help with drafting of the engagement outcomes and summary report and co-facilitating strategic planning efforts. So think of us as the boots on the ground in Wake County. And we're going to be partnering with Cardea, which is a national nonprofit with over 50 years of evaluation, policy, advancement, capacity, development, and professional learning. They were unable to be on the call today, but Cardea, Omni, and FactForward have great long-standing relationships, and Cardia is going to be assisting FACT4 with co-leading the youth and family advisory group development, co-leading the structured engagement sessions with Wake County community, and drafting the engagement outcomes and summary reports.

Wonderful Thank you so much reena we're going to move now into an overview of the work plan and timeline so you'll see here that, on the timeline we have four different phases. And there i'll go through each of the phases individually, but below you can see, based on the icons that are there, who will be leading and co working together on these phases amongst our consultant group. So the first phase begins now in June, and we'll go through August, and that is our needs assessment. Omni will be leading this work. We have had a kickoff meeting. We've just about finalized our project work plan, and we're moving now into data collection for the needs assessment. I'll give a little bit more detail about that in a future slide. And then after phase one, we'll move into phase two from July through October. And this is really where Cardia and Fact Forward will pair together. And that will be in doing the boots on the ground work that Rena just described of stakeholder engagement, which includes stakeholder identification and mapping, leading the structured engagement sessions with the Wake County community, and then developing an engagement outcome summary report. So what did we learn by engaging with the community? Phase three will take place from October through December of this year. And that will be led by Omni. And this is a best practices and benchmarking process where Omni will go through a systematic review of the peer reviewed literature and scan of different models of excellence for behavioral health service provision to youth and families. And then in 2027, January through May is phase four. And this is all about developing a strategic plan for Wake County. We will all work together on this phase. So Omnicardia and Fact Forward are sort of taking everything that was learned in phases one, two and three and bringing it all together to facilitate meetings with county leadership to develop a strategic plan for service provision to Wake County families. This will include a development of a final report that synthesizes all of the information learned across phases one through three, as well as the strategic priorities that will be determined. And then we'll give a presentation of key findings and recommendations at the end of the project. Next slide. And we'll go into a little bit more detail about these project phases now. So the goal of the needs assessment is to identify patterns and trends to really support that strategic planning process, as well as the community engagement. The needs assessment will really focus on two different things. First will be to create an agency inventory of all agencies across Wake County that are providing services to youth. So this will allow us to highlight service availability across the county, including types of services provided, populations served, as well as geographic coverage. Then we will also write up some narrative discussions around gaps that might exist by service type. So that could be things like mental health services, extracurricular activities, family services. So the youth serving agency inventory will really show us what is available to youth and families across the behavioral health continuum of care and where there may be gaps that we should prioritize for the future. The additional part of the needs assessment is the secondary data assessment, and our team has already really dug into what types of data we're going to be able to access to really give us a clear picture of patterns and trends related to youth and family behavioral health risk and protective factors, outcomes, and more. The data will highlight disparities across the county by demographic group, as well as different geographic areas where that data is available. And the assessment is really also designed to highlight current data gaps. So places where we can't find data, we will be systematically tracking and detailing that to support future capacity building. So if future data collection would support a stronger continuum of care, we will make those recommendations.

Next slide.

I'll pass. Oh wait, one more slide and then I'll pass to Rena. Some example indicators that we might be pulling together for the needs assessment include risk and protective factors. So these are the factors that precede various behavioral health outcomes that may increase risk or decrease risk. So those could be things like adverse childhood experiences, housing instability, things like that. We will also gather data related to youth substance use, youth mental health, as well as indicators related to the schools, as well as the community at large. So it could be things like chronic absenteeism, graduation rates, and emergency department visits amongst youth in the county.

Next slide.

Off to Rena.

Thanks so much. Thank you, Eden. So for stakeholder engagement, our goal is to get into the community and talk to any and everyone about how this topic impacts them and what would they want to see and envision as we put together this needs assessment. So we're going to be looking for lived experiences and systems insights from youth, families, and key partners across the behavioral health continuum. So we're going to be working to get groups of young people together. We're going to be working to get groups of parents together, as well as people in the community who serve both families and youth. We're going to identify strengths, gaps, and duplications in services, and identify those programs that support youth and families. We're also going to start this actionable opportunities for systems improvement and integration and investment. I like to call this the low hanging fruit and also identify areas where there needs to be more systematic level change going on in the community. we're going to ensure equitable representation and intentionality include intentional inclusion of underrepresented communities and populations so when i say we're going to talk to everybody we're going to talk to everybody we want to make sure we have a true understanding of who lives works plays in wake county and make sure all those groups are represented in our stakeholder engagement process. And then we're also gonna foster shared ownership of findings among stakeholders to inform sustainability policy and practice change. This is your data, this is data about your communities, and we wanna make sure that you own that data and are able to talk about it just as we talk about it in the big, I call it the big R research, but you should be able to share this information in anyone in your community. Next slide, please. So as I mentioned before, we're going to be talking to youth caregivers and family advocates, youth serving community-based organizations, managed care organizations, youth development programs. We're going to go into the medical community and talk to pediatric and primary care providers. We're going to talk to the public school system. So we're going to talk to leaders and staff that work in public schools. We want to talk to homelessness service providers and housing partners. as well as those that impact the juvenile justice and child welfare representatives, as well as faith-based and cultural organizations. So we think we have a wide gamut of people that we want to talk to and engage with this work. Next slide, please. And how are we going to do that? We're going to have focus groups and roundtables. This is something that Fact Forward has been doing in Wake County already. We're going to have four to six sessions intended to gather insight from youth caregivers and frontline providers. We're going to have community listening sessions. So we're going to get out there and invite the community to come. I'm from the South, too, so, you know, we got to feed people when you come and bring them out to a community listening session. And then we're also going to have key informant, which means like one-on-one interviews where we can kind of go into detail. We're going to do 10 to 12 of those key informant interviews with systems leaders, including Wake County public schools, managed care organizations, health systems, and community-based organizations. Next slide, please. Thank you, Edith.

So after the community engagement process wraps up, we'll be moving into phase three, which is best practices and benchmarking. And this phase will consist of two different components. First is a systematic review of the peer-reviewed literature. So basically our team is going to really dig into the research to identify evidence-based programs and practices for youth and family behavioral health. organized by developmental stage, meaning that we are going to start all the way from prenatal care all the way up into youth. And we want to also benchmark against national standards, so SAMHSA standards, NIDA standards, to really assess where Wake County's current system is strong and where gaps exist. And so we've done reviews like this many times before, and the idea here is to look for models and key programs that Wake County could implement to further strengthen the behavioral health continuum of care. We will also be conducting a scan of national, state, and regional models, which will service these evidence-based models that could be a fit. So this is really looking from state to state, community to community, to see how other behavioral health systems are structured and what their outcomes are based on those structures. So we can find Some models that might be a fit for Wake County's context, your structure, your population needs. And this scan will also prioritize culturally responsive approaches for the most high need subpopulations that we identify through the needs assessment and stakeholder engagement. So there's a piece of this that goes really in depth onto what are the most high needs folks in Wake County and how can we systematically implement approaches that will help their behavioral health outcomes. Next slide. Once we wrap all of those pieces up, like I said before, this is everything coming together at the end. We're going to take the data that we've collected for the needs assessment, all of the work that Cardea and Fact Forward will do together to engage the community and have those rich conversations about what folks in Wake County feel that they need. And then we'll bring it together to facilitate a strategic planning process with Wake County leadership, all with the goal of paving the way for a stronger continuum of care. We will start with a SWOT analysis. SWOT stands for strengths, weaknesses, opportunities, and threats. This will be a two-hour meeting to review the findings. We will present everything we've learned. We'll identify those gaps, places where we know that there's room for improvement, and really establish goals and strategies based on this conversation. Then we'll move into step two, where we'll review and finalize those strategies. So we'll walk through the final recommendations and finalize what those strategies will be. Then the third step is strategic plan development. Our teams will work together to develop a highly visual document, really something that the community can absorb. As Rena said, maybe not the capital R research, it's gonna be accessible, approachable with language that the entire community can understand. And we'll keep technical details in an appendix for those who really wanna dig into those materials. And so this document will outline Wake County's approach to strengthening youth and family services based on everything we've learned. Then the last step will be to disseminate that plan. We will have a final presentation to the county, the Youth and Family Advisory Committee, key partners who were involved in providing data and participating in the stakeholder engagement process, and the broader community at large to showcase that final strategic plan and really pave the way for the future of Wake County. Last slide. The features of the strategic plan. I spoke a little bit about this already, but we want to make sure that the plan is easily digestible by everyone in the community. So that will start with a highly visual executive summary that highlights the key pieces of the process, where decisions were made and the outcomes that we are hoping to achieve. That will be provided in accessible formats, including ADA compliant imagery and language. It will involve a clear representation of Wake County's selected strategies and the approach to implementing those strategies over the following years of the strategic plan. It will include a timeline for implementing the approach, what we will start with, how the different pieces will build on each other to reach intended outcomes. And then we will also create four distinct strategic plan summaries that are tailored to diverse audiences. So we'll have a strategic plan summary that's really focused on youth that can be delivered directly to youth, one that's really tailored towards policy makers, one for providers, and then as well as parents and families. And you can see the visuals here are just an example of the kind of visual presentation that we have used in other strategic plan reports. So really talking through what the approach is, some key results from the data, as well as the process that got us there. Next slide. So that is our approach. And we thank you so much for your time today and would love to use the rest of our time to open it up for questions for anyone that wants to learn a little bit more.

Thank you both so much for what a comprehensive presentation. So really looking forward to the data you gather and the recommendations that you make. So let me see if any of my fellow commissioners have any comments or questions that they'd like to make at this time. Commissioner Chair Ma, I'll go right ahead. And then Vice Chair Jackson.

Okay. I just want to make a comment. First of all, yes, Commission started indicate this is very, very comprehensive and I love what you guys are doing. You know you fear in the community definitely programs like this. I retire from the Department of Juvenile Justice, so I definitely really appreciate the direction and what you guys are doing because we know that there's a great need and our youth population is growing and it's important to us that we continue to do everything we can to support them in their endeavors and especially their families because they are key to making sure this process works. So again, I just appreciate what you guys have brought forth to us this morning. Thank you.

Thank you so much.

Thank you. All right, Vice Chair Jackson, go right ahead. No, we're not hearing you. I don't know what happened.

Okay, take down. Can you hear me? Okay. All right. Thank you so much for this presentation and laying out your plan. I am so excited for what you will hear from community, what we will get to wrestle with, and what direction will chart for our county in terms of behavioral health. I also want to acknowledge how much my heart fluttered when you said when you acknowledge the spectrum of behavioral health and said that you all were going to intentionally start from prenatal. So essential. So I look forward to our early intervention folks, our infant early childhood mental health folks, and even our early childhood educators hopefully will be engaged as stakeholders so that we can make sure that that birth to five spectrum that can easily get overlooked in this conversation And I'm just so happy and I'm looking forward to it. Thank you so much. Any way that we can help spread the word and get people participating, you can count on me to help spread the word so that we can get as many voices as possible. Thank you so much.

We appreciate that. Thank you so much.

Any other comments from commissioners? I don't know if any others are on the call at this time. Well, I see Commissioner Evans is on, but not sure if she has any comments. But I just want to say you answered a lot of my questions as you spoke, so that's a good thing. One thing that our board is so intentional about is wanting comprehensive things done in a very inclusive, equitable way. And you already addressed that, you know, particularly going into underrepresented communities and really, really, really, really going into underrepresented communities and really getting those perspectives. We have a lot of diversity in Wake County and also with language issues. You know, you didn't specifically mention that, but I'm sure that's included, too, thinking about language barriers, too, from our diverse community. But I serve on a lot of Health and Human Services boards and committees, and we know there's a lot of good things going on in Wake County, but we clearly know there are disparities. We see those disparities in public health data in our countywide Health and Human Services meetings. So I appreciate that you're going to really help us bring to light disparities that exist and recommendations. And one thing, too, that I don't think was mentioned is funding and how we try to efficiently, as you continue to look at models throughout the state and nation, how do we make the most out of sometimes strained resources, strained financial resources, but really helping to link that roadmap to what financial investments are needed and what does that look like in trying to you know, invest as efficiently as we can, but also being real with this too, being realistic, you know, what is it really need, what is it going to take to get us where we really need to go? And one other comment is sometimes I've heard our commissioner colleagues talk about strategic plans, strategic plans, but we want to integrate them into the broad strategic plan that the commissioners have adopted and assuming that will be a subset and integrated well into our existing strategic plan that this board has adopted. I don't know if you want to add anything to that. I do.

That's wonderful. Thank you so much, Commissioner. Yes, it's going to be key to take the strategic plan and make sure that it really is downstream from the strategic plan that you all have already developed and that will be there'll be a lot of pieces in that strategic planning process that are really focused on what is realistic to implement as well as recommendations for for sustainability sustainability needs to be baked in from the very beginning so as we're having those early conversations about what are these priorities how will they be implemented what partners need to be at the table in order to ensure that implementation takes place We have worked in the strategic planning space for a long time as has Fact Forward. And we really know the difference between a kind of strategic plan that gets like yay, put up put on a shelf never to be heard or seen from again, and ones that really get implemented in real life. And it has to do with making sure that there are champions for this work, making sure that those who will then take on pieces of the work are involved from the beginning. So we're really going to make sure that that holistically represents the strategic plan that you all have already put in place, as well as represents the community at large.

Yes, I, for one, like strategic plans with legs that walk in our actions. Yes, that walk right out into the community. We don't want any on-the-shelf dust-gathering plans. We want them to be put into action for the betterment of our community. So thank you so much. Any other comments, commissioners, or questions? Okay. Any final comments? Denise, did you want to make any final comments?

Sure. I just wanted to say thank you to the commissioners for supporting this work. We really wanted you to understand who the team was. We hope the community will want to be involved in this. And so we will likely follow up with some of you all to help make sure that we're getting the right folks to the table. But I also wanted to thank Alyssa Kitlis from our team. She has worked with our consultants to Take something that's really broad and big and make it digestible and hopefully something that's going to be really impactful. Because as you said, we want to take these learnings and then turn that into something that can really help our kids and their families across this community. So really looking forward to this work. Thank you for your support. And thank you to Alyssa for an incredible job of getting us to here today.

Thank you, Denise. And shout out to Alyssa, as always, always doing good work, as is so many of our staff. So thank you again, Dr. Rena and Eden, for being with us, and we'll look forward to hearing from you again in the future, okay, as this progresses. Thank you again so much. Thank you. All right. Okay, next up, we're going to hear from Alliance Health, and here comes CEO Rob Robinson. So some of my commissioner colleagues know I'm the commissioner liaison to Alliance, but It's always good when the CEO is in the house and he can break things down for us. So, Rob, take it away, and I think you've got some other colleagues from Alliance that you may introduce, and we'll look forward to getting an update from you next.

Thank you, Commissioner Stallings. Just real quick, hey, Ben, Sarah Wilson is saying she doesn't have access to her camera and mic.

Would you mind turning that on for her if you can? Yes, just a second. All right.

All right. Good morning, members of the Health and Human Services Committee. Thank you for the opportunity to be here today. Again, my name is Rob Robinson, and I serve as the CEO of Alliance Health. I am joined this morning by Shawn Scheiber, our Chief Innovation and Strategy Officer, who will assist with today's presentation. I also have with me Kelly Goodfellow, our Chief Financial Officer, and Sarah Wilson, our Chief of Staff, who are available to address any questions you may have. So for today's presentation, I'm just going to begin with a brief overview of the Medicaid system and alliances role within it. I will then turn the presentation over to Sean who will discuss services and programs supporting Wake County residents. We understand that we've been asked to complete our remarks within 20 minutes and we will do so to leave ample time for questions. Before we begin, I would like to express my sincere appreciation to the Wake County Commissioners and county leadership for your continued support and partnership. I would like to especially recognize Commissioner Stallings, whose service on the Alliance Board has been both meaningful and instrumental. So just real quickly, Alliance was formed in 2012 through the merger of Durham County and Wake County's local management entities. And we remain deeply grateful for Wake County's longstanding leadership and commitment to serving residents with the greatest needs. Worked with Denise for a long time. She and I spent many hours in a room negotiating terms of the merger. I am almost over the trauma that she put me through to get to this place, but it was definitely worthwhile. One last point I want to make, in case you were not aware, Wake County provides more funding than any other county in the state to support services for individuals who do not have another needs to pay. And this investment has made a significant difference in the alliance that we collectively served. All right, next slide, please, Ben. All right, so I'm going to give you the quickest tutorial on Medicaid system that you've ever received. So there are three types of Medicaid health plans in North Carolina. There are standard plans for which there are four. There are four, soon to be three, Taylor plans, and then there's one child and family specialty plan. So most of the people with Medicaid are in the standard plan. These are operated by commercial health plans. The way I describe it, what separates standard plans from Taylor plans is that standard plans are responsible for people with mild to moderate behavioral health needs. And again, mild to moderate is either they're not receiving mental health substance use services or they're just receiving basic outpatient. Tailor plans, which Alliance is one of four, we are responsible for the care of people with severe mental health, severe substance use, and people with intellectual intellectual developmental disabilities and those with traumatic brain injuries. We are responsible again for those with Medicaid and also for those who are uninsured. So bottom line is Taylor plans Alliance Health responsible for people with the greatest needs in North Carolina. And then of course, there's the Child and Family Specialty Plan, which I think you're gonna hear a presentation later. These are responsible for kids in child welfare foster care system. Next slide, please.

All right, here's the map of the Taylor plan system.

I know it looks real smooth and cohesive, but there are currently four, right? Alliance is the dark blue. We are the tailored plan that is responsible for the urban settings, right? We've got Wake and Charlotte and Durham, Orange, Cumberland, and Johnston County. There's a Two LME MCOs to the left in the western part of the state, and Trillium, of course, is the right. Partners and VIA announced a merger. They're going to merge October 1st, which will put three in the state. Again, the geographic makeup of the Taylor plan may look a little skewed. Wise Alliance only have seven counties and the other two have 40 plus counties. They're primarily rural. Again, ours is in a metropolitan, we're responsible for serving a metropolitan area. The population sizes amongst the three will be about equal. And again, the LME, if you're, LME stands for local management entity. That's our responsibility for serving people who are uninsured, underinsured. MCO stands for managed care organization, and that's our responsibility serving those with Medicaid. Next slide, please. All right, so a little bit about Alliance. You can see the seven counties that we serve. We have a staff of about 1,500. The Taylor Plan population, that's where we're responsible for the behavioral health and IDD needs as well as the physical health and pharmacy needs of the people that we serve. Medicaid Direct, that population are those individuals who have been delayed or excluded from managed care. There are approximately about 80,000 of those members. We only manage the behavioral health and IDD services of those individuals. The physical health and pharmacy needs are managed fee for service. And then, of course, we are responsible for the uninsured across our seven counties, and that estimate is about 317,000 people. that we serve those folks through state and county funded. We also contract with over 5,000 providers across the state. That includes those that provide outpatient all the way through hospitals and health system. We contract with every hospital and health system across the state. Next slide, please. All right, just real quickly about the system. We are a government entity. We're considered a quasi-state entity. This is a unique model across the country. I get a lot of questions about the work we do. What's interesting, we're a government agency asked to compete against commercial health plans. So all of the standard plans, United, the Blue Cross Blue Shield, the Mayoral Health Caritas, we have the same responsibilities as they do. And again, when we have to rebid for our contract in a couple of years, we will be competing against those companies. So that's a unique model that is not seen across the countries. Again, we are not a service provider. We contract with providers to deliver care. One of the big differences between the LME MCO model and the commercial is that the money that we save is used to reinvest back into care. That is the awesome part about the work we do. I am not responsible for a board. I don't have to satisfy shareholders. I don't have to pay dividends. All the money we save goes back into care. Next slide, please. Just real quick, what we think is gonna make us competitive is our longstanding relationships in the community, right? We know, and it was mentioned earlier, that the work we do, we can't do it alone, right? We have gotta do it in partnership with the community. Our folks are not gonna be successful if we just provide them outpatient treatment, right? They have housing needs, financial needs, family needs. food and securities. Part of our responsibility is to build those relationships and help get our folks connected to address those social and economic factors that impact them from being successful. We are, I do have a board of directors. I've actually feel like I've got a couple of bosses First and foremost is our board. We have representation from all of our counties. And I mentioned earlier, Commissioner Stallings is part of our board. We also have a consumer and family advisory committee. Those are made up of members and families who are served by Alliance. And then we also have a county commissioner advisory meeting. County, that's an opportunity for us to hear from our county commissioners about what's happening at the local level. Next slide, please. All right, just a quick overview of our budget. As you can see, we are a $3.6 billion organization. The majority of that funding is Medicaid. We also receive federal and state dollars to serve people who are uninsured. And I always want to make it a point. We do everything we can to get people on Medicaid. Medicaid expansion was a huge benefit for the people that we serve. There's a major disparity on services available for those with Medicaid versus those who are uninsured, underinsured. Wake County funding, you will see here about $20 million. Again, that is by far the most of any county in the state. And I can't tell you how grateful we are for that funding to serve the uninsured. We get about another $11 million from our other counties in total. And then administrative, we are a lean organization. Our admin is under 8%. And then we get some other grant funding that makes up about $87 million. Next slide, please. All right, this is when I'm going to turn it over to Mr. Schreiber, who's going to talk about our services and programs in Wake.

Good morning, Shawn Schreiber, Chief Innovation and Strategy Officer, and Commissioner Stallings, thank you for having us here today. And as Rob said, appreciate the partnership. And also just want to give a shout out, I've had the opportunity like Rob to work with Denise Foreman for years, and she really helps us think a lot about the services and how best deploy the funds you provide to us. So Alliance uses Wake County funds in several ways. Sometimes your fund is used to just create new programs that are unique to Wake County, only serve Wake County members. Sometimes they're braided with other funds that lines received from the state or Medicaid to make the services a little bit more unique and innovative and cover things that just are not really funded on a straight fee for service. I don't want to go into a long description of each of these programs, but roughly your dollars go to fund about 35 programs in the community. And we have them bucketed by things like crisis services, programs to support people coming out of justice center settings, just general community supports and recovery. What I did for the presentation is I pulled out a couple of programs that are either funded with these dollars or are some combination of your dollars and some funding from Alliance. But to give you an idea, the crisis bucket that you fund helps pays for things like Wake Brook. The treatment dollars you provide to us provide support so we can have mental health providers that are in your regional service centers. that do open access. So if someone walks in, maybe in needing food stamps, they could also receive a mental health assessment and ongoing counseling. For the most part, services for adults who need residential care, there's really no funding source for that in the state. Medicaid doesn't generally pay for adult residential. State dollars are very limited. So the county has supported alliances up a number of supportive and transitional housing programs. And other things as well, just to highlight on this dollars, One of the things, like as Rob said, with Medicaid expansion, there's really an opportunity to get people onto Medicaid and get them really the full wraparound care that they can get through Medicaid, including physical health. So we do use some of your funding to hire what are called SOAR workers. These are people who help people kind of identify who could be linked with Medicaid, who might have disabilities that could benefit from full disability type Medicaid, and they do that work. So this is a combination of how the funding is used. Next slide, please. One of the programs I want to highlight, maybe one of the most innovative, and it's really, I think, only done in Alliance counties, and Wake was certainly the first to fund this, was building a school-based care coordination team. This is available to any student in Wake County schools. It's not just Alliance members. The idea is students' assistance team identify children with behavioral health needs or maybe have needs for intellectual and developmental disability services. They get linked to our care coordinators who help families and students navigate the system. A huge component of this is part of the Wake County crisis response approach for youth. So we have a team who is involved with getting children who are identified as being at risk or in a mental health crisis. They make sure they get connected to various crisis services. And if these youth ultimately need to leave the school setting for some extended period of time to get treatment and supportive aftercare treatment, the team then makes sure they can successfully reintegrate into schools. That's really unique. So many children, once they leave their community for care, often have long delays, months of getting back enrolled at school. And the team is working in partnership with school to get to less than 10 days on average. And about 1,000 of these youth are served annually. Next slide. While this is not necessarily a specific Wake County program because it happens within Wake County and is sort of in the Raleigh area, I wanted to highlight this is another creative partnership. This is actually a mix of some Alliance funding and some city funding, but it is for the benefit of members where we have Alliance licensed clinicians who are embedded in the integrated 911 call center. The idea is for them to take calls that can be diverted from a typical more expensive or law enforcement placement crisis response. It's a relatively new program, but so the calls are continuing to grow. The impressive thing so far with this team is they've been able to get on crisis calls that would have resulted in a 911, excuse me, not 911, law enforcement or EMS response and divert those calls totally, saving your law enforcement to work on other issues in the community. Next slide. So another thing that's really unique in the state, there's a group called Promise Resource Network. And it is a company that is run by someone with lived experience or a peer supporter. And they've begun setting up programs. This was, I believe, the second in the state of respite homes that provide a place for people with behavioral health crisis to go. They don't have to go through an involuntary commitment process. They don't even need to go to a hospital. And they can get care. They need a supportive environment. Thanks to Wake County, we were able to put our funding together with some state dollars and help this entity purchase a facility. And now they're serving on average about 12 people a month. An average stay is about nine days. The other part that was really nice, we also added a community hub to this program. And it's roughly serving 330 people a month. And a big part, they do lots of education. They do some harm reduction. And they've given out 764 doses of Narcan, which is an opioid reversal drug. So not just kind of providing people education, but potentially providing some kind of life-saving interventions if needed. Next slide, please. This is a program that is really dear to Alliance and a partnership that comes out of Wake County and Alliance and UNC. Alliance for years managed behavioral health needs of individuals in our community. And there's a statistic that many of you may have heard, and it's still true today, that people with serious mental illness tend to live on average of 26 to 35 years less than a peer who's not of serious mental illness. And these are not the premature deaths onto things like you think about, like suicide or accidents. These are from preventable health conditions. We partnered with UNC, and they created a one-of-a-kind primary care center that's specifically designed to work with people with serious mental illness. They provide dual treatment, so they provide both physical care, behavioral health care, psychiatric medications. And because this is a really hard-to-serve population with multiple things, they continue to innovate and use their funds to do things more creatively. They now have 200 Alliance patients getting delivered meals And since they've set up their practice, they added a community food closet, knowing so many people with serious mental illness, you know, live at the poverty level and well below, don't have oftentimes consistent access to food and healthy nutrition. They built a food pantry, which has supported 3,500 visits. So this really, when you think about it as a truly integrated care experience, every one of the members kind of health related needs can be met at one facility. And, studies of this clinic have shown over time reduction ED utilization. And maybe one of the most impressive things, these members tend to not be great at getting routine healthcare and screening. They spent two years really working on quality measures that if you're a non Medicaid cash paying person going to UNC Center, there's certain quality measures they look at. This clinic was able to get those same kind of scores for this population, which is really dramatic and life changing. Next slide, please. So again, another partnership between Wake County and Alliance. One of the challenges we've noted in the community, there are still unfortunately too many people living with homelessness. When these individuals get really sick and go to the hospital for inpatient care, they're often not be able to be discharged in a timely fashion because there's not a place where they can go for additional kind of healing and recovery. So these are individuals who don't necessarily need nursing homes. They might need home health, but because they don't have a place to live, they end up staying in the hospitals. Alliance is partnering with the county, the Women's Center. We're getting support from the Advanced FQHC in Wake Med that will lead to the opening of a 48-bed medical respite center. A lot of people have some medical needs to heal in a safe and clean environment where medications, home health, and other clinical services can be delivered, and care managers can work at finding longer, permanent, supportive housing. I apologize for running through as quickly. I want to be sensitive time and make sure we have time for questions. Next slide, please. Just again, another partnership. One of the things the county is funding, and it goes along the lines of your discussion around strategic planning. It's been noted in a previous plan that mobile crisis, it's a service that's meant to go out in the community and address problems people with behavioral health crisis before having to bring them to a facility or before having to deploy law enforcement. It's been kind of a weakness in the state service array. We've tried different models within Wake County and we decided to take a step back and say what we've been doing hasn't been working as well as it should be. We hired a consultant who would really bring a different approach and framework, put together a community project team and we'll be presenting to the county kind of a new model that's more based on research, based on more current best practice and how to leverage teams. Again, the goal is to really reduce the time that law enforcement and first responders have to spend with people in behavioral health crisis. And I think we're getting to the end. Next slide, please. And just lastly, the Wakebrook expansion. So this is an example of a service that could not exist without the county's support. Wake County has probably one of the the gold standards for a crisis system for many years. Even before Alliance came into scene, the county built a really state-of-the-art crisis facility. It's had different operators over the years. UNC was operating up until probably about two years ago. A new group with a model that the county and Alliance thought would serve members really well came in. That's RI International. They're currently operating a 24-7 behavioral health urgent care And they have 16 chairs where people can stay for longer observation for up to 23 hours in a crisis. Unfortunately, every time you change operators for these things, you have to go through a licensing process, the licensure rules change. And so the state has to come in and relicense some of the space. And we also decided to use some of this time to expand the behavioral health urgent care that was in the community. A big challenge under the old system would be that it would do a great job serving people in crisis, but then it would get full and close and people would still have to be diverted to the ED. So part of the redesign and innovation of the crisis system is to expand that urgent care and have up to 23 chairs where people can stay for shorter term evaluation. And even the model used by this provider tends to have people coming in and out a little quicker. For instance, they are taking first responder drop-offs. So you can see the average time a police officer has to spend on site is less than four minutes. So that really is helpful for the crisis system. And having more chairs will just make that time even drop and serve more people. Eventually, once licensing is through, there'll be two 16-bed rooms. longer-term residential units that provide support for anywhere from three to seven days. The facility-based crisis beds we're hoping will get open by January 2027, so a couple more months. The expansion of the urgent care is targeted to be ready to open in April. Next slide. And I think that is it. Closing just with a reminder of how to reach Alliance and that we run a 24-7 behavioral health crisis line that's available to Wake County and all of our counties to support members in need. Thank you for your time and happy to answer questions.

Thank you so much, Sean. I appreciate that. And Rob as well. So, Commissioners, any questions or comments that you might have? Vice Chair, it looks like you may have one. Go right ahead.

Yes, awesome. Thank you, Rob, Sean, everyone here from Alliance for leading on this good work. It's really good to see a snapshot of the impact that you're making in the county. Thank you for that. My question is about trends. financial pressures, Medicaid pressures, changes. Can you just give us a synopsis of what you all as leaders of this organization see on the horizon as anything that threatens what you have shared with us or maybe even potentially expands or enhances?

Yeah, Commissioner Jackson, great question. I'll kick it off and then Sean, if you want to add anything to that, please do. There's a couple things. This past year was a challenging year for Alliance. I think the state had implementing some well-meaning, well-intended changes to policy to help improve access. But I think it was an overcorrection. And we saw a dramatic increase in behavioral health spend these past year and a half. We've been under budget. Since our inception up into this past year, and we've been able to use those funds to reinvest. The policy changes really impacted our financial position and quality of care. It essentially opened up the network to any willing provider. And unfortunately, we could not control who came into the network. So I'm trying to make this as brief as I can. But we've seen a dramatic increase in spend, but more importantly, a dramatic increase in fraud, waste, and abuse. And we spent the past year working with the state to try and change over and give us back our managed care tools so that we could have a quality network that that deliver care based on the needs of the members and not necessarily based on the needs of the financial position of the providers. And I need to say this. We are very fortunate. We have many very good, qualified, competent, well-meaning providers. Unfortunately, we also have a few that are not bad actors that we would not like to see in the network. Bottom line is we've worked with the state for the past year. There are some policy changes in the works that will give us back the tools we need, and we should be in a better position next year to get back what Alliance wants to do and does very well, which is working with our providers to expand and improve care. I hope that that's kind of the major issue for us. And, Sean, I don't know if you had anything you wanted to add about the future and what we're looking to do.

Yeah, Commissioner Jackson, great question. I think the concern, probably like everyone in the system, what happens when some of the Medicaid work requirements, the redetermination rolls out? I think what's been great over the last couple of years since Medicaid expansions, we've been able to do some more creative things with state dollars, even county dollars that used to just have to go pay for treatment. Like now we've been able to do system building with some of that money. Really worried what's going to happen if people really start losing their Medicaid en masse. Our crisis system is really dependent now on more Medicaid. I think that's probably the big trend too, other than where Rob was talking about the service utilization we're concerned about.

Yeah, can I just tag onto that? H.R. 1 rules, we were in a good place. The state defined medical frailty, and that's the group that does not have to meet all the requirements around H.R. 1, that their needs are too great, that they can essentially – remain in the system as it is today. The federal government just recently released a statement that they're not necessarily going to support North Carolina's approach, which we were very disappointed to see. And so I think the state's in negotiation with the feds on what the definition of medical frailty is. So that's a risk that we're trying to monitor closely. We've had a couple meetings with CMS to talk about some of that, and hopefully they will heed our advice, because I know the federal government wants to hear what Alliance has to say.

That's very helpful. Thank you.

Thank you so much for the question, and thank you for, yeah, the HR1 was really important. I serve on the HHS committee and the State Association for the County Commissioners, and we just had people from NC Medicaid come and speak when this document just dropped from the federal about medical frailty and the sort of convoluted information that came out and the concern about all the steps that need to be taken. So I'm hopeful that maybe some more clarity will come from this. I guess time will tell, but I think there was concern about a lot of work that's going to be placed on our DSS workers who, at the county level in North Carolina, are the ones who are making decisions about eligibility as well as the work requirements. And it's a lot of work being placed on our county departments of social services. Just lastly, Sean and Rob, and I see Sarah, you came on as well. Do you want to speak briefly about the advocacy that Alliance is doing at the state level to try to help navigate some of these issues? I don't know if you want to make any comments about that.

Sure. One thing that I'm proud to say, the other Taylor plans via partners in Trillium, we work closely together. We meet every week, most of the time, more than once a week to talk about what are the policy changes we'd like to make. And we do have a voice. We have a trade association that's led by Dave Richard. who is our executive director of the trade association. So we spend a lot of time trying to make changes. You know, we also spend a lot of time with legislators. We're very grateful that we have a lot of support from legislators about the work we do. It feels like since I've been in North Carolina since 2002, the LME MCO, the public system is under attack. And do we need the public system anymore? We, of course, believe that we do. You know, again, it's under scrutiny on whether there's too many health systems and the public system is the ones that there's conversations about, not because of the performance or the work we do, but because of whether or not you want to privatize, commercialize Medicaid versus the public system. So We spend a lot of time trying to advocate and talk about the benefits of what we do. And just real quickly, I think we are, the system is still in play because of the advocacy from our counties. We are extremely grateful for that. I know not every county across the state is supportive of their LME MCO, but we've appreciated all Wake counties and our other six counties have done to support and advocate for Alliance.

Well, thank you so much. We may have to stop there just for this sense of time, but we appreciate you so much, and we hope to have you back again to give us some more updates. This was a really good overview, so thank you all, and we will see you at another Time Alliance, and we're going to transition to our vice chair. Did you have one other comment?

Yes, just one other quick question. Rob and others, if you all have any kind of legislative agenda that is written and can be shared, I would appreciate that being shared. Thank you.

Will do.

Yeah, very good, good comment and question. Thank you so much, Alliance, and we'll see you again at another time. And now we're going to transition to hear about Healthy Blue. So, Ms. Diamond Wimbush, if you are here, you are welcome to take it away with your presentation. Thank you for being with us this morning.

Absolutely. Good morning. Thank you all for having me. And thank you for the opportunity to provide an update on Wake County's transition to the Healthy Blue Children and Family Specialty Plan. While this transition may appear at surface level to have been a simple change in Medicaid coverage for the young people that we serve through foster care, we certainly had hopes that it would eliminate several pervasive systematic barriers that face these youth and their families in the recent years. From the beginning, our priority has been simple, and that was to ensure that no child experiences unnecessary disruption in services related to this transition. This has required extraordinary efforts from staff across child welfare and developing strong partnerships with both Healthy Blue and our state leaders. This morning, I'd just like to take this opportunity to briefly walk you through an overview of the Children and Family Specialty Plan, what Healthy Blue Care Together shared with us as their goals in service delivery, how Wake County prepared for this transition, some of our early successes that we've experienced, and then we'll talk about some of the challenges that remain. Next slide. So the Children and Families Specialty Plan is a statewide Medicaid plan designed specifically for children, youth, and families who have child welfare involvement. If you think back to Mr. Robinson's slide that had the picture of the state and the colors of different MCOs, Prior to this statewide plan, if we had a young person enter foster care and go from being in an alliance catchment area, maybe to a Trillium catchment area, not only was the child then facing transition from their family, but also potentially from medical providers, therapists that they had had connections with. And so being under one statewide plan was intended to make sure that children have a continuity in care and services. Also, we're going to be talking specifically today about the transition for youth in foster care, but the plan has included a phase two, which was actually supposed to roll out in June of 2026, that would incorporate the family members of any child who's in foster care. We know that parents, when their children enter foster care, they lose some eligibility to be able to continue with Medicaid, which makes it a barrier for them to engage in mental health. and physical health services, substance use services that they might need to be able to safely reunify. And so this plan was designed to be able to also help make sure that those parents maintain their services as well. So the goal is to improve coordination and continuity of care across the physical health, behavioral health, and child welfare systems. And again, phase one was implemented December 1 of 2025, so we're about six months in. for children currently or who have been in foster care. Next slide. This slide just gives an overview of what Healthy Blue shared as their goals and their ability to provide services. Their contracts were intended to ensure an overall well-being of any child who was served under their plan for behavioral health, physical health, any medication or pharmacy services, unmet health-related resource needs. So that can include like independent living services for our youth who are about to transition into adulthood. There's some value-added services also for foster parents who can receive 12 free therapy sessions per year under this plan to also provide them with support, long-term services and supports, and intellectual developmental disability services, so IDD services. all with the goals of being able to strengthen and preserve families, increase access to services, improve coordination and collaboration with stakeholders to help avoid boarding in local DSS offices and emergency departments, improve member outcomes, and coordinate care and facilities for seamless transitions. I will say that as we get to a place where we're talking about Some ongoing barriers and things that we continue to address, those things that fall in that very last column, those three things about helping avoid boarding, improving member outcomes, and increasing a continuity of care are things that we still are struggling with. Next slide. So in preparation for this transition, Wake County was committed to trying to make sure to think about any potential barriers that could exist for our young people and trying to eliminate those ahead of time. And so 848 NCFAS records were reviewed by our child welfare eligibility team. We wanted to make sure that an accurate authorized representative was listed in each child's file. because it was clear to us from the state that only the authorized representative that was listed would be able to speak with enrollment services to make any changes or to ask any questions about that member. So we wanted to eliminate that as a barrier and make sure that the appropriate authorized representatives were listed in each child's file. We had over 500 face-to-face transition meetings between the Healthy Blue Care managers and our child welfare staff. This was intentional to make sure that we talked individually about the needs and the strengths of each individual child. We also reviewed what the permanency plans were for the children, any upcoming appointments, who their current service providers were, so that we could talk through any barriers that were gonna be existing, and also that Healthy Blue would be aware come December 1st that they would be ready to have services in place for the youth that we were serving. We had four transition readiness meetings with the state and with our Healthy Blue partners. This was really to look at more systems-wide things that were needed. We needed to make sure that all of our staff had updated NCIDs because Healthy Blue uses a platform called Care Points Connect that allows our staff to log in and be able to communicate with Healthy Blue members. We just wanted to make sure that we had everything needed in place, that our staff had taken all the appropriate trainings. And so we engaged in those meetings to make sure that we were ready. And then one huge systems barrier that we had identified is our eligibility process. And so a big worry that we had when we were working with Alliance, the majority of our youth who enter care had already been served by Alliance. And so Alliance was familiar with those children. They had already been maintaining care management for those children. And so it wasn't a huge leap to transition over and children didn't get lost in the gaps. However, now the process happens where the children aren't even known to healthy blue until a form called a 5120 is submitted to the state. And we wanted to ensure that our process for completing and submitting those 5120s was going to be a seamless process and that we didn't add any time to that transition. And so we did an overhaul, we streamlined the process instead of having the individual social workers complete the 5120s, we have that task assigned to one person, We also streamline the way that our eligibility team is copied so that they know when new youth are entering foster care and that they can go ahead and enter the foster care evidence into NCFAS so that there's not any delays in transitioning over to Healthy Blue Medicaid. Next slide. So some of our early successes and positive impact, we have seen increased collaboration between the care managers, social workers, youth, and placement providers. something that both the foster parents and our social workers feel is very supportive is that the care managers do go out to foster homes and make visits both with the children and with the foster parents so that they're not just leaning on the information from the social worker but also from their own independent interactions about services and resources that are needed what's helpful what could be improved and so that seems to be a positive interaction and a positive difference from what we've experienced before. There is improved access to statewide resources and placement options. I would say the caveat to that is that the providers have to be contracted with Healthy Blue for it to be a benefit. And so we have seen a little bit of hesitancy for providers contracting with Healthy Blue just out of concerns of not being paid or not being paid what they feel like is a marketable rate via the contract. And so that has created some delays. But Healthy Blue continues to actively work on improving their contracts. And so our hope is that eventually we will see that improve. I keep trying to tell myself it's only been six months. And so there's still some time for improvement.

We do have a dedicated care navigator.

support who is in our Swinburne building face-to-face Monday through Friday from 8.30 to 5.15. She does not carry a caseload, and so she's able to act as a liaison. She's here and available to social workers if there's a question, if we need to get member cards for any of our new youth who are entering foster care to problem solve. She's available for those things. And then we've also, as of June 1st, just implemented where That person will attend any of our initial child and family team meetings when new youth come into foster care. So that way she can gather information at the time that youth are entering care because of the transition, they may not be assigned a care manager yet. She can collect the information, make sure it gets back to the care manager and start any preliminary connection with resources. We're also really grateful for the continued availability of some critical non-billable, non-Medicaid billable services. So when we were actively partnering with Alliance to serve this demographic, Alliance helped us put in place some services to support our youth who do await placement in our building. And two of those services include Thompson's Crisis and Placement Stability Services and Pinnacle Therapeutic Relief. And so these are not clinical services, so they're not Medicaid billable, but they do help support positive outcomes for the youth. And so for Thompson's placement and stability. It offers the youth a positive connection who's not their social worker to be able to help support them in the transition to the next placement. We found that a lot of young people were very hesitant to leave the building and go to placement. They have formed relationships with the staff members here, and it's always scary to move into the next, to the unknown. And so these members are people who will help support and still be there after that transition, check in on the youth, They also provide some crisis de-escalation here in the building and their staff actually have offices here for first and second shift of Monday through Sunday, every day of the week. And then for Pinnacle Therapeutic Relief, those are services where those workers actually come in and take the children out into the community and just help them work on their coping skills. And those are positive things that we can put in a placement referral to show how the youth is actively working towards improving on some of their goals. So Healthy Blue covered those services for six months. We were a little afraid that as of June 1st, those services were going to end. But Healthy Blue has again said that the state allows them to cover the services for another six months. And we're hoping that the state can see the value of these services and continue to cover them after December. Next slide. Some opportunities for improvement. Despite available statewide placement resources, we still have not seen a decrease in youth awaiting placement in our office building. And that was something that was a true goal for us and a hope that this would eliminate that as a problem. Today, we have 12 youth who are in our building, and so our numbers have not decreased. I want to say that last Monday, we had risen up to 23. And three of the children who are currently in our building have been here since March. And so that's unacceptable, and we really need to be able to move forward with making sure that processes are streamlined so that these children do not have to await placement in a setting that is not designed to meet their needs. So that continues to be an opportunity for improvement. I'd spoken a little earlier about delays in providers contracting with the network. And that just creates some limited timely access to placements and physical and mental health resources. I'll give an example. We had a young person who was in the middle of some dental treatment. So she had a whole dental plan that was laid out for her. And at the time of the transition, her dentist was hesitant about contracting with Healthy Blue and they were going to discharge her from services to where she would have had to start all over again, or the county would need to pay for these services that are Medicaid-billed services. And so issues like that have created some barriers to ongoing treatment. We have worked out a process. There's an email address now that when we come across providers who have concerns about being paid or just overall concerns about contracting, there's an email address that Healthy Blue has provided where we can contact direct those providers to that email address so that someone from Healthy Blue can talk them through their concerns. I'd like to see something different where there's more of a warm handoff and someone to be able to really address those needs. Delays in transitioning youth newly entering foster care to the Healthy Blue system impacts how quickly services are initiated. So this is a Big pet peeve of mine. As I mentioned earlier, when the young people enter foster care, we have to complete what's called a 5120 form in order for the young person to show up in the NCFAS system. We've kind of figured out a way to put in Medicaid eligibility with our eligibility staff, put in that evidence in the system so that it can switch over quickly. But the way that the Medicaid system rules seem to be written, and I'm giving this presentation as a consumer and not a Medicaid expert, is that even if a young person comes into care, let's say June 1st, that the Medicaid isn't actually active until the first of the following month, and then it's backdated. And so if a young person comes into care on June 1st, the state doesn't have to enact their Medicaid until the first of the following month. We have tried calling enrollment brokers, Healthy Blue does have what they call a fast track system. And so for every new youth that comes into care, we've made it a part of our process that we put in a request from the fast track system for that youth to be fast tracked and for Healthy Blue Medicaid to be opened. But there's no requirement. We've seen inconsistency in how quickly those changes are made. Sometimes they're made within two days. Sometimes we're told that it has to wait until the first of the following month. And so you could have young people who don't have access. They still have Medicaid from whatever, whoever their previous provider was, if it was Alliance or Viya or Trillium, but they're not really transitioning to the Healthy Blue specialty care plan sometimes until 30 days later. And then we just like to see a greater urgency and sense of shared responsibility to ensure that the needs of our children are being met timely. It's in a future slide, but we have weekly meetings to talk about some of our high needs youth and the resources that are in place. And we put those on weekly with Healthy Blue and our child welfare social workers so that we can keep things going. And it seems as though the system is just very overwhelmed because several weeks, sometimes in a row, it's the same update and things haven't really moved forward. And that's just unacceptable for our youth when we know that there's an identified need. we need to be working towards addressing that. Next slide. So collaborative actions that are underway to attempt to address things or make things better. As I mentioned, we're conducting weekly multidisciplinary staffings with Healthy Blue Care managers, our social work supervisors, and our Wake County placement team with the intent of identifying our agendas to look at three barriers towards helping a youth get their needs met. And let's talk about some actionable next steps that are going to help us to move that along from one week to the next until we hopefully can remove that youth from the agenda. We also hold monthly leadership meetings where we're not talking about individual cases, but more about systems-wide changes that need to be made. For example, one thing that we're working on, the state has allowed, there's a law in place, it's NC-122, that allows us to invoke and that hospitals, MCOs, and DSS agencies all have some responsibilities when we have a youth who presents to an emergency room for a behavioral health crisis and doesn't have an adequate discharge plan. Prior to NC-122, those young people were discharged to the building. Now through this process, we can invoke and then we all have meetings to talk about mutual responsibilities of how to get services in place, the appropriate services in place for the youth. Healthy Blue doesn't have a, process in place for how we invoke with them and make them aware that we have a child in the ED. During the daytime, we've just been calling the care manager, but especially in the evening times. And this is something we've talked about since November prior to the plan being implemented. And so those are some of the things that we continue to talk about our monthly meetings when there are more systems level opportunities for changes and things that need to be worked on. We definitely have engaged our county leadership, very appreciative of deputy county manager, Mr. Holder, who has attended some of our meetings with Healthy Blue leadership and some of our state leadership and continues to elevate systems barriers impacting our children and families. Thank you to our behavioral health director, Denise Foreman, who was going to help put together a pilot of meetings between us and Healthy Blue to more map out some of the systems barriers and have a collaborative approach to what some of the solutions could be to those barriers. And then we continue to partner with state leaders to evaluate outcomes. One thing that is super frustrating is it would be nice to use the opportunity of having a statewide system to determine statewide successes and then also statewide gaps. It seems like there would be an opportunity now to look at data and see where there are service areas that need to be put in, implemented in the state to meet the needs of our youth. It just doesn't seem like those opportunities are being utilized to our advantage. We know that there's one adolescent residential substance use treatment facility in the entire state to serve all adolescents struggling with substance use across the state. that's a clear barrier and that's something that the state could receive some data from this plan and know that that's a place where we need to improve. We also continue to advocate for, since we are at a six month timeframe, we really advocate that the state maybe send out surveys or have some interest meetings to hear from our DSS agencies, to hear from the service providers and also from some of the youth who have been impacted to make sure that this plan is achieving some of the desired outcomes that they had for the plan. There are definitely some areas for improvement and ways where we could pivot, and now would be the time for us to assess and move forward with that. Next slide. So just in summary, Wake County was prepared. We reviewed 848 records. had over 500 in-person transition meetings and redesigned internal processes to help decrease barriers. Progress made. We do have stronger partnerships with Healthy Blue and continue to develop those partnerships. There's some dedicated care coordination and improved communication, and the work continues as we continue to address placement barriers, improve provider participation in contracting, and advocate for timely access to care. And I

that i think that's my last line i'm happy to answer any questions that folks might have thank you so much miss wimbish for just such a thorough and comprehensive presentation and it's So obvious that you and your team are just boots on the ground working on this. And I just really appreciate all of your perspective and highlighting things that potentially are good, but really opportunities for improvement. And just thank you. Thank you for that. Commissioners, we've got about five minutes or so for questions. Does anyone have any questions or comments?

Yes, I do.

Okay, go right ahead.

Ditto what you said. Thank you, Diamond, for such a comprehensive look at what's working, what's not working, and what you all are doing to see some opportunities to make it better. I've been thinking a lot about this since it rolled out in December, what we gained, what we lose, and there was a lot of promise to this model. So I have just a couple quick questions. In the collaborative actions underway slide, did I hear that you are already partnering with state leaders to evaluate outcomes or you are suggesting that that be taken up?

I'm suggesting that that be taken up. That's something we have state representatives come to our child welfare leadership team meetings. And that's something that we've suggested in the last couple of meetings that that would be a great opportunity. When we are in meeting settings with other DSS agencies, they are having similar experiences as we are. And so how do we get the state to hear that and be able to address those concerns?

Okay. Okay. That's great. It seems like it would be a very obvious thing to do six months in. So I hope that those state leaders that you all are appealing to will take that up. I look forward to hearing if that will happen. Duane, do you want to add to that?

Yes, I'm sorry. Thank you, Vice Chair, and thank you, Diamond, for the presentation. I just wanted to add that in addition to some of the preliminary work that's been done in meeting with Healthy Blue, Denise Forman and myself actually have recently met with the Deputy Secretary at DHHS, as well as, which is Mike Lays, and also Angela Boykin, who's the CEO of Healthy Blue. There is a recent full court press to look at Wake County because there's a feeling that if we can, quote unquote, fix things in Wake County, it will also help the entire state. And so we'll be including Diamond and Sheila and folks at DSS, as well as some staffers at Healthy Blue and at State HHS to kind of do some more deep dive looks into the systems and what things are Healthy Blue strapped with that the state has implemented in their contracts that may be also conflicting or challenging the progress that we can make in getting kids placed adequately. So we will keep you updated as we work through that with the state and with Healthy Blue.

Great. Yes, please. Thank you. That was going to be my next question. What do we know that's getting in the way of the placement barriers? Sounds like some more looking on that is happening.

We're discovering that, yes.

Okay, great. And then my last question, we just had Alliance Health here and I know I spoke with them before this change and about their commitment to this particular population. But what can you tell me about the network and provider participation before and after? Did we lose when it shifted from Alliance to this Healthy Blue? What's happening with our provider participation?

I think we definitely gain providers from other parts of the state. I think that there are also some mom-and-pop providers who are here within our catchment area who are really concerned about the switchover, maybe because they've heard bad things, maybe just because of a change. So really trying to get them information directly from Healthy Blue so that they can make informed decisions. UNC, even though this rolled out December 1st, UNC, I don't believe contracted with Healthy Blue until maybe February or March of this year. So from what I've heard anecdotally is that there is a difference in pay that is contracted through Healthy Blue and with some of the other providers. And that also is a concern for providers.

Thank you.

Did that answer all your questions, Vice Chair?

Yes, I look forward to continuing to follow this with you all. Thank you, Duane, Diamond, and Commissioner Stallings, and I know you're right in the middle of this, too.

Well, we will continue to monitor this closely and provide updates. Commissioner Evans, I thought I saw your hand. Did you have a question?

No, it got covered, but thank you. I appreciate the update very much.

Yes, I do too. And just lastly, I'll just say, I mean, it sounds like to me, Wake County has a good pulse on this, things that are going well and opportunities for improvement. And I just appreciate our staff being willing to be pilots. for this. Geographically, it makes sense to just where we're located. And, you know, I know that's part of it, too. But just thank you for being willing to to offer us as a model of intervention and possibility, because I think you're right. If we can get it right here, it'll have lessons for the whole state. But I really appreciate, Dwayne, your work, Denise and others. This is so important. And we waited so long for this to be launched. And we heard so many good things about how it was supposed to be. And maybe six months, maybe it's too soon. But yet, we need these kids to get the services they need. And like you said, it's not acceptable where we're at. But thank you for the work that you're doing, and let us know as a board what we can do to support you in this effort, because we clearly support you and our children, particularly with complex needs. So if there's more we can do, please let us know. We will.

Thank you for the opportunity, and thank you for your ongoing support.

Yes, ma'am. Thank you for the work. All right. Well, we're going to transition to our last presentation. So clearly, last but not least for sure is we're going to have Darlene Singletary come on board and talk to us about our maternal and infant mortality work group report. There's been a lot of work on this important issue. We know Wake County does a lot of good things, but we have disparities still there. on a number of issues, unfortunately, and this is one of them. So Darlene and Commissioner Thomas sort of co-led this work group, and Vice Chair Jackson and I participated as well. So Darlene, the floor is yours to update us on where we're at and where we're going on this important issue. Thank you for being with us.

Thank you. Thank you for extending the invitation. So I'm very excited to give this brief update on where things are since the convening of the maternal and infant mortality work group. So, yes, I put together a few slides and just plan to kind of give all of those who aren't as familiar a background or overview and then kind of give you all an up to date of where we are today. So just reiterating, my name is Darlene Singletary. I'm the maternal and child health section manager within Wake County Public Health. And we can go to the next slide, Ben. So just to start off a little bit with background. So in response to the different disparities that we noticed here within Wake County, there was a new Wake County maternal and infant mortality work group that was launched in 2025. Prior to that, back in 2019, 2020, there was a infant mortality work group, but Last year, what was decided was that we were gonna include the maternal aspect as well. So with that, what we were wanting to look at was how do we improve care, particularly for those vulnerable populations within Wake County, aiming at how do we make the county a safer place for childbirth? So as you can see here, I wanted to include some statistics just to kind of give a story of what the maternal and infant outcome or health looked like at the current time of when the work group was convened. So as you can see, Specifically for Black infants and Black women here in Wake County, for Black infants, they were twice as likely to die within the first year compared to other races, as well as they were at a higher risk of having a higher rate of preterm birth, meaning that they were born before that 38 to 40 weeks, low birth weight, as well as infant mortality compared to other groups. And then for Black women, it showed that they faced a higher rate of severe pregnancy complications.

Next slide, please.

So because of those different alarm and disparities here in the county, the maternal infant mortality work group began meeting back in March of 2025. This was led by myself as well as Commissioner Shanika Thomas. And then we also brought in a facilitator from UNC to come in and help us to guide these conversations, but also too, to help us to drive the work. So over a 10-month span, we were able to convene different members throughout the community. And we wanted to make sure specifically that it was a diverse group. So we wanted to make sure that we include parents and those with lived experiences. We wanted to ensure that we had health department staff, public health providers, researchers, community advocates, and all of the above. So throughout that, we were able to meet to where we were able to analyze data, discover and discuss root causes and explore new and existing resources that the county had. Next slide, please. So from that, The purpose of the work group was for the stakeholders to come together with a common goal of how we were going to look at improving maternal and infant outcomes here in Wake County. So we wanted to look at four different things. We wanted to address, assess, identify, and examine. Address meaning that we wanted to look at what the health disparities were. Assess, we wanted to coordinate what were the existing resources and what could we look at implementing that was new. And then we also wanted to identify evidence-based strategies so that we can look at how will we tailor out what our recommendations or our focus areas would be to reduce the inequities and the different disparities that were noticed, as well as examine those recalls and those structural factors that were the driving things that contributed to those disparities noticed. Next slide, please. So as we started to think about maternal mortality and even infant mortality, we had to start thinking about things like how are we able to end preventable deaths for women and babies? One thing that we knew is that every pregnant woman and newborn baby needed to have access to skilled care at birth with evidence-based practices. And we wanted to make sure too that we had to look at things like how is it going to be, or how do we assess to know that it's delivered in a humane, supportive environment? Because from our findings and from our conversations, One thing that we could all agree on was that whenever a person or a birthing person was given good quality of care, and if it was given in an appropriate way, whether that was clinical or non-clinical interventions, that helped to strengthen the health infrastructure, but also to that overall experience and outcome for mom and baby. From that, the outcomes that we specifically looked at was maternal and infant mortality, as well as severe maternal morbidity. Just looking here, just kind of looking at some of the statistics that I mentioned earlier, but if you look more so at the severe maternal morbidity, you can see that here in Wake County between 2020 and 2024, there was a we looked at the different rates of the near misses. What the near misses means that the mom, it didn't lead in a fatality, but it did lead to complications. So those were things too that we wanted to take into consideration that, you know, what were some things that contributed to this mom having a poor birth outcome and what were the things that could be done or put in place to improve that outcome for her next birth, but also too for the next mom that was going to deliver or go through a childbirth experience.

Next slide, please.

And I did want to highlight, I know I mentioned that we had a diverse group of committee members, but I did want to highlight the different organizations that were representatives of this work group because it extended between nonprofit organizations, Medicaid plans, hospitals, provider offices, as well as early childhood development. So I wanted to highlight a little bit of those folks that were a part of this work and still a part of this work. Next slide. And just to highlight a little bit of the folks that were there, these are the people that were actively participating over that 10 month span and were able to contribute and provide really good valuable information that helped us to develop the 2025 report. Next slide. So during that 10 month span, we were able to meet about eight different times. And each time we tried to ensure that the agenda was set to where we were talking about different things, or we continue conversations from the previous meeting. So just to give a quick summary of what were the things that we kind of build upon and discuss to get to the end game of the report and the ongoing interventions. We started off with things like looking at building understanding of what maternal and child health issues were within Wake County. We wanted to make sure that we identified different interventions in the gaps, conduct that route analysis, as well as conduct surveys. Because one of the major things that we wanted to keep in mind was that, you know, us that were a part of the work group, Although we had people with lived experience and parents, we also wanted to make sure that we had the voice of the community, specifically for those that were impacted by any type of infant mortality or maternal morbidity issues. Next slide, please.

Okay.

Sorry about that.

And then also for the Later end of the meetings, we were getting into making sure that we really pulled out what the community were saying were contributing factors to the maternal and health or maternal and infant health outcomes that they were noticing. And that really helped us to pull in and identify what our priority areas were going to be. We wanted to be inclusive of not only the community, but also to the professional settings, but also to what the data was showing us. And that really helped us to refine our recommendations, our focus areas, and also to be able to identify supporting resources that can directly influence and impact the outcomes and the suggestions that were made. Within our last meeting, we were able to review the report, but also to One of the things that we wanted to make sure of is that we didn't just develop a report and it just sat there. We wanted to make sure that those that were at the table knew how to align themselves with others that were in the room, but also to other organizations and agencies that were working directly with the populations that we knew were being impacted. So one of the things that we also were able to discuss and review with the community members was a partner alignment. and implementation strategy plan to kind of show them, you know, this is the population that you're working with. This is the gaps or barriers that you're noticing within your system. However, this organization over here, they provide the things that you're missing. And this is how you should be able to connect and align your work together so that you can be able to be more impactful with reaching the community that is the top need or the vulnerable population that you're working with. Next slide, please. So from that, in January of this year, we published our 2025 report. It was very comprehensive. It included stories from residents with lived experience. It also included a story from a Wake County staff person that also had lived experience. It also highlighted our key focus areas. It included existing resources because we also wanted to make sure that we didn't have to reinvent the wheel if we didn't have to. But it also was able to provide that implementation plan that spanned over three years because we understood that You know, a lot of work may not happen within the first month. A lot of work may not happen within the first year. So we kind of broke it out into a yearly plan to where within year one, we would like to see X, Y, and Z completed. Within year two, we would like to see these things completed or at least conversations started around these things to where we can look at more ways of how we can implement these efforts. Also within that, we were able to look at different things like a toolkit as well as a resource map that was developed to support the work, but also to serve as a guide for many organizations, but also something that could be shared out to the community. Next slide, please. So from there, our focus areas were quality perinatal health services, women's health promotion and education, as well as community engagement and wraparound care and early childhood education development and care. Next slide, please. So. From that, just to explain a little bit of what each focus area, what we meant by those titles is focusing on improved, for quality perinatal health services, we wanted to focus on improving access to high quality patient-centered as well as culturally competent prenatal and postpartum care to reduce maternal and infant health disparities. With this, we wanted to emphasize on providers training, trauma-informed care, as well as targeted support for populations most impacted by severe maternal morbidity, preterm birth, low birth weight, as well as infant mortality. Next slide, please. And then for focus area two, we wanted to focus on increasing education, as well as awareness about women's health issues that disproportionately impacted maternal health across the contraception, prenatal, as well as postpartum periods. Within this, this emphasized partnership and community engagement, such as things like the Hear Her campaign, as well as the I Gave Birth initiatives. And within these initiatives and campaigns, they really had an emphasis on how you help women, family, and providers recognize urgent maternal warning signs and how are we able to access more supportive resources.

Next slide, please.

Focus Area 3 was focusing on strengthening the coordination and access to family support services across prenatal and postpartum periods. It emphasized expanding community-based doula programs, community health workers, transportation, home visitation programs, as well as the supporting network to ensure continuous comprehensive care for birthing people and families within Wake County. Next slide, please. And then for our last focus area, we wanted to focus on how do we increase access to high quality, effective or affordable early childhood education and childcare, specifically for infants, toddlers and children with special healthcare needs. And the emphasis behind that was that we were looking at supporting families, strengthening the childcare workforce and improving early development outcomes and to prepare children better at a better rate um for kindergarten and beyond next slide please and of that like i mentioned before there were uh different resources that were developed and created during this time during this time we had a graduate student to assist with the work of the work group and during that time she was able to develop what we call the maternal and child health best practice toolkit this was in collaboration with our population health team within public health And really what this toolkit served as was a guide for maternal and infant health efforts. This was something that our stakeholders and even internal folks could use as a way of how they can implement, how they were able to guide and drive efforts. And if they were not non-related to maternal and child health populations or services, it showed them how they could become more integrated with improving the health outcomes through collaboration and advocacy. Next slide, please. Another resource that we were able to develop, which I always get very excited when I start to talk about this, because I think that this was something that was missing. And I think that is a great asset, not only to those that are working with maternal and infant populations, but even just for parents and caregivers themselves. So one of the major things that one of our interns was able to do was develop this Google Maps. And this is pretty much a maternal and child health Google Map that lists out different maternal and child health resources. And it expands from OBGYN and pediatrician offices It shows folks where they can access lactation rooms and breastfeeding support. It talks about where they could access doula services. It talks about women and children's shelters as well as food pantries. It also includes things like childcare providers and things of that nature. And one of the greatest things about this Google map is that being that it's connected to Google is something that kind of updates on its own as those providers updates their information. And this was very helpful because as we started to think about, you know, what could we look at that could be like a resource hub? One of the major things that kind of impacted how to move forward with that is the capacity. And is there one person that could kind of stay on top of that? Being that this is something that Google allows that we could create, Google kind of helps to keep that information as up-to-date as possible. The only thing that we typically have to man is just adding in more resources as we learn more. And since the launch of this, we've had over 9,000 views between either our staff, partners, or families themselves.

Next slide, please.

Now, after all of that, you know, we had great conversations over those 10 months. We were very excited about the report and it was very comprehensive to show all of the hard work that was put into it, but also too, to give a good detail of what the maternal and child health state looked like. for Wake County. But we also wanted to look at what's the sustainability around this? How do we ensure that this work just doesn't sit here and we can continue these efforts and continue to go on that momentum of the committee members as well as the community? So one, is that we decided as a group that we will convene within six months, which we will have a meeting next month, and then we will meet once a year over the next three years. And what that work group check-in would kind of consist of is just a report out to show, you know, this is where we're moving within this implementation plan. These are the contacts or these are the things that have been done to kind of help drive or push the needle. We also were able to work with our population health team again to look at a system called Apricot 360. And this is what we call a customer relation management system. So this really helped us to... be able to monitor and track partnerships and relationships. So, you know, being able to see, you know, has Smart Start been communicating with the public health center or has the public health center been communicating with advanced community health? So being able to track those relationships and being able to see what is happening with the relationships or the connections that have been made. And then also, too, we started off with hosting multiple town halls throughout the county because we also wanted to make sure that the work group report wasn't just something that we as the committee was aware of or that professionals were aware of. We wanted the community themselves to know that a report had been developed and to pretty much provide them guidance and understanding of what it consists of, but also how they can contribute and work to help us with improving the outcomes. So, so far, we've hosted town halls within different regions here in Wake County.

Next slide, please.

All right, so KEEP Community Partner Highlights. So one of the things I wanted to kind of show you all is just where things have been going since the work group had their last meeting. And since then, like I mentioned before, we have the town hall meetings. We've also collaborated with the Health Lit for Weight team and we're able to collaborate to do what we call Ask the Doc. We've been able to provide that in both English and Spanish. From that, we've been able to provide or contribute to more supportive community outreach and engagement. Another thing is we've been able to have some conversation with Carolina Complete being that one of their medical directors was a part of the committee. So we were able to have her to be one of our reoccurring panelists within our town halls and ask the doc sessions. And with events community health, this is one of the providers office here within Wake County. We've been able to have conversations with them in which they are very on board with how they are able to partner with their centering program to be able to offer those doula and postpartum parenting support to families as well as the libraries. This is a place that we know that a lot of families frequent often. So we knew that this is a great place to be able to share this information and they have allowed it to be where we can go out and be able to promote the report, but also to be able to provide them with a physical copy that they would put in each of the libraries.

Next slide, please.

And then I just wanted to show you all so far how many town hall meetings we've had or promotional opportunities we've been a part of. So as you can see, just to highlight a few, we've been able to actually go to Wake Tech, and they do provide a community health worker course where the two young ladies that have been a part of helping with the town halls, they've been able to go in and provide presentation on what the maternal health report looks like how the CHWs could be a part and where their roles lie. Other places have included the UNC-REx perinatal region five nurse leadership meeting. And this is where there's a diverse group of nurses that are working within our area and other counties to look at how to improve maternal health. Next slide, please. And then just community impact. So, so far since About February, March, we've been able to reach over 600 people through various things. So like how I mentioned before in the last slide, the town hall meetings and different things like that. So far, we've been able to reach a good number of folks. We've been able to go within the different regions. We're still working to get into the southern region. But things have been very... very great with people being very receptive of learning about the report and also to looking at how can they contribute to improving maternal and infant mortality here within the county. Next slide, please. And I just wanted to show you all the flyer for our next town hall, just if anybody is interested. This is something that we were able to connect with the Wake Forest Rotary. and they provide it to where they're gonna offer a space and provide food for participants to come out and learn. They've also been able to promote this very well for us. So next month, July 16th, we will be hosting another town hall meeting within Wake Forest. And as you can see, we have a few different panelists that will be there to talk about the report, but also too, just to answer questions around maternal and infant mortality here within Wake County. Next slide. And then lastly, next steps with all of that we have done within this short period of time, there are still other things to do or things that we have lined up and set to do. So one is that we're going to continue to meet with different community partners to educate them on the report, but also to be able to show them where they align. We've also, like I mentioned before, promoting the report at the Wake County Libraries, being able to establish a collaboration with Carolina Complete, as well as the other PHP plans. And then also being able to provide TA support to partners to assist with connectivity and data tracking. So this is more so for those committee members or those that are just wanting to contribute to this report, being able to have those conversations with them on what data they should be looking at or pulling, but also to what is that connective tissue when it comes to the improvement for our moms and babies. Next slide. And that pretty much concludes where things are so far with the maternal infant mortality report and the work of the work group. And I definitely would like to open it up if any of you have any questions for me.

Darlene, this is amazing. And I just can't thank you. And I see Tiffany is on as well. And all the work, you know, having been on the work group, just the commitment and dedication to the team was just phenomenal. phenomenal and you and commissioner thomas did such a wonderful job leading and vice chair too and it was just a really good effort and i'm convinced that this will sustain this will also not be a plan that sits on the shelf this has legs and we will make sure that we continue to make improvements and reduce these disparities all right commissioner thomas go right ahead

Thank you so much. And thank you, Commissioner Stallings, for not only serving on the work group, but bringing this forward to the committee so that the other commissioners can hear about what we did. So a couple of things, Darlene. Thank you so much. I know that this was not easy work. there were lots of times Darlene and I had conversations and I was like no we're not going in the right direction we go that way go that way um and so we had to have lots of those conversations but I really want to applaud you for the continuation of the work I think that this is something that we had talked about I had brought up to our board for multiple years I know that Commissioner Adamson served on an infant mortality work group when she was first elected And I really wanted to focus this more on the mothers, on the maternal mortality. So a continuation of that work. So thank you so much for that part. I appreciated, too, that there were so many different folks at the table. I mean, from lived experience to fathers, all of those things were present when we did this work. Also, I think that everybody wants to call me. OK, maybe they're excited about the maternal health work group work. So thank you for bringing all those folks to the table, the fathers, the lived experience, the practitioners, and not just practitioners from Wake County Public Health. I think that was an important thing too. Lots of times when we do things like this, we see folks who take all the work on themselves. These recommendations cannot be done only and implemented only by public health. We've seen that before. And so it was great to have other partners at the table, whether that was Duke Health or like you said, Advanced Community Health or so that they could actually own some of these. So the partnership that we got out of this, I think where they took ownership to was really, really important. My favorite part is going to be the Google map of resources. and how it continually updates. I look at what it looks like today versus what it looked like when we first ended the conversations as a group. And so many more people are getting engaged and involved and doing this work with us alongside us. So I think that that's my favorite part. And I think that was one of the best things that came out of this work group so that folks in community can find the resources they need and don't always have to rely on searching our website or they find it where they are. And that's really important. The last thing I would say is, Darlene, to you and your team, thank you so much again. I saw, last week I was at the North Carolina General Assembly for some advocacy days for counties, and I saw several of the folks from Wake County Public Health there. They were there for the Momnibus and Senator Natalie Murdoch's press conference. on this work and other work around maternal mortality. And they were also there lobbying members of the General Assembly. And so the partnership is not just with folks in community, but it's also with our legislators at the General Assembly, with other folks around the country. We've talked to folks in Franklin County, Ohio, who have very, very good programs. And so the partnership is really reaching across several areas. and elected bodies. So thank you so much for that work. So I said all that to say, Commissioner Stallings, I didn't have a question. I just wanted to give Darlene and our public health folks and you and Commissioner Jackson your flowers for doing this work. I asked for this for a long time, and I was thrilled when it started, and it was hard work, and I'm thrilled to see where it's going to continue to go and how it's going to change outcomes for our community. So thank you so much. Absolutely.

All right, Vice Chair, go right ahead.

Yes, I just want to say, Darlene, I offer my help. Let's get something going in the South. I'm excited to bring this report and hear what folks think in the southern part of the state. So I'll follow up with you so that we can get that scheduled, hopefully before the summer ends. I know time is clicking away.

That would be great.

And then the other thing is regarding the community resources. I don't see... on the line here, but another opportunity to get the word out. I don't recall if we ever did a press release regarding the resources. But I think it's time to do that, and I just request that we, it's great to see how many people have already used it, but now that we're six months in, it's just a real opportunity for us to have another touch point. So I want to just follow up with that as well, to just continue to get the word out, because like you said, Commissioner Stallings, the plan has legs, but oftentimes this topic is a bit taboo or unknown. And we really do have to socialize the urgency of preserving life for women and children, and specifically black women and children. So thank you, Darlene. It's been a pleasure working with you, Commissioner Stallings and Thomas, and I look forward to our big meeting six month check in next month. Thank you.

Thank you.

Yes, absolutely. And if I can help you in the West, too, I know those numbers were a little bit low. Let me know, Darlene, as well, if I can provide any support in that direction. And I also want everybody to know we're also going to have Darlene speak at our county Health and Human Services board meeting as well with an update of this, probably in the early fall. But if someone hasn't reached out, Darlene, they will be to see if we can get you on the calendar for that as well. So any remaining comments, anyone? Questions? Okay, if not, thank you again so much, Darlene, for the work and for the continued work, and we look forward to supporting you along the way. All right, everybody, I'm going to call this meeting adjourned, take a little break, and I'll see commissioners and staff at 2 o'clock. Bye, y'all.