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A
And
noted
we
do
have
a
quorum.
This
is
the
fifth
meeting
of
our
chfs
organizational
structure,
operations,
Administration
task
force;
I,
don't
get
a
little
ahead
of
myself,
but
we
will
have
one
more
meeting
on
November,
2nd
and
possibly
one
other
after
that,
depending
on
what
kind
of
progress
we
make
at
the
next
two
meetings
today
included
with
that,
they
got
a
lot
of
material
to
cover.
Let's
get
right
into
the
agenda.
A
Is
there
a
motion
to
prove
the
minutes
of
September
21st
2022
meeting
motion
by
representative
Bentley's
second
device
center
Alvarado,
all
this
papers
say
aye
in
the
opposition,
but
like
sign,
they're
being
done
minutes
past,
jumping
right
into
our
presentations,
our
Kentucky
Department
of
Behavioral,
Health
development
and
disabilities,
see
that
you're
all
here
and
present.
If
you
would,
you
know
the
routine,
identify
yourself
for
the
record
and
feel
free
to
proceed.
C
Thank
you,
Eric
friedlander
Secretary
of
the
Cabinet
for
Health
and
Family
Services
Wendy.
C
C
So
I
think
one
of
the
biggest
things
and
I'll
I'll
tell
you
a
quick
story
and
then
move
on
because
I
like
to
tell
stories
when
I
went
to
the
department
for
Behavioral
Health
I
come
from
the
commission
for
children
with
special
Healthcare
needs.
Previous
to
that,
and
so
we
were
doing
a
commissioner
search
and
I
I
wanted
to
make
sure
I
had
everybody
who
was
involved
in
that
as
a
part
of
it.
So
I
had
all
everybody's
I.
C
Had
parents
and
I
got
a
ton
of
grief
because
the
people
with
behavioral
health
issues,
who
were
adults,
said
our
parents,
don't
speak
for
us
anymore,
and
it
was
one
of
those
nothing
about
us
without
us
moments
and
where
I
was
trying
to
do
or
I
thought.
I
was
trying
to
do
the
right
thing
where
I
got
an
education,
pretty
quick
on
people
that
I've
been
leaving
out
and
left
out
unintentionally,
but
it
was.
It
was
a
great
great
education.
C
For
me,
as
you
all
know,
Behavioral
Health
is
is
really
and
substance
use.
This
department
has
probably
going
to
have
over
the
next
has
and
will
have
over
the
next.
Several
years,
some
tremendous
challenges
as
we
look
at
what
has
happened
with
substance
use
disorder.
Overdose
deaths
in
Kentucky
really
been
on
the
front
lines
with
making
some
progress
and
then
really
we
saw
some
we've
seen
some
real
declines.
C
Last
couple
of
years
you
know
I
talk
about
covid
as
being
The,
Perfect,
Storm
of
isolation
and
economic
uncertainty
and
having
those
questions
and
and
and
worried
about
where
you're
going
as
as
being
a
perfect
storm
and
not
having
necessarily
ready
access
to
treatments
and
services
as
being
a
perfect
storm
for
kicking
the
opioid
addiction
overdose,
backup,
which
is
what
we
have
seen
attended
last
night
with
representative
Moser
attorney
general's
listening
session
in
Northern
Kentucky.
It
was
also
very
educational.
I
was
saying
to
this
group
beforehand.
C
There
was
a
discussion
at
the
EMS
task
force
about
some
of
the
issues
that
we
heard
about
Transportation
Transportation
transportation
and
what
happens
with
EMS
and
and
where
they
actually
send
folks
and
and
how
hospitals
do
a
warm
handoff
for
folks
with
substance
use
disorder
and
some
of
the
collaboration
that
representative
Mosey.
You,
of
course,
sponsored
in
Northern
Kentucky
and
had
a
lot
to
do
with
so
I
I
hope
you
felt
affirmed
in
all.
You
had
done
up
there
yeah,
so
I
want
to
say
thank
you
for
that.
C
Also
then
Behavioral
Health
and
you
all
have
seen
this
right.
Behavioral
Health
in
schools,
which
we've
seen
the
challenges
there,
Behavioral
Health
in
general.
Those
are
challenges
that
that
we
have
as
a
as
a
state
when
we
look
at
Medicaid
and
we
look
at
the
highest
prescribed
medication
in
Medicaid,
it's
antidepressants.
C
D
B
E
D
Okay,
there
you
go
all
right
so
start
with
our
vision
and
Mission,
which
we
did
recently
update.
So
our
vision
is
that
all
kentuckians
are
going
to
have
access
to
quality
services
and
supports
to
live
full
and
healthy
lives.
Our
mission
to
promote
health
and
well-being
by
facilitating
recovery
for
people's
lives
have
been
affected
by
mental
illness.
Substance
abuse,
supporting
people
with
intellectual
other
dis,
developmental
disabilities
and
building
resilience
for
all
a
little
bit
about
our
responsibility
and
Authority.
D
We
are
designated
as
Kentucky's
mental
health
substance,
use,
treatment,
prevention
and
developmental
intellectual
disability,
Authority,
we're
responsible
for
the
administration
of
both
state
and
federally
funded
mental
health
substance
use
disorder
and
developmental
intellectual
disability
programs
and
services.
Throughout
the
Commonwealth.
We
provide
funding,
Services
technical
assistance
and
oversight
to
facilities
and
community-based
programs
across
the
team
of
care
and
throughout
the
Commonwealth.
Then
we
also
consult
and
collaborate
across
systems
using
our
Collective
expertise,
just
some
examples
of
places
we
collaborate.
Of
course,
we
collaborate
a
lot
within
our
cabinet.
D
The
office
of
the
secretary
public
health,
Medicaid
dcbs
Dale,
all
of
the
major
and
minor
departments
there
at
the
department,
and
then
we
also
collaborate
with
a
host
of
other
state
agencies.
These
are
just
some
examples:
office
of
drug
control,
Policy
Department
of
Corrections
of
the
Kentucky
Emergency
Management,
especially
during
the
recent
disasters,
the
Kentucky
Department
of
Veterans
Affairs
AOC
Department
of
Public
advocacy
Department
of
Education,
so
we
are
involved
in
all
kinds
of
things.
D
This
is
our
map.
I.
Think
I
show
this
literally
every
time
I
come
over,
no
updates,
it's
the
same
map,
but
again
it
kind
of
shows
all
of
our
hospitals,
ICF
specialty
clinics,
all
the
different
Services
we
have,
and
then
it
breaks
with
those
large
black
lines
into
the
14
Community
ml
Health
Centers.
D
On
any
given
day,
we
have
about
800
individuals
in
all
of
our
facilities
combined
and
this
system.
Overall
is
the
public
behavioral
health
safety
net.
D
So
this
just
shows
the
organizational
structure,
so
we
now
have
five
divisions,
so
the
division
of
mental
health
and
substance
use-
and
we
did-
as
you
know,
recently,
divide
those
it
used
to
be
the
division
of
Behavioral
Health
and
that's
because
there's
so
much
more
going
on
with
substance
use
and,
quite
frankly,
a
lot
more
going
on
with
mental
health.
Now
that
we
just
didn't
have
the
capacity
to
really
do
that,
all
in
one
division.
D
So
we've
we've
teased
that
out,
then
we
have
the
traditional
AFM,
our
Developmental
and
intellectual
disabilities
Division
and
then
our
division
of
program
Integrity.
So
we
have
three
clinical
divisions
and
two
support
divisions.
The
office
of
autism
is
attached
to
us
administratively
they're
at
the
top,
and
then
we
have
a
host
of
facilities.
Arh
looks
a
little
different
on
here,
because
it's
a
facility
that
we
don't
own
but
we
do
operate.
They
are
a
state
designated
hospital
that
we
we
have
a
contract
with
them.
D
So
all
told
we
employ
about
1300,
State
and
contract
facilities
and
then
there's
additional
1400
staff
that
are
employed
in
our
contracted
facilities.
E
So
the
Department's
FY
23
budget
slide
shows
is
530.9
million
dollars.
The
largest
portion
of
that
budget,
299.7
million
56
percent,
is
our
for
residential.
That's
for
our
facilities,
our
psychiatric
hospitals,
icfs
and
nursing
facilities.
21
110.2
million
supports
community-based
programs
that
provide
substance,
use
prevention
and
treatment
services,
16
82.7
million
provides
for
community-based
mental
health
programs
16
or
five
percent.
E
E
The
next
slide
shows
our
budget
by
fund
Source
of
the
530.9
million
228.1
million
43
percent
are
agency
funds
and
those
are
primarily
receipts
from
the
operation
of
our
facilities,
Medicaid,
Medicare
and
other
third
party
payers,
probably
about
210
million
of
that
and
then
33
177.8
million
is
general
fund.
7.7
million
two
percent
is
tobacco
settlement
funds
and
those
are
for
programs
for
pregnant
and
parenting.
Women
with
substance
use
disorder
and
then
117.3
million
22
percent
are
Federal
grant
funds.
E
The
largest
part
of
those
our
largest
Grant,
is
our
state
opioid
response
effort,
Grant
36
million,
our
sapt
block
grants
around
20.5
million
and
our
community
mental
health.
Community
Mental
Health
Services
bought
grants
about
10.7
those
are
our
larger
grants
and
then,
in
addition
to
the
larger
grants,.
C
May
I
just
for
one
second,
that
agency
fund.
That
is
really
almost
all
Medicaid.
That's
you
know
when
we
talk
about
agency
funds
in
the
Cabinet
for
Health
and
Family
Services
I
think
I've
said
earlier
on
in
different
departments
that
that
agency
fund
is,
and
particularly
in
Behavioral
Health.
A
lot
of
that
is
Medicaid
vast
majority
yeah.
E
In
addition
to
those
larger
recurring
grants,
the
Department's
fairly
successful
at
securing
competitive
grants,
primarily
through
Substance
Abuse
and
Mental
Health
Services
Administration,
so
this
slide
just
presents
provides
a
list
of
some
of
the
competitive
grants
that
we
have
applied
for
over
the
past
several
years
and
been
awarded
on
an
annual
basis.
These
would
be
approximately
17
million
dollars.
D
All
right,
so
the
next
couple
slides
just
go
through
some
of
our
clinical
divisions.
This
again
is
a
division
of
mental
health.
It's
a
new
graphic
and
I
think
it
just
is
a
good
representation
of
just
how
diverse
the
services
that
we
offer
for
adults
for
children,
school-based
services,
deaf
and
hard
of
hearing
services.
D
D
So
again
we
work
for
those
outpatient
services,
primarily
with
the
Community
Mental
Health
Centers
Who
provided
services
to
over
146
000
individuals
with
mental
illness,
including
forty
four
thousand
adults
with
serious
and
persistent
mental
illness
over
12
000
children
with
serious
emotional
dis,
disability,
and
then
we
answered
somewhere
between
2000
and
2500
998
crisis
Center
calls
per
month
and
again
that
number
was
changed
to
998
this
summer,
but
it
was
the
lifeline
previous
and
we've
been
building
that
system
for
15
years.
D
D
Just
all
types
of
peer
support,
all
types
of
things
here
and
in
fiscal
year
22
the
cmhcs
reported
they
served
over
24
000
individuals
who
were
diagnosed
with
substance
use
disorder
who
got
Outpatient
Therapy
2600
unduplicated
individuals
who
receive
short-term
Residential
Services
844,
who
got
long-term
Residential,
Services,
6,
700
adults
who
received
substance,
use
disorder
peer
support
services,
then
some
additional
things
would
be.
D
There
were
about
33,
500,
sorry,
33
million
doses
of
prevention
and
what
they
kind
of
what
their
this
bucket
would
include
would
be
disseminate
information
such
as
a
community
events,
media
campaigns,
community-based
programs.
D
Again
those
would
be
meetings
or
trainings
education,
such
as
school
curricula
like
too
good
for
drugs
or
youth,
mental
health,
first
aid
for
school
personnel
and
other
folks
who
work
with
youth
problem
identification
referral-
and
this
is
a
place
to
secretary
freelander's
point
where
our
numbers
have
really
increased
substantially
due
in
part
due
to
the
expansion
of
substance,
use
prevention,
media
campaigns,
but
because
we
just
know,
kids
are
really
really
struggling
right.
Now.
D
This
next
slide
is
on
our
opioid
response
effort,
again
prevention
of
initiation
and
misuse
early
intervention,
treatment,
access
and
retention
and
sustaining
recovery.
So
you
can
see,
there's
numbers
in
each
one
of
these
boxes
focused
on
some
youth
primary
prevention.
We've
got
a
number
of
hospitals
committed
to
opioid
stewardship,
doing
lots
of
screen
and
assessment
work,
lots
of
over
14
000,
opioid
use
disorder,
treatment,
services,
55,
core
funded
peers
were
hired,
Statewide
and
9.
500
folks
received
recovery,
support
and
then
for
harm
reduction,
which
we
do
in
collaboration
with
public
health.
D
Our
last
clinical
division
is
for
the
division
of
Developmental
and
intellectual
disabilities.
This
is
where
our
department
administers
the
supports
for
community
living
or
scl
waiver,
and
the
Michelle
P
waiver
for
Medicaid
supports
over
15
000
people
to
live
in
the
community.
We
provide
technical
assistance,
administer
functional
assessments,
collaborate
with
and
monitor
the
14
Community
Mental
Health
Centers,
who
serve
more
than
16
000
folks
with
idd.
D
Every
year
we
oversee
the
crisis
program
who
to
support
folks
with
idd,
with
over
1600
crisis
contacts
made
in
2021,
and
then
we
review
and
complete
fall
for
an
average
of
1400
critical
incidents.
Every
month
again,
the
office
of
autism
is
administratively
attached
to
our
department
and
tell
Curry
who
oversees
that
does
participate
in
all
our
leadership
meetings.
D
The
mission
there
is
to
promote
collaborative
efforts
and
Advocates
to
improve
systems
of
supports
for
individuals
with
autism
and
their
their
vision
is
that
individuals
with
autism
of
all
ages
are
engaged
in
self-determined
lives
and
are
valued
citizens
of
the
community,
so
they
provide
a
communication
Network
between
state
agencies.
Work
to
improve
the
coordination
of
resources,
provide
administrative
support
to
the
Kentucky
advisory
Council
on
autism
and
support
the
28-member
advisory
Council.
D
So
these
are
just
some
other
areas:
I
guess
for
collaboration
where
we
have
a
seat
and
where
we
interact
again
with
folks,
not
just
from
across
our
cabinet
but
across
other
agencies.
So
ciac
Juvenile,
Justice
oversight,
committee,
House,
Bill
144,
which
is
folks
with
idd
we've
got
the
eating
disorder,
Council,
Kentucky
suicide
prevention
group,
Center
for
school
safety
board,
The
Core,
State
implementation,
team,
opioid
abatement
task
force,
Etc,
so
just
lots
of
ways
that
we
work
with
other
folks.
A
Thinking
I'm
sure
we'll
have
questions.
We
will
entertain
those.
If
you
would.
Let
me
start
it
off
that
you
know
I've
got
40
years
of
working
in
healthcare,
but
I've
never
professed
to
be
a
health
care,
professional
I'm,
a
businessman
who
just
happens
to
be
in
the
administration
of
health
care,
so
I
view
things
from
a
very
different
perspective
than
some
people
do,
and
one
of
the
things
that
comes
to
mind
to
me
on
your
slides
is
regard
to
how
substance
abuse
fits
into
Behavioral,
Health
and
in
development
and
intellectual
disabilities.
A
D
A
D
So
you're
well
I
mean
one
of
those
is
overdose.
Is
one
of
those
is
recovery,
sustainability,
employment,
there's,
there's
lots
of
ways,
there's
also
so
much
co-occurring
right.
A
lot
of
folks
have
substance
induced
mental
illnesses,
so
depression
anxiety
often
can
come
when
you
have
a
substance,
use
disorder
and
then
there's
folks
with
primary
mental
illness
who
self-medicate
with
substances
to
you
know
mitigate
their
hallucinations
or
paranoia
or
other
symptoms
that
they
have.
So
it's
almost
impossible
to
pull
those
apart.
A
F
Thank
you,
Mr
chairman.
It's
to
that
point,
so
you
know
right
now,
I
think
we've
got
what
office
for
drug
control
policy
has
some
say
in
this
Department
of
Health
of
Public
Health
oig,
all
of
them.
You
guys
on
your
your
third
slide.
There
I
think
you
call
yourselves
the
authority
on
this
issue,
so
we've
got
at
least
four
different
agencies
that
are
kind
of
working
on
drug
policy
and
we're
this
this
we're
tasked
here
to
try
to
find
ways
to
kind
of
eliminate
redundancy
and
try
to
find
to
be
more
efficient.
F
With
this,
we
have
four
different
departments
outside
of
the
cabinet
now
justice
as
well,
that
handles
a
lot
of
this,
and
so
that
becomes.
The
question
is:
should
this
be
scattered
through
four
different
departments,
all
working
together,
or
should
it
be
under
one
department
where
everything
is
handled
on
this
topic,
and
this
issue
and
I
know
there's
a
different
very
outside
issues
about
these
things,
I
mean
there's.
F
It
would
be
better
to
put
this
all
underneath
one
kind
of
umbrella
when
it
comes
to
this
topic
instead
of
scattered
through
several
different
ones,
and
but
to
get
your
take
on
that.
Well,.
D
I
mean
I
would
say,
we
probably
have
the
biggest
role
in
it,
because
we
do
not
just
prevention
and
harm
reduction.
We
do
treatment
and
you
know
that,
like
the
whole
realm
and
and
right
now,
the
block
grant
dollars
come
to
our
department,
the
opioid
abatement
funds
come
to
us,
or
rather
the
the
core
funding
from
the
federal
government.
D
So
those
those
come
to
us.
We
do
collaborate
closely
go
ahead.
E
I
was
just
going
to
add
and
we
do
collaborate
closely
with
office
of
Direct
Control
policy,
so
they
do
receive
funding
statutorily
for
treatment
services
through
the
Community
Mental
Health
Centers
and
for
services
to
address
neonatal
abstinence
syndrome,
and
they
come
to
us
to
administer
those
funds.
So
we
work
really
closely
with
them.
That
was
a
choice
made
on
their
part
that
we
were
the
treatment,
recovery
experts
and
that
they
wanted
us
to
do
that
piece.
C
But
we
can
certainly
see
your
point.
We
think
it's
we
think
it's
where
it
needs
to
live
again,
showing
my
long
time
in
the
cabinet
I.
Remember
when,
when
it
was
all
everything
was
under
a
public
health,
Banner
right
everything
was
under
the
public
health
banner
and
it
was
decided
that
this
is
my
memory
that,
because
it
all
sat
under
Public,
Health,
like
the
behavioral
health
side
wasn't
getting
and
that
that
it
did
include
substance
use
was
not
getting
the
attention
that
it
needed.
C
I
think
it's
the
call
of
this
committee
right
the
charge
of
this
committee
to
look
at
like
what
is
the
best
arrangement
and
and
so
I
think
you
know
there
can
be
a
variety
of
opinions
and
a
variety
of
of
how
you
might
set
it
up
from
an
organizational
structure.
Absolutely
and
I.
C
Just
at
this
point,
I
know
that
the
professionals
within
the
department
for
Behavioral
Health,
you
all
probably
know
Dr
brenzel,
Dr
Marx,
really
have
done
a
tremendous
job
in
in
doing
some,
some
leadership
through
the
core
pieces
and
and
we've
seen,
we've
seen
additional
challenges.
There's
no
question
around
that.
F
Out,
if
we're
going
to
restructure
this,
how
where
would
fit
best
to
coordinate
I,
know,
there's
different
aspects
of
it.
Everybody's
got
their
own
specialty
underneath
that,
but
it's
just
trying
to
find
a
way
to
reduce
redundancies.
On
that
another
question:
I
had
was
also
on
the
on
our
scl
Michelle
P
waiver
kind
of
programs.
D
So
the
our
division
oversees
that
waiver,
so
we
we
provide
oversight
of
the
providers,
do
in-home
visits
and
cite
them
when
we
need
to
provide
technical
assistance,
provided
lots
of
support
during
the
disasters
during
covid
to
make
sure
folks
were
okay
and
we
I
mean
we,
we
communicate
regularly
with
Medicaid
about
those
types
of
things.
So
I
don't
know.
If
that
answers
your.
F
Yeah
so
I
mean
some
of
the
things
I
had
written
down
here
in
my
notes,
so
you
administer
these
programs
on
behalf
of
Medicaid
correct.
D
D
F
F
Okay,
so
was.
C
F
That's
what
I'm
getting
at
two
years
right
effectively,
that
is,
you
know
how
does
the
cabinet
kind
of
reconcile
medicaid-finded
programs
being
administered
by
completely
different
department,
with
a
different
commissioner
and
Leadership
staff
and
all
those
sorts
of
things,
and
could
the
expertise
that
exist
really
within
your
guys's
Department
to
administ
these
programs
be
relocated
to
Medicaid
or
not
so
again,
it's
just
I'm
trying
to
find
a
way
to
reduce
redundancies,
and
it's
that
point
is
where's
the
best
place
for
some
of
those
and
we've
got.
F
We've
had
members
from
Health
and
Welfare,
who
are
very
passionate
about
those
waivers.
Obviously,
and
a
lot
of
us
try
to
keep
finding
funding
and
it's
always
a
topic
of
conversation
every
year,
but
it's
just
trying
to
figure
out
the
best
place
for
that
and
that's
kind
of
where
I'm
getting
out
with
those
those
questions
as
well.
I,
don't
know
if
anybody
has
the
answer
per
se,
but
I
don't
think
there
is
right.
Thank
you,
Mr
chairman
thank.
C
You
may
I
go
back
one
on
this
is
just
history.
Okay,
so
two
history
points
because
I'm
old
one
is
the
first
one
is
until
probably
about
five
six
seven
years
ago
for
a
Community,
Mental,
Health
Center
to
treat
substance
use
there
had
to
be
a
mental
health
diagnosis,
Behavioral
Health
diagnosis,
mental
health,
diagnosis,
sorry
again,
I'm
old,
I'll
I'll.
C
Just
you
know
there
had
to
be
a
diagnosis
before
you
could
treat
the
substance
use
and
we
were
forcing
a
lot
of
the
Community
Mental
Health
Centers
to
come
up
with
a
behavioral
health
diagnosis
before
somebody
could
get
the
substance
use
treatment
again,
probably
a
reason
why,
particularly
historically
it
resided
within
the
part
for
Behavioral
Health
that
that
changed
several
years
ago,
and
that
that's
a
that's
a
good
change
but
I.
Just
that's
a
history
piece
go
ahead.
D
C
And
the
other
piece
to
your
waiver
question
again.
This
is
a
long
time
ago,
when
Mark
bird
whistle
was
in
Medicaid
and
I
was
in
the
inspector
General's
office.
It
was
about
who
was
going
to
regulate
and
regulate
the
providers,
and
so
I've
been
around
long
enough
that
some
of
the
decisions
I
helped
create,
have
come
back
to
bite
me.
C
G
G
I
just
wondered
because
they
hit
us
with
that
news
notice.
Today
he
was
there
at
Prestonsburg.
My
question
is
this
summer:
in
the
interim
we
had
in
Health
and
Family
Services,
and
this
is
to
you
secretary,
the
last
session
I
sponsored
House
Bill
349
on
cmhcs,
the
regional
Legislation,
during
that
testimony
this
summer,
at
the
interim
Health
and
Welfare
and
Family
Services
committee,
the
regional
bill
was
discussed
and
some
well
I.
Remember
one
Senator
asked
me
directly:
some
members
asked:
does
the
cabinet
and
secretary
Freelander
support
the
legislation?
C
So
this
is
the
one
around
the
the
types
of
services
that
a
cmhc
can
provide
inside
and
outside
of
their
their
region.
Is
that.
C
C
So
the
Eric
I'm
going
to
refer
to
you
again.
We
at
the
time
those
regions
were
were
defined
and
you
really
couldn't
provide
services
outside
your
region.
C
Decision
was
made
and
I
would
have
made
the
exact
same
one
that
you
know
competition's
good,
let's,
let's
let
folks
provide
services
outside
their
region.
Let's
make
sure
that
we're
getting
enough
Services
across
across
Kentucky,
as
we
need
the
Nuance
to
that
and
I
think
it
was
a
part
of
your
bill
that
I
I
now
fully
support
is
that
if
a
center
is
going
to
provide
services
outside
of
their
region,
they
should
probably
be
licensed
as
a
Behavioral,
Health
Services
organization
and
provide
under
that
license.
C
The
reason
is,
if
you're,
a
comprehensive
care
center,
you
can
provide
services
in
a
way
under
that
license
in
your
region
that
that
that
allows
for
for
different
levels
of
professionalism.
I'll
just
say
it
that
way:
different
training,
different
requirements
there,
which,
which
are
which
are
not
the
same
as
the
Behavioral
Health
Services
organization,
I
I,
would
love
for
all
of
our
comprehensive
care
centers
to
get
licenses
of
Behavioral
Health
Services
organization
and
try
to
provide
services.
All
across
the
state
I
think
that
that's
that's
a
good
thing
to
to
encourage
that
kind
of.
C
We
know
we
have
deficits
in
in
professionals
across
the
state.
We
know
we
have
challenges
in
providing
those
services
in
schools
and
to
other
other
providers
and
other
levels
of
care.
So
I
think
that
kind
of
piece
is
a
good
thing.
I
think.
If
you're
going
to
provide
outside
of
your
designated
State
designated
region,
you
should
be
licensed
to
provide
those
Services
outside
that
region.
So
that's
the
only
Nuance
that
I
would
put
to
that
and
I
think
that
that
was
in
keeping
with
your
bill.
Yeah.
A
C
C
They
pretty
much
follow,
except
for
119
counties,
follow
the
area
development
districts,
which
is
again
I,
think
the
right
thing
to
do
so
that
that's
how
they're
defined
there.
C
We'll
show
this
before
the
regional
system
was
set
up
by
Under
the
Kennedy
administration,
so
the
the
whole
concept
of
a
Comprehensive
Care
Center
was
under
that
statute.
You
can
get
me
lecturing
now
was
under
that
statute
put
in
place,
because
the
point
was
to
provide
services
in
community
and
to
move
people
out
of
psychiatric
hospitals
and
provide
services
in
community.
What
the
reality
of
what
happened
and
we've
all
seen
it
is
folks,
certainly
got
moved
out
of
facilities.
C
The
the
psychiatric
hospitals
are,
you
know
you
had
thousands
of
people
in
psychiatric
hospitals
prior
to
that,
so
folks
got
moved
out
of
those
facilities,
but
we
never
followed
up
with
the
funding
for
community.
So
what
happened?
A
lot
of
people
get
Behavioral
Health
Services
in
our
prison
system
in
our
correction
system,
a
lot
of
folks
who
ended
up
on
the
street-
and
you
all
have
seen
it
right
at
behavioral,
health
or
substance
use
issues,
and
and
because
we
didn't
fully
fund
the
community
back
in
the
60s
fully
fund
that
system
for
Community.
C
A
E
No
I
think
in
statute,
this
statutes
in
krs-210
and
it
allowed
regions
and
communities
to
come
together
to
form
those
Regional
boards
that
were
to
be
approved
by
the
secretary
of
the
cabinet.
That's
the
that's!
What's
in
statute
right
now,
and
so
those
boards
were
established
years
ago.
That's
what
the
Community
Mental
Health
Centers
and
as
far
as
I
know
from
the
initial
establishment,
probably
the
combination
of
Pathways,
which
was
two
regions
at
one
time,
that's
really
where
they
exist.
I.
H
C
C
Setup,
it's
it's
a
little
complicated,
so
they
were
set
up
their
Community
Mental
Health
boards
on
each
Community
to
help
mental
health
board
is
a
definition
of
who
needs
to
be
on
it
right
in
in
terms
of
the
County
judge
and
and
the
folks
who
who
comprise
that
region
that
it
that
then,
has
become
since
the
initial
setup.
Those
are
the
regions.
H
C
Was
an
initial
setup
a
long
time
ago,
I'm
not
sure
which
secretary
it
was,
that
did
it,
but
that's
that's
what's
established
those
regions
is
that
groups.
C
D
Was
approved
by
somebody
decades
ago
and
we've
we
have
abided
by
that
ever
since,
because
those
I
mean
they
are
boards
and
they
have
membership
from
every
County
they
serve.
And
then
we
contract
with
that
board.
Okay,.
H
C
Right,
well,
it's
it's
a
collab,
it's
more
collaborative
than
that.
You
know
I
I!
Think
if
we
went
in
and
tried
to
dictate
a
change.
You
all
might
have
us
up
here
and
not
be
happy
with
us.
H
Gotcha
all
right
Mr
chair,
if
I,
if
I
may,
that
wasn't
actually
what
I
was
going
to
ask
deja.
B
A
H
On
the
substance
use
disorder,
piece,
I
would
agree
actually
that
that
beaded
kind
of
stay
in
in
the
Hub
and
spoke
model
as
the
center
of
that,
because
I
think
that
there's
you
have
the
ability
to
to
well
and
you've,
made
a
lot
of
changes
in
in
in
Awareness
campaigns
and
so
forth
to
really
educate
the
public
on
what
the
underlying
issues
are
as
to
substance,
use,
disorders
and
all
of
the
co-occurring
disorders
that
happen,
and
you
have
the
ability
to
partner
with
the
the
other
departments.
H
You
know
the
Kentucky
office
of
drug
control
policy
and
so
forth
to
to
put
policies
in
place
or
really
understand
programs.
So
I'm,
not
convinced
that
you
know
we
really
need
to
make
a
change.
There,
maybe
other
places,
but
you
know
I
I
do
agree
that
understanding,
Behavioral
Health
is
key
to
addressing
substance,
use
disorders,
and
so
that's
my
comment
and
then
my
question
is
on
slide.
Nine.
H
There
are
some
references
to
samsa
Grants
for
or
or
there
are
grants
for
assisted
Outpatient
Treatment
is
Tim's
law
included.
That
is,
that
is
Tim.
H
H
D
Were
some
funds
return
to
first
year
and
so
and
I'm
not
sure
where
we
stand
Stephanie
with
the
second
year?
But
you
know
we
we
look
to
expand
it,
that
that
the
criteria
for
this
grant
was
set
up
before
the
law
was
expanded
and
it
was
pretty
narrow
and
there
was
no
referral
that
was
turned
away
due
to
lack
of
funding.
So
in
order
to
make
a
you
know
a
plea
to
keep
our
funding,
we
had
to
be
able
to
say
so
what
else
you're
going
to
do
with
it.
D
So
we
grew
the
regions
yeah,
so
we
could
serve
more
people
and
more
regions
with
those
same
dollars
and.
C
C
C
I
think
there
was
some
real
concern
on
the
part
of
folks
from
Jefferson
County
in
particular
that
that
perhaps
their
area
lost
out
on
funding
I
want
to
be
clear
and
I
think
it
was
clear
with
the
folks
who
were
concerned
that
I
personally
called
Seven
Counties
and
said,
and-
and
we
are
all
in
agreement
right-
that
whatever
expenses
you
have
we're
going
to
cover,
so
I
want
to
be
really
clear
that
those
expenses
related
to
Tim's
law.
C
C
E
We
are
in
your
three
of
the
four-year
grants,
so
there
is
funding
still
I
think
the
first
year
we
only
spent
around
374
000,
but
things
hopped
up
the
second
year.
We
did
spend
around
720
000
for
the
second
year
and
we're
in
the
middle
of
the
third
year.
So
there
is
still
is
great
funding
for
us
to
carry
forward.
Okay,.
A
Believe,
representative
Bentley
has
a
follow-up
question.
Then
we
have
co-chair
me
and
I'll
cut
it
off
there,
because
we
need
to
move
on.
We
still
got
a
lot
of
territory
to.
D
E
G
349
will
delineate
right
the
regions
and
no
to
A.D
districts.
F
D
B
Thank
you,
Mr
chairman
I,
just
have
a
question
that
just
a
follow-up
to
actually
something
that
was
covered
in
the
last
child
welfare
oversight
advisory
committee.
The
children's
lives
came
in
and
during
that
meeting
in
admission,
that
psych
hospitals
are
denying
care
to
foster
children
that
are
coming
from
those
residential
foster
care
facilities.
Is
that
the
case
are
those
psych
hospitals
allowed
to
refuse
that
treatment
to
those
who
who
had
those
severe
mental
disabilities?
We.
C
That
is
a
tremendously
difficult
issue
and
it
is
true:
we
have
psychiatric
hospitals
that
no
longer
have
placement
for
some
kids.
We,
the
kids
that
are
most
difficult
to
place.
Those
folks
who
have
those
kids
who
have
developmental
intellectual
disabilities
may
be
sexually
reactive,
have
some
other
behavioral
health
issues,
though,
and
and
have
and
act
out
right
and
have
some
have
some
violence
issues.
C
Those
kids
and
and
they're
still,
kids
are
very
difficult
to
place
even
out
of
state
I
think
when
I
was
up
here
with
Social
Services
last
time,
I
I
identified
for
you
all
that
that
that's
I,
maybe
didn't
give
it
enough
drama.
But
you
know
we
have
kids
that
that
occasionally
we
have
no
place
to
place
them
and
they
end
up
in
a
DCPS
office.
That's
a
that's
a
terrible
outcome
until
we
can
find
placement.
So
yes,
that
is
accurate.
C
I've
got
a
group
inside
the
cabinet,
because
I
think
this
is
going
to
be
a
three-pronged
approach.
There's
got
to
be
a
short-term
issue
and
we've
been
working
with
Aetna.
There
are
they're
called
the
sky,
they
have
the
sky
program,
which
is
a
foster
care.
It's
a
single
place
where
they
go,
they
they've
been
pretty
good
partners.
I
have
to
give
them
credit,
but
it's
a
challenge
out
of
state
facilities.
Nobody
wants.
C
Occasionally
we
have
to
do
some
of
that.
Department
of
Juvenile
Justice
faces
has
some
of
these
same
kids.
We
actually
had
a
meeting
with
them
today
to
identify
some
of
these
challenging
issues.
We
don't
necessarily
have
a
great.
C
We
don't
have
a
great
licensed
facility
placement
for
these
kids
because
they
are
so
challenging.
We
think
we
have
maybe
dcbs
folks
think
we
have
100
200
of
these
kids
across
the
state.
I
I
hope
that
estimate's
lower,
but
you
know
I
think
we've
testified
before
that.
We,
what
we're
seeing
are
kids
that
are
more
challenging,
more
acute
and
and
I
think
anybody
that
I
think.
C
Probably
they
said
that
to
you
at
child
welfare
oversight,
we
have
some
kids
that
are
are
really
are
really
challenging
and
we
are
struggling
with
placement
now
we're
we're
working
on
it.
I,
like
we're
going
to
have
I've,
got
somebody
we're
working
on
like
what's
a
short-term
solution
right,
but
then
there's
going
to
be
a
longer
term
solution
and
we
will
come
back
to
you
all
because
I
think
what's
appropriate
placement.
If,
if
there's
a,
if
there's
a
lot
of
violence
involved,
is
it
is
it
a
secure
placement,
then?
C
How
do
we
make
sure
that
we
give
the
proper
behavioral
health
support
for
these
kids,
which
is
a
challenge
right
now,
particularly
in
a
secure
placement?
We've
got
facilities
that
are
challenged
to
provide
the
services
and
and
I'm
not
sure
it's
a
reimbursement
issue,
I'm
sure
it
is
some
it's
always
a
little
bit
of
that.
But
I
don't
know
if
it's
a
reimbursement
issue,
because
because
the
behaviors
are
so
challenging
and
we
really
and
it's
younger
and
younger
kids,
and
so
we
we're
trying
to
face
down
that
challenge.
C
So
we've
we've
got
to
probably
come
back
to
you
all
with
what
does
that
look
like
from
a
how
we
want
to
treat
these
kids
in
a
system
and
which
system
do
we
want
to
treat
them
in?
And
how
do
we
want
to
assure
that
Behavioral
Health
Service?
Is
there
and
I
can
tell
you
it's
going
to
be
expensive
and
and
that's
it's
it's
a
challenge.
I
think
every
State's
seeing
it
I,
don't
think
we're
alone,
at
least
when
I
talk
to
other
states,
we're
not
alone,
but
that
doesn't
mean
we.
D
And
I
would
just
add
that
all
of
the
state
beds
are
for
adults,
18
and
older.
We
don't
operate
any
inpatient
beds
for
children,
yeah.
C
And
so
like
with
adults,
we
have
Adult
Psychiatric
facilities
where
we
control
the
front
door.
Essentially
we
control
admission.
We
don't
have
that
with
kids
right.
We
just
we
just
don't
we
don't
have
any
specialty
children's
I
mean
we
don't
have
a
state
run
where
we
control
the
front
door,
children
psychiatric,
we
have
children
psychiatric,
but
but
not
where
we
say
you
have
to
take
this
kid
right.
We
don't.
C
A
C
Don't
think
we've
asked
other
states
for
their
models.
Some
states
there's
a
game
that
states
play
with
Medicaid
and
I'm
just
going
to
say
it
it's
a
game.
You
can
pay
somebody
more
sometimes
by
placing
the
child
out
of
state.
C
So
I
won't
use
our
state
as
an
example,
but
like
Georgia
and
North
Carolina
right
and
sorry
if
anybody's
in
Georgia,
North
Carolina,
but
they'll
George
will
send
kids
to
North
Carolina
because
they
can
pay
more
and
then
North
Carolina
will
turn
around
and
send
their
kids
to
Georgia
because
they
can
pay
more
in
Medicaid
and
it
it's
not.
It's
not
a
good
system
and.
C
A
C
A
I
I
I
Kentucky
Department
for
public
health
exists
to
create
healthier
people
and
therefore
healthier
communities
as
a
result,
and
we
work
in
support
of
the
cabinets
overall
mission
to
ensure
that
every
Kentuckian
has
the
opportunity
to
reach
their
full
human
potential,
and
we
do
that
through
these
three
primary
ways.
I
Prevention,
if
you
think
about
that,
is
a
way
to
involve
guarding
against
a
very
I
think
this
is
actually
backwards
on
the
slide
prevention
to
like
for
diabetes
and
for
hypertension
and
for
chronic
lung
disease,
and
things
like
that,
where
we
can
do
targeted
interventions
to
specifically
reduce
the
burden
of
chronic
illness
promotion
would
be
more
to
like
create
a
healthier
living
environment
and
to
try
to
Foster
the
circumstances
and
conditions
where
we
would
have
healthier.
People
and
protection.
I
Is
that
there's
dangers
in
the
world
within
which
we
live,
and
how
can
we
protect
people
from
those
so
think
about
food
safety,
inspections,
there's
going
to
be
infections
and
there's
going
to
be
risk
of
contagion?
How
do
you
go
do
site
inspections
and
make
sure
that
restaurants
are
safe
and
that
they're
using
proper
hygiene
and
controls?
So
we
do
these
kind
of
activities
and
I'm
going
to
go
into
more
detail
on
the
structure
of
the
department.
What
I
thought
first,
we'll
talk
about
the
money
pre-covered.
I
This
agency
was
about
a
360
million
dollar
in
expenditure
agency.
Obviously,
covid
changed
things
quite
a
a
bit
starting
mid
to
late
2020.
Additional
federal
funds
were
coming
into
the
agency
to
support
coveted
related
activities,
and
then
substantial
funds
really
came
in
and
that
supported
activities
in
2022
and
2023
ahead.
What
will
end
up
happening
is
by
mid-2024
all
that
Federal
covid
funding
will
essentially
wash
out
and
and
be
gone.
So
most
of
those
grants
were
intended
to
be
available
for
use
through
the
summer
of
23.
I
Every
state
has
asked
for
extensions
for
some
of
the
bigger
ones,
but
those
extensions
now
go
through
about
the
summer
of
24,
and
at
that
point
it's
likely
that
no
further
extensions
will
be
granted
and
the
coveted
money
will
be
gone.
So
that's
what
caused
us
to
grow
from
a
360
million
dollar
agency,
all
the
way
up
to
about
600
640
million
dollar
agency,
and
it
has
crested
now
and
it
will
then
descend
back
down.
I
Most
of
those
activities
were
contained
with
specific
things
that
we
did
right,
so
creating
testing
capacity,
getting
PPE,
supporting
local
communities
allocating
and
helping
to
facilitate
education
and
distribution
of
vaccines.
So
those
that
the
money
came
in
for
a
specific
purpose.
It
was
used
for
that
purpose.
I
The
purpose
is
receded,
and
so
we
will
end
up
falling
back
into
a
more
normal
footprint
for
what
public
health
more
typically
would
have
been
now
more
normal,
won't
be
360
million
it'll
be
a
bit
more
because
you've
all
invested
in
public
health
transformation,
which
is
in
the
17
to
19
million
dollar
range.
So
that's
helped
to
increase
our
resources
to
local
Health
departments,
and
there
are
some
federal
grants
that
were
specifically
created
to
help
with
public
health
Workforce
develop
and
to
try
to
help
build
a
more
robust
and
a
more
sustainable
public
health
system.
I
And
so
there
are
some
of
those
additional
funds
and
then,
of
course,
Clinical
Services
took
a
dip
in
21
with
the
peak
of
the
covet
pandemic,
like
happened
in
a
lot
of
other
areas,
and
those
are
now
starting
to
return
more
to
a
normal
Cadence,
and
so
all
of
that
results
in
a
retreat
from
the
peak
of
the
640
million
dollars.
You
see
in
FY
23
down
to
about
522
million
and
then
that'll
go
down
into
the
400s
for
millions
in
the
next
biennial
budget.
So
we've
we've
had
a
quite
a
journey.
I
I
mean
we've
really
had
to
expand
like
an
accordion
to
deal
with
the
pandemic
and,
of
course,
deal
with
a
lot
of
other
issues
that
I'll
touch
on
as
I
go
through
the
next
slides
in
a
normal
year.
We
are
about
three
quarters
of
all
of
our
revenue
is
federal,
and
so
a
lot
of
resources
are
passed
through
from
federal
grants
directly
to
local
Health
departments
to
provide
services
to
the
people
in
your
cities.
We
also
have
some
general
funds.
I
The
general
funds
is
only
about
a
little
under
nine
percent
of
our
total
on
this
current
fiscal
year
22..
We
also
have
restricted
funds
which
we
have
to
work
to
earn.
If
you
will,
you
have
to
get
fees
for
doing
inspections,
provide
Medicaid
services,
do
a
number
of
different
things,
and
then
only
about
one
and
a
half
percent
of
our
funds
are
tobacco
related.
C
This
public
health
is
the
only
department
where
that
restricted
fund
agency
fund
pie
piece.
There
are
a
lot
of
fees
in
there,
and
so
they
come
in
as
a
restricted
fund.
So
it
is,
it
is
not
the
same
percentage
that
is
Medicaid
here,
as
it
is
in
every
other
department.
Just
since
I
brought
it
up,
every
Department
I
thought
I'd
say
it
here.
I
I
It
was
a
little
higher,
but
as
we're
retreating
from
some
of
the
covet
activities,
it's
kind
of
in
a
slow
downward
Trend,
so
we've
got
about
400,
Merit
staff,
about
170
or
so
either
contracted
or
CDC
staff
at
the
local
Health
departments
and
I
believe
this
includes
the
remember.
We
have
120
counties
which
you
all
know.
Well,
we
have
61
local
Health
departments
that
serve
them.
This
I
think
captures
58
of
those
Health
departments,
because
three
of
them
are
independent,
so
Lexington,
Louisville
and
Northern
Kentucky
District
are
Independent
Health
departments.
I
So
these
numbers
I
think
reflect
the
58
Health
departments
that
serve
all
the
other
areas
of
the
state.
There's
1500
Merit,
employee
boys,
and
then
they
have
about
646
contracted
employees
and
there's
a
few
hundred
more
people
who
work
in
Northern,
Kentucky,
District,
Health,
Department,
Louisville,
Metro
and
Lexington
Fayette.
County
Health
Department,
so
you
have
about
3,
100,
I,
think
all
in
public
health
workers
in
the
state
I
am
very
proud
to
serve
alongside
them.
They
they
really
do
a
fantastic
job.
I
So
here's
our
top
level
organizational
chart
I,
will
say,
I
feel
good
about
this
when
I
started,
I
was
the
fifth
commissioner.
In
five
years
it's
very
very
hard
I.
You
know
Senator
Meredith,
you
know
having
Run
Healthcare
and
Enterprises,
it's
very
very
hard
to
run
a
stable
organization.
When
you
have
that
kind
of
revolving
leadership,
so
this
senior
leadership
chart
was
very
pockmarked
with
vacancies
when
I
started.
We
now
have
filled
all
of
these
positions.
I
We
have
every
division
director
field,
we
have
seven
divisions,
we
have
assistant
division
directors
field
and
we
have
slightly
cleaned
up
the
Commissioner's
Office,
where
we
we
have.
You
see
at
the
top
there's
three
directors
who
are
cross-cutting
in
different
ways.
So
we
have
a
new
director
for
public
health
transformation
and
I'll
touch
on
that
in
the
Commissioner's
Office
slide.
I
We
have
a
director
for
Health
Equity
that
was
there
before,
but
is
now
one
of
these
three
individuals
in
the
director
of
nursing
and
those
three
directors
support
the
whole
agency
and
then
the
other
division
directors
have
bodies
of
work
underneath
them
so
going
through
this.
So
we'll
have
eight
slides
here,
the
commissioner's
office
and
then
seven
divisions.
I
We
have
public
health
transformation
here,
so
this
was
a
result
of
legislation
in
2020,
Senator,
Alvarado
and
representative
Mosher
played
a
key
role
in
that
and
we
are
now
implementing
that
and
then
funding
followed
in
the
most
recent
biennial
budget.
So
thank
you
for
that.
That's
essential
because
your
local
Health
departments
are
eager
to
rebuild
public
health
and
to
have
it
on
a
sustainable
footing
and
that
funding
is
essential.
So
thank
you
very
much
and
the
commitment
to
continue
funding
that
is
is
very
greatly
appreciated
and
essential.
I
For
this
to
be
successful,
we
are
working
through
committees,
task
forces,
work
groups
in
partnership
with
the
local
Health
departments,
to
try
to
implement
the
core
and
foundational
model
of
Public
Health
and
then
with
local
Health
priorities,
which
are
custom
tailored
and
a
more
specific
level
based
on
Community
Health
assessments
on
a
health
department,
specific
level.
So
a
lot
of
work
underway
there.
The
office
of
Health
Equity,
was
an
existing
office.
We
now
have
a
substantial
Federal
grant,
which
again
will
it's
kind
of
tied
to
the
covid
pandemic?
I
Will
exhaust
in
2024,
but
we
strive
to
help
Advance,
Health,
Equity
and
equity
in
all.
We
do
this
means.
The
person
in
rural
Appalachia
should
have
the
same
chance
of
success
as
the
person
in
central
Lexington
Kentucky.
A
person
in
the
community
of
color
should
have
the
chance
same
chance
of
success
as
a
Caucasian
person
in
Northern
Kentucky
urban
area.
I
So
we
are
trying
to
ensure
that
all
four
and
a
half
million
Americans
hit
or
four
and
a
half
million
kentuckians
have
a
chance
to
reach
their
full
potential
and
Health
Equity
in
all
its
forms
helps
us
with
that.
Of
course,
the
community
health
worker
program
fits
in
here
a
little
bit.
We
have
a
separate
area
specifically
for
community
health
workers,
but
we
are
using
a
number,
a
substantial
amount
of
the
grants
here
to
fund
expansion
for
community
health
workers,
the
goal
being
to
have
people
who
are
closer
to
the
people
they
serve.
I
Who
understand
their
needs
more
personally
and
can
help
them
to
navigate
our
complex,
Health
Care
system.
So
they
can
get
the
things
they
need
and
access
services.
So
we're
excited
about
that
and
then
Public
Health
nurses
have
long
played
a
really
Central
show
an
important
role
in
public
health,
and
so
our
director
for
nursing
helps
support
our
Public
Health
nurses,
but
also
more
generally,
education
on
a
wide
variety
of
clinical
related
topics
across
Public
Health,
division
of
maternal
and
child
health.
I
I
Of
course
they
had
to
navigate
the
infant
formula
shortage
now,
which
is
not
resolved
but
hopefully
is
improving
and
some
of
the
most
the
worst
scarcities
seem
to
have
abated
at
this
point
in
time,
hands
program.
Now
this
is
a
program.
That's
all
throughout
Statute,
in
a
variety
of
different
places.
I
Kentucky
as
you've
talked
about
before,
has
challenges
with
you
know
healthy
childhoods
and
children
having
a
good
upbringing
and
a
chance
to
have
the
best.
You
know,
outlook
on
life,
hands
actually
provides
home
visiting
to
the
home
to
help
young
parents,
and
you
can
enroll
a
child
either
before
they're
born
when
you're
pregnant
or
in
the
first
90
days
of
their
childhood.
I
I
The
stories
they
tell
will
just
melt
your
heart
about
how
they
form
these
bonds
with
the
children
and
with
the
parents,
how
the
parents
and
the
children
as
they
grow
up,
keep
in
touch
with
these
workers
over
a
lifetime
and
will
reach
out
at
Key
moments
later
on
in
grade
school
and
in
high
school
and
in
college
and
the
program's
been
around
22
years.
But
these
these
bonds
and
the
impact
is
incredible.
I
We're
going
to
really
focus
hard
this
year
on
trying
to
grow
and
expand
this
program
and
to
make
it
even
more
so
we
can
reduce
the
adverse
impact
of
adverse
childhood
events.
I
won't
go
over
all
of
these,
but
Keys.
That's
first
steps
that
helps
where
we
go
into
I
think
over
14
000
children.
We
help
serve
each
year,
who
have
special
needs
with
with
substantial
disabilities,
and
that
program
helps
to
support
those
in
the
new
foreign
screening
program,
where
we
help
facilitate
follow-up,
but
also
the
overall
newborn
screening.
I
We
test
for
55
inborn
errors
in
metabolism
at
the
state
lab.
We
find
I
think
it's
about
one
in
400
children
are
born
with
one
of
those
inborn
errors
metabolism
and
trying
to
help
ensure
that
they
don't
suffer
any
preventable
harm
by
intervening
quickly
at
the
very
beginning
before
harm
occurs,
I
mean
some
of
these
programs
are
really
impressive
and
there
are
many
other
ones
too,
but
I
won't
touch
on
all
of
them.
Division
for
Women's
Health
is
the
smallest
of
our
divisions.
I
They
principally
do
women
cancer
screening
program.
They
get
funding
to
help
women
who
are
under
250
percent
of
the
federal
poverty
level,
who
otherwise
don't
have
health
insurance
or
coverage,
have
access
to
cervical
and
breast
cancer
screening
and
if
cancer
is
identified
and
they
meet
other
criteria,
the
Kentucky
women
cancer
screening
program
has
a
route
to
be
able
to
help
Foster
their
eligibility
for
Medicaid
coverage
if
they're
eligible,
so
that
they
can
get
services
covered
and
get
access
to
prompt
treatment.
I
So
this
is
a
wonderful
work
that
they
do
and,
of
course
they
have
the
breast
cancer
education
trust
fund,
which
is
related
to
the
pink
license
plates
that
you
sometimes
see
around
in
a
portion.
I
think
it's
ten
dollars
out
of
the
forty
four
dollar
fee,
get
into
a
separate
account
to
help
support
breast
cancer
awareness
and
research
and-
and
they
have
a
a
committee
that
specifically
disburses
funds
that
come
in
for
that
purpose,
to
help
support
research.
I
So
a
lot
of
important
work
there
to
support
Women's,
Health,
The,
DaVinci,
the
division
of
prevention
and
quality
improvement.
This
is
all
the
chronic
diseases
you
would
think
of
so:
diabetes,
heart
disease,
colon
cancer,
lung
cancer,
there's
new
funding
and
a
new
program
that's
being
established
now,
because
in
lung
cancer
funding
that
the
legislature
directed
our
way.
This
last
session,
of
course,
tobacco
prevention
and
cessation
efforts
are
reside
here.
Oral
health
I
had
the
chance
to
go
visit.
I
The
Kentucky,
American
Water
Plant
treatment
plant
in
Lexington
just
a
month
and
a
half
ago,
and
see
the
machines
and
see
the
plant
and
all
the
work
that
they
do
to
keep
our
water
safe,
including
fluoridation
to
try
to
ensure
that
we
have
healthy
teeth
and
strong
teeth
that
have
fewer
cavities
Health
Care
access.
This
has
to
do
with
Workforce
shortage
areas,
there's
a
number
of
different
programs.
I
The
the
hospitals
are
the
ones
who
typically
sponsor
them,
and
they
submit
applications
and
sponsor
the
Physicians
and
so
I'm
in
contact
periodically
with
some
of
the
hospital
leadership
when
they
have
issues
and
need
to
deal
with
that,
and
then
we
also
Kentucky
Department
for
public
health
became
a
public
health
accredited
State
Health
Department
just
this
year.
It
was
a
10-year
Journey.
Getting
to
that
point
and
a
substantial
accomplishment,
it's
a
commitment,
just
like
any
other
kind
of
accreditation
to
Excellence
and
continuous
quality
improvement.
I
Our
folks
who
support
that
effort
reside
in
this
division
as
well.
Division
of
Public,
Health
protection
and
safety.
Multiple
things
here,
but
think
of
it
in
two
buckets.
The
public
health
preparedness
program
is
all
the
emergency
Disaster
Response.
So
for
the
tornadoes
they
help
make
sure
that
there
were
portable
showers
outside
temporary
housing
for
volunteer
workers
who
had
come
in.
They
get
portable
generators
to
come
in
to
help
support
people
who
have
lost
their
electricity.
I
They
helped
facilitate
delivery
or
a
donation
of
medical
supplies
into
an
area,
a
whole
bunch
of
other
activities,
and
they
did
the
same
thing
in
Eastern
Kentucky
flood
area.
We
have
warehouses
that
we
lease
that
are
distributed
throughout
parts
of
the
state
and
our
warehouse
in
Eastern
Kentucky
became
the
Hub
where
a
lot
of
the
Kentucky
Department
of
Transportation
semi
trucks,
delivering
materials
were
able
to
come
through
and
Stage
things
pick
up
stuff
and
then
deliver
it
to
secondary
locations.
So
we
play
our
role
as
ecsf8.
I
Emergency
support
function,
8
within
the
Kentucky
Emergency
Management
incident
command
structure,
and
so
we
we
have
a
pivotal
role,
helping
to
support
people
in
times
of
natural
and
other
disaster.
The
other
major
parts
in
this
division
are
all
the
protection
and
inspection
programs
you
might
be
familiar
with,
so
we
help
oversee
the
radiation.
So,
like
medical
radiation,
people
can
do
nuclear
medicine,
scans
or
other
types
of
tests.
We
help
oversee
radiation
safety
in
the
state.
We
also
do
food
safety
programs
at
the
state
level.
We
man,
like
we
inspect
food
manufacturers.
I
So
if
you're
going
to
talk
about
an
actual,
you
know
a
peanut
butter
manufacturer
someone,
we
would
be
the
ones
who
go
in
and
do
those
food
safety
inspections.
Local
Health
departments
are
the
ones
who
do
restaurant
inspections
and
food
trucks,
and
things
like
that
so
and
I'll
emphasize.
It
is
really
a
partner
between
the
state
and
local
Health
departments.
I
mean
we
statute
and
reg
gloriously
hold
us
all
accountable
and
disempower.
All
of
us
just
enough
to
be
able
to
frustrate
each
other.
It
is
a
system
that
really
requires
open
communication.
I
I
We
also
have
a
roll
of
milk
safety
in
the
state
and
actually
inspect
farms
for
that
where
they
produce
the
milk
pool
inspections
and
a
variety
of
other
things,
and
then
I'm
going
to
just
touch
on
this
briefly
here,
because
I
think
commissioner
Morris
and
secretary
Freelander-
and
you
all
have
already
discussed
it,
but
we
do
play
a
small
role
here
in
the
substance
use
disorder
with
the
harm
reduction
efforts.
So
this
goes
to
the
prevent,
promote,
protect,
you'll
notice.
The
word
treat
is
not
in
the
public
health
Paradigm.
I
We
generally
don't
treat
disease
and
illness.
We
try
to
help,
promote
it
or
prevent
it
rather
or
promote
an
environment
that
minimizes
its
occurrence,
but
once
it's
found,
other
people
generally
are
the
ones
who
deal
with
treating
it
in
Behavioral
Health.
Those
are
the
experts
who
deal
with
treating
it
even
at
the
federal
level.
They
have
this
divided
in
samsa,
the
the
substance
for
mental
health
and
substance
abuse
they
integrate
those
too,
and
so
it
really
is
a
treatment.
I
Medical
Paradigm,
of
course,
you're
going
to
have
law
enforcement
and
a
lot
of
others
who
get
involved
social
services
and
others.
Because
of
the
nature
of
the
problem,
but
I
actually
do
think
it
is
well
positioned
the
way
it
is
and
beaded
and
we
do
work
in
cooperation
and
partnership.
The
Kentucky
agency
for
substance,
abuse
policy,
Kentucky
ASAP.
They
have
cross-cutting
meetings
that
involve
all
these
different
agencies
and
there's
a
lot
of
communication
and
partnership.
So
I
think
we
work
very
well
together.
I
Unfortunately,
the
problem
is
tragic
and
enormous
and
shows
no
sign
of
abating.
So
I
help
us
all
that
we
can
find
some
path
to
relief
on
that
we're
getting
towards
the
end
here
now:
division
of
epidemiology
and
health
planning,
Vital
Statistics
you
get
married,
you
die,
you
get
divorced,
they're,
the
ones
who
track
those
kind
of
documents,
and
so
that's
an
important
role.
We
have
infectious
disease
Branch,
they
deal
with
Health
Care,
acquired
infections,
all
reportable
diseases,
whatever
they
may
be,
covid
being
the
most
prominent
one.
Recently
monkey
pox
being
another
one.
I
You
know
that's
recent
for
us
hepatitis
TB,
the
TB
is
important,
I
mean
there's
multi-drug
resistant
and
extreme
multi-drug
resistant
TB.
It
is
a
real
Global
crisis
that
we
have
folks
who
have
to
keep
tabs
on
and
help
ensure
treatment
for
people
who
have
these
conditions.
It's
a
big
deal,
STDs
and,
of
course,
HIV
AIDS,
environment
immunizations.
I
Our
lab
is
a
gym.
It
is
there's
nothing
like
it
in
the
state
of
Kentucky,
so
it
is
the
only
place
that
does
all
that
newborn
screening
for
about
54,
55
000
live
births.
If
that
lab
were
to
go
offline,
we
have
to
ship
it
to
another
state.
There
is
no
other
in-state
alternative
for
that,
and
it's
much
more
expensive.
If
we
do
that
by
the
way,
we
also
are
the
only
BSL
level
3
lab
it's
a
biosafety
level,
3
lab
in
the
entire
Commonwealth.
I
The
only
higher
level
is
bsl4
and
that's
what
you
have
at
Emory
and
in
New
York
and
those
are
the
Ebola
places.
Those
are
the
scary
biotox
places,
but
our
folks
will
deal
with
Anthrax
and
race,
ricin
and
Other
Extreme
pathogens.
Our
lab
is
the
one
that
would
test
for
those
substances.
Should
there
be
a
need
to,
there
is
no
alternative
in
the
state.
We'd
have
to
ship,
it
I
think
over
to
Tennessee
as
our
backup
there's
a
variety
of
other
things
that
they
do.
I
I'm
only
going
to
say
this
verbally
but
I'm
going
to
say
it.
Every
hearing
I
have
the
privilege
to
be
in
front
of
y'all.
We've
got
to
get
in
the
next
capital
budget,
a
new
lab.
The
lab
is
30
years
old
it,
the
machines,
do
things
that
are
like
Star
Trek
level
now
compared
to
when
the
building
was
built.
They
generate
heat
and
humility
or
humidity
and
require
the
kind
of
infrastructure
controls
that
just
didn't
exist.
I
I
You're
talking
29
30
before
it's
moving,
you're
going
to
be
almost
40
years
old,
so
I
I,
just
it
won't
be
me,
be
some
other
commissioner
and
some
other
governor
and
probably
a
whole
bunch
of
other
legislature
who
gets
to
go
cut
the
ribbon,
but
we
all
need
to
give
that
that
resource
to
the
people
of
Kentucky
in
the
future.
It's
that
important
and
I'll
keep
saying
it.
I
just
urge
you
to
look
at
that
in
the
next
budget
cycle.
I
Please
and
then
we
have
a
division
that
just
as
Administration
financial
management,
this
one
is
invaluable
they're.
The
ones
who
help
support
the
local
Health
departments
make
sure
all
this
funding
that
goes
through
the
state
to
the
locals
gets
done
properly
that
we
work
with
them
to
support
the
HR
functions.
We
have
to
do
a
whole
lot
of
other
things
too,
but
they're
the
quiet
behind
the
scenes.
Folks,
who
just
help
make
sure
the
rest
of
us
can
get
all
this
other
stuff
done.
I
In
my
final
slide,
we
work
with
every
agency
in
the
Cabinet
for
Health
and
Family
Services
I
just
want
to
emphasize
that
we
worked
with
the
oig
closely.
We
went
through
all
the
coveted
stuff
with
all
the
disruptions
in
health
care.
We
worked
with
Dale
to
help
make
sure
that
people
who
are
vulnerable
and
homebound
could
get
vaccines
for
covet
or
in
the
flood
impacted
areas
or
the
tornado
impacted
areas.
I
Dale
was
invaluable
to
help
make
sure
they
could
support
our
function
in
Kentucky
Emergency
Management
B
did
we
work
with
the
substance,
use,
disorder,
problems
and
arm
reduction
in
a
great
way
and
I
could
go
on
it.
We
have
Partnerships
with
every
single
one
of
our
sister
agencies
and
we
work
regularly
with
them.
I
couldn't
be
more
proud
again
to
be
part
of
that
team
and
to
serve
alongside
my
colleagues.
I
really
do
think.
Having
these
agencies
proximate
and
under
the
leadership
of
a
single
cabinet
secretary
has
made
it
possible
for
us
to
do
things.
I
State
government
is
frustrating
I,
hope,
I'm,
not
telling
you
something
you
don't
know.
Any
big
company
is
difficult.
Any
big
company
would
be
difficult,
but
the
bureaucracy
that
goes
with
navigating
it
is
very
difficult
at
times
to
navigate
I.
Don't
I,
don't
know
how
in
the
I
don't
know
how
in
the
world
you
could
really
survive
if
we
separated
out
some
of
these
things
and
had
to
go
across
cabinet
that
level
of
communication
is
just
just
intrinsically
much
more
difficult
and
I
think
that
this
serves
us
very
well
having
us
Under,
One,
Roof
Center.
A
I
On
that
yeah
so
again,
so
the
hands
program,
for
example,
hands
program
our
large.
So
it's
funded
by
three
funders.
There's
some
tobacco
funds,
there's
Medicaid
funds
and
there's
hersa
McBee
funds
from
a
federal
agency,
Medicaid's
the
biggest
funder
of
the
three,
and
we
use
tobacco
funds
for
a
match
to
make
sure
that
we
can
draw
down
the
money
from
Medicaid.
I
So
we
administer
that
program,
so
the
Health
Department's
Bill
through
Us,
in
order
to
provide
those
services
for
home
visitation
for
families,
Medicaid
then
pays
it
gets
paid
out
through
us
and
so
that
whole
program
is
incredibly
valuable
and
with
without
the
partnership
for
Medicaid,
we
wouldn't
be
able
to
do
that
and
to
do
that.
That
way.
Another.
C
Another
piece
and
I
think
I've
testified
about
this
before,
but
something
that
I've
been
wanting
to
do
forever
was
have
a
basically
a
medical
staff
at
the
Cabinet
for
Health
and
Family
Services.
The
CMO
of
the
medical
staff
is
right
here.
C
Dr
stack
as
the
commissioner
for
public
health
I
think
is,
is
rightfully
the
head
of
the
medical
staff
at
the
cabinet,
so
that
includes
the
Medicaid
medical
director
and
the
and
the
dcbs
physician
and
and
Dr
brenzel
and
and
the
host
of
Physicians
that
actually
work
really
closely
with
the
cabinet
and
an
example.
C
The
first
I
think
the
first
piece
I
gave
them
was
to
help
us
Define
the
quality
measures
for
hospitals
on
the
on
the
atrip
on
the
reinsurance,
the
reimbursement
program,
hospitals
to
Define
what
it
is
that
we
want
to
see
from
quality
measures
from
the
hospitals
for
that
additional
funding
up
to
the
average
commercial
rate
which
has
helped
our
hospitals
I.
Think
they've
testified
to
you
about
that,
but
the
medical
staff
came
up
with
a
list
of
quality
measures.
C
A
Hospital
Association
came
with
a
list
of
Quality
quality
measures
and
we
work
together
to
to
come
up
with
that
list
for
the
atrip
program.
I
think
I'm,
talking
with
Nancy
galvani
I,
think
we're
going
to
see
some
some
good
quality.
At
least
she
promises
good
progress
on
quality,
but
that's
another
way
that
we're
trying
to
integrate
our
our
physician
resources
to
impact,
basically,
all
the
programs.
But
since
you
asked
about
Medicaid,
that
was
actually
the
first.
The
first
task
and.
A
A
In
our
state
and
I
think
for
the
most
part
done
an
exceptional
job,
but
I
think
it
should
grow
even
beyond
that.
You
know
your
mission
statement
says
our
mission
is
to
prove
the
health
and
safety
of
the
people
in
Kentucky.
Well,
I
think
we've
advocated
that
responsibility
for
a
third
of
our
population
to
ncos
and
I.
Don't
understand
why
there's
not
a
more
direct
relationship
between
Department
Public
Health
and
the
mcos,
rather
than
have
to
go
through
the
department
of
Medicaid.
I
I
mean
so
it's
interesting,
so
I
I
try
to
have
to
separate
something.
Remember:
I'm
I'm
a
past
present
American
Association
I
engaged
in
public
policy
at
the
federal
level
for
quite
a
while.
So
but
that's
not
my
role
right
now
today.
My
role
is
as
the
commissioner
for
public
health
in
Kentucky.
So
in
a
public
health
role,
we
do
have
incredible.
Partnerships
I'm,
going
to
come
back
straight
to
what
you
said
Senator,
but.
I
To
think
about
community
health
workers
as
an
example
representative,
Moser
passed
legislation,
and
so
there's
efforts
afoot
to
expand
further
community
health
workers,
but
there
are
different
parts
of
it.
There's
the
there's,
the
certification
part
that's
solidly
in
our
area,
we're
we're
currently
involved
in
helping
to
certify
folks
and
support
the
profession.
The
funding
part
is,
in
the
Medicaid
part,
additional
funding.
We
have
some
grant
funding,
but
the
sustainability
would
be
more
Medicaid.
I
That's
the
commissioner
for
Medicaid
services,
but
we've
worked
together
the
two
of
us
within
the
confines
of
our
cabinet
across
the
the
cabinet
on
bi-weekly
meetings,
to
try
to
come
up
with
how
we're
going
to
handle
that
and
work
together
so
that
it
is
sensitive
to
the
needs
of
the
community
health
workers,
but
also
sensitive
to
the
constraints
that
commissioner
for
Medicaid
services
has
to
deal
with
now
when
it
comes
to
talking
about
population,
health
and
wellness,
I'm,
an
unabashed
promoter
for
public
health
and
the
things
that
we
can
do
in
the
role
we
can
play.
I
Never
going
to
have
me
sit
down
here
and
and
Advocate
on
me
and
I,
don't
think
so
on
behalf
of
for-profit
health
insurance
companies,
because
I
think
there
are
great
difficulties
and
conflicts
that
ensue
with
that.
So
I'm,
not
gonna
I'm,
not
going
to
argue
against
your
point.
Senator
I
tend
to
probably
agree
with
the
part
that
I'm.
I
A
G
A
Have
not
improved
the
health
population
when
it
started
they,
we
were
47th
in
the
nation.
Now
we're
44.
and
I
think
that's
more
to
do
with
the
fact
that
people
have
coverage
they
haven't
had
before,
but
they
have
not
improved
the
health
population.
So
when
would
say,
the
mission
of
Public
Health
has
improved
the
health
of
the
population
and
safety.
We
failed
in
that,
if
we're
not
providing
more
direct
oversight
for
the
mcos
and
quite
truthfully,
I
think
that
the
Managed
Care
function
should
be
a
function
of
Public.
A
Health
mcl's
had
their
roles,
not
as
managed
care,
but
as
an
insurance
company
says
the
claim,
so
you
can
distinguish
between
the
two
Medicaid
and
should
be
the
the
fiscal
arm
of
it,
but
as
far
as
the
quality
of
care
side
of
it
I
think
that's
a
public
health
function
should
be
because
how
can
we
say
we're
improving
the
health
population
when
we
haven't
we've
advocated
that
responsibility,
a
third
of
our
population
to
an
insurance
company
who
has
an
obvious
conflict
of
interest
there?
So
I
think
this
could
be
addressed.
A
You
know
we
hear
a
lot
of
recommendations
during
our
sessions
about
how
to
improved
the
health,
such
as
I.
Remember
the
hep
C
discussion.
We
had
well
personally
I
think
if,
if
Medicaid
or
the
MCAS
are
responsible
for
the
improving
the
health
population,
that
should
have
been
something
they
undertook
years
ago,
but
they
had
no
reason
to
because
the
contract
doesn't
call
for
today.
That
certainly
is
a
public
health
function
and
if
you
folks
were
directing
the
Managed
Care
portion
of
Medicaid
I
think
those
things
would
be
done.
A
Another
thing
we've
struggled
with
for
years
is
we're
supposed
to
have
a
a
trauma
Network
in
Kentucky,
been
established
by
by
law
years
ago,
but
has
never
become
operational.
That's
costing
lives
in
this
state,
it's
costing
money
in
the
state.
Why
isn't
that
a
public
health
function
and
why
don't
we
incorporate
that
in
there
in
in
and
fund
that,
as
it
should
be
so
again,
I
want
to
give
you
a
broader
role.
A
You
can't
pick
and
choose
what
we
do
if
somebody's
got
responsible
for
the
health
of
the
population
and
that's
part
of
the
reason
we're
failing
so
miserably
is.
Nobody
is
accountable
now
you
folks
have
some
measure
of
it,
because
the
specifics
that
you
do
but
you're
kind
of
treating
the
symptoms
not
curing
the
disease.
We've
got
to
change
that
model
and
I
think
there's
a
role
in
public
health
to
do
that
if
you
folks
are
willing
to
embrace
it.
But
that's
concern
to
mind.
A
J
You
Mr
chairman
I,
have
both
a
comment
and
a
question.
First
of
all,
thank
you
for
a
very
interesting
presentation.
I
am
a
huge
proponent
of
Public
Health
and
I
really
appreciate
everything.
Everything
that
you
shared
with
us
today,
I
do
have.
I
do
have
a
serious
question
that
I
noticed
we
did
not
discuss
and
is
perhaps
a
personal
personal
mission
of
mine
based
on
where
you
know,
I
have
worked
for
so
many
years.
J
I
am,
unfortunately
sit
in
the
back
of
the
emergency
room
at
University
of
Louisville
Hospital
and
and
started
actually
the
Department
of
Emergency
Radiology
there
over
30
years
ago
and
now
I'm
back,
and
we
have
a
real
real,
serious
Public
Health
crisis
in
this
nation
and
in
this
state
with
gun,
violence
and
I
did
not
see
it
addressed
on
any
of
our
slides
I'm
going
to
share
a
little
bit
of
data.
J
You
know,
I'm
speaking
to
the
choir
I
am
sure,
but
I
just
want
to
make
sure
that
people
understand
the
extent
of
the
cost
that
this
Public
Health
crisis
is
costing
us
averages
are
that
Kentucky
alone
spends
five
billion
dollars
from
top
to
bottom,
on
the
cost
of
gun,
shot
wounds
and
deaths
annually,
181
million
of
which
is
actually
paid
by
Kentucky
taxpayers,
181
million
dollars
annually.
Guys
and
I
think
this
is
a
public
health
crisis
that
we,
for
some
reason
refuse
to
discuss,
refuse
to
address
and
I'm.
J
I
I
had
an
answer
to
that:
I
would
really
be
a
special
person,
so
one
of
the
one
of
the
last
things
I
did
is
I
was
leaving
office
as
president
of
the
American
Medical
Association
was
on
behalf
of
the
AMA
that
declare
gun
violence,
a
public
health,
emergency
gun,
violence,
okay,
I'm,
not
talking
about
the
guns
themselves
and
stuff,
there's
all
sorts
of
complexity
there,
but
gun
violence
is
a
public
health
emergency.
I
Now,
beyond
that,
and
I
and
I
will
say
that
unapologetically
I
really
believe
it
to
be
the
case
and
I
and
I
desperately
think
as
a
society.
We
have
to
find
a
way
to
have
discussions
about.
How
can
we
allow
gun
owners
to
have
a
you
know
the
use
of
their
guns
and
to
honor
the
Second
Amendment
for
the
way
it
was
intended
to
be
written
but
to
allow
the
rest
of
society
not
to
have
this
really
epidemic
of
gun
related
violence?
I
I
I
If
we're
going
to
address
it
in
a
way
that
has
a
chance
of
getting
majority
votes
out
of
a
legislature
and
a
Governor's
signature
and
in
Nationwide
the
same
thing
for
Congress
and
the
nation
and
you've
seen
the
difficulty
you
live
it.
You
are
elected
leaders
in
the
state.
I
just
hope
that
we
can
all
somehow
find
a
way
to
find
a
better
path
through
this.
But
it
has
been
obviously
challenging.
J
Of
all,
thank
you
for
your
answer,
a
follow-up
question.
Do
we
are
we
aware
of
any
federal
dollars
that
we
can
bring
into
this
state
under
the
new
legislation
that
would
help
us
enact
some
common
sense
gun
legislation
in
this
state
that
might
decrease
the
amount
of
gun
violence,
we're
seeing
and
have
a
positive
impact
on
the
amount
of
money
we're
spending
on
this
issue
under
Biden's
new
plans,
for
you
know
incentivizing
states
to
come
up
with
better
Common
Sense
gun
legislation.
Do
you
have
any
awareness
of
that.
H
Mr
chair,
thank
you
for
being
here.
I
appreciate
all
the
all
the
work
that
you
do
genuinely
and
we've
known
each
other.
So
a
long
time
so
I
know
it
hasn't
been
an
easy
job
these
these
past
couple
years.
So
thank
you.
I
have
a
question.
Maybe
a
comment.
H
First
and
and
a
question
about
you
talked
a
little
bit
about
the
role
that
dph
plays
in
dressing
substance,
use
disorders
in
keeping
with
the
corn
foundational
services
that
the
local
Health
departments
are
now
tasked
with
staying,
staying
on
task
with,
and
you
know,
we've
we've
kind
of
gotten
away
from
the
unwieldy
local
Health
departments
to
really
focus
on
those
issues.
H
I
I
think
the
one
area
that
we
can
really
focus
on
in
dealing
with
substance
use
disorders
is
the
hands
program
and
I'm
really
happy
to
hear
that
you're
looking
to
expand
it
I,
don't
know
exactly
what
that
involves
in
in
getting
more
federal
funds,
because
a
great
deal
of
the
funding
comes
comes
from
the
federal
dollars
in
tobacco
settlement,
but
I
do
think
that
it
has
the
potential
to
really
have
long-term
lasting
effects
on
the
families
and
when
we're
talking
about
things
like
gun,
violence
and
violence
in
general
and
substance,
use
disorders,
I
think
when
we
address
the
core
problems
with
the
families
and
the
children
and
address
the
the
trauma-
and
you
know
I
all
of
the
things
that
come
with
challenges
that
families
are
are
struggling
with,
I
mean
I
think
that
we
really
have
an
opportunity
to
mitigate
those.
H
Those
negative
effects
and
I
I
believe
that
about
Early,
Childhood
learning
I
believe
that
this
is
a
program
that
can
then
that
can
really
help
address.
Some
of
that
and
I
just
I
think
that
that's
maybe
more
of
a
solution
than
you
know.
I
mean
the
the
whole
gun.
Control
issue
is
a
big
difficult
conversation,
but
if
you
really
want
to
address
what's
going
on
in
our
society,
we've
got
to
interrupt
the
cycle
of
all
of
this.
H
This
dysfunction
that
we're
seeing
and
we
have
to
do
it
early
and
help
kids
and
families
build
healthy
coping
skills
and
resiliency
and
I
mean
we.
We
can't
be
all
things
to
all
people,
but
if
we
know
that
we
have
a
program
that
works,
I
say
we
we
expand
it
is
there
anything
else
that
you
see
that
the
local
Health
departments
can
do
to
help
with
the
substance
use
problem.
You.
I
Know
we
have
the
most
number
of
syringe
service
programs
in
the
United
States
and
Kentucky.
We
also
are
one
of
the
state's
most
adversely
impacted
by
substance
use
disorder.
We
we
have
really
wonderful
collaborative
efforts
like
like
I've
described
with
beaded
in
our
own
cabinet
for
Behavioral
Health,
but
also
with
Justice,
with
Ann
Ingram,
the
Kentucky
office
of
drug
control
policy
and
others.
What
I,
what
I
observe
across
the
country
is,
despite
a
lot
of
people's
really
really
concerted
and
sincere
efforts.
I
It's
multifactorial,
so
I
represented
I
wish
I
really
wish
I
had
an
answer,
and
you
know
I'll
be
straight
if
I
think
I
have
a
thought
on
how
we
can
navigate
something,
but
a
lot
of
people
have
really
spent
a
lot
of
effort
trying
to
figure
out
how
we
could
turn
that
tide
and
we
have
not
figured
that
out
yet
we
just
have
not,
and
and
we've
we've
got
to
hopefully
do
better
and
for
the
hands
program.
The
program's
been
around
22
years.
I
I
22
years
we
just
gave
the
first
rate
increases
in
22
years
in
that
program
to
the
providers
doing
it,
I
mean
we're
doing
other
things
to
draw
down
additional
Federal
funding,
to
provide
additional
support
to
the
local
Health
departments
and
I
attended
the
hands
conference
with
over
300
hands
workers
from
around
the
state
just
a
couple
of
weeks
ago,
two
or
three
weeks
ago,
so
I
do
think.
I
If
we
can
do
some
blocking
and
tackling
and
invest
in
the
structure
and
the
infrastructure,
the
things
you've
done,
giving
an
eight
percent
increment
and
hopefully
another
one
next
year
for
state
workers
and
the
things
we
need
to
do
with
addressing
Personnel
issues
across
state
government.
You
can't
you
know
any
of
you
working
in
healthcare,
we're
paying
nurses,
or
at
least
we're
trying
to
pretend
to
pay
nurses.
A
Can
I
ask
you
in
certainly
we
could
spend
a
couple
days
just
talking
about
substance
abuse,
but
I'm
kind
of
curious
as
to
what
our
philosophy
is
it
right
now?
Is
it
kind
of
accepting
kind
of
surrendered
a
little
bit,
because
I
know
that
some
departments
have
supported
programs
to
shall
say.
A
Poor
safe
use
of
illegal
drugs
is
that
really
the
position
we
want
to
take
and
I
don't
think
it's
widespread
I
know
that
Louisville
specifically
had
a
program
and
this
past
summer,
when
one
of
the
larger
events
they
had,
they
actively
promoted
that
you
know.
Here's
Narcan
and
here's
be
sure
you
practice
safe
drug
use
is
that
the
philosophy
we're
going.
I
I
I
Here's,
the
here's,
the
the
situation
where
they're
called
harm
reduction
initiatives
for
for
a
reason
and
I
may
even
distort
this
from
what
the
harm
reduction
Community
would
would
prefer
I
say,
but
the
problem
of
substance
use
in
particularly
injected
substance
use
exists.
It
is
there
it.
It
is
growing
for
reasons
that
have
been
difficult
to
control.
I
I
So
what
we
try
to
figure
out
that
problem,
the
harm
reduction
is
trying
to
make
sure
they
don't
get
bloodborne
infections
at
the
same
time
that
they
don't
get
HIV
and
hepatitis
that
they
don't
get
bacterial
endocarditis,
that
they
don't
end
up
having
a
valve
replacement
that
they're,
not
in
the
hospital
for
six
weeks,
you
know
getting
intravenous
antibiotics,
so
the
harm
reduction
is
not
to
potentiate,
promote,
indulge
support
and
courage.
The
use
of
drugs
is
absolutely
not
that
the
it's
the
recognition
that
it
is
happening
in
absent
other
interventions.
We
will
pay
more.
I
So
it's
about
the
person
we're
trying
to
help,
but
it's
actually
about
Society
at
large
too,
because
all
these
folks
consume
massive
amounts
of
economic
resources.
They
drive
away
surgeons
from
your
smaller
communities,
because
people
have
all
these
abscesses
and
they
come
in
and
then
the
surgeons
say
I
can't
keep
doing
this.
I
can't
constantly
do
that
I'm
going
to
leave
your
communities.
You
may
know
some
surgeon
who
share
this
infectious
disease.
Doctors,
it's
difficult
because
the
patient
with
substance
use
disorder
is
a
medical
problem
where
their
brain
chemistry
is
horribly
altered.
I
It's
not
a
volitional
choice
once
it
may
have
been
a
choice
to
try
it
it,
but
very
quickly
it
becomes
a
real
chemical
imbalance
in
the
brain.
That
is
not
just
a
thing
based
in
logic.
It's
it's!
It's
an
incapacity
to
overcome
without
outside
help,
and
so
this
the
situation
is
not.
Are
we
promoting
it?
I
No
I
absolutely
have
no
interest
in
promoting
substance,
use
disorder,
but
it
it's
are
we
going
to
allow
all
those
other
harms
to
happen
too,
which
not
only
hurt
the
individual
afflicted
by
substance,
use
disorder
but
hurt
all
of
us,
because
then
you
don't
have
surgeons
in
your
communities.
You
don't
have
infectious
disease
doctors
because
they
they
leave
to
get
out
of
there
to
go
somewhere.
I
Where
there's
more
support,
you
don't
have
your
health
insurance
premiums
go
up
because
remember
in
the
United
States
Impala
guarantees
everybody's
going
to
get
the
most
expensive
part
of
the
care
they're
just
not
going
to
get
the
rest
of
the
care
that
keeps
them
healthy.
So
when
they
fall
to
their
low
they'll,
go
to
a
hospital,
go
to
an
emergency
department,
get
admitted
to
a
hospital,
get
transferred
to
a
bigger
hospital
to
get
all
that
care
that
somehow
we
all
have
to
pay
for
it's
just
when
they
get
discharged.
I
If
they
have
no
access
to
care,
then
they'll
re
the
recidivism
kicks
in.
They
fall
right
back
into
the
pit
they
came
from,
so
so
no
Senator
I
I
am
sympathetic
to
the
concern
that
it
appears
like
well.
Why
are
you
promoting
this
I
I
have
no
desire
to
promote
this.
I
None
of
us
do,
and-
and
certainly
commissioner
Morris
and
her
colleagues
have
beat
it
no
one's
given
up
on
trying
to
find
a
way
to
treat
it,
but
it
has,
it
has,
unfortunately,
been
diminished
really
really
difficult
to
find
the
way
to
treat
it,
but
harm
reduction
is
to
spare
us
all
those
other
calamities
occurring.
In
addition
to
the
the
primary
Calamity
which
is
which
is
the
using
of
the
substance
final.
A
I
Don't
but
but
that's
that's
me
just
I
when
I
was
in
a
different
role.
Senator
Alvarado
kindly
tried
to
facilitate
communication
between
the
provider
community
and
the
Private
health
insurer,
community
and
no
I
I
will
remain
a
skeptic
I.
There
are
incredible
barriers
to
people
getting
the
care
that
they
need
in
roadblocks
administratively.
Prior
authorization
is
an
enormous
one
that
that
is
burning
out,
Physicians
and
causing
all
sorts
of
other
harms
to
the
clinical
Workforce.
So
no
I
think
there
are
complex
discussions
there
and
I
think
there's
a
lot
of
work.
A
I
No
I'm
going
to
the
reason
I
paused
was
I,
was
listening
to
you
attentively
and
thinking
that
there's
some
things
that
there's
opportunity
for
dialogue
and
then
your
inflection
made
it
a
question
and
that's
what
caught
me
off
guard
so
it
is,
it
is
really.
It
is
really
tough
and
it's
amazing.
It's
a
reasonable
societal
debate
to
discuss
what.
When
and
where
do
you
intervene?
How
do
you
do
it
I
think
covid
kovid's
a
once
in
a
century
event.
Let
us
all
hope
none.
E
A
I
Look
we're
dealing
with
other
things
now
like
Ebola
and
Uganda,
which
thank
goodness
is
not
here
in
the
United
States
as
far
as
we
know
now,
but
we're
trying
to
surveil
for
that.
We
deal
with
TB
all
the
time
we
got
monkey
pox
and
none
of
those
interventions
have
anywhere
you
know
remotely
been
like
coveted,
so
covet
I
think
was
really
unique,
but
but
as
far
as
how
those
decisions
are
made
and
all
it
well,
it's
a
it's
supposed
to
be
a
partnership.
You
know
across
Society
for
public
and
private.
A
It
is
complicated,
but
I
think
we
could
argue
that
you
know
we'd
like
to
see
a
partnership,
but
we
really
weren't
involved
in
those
decisions
and
think
we
should
have
been,
but
I
don't
want
to
get
in
that
today.
I
appreciate
your
testimony
and
again
I
want
to
see
a
broader
role
for
public
health
and
and
for
what
you
do
for
Kentucky,
but
I
appreciate
you
being
here
today.
We
need
to
move
on
to
our
last
department
and
that's
Family,
Resource
Center
and
volunteer
services.
C
And
yes,
I
was
over
these
groups
at
one
point
in
time.
As
a
matter
of
fact,
before
the
Family
Resource
Center
division
became
a
division,
it
was
a
branch
and
I
was
the
branch
manager
there.
These
are.
These.
Are
the
good
news
programs
I
love
these
programs
I
never
get
any
bad
news
out
of
them.
They
they
always
what
they
do
in
our
communities.
What
they
do
in
our
schools
makes
such
a
tremendous
difference
over
response
to
emergencies,
both
that
they
have
done
the
impact
on
children.
C
Their
impact
is,
is,
is
so
broad
and
I
think
it
really
brings
and
and
highlights
what
I
think
is
best
best
about
Kentucky.
L
L
So
when
we
look
at
the
purpose
of
the
Family
Resource
and
youth
services
centers,
our
goal
is
to
assist
at-risk
students
by
mitigating,
eliminating
reducing
non-cognitive,
non-academic
barriers
to
learning
and
schools
in
our
state,
with
at
least
20
percent
free
reduced
lunch
student
population
qualify
for
a
center
and
right
at
this
minute.
All
of
our
schools
that
have
20
percent
free
reduced
lunch
and
want
to
have
a
Family
Resource
Center
have
one.
L
So
these
are
our
components
set
forth
by
KRS
156496
Our
Family
Resource
Centers
are
in
our
elementary
schools,
so
you
can
see
that
that
a
lot
of
those
components
are
around
earlier
learning
and
early
childhood,
and
then
our
youth
services
centers
migrate
over
to
our
middle
and
high
schools
and
involve
things
like
substance
use,
education,
job
Development,
Career,
Development,
family
crisis
and
mental
health
counseling
as
well.
L
So
we
really
believe
that
activities
should
be
driven
by
local
need.
That's
the
way
this
program
was
set
up
from
the
beginning,
and
so
we
do
have
a
process
for
that.
Each
of
our
frisks
completes
a
school
and
Community
specific
needs
assessment.
If
they're
required
to
do
it
every
two
years,
some
of
them
do
it
every
year
where
they
look
at
what
needs
they
have
in
their
Community.
They
do
this
in
a
variety
of
ways:
I'm
happy
to
go
into.
L
If
you
have
questions-
and
they
also
analyze
their
resources,
because
we
certainly
don't
want
any
of
our
family
resources
service
centers
to
duplicate
efforts
that
are
already
happening
in
their
Community,
they
submit
a
program
plan
to
our
division,
that's
tailored
to
meet
their
local
need,
and
then
we
approve
those
plans,
give
them
feedback
on
those
plans
and
one
of
the
biggest
things
that
we
consider
as
we're
looking
at
those
plans
is
how
they're
going
to
measure
success.
How
are
they
going
to
evaluate
what
they're
planning
to
do?
L
How
is
it
tied
back
to
the
needs
that
they've
identified
and
how
are
we
going
to
measure
what
they're
doing
our
data
is
collected
in
Infinite,
Campus
and
then
Frisk
counts?
Infinite
Campus,
as
you
guys
are
probably
aware,
is
the
school-based
system,
and
it
works
really
well
for
most
of
what
our
family
resource,
Youth
Services
Centers
do
allows
us
to
coordinate
services
with
other
people
in
the
building
around
students
and
families.
There
are
some
things
that
our
first
are
responsible
for.
That
will
never
go
into
Infinite
Campus,
because
they're,
not
about
kids,
who
are
enrolled.
L
So
this
is
a
snapshot.
I
have
two
things:
I
just
want
to
pull
out
because
I
know
we're
short
on
time.
Something
we're
really
proud
of.
Is
our
first
reported
over
17
million,
and
this
is
fiscal
year
22.
our
fist
reported
17
million
dollars
in
cash
and
income
contributions
from
their
communities,
so
this
is
Cash
donations.
This
is
time
volunteer
time,
people
who
volunteer
for
our
centers
and
then
our
backpack
program.
A
lot
of
you
may
be
familiar
with
that.
L
Don't
use
General
funds
for
that
they
partner
with
their
face
faith-based
community
and
other
community
organizations
to
make
that
happen,
and
then,
lastly,
our
grandparents
support
we
had
over
77
000,
grandparents
and
relatives
that
participated
in
frisk-led
parent
relative
support
activities
and
then
there's
some
other
data
points
on
the
bottom
there
as
well
I
wanted
to
share
a
couple
things
about
outcome
data,
so
we
our
frisks,
you
know
I
referenced.
L
We
we
look
at
how
they're
going
to
measure
their
activities
when
they
submit
their
program
plans,
and
so
after
they
are,
are
complete
a
cycle
with
us.
They
send
in
really
every
year
some
outcome
and
impact
level
data
and
so
I
provided
an
example
for
you
here.
L
We've
really
been
pushing
this
local
level
outcome
data.
This
Family,
Resource,
Center
coordinator,
really
looked
at
grades
and
attendance
and
how
getting
a
bed
for
these
students
really
impacted
those
educational
outcomes
they
surveyed
the
students
and
found
that
they
reported
better
sleep.
We
educated
the
students
on
the
importance
of
sleep
which
we
all
know
is
going
to
impact
performance
right,
and
so
this
we're
really
really
proud
of.
We
I
think
that
you
have
a
summary,
a
one-page
summary
with
a
QR
code
that
has
our
full
report.
For
the
past
year.
L
Now
that
we
have
better
data
for
several
years
in
a
row,
we
have
started
the
process
in
procuring
a
social
return
on
investment
study
which
I'm
so
excited
I
hope
to
come
back
next
year
and
hand
it
to
all
of
you,
the
second
bullet,
our
Statewide
standards
of
quality,
Statewide,
quality
of
practice
standards.
We
adopted
the
was
about
four
years
ago.
We
talk
a
lot
about
Aces,
and
so
it
made
all
the
sense
in
the
world
to
me
for
our
frisks
to
have
standards
of
quality
and
practice
that
are
based
on
protective
factors.
L
So
as
they're
looking
at
the
activities
that
they're
doing
in
a
two-year
cycle,
they're
looking
at
how
they
can
develop
concrete
supports
in
times
of
need
for
our
families,
they're
looking
at
the
protective
factors
and
the
principles
of
engaging
families
and
kind
of
running
it
through
that
filter.
If
you
will,
as
they're
looking
at
their
activities,
which
is
helping
us
to
have
more
quality
and
consistency
across
the
state,
it's
harder
to
do
when
you
have
a
lot
of
local
flexibility.
L
But
we
believe
that
we
have
a
we're
getting
a
better
balance
and
then,
lastly,
collecting
success
stories.
I
believe
you
have
one
in
your
packet
I'm
not
going
to
go
into
it,
but
we
believe
that
will
always
be
a
part
of
what
we
do.
It's
really
difficult
to
distill
everything
that
we
do
down
into
data
points.
There's
always
going
to
be
those
times
when
we
put
a
lot
of
effort
into
a
particular
student
that
I'm
and
I
believe
that
we
change
the
trajectory
of
his
whole
future
and
future
generations
for
that
family
and
I.
K
So
Surf
Kentucky
is
the
organization
that
oversees
the
Americorps
programs
across
the
state.
We
do
a
lot
of
work,
also
with
volunteer
work
and
in
disaster
recovery,
but
Americorps
to
give
you
an
idea,
sort
of
like
a
domestic,
Peace
Corps
and
what's
what's
really
powerful
behind
what
we
do
when
we
start
a
core,
we
work
with
local
Champions
that
find
and
need
the
assessor
Community.
They
find
something
that
they
want
to
do
to
address
that
need
we
help
them,
build
a
core.
K
We
help
them
bring
in
federal
dollars
and
they
recruit
the
members
in
in
that
community
that
will
serve
for
a
year
addressing
that
need
so
again
the
power
behind.
What
we
do
is
folks
that
are
locally
doing
this
work.
We
build
really
really
strong
public
and
private
Partnerships,
which
is
again
at
the
heart
of
all
the
work
that
we
do
so
there's
got
to
be
local
buy-in.
This
isn't
a
large
Federal
program.
It's
sending
people
to
Appalachia
to
work
on
housing.
It's
it's!
K
50
of
your
entire
budget
has
got
to
be
public
investment,
so
I
think
I
think
that
that's
a
real
strong
aspect
of
who
we
are
it's
also
perceived
as
it's
like
a
multi-tool
in
a
lot
of
areas
where
there's
sort
of
like
a
gap
in
Social
Services
people
have
found
that
Americorps
is
an
excellent
place
where
we
can
pop
in
parachute
in
and
really
help
build
some
capacity
there,
uniquely
our
budget.
If
you
look
at
a
budget,
we're
tiny
man,
I
mean
we
are.
K
We
we
are
the
Mighty
Mouse
of
the
cabinet,
I
think
we're
the
cow
building
the
band,
but
that
Mighty
Mouse
cowbell.
We
leveraged
that
to
bring
24
million
dollars
into
the
Commonwealth
of
Kentucky
and
we
do
that
with
that
local
match
and
we
do
it
with
the
education
award,
because
every
Americorps
member
that
serves
in
Kentucky
is
going
to
get
this
education
award
that
they
can
then
go
on
and
further
their
education
or
pay
off
their
back
student
loans.
A
couple
examples
down
there
of
the
kind
of
work
that
we
do.
K
We
do
quite
a
bit
of
work
and
in
the
in
the
the
Senior
Care
Community,
where
basically,
we
gotta
have
a
companions
program
in
Americorps
there
are
40
across
the
state
about
4
400
senior
Corps
members
that
are
actively
working
in
centers,
mostly
serving
as
companions
or
as
Foster.
Grandparents
we
heard
earlier-
and
we
did
about
the
too
good
for
for
too
good
for
drugs
program,
that's
run
by
operation,
unite,
we've
got
unite
service
Corps.
K
A
couple
pieces
here
just
about
some
impact,
just
some
numbers,
so
you
can
that
you
can
see
the
Teach
for
America
program.
It
is
a
national
program
where
folks
that
want
to
be
teachers
go
into
an
underserved
community
and
they
teach
for
a
year,
typically
in
a
stem
field.
So
we've
had
a
really
really
strong
presence
down
in
South
in
in
Appalachia,
with
our
Teach
for
America
program.
Again,
we've
had
83
that
that
we've
brought
in
we've
got
58
that
are
still
teaching
a
couple.
K
Next,
so
our
state
service
plan,
I
I,
put
this
on
the
desk
for
all
y'all.
If
you
want
to
check
this
out
a
little
bit
later,
it
was
a
pretty
robust
plan
we
put
together
with
our
governor
appointed
commissioners
and
our
staff
and
all
of
our
Champions,
where
we
did
a
pretty
in-depth
year
and
a
half
study
and
Survey
of
volunteering
in
Kentucky
and
service.
K
You
know
the
the
kind
of
things
people
want
to
see
and
do
how
we
can
better
serve
and
why
that's
in
that
state,
Service,
Plan
and
there's
some
pretty
eye-popping
information
you'll
see
so
we're
really
really
proud
of
what
we
came
out
on
this
plan.
These
are
the
four
key
elements.
Mainly
we
are
going
to
lead
the
nation
in
Impact.
We
have.
We
have
grown
about
400
percent
in
the
last
nine
years,
and
that's
only
because
we've
built
the
staff
and
the
Commissioners
that
have
shown
the
kind
of
input
that
want
to
do
that.
K
K
So
we
know
that
it's
just
smart
for
people
to
volunteer
we've
got
to
tell
our
story
across
the
Commonwealth
this
a
that
I
proudly
wear
people
don't
know
who
we
are
and
we
need
to
do
a
better
job
of
that.
The
disasters
we've
seen
in
both
sides
of
the
state
we
were
on
the
ground,
24
hours
after
those
disasters,
some
during
the
disasters
actually
still
happening
and
and
we're
still
there
and
we're
going
to
be
there
years
after
everyone
else
is
gone.
K
That's
what
we
do
during
disaster
time,
but
we
need
to
do
a
better
job
of
sharing
our
story
and
helping
people
see
who
you
are
it's
my
dream,
someday
I,
don't
have
to
look
at
y'all
and
say
we're
a
domestic
Peace
Corps,
where
I
want
to
say
the
Peace
Corps,
that's
kind
of
like
International
Americorps.
You
know
that's
kind
of
where
we're
going
for
someday
and
then.
Lastly,
we
want
to
continue
to
do
the
important
work
in
the
disaster
zones.
We
get
disasters
as
we
know
every
single
year.
K
It's
not
just
big
big
floods
or
tornado.
That
comes
from
time
to
time.
It
is
the
winter
ice
storms
we
get
it's
the
constant
flooding
and
what
we
can
provide.
America
members,
our
alumni
have,
if
you've
heard
ever
heard,
of
Team
Rubicon
that
was
birthed
from
Americorps.
These
are
combat
veterans
that
are
there
on
the
ground
and
doing
the
hardest
work
that
that's
needed
immediately.
K
Our
members
right
now,
two
days
ago,
I
was
down
in
South,
Houston,
Kentucky,
mucking
and
gutting,
with
two
different
teams
of
Americorps
members
we'll
be
down
there
doing
that
until
we
don't
have
to
do
any
longer.
In
Western
Kentucky
we're
part
of
the
habitat
projects,
rebuilding
those
houses
that
were
all
blown
away
and
those
businesses
that
we
need
to
bring
back
so
big,
big
key
part
of
who
we
are
and,
lastly,
the
map.
We
have
two
different
Maps,
this
one
I
love
showing
because
it
shows
where
our
programs
are
is.
K
K
We
are
literally
taking
people
power
and
serving
in
every
single
County
in
Kentucky
through
Americorps,
so
a
little
bit
about
the
map
there,
the
last
couple
things
that
I
want
to
mention
that
that
I
love
about
about
who
we
are
and
what
we
do
I
think
that's
a
lot
is
that
the
last
one?
Okay,
the
about
who
we
are
and
what
we
do
about
nine
years
ago,
General
Henry
mccrystal
put
together
a
a
committee
through
the
Aspen
Institute.
K
It's
called
the
Franklin
project
and
19
different
four-star
generals
joined
General
McChrystal,
and
they
came
up
with
a
plan
seeing
that
less
than
one
percent
of
Americans
serve
in
the
military
less
than
one
percent
and
they're
not
having
ways
in
in
other
other
ways
of
impacting
and
server
the
country.
This
is
a
way
that
we
can
do
that.
Top
military
brass
have
seen
that
that
this
can't
be
the
only
way
to
serve
your
country
any
longer
going
in
the
military.
Of
course,
that's
wonderful.
K
It's
a
great
thing
to
do,
but
we've
got
to
give
you
other
aspects
of
doing
it.
National
service
is
a
way
of
doing
that,
so
we're
putting
a
lot
more
focus
into
doing
that,
and
it's
also
a
way
that
we
continue
to
work
with
veterans
right.
We
have
thousands
of
veterans
that
serve
every
year,
Kentucky
after
they
retire.
They
find
that's
a
way
they
can
keep
serving
their
country
really
proud
of
that
work.
K
So,
lastly,
I
just
went
into
this
way:
yeah
Americorps,
really
it
is
for
kentuckians
who
sometimes
need
a
second
chance
or
a
third
chance
in
life.
It
is
for
seniors
who
want
to
stay
connected
to
their
families
and
their
communities,
and
they
know
volunteering
is
going
to
keep
them
viral
and
healthy
and
and
young.
It's
for
young
people
that
need
resources
to
go
back
to
school,
to
get
a
degree
or
to
pay
off
their
student
loans
or
to
get
out
of
mom
and
dad's
house
we're
going
to
help
them
do
that.
K
It's
for
people
that
want
to
build
skill
sets
so
they're,
better
poised
to
go
into
the
workforce.
And,
lastly,
and
personally
it's
for
people
like
me,
I
did
this
in
1989
I
was
in
Vista,
because
I
need
a
direction
in
my
life,
I
needed
something
to
do,
but,
most
importantly,
it
was
a
promise.
I
I
gave
to
my
mom
and
dad
that
I
was
going
to
do
something
for
my
country
and
that
led
me
to
Kentucky
and
33
years
later,
I'm
still
her
serving
the
people.
Because
of
that.
A
First
question
would
be:
do
you
have
any
passion
for
this
program.
K
B
He
did
a
good
job,
that's
for
sure.
First
of
all,
I'll
say
that.
Thank
you
all
for
being
here.
I
think
I
speak
on
behalf
of
the
entire
general
assembly,
but
especially
those
from
rural
communities.
We
love
you
guys.
We
appreciate
what
you
do.
I
appreciate
your
service
to
our
communities
and
Joe.
I'll
also
say
that
you
mentioned
that
your
organization
was
the
cowbell
to
I,
guess
to
take
a
live
from
Saturday,
Night
Live
I.
B
Guess
we
need
a
little
more
cowbell,
but
I
do
have
one
question
real,
quick
and
those
of
us
that
are
familiar
with
the
Frisk
program,
which
is
probably
most
of
us.
We
know
that
you're
you're,
really
in
very
school-based
and
educational
oriented
and
as
we
look
for
ways
to
streamline
and
cut
down
the
cabinet
thin
down
the
cabinet
to
make
them
more
efficient
would
would
your
program
fit
within
the
Workforce
Development
education,
labor
cabinet,.
L
So
would
it
fit?
Was
your
question?
Yes,
maybe
I
think
we
would
do
great
work
if
you
put
us
in
transportation
right,
like
I,
think
we
do
great
work
anywhere,
I.
Think
when
you
look
at
the
mission
and
the
and
the
purpose
of
the
program
and
you
we
really
hone
in
on
non-academic
non-cognitive
learning
barriers.
I
know
that
was
part
of
the
reason
that
it's
in
the
cabinet
in
the
first
place,
the
expertise,
the
services,
the
support
that
is
needed
that
really
fit
into
that
non-cognitive.
L
Non-Academic,
you
know
line
really
does
live
at
the
Cabinet
for
Health
and
Family
Services
I've
never
worked
it.
The
conduct
Market
of
education,
so
I
can
only
speak
to
my
experience,
but
I
think
that
you
know
I
know
that
we
are
sharing
information
with
our
families
around
Medicaid,
like
unwinding,
you
know
we're
we're
sharing
information
with
fris
about
the
unwinding
right
now
we're
making
sure
that
they
have
a
basic
understanding
of
that
I
can
give
you
lots
and
lots
of
examples.
I
know
you
didn't
ask
for
all
that.
L
A
You
made
a
reference
at
four
years
ago,
you
put
together
these
measurements
of
success
and.
A
I
remember
my
one
of
my
first
committee
meetings
back
in
2017
as
we're
preparing
for
the
budget.
I
said
very
questions.
How
do
you
determine
success?
And
at
that
time,
when
the
answers
was
well,
we
served
like
a
hundred
thousand
kids.
Well,
that's
not
measure
of
success.
Just
like
you
know
having
1.6
million
people
on
Medicaid,
it's
not
a
measuring
success
either.
It's
a
barometer
of
the
I
think
in
social
economic
status
of
our
state.
A
So
I
think
that's
a
discussion
that
we're
going
to
have
to
have
a
little
bit
more
is
where
is
the
best
fit
for
this
is
not
to
make
people's
lives
more
difficult,
more
challenging,
just
where's
the
best
place
and
what's
the
best
utilization
of
services,
and
so
oh
yeah.
The
questions
comments,
if
not
greatly.
Thank
your
presentation.
Yes,
secretary
friedlander.
C
So
please
don't
take
my
good
news
stories
away,
but
the
the
other
thing
I
want
to
point
out,
and
so
you
all
set
this
agenda
and
had
the
groups
up
here
that
you
had
Dr
stack
talk
about
some
of
the
long
Arc
of
programs.
I
want
to
point
something
out
to
you
all
I
think
when
I
began
to
testify
the
very
first
time,
I
I,
let
you
know
I
was
appointed
under
the
pat
by
Governor.
C
Patton
served
completely
the
term
under
Governor
Fletcher
and
then
served
under
as
our
present
Governor
likes
me
to
call
him
Bashir
the
Elder,
so
I
want
the
three
three
folks
you
had
up
here,
commissioner
Morris
Joe
bring
Gardner
Melissa
Goins,
we
I
hired
him
under
beshear
the
Elder.
They
served
the
entire
term
under
Governor,
Bevin
and
they're.
C
Still
here
under
Bashir,
the
younger,
so
I
I
say
that
to
lift
up
that
that
some
of
these
positions
transcend
politics
that
that
what
folks
do
is
just
they're
trying
to
do
the
work
of
the
Commonwealth
and
and
that's
what
I
hope,
I
Inspire,
that's
what
I
hope
they
Inspire
I
know.
I
know.
I
hope.
You
all
appreciate
that,
but
you
just
happen
to
pick
three
folks
that
that
span
that
and
so
I
I
felt,
like
I,
wanted
to
point
that
out
for
for
what
it's
worth
well,.
A
I
think
it's
interesting
when
something
goes
well.
You'll
take
credit
for
that
one.
But
then
you
do
a
punches.
I've
seen
your
pattern
here,
but
I
think
I
speak
on
behalf
in
the
entire
committee.
Is
we
truly
appreciate
the
work
that
you
folks
do
and
know
your
passion,
your
commitment
and
that's
everyone
who's
presented
again.
The
mission
of
this
task
force
has
never
been
to
you.
Have
a
I
got
you
or
somebody's
doing
something
wrong?
It's.
How
can
we
do
it
better
more
efficiently?
A
And
you
know
one
of
the
things
that
we've
been
requested
to
consider
is
hearing
from
providers
because
they're
a
customer
from
employees
and
again
not
the
micromanagement,
the
the
and
the
cabinet,
but
employees
are
the
rank
and
file
they've
got
some
great
ideas
may
have
some
great
concerns
and
then
there's
the
the
general
public
consumers,
but
with
only
five
months
to
do
this
work,
it's
virtually
impossible.
A
I
think
one
of
our
recommendations
will
probably
be
that
this
needs
to
be
a
multi-year
commitment
three
four
years
and
as
we
get
into
this,
if
we
get
approved
for
that
the
next
session,
we
may
invite
people
to
provide
testimony.
They
give
us
our
Impressions,
because
you
know
people's
perception
is
their
reality
and
we
want
them
to
have.
A
The
best
perception
in
the
world
is
what
this
cabinet
is
capable
of
doing,
and
we
want
this
to
be
a
partnership
with
legislature
and
with
with
you,
folks
and
I'll,
show
you
that
it
will
be
but
again
we're
in
the
the
very
tail
end
of
this
thing
and
we've
got
to
wrap
up
our
work,
but
I
appreciate
the
testimony
and
we'll
see
where
we
go
from
here,
but
it's
been
a
real
education
for
me
personally,
I
think
all
of
our
committee
members.
A
We
really
appreciate
that
and
wish
we
could
do
more
of
it,
but
I
appreciate
y'all's
testimony
today.
Everyone
that's
here
and
presented,
you
know
excellent
job
and
we
we
appreciate
it
greatly.
Thank
you.
Thank
you
for
serving
the
Commonwealth.
Our
next
meeting
is
November,
2nd
at
3
P.M.
So
agenda
will
follow.
Thank
you
all.