►
From YouTube: Severe Mental Illness Task Force (10-19-21)
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
Additionally,
in
the
environment,
unfortunately,
we
still
see
a
lot
of
stigma
related
to
the
the
use
of
medications
and
the
treatment
of
mental
health
disorders,
and
so
stigma
can
be
from
coming
from
anyone.
So
it
could
be
coming
from
their
health
care
provider.
It
could
be
coming
from
someone
that
they're
living
with
judging
them
or
treating
them
differently
because
of
their
mental
health
disorder.
A
So
they
don't
want
to
take
the
medication
so
that
they
don't
are
perceived
as
having
one
or
they
could
be
going
to
the
pharmacy
and
having
stigma
or
being
treated
differently
when
trying
to
pick
up
their
medication.
So
they
stop
going
to
the
pharmacy
or
stop
seeing
their
health
care
provider,
but
also
the
mental
health
care
system
is
difficult
and
can
be
difficult
for
them
to
navigate
so
not
having
access
or
being
able
to
adequately
transport
to
a
different
provider
or
to
receive
their
medications
can
also
lead
to
non-adherence.
A
Additionally,
their
relationship
with
their
prescriber
can
determine
adherence.
So
if
the
prescriber
is
just
putting
medications
on
them
without
having
collaborative
dialogue
and
understanding
of
what
the
patient's
preferences
are,
that
could
lead
to
not
adherence
or
they
may
feel
like
the
prescriber's,
having
control
or
power
over
them,
and
then
the
medication
itself
and
it's
the
treatment
regimen
could
be
a
predictor
of
non-adherence,
so
it
could
be
on
a
complex
regimen.
A
I
don't
know
about
you,
but
if
I
have
to
take
a
medication
more
than
once
a
day
or
even
once
a
day,
it's
really
hard
to
remember
to
do
that,
and
so
in
someone
who
is
having
or
suffering
from
severe
mental
illness.
This
can
be
even
more
difficult
and
then
a
lot
of
these
medications
do
have
side
effects
associated
with
them
or
they've.
Had
previous
negative
response
to
treatment,
and
so
that
will
prevent
them
from
wanting
to
continue
to
take
the
medication
or
try
a
new
medication
in
the
future.
A
A
So
I
listed
some
of
these
already
so
providing
them
education
about
improving
adherence
organizers,
simplifying
their
dosing,
regimen
we're
starting
to
see
these
pill
packs
put
together
to
to
put
all
of
their
daily
medications
into
one
little
packet.
That
does
have
an
additional
cost
to
it,
but
we
do
have
long-acting
injectable
antipsychotics.
So
that's
giving
a
a
less
frequent
dose
of
medication
that
lasts
a
longer
period
of
time,
and
then
we
do
have
the
assertive
assertive
community
treatment,
services
or
act
team
a
little
bit
more
about
long-acting
injectables.
A
So
these
are
intramuscular
or
subcutaneous
formulations
of
antipsychotics
that
can
be
given
between
every
two
to
26
weeks,
so,
instead
of
a
once
a
day
twice
a
day,
sometimes
three
times
a
day
oral
medication.
These
decrease
pill
burdens
significantly
while
maintaining
stable
drug
levels,
and
this
improves
adherence
and
decreases
hospitalizations.
A
A
What
I
see
in
daily
practice
is
prescription
insurance
coverage
so
with
the
with
all
of
our
managed
care
organizations
going
under
med
impact,
now
we're
requiring
prior
authorizations
for
every
antipsychotic,
and
so
this
leads
to
more
frequent
denials
and
delays
and
treatment.
A
So
when
I
was
in
the
inpatient
setting
and
trying
to
discharge
patients
out
of
the
hospital,
we
were
not
able
to
get
their
medications
approved
by
insurance
to
be
covered
before
they
could
leave
the
hospital
so
that
led
to
us
needing
to
pay
for
their
medications
or
delaying
ability
to
give
them
their
medications.
At
discharge.
A
There
are
issues
with
transitions
of
care,
so
communication
between
inpatient
outpatient
providers
and
making
sure
that
there's
follow-up
from
the
inpatient
setting
to
outpatient
setting
and
then
in
kentucky.
We
do
have
issues
with
proximity,
to
pharmacists,
to
pharmacies
and
to
specialists,
and
then
other
barriers
include
cultural
competency
and
the
stigma
that
I've
talked
about
so
ways
to
improve
access
to
medication,
so
rational
selection.
So
we
need
to
use
these
guidelines
that
we
have
to
maximize
clinical
effectiveness
and
minimize
harm.
A
We
also
need
to
improve
the
availability
of
these
effective
medications
and
have
them
available
on
our
prescription
formularies
and
not
be
restricted
to
just
solely
selecting
medications
based
on
price
or
what's
available
on
formular,
because
they
may
not
necessarily
be
most
clinically
effective
with
minimal
harm
and
then
making
sure
that
there
is
an
affordable
option
with
insurance
coverage
and
co-pays
and
an
appropriate
use
of
medication.
So
we're
not
wasting
our
scale
scares
mental
health
through
resources
and
respecting
the
patient's
choice
and
just
to
highlight
what
I
do
as
a
psychiatric
pharmacist.
A
So
we
help
with
many
aspects
of
this
so
help
reduce
the
cost
of
mental
health
care,
help
resolve
adherence
issues
that
someone
might
have
providing
them
education
and
also
providing
doing
prior
authorizations
and
providing
long-acting
injectables.
If
those
are
covered
by
insurance
for
the
the
patient
and
can
be
used.
C
Actually,
this
is
a
topic
that's
near
and
dear
to
me,
just
in
terms
of
adherence,
I
think
you
know
I
was
going
through
the
list
of
medications
that
you
had
on
there
and
how
many
of
those
I
commonly
prescribe
in
long-term
care
settings
in
nursing
home
settings
and
how
many
individuals
with
smi
are
kind
of
finding
their
way
into
longer
term
settings
these
days
here
in
kentucky
and
the
difficulty
we
have
with
you
know:
people
adhering
to
those
medicines
in
an
outpatient
setting
is
probably
what
you're
referring
to.
C
C
The
rules
there
are
kind
of
generally
the
same
as
far
as
a
doctor
wanting
to
prescribe
a
medicine
for
somebody
you
get
into
long-term
care,
and
I
don't
think
people
are
aware
of
this,
but
it's
something
that
it
needs
to
be
mentioned,
that
a
lot
of
our
nursing
homes
are
basically
dinged
or
they're.
They're
marked
down
for
having
people
on
any
psychotic
medications.
So
you'll
have
a
lot
of
folks
who
might
have
dementia,
with
significant
psychosis
they're
admitted
to
a
hospital
they're
put
on
a
low
dose
of
seroquel
or
a
low
dose
of
an
antipsychotic.
C
They
do
very
well.
Behavior
is
controlled,
they're
functional,
but
they
come
to
a
nursing
home
and
if
they
keep
them
on
that,
without
the
diagnosis
of
schizophrenia,
that
nursing
home
is
marked
down
in
quality,
saying
you're
a
substandard
facility
for
giving
someone
without
the
appropriate
diagnosis.
C
Whoever
made
that
up
and
saying
you
are
low
level,
you
have
low
quality
because
you're
keeping
someone
on
that,
even
though
they're
functional-
and
you
can
write
your
note
as
pretty
as
you
want
the
reports
to
go
to
the
federal
government,
all
they
care
about
is
how
many
folks
do
you
have
how
many
are
on
these
medicines?
If
you
have
too
many,
if
you're
above
the
national
average
you're
trying
to
do
people
up
and
they
ding
you
for
quality,
maybe
you
could
comment
on
that.
C
I
don't
know
if
you're
hearing
a
lot
of
that,
I
find
it
very
frustrating
because,
as
we
get
more
and
more
folks,
most
of
the
referrals
we
get
now
at
least
half
or
more
are
on
some
of
these
significant
medicines.
And
if
I
try
to
wean
them
off
of
it
and
they
don't
do
well
and
they
wind
up
going
back
to
the
hospital,
you
try
to
keep
them
on
it.
But
if
you
have
too
many,
you
get
marked
down
in
quality
and
you're
you're
labeled
a
substandard
facility,
and
you
get
written
about
in
the
newspapers.
A
Yeah
and
I
am
familiar
with
the
requirements-
and
I
think
from
what
I'm
aware
of,
is
as
long
as
you're,
showing
that
you're
trying
to
reduce
the
medication
or
you've
done
a
trial
within
a
certain
time
frame
that
is
appropriate.
But
what
we've
also
seen
is
that
we're
getting
a
lot
of
denials
of
our
patients
to
be
able
to
go
to
long-term
care
facilities
because
they
may
already
be
on
an
anti-psychotic.
A
A
The
the
black
box
warning.
That's
on
the
medications
that
have
been
placed
on
there
from
the
fda
and
their
input
and
role
in
it,
but
I
don't
necessarily
see
a
way
around
it.
Unless
those
adjustments
can
be
made
to
what
the
requirements
or
standards
are
in.
The
monitoring
and
adjustments
of
the
medications.
C
Right
now
I
appreciate
that,
and
there
are
warnings
and
you
check
labs
for
those
purposes
for
diabetes
and
cataract
issues
and
all
kinds
of
things,
those
medicines
you
do
those
screenings
appropriately,
but
it
it
just
comes
down
to
a
matter
of
numbers,
because
what
they'll
judge
you
on
is,
if
the
percentage
of
patients
you
have
either
above
a
certain
percentage
or
above
state
or
national
average,
and
so
what
happens?
Is
they
don't
want
those
folks,
because
the
more
than
you
take
your
numbers?
Look
worse,
you
get
dinged
on
your
quality.
C
You
can
do
everything
right
and
do
everything
appropriate
and
it's
appropriate
for
them.
If
you
don't
have
you
know
unless
you're
an
expert
and
I'm
an
internal
medicine
guy,
but
I've
got
to
label
somebody
as
having
schizophrenia
to
be
able
to
get
them
qualified
to
take
that
medicine
and
not
have
it
hurt
you,
even
though
they
may
not
have
that
diagnosis,
but
it
helps
them
in
other
regards
I
just
wanted
to
make
that
mention.
Mr
chairman,
thank
you.
B
Okay:
okay,
thank
you,
mr
dr
johnson.
We're
glad
to
have
had
you
here
today
and
I
brought
up
that
there
were
pharmd's
who
specialized
in
antipsychotics
and
no
one
knew
about
them,
so
we
count
them
throughout
kentucky.
There's
about
13
like
you
here
in
the
state.
So
thank
you
very
much
for
presenting
I'm
a
pharmd
also,
so
I
was
glad
to
see
anti-psychotic
farm
to
econ.
Thank
you
for
having
me
okay,.
B
E
Good
afternoon,
thank
you
co-chair
bentley,
and
thank
you
to
the
task
force
for
giving
me
the
opportunity
to
speak
today
also
give
a
shout
out
to
senator
kerr,
who
represents
my
home
district
in
fayette
county,
I'm
a
licensed
clinical
psychologist
and
I'm
an
assistant
professor
of
psychology
at
the
university
of
kentucky
prior
to
my
current
position.
Thank
you.
Prior
to
my
current
position.
E
I
worked
full
time
for
almost
25
years
providing
mental
health
services
to
adults
with
severe
mental
illness
and
substance
use
disorders
at
eastern
state
hospital
in
lexington,
and
I
consider
my
time
there
as
the
central
focus
of
my
professional
career.
I
also
wanted
to
mention
that
my
wife,
kathy
sussman,
a
master's
level
psychologist,
also
gave
over
21
years
of
service
to
eastern
state
as
a
clinician
and
as
an
administrator,
so
our
family
has
collectively
provided
about
46
years
of
service,
as
we
counted
it
up
to
these
very
deserving
individuals
with
severe
mental
illnesses.
E
As
an
example,
I
remember
a
patient
I'll
call,
mary,
mary
and
I'll
call
her
that
to
protect
her
privacy,
but
mary
had
a
horrendous
history
of
childhood
trauma
and
abuse,
and
when
we
saw
her,
then
she
was
in
her
late
20s.
She
was
struggling
with
major
depression,
she
had
post-traumatic
stress
and
she
would
hear
constant
voices
in
her
mind
of
those
who
had
horribly
abused
her.
E
We
would
find
her
under
her
bed
and
she
was
sobbing
and
afraid
to
come
out
for
fear
that
her
abusers
would
be
there
lying
and
wait
for
her
mary
was
a
single
parent.
She
had
two
young
sons,
she
was
unemployed
and
at
that
time
she
was
homeless
because
she
couldn't
sustain
her
employment
due
to
her
illness.
She
was
in
jeopardy
of
having
her
children
removed
because
she
couldn't
provide
for
the
basic
needs
of
their
food,
clothing
and
shelter.
E
This
lack
of
insight
or
understanding
that
a
person
has
an
illness
is
actually
a
common
symptom,
called
anasagnosia
which
is
associated
with
schizophrenia
or
other
severe
mental
illnesses.
Also,
all
people
with
severe
mental
illnesses
have
borne
the
burden
of
stigma.
The
term
stigma
refers
to
negative
thoughts,
feelings
and
behaviors
directed
towards
someone
with
a
mental
illness.
More
accurate
terminology
would
be
prejudice
and
discrimination
for
people
with
severe
mental
illnesses
face
discrimination
in
many
forms.
E
But
now,
let's
go
back
to
mary
mary
received
acute
care
in
our
hospital,
including
medications,
short-term
therapy
and
engagement
and
recovery
and
rehabilitation
groups
and
activities
in
our
award-winning
recovery
mall
program.
One
of
her
favorite
groups
was
music
therapy
as
she
loved
to
sing
after
discharged
from
the
hospital
mary
returned
to
the
community,
and
she
participated
in
treatment
at
her
local
community
mental
health
center.
She
was
prescribed
effective
medications.
She
engaged
in
longer-term
trauma-focused
psychotherapy
and
she
learned
effective
coping
skills
to
manage
her
moods
and
her
behavior
over
time.
E
E
Mary's
journey
of
recovery
continued
over
several
years
when
she
ultimately
found
a
new
quality
of
life
and
some
peace
of
mind
mary
kept
in
touch
with
me
for
many
years
through
phone
calls
and
letters,
and
I
was
always
happy
to
hear
positive
reports
about
how
she
her
children
and
eventually
her
grandchildren
were
thriving.
Soon
after
we
moved
to
the
new
eastern
state
hospital
in
2013.
E
She
sent
me
a
message
and
she
said
you
know.
If
I
had
known
you
were
opening
up
that
new
hospital,
I
would
have
come
there
to
the
opening
and
I
would
have
sung
a
song
for
you
all
and
I
responded
and
I
asked
her.
I
said
what
song
did
you
want
to
sing
and
she
said
climb
every
mountain
forward.
Every
stream
follow
every
rainbow
till
you
find
your
dream.
E
Mary's
story
personifies
how
recovery
is
possible
for
individuals
with
severe
mental
illness,
as
described
in
this
definition
of
recovery
offered
by
the
u.s
substance,
abuse
and
mental
health
services,
administration
or
samsa,
and
you
can
see
that
the
definition
says.
Recovery
is
a
process
of
change
through
which
individuals
improve
their
health
and
wellness
live
a
self-directed
life
and
strive
to
reach
their
full
potential.
E
Also.
I
believe
it's
important
to
understand
what
are
considered
the
four
essential
components
of
recovery,
focused
services
again
drawing
from
samhsa's
framework.
First
is
health
overcoming
or
managing
one's
illness,
as
well
as
living
in
a
physically
and
emotionally
healthy
way.
Second,
home
having
a
safe
and
stable
place
to
live
third
purpose,
meaningful
daily
activities
and
the
independence,
income
and
resources
to
participate
in
society
and
fourth
community
relationships
and
social
networks
that
provide
support,
friendship
and
hope.
E
I
had
the
opportunity
to
briefly
review
the
materials
and
testimony
given
at
your
previous
task
force
meetings.
You've
heard
from
many
expert
mental
health
professionals
advocates
and
family
members,
and
you
will
hear
from
several
more
today
and
next
month
they
have
thoroughly
catalogued
the
current
challenges
facing
kentucky
citizens
with
severe
mental
illnesses.
E
E
It
may
be
an
oversimplification,
but
I
believe
from
my
experience,
the
only
answer
to
begin
to
address
these
complex
issues
and
to
improve
recovery.
Focused
services
for
kentucky
citizens
with
severe
mental
illnesses
is
to
increase
funding
immediately
and
to
build
a
plan
to
continue
to
increase
funding
on
a
sustained
long-term
basis.
As
you
may
already
know,
kentucky
is
consistently
ranked
46th
or
47th
out
of
the
50
states
in
the
amount
of
money
devoted
to
mental
health
services.
E
Yes,
for
the
past
22
years,
these
vital
centers
have
either
had
flat
funding
or
decreases
in
funding.
In
that
same
span
of
time,
our
population
in
the
commonwealth
has
increased
by
over
500
000
people.
If
we
accept
the
estimate
that
about
five
percent
of
our
population
has
a
severe
mental
illness,
then
the
number
of
individuals
with
the
severe
mental
illness
in
kentucky
has
increased
from
approximately
225
000
to
250
000
people.
Across
this
twenty
plus
year,
a
twenty
plus
year
span
of
no
increased
funding.
E
Twenty
five
thousand
additional
people
need
to
be
served
and
there
has
been
no
additional
money
to
serve
them.
A
student
of
basic
economics
could
explain
that
with
increased
demand
for
services
and
no
increased
supply
of
services,
more
and
more
people
will
be
unserved
or
not
adequately
served,
but,
of
course,
our
budgets
have
limits
and
where
would
any
increases
in
funding
best
be
allocated?
E
E
E
The
second
area
to
prioritize
funding
would
be
to
fund
tim
laws,
tim's
law
statewide-
and
I
know
you're,
going
to
hear
more
about
tim's
law
today
and
you've
heard
previous
testimony
about
this
very
important
law,
which
affords
options
for
assisted
outpatient
treatment
for
persons
with
severe
mental
illness.
This
law
is
currently
funded
in
five
regions
across
the
state,
through
a
grant
which
will
expire
in
two
years.
E
E
A
related
longer
term
goal
would
be
to
increase
per
capita
funding
for
mental
health
services
in
kentucky
from
its
current
level
of
47th
out
of
50
states
to
reach
the
median
level,
which
would
be
a
rank
of
number
25
out
of
50
states.
If
consistent
funding
increases
were
provided
to
the
state
community,
mental
health
centers,
they
could
increase
their
pool
of
providers,
offer
expanded
services
and
ultimately
address
some
of
the
great
unmet
need
for
care
which
currently
exists.
E
E
In
that
regard,
the
task
facing
us
is
not
just
about
budgets
and
funding.
It
is
also
a
moral
choice
and,
in
my
view,
an
obligation
to
show
with
our
fiscal
priorities
that
we
value
these
individuals
and
that
we
are
no
longer
content
to
let
them
face
stigma,
discrimination
and
lack
of
care
when
we
hold
the
keys
to
help
them
attain
a
brighter
future.
F
Thank
you,
mr
chairman,
and
thank
you
for
your
presentation,
dr
sussman,
you
talked
about
the
fact
that
the
cost
of
care
do
you
all,
have
any
stats
on
the
cost
of
care
versus
out
inpatient
versus
outpatient.
E
I
I
know
there
there
are
numbers
on
that.
I
don't
I
don't
have
current
access
to
those
numbers,
but
I'm
I'm
sure
we
could
get
those
from
the
department
of
mental
health
and,
from
the
you
know,
community
mental
health
center
system.
You
know
I
do
know
things
like
you
know.
Inpatient
care
is,
you
know,
probably
around
a
thousand
dollars
a
day
or
more
compared
to
many
of
the
outpatient
services
are
much
more
cost
effective.
Hence
the
reason
to
try
to
keep
people
out
of
the
hospital.
E
B
F
Do
you
have
any?
Besides
the
fiscal
I
mean
the
funding
is
important,
but
there
are
other
issues
out
there.
I
know
that
my
constituent
faced
many
that
I
don't
know
if
you
saw
the
young
lady
who
advocated
for
her
sister-in-law,
you
didn't
see
that
okay,
okay,
okay,
thank
you.
Thank
you,
mr
chair.
Thank.
B
E
E
B
D
All
right
good
afternoon,
I'm
judge
stephanie
burke,
I
am
a
district
court
judge
in
jefferson
county,
I'm
also
the
aot
judge
and
the
drug
court
judge
in
jefferson,
county
meaning.
I
conduct
two
specialty
courts,
one
for
addiction
and
one
for
mental
health.
D
I'd
like
to
thank
you
all
of
the
members
of
the
task
force
for
having
me
here
today,
and
I
would
like
to
thank
you
for
your
work
and
your
attention
to
this
population
of
the
seriously
mentally
ill
in
kentucky.
D
We
need
to
give
them
support
for
them
to
be
successful
in
recovery.
Individuals
who
are
suffering
with
the
criteria
of
to
be
in
this
smi
category
cannot
do
this
on
their
own
and
sitting
in
the
seat
that
I
sit
for
the
last
11
years.
I
can
tell
you
that
tim's
law
is
the
smartest
change
in
public
policy
and
social
justice
policy
that
I
have
seen
we
have
in
implementing
aot,
which
is
the
practice
of
delivering
outpatient
treatment
pursuant
to
a
court
order
to
adults
with
smi
who
meet
a
specific
criteria.
D
We
are
handling
these
individuals
in
a
civil
manner,
rather
than
the
way
they
have
been
treated
for
decades,
which
was
through
the
criminal
process,
kentucky
jails,
our
mentally
ill
population
at
unbelievable
numbers
and
we're
still
seeing
this,
and
so
it's
time
that
we
pay
more
attention
and
take
more
attention
and
time
and
effort
to
make
sure
that
that's
not
what
we're
doing.
D
We
need
to
concentrate
our
efforts
on
giving
individuals
the
opportunity
to
reside
safely
in
the
community
rather
than
being
on
the
track
to
jail
or
hospitalization.
D
Aot
is
the
practice
of
monitoring
an
individual
who
is
subject
to
a
court
order
for
outpatient
treatment
in
a
manner
that
looks
very
much
like
other
specialty
courts
and
it's
a
team
approach.
The
team
is
the
leader
of
the
team.
Is
the
judge
the
members
of
the
team
consist
of
the
community
health
providers
and
the
patients.
The
patient
has
some
ownership
in
the
team.
D
You
get
the
patient
into
the
aot
process,
meaning
you
enter
the
court
order
at
a
time
when
the
patient
is
stable
in
coming
out
of
the
hospital
when
the
patient
is
stable
and
coming
out
of
the
hospital,
and
they
know
that
they
become
subject
to
a
court
order,
they
want
to
comply,
they
don't
want
to
be
in
trouble.
They
don't
want
to
do
things
that
are
going
to
cause
them
to
be
crosswise
with
the
court,
so
the
black
robe
effect.
You
need
to
create
that
relationship
up
front.
D
That
black
robe
effect
is
that
relationship.
And
so,
if
we
continue
to
utilize
tim's
law,
we
need
to
identify
the
appropriate
people
and
who
are
those
people.
They
are
people
who
have
a
history
of
repeat
hospitalizations.
They
have
a
history
of
non-compliance
and
non-adherence
with
treatment
outpatient.
D
So
right
now
I
have
17
individuals
in
my
court
and
we
have
about
maybe
15
in
hardin
county
and
that's
that's
actually
a
really
good
number.
Considering
we've
only
been
doing
this
for
15
months
and
if
you
could
take
those
numbers
and
extrapolate
them
across
the
state
to
each
judicial
district,
you
would
save
millions.
D
The
aot
addresses
the
situation
where
patients
who
are
repetitively
hospitalized
due
to
their
decompensating,
get
in
the
hospital
they
stabilize
and
they're
immediately
released,
and
then
that's
often
too
soon
and
they
go
out
of
the
hospital.
And
what
do
they
do?
They
go
off
their
medication
and
then
they're
right
back
to
the
hospital
and
some
of
the
patients
that
I'm
seeing
have
upwards
of
50
or
more
hospitalizations
in
a
period
of
10
years
or
less
some
have
35
or
more
hospitalizations
in
three
or
four
years.
D
D
We
need
to
make
sure
that
we
do
everything
we
can
to
keep
the
time
between
hospitalizations
longer
and
if
we
can
increase
that
period
of
time
by
keeping
them
out
of
the
hospital
keeping
them
from
decompensating
for
longer
periods
of
time.
They'll
have
a
better
quality
quality
of
life.
For
a
longer
period
of
time,
aot
has
been
shown
to
decrease
harmful
behaviors.
D
D
D
We
know
that
they
are
a
drain
on
our
criminal
justice
system
and
our
hospitals,
our
our
ers
and
our
mental
health
system,
and
we
know
that
aot
after
studies,
the
original
study
was
done
in
2005
in
new
york.
In
the
studies
since
then
have
been
consistent.
That
aot
reduces
hospitalization
by
as
much
as
77
percent.
D
D
Those
numbers
are
staggering
when
you
start
thinking
about
the
dollars
that
are
attached
to
those
statistics
in
phase
one
of
the
grant
program
under
the
samsa
grant
that
we
received
here
in
kentucky,
only
services
are
provided
around
central
state,
so
the
only
place
that
we're
currently
doing
this
for
the
first
two
years
of
the
grant
are
the
counties
feeding
into
central
state
and
that's
jefferson
and
hardin.
It's
community
care
and
seven
county
services.
D
In
years,
three
and
four
of
the
grant
the
grant
will
expand
to
western
state
hospital,
and
this
will
expand
out
for
a
total
of
to
reach
33
counties.
That's
not
enough
to
only
do
this
for
four
years,
with
only
a
very
small
part
of
the
state.
That's
not
enough!
We
need
to
do
this
statewide,
and
I
can
tell
you
that
with
our
very
first
patient-
and
many
of
you
probably
heard
me
talk
about
this
before
when
I
spoke
to
you
in
2019
and
asked
you
to
expand
the
criteria.
D
Because
somebody
took
the
time
and
energy
and
effort
to
see
that
he
got
an
increased
level
of
services
and
support
for
a
year,
which
was
what
it
took
and
it
set
him
in
motion
to
have
a
much
better
quality
of
life.
He
will
live
longer.
I
see
him
out
on
the
street.
He
lives
not
too
far
from
me.
I
see
him
on
the
street
like
going
to
walgreens
and
things,
and
it
just
blows
my
mind
to
see
this
man
and
to
know
what
he
was
living
like
before
and
what
he's
living
like.
D
Now,
we
can
have
many
many
people
like
that.
I
currently
have
patients
2
through
17
in
my
docket
and,
like
I
said
they
range
from
having
4
to
34
hospitalizations
in
a
three
to
four
year
period.
D
That
is
a
great
improvement,
so
this
really
does
work.
We
have
a
statute
that
is,
you
know
in
place,
and
I
think
it's
important
that
you
look
at
the
cost
savings
and
the
way
that
you
can
analyze
data
to
determine
what
is
the
cost.
Savings
is
to
first
determine
what
is
the
size
of
the
jurisdictions
eligible
population,
meaning
how
many
people
in
our
population
in
kentucky
would
be
eligible
for
aot.
D
D
And
then
what
is
the
net
savings?
Meaning?
What's
the
difference
between
those
two
numbers-
and
I
could
tell
you
that
direct
costs
are
the
things
like
hospitalization
inpatient
care,
pharmaceutical
costs,
indirect
costs
are
law
enforcement,
court,
cost
jail,
cost,
shelter,
housing
things
like
that,
and
those
are
things
that
we
can
quantify
and
if
we
take
the
time
and
effort,
we
can
study
that
and
determine
how
we
can
save
money
in
this
state
and
do
a
much
better
job
of
treating
this
population
representative
prunny
asked
if
there
were
numbers
there
are
numbers
the
treatment
advocacy
center.
D
D
Of
course,
they
did
because
they're
not
in
the
hospital
anymore,
but
that
number
is
dwarfed
by
those
red
towers,
and
that
is
the
number
that
you're
looking
for
and
that
we
need
to
seek
and
that
we
need
to
capitalize
on,
and
these
numbers
are
consistent,
and
I
can
tell
you
kentucky-
has
a
really
good
opportunity
here
in
that
the
cost
in
corrections.
Numbers
has
not
been
studied
on
a
broad
scale.
D
We
know
that
kentucky
incarcerates,
a
very
high
number
of
the
seriously
mentally
ill
population
and
kentucky
is
the
perfect
place
for
the
study
to
start
from
ground
zero
start
from
scratch
and
to
perform
a
study
to
see
exactly
how
much
savings
there
is
by
doing
this
and
the
treatment
advocacy
center,
who
are
the
experts,
are
willing
to
come
into
kentucky
and
do
the
study
and
study
us
as
we
do
this?
If
we
have
the
opportunity
to
take
it
statewide
and
just
to
see
how
we
quantify
the
savings.
D
There
are
two
things
in
two
recommendations
that
I'm
going
to
ask
the
legislature
in
this
session,
one
I'm
going
to
ask
that
you
expand
the
definition
or
the
class
of
eligible
members
or
individuals
that
can
have
access
to
aot
and
then
second,
I'm
going
to
ask
that
you
do
a
housekeeping
measure
with
an
amendment
to
the
statute
and
I'm
going
to
explain
that
as
simply
as
I
can.
If
you
look
at
the
next
slide
here,
this
is
the
criteria
for
eligibility
for
aot.
D
The
red
line
is
marking
out
what
the
current
statute
says.
Currently
you
have
to
have
been
hospitalized
in
involuntarily
twice
in
a
24
month
period
and
be
diagnosed
with
a
serious
mental
illness.
Have
it
be
unlikely
to
adhere
to
outpatient
treatment
and
have
what's
defined
as
antisignosia
our
statute
compared
to
that
of
every
other
statute
in
the
country
is
problematic
and
it's
not
as
it's
not
as
helpful
to
this
population
as
it
could
be
for
one.
D
I
think
the
better
language
be
leading
to
hospitalization
or
arrest
or
within
the
last
24
months,
resulted
in
an
act,
threat
or
attempt
at
serious
physical
harm
to
sell
for
others.
This
really
broadens
who
is
eligible,
but
what
it
does
is
it
reaches
those
people
that
we
are
incarcerating
in
the
people
who
are
committing
violent
acts
in
threatening
violent
behaviors.
D
D
D
What
the
statute
currently
does
in
its
current
form.
Is
it
interchanges?
The
word
examination
of
the
petitioner
who's
the
person
taking
out
the
aot
petition,
the
person
bringing
the
action,
and
that
is
to
mean
that
the
person
is
being
examined
by
the
court
meaning
being
put
under
oath
in
sworn
testimonies
being
given,
so
that
you
can
get
the
veracity
of
their
statement.
Okay,
so
that's
an
examination
of
a
witness.
D
D
So
the
order
should
say
that
order
the
respondent
be
evaluated,
not
examined,
because
that
would
be
just
like
asking
them
for
testimony
like
you
would
have
with
the
petitioner
and
the
other
sentence
in
here.
That
is,
that
needs
corrected,
is
if
you
get
down
here
to
paragraph
six
section,
a
the
way
it
is
currently
drafted.
D
It
requires
that
the
evaluation
of
the
patient
be
conducted
no
more
than
five
days
prior
to
the
filing
of
the
petition,
so
bear
with
me
here
so
say
that
was
five
days
ago,
and
it
says
that
you
then
set
the
hearing
six
days
from
that
evaluation
of
the
of
the
patient.
So
if
you
file
the
petition
on
the
fifth
day,
that
means
your
hearing's
going
to
be
tomorrow.
D
D
D
D
D
B
Thank
you
judge
burke.
Do
we
have
any
questions
representative,
dr
wilner.
F
Yes,
thank
you,
dr
chairman,
and
thank
you
judge
burke
for
this
presentation.
F
Actually,
all
three
of
these
presentations
have
just
been
really
wonderful
and
we've
covered
a
lot
of
turf
in
this
task
force,
and
it
was
great
to
really
get
back
to
the
nuts
and
bolts
of
severe
mental
illness
with
all
these
presentations,
and
I
wanted
to
ask
you,
judge
burke
and-
and
maybe
it's
just
a
matter
of
funding,
but
your
testimony
about
how
well
this
is
working,
how
much
money
it's
saving,
how
it's
preserving
people's
dignity.
It's
the
compassionate
thing
to
do
as
well
as
the
fiscally
responsible
thing
to
do.
F
What
do
you
see
as
the
barriers
to
implementing
this
statewide.
D
I
think
the
barriers
to
doing
this
state
right
statewide
are:
you
have
to
have
the
structure
in
each
of
the
regions
to
actually
do
it
and
you
have
to
have
the
the
actual
court
set
up.
So
if
you
say,
if
the
legislature
says
we're
going
to
do
this
and
then
the
courts
you
know
would
start
implementing
it,
there's
got
to
be
a
partnership
between
aoc
and
the
legislature.
D
D
D
F
Think
great
work
you're
doing
in
jefferson,
county
and
for
being
here,
and
when
we
had
our
last
presentation
on
tim's
law.
I
was
just
so
struck
that
you
know
a
lot
of
my
colleagues
on
this
task.
Force
represent
areas
where
they
don't
have
this
opportunity
for
the
folks
they
represent,
and
so
I
feel
really
fortunate
to
be
in
jefferson
where
we
have
this,
and
I
really
would
love
to
see
people
across
the
state
have
access
to
this.
So
thank
you.
G
You
knock
out
of
the
park
from
jefferson
county
as
a
judge,
you're
knocking
out
the
park,
and
I
love
to
see
the
data
that
you
presented
to
make
a
really
compelling
case
in
terms
of
funding
and
so
forth.
Mr
chair,
I
want
to
ask,
I
know
there
are
some
slides
on
the
on
the
website,
but
I
don't
I
didn't
see
any
other
slides
you
should
put
up.
Is
that
available,
or
did
I
miss
it?.
D
G
D
D
I
was
studying
the
eligibility
of
all
cases
that
were
coming
through,
I
would
say,
10
percent
would
be
good
good
candidates
and
that's
probably
three
a
week
in
jefferson
now
some
of
those
people
are
coming
from
hardin
because
they
come
from
central
state
or
from
communicare,
and
so
when
they
transfer
the
patient
to
central
the
case
comes
to
jefferson
county
with
the
patient.
So
that's
you
know
not
just
jefferson
county
patients,
it's
also
hardin
county
patients
in
communicare
patients.
D
It's
everybody
feeding
into
central,
but
I
think
that
you
could,
if,
if
we,
you
know
had
the
ability
to
and
we
tweaked
the
eligibility
in
the
statute,
you
know
to
be
more
conducive
that
if
we
could
get
a
hundred
in
our
jurisdiction
that
that's
totally
doable.
D
D
G
Okay,
all
right,
okay,
clear!
That's
right!
One
more
question,
mr
chairman:
you
provided
sort
of
a
framework
of
this
the
structure
that
could
be
implemented.
Statewide
and
such
can.
You
give
me
an
assessment
on
the
how
the
current,
how
the
structure
exists
in
terms
of
implementing
this
or,
what's,
basically,
what
the
status
is
a
current
status,
because.
D
G
D
One
thing
I
could
tell
you
about
the
grant
money
is
a
lot
of
the
grant.
Money
has
gone
into
creating
the
structure
and
so
moving
forward
that
won't
those
costs
won't
have
to
be
spent
again
you.
So
if
you
keep
feeding
money
to
the
program,
you'll
just
keep
getting
more
services,
and
you
won't
have
to
you
know,
keep
setting
up
the
the
actual
structure
itself.
D
The
other
personnel
that
has
been
hired
is
a
case
specialist
who
is
out
on
the
street
literally
trying
to
see
our
patients
several
times
a
week,
and
we
also
have
a
therapist
and
another
clinical
person,
so
it's
providing
increased
clinical
services
are
being
supplemented
through
the
grant
and
we
also
are
having
to
pay
for
housing
for
a
few
of
our
clients
they're.
Actually,
we
remove
them
from
some
pretty
dangerous
situations
and
put
them
into
safe
housing,
and
the
grant
is
paying
for
that.
D
So
I
think
that,
in
order
to
take
this
statewide,
there
would
be
training
on
behalf
of
the
judges
which
we've
had
training
for
all
of
the
judges
across
kentucky.
As
soon
as
the
statute
went
into
effect,
we
did
it
in
2017.
We
did
it
again
2019
when
it
expanded
and
our
judges
want
to
do
this
across
the
state.
I
get
calls
all
the
time.
D
H
E
G
D
Either
foundations,
if
we
do
well
with
this
and
we
show
buy-in
if
we
get
buy-in
they're
going
to
keep
giving
us
funding,
I
mean
it's
pretty
that
it's.
I
think
it's
pretty
well
understood
that
the
in
the
future,
we
will
keep
getting
support
if
we
keep
doing
it,
but
they
need
to
see
buy
in
elsewhere.
They
can't
be
footing
100
of
the
bill.
G
This
is
almost
like:
a
judicial
public
partnership,
private
partnership,
a
three
big
ppp,
so
yep.
Thank
you,
mr
turner.
Thank
you
judge
appreciate
it.
Thank
you.
F
Thank
you,
mr
chairman,
and
thank
you
for
your
presentation
and
your
passion.
It's
obviously
you're
very
passionate
and
persevered
and
working
hard
to
get
all
the
right
players
and
make
it
all
work
in
jefferson
county.
My
question
is
referring
to
the
criminal
justice
services
bar
on
your
your
five
county
sample
and
the
revolving
door
situation.
F
The
issue
that
I
heard
here
at
home
and
and
who
came
and
presented
to
the
this
task
force
are
my
law
enforcement
people,
my
police
chiefs,
my
sheriff
and
then
jailor.
Do
you
have
an
opinion
on
how
to
improve
that
situation?
It's
almost
like.
We
need
to
bypass
that
system
and
get
them
to
where
they
need
to
be
to
get
their
mental
health
services,
but
they
get
tied
up
in
the
legal
system
and,
like
my
jailer
says,
you
know
we
I
don't
have
I
have
nurses,
but
they
can't
provide
those
kind
of
services.
D
D
I
mean
it
could
be
as
simple
as
a
as
shoplifting
and
they
come
into
court
and
their
their
attorney
immediately
realizes
that
they
believe
that
the
person
isn't
competent.
They
realize
they're
dealing
with
somebody
who's
seriously
mentally
ill.
They
then
have
an
obligation
to
make
a
motion
for
competency
that
stays
the
proceedings.
D
Many
of
these
people
stay
in
jail
because
once
they're
in
custody
or
the
bond
is
set,
the
court
has
no
authority
to
do
anything
on
their
case
until
that
competency
decision
is
made.
So
we
have
in
like.
I
can't
even
imagine
the
numbers
of
how
many
people
are
staying
in
custody
and
it's
taking
sometimes
as
much
as
six
months
or
more
to
get
an
evaluation
on
competency.
D
D
If
you
did
this
process,
this
will
give
us
another
opportunity
to
avoid
that,
and
that
would
save
extraordinary
amounts
of
money,
but
it's
just
so
much
more
humane
in
the
treatment
advocacy
center,
and
I
we've
discussed
this
at
length.
They
are
willing.
That
is
what
they're
really
wanting
to
see
in
kentucky
is
to
see
us
focus
on
that
and
they
will
come
in
with
us
and
help
us
look
at
those
numbers
and
see
where
we
go
with
that
and
try
to
analyze
the
savings.
D
B
Okay,
next
we'll
have
dr
carmen
pinto
doctor
we'll
be
discussing
treatments
for
patients
with
severe
mental
illness.
Doctor
please
introduce
yourself
and
you
may
begin.
I
I
B
I
I
The
green
light's
on
now
right
is
that
good
all
right
anyway,
so
I've
been
practicing
in
rural
kentucky
for
about
30
years
and
I'm
actually
the
medical
director
of
an
aot
team
as
well
as
an
act
team,
and
what
I
want
to
talk
about
today
is
actually
long-acting
injectable
antipsychotics,
because
I
actually
have
good
news
and
all
these
issues
we're
talking
about.
I
These
are
really
quite
amazing,
medications,
we're
going
to
mainly
talk
about
schizophrenia,
but
there's
also
a
long-acting
injectable
antipsychotic
approved
for
bipolar
disorder,
but
there's
more
data,
information
and
drugs
approved
for
schizophrenia.
So
that's
where
I'm
going
to
spend
my
time.
It's
schizophrenia,
as
you
know,
it's
genetic
disorder
and
it
causes
dysregulation
the
neurotransmitter
system
in
the
brain
that
leads
to
brain
dysfunction.
It
leads
to
symptoms
of
both
mental
and
physical
disease
and
unfortunately,
it
starts
early
in
life.
I
We're
talking
about
one
out
of
a
hundred
people
are
born
with
schizophrenia
and
one
out
of
100
people
are
born
with
bipolar
disorder.
The
life
expectancy
is
cut
short
by
about
a
decade,
and
this
is
due
to
increase
in
medical
illnesses,
accidents,
violence
and
suicide.
90
percent
of
these
people
use
tobacco
products.
I
This
chart
has
been
referred
to
by
people
already
today,
it's
from
current
psychiatry
and
what
it
shows
is
time
along
the
horizontal
axis
so
in
years,
and
then
a
functioning
level
of
functioning
across
the
vertical
axis
so
prior
to
the
start
of
schizophrenia,
which
usually
shows
onset
somewhere
around
the
late
teens
or
early
20s
for
most
people
functioning
level
is
quite
high.
I
There's
a
break.
There's
a
loss
of
function,
there's
a
little
picture
on
the
bottom,
which
I
will
actually
have
a
enlargement
of
in
a
second
which
actually
shows
mri
images
of
the
brain,
and
we
actually
can
see
the
brain
shrink
over
time
related
to
the
number
of
psychotic
breaks
and
untreated
illness.
That
a
person
has
the
purple
arrow
I
put
on.
There
is
the
age
of
the
first
use
of
long-acting
injectable
antipsychotics,
which
is
usually
at
34
years
old.
I
So
a
person's
been
sick
for
about
a
decade
and
a
half
they've
had
multiple
hospitalizations
or
incarcerations
and
they've
tried
multiple
trials
of
oral
antipsychotics.
Don't
get
me
wrong.
Oral
antipsychotics
are
fantastic
medications
and
they
all
work
very,
very
well.
There's
no
oral
antipsychotic.
That's
ever
been
shown
to
be
significantly
better
than
another
they're
all
similarly
effective,
but
what
really
makes
the
difference
is
the
delivery
of
that
medication.
I
I
The
most
common
reasons
for
people
to
have
relapse
with
either
schizophrenia
or
bipolar
disorder
is
non-adherence
to
oral
medications,
as
we've
already
heard
from
dr
johnson
substance,
use
and
ongoing
stress.
The
most
common
way
to
respond
to
these
relapses
is
people
change
oral
medications
and
they
seem
to
do
that
over
and
over
again,
when
it
hadn't
succeeded.
The
first
time
around
this
is
a
trial.
I
From
early
on
in
the
early
2000s
called
the
katy
trial,
it
was
done
by
the
national
institutes
of
mental
health
and
it
had
around
1
500
people
who
suffered
from
schizophrenia,
and
it
was
18
months
long
and
at
the
time
all
they
had
was
oral
medications
available
and
they
used
the
best
oral
medication
of
the
day
and
actually
those
medications
are
still
used
in
about
half
the
patients
or
people
treated
with
schizophrenia
today
and
what
they
were
looking
for
was
a
discontinuation
of
treatment
for
any
reason,
and
what
the
study
showed
was
74
3
out
of
4
people
with
schizophrenia
discontinued
their
medication
by
the
end
of
the
trial.
I
The
number
one
reason
was:
the
patient
just
didn't
want
to
take
their
medication
anymore.
Two-Thirds
of
the
patients
in
this
trial
had
substance,
use
issues
and
half
those
or
about
a
third
were
substance
dependent
and
they
had
the
worst
outcomes
of
all
and
so
to
me,
the
obvious
takeaway
from
this
is,
if
not
taking
oral
medications
correctly
and
substance.
Use
are
the
reasons
most
common
reasons
for
relapse,
with
schizophrenia
and
bipolar
disorder.
I
I
It
is
also
the
same
medication
available
in
oral
form,
and
so
what
you
have
is
oral
medications
versus
injectable
medications
and
what
it
showed
over
a
course
of
two
years
here
was
that
the
injectable
medication
had
a
relapse
rate
of
15
percent
versus
21,
with
the
oral
medications,
a
29
reduction
over
two
years
and
another
way
to
look
at
is
the
time
to
relapse,
and
we
heard
the
judge
talking
about
the
the
more
time
we
have
to
to
keep
people
well.
I
The
long-acting
injectable
anti-psychotic
on
average
had
seven
months
greater
time
before
there
was
a
relapse,
seven
months
time
to
get
people
into
relapse
time
to
keep
them
in
their
apartment
time
to
help
them
with
school,
help
them
with
the
job.
You
know,
if
you
think
about
it:
seven
months
could
go
from
two
hospitalizations
a
year
to
one,
and
I
think
that
is
quite
significant
and
impactful.
I
This
is
another
trial,
and
this
one
is
actually
a
little
more
interesting.
This
is
polyperidone
again
a
long-acting
injectable
antipsychotic
again
compared
to
a
clinician's
choice
of
oral
antipsychotics.
Now
these
were
folks
who
would
never
make
it
into
usual
studies.
This
is
called
real
world
data,
so
these
were
folks
who
had
been
incarcerated
at
least
twice
in
the
last
two
years
and
once
in
the
last
six
months,
these
are
folks
who
could
be
using
drugs
and
alcohol.
These
are
folks
who
could
be
incarcerated.
I
Those
would
all
be
things
that
would
disqualify
you
from
other
kind
of
studies.
So
these
are
what
is
called
real
world
data
and
again
you
see
almost
identical
results.
The
idea
that
the
long-acting
injectable
antipsychotic
compared
to
oral
medications,
delayed
relapse
by
about
6
months,
45
or
excuse
me,
40
percent
relapse
rate
for
the
long,
acting
injectable
antipsychotic
people
versus
54
for
the
oral
medications.
I
I
Hospitalization
was
the
second
most
common
cause
and
it
was
reduced
by
31
percent.
And
now
I'm
going
to
tell
you
the
sad
part.
13
is
the
date.
I
know
dr
johnson
was
talking
about
some
figures
earlier,
but
about
13
percent.
One
out
of
six
people
who
suffer
with
schizophrenia
are
given
long-acting
injectable
antipsychotics
in
this
country
in
europe,
it's
over
50
percent,
and
so
I
would
suggest
to
you
that
we
under
use
long-acting
injectable
antipsychotics
the
most
common
reason,
and
I
actually
want
to
disclose
that.
I
I
speak
for
pharmaceutical
companies
and
I
speak
for
all
the
pharmaceutical
companies
that
have
long-acting
injectable
antipsychotics
and
I
talk
to
people
around
the
country
and
I
ask
them:
why
are
you
not
using
more
long-acting
injectable
antipsychotics
and
they
always
say
well,
I
asked
and
the
patient
said
no
and
that
part
always
baffles
me.
If
a
nephrologist
talked
to
a
patient
who
had
severe
kidney
illness
and
said
you
know,
I
want
to
put
you
on
dialysis
and
the
patient
said.
I
Well,
you
know
I
don't
want
dialysis,
because
I
don't
like
needles
and
the
nephrologist
said
well,
I
asked
they
said
no,
and
that
was
the
end
of
it.
We
would
think.
Oh,
my
gosh.
What
kind
of
care
is
that
and
that's
my
point?
I
think
the
suggestions
that
I
bring
today
are
actually
quite
simple
and
I'll
talk
to
you
about
them
at
the
end.
So
this
is
a
study
that
is
quite
interesting.
It
was
about
how
the
long-acting
injectable
option
was
presented
to
the
person
made
quite
a
difference.
I
If
somebody
just
said
hey,
do
you
want
to
take
a
shot?
Even
just
that?
I
think
unmotivated,
unexciting
presentation
to
the
patient
still
one
out
of
three
36
percent
said:
yeah:
okay,
but
still
only
half
those
numbers
being
used,
13
use
of
long-acting,
injectable
antipsychotics,
but
look
at
the
very
bottom
and
black.
If
a
positive
offer
was
made
explaining
to
the
patient
how
much
the
advantages
this
could
bring,
how
it
could
be
appropriate
to
their
situation.
I
96
of
the
patients
were
agreeable
to
a
long-acting
injectable
antipsychotic.
The
advantages
are
many.
I
just
want
to
point
out
a
few
one
is
the
reduction
in
household
conflict,
one
of
the
things
I
have
noticed
over
my
time
using
long-acting
injectables
is
prior
to
this.
Most
of
these
folks
were
living
with
adult
caregivers
and
there
would
be
a
lot
of
conflict.
Did
you
take
your
medication
today?
I
Why
are
you
asking
me
it's
none
of
your
business
I'll,
take
it
when
I
want
to
take
it
when
we
use
long-acting,
injectable
antipsychotics,
we
remove,
we
deconflict
the
family
no
longer
has
to
wonder,
or
the
caregiver
no
longer
has
to
wonder.
Has
the
medication
been
taken?
Another
very
big
advantage
is
when
you
take
a
pill,
the
medicine
rises
in
your
system
to
quite
a
high
level
and
then
drops
over
24
hours,
and
then
you
take
it
again.
I
It's
called
a
seesaw
pattern,
peaks
and
troughs,
and
it's
at
the
highest
levels
when
you
have
most
side
effects,
but
the
highest
levels
are
much
higher
than
you
need
to
actually
stay.
Well,
you
just
have
to
take
that
pill
to
keep
it
in
your
system
that
long
with
long
acting
injectable
antipsychotics.
We
have
a
much
lower
day-to-day
variation
between
peak
and
trough,
and
I
think
that
actually
represents
a
chance
for
much
more
tolerability
and
then
the
last
thing
I
wanted
to
mention
about
this
was
the
idea
that
we
now
have
formulations.
I
I
mean
it's
amazing
and
for
me,
what
we
have
done
is
most
of
the
folks
that
are
referred
to
us.
Come
in
on
four
five,
maybe
six,
maybe
even
more
psychiatric
medications
and
half
the
folks
that
we
have
put
on
long-acting,
injectable
antipsychotics
are
doing
monotherapy,
that's
all
they're
taking,
so
we
think
it's
quite
advantageous.
I
So
what
would
help?
I
think
what
would
help
is
actually
this
idea
that
I
think
is
going
to
be
talked
about
later,
an
integrated
approach.
I
would
call
it
a
full
court
press.
It
can't
just
be
the
prescriber
who
says:
hey.
Do
you
want
to
take
a
shot?
I
think
it
has
to
be
the
rest
of
the
treatment
team.
The
case
manager,
the
nurses,
the
therapist,
but
not
only
that,
I
think
if
we
had
like
the
judge,
was
talking
about
the
black
robe
effect
with
aot.
I
If
the
judge
is
saying
hey,
have
you
thought
about
taking
the
injection?
Dr
pinto
has
told
you
about
that
kind
of
integrated
approach.
Where
I
expect
the
first
time
I
ask
someone
if
they
want
to
take
an
injection
they're
going
to
tell
me
no,
and
if
I
stop
there,
I
don't
think
I've
really
done
a
very
good
service
to
that
person.
If
it's
something
that's
important,
if
it's
something
I
believe
in,
I
think
I
have
to
continue
not
in
a
mandated
way,
not
in
a
demanding
way,
but
in
a
respectful,
caring,
curious
way.
I
Well,
tell
me
why
it
is
that
you
don't
want
to
take
this
injection
if
I've
just
told
you
all
these
things
that
it
might
do,
and
when
I
find
that
I
do
that,
and
I
always
tell
my
students,
you
never
know
when
a
person
will
say
yes,
it
doesn't
have
to
be
today.
It
doesn't
have
to
be
tomorrow,
but
I
find
they
eventually
do
say.
Well,
let's
give
it
a
try
and
that's
all
we
need
is
to
get
our
foot
in
our
door.
I
I
always
say
after
the
first
injection,
it's
all
downhill,
I
think,
of
the
injections
as
a
foundational
treatment.
That
then
opens
the
door
to
other
treatments
such
as
substance
abuse
treatment
such
as
therapy
other
things
that
the
injections
lead
to.
So
what
I
would
ask
today
is
just
like
with
the
covid
vaccine,
where,
as
a
country,
we
thought
it
was
important
and
we
set
a
goal.
We
said
by
a
certain
time
we
want
to
have
a
certain
percent.
I
I
would
like
to
see
us
try
to
double
our
usage
of
long-acting
injectable
antipsychotics
from
13
percent
to
around
25
percent,
and
I
would
say,
2025
is
not
overly
ambitious,
so
25
by
2025,
through
a
variety
of
things
such
as
state
education
for
both
prescribers
treatment
teams,
families
and
a
variety
of
other
kind
of
things.
I've
listed
with
that
I'll
close
my
prepared
remarks
and
see.
If
there's
any
questions
that
I
can
thank.
C
Thank
you
very
much.
Thank
you.
You
probably
heard
my
remarks
earlier.
I
do
a
lot
of
long-term
care
and
we've
heard
testimony
and
I
think
our
very
first
meeting
I
want
to
say
it
was
in
this
task
force
that
we
had
from
a
good
friend
of
mine,
dr
mccarron
who's
at
uc,
irvine
he's
a
internal
medicine,
psychiatry
physicist
professor
there
and
a
lot,
and
you
talk
about
a
lot
of
injectables,
which
is
great.
We
use
some
injectables.
At
least
I
can
just
convey
my
own
private
practice.
C
I
think
part
of
the
problem
we're
not
seeing
a
lot
of
injectables
being
used
a
lot
of
primary
care.
Doctors
are
not
trained
in
using
those
they're,
not
comfortable
with
using
those;
they
don't
know
how
to
use
them,
how
to
adjust
them.
They're
accustomed
to
pills-
and
I
think
another
thing
that
we're
seeing
is
a
lot
of
our
insurance
companies.
Frankly,
don't
cover
our
injectables,
they
look
at
the
cost.
They
look
at
what
the
traditional
method
of
using
those
on
a
monthly
basis,
they're
higher
they're,
probably
more
effective.
C
So
you
got
a
combination
of
providers
who
aren't
well
trained.
They
don't
you
know
again
for
you,
it's
easy,
you're,
a
psychiatrist.
This
is
your
world
you're
trained,
you're,
a
specialist
in
it
a
lot
of
our
primary
care.
Doctors
are
not
accustomed,
a
lot
of
the
guys
that
you
know,
people
that
are
out
there
practicing
now
are
not
accustomed
to
it
and
don't
have
a
really
a
lot
of
education.
C
So
I
know
we
heard
there's
some
programs
out
there
now
for
providers
where
there's
I
know
in
california-
and
we
heard
some
testimony
early
about
them-
training
primary
care,
physicians
to
start
handling,
moderate
to
maybe
more
severe
mental
illness
cases
on
their
own,
just
because
it's
a
shortage
of
psychiatrists
available
to
start
being
to
be
taught
on
how
to
approach
a
lot
of
these
patients.
How
maybe
to
use
these
kinds
of
medications.
C
C
I
don't
have
any
formal
training
on
it
and
they'll
say
well,
you
need
to
go
see
a
psychiatrist
which
is
often
very
difficult
for
us
to
get
somebody
in
to
be
seen
to
adjust
those
so
part
of
it's
just
the
approval
process
by
insurance
companies
on
approving
some
of
these
drugs
and,
frankly,
the
training
for
a
lot
of
our
providers.
So
I
know
they've
had
some.
We
have
a
proposal
before
us
in
the
thought.
C
Maybe
maybe
something
we
as
a
task
force
are
going
to
recommend,
is
to
consider
having
our
psychiatrist
start,
providing
some
training,
some
kind
of
a
certificate
training
for
a
lot
of
our
pcps
that
are
out
there
to
start
thinking
about
being
trained
in
this,
and
I
don't
know
what
your
thought
is.
I
mean
obviously
you're
a
specialist
in
this.
Are
there
pitfalls
in
that
regard?
If
we
started
providing
our
a
lot
of
our
pcps
to
start
using
these
drugs
and
start
kind
of
knowing
how
to
adjust
them.
I
Right,
I
thank
you
very
much
for
the
question.
I
think
it's
an
excellent
observation.
My
belief
is
education
and
regulation
and
combination.
So
the
idea
would
be
that
we
would
have
some
state
sponsored
training
and
I
put
on
their
injection
team,
specialist
consultants
or
point
of
contact
where
what
we
could
do
is
actually
train
some
primary
care
folks
how
to
use
these
medications
and
then
have
resources
available
so,
for
example,
through
telemedicine
or
something
else
where
they
could
actually
call
and
say,
hey
here's.
I
What
I'm
thinking
about
doing
you
know
would
this
make
sense
so
that
they
would
feel
confident
they
would
have
some
backup,
so
they
didn't
feel
they
were
in
uncharted
waters
or
over
their
head,
the
cost.
You
know,
there's
lots
of
cost
data
out
there.
That
shows
that
there
potentially
is
a
great
cost
savings
by
using
long-acting
injectables,
even
though
the
cost
acquisition
is
higher,
although
maybe
not
that
much
higher
than
what
we're
talking
about
branded
drugs.
I
It
turns
out
about
75
of
the
folks
who
suffer
from
schizophrenia,
are
treated
with
generic
drugs
and
that's
probably
not
going
to
change.
So
I'm
only
talking
about
25
percent,
who
are
actually
treated
with
branded
medicine,
of
that
it's
about
two
to
one
injections
versus
pills.
The
injections
are
are
more
expensive
than
the
pills,
probably
not
so
much
more
so,
but
then
again
when
you
look
at
the
idea
that
there
could
be
23
percent,
less
incarceration
or
30
percent
less
hospitalization
that
can
be
made
up
on
the
back
end.
C
Mr
german,
it's
the
follow
up
again,
that's
an
excellent
point.
It's
unfortunately,
it's
like
any
insurance
company
most
of
the
time
they
they
operate
in
silos.
It's
their
pharmaceutical
folks
say
I
just
got
to
reduce
my
costs.
I
don't
care
how
it
affects
my
re-hospitalizations.
I
don't
care
how
it
affects
other
parts
of
it.
I'm
just
working
in
my
silo
government
often
works
the
same
way.
Unfortunately,
when
medicaid
is
just
worried
about
their
costs,
they're
not
saying
hey,
we
have
a
greater.
C
You
know
kind
of
parameter
here
to
look
at
is
it
is
going
to
affect
downstream
costs
for
us
in
terms
of
incarcerations
and
those
sorts
of
things.
So
I
I
just
a
lot
of
times
it's
trying
to
get
those.
If
I
order
in
vega,
if
I
order,
you
know
your
spirit
alcanta
for
somebody
I'll
typically
get
a
blowback
from
a
I
get
a
prior
authorization
request
and
I'll
say
I
don't
have
a
psychiatrist
to
send
to.
C
I
don't
have
the
training
I
just
this
is
what
I've
observed,
I'm
desperate
for
some
treatment
for
this
person.
I
don't
want
to
send
them
back
to
the
hospital
and
then
you'll
get
either
your
nursing
home,
or
someone
saying
this
is
going
to
cost
us
a
lot
more
money.
If
you
don't
get
the
prior
off,
all
those
things
become
factors,
but
to
your
point
I
think
sometimes,
if
you
use
the
proper
treatment
up
front,
you
save
a
lot
again
on
the
back
end.
So
and
again,
that's
something
just
to
remind
ourselves.
C
B
Thank
you
very
much.
It's
it'll
be
saving
a
lot
of
lives,
one
and
then
money.
Okay.
Now
we
have
dr
scott
hedges,
colleen,
colassa
and
steven
hash
from
seven
counties.
You
all
may
begin
in
any
order,
but
please
keep
the
presentation
to
no
more
than
12
minutes
as
we're
on
low
on
time.
K
Good
afternoon,
I
want
to
take
the
opportunity
to
thank
chairperson,
current
bentley
for
providing
us
with
an
opportunity
to
speak.
It's
a
pleasure
to
be
able
to
testify
today
and
it's
great
to
be
able
to
hear
some
names
that
I'm
really
familiar
with
that
have
been
talking
with
the
subcommittee
today.
K
Now,
today,
my
guests-
and
I
would
like
to
speak
with
you
about
the
topic
of
integrated
care
and
I'm
joined
by
two
people
who
share
the
hope
for
a
better
vision
for
integrated
care
for
kentuckians
colleen
colosa
is
a
registered
nurse
and
she's.
Actually,
the
director
of
our
kentucky
care,
integrated
medical
care
and
has
been
with
our
program
since
its
inception,
and
we
did
have
to
make
a
substitution,
but
I
think
it's
one
that's
worthwhile
to
the
committee.
We
are
also
joined
by
mrs
jennifer
marshall.
K
This
is
jennifer
marshall,
who
has
utilized
our
integrated
care
services
since
december
of
2019,
and
so
she
will
provide
us
with
a
firsthand
experience
of
what
it
means
to
be
in
integrated
care,
and
today
we
wish
to
provide
a
following
I'll.
Just
bring
a
brief
introduction.
This
collosa
is
going
to
provide
the
task
force
with
a
voice
of
a
worker
on
the
front
line,
and
miss
marshall
will
add
her
voice
to
her
personal
experiences
to
these
services.
K
While
there
is
not
a
nationally
recognized
definition
of
integrated
care,
our
organization
uses
the
term
to
describe
efforts
to
provide
health
care
services
that
bring
together.
All
of
the
components
that
make
humans
healthy,
given
that
the
promotion
of
health
involves
a
variety
of
factors
with
psychological
and
biological,
social
communal,
judicial
economic,
many
of
which
we've
heard
about
today.
K
Seven
counties
has
pushed
the
boundaries
of
integrated
care
models
by
placing
behavioral
health
specialists
on
site
at
our
locally
federally
qualified
health
care
centers.
We
have
provided
clinicians
to
a
number
of
outpatient
care
systems
in
the
jefferson
county
and
surrounding
areas,
and
we
provided
peer
support
specialists
for
emergency
department
resources.
K
We've
also
fostered
research
opportunities
in
universities
and
healthcare
companies,
promoting
research
and
care
coordination
in
areas
such
as
liver
disease,
hepatitis,
hiv
and
we
strive
in
these
relationships
to
improve
the
health
outcome
and
to
train
professionals
to
learn
to
work
in
concert
with
one
another
time
does
not
allow
today,
but
one
of
these
days
I
would
love
to
share
the
results
of
our
hepatitis
c
work
where
we've
improved
dramatically
to
follow
through
with
the
treatment
of
hepatitis
c
for
another
conversation
in
the
end,
integrated
care
results
in
a
unified
framework,
often
side
by
side,
whether
physically
or
through
technology
like
we're
doing
today
incorporating
the
whole
patient
experience,
the
patient,
the
family,
the
community
is
equal
partners,
but
the
result
is
care.
K
That's
humane,
person-centered,
efficient,
cost-effective
and
resulting
in
positive
health
outcomes
is
meaningful
fulfilling
to
the
people
who
access
our
services.
The
question
remains:
why
do
we
go
through
such
efforts?
Why
is
it
important
for
kentucky
legislators
to
consider
this?
Why
is
it
important
for
us
to
think
about
better
ways
of
doing
this?
K
The
answer
is
simple
and
painful
people
with
severe
mental
disorders
and
substance
use
disorders
on
average.
Here
in
kentucky,
I
tend
to
die
earlier
than
the
general
population,
and
not
by
a
little
bit,
but
by
many
years
there
is
a
10
to
25
year,
life
expectancy,
reduction
in
patients
with
severe
mental
illness
disorders
and
substance
use
disorders.
K
One
way
to
think
about
integrated
care
is
to
consider
the
various
models
and
clinic
pathways
and
perspectives
that
make
up
these
efforts
to
bring
together
parts
of
the
healthcare
delivery
system
that
traditionally
work
in
silos
and
to
help
us
and
to
help
the
task
force.
Think
about
this
I'd
like
to
start
by
asking
colleen
colossa
to
speak
a
little
bit
with
the
task
force
force
about
her
work
and
the
special
clinic
that
we
have
that's
been
part
of
our
samson
grant
pop
activity,
calling.
L
L
The
mission
was
implemented
by
the
kentucky
cabinet
for
health
and
family
services.
After
samsa,
the
substance,
abuse
and
mental
health
service
administration
identified
a
substantial
need
to
improve
adults,
physical
health
status
with
mental
illness
and
those
with
co-occurring
substance
use
disorders.
L
We
provide
co-located
and
combined
services
that
offer
an
all-inclusive
health
home
through
coordination
of
care
and
the
collaboration
within
our
clinical
practice.
Our
services
encompass
health
prevention
strategies,
evidence-based
screenings
and
assessments,
the
diagnosis
and
treatment
of
acute
and
or
chronic
health
problems.
We
offer
mental
health
counseling
case
management,
adult
peer
support
and
connection
to
community
resources.
L
In
march
of
this
year,
we've
presented
the
following
patient
profile
in
the
medical
news
journal
and
I'd
like
to
share
it
with
you.
Today
we
have
a
50
two-year-old
female,
with
a
history
of
major
depression,
post-traumatic
stress,
disorder,
mood
disorder,
opioid
use
disorder,
methamphetamine
use
disorder,
tobacco
use
disorder
and
hepatitis
c
presented
to
our
clinic
with
decreased
activity,
tolerance,
shortness
of
breath,
daily,
productive,
cough
joint
pain
and
a
rash
after
completing
evidence,
our
evidence-based
program,
screening
and
assessments
and
a
comprehensive
panel
of
labs.
She
was
evaluated
with
elevated
liver
enzymes.
L
She
was
negative
hepatitis
c
viral
load,
which
was
great
and
she
had
elevated,
inflammatory
markers
and
her
chest.
X-Ray
showed
mild
emphysema
and
an
office
spirometer
demonstrated
moderate
copd.
The
patient
was
prescribed
a
lung
acting
inhaler,
a
rescue
inhaler
administered,
her
pneumococcal
and
flu
vaccines.
L
She
was
educated
on
smoking,
cessation
and
she
was
referred
to
rheumatology
for
further
evaluation
after
receiving
outpatient
psychiatric
care,
or
excuse
me,
while
receiving
for
outpatient
psychiatric
care,
her
suboxone
maintenance
therapy.
We
call
mat
and
intense
outpatient
treatment
services
for
substance
abuse.
She
participated
in
wham,
a
whole
health
action
management
class.
This
is
a
peer-led,
evidence-based
wellness
program
to
help
self-manage
their
physical
and
chronic
disease
by
teaching
goal
setting
through
action
plans.
It's
an
eight
week
course,
and
after
finishing
this
course
and
visiting
with
her
rheumatologist,
she
received
a
new
diagnosis
of
lupus
with
polyarthritis.
L
The
client
was
started
on
plaquenil
twice
a
day
and
began
to
feel
better
and
after
multiple
interactions
with
program
staff.
She
followed
up
with
dental
ophthalmology,
completed
her
screening.
Mammogram
enjoyed
a
bridge
walk
by
a
peer
support,
specialist
and
returned
to
the
workforce
with
part-time
employment.
L
L
L
L
Eleven
percent
have
a
diagnosis
of
schizophrenia,
eleven
percent
bipolar,
twenty
nine
percent,
major
depressive
disorders
and
thirty,
six
percent
with
anxiety
disorders
and
92
percent
with
tobacco
disorders.
Many
of
our
adult
patients
began
smoking
cigarettes
at
a
young
age
and
they
have
poor
nutritional
habits
and
lead
sedentary
lifestyles.
L
These
behaviors,
combined
with
the
adverse
effects
of
antipsychotic
medications,
contribute
to
obesity,
hypertension,
diabetes,
high
cholesterol
and
to
further
impact
our
positive
health
health
outcomes
with
kentucky
integrated
care.
We
recognize
the
million
hearts
initiative
campaign
to
prevent
cardiovascular
events
such
as
heart
disease.
L
Okay,
all
right
and
that's
all
I
have
to
say
I'll.
Let
jennifer
speak
now.
J
J
They
took
their
time
with
the
verbal
assessments
and
got
to
know
me
without
judgment
and
made
me
feel
like
a
human
being
again
that
renewed
my
faith
in
the
medical
profession,
who
had
felt
judged
me
and
stopped
listening
to
me.
Listening
to
me
due
to
my
addiction
and
their
own
preconceptions,
the
lab
work
they
were
was
the
most
thorough
I
have
ever
encountered
and
even
included
genetic
testing
to
see
what
medications
would
work
best
for
me
and
what
ones
do
not.
J
J
J
The
staff
celebrated
my
accomplishments
with
me,
sometimes
with
just
a
text
of
your
encouragement,
a
surprise
gift
for
being
in
compliance
or
even
once
purchasing
me
some
tomato
plants
to
plant.
In
my
garden
at
my
new
home
little
acts
of
kindness
that
may
seem
like
they
didn't
mean
much
to
anyone
else,
but
they
did
so
to
me.
They
let
me
know
that
they
listened,
they
knew
me
they
cared
and
saw
my
growth
and
they
believed
in
me.
J
J
I
know
without
a
doubt,
if
it
wasn't
for
this
program
and
these
wonderful
people
who
carry
out
their
vocation
with
such
love,
respect
and
care
that
I
would
not
be
where
I
am
today
today,
I'm
employed,
I
am
independent.
I
am
productive
and,
more
importantly,
I
am
excited
for
what
is
in
store
for
me
next,
as
I
continue
on
this
path
of
personal
growth,
I
could
not
have
done
this
without
them.
Thank
you,
ladies
and
gentlemen,
for
listening
to
me.
B
Everybody
hear
me.
I
hope.
Okay
up
next,
but
last
but
certainly
not
least,
we
have
brenda
benson,
jim
benson
and
chris
stevenson,
brendan
jim,
are
from
nami
murray
kentucky
and
chris
steveson
is
from
mshn
enterprises.
I
believe
mr
stevenson
is
appearing
remotely
since
we
are
running
low
on
time.
Please
keep
the
presentation
to
no
longer
than
12
minutes.
M
Can
you
hear
me
now?
Okay,
thank
you
for
having
us
here
today.
My
name
is
brenda
benson
and,
along
with
me
today,
in
the
room
is
jim,
my
husband
rhonda
flood
and
janice
morgan.
We
are
members
and
leaders
in
our
local
nami
affiliate
and
we
are
also
parents
of
adult
sons
with
a
severe
mental
illness
and
shortly
chris
stevenson
will
join
us
via
zoom.
He
is
the
chief
information
officer
for
mshn
enterprises
in
the
state
of
tennessee.
M
Along
with
that
is
our
stories
documenting
our
struggles
in
providing
proper
care
and
housing
for
our
sons,
jim
and
I
have
a
36
year
old
son
with
paranoid
schizophrenia
and
a
co-occurring
substance.
Addiction
rhonda
has
a
40
year
old
son
with
paranoid
schizophrenia
and
janice
has
a
33
year
old
son
with
bipolar
2
and
a
co-occurring
substance
addiction.
M
Last
month
at
the
task
force
meeting
you
heard
from
andrea
blake.
Her
story
is
not
an
isolated
occurrence:
it
is
a
norm
for
a
family
seeking
help
for
a
severely
mentally
ill
family
member,
and
it's
also
our
story
and
many
other
kentucky
families.
M
For
many
years
we
each
this
table
have
searched
for
supported
housing
for
our
sons.
That
would
be
more
than
simply
room
and
board,
but
housing
that
fostered
healthier,
living
with
programs
that
included
integrated
services
to
help
them
achieve
their
better
lives,
and
we
have
found
a
model
and
it's
in
the
state
of
tennessee
and
it's
mshn
enterprises,
and
now
I'd
like
to
turn
our
presentation
over
to
chris
via
zoom,
and
let
him
tell
you
a
little
bit
about
their
supported
housing
model.
B
H
Okay,
so
I'll
be
very
very
brief.
With
my
presentation
we're
the
largest
msh
enterprises
is
the
largest
provider
in
tennessee.
We
support
about
500
people
across
the
state,
some
of
the
services
that
are
offered
within
our
our
model.
We
have
three
different
levels
of
care
at
the
housing
level,
the
artf,
enhanced
and
supportive,
and
what
those
three
different
levels
of
care
do
is.
Is
it
allows
the
the
resident
to
come
into
the
program?
H
The
higher
levels
of
care
have
obviously
higher
levels
of
care,
the
you
know
intense
medication
management,
they
have
more
therapy
sessions
and,
as
they
graduate
to
the
program,
they
either
are
able
to
live
on
their
own
after
they
have
their
training
and
after
they
have
their
medication
management
as
well
as
individual
therapy.
A
lot
of
our
residents
do
make
it
out
of
the
program
and
live
independently
once
they
have
the
the
tools
provided
to
them
in
the
state
of
tennessee.
H
The
tennessee
department
of
mental
health
and
substance
abuse
services
provides
the
regulatory
information
and
then
our
mcos.
Those
are
the
insurance
companies
kind
of
manage
the
funds
that
pay
for
it
see
we
contract
with
the
community
health
mental
health
centers.
We
found
several
about
20
years
ago,
actually
that
the
community
mental
health
centers
were
extremely
great
at
what
they
do,
but
when
they
were
asked
to
provide
housing
that
was
kind
of
a
different,
a
different
struggle
for
them.
H
So
companies
like
us
came
in
and
contract
with
the
mental
health
centers
to
provide
the
aspect.
The
housing
part
of
the
model
see
one
of
our
most
important
services
is
continual
medication
oversight.
We
have
group
therapy
almost
on
a
daily
basis
for
residents
to
make
to
memorize
their
medications
and
understand
the
importance
of
taking
their
medications.
H
H
Without
our
without
our
housing
programs,
I
would
incarceration
estate
or
federal
penalty
systems
resulting
in
a
higher
cost
that,
or
they
end
up
homeless
or,
as
it
was
stated
earlier
today
with
that
lower
lifespan,
and
they
end
up
in
the
more
I
want
to
spend
some
time
on
this
graph.
Mma
thai
is
one
of
our
state-run
mental
hospitals,
and
so
in
the
year
prior
to
this,
these
residents
coming
to
our
system.
H
H
H
And
just
different
structure
that
we're
able
to
offer
within
our
within
our
program.
I
know
we're
short
on
time,
so
we'll
go
ahead
and
open
it
up
to
questions.
B
Okay,
that
was
very
informative
and
thank
you
very
much.
We
have
any
questions
you
may
want
to
doesn't
look
like.
We
have
any
questions.
I
know
we're
late,
so
there's
no
other
questions,
then
our
next
meeting
will
be
november
16th
at
3
o'clock
in
this
room,
and
it
will
be
for
the
recommendations
from
the
committee
only
so
bring
your
recommendations,
we're
going
to
discuss
it
next
month
and
so
do
I
have
a
motion
to
adjourn.