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Description
Behavioral health conditions are often difficult to diagnose and treat under normal circumstances, but adding a global pandemic to the situation can raise additional hurdles. Changes and temporary halts to traditional health care delivery models have increased stress for patients and behavioral health providers. Join NCSL to learn how state policymakers, health directors, health systems, providers and consumers have adjusted to telehealth and other changes to behavioral health care in the coronavirus era.
A
All
right,
hi,
hi
and
welcome
everybody,
I'm
carmen
hansen
program,
director
of
behavioral
health
and
pharmaceuticals
at
the
national
conference
of
state
legislatures.
Thank
you
all
for
joining
us
today
and
we
are
going
to
hear
from
some
very
experienced
behavioral
health
directors
about
how
covid19
further
complicates
behavioral.
Health.
Here
is
a
quick
look
at
our
agenda.
For
today
we
are
going
to.
We
have
at
least
100
people
registered
for
today's
event,
which
is
super
exciting,
and
we
would
like
to
get
a
feel
for
where
you're
all
from.
A
If
you
would
please
be
so
kind
as
to
open
up
your
chat,
which
the
bot
the
button
is
in
the
bottom
center
of
your
zoom
window,
we're
kind
of
assuming
you're
all
zoom
experts
at
this
point
in
time.
But
if
you
could
just
tell
us
in
the
chat
where
you're
from
so,
we
can
get
a
sense
of
where
everybody's
coming
in
from
right.
A
Now
wow
we
have
some
beautiful
states
listed.
Look
at
that
lots
of
great
states.
We
got
some
iowa
a
couple
iowas
couple:
texas,
florida,
wisconsin,
south
dakota
nice.
We
got
I
I
checked
earlier
and
we
have
at
least
34
states
represented
and
three
countries.
So
that's
that's
pretty
impressive
for
us
to
have
such
diversity
on
a
call.
So
we
really
appreciate
that
we
are
coming
to
you
live
today
from
ncsl's
home
in
beautiful
denver
colorado.
A
We
have
a
few
ncsl
staff
on
our
call
today,
our
esteemed
experts
and
you
the
audience
who
represent
a
wide
variety
of
perspectives
and
interests
in
this
issue.
Our
magical,
co-host,
colleen
becker,
is
going
to
launch
a
fun
one
question
pulse
poll
for
you
and
it's
just
about
how
you
are
feeling
about
your
own
behavioral
health.
Lately.
This
is
completely
anonymous
so
and
it's
just
kind
of
fun.
But
honestly,
if
you
do
need
help,
please
contact
a
health
professional.
A
I
think
it
would
be
bad
for
us
to
have
a
call
about
behavioral
health
and
not
to
mention
that
if
you
do
need
help,
please
seek
out
assistance
from
a
medical
professional.
So
the
categories
are
great:
I'm
loving
it
you're.
Finally,
finding
your
groove
meh,
okay
and
not
much
fun
and
get
me
out
of
here,
you're
sick
of
it.
Let's
you
know,
try
to
get
back
to
normalcy,
so
we'll
just
keep
that
up.
For
a
few
more
seconds,
we've
got
about.
A
And
show
us
how
we're
all
doing
so:
yeah
meh,
okay,
I
think
that's
pretty
much
about
where
most
people
have
been,
at
least
in
my
group
of
friends
and
and
colleagues,
everyone's
kind
of
in
the
getting
used
to
it
or
math
category,
I'm
for
sure
in
the
getting
used
to
it
mac
category
most
days
too.
So
I
appreciate
you
guys
for
giving
us
your
feedback
on
that.
A
So,
let's
dive
into
today's
material,
this
webinar
is
not
only
part
of
ncsl's
larger
series
of
covid
19
related
webinars,
but
it
is
part
of
a
centers
for
disease
control
and
prevention,
supported
project
about
connecting
behavioral
health
and
public
health
systems
to
improve
overall
health
and
those
systems,
and
just
a
reminder
for
everyone.
Today,
if
you're
not
familiar
with
ncsl,
we
are
the
bipartisan
organization
representing
all
state
legislators
and
legislative
staff
across
the
country.
A
We
do
not
take
any
position
on
state
legislation
and
we
serve
the
nation's
7,
383,
state
legislators
and
legislative
staff
and
over
30
000
legislative
staff,
and
we
also
work
to
strengthen
the
legislative
institution.
Ncsl
has
been
quite
busy
responding
to
coronavirus,
related
questions
for
our
constituents.
We've
answered
hundreds
of
research
requests,
we've
produced
dozens
of
webinars
and
podcasts.
The
numbers
on
your
screen
right
now
are
at
least
a
month
old.
A
A
Now,
if
you'd
like
to
save
them
for
later
and
they're,
also
on
your
screen
now
to
kick
things
off
today,
we
are
going
to
hear
from
ncsl's
own
charlie,
severance
health
policy
program
specialist
in
the
health
program
and
he's
going
to
give
us
an
overview
of
a
new
brief
that
we
just
just
at
least
about
a
week
ago,
one
of
the
co
co-authors
on
it,
and
so
without
further
ado.
Please
welcome
charlie
thanks
for
joining
us
today.
B
This
brief
highlights
examples
that
show
that,
by
connecting
behavioral,
health
and
public
health
systems,
policy
makers
can
better
leverage
resources
across
different
sectors
that
are
currently
operating
independently
of
each
other.
This
allows
both
for
better
health
outcomes
and
more
effective
use
of
scarce
resources.
B
B
The
first
we
take
a
look
at
is
data
so
really
looking
at
this
from
an
infrastructure
standpoint
and
showing
how
states
have
combined
disparate
or
siloed
data
sources
to
create
clearer
pictures
of
the
problems
and
potential
solutions
to
those
problems
in
their
respective
states.
We've
also
looked
at
partnerships
so
making
sure
behavioral
and
public
health
agencies
are
working
in
tandem
with
each
other
and
not
against
each
other,
to
achieve
common
outcomes
and
also
to
make
sure
that
we're
leveraging
those
resources
in
the
most
helpful
way
possible
and
finally,
we're
looking
at
financing.
B
So
how
can
states
create
sustainable
funding
streams
that
best
use
your
important
tax
dollars?
This
was
a
brief
that
I
co-authored
with
my
fellow
ncsl
colleague,
tammy,
jo
musgraves,
and
I'm
sure
many
of
you
know
her.
If
you
have
more
questions
about
it,
I'm
sure
either
of
us
would
be
happy
to
answer
them.
I
think
colleen
went
ahead
and
posted
a
link
to
the
brief
in
the
chat.
B
A
Great,
thank
you
so
much
charlie.
Yes,
I
do
know
that
you
and
tammy
joe
put
in
so
much
work
over
this
brief.
The
in
the
last
year,
colleen
did
post
a
link
in
the
chat
box,
so
please
folks
can
bookmark
that
and
check
it
out
a
little
later
so
now,
we'd
like
to
start
off
today's
main
event.
We're
thankful
to
have
us
with
us
today.
A
Elizabeth
romero
is
the
director
of
the
delaware
division
of
substance,
abuse
and
mental
health.
Formerly
she
served
as
the
senior
director
for
health
improvement
with
the
association
of
state
and
territorial
health
officials,
where
she
oversaw
behavioral
health,
injury,
substance,
abuse
and
chronic
disease
teams,
with
a
focus
on
building
systems
to
improve
population
and
community
health.
A
She
also
provided
capacity
building
assistance
to
more
than
49
state
and
territorial
health
departments
and
a
national
and
with
other
national
partners
to
support
policies
and
evidence-based
practices
for
substance
abuse
prevention,
she's
worked
at
other
health
organizations,
including
the
harvard
prevention
research
center
and
the
harvard
school
of
public
health,
so
welcome
dr
romero,
and
then
we
also
have
doug
thomas
director
of
the
his
division
of
substance,
abuse
and
mental
health
in
utah
he's
not
only
the
director
of
the
division.
He
is
a
really
busy
person.
A
He
serves
on
the
board
of
directors
of
the
national
association
of
state
alcohol
and
drug
abuse
directors
and
the
national
association
of
state
mental
health
program
directors,
and
that's
not
all
he's
an
active
member
of
the
utah
substance
abuse
advisory
council
he's
worked
in
mental
health
and
substance
use
disorder
field
for
over
24
years
in
various
capacities,
he's
been
a
direct
service
provider
and
administrator
for
both
urban
and
rural
settings
and
he's
also
worked
with
tribal
governments.
So
welcome
director
thomas.
A
So
I
know
you
have
both
been
so
extremely
busy
these
last
few
months,
not
only
with
just
your
regular
state
duties,
but
your
national
meetings
and
other
meetings,
and
just
so
many
you
know
plates
up
in
the
air
right
now.
So
we
appreciate
you
juggling
us
as
one
more
thing
to
do
right
now.
Your
states
may
not
be
familiar
to
everybody
here
on
the
call
today.
C
But
we
have
a
population
of
approximately
971
000
people.
We
have
a
small
three
counties,
however,
they
represent
both
urban
and
rural
environments
and
suburban
environments.
We
also
have
a
lovely
set
of
beaches.
If
anyone
wants
to
come
by
as
long
as
you
are
tested
prior
to
coming,
and
then
we
also
have
we
are
on
the
95
corridor,
so
we're
very
close
to
philadelphia,
baltimore,
washington
dc
and
new
york.
C
So
we
sort
of
bring
and
have
the
op
the
ability
to
be
surrounded
by
many
different
people
and
diverse
communities
throughout
our
state,
and
our
agency
is
within
the
department
of
health
and
social
services,
and
so
our
division
serves
all
the
behavioral
health
throughout
the
state.
For
those
18
and
up.
D
Great,
thank
you
glad
to
be
here
and
utah.
We
also.
We
have
a
population
of
about
3.3
million
people.
80
of
those
people
live
within
about
an
hour
drive
north
or
south
of
salt
lake
city,
so
some
population
density
there
with
about
2.5
million
people
and
then
the
rest
spread
out
throughout
our
state.
D
So
we
have
our
county-based
local
substance,
abuse
and
local
mental
health
authority
system.
So
our
state
government
works
with
the
county
government
they're
the
providers
of
services,
or
they
contract
for
services
and
there's
they're,
spread
out
the
larger
counties.
Pretty
much
are
their
own
and
then
small
counties
bound
together.
The
largest
area
is
a
six
county
area
that
provides
services
to
people
throughout
the
state.
D
The
division
of
substance,
abuse
and
mental
health
sits
inside
of
the
department
of
human
services,
with
other
agencies
like
child
welfare
and
juvenile
justice
and
services
for
people
with
disabilities,
and
our
director,
ann
williamson,
is
the
one
who
is
on
the
cabinet
with
our
governor
gary
herbert.
So
we
are
the
single
state
authority
for
mental
health
and
substance
use
in
our
state
and
coordinate
all
the
publicly
funded
behavioral
health
treatment
and
prevention
and
recovery
support
services
that
exist
throughout
our
state
work
closely
with
our
medicaid
office
and
our
department
of
health
and
their
prevention
programs.
D
Even
though
we're
not
in
the
same,
you
know,
department
structurally,
we
work
together
really
closely
and
have
lots
of
coordination
and
collaboration
meetings
across
our
two
areas.
So
we're
really
glad
to
be
here-
and
you
know,
to
have
elizabeth
and
delaware
here,
she's
a
great
director
as
well
so
hoping
to
learn
as
well
as
you
from
her
as
we
get
going.
A
Here
I
am
trying
to
use
the
shortcuts
of
the
space
bar
and
it
just
doesn't
want
to
work
for
me.
So
all
right,
let
me
try
again
thank
you
both
for
giving
us
a
little
brief
overview
of
your
of
your
state
programs.
It's
really
helpful.
I
think,
to
give
people
some
context
of
of
what
you're
directing
in
your
states
we
have
about
seven
or
nine
questions
we're
going
to
try
to
get
through.
So
these
questions
were
made
with
a
lot
of
input
from
the
participants
the
when
they
registered.
A
They
were
allowed
to
give
us
some
ideas
for
questions,
so
we've
tried
to
incorporate
as
many
of
those
as
possible,
but
if
people
do
have
like
a
really
burning
question,
we'll
try
our
best
to
get
to
it.
Just
put
that
in
the
chat
while
you're
while
you're
thinking
about
it.
So
the
first
question
and
we'll
start
off
with
director
romero
again
and
then
we'll
alternate
from
here
on
out.
If
you
could,
please
describe
how
the
pandemic
affects
behavioral
health
needs
and
treatment
in
delaware,
in
particular,.
C
Thank
you
carmen.
Is
this
a
good
time
if
we
wanted
to
show
a
couple
slides
to
answer
that?
Or
would
you
like
a
sure
letter
yeah?
So
that's
a
great
question
and
I
also
want
to
say
it's
a
mutual
admiration
society
with
with
doug,
because
I
think
he's
done
amazing
work
in
utah
and
I'm
really
looking
forward
to
his
presentation.
C
So
really
briefly,
you
know
and
I'll
just
go
straight
to
the
slide.
First,
hopefully
I
understand
is:
we
are,
unfortunately,
in
delaware
because
of
our
location.
We
have
a
high
opioid
death
rate
in
in
our
state,
and
one
of
the
things
that
we
tried
to
do
in
preparation
of
that
is
really
think
about
how
to
make
the
system
easier.
C
So
this
was
an
initiative
that
we
were
working
on
before
the
pandemic
began,
which
is
really
trying
to
connect
people
to
care,
get
them
where
they
needed
to
be
make
sure
they
had
wraparound
supports
and
they
ended
up.
You
know
with
the
outcomes
needed
for
their
lives,
so
we
actually
had
a
strategic
map
that
we
were
working
on,
that
looked
at
improved
well-being,
improved
mental
health
and
addiction
outcomes.
Years
of
life
gained
as
well
as
thriving
in
resilient
communities
through
the
pandemic.
C
One
of
the
things
that
was
really
important
when
I
first
got
here
was
to
make
it
easier
for
people
to
have
access
to
the
system.
So
doug
had
alluded
to
this
director
thomas.
It
alluded
to
the
bi-directional
referral
system,
the
delaware
treatment,
referral
network
that
we
had
up
and
running,
and
so
in
that
is
it's
a
platform
that
allows
for
connections
between
different
communities.
C
So
you
can
see
that
you
can
see
real
time.
They
actually
update
this,
sometimes
multiple
times
a
day
for
the
ones
that
are
the
busiest,
but
they
will
refer
and
see
twice
a
day
where
you
can
see
what's
available.
What's
not
and
again
in
a
pandemic,
you
want
to
ease
passage
from
place
to
place
because
those
transitions
are
where
people
were
getting
lost,
we've
actually
even
added
social
determinants
to
this,
as
well
as
a
new.
C
I
think
it's
going
live
this
month,
which
is
a
connection
to
a
program
called
roundabout,
so
you
can
actually
get
transportation,
logistics
management
as
well.
The
other
part
that
we
included
again
is
because
substance
use
treatment
is
really
challenging.
I'm
sure
director
thomas
can
allude
to
this
is
that
people
who
are
not
in
behavioral
health
field
don't
even
understand
what
is
asam.
C
What
does
that
mean-
and
you
might
have
heard
of
that
for
legislators
that
are
on
the
call
where
people
talk
about
asean
levels
of
care,
but
they're
really
just
levels
of
care
that
relate
to
the
acuity
needs
of
someone's
substance
use
disorder
and
so
this
tool
also,
we
worked
very
closely
with
the
platform
to
create
a
decision
support
tool,
so
someone
could
enter
information
across
all
the
different
dimensions
that
relate
to
helping
people
identify.
Where
is
the
best
place
for
this
person
to
go?
C
And
it's
important
to
understand
this,
because
we
actually
now
have
about
a
year's
worth
of
denial
data,
and
so
we
can
actually
look
to
see
how
many
denials
have
been
happening,
so
we
actually
have
had
to
date.
We
have
almost
50
000
referrals,
a
clock
across
our
platform
and
almost
two
years
worth
of
being
in
existence,
but
in
one
years
of
data
we
were
able
to
really
try
to
understand
what
was
accepted
and
what
was
declined
and
why
so?
C
C
So
we
saw
that
there
were
actually
about
eight
providers
that
accounted
for
the
majority
of
the
referrals.
So
when
we
went
into
our
covid
response,
we
worked
very
closely
with
these
eight
providers
to
simplify
and
make
the
process
getting
into
their
system
much
faster.
So
again,
based
on
this
information,
we
really
found
about
87
percent
of
their
denials
were
coming
from
these
top
eight
providers.
C
C
Another
provider
18
had
areas
to
improve
in
which
they
didn't
manage
and
client
relationships,
which
means
those
were
people
that
had
already
been
in
that
system
before
and
they
were
declining
them
because
they
said
well,
we
you
know
patient,
acuity
and
other
issues,
so
the
reasons
that
we
saw
that
were
70
of
all
reasons
for
decline
related
to
general
acuity.
So
is
the
wrong
level
of
care
to
the
wrong
location,
aggression,
violence
and
behavioral
health
acuity
facility
at
capacity
which
happens
sometimes,
but
again
it
wasn't.
C
All
the
time
did
not
meet
the
facility
criteria
in
general.
So
we
did
see
often
where
maybe
a
youth
was
being
sent
to
a
place
that
it
really
was
for
older
adults
and
then
also
legal
issues
of
the
patient,
limited
mobility,
medical
acuity,
which
includes
things
like
their
blood
pressure,
was
too
high.
So
again,
when
you're
dealing
with
a
cova
crisis,
if
someone's
blood
pressure
is
too
high,
then
all
of
a
sudden
they
deny
them
when,
in
fact,
that
person
was
managing
their
blood
pressure
very
well.
C
C
So
again
we
were
able
to
use
this
information
and
then,
as
we
went
into
our
covid
response,
we
really
looked
at.
How
do
we
take
what
we
were
doing
and
adapt
it?
And
so
because
we
were
able
to
use
dtran,
we
simplified
and
created
an
emergency
room
discharge
process
where
our
team
actually
worked
with
anybody
that
got
a
denial.
Our
team
would
immediately
respond
24
hours
a
day,
seven
days
a
week
and
help
move
people
out
of
the
emergency
room
as
soon
as
possible.
Because
again
you
wanted
to
keep
the
compression
low
there.
C
So,
within
one
week
all
of
the
providers
in
our
state
had
gone
on
to
telehealth
and
we
had
to
really
create
like
a
whole
training
program
for
them,
and
things
like
that.
We
also
had
to
really
think
about
naloxone,
because
people
were
taking
home
their
medication
for
a
long
period
of
time
and
then
really
thinking
about
supports
for
the
community.
So
really
thinking
about
what
wraparound
supports
what
housing
and
because
we
had
a
large
homeless
population.
C
One
of
the
things
we
had
to
do
is
get
creative
about
how
we
were
going
to
deal
with
the
homeless
in
our
state,
and
so
our
team
actually
worked
and
set
up
an
integrated
treatment
facility
for
those
that
were
homeless
and
potentially
coveted
positive
one
in
every
county,
and
we
were
able
to
house
some
of
the
most
challenging
homeless
in
our
state
for
about
two
months
where
they
got
treatment
brought
to
them.
Social
services
were
brought
to
them
and
then
about
70
to
80.
C
Percent
of
them
were
connected
once
the
one
sort
of
the
order
was
lifted
to
allow
people
to
move
around
we're
actually
able
to
get
people
connected
to
recovery
homes
so
that
they
would
actually
succeed,
make
sure
that
they've
had
case
management
from
their
their
insurance
provider
if
they
had
one
and
then
make
sure
that
they
also
got
again
the
ongoing
support
that
they
needed.
So
again,
we
really
had
to
think
about
how
do
we
help
our
providers?
How
do
we
help
our
community
and
really
support
them
in
that?
C
C
So
again,
we
really
looked
at
their
well-being,
scores
over
time,
really
looked
and
targeted
those
again
for
social
isolation
and
loneliness
and
those
again
that
were
suffering
and
because
of
that,
we
actually
also
worked
with
all
of
our
providers
to
create
a
community
support
group
calendar
so
that
any
provider
could
help
someone
if
they
were
identified
as
lonely
if
they
were
defined
by
identified
as
hopeless,
be
able
to
connect
them
to
the
online
resources
that
our
behavioral
health
providers
were
providing.
So
whether
it
was
a
teen
class.
C
I
myself
really
probably
needed
to
sign
up
for
a
quarantine
for
boys
class
that
I
could
be
a
better
parent,
too
my
senior
in
high
school,
but
there
was
a
lot
of
different
things
that
were
offered
by
our
providers
to
truly
try
to
help
people
and
again
you
really
are
trying
to
look
at
this
from
a
population
health
perspective.
So
not
only
did
we
do
that,
but
then
we
looked
at
the
worried.
C
Well,
so
if
we
were
really
worried
about,
you
know
our
population
of
971
000,
we
as
a
behavioral
health
agency,
had
to
really
think
about.
You
know
that
resilient
community,
so
that
includes
developing
a
hope
line,
which
we
also
tried
to
really
set
up
for
folks,
as
well
as
making
sure
that
people
had
access
to
other
types
of
support
services.
So
working
with
our
schools-
and
I
know
director
thomas-
has
a
really
strong
network
with
this
type
of
things
that
he
was
doing
with
the
school.
C
So
it's
china-
I
was
very
jealous
about
that,
but
I
would
say
that
we
really
are
trying
to
again.
We
have
a
community
well-being,
coaches
we're
trying
to
reach
out
into
our
communities,
especially
in
our
area.
We
had
to
deal
with
a
lot
of
the
issues
in
wilmington
and
dover
and
different
parts
of
our
state
around
racism
and
injustice,
so
covid
not
only
the
pandemic
itself,
dealing
with
loneliness
and
social
isolation.
C
We
had
to
then
also
deal
with
the
injustices
that
people
have
had
and
so
had
to
shift
a
lot
to
really
think
about.
How
are
we
making
sure
we
were
always
intentional
about
reaching
out
to
our
communities
of
color,
but
especially
in
this
time,
the
feedback
that
we
got
is
that
people
now
more
than
ever
needed.
Knowing
that
there
was
someone
to
call
someone
to
talk
to,
that
was
like
them,
so
for
us
in
our
behavioral
health
response.
C
A
D
Sure,
thanks
carmen
and
and
thanks
elizabeth,
you
can
see
why
I
enjoy
her
so
much
she's
got.
I
need
to
suck
off
some
of
her
energy
and
so
for
us
in
utah.
I
think
people.
What
we
see
is
people
with
serious
mental
illness
and
addiction.
The
people
that
are
in
our
public
system
already
have
really
weak
or
non-existent
informal
and
social
support
systems.
D
And
one
good
example
was
one
of
our
clubhouses
that
you
know
people
come
in
and
they
learn
job
skills
and
they
get
placed
in
jobs
and
creates
a
sense
of
community
and
it's
understaffed
on
purpose,
so
that
the
clubhouse
has
to
have
lots
of
members
there
to
actually
run
and
function
well,
based
on
all
the
guidelines
that
couldn't
happen
anymore.
So
they
had
a
core
staff,
come
in
and
make
meals
and
make
the
newsletter.
D
And
then
they
did
outreach
to
all
of
the
homebound
people,
and
you
know,
checked
on
them
and
did
assessments
and
gave
made
sure
they
had
food
and
then
had
to
do
some
shopping
groups
and
some
different
things
that
to
really
meet
the
needs
of
of
our
most
vulnerable
people,
for
people
that
were
kind
of
doing.
Okay,
but
maybe
had
some
mental
illness
or
some
problem.
Drinking
behavior,
some
of
them
with
the
pandemic,
really
got
affected
and
slipped
into
needing
treatment
and
needing
active.
D
A
Great,
thank
you
director,
thomas
other
people,
are
adding
some
comments
in
the
chat
of
how
they've
seen
their
states
reacting
to
say,
keeping
liquor,
stores,
open
and
things
like
that
during
the
pandemics.
So,
thanks
for
sharing
those
other
ideas
in
the
chat,
everyone
could
you
each
tell
me
a
little
bit
more
about
how
your
state
is
leveraging
those
telehealth
technologies
and
providing
behavioral
health
services?
Maybe
just
a
you
know
brief
statement
or
two
about
what
you're
hearing
from
local
providers
and
or
your
own
health,
your
own
department
providers.
D
Yeah,
so
for
us
we
already
had
a
platform
that
was
set
up
for
people
to
use,
but
it
wasn't
being
used
very
much.
It
was
underutilized
and
as
soon
as
the
pandemic
hit,
we
had.
You
know
five
years
worth
of
telehealth
growth
in
a
couple
of
weeks
and
and
the
sustainability
of
that,
and
now
people
are
learning
how
to
use
it
better
and
we're
looking
at
outcomes
and
symptom
reduction
and
some
of
the
tools
and
measures
that
we
have
to
see.
How
does
delivering
care
this
way
compare.
Do
we
get
some
do
we?
D
You
know
see
that
for
different
groups?
Does
it
help
more
or
less,
and
you
know
some
people
still
need
face-to-face
care
and
so
effectively
different
delivering
that
as
well
has
been
interesting,
and
some
of
our
providers
had
some
difficulty
getting
ppe
in
the
beginning.
So
that
was
you
know
one
of
the
things
that
you
know:
kind
of
slowed
things
down,
and
then
residential
systems
and
levels
of
care.
You
know
how
do
you
avoid
spread
and
how
do
you
protect
your
staff
and
your
patients?
And
you
know,
working
through
those
things.
D
D
So
many
of
our
providers
were
unprepared
for
that
and
so
had
to
rethink
and
retool,
and
one
of
the
other
things
that
we
did
is
we.
We
were
pretty
far
down
the
road
getting
an
app,
that's
called
my
strength
and
we
we
have
this
app
and
purchased
it
licenses
for
it
for
basically
our
entire
state.
We
we
have
a
limit,
but
we
don't
know
if
we'll
ever
hit
the
limit,
but
we
hope
to
because
we
saw
that
more
crisis
calls
were
happening,
but
less
people
were
going
to
the
er
because
of
the
pandemic.
D
So
we
needed
to
give
them
resources
and
things
they
could
do
before
they
could
get
into
care,
and
so
there's
a
lot
of
tools
on
this
app
around
self-care.
But
you
can
also
use
it
if
you're
in
treatment
with
your
therapist
and
your
therapist
can
give
you
assignments
and
then
check
on
how
you're
doing
with
the
tool,
and
so
that
was
another
telehealth
and
technology-based
intervention
that
we
found
to
be
really
helpful.
A
C
Oh,
there
were
a
couple
things:
our
governor
issued,
an
emergency
order
that
we
have
a
public
behavioral
health
shortage
in
our
state.
So
the
first
thing
that
was
important
and
we've
actually
now
got
legislation
that
extended
that
which
allows
delawareans
to
seek
behavioral
health
services
from
any
licensed
professional
across
the
country,
provided
that
they
knew
at
the
time.
It
was
just
anyone
and
then
now
there's
actually
they
have
to
fill
out
a
form
with
their
division
of
professional
services.
C
So
our
mental
health
and
substance
use
providers
now
have
you
know,
I
mean
people
who
would
like
to
reach
different
folks
that
they
needed
access
to
have
access.
So
that's
for
people
and
for
the
providers.
Obviously
I
think,
as
doug
as
director
thomas
referred
to,
we
had
to
really
not
only
there
was
assistance
but
then
also
helping
and
we
provided
a
training
for
staff
of
providers
because
it
was
kind
of
like
now
you're
on
telehealth.
Now
what
do
you
do?
C
Adjacent
tools
where
people
who
already
have
a
provider
could
actually
utilize
an
app
such
as
that
if
the
provider
was
offering
it
and
then
the,
but
the
real
challenge
we
faced
were
people
who
were
either
not
comfortable
with
telehealth
tools.
So
we
saw
a
drop
off
in
those
and
then
the
second
part
are
people
who
didn't
have
access
to
health,
telehealth
tools
and
some
of
our
federal
funding
and
our
state
funding
was
really
challenging
for
us
to
be
able
to
actually
get
telehealth
equipment
to
the
people
that
needed
it
in
order
to
actually
use
it.
C
And
so
we
worked
very
closely
with
our
state
legislators.
We
actually
have
an
opioid
impact
fee
fund,
and
so
our
recommendation
to
the
opioid
impact
fee
fund
was
to
use
it
to
purchase
telehealth
equipment
in
a
preparation
for
a
second
wave,
so
that
we
can
make
sure
that
people
in
the
community
have
access
to
telephones
and
computer
equipment
that
they
need
to
engage
and
stay
in
treatment.
But
then,
on
the
other
part,
we
also
looked
at
it.
I
think
the
my
strength
app
is
a
really
great
tool.
C
We
actually
are
in
the
process
of
getting
ready
to
launch,
with,
in
partnership
with
our
university
of
delaware,
a
peer-to-peer
platform
because,
similar
to
what
he
was
saying,
is
that
absolutely
people
some
people
are
interested
in
using
phones,
but
not
everyone
is,
and
they
were
staying
home.
We
used
and
looked
at
our
data
pretty
carefully
to
make
sure
we
were
monitoring.
Crisis
calls
9-1-1
calls
and
definitely
during
the
lockdown.
C
It
almost
was
like
everyone
was
quiet,
overdose
rates
went
down
suicide
rates
down,
everything
was
kind
of
quietly
down,
people
using
the
er
for
non-coveted
purposes
were
down,
and
we
were
watching
that
very
carefully.
The
one
thing
our
open
beds,
our
d
trend
platform
showed
us
is
that
the
if
there
was
any
referrals
for
substance
use
in
that
time
it
was
all
all
of
a
sudden
it
flipped
and
it
became
alcohol.
Alcohol
was
one
of
the
number
which
shot
up
to
the
number.
C
One
reason
why
people
were
being
referred
to
treatment
in
every
county
for
a
good
six
weeks,
and
then
it
started
as
the
doors
were
opening
we
could
watch
and
we
saw
the
substance.
Uses
substances
start
changing
again.
Alcohol
still
remains
at
the
top,
but
now
we're
obviously
once
the
doors
open.
We
saw
a
huge
influx,
unfortunately,
of
overdose
deaths
in
may
and
the
beginning
of
june,
and
then
it
kind
of
got
quiet
again
and
now
it's
starting
to
go
back
up
again.
C
C
A
Great.
Thank
you.
That's
all
very
helpful.
Oh
thanks.
The
next
question
is
about
special
populations
that
you're
trying
to
reach
out
to.
Could
you
each
give
like
one
or
maybe
two
short
examples
of
how
you're
reaching
out
to
a
special
population,
so
people
with
chronic
conditions,
older
adults,
low-income
communities,
kids,
maybe
racial,
ethnic
minorities,
tribal
rural?
You
know
if
you
have
just
like
one
example
that
you
could
dive
into
a
little
bit
about
each
of
those,
and
you
can
go
ahead
and
start
elizabeth
with
that.
C
Sure
so
one
of
the
ones
that
we've
been
doing-
and
I
was
just
at
this
morning
in
the
pouring
rain-
is
actually
reaching
out
to
those
that
are
food
insecure,
because
we
do
know
that
that
is
also
one
of
the
issues
that
causes
our
population
to
really
destabilize.
And
so
we
actually
partner
with
the
food
bank
in
our
state.
First
then,
when
they
were
doing
big
mobile
pantry
outreaches
were
two
thousand
three.
You
know
people
thousands
of
people
were
coming.
C
We
actually
would
bring
materials
and
naloxone
to
give
out
and
then
what
we
did
is
partner
to
the
highest
zip
codes,
our
low
income
and
also
some
of
our
communities
of
color
that
were
not
being
reached
where
we
did
targeted
mobile
pantries
and
would
feed
you
know
180
households
and
then
give
out
narcan
to
those
households.
And
so
we
really
tried
to
make
sure
that
we
were
reaching
our
communities
in
color.
A
D
Great
for
us,
we've
been
for
the
last
five
years,
really
focused
on
with
our
crisis
counselors
and
that
program
of
reaching
out
to
minority
businesses
and
churches,
religious
communities,
tribes
and
other
organizations
to
train
them
so
that
the
they
could
help
and
we
would
have
an
infrastructure
that
could
respond
to
people
with
their
language
culture,
those
kinds
of
things.
So
we
took
our
fema
grant
that
we
received,
and
one
of
our
teams
is
a
statewide
team.
A
Great,
thank
you,
are
you
do
either
of
you?
Have
any
specific
partnerships
happening
right
now
with
your
departments
of
public
health
and
if
you
could
just
give
an
example
or
just
describe
that
you
know
we
we're
about
halfway
through
our
questions
and
not
much
time
left,
so
we're
just
gonna
keep
going
as
fast
as
we
can.
So
we.
D
Mention
all
of
them.
We
have
lots
and
lots,
and
we,
for
instance,
one
is
we're
meeting
every
two
weeks
and
reviewing
overdose
death
date
and
suicide
data
in
real
time,
which
usually
there's
such
a
lag
on
that
because
of
how
many
hoops
it
has
to
go
through
to
be,
you
know
validated,
but
we're
just
doing
it
based
on.
You
know
the
data
that
we
have
and
then
we're
making
adjustments
on
our
messaging
and
our
campaigns
and
our
outreach
and
our
distribution
of
resources.
D
And
you
know
we
had
two
or
three
weeks
in
may,
where
our
numbers
went
up
and
we
did
some
things
and
they
went
back
down
and
they've
been
pretty
stable
and
now
in
july,
they've
gone
back
up
again
and
so
we're
going
back
out
and
retargeting
in
some
different
areas.
And
it's
our
our
partnerships
with
the
department
of
health
are
invaluable,
they're,
just
so
meaningful
and
both
on
the
prevention
side
and
then
also
with
emergency
operations
and
getting
the
word
out
about
resources.
C
C
But
then
the
other
part
to
add
is
that
they've
been
important
partners
in
helping
us
be
able
to
help
the
providers
themselves
navigate
the
entire
covet
epidemic.
So
for
those
that
were
residential
treatment,
inpatient
recovery
homes,
we
had
to
really
partner
around
ppe
and
the
ever-changing
science,
so
we
had
weekly
calls,
but
often
we
would
make
sure
to
make
the
talk
to
dph
and
make
sure
that
they
were
giving
the
best
information
that
we
had
at
the
time
we
had
it
to
our
to
our
provider
community
because
they
were
struggling
on.
C
How
do
they
navigate
this?
What's
the
best
ppe?
What's
the
best
information,
and
so
I
think
from
perspective,
you
know
those
partnerships
across
agencies
and
allowing
that
free
flowing
of
communication
and
data
sharing
really
help,
because
then
you're
able
to
maximize
and
get
out
as
much
information
as
possible
to
as
many
people
as
possible.
That
were
scared.
A
Great,
thank
you
so
much
on
that
same
note,
director
romero.
We'll
have
you
start
with
this
question?
Do
you
have
any
considerations
or
advice
for
state
legislators
or
other
policy
makers
looking
to
address
behavioral
health
issues,
particularly
during
a
time
of
covid
or
you
know,
within
the
disparities
within
their
communities.
C
Sure
so
I
think
there's
a
few
areas
again
that
we
we
found
invaluable
the
executive
order
allowing
for
tele
behavioral
health
and
looking
to
make
sure
that
there
were
no
barriers
for
people
to
access
treatment.
So
whether
it
be
you
know
requiring
an
initial
face-to-face
before
induction,
maybe
helping
to
relax
rules
immediately
and
respond
quickly,
so
that
that
was
really
important.
C
D
And
carmen,
I
would
just
add,
I
second
everything
elizabeth
said
and
then
also,
I
would
add,
ask
your
state
mental
health
or
substance
use,
department
or
division
directors
for
any
needs
assessments
that
they've
done
that
identify
the
gaps
in
your
system,
because
every
state
is
so
different
that
it's
hard
to
say.
This
is
what
you
need.
D
What
what
you
need
is
where
your
gaps
and
your
barriers
are
so
often
they
will
have
needs
assessments
that
they
can
give
you,
where
they've
partnered,
with
your
hospital
associations
and
with
your
department
of
health
and
other
behavioral
health.
You
know
the
public-private
partnerships
to
address
those
and
your
governor's
office
may
also,
depending
on
how
they're
structured
have
some
of
these
reports
where
they
could
share
with
you
and
and
really
look
at
what
your
gaps
and
your
barriers
are
and
address
them.
D
I
know
for
us
in
utah
our
barrier
and
our
gaps
were
in
our
crisis
subsystem,
so
you
could
get
a
call
in,
but
then
where
could
you
go
for
care
right
after
until
you
could
get
in?
And
so
that's
really,
where
we've
been
focusing
this
last
year
or
two
because
of
the
data
because
of
the
needs
assessments
that
I
think
have
driven
that,
and
it's
been
a
partnership
with
our
legislature,
our
hospital
association.
D
All
the
other
partners
I
mentioned,
and
we
have
what
we
call
our
crisis
line
commission
and
we
have
a
senator
and
a
representative
on
there
who
are
just
so
amazing
at
you
know,
asking
the
right
questions
and
getting
us
thinking
about
the
policies
that
will
change
and
shape
the
system
for
the
future
and
you're
so
instrumental
in
that
and
your
state
directors
really
want
to
work
with
you
on
that.
So
that
that's
would
be
my
advice
and
where
I
would
start.
C
And
I
would
just
add
one
thing
to
that,
and
and
is
the
importance
of
also
looking
at
some
of
the
consortiums
that
exist.
So
I
think
exactly
what
director
thomas
said,
and
then
we
also
in
our
state
have
a
behavioral
health
consortium
led
by
our
lieutenant
governor
with
representative
bence,
who
I
believe
is
one
of
the
members,
as
well
as
senator
hansen
and
senator
townsend,
and
so
they've
been
hugely
important
in
helping
us
be
able
to
get
through
some
of
these
policies
initially.
C
But
I
think
those
consortiums
make
a
big
difference,
because
they
also
have
needs
assessments
that
they've
done,
and
so
I
think
putting
that
all
together
and
for
us
we
were
able
to
look
at
our
data.
So
I
think
that
those
things
are
really
important
to
really
help
prepare
for
either
the
wave
that
you're
currently
in
or
one
that
might
be
coming
up
as
everyone
predicts
for
the
winter,
especially
around
social
determinants.
That's
going
to
be
a
huge
housing
employment
telehealth,
which
we
see
as
a
social
determinant
in
delaware
and
wi-fi
broadband
access.
A
Great,
thank
you.
Okay,
so
we're
gonna
move
into
our
pre-submitted
question
time
here
and
the
first
question
we
have
from
one
of
the
registrants
or
the
participants
today
is:
how
have
you
all
switched
to
completing
crisis
assessments
during
the
pandemic?
How
has
that
changed?
What's
it
look
like
now
versus
before,
if,
if
at
all,.
D
Sorry
I
hit
unmute,
but
obviously
I
didn't
let
go
fast
enough
for
us.
The
crisis
assessments
it
really
has
had
to
be
more
coordinated
because
of
the
pandemic,
and
we
have
our
crisis
line
and
we've
coordinated
with
the
disaster
relief
line,
and
we
have
an
emotional
relief
line
that
started
from
covid
and
then
we
have
the
emergency
rooms
and
we
have
our
mobile
crisis
outreach
teams
that
are
outreaching
steel
and
so
sometimes
those
have
been
limited
because
of
ppe
or
some
of
the
other
things
in
the
beginning.
D
Especially
now
the
ppe
isn't
as
much
of
an
issue,
so
I
would
say
that
the
crisis
evaluations
haven't
they've
they've
shifted
because
most
people
aren't
going
to
the
er
for
behavioral
health
crisis
anymore.
They
are
calling
or
they're
just
delaying,
and
so
some
of
that
is
coordinating
with
your
law
enforcement
as
well,
and
having
really
good
systems
set
up
between
your
mobile
crisis
outreach
or
your
diversion
programs
and
law
enforcement.
C
For
us
we
building
on
that,
we
we
did
continue
to
do
outreach
and
then
our
partnership.
I
I
absolutely
agree
with
the
director
with
law
enforcement
has
been
critical,
especially
after
the
incident
with
george
floyd
and
sort
of
the
concerns
around
the
police,
and
so
the
police
in
our
state.
We've
already
been
working
with
them
on
trying
to
develop
our
delaware
state
police.
With
the
attorney
general
and
lutely
governor,
we
were
working
on
a
diversion
program
for
the
whole
state,
and
so
this
just
amplified
and
accelerated
that
partnership.
C
A
Great,
thank
you.
I'm
going
to
try
to
squeeze
one
last
question
in
it.
It's
just
kind
of
like
a
yes
or
no
question
or
how
you're,
how
you're
looking
at
addressing
this
right
now,
but
are
you
looking
at
forward
to
the
long-term
effects
of
covid
on
behavioral
health?
You
know,
are
you
are
starting
to
do
data
analysis?
Are
you
collecting
data
kind
of?
Where
are
you
with
looking
forward
to
what's
going
to
happen,
post
coping.
C
C
Look
at
our
denial
data
to
make
sure
we
can
simplify
and
get
people
connected
to
care,
make
sure
that
they
have
this
resources
for
social
determinants
that
they
need
and
that
we've
been
able
to
help
communities
that
have
never
accessed
our
treatment
system
before
be
able
to
connect
to
it
much
easier,
and
I
think
one
of
the
things
is
to
really
be
prepared
for
when
you
know,
there's
a
mor
the
moratoriums
on
evictions
and
more
sort
of
some
of
the
stimulus
funding
for
employment.
That's
what
we've
been
looking
at!
C
That's
potential,
second
wave
of
despair
that
we're
very
concerned
about,
and
so
we've
been
working
to
make
sure
that
people
know
what
resources
exist,
support
our
department
of
labor
as
well
our
department
of
social
services,
so
that
they
know
how
to
connect
people
to
our
services
as
well.
When
people
are
calling
who
are
having
a
mental
health
or
substance
use
need.
D
D
Besides
just
see
the
psychiatrist
see
an
individual
therapy
person,
you
have
to
have
an
array
of
services
and
an
array
of
people
and
peer
support
is
one
of
those
huge
ones.
So
if
you
don't
have
peer
support
services
in
your
state
plan
with
medicaid
and
in
your
in
your
array
of
services,
that
would
be
a
really
good
area
to
focus
on
to
get
an
increase
in.
You
know,
touches
and
people
able
to
provide
interventions
and
then
really
you're
supporting
your
recovery
support
community.
D
So
that
people
aren't
recycling
back
through
taking
up
treatment
slots,
but
they're
staying
and
maintaining
their
gains
that
they
make
in
treatment
post-treatment
for
longer,
and
so
really
those
have
been
two
of
the
main
areas
we've
been
focused
on,
as
well
as
working
with
our
health
department
to
identify
questions
in
our
surveys
that
go
out
to
to
say
what
are
you
know
the
trends?
How
are
people
responding
and
those
surveys
will
will
hopefully
inform
us
even.
A
More
great,
thank
you
so
much
this
kind
of
ends
the
q,
a
portion
of
our
event
today.
So
thank
you
both
for
sharing
your
experiences
with
us
in
delaware
and
utah.
I
think
it's
been
really
valuable.
Just
to
get
a
flavor
of
what's
been
happening
in
in
pretty
different
states
before
everybody
leaves
today,
we
have
the
opportunity
for
you
to
earn
some
very
good
karma
points.
We
have
a
very
short
evaluation
on
your
screen,
it's
very
very
important
to
us
and
valuable
for
our
project
and
it
informs
our
our
future
activities
for
you.
A
So
thank
you
again
for
all
for
everyone
for
joining
us
today
and
another
big,
thank
you
to
our
speakers,
charlie
dr
director
romero,
director,
thomas
and
colleen,
for
running
the
show
and
another.
Thank
you
to
the
centers
for
disease
control
and
prevention
and
our
technical
monitor,
kristen
chapman.
For
supporting
this
event,
we
could
not
do
this
important
work
without
all
of
you
and
we
appreciate
the
time
you
all
have
taken
to
share
your
experiences
with
us
today
which
may
inform
legislators
and
legislative
staff
working
on
these
important
issues.