Joint Legislative Public Hearing on 2017-2018 Executive Budget Proposal: Topic "Mental Hygiene" - Testimonies

13 Senator Catharine M. Young
Chair, Senate Finance Committee
14
Assemblyman Herman D. Farrell, Jr.
15 Chair, Assembly Ways & Means Committee

16 PRESENT:

17 Senator Liz Krueger
Senate Finance Committee (RM)
18
Assemblyman Robert Oaks
19 Assembly Ways & Means Committee (RM)

20 Senator Diane Savino
Vice Chair, Senate Finance Committee
21
Senator Robert G. Ortt
22 Chair, Senate Committee on Mental Health
and Developmental Disabilities
23
Assemblywoman Aileen Gunther
24 Chair, Assembly Committee on Mental Health

1 2017-2018 Executive Budget
Mental Hygiene
2 2-6-17

3 PRESENT: (Continued)

4 Assemblywoman Linda B. Rosenthal
Chair, Assembly Committee on Alcoholism
5 and Drug Abuse

6 Senator George A. Amedore, Jr.
Chair, Senate Committee on Alcoholism
7 and Drug Abuse

8 Assemblywoman Ellen C. Jaffee

9 Senator James Tedisco

10 Assemblyman Angelo Santabarbara

11 Assemblyman Michael Cusick

12 Senator John E. Brooks

13 Assemblyman Clifford Crouch

14 Senator Todd Kaminsky

15 Assemblywoman Didi Barrett

16 Assemblyman Michael P. Kearns

17 Senator Fred Akshar

18 Assemblyman John T. McDonald III

19 Senator David Carlucci

20 Senator Patrick Gallivan

21 Assemblywoman Melissa Miller

22

1 2017-2018 Executive Budget
Mental Hygiene
2 2-6-17

3 LIST OF SPEAKERS

4 STATEMENT QUESTIONS

5 Ann Marie T. Sullivan, M.D.
Commissioner
6 NYS Office of Mental Health 9 15

7 Helene DeSanto
Acting Exec. Deputy Commissioner
8 NYS Office for People With
Developmental Disabilities 91 97
9
Arlene Gonz·lez-S·nchez
10 Commissioner
NYS Office of Alcoholism
11 and Substance Abuse Services 169 175

12 Jay Kiyonaga
Executive Deputy Director
13 NYS Justice Center for the
Protection of People with
14 Special Needs 241 249

15 Michael Seereiter
President and CEO
16 New York State Rehabilitation
Association
17 -and-
Ann M. Hardiman
18 Executive Director
NYS Association of Community
19 & Residential Agencies 289

20 Steven Kroll
Executive Director
21 NYSARC 296

22 Glenn Liebman
CEO
23 Mental Health Association
in New York State 303 314
24

1 2017-2018 Executive Budget
Mental Hygiene
2 2-6-17

3 LIST OF SPEAKERS, Continued

4 STATEMENT QUESTIONS

5 Harvey Rosenthal
Executive Director
6 NY Association of Psychiatric
Rehabilitation Services 318
7
Wendy Burch
8 Executive Director
Irene Turski
9 Government Affairs Chair
National Alliance on Mental
10 Illness of New York State 331

11 Kelly A. Hansen
Executive Director
12 NYS Conference of Local
Mental Hygiene Directors 339 350
13
John J. Coppola
14 Executive Director
NY Association of Alcoholism
15 & Substance Abuse Providers 352 364

16 Ed Snow
Statewide PEF/OPWDD Labor
17 Mgt. Committee Labor Chair
-and-
18 Virginia Davey
Statewide PEF/OMH Labor
19 Mgt. Committee Cochair
Public Employees Federation 367
20
Paige Pierce
21 CEO
Families Together in NYS 379
22

23

24

1 2017-2018 Executive Budget
Mental Hygiene
2 2-6-17

3 LIST OF SPEAKERS, Continued

4 STATEMENT QUESTIONS

5 Barbara Crosier
VP, Government Relations
6 Cerebral Palsy Associations
of New York State
7 -and-
JR Drexelius
8 Government Affairs Counsel
Developmental Disabilities
9 Alliance of Western NY
-for-
10 Coalition of Provider
Associations (COPA)
11 -and-
#bFair2DirectCare 384
12
Christy Parque
13 CEO and President
The Coalition for
14 Behavioral Health 391

15 Lisa Wickens-Alteri
President, Capital Health
16 Consulting, LLC
-on behalf of-
17 Save Our Western New York
Children's Psychiatric Center 404
18
Arnold Ackerley
19 Administrative Director
Clint Perrin
20 Director of Policy
Self-Advocacy Association
21 of New York State 410

22

23

1 2017-2018 Executive Budget
Mental Hygiene
2 2-6-17

3 LIST OF SPEAKERS, Continued

4 STATEMENT QUESTIONS

5 Stephanie M. Campbell
Policy Director
6 Friends of Recovery New York
-and-
7 Pete Volkmann
Police Chief
8 Chatham, NY
-and-
9 Kristin Hoin
Mother of Summer Smith 414
10
Patrick Curran
11 Member, Steering Committees
Eastern NY Developmental
12 Disability Advocates
(ENYDDA)
13 -and-
StateWide Advocacy Network
14 (SWAN) 427

15

1 CHAIRWOMAN YOUNG: Good afternoon.

2 CHAIRMAN FARRELL: Good afternoon.

3 CHAIRWOMAN YOUNG: I'm Senator

4 Catharine Young, and I'm chair of the Senate

5 Standing Committee on Finance.

6 I'm joined by my colleague Assemblyman

7 Denny Farrell, chair of the Ways and Means

8 Committee.

9 And we also have several colleagues on

10 the Senate side. I would like to introduce

11 Senator Rob Ortt, who is chair of the Mental

12 Hygiene and Developmental Disabilities

13 Committee in the Senate. We have Senator

14 Fred Akshar, Senator Jim Tedisco, Senator

15 John Brooks, and last but not least, my

16 colleague who is ranking member on the

17 Finance Committee, and that's Senator Liz

18 Krueger.

19 CHAIRMAN FARRELL: And we have been

20 joined by Assemblywoman Aileen Gunther,

21 Assemblyman Michael Cusick, Assemblyman

22 Angelo Santabarbara, Assemblywoman Ellen

23 Jaffee, Assemblyman Michael Kearns, and

24 Mr. Oaks.

1 Good morning -- good afternoon.

2 CHAIRWOMAN YOUNG: Thank you,

3 Mr. Chairman. We're a little bit maybe

4 off-sync today because we normally start

5 early in the morning. But it's great to be

6 here this afternoon after the Super Bowl.

7 Pursuant to the State Constitution and

8 Legislative Law, the fiscal committees of the

9 State Legislature are authorized to hold

10 hearings on the Executive Budget. Today's

11 hearing will be limited to a discussion of

12 the Governor's proposed budget for the Office

13 of Mental Health, the Office of Alcoholism

14 and Substance Abuse Services, the Office for

15 People With Developmental Disabilities, and

16 the Justice Center for the Protection of

17 People with Special Needs.

18 Following each presentation there will

19 be some time allowed for questions from the

20 chairs of the fiscal committees and other

21 legislators.

22 First of all, I'd like to welcome

23 Dr. Ann Sullivan, who is commissioner of

24 Mental Health. And following the

1 presentation by Dr. Sullivan will be Helene

2 DeSanto, executive deputy commissioner of the

3 Office for People With Developmental

4 Disabilities; the Honorable Arlene

5 Gonz·lez-S·nchez, commissioner of Alcoholism

6 and Substance Abuse Services; and Jay

7 Kiyonaga, executive deputy director of the

8 Justice Center for the Protection of People

9 with Special Needs.

10 So good afternoon, Commissioner.

11 Welcome. We look forward to your testimony.

12 COMMISSIONER SULLIVAN: Good

13 afternoon, Senator Young, Assemblyman

14 Farrell, and members of the Senate and

15 Assembly fiscal and Mental Health committees.

16 I want to thank you for the invitation to

17 explain this year's Office of Mental Health

18 budget.

19 First allow me to provide a little

20 background. As we've discussed before, the

21 Office of Mental Health seeks to expand

22 community services to provide better care to

23 more New Yorkers. The goal is based upon the

24 framework developed by the Institute of

1 Healthcare Improvement, which aims to

2 optimize health system performance.

3 ASSEMBLYWOMAN GUNTHER: Excuse me.

4 Can you pull that a little closer to your

5 face?

6 COMMISSIONER SULLIVAN: Sure. I'm

7 sorry. Is this better? It still echoes?

8 CHAIRWOMAN YOUNG: Yes.

9 COMMISSIONER SULLIVAN: The "Triple

10 Aim" framework seeks to accomplish three

11 things: Improve patient care for

12 individuals, including quality and

13 satisfaction; improve the health of

14 populations; and, through these two

15 improvements, reduce the per-capita cost of

16 healthcare.

17 For decades there were few options for

18 individuals with mental illness in the

19 community. Inpatient care was the only

20 readily available and standard option.

21 Unfortunately, it was not the best option for

22 many people. In the years since

23 institutionalization was the norm, mental

24 health care has evolved so that individuals

1 need not spend their entire lives as an

2 inpatient, but can successfully live and work

3 in their communities.

4 Through your continuing support of

5 reinvestment, our efforts to provide

6 individuals with mental illness the right

7 service at the right time in the right

8 setting have started to bear fruit. With a

9 commitment of more than $81 million thus far,

10 we have been able to provide services to more

11 than 20,000 new individuals through December

12 2016. This includes new supported housing

13 for more than 900 individuals; state-operated

14 community services, including crisis

15 residences and mobile integration teams that

16 have served an additional 6,900 individuals;

17 and a wide range of locally operated

18 community-based programs, including peer

19 crisis respite, first-episode psychosis,

20 community support teams, and Home and

21 Community-Based Waiver services for more than

22 13,000 individuals.

23 Because these community services are

24 now in place, we are able to provide

1 inpatient services when needed, and also

2 assure the necessary outpatient care and

3 supports are available when an individual is

4 discharged. Our ability to serve more

5 citizens of the state has increased through

6 the combination of these improvements to new

7 and existing services.

8 The fiscal year 2017 Executive Budget

9 priorities. Next I will move to what we plan

10 on doing this coming year. For the next

11 fiscal year, OMH will continue on this path

12 towards greater access to community-based

13 services, targeted at each individual's

14 particular needs. Importantly, the 2017-2018

15 Executive Budget proposes to:

16 (1) Continue the investment in

17 community services. The budget adds another

18 $11 million, annually, to expand capacity in

19 less-restrictive, more-integrated

20 community-based settings. This amounts to an

21 annual investment of $92 million since fiscal

22 year 2015 to expand community mental health

23 services based on OMH inpatient savings.

24 (2) Fund 280 additional supported

1 housing community beds. OMH will reconfigure

2 140 state-operated residential beds, which

3 are less integrated and more costly to

4 operate, and replace them with funds to

5 develop 280 community-based, scattered-site

6 supported housing units in the same

7 geographic area. These new units, when

8 provided in tandem with access to other

9 existing community services, will ensure the

10 continued support and care of all individuals

11 transitioning into less-restrictive settings,

12 while keeping them close to their families.

13 (3) Provide $10 million to enhance

14 support for existing residential programs.

15 The budget increases funds for supported

16 housing and single-resident-occupancy

17 programs. This investment will help preserve

18 access and maintain existing housing capacity

19 as the state brings new housing units online

20 through the Empire State Supported Housing

21 Initiative.

22 In this year's budget we continue

23 investing in the implementation of Medicaid

24 managed-care initiatives for adults and

1 children. Key accomplishments and

2 initiatives include:

3 Increased HARP enrollment. Almost

4 80,000 people are currently enrolled in

5 Health and Recovery Plans (HARPs), the

6 state's behavioral health specialty

7 managed-care product, approximately 45,000 in

8 NYC and 34,000 in the rest of the state;

9 New ACT Teams. Funding for 20 new

10 Assertive Community Treatment teams offering

11 targeted help for homeless and high-need

12 individuals in need of intensive behavioral

13 health services;

14 Managed care for youth. A commitment

15 to integrate children's behavioral health

16 services into managed care, including the

17 expansion of six new state plan services for

18 children and continued support for the

19 operation of a comprehensive Home and

20 Community-Based Services network.

21 Lastly, as I noted earlier in my

22 testimony, improving patient care and the

23 health of our population will save the state

24 money. OMH's strategy to achieve this goal

1 is through the development of targeted

2 community services to assist individuals in

3 their communities and hopefully intervene

4 with these services in order to avoid the

5 need for inpatient hospitalization.

6 For those individuals who continue to

7 occasionally need inpatient hospitalization,

8 New York State has the largest number of

9 psychiatric inpatient beds available in the

10 nation, and we will continue to preserve

11 access to inpatient care as we work to

12 transform the system.

13 Again, thank you for this opportunity

14 to address you on the 2017-2018 OMH budget,

15 which supports and continues the work we have

16 begun to transform New York's mental health

17 system. Thank you.

18 CHAIRWOMAN YOUNG: Thank you.

19 We've been joined by Senator Diane

20 Savino.

21 ASSEMBLYMAN OAKS: We've been also

22 joined by Assemblywoman Miller.

23 CHAIRWOMAN YOUNG: Thank you.

24 Our first speaker will be Senator Rob

1 Ortt, chair of the committee.

2 SENATOR ORTT: Good morning,

3 Commissioner. How are you?

4 COMMISSIONER SULLIVAN: Good

5 morning -- afternoon.

6 SENATOR ORTT: I want to thank you for

7 joining us. I certainly appreciate your

8 testimony this morning and your presumed

9 forthright answers to all the questions that

10 will be coming your way.

11 You and I have spoken significantly

12 over the past two years about the Western

13 New York Children's Psychiatric Center, and I

14 guess I wanted to start off by asking, so

15 where is that today? Where are we in the

16 process of the planned merger -- the closure

17 of Western New York Children's and the merger

18 with Buffalo Psychiatric Center?

19 COMMISSIONER SULLIVAN: At this point

20 in time, we are still continuing to work on

21 and review the plan to move Western

22 Children's to relocate to Buffalo. I think

23 you're probably aware that a bid did go out

24 for the construction for Buffalo. And those

1 bids will be received in February and

2 reviewed. So at this point in time we are

3 still in the process of continuing moving

4 towards that goal.

5 SENATOR ORTT: And you and I have had

6 back and forth discussions on this. But, you

7 know, one of the main arguments that I've

8 heard from families and from advocates in

9 both my district and across Western New York

10 is that several years ago, Western New York

11 Children's in West Seneca was created because

12 there was evidence, clinical evidence to

13 suggest that separating children from adults,

14 having them on a separate campus, having them

15 I think specifically on that campus, was much

16 more conducive to their rehabilitation and to

17 providing them the treatment and services

18 that we know we need in children's mental

19 health.

20 So I guess has something changed

21 clinically or has something shifted that

22 makes merging it with the Buffalo Psychiatric

23 Center a -- the right move from a clinical or

24 service standpoint?

1 COMMISSIONER SULLIVAN: There are many

2 models, actually, of children's psychiatric

3 services. Sometimes children's inpatient

4 services are collocated within the same

5 building as adult services, sometimes they

6 are in separate facilities, sometimes they

7 are within facilities but right next door to

8 adult services.

9 So the model has taken various forms

10 over the years. In 1968, when West Seneca

11 was established, I'm assuming a decision was

12 made that it made sense at that point in

13 time. The length of stay in those days was

14 much, much longer in children's facilities.

15 The average length of stay today is about two

16 months, which is probably just a little bit

17 longer than some of the acute-care services,

18 which is sometimes like a month's stay. And

19 they are right next to, sometimes in the very

20 same building as adult care services.

21 So the models differ. But the

22 literature today is really showing very

23 strongly that if you have the right

24 community-based services, that that's the

1 key. Because really we should only be having

2 youth in hospitals when it's absolutely

3 necessary.

4 So the plan for West Seneca in terms

5 of moving it was to enable us to put those

6 community services in place for like a

7 thousand youth.

8 I do not believe there will be any

9 diminishing of the quality of care. The same

10 clinical team will move. We will have the

11 same number of beds. The new facility is

12 designed to be separate, both separate

13 entrances, a separate recreational area for

14 youth. And I have seen facilities located

15 like that that provide excellent care. So I

16 don't think there will be any diminution in

17 care, and it enables us to invest in

18 community services.

19 SENATOR ORTT: Would you agree that

20 the data shows that the outcomes currently at

21 Western New York Children's are the best of

22 any state children's psychiatric center?

23 COMMISSIONER SULLIVAN: They have

24 great outcomes, yes, they do. We're very

1 proud of them for that.

2 SENATOR ORTT: Right. So the model --

3 it would be wrong to argue that the model in

4 West Seneca is not producing the desired

5 outcomes.

6 COMMISSIONER SULLIVAN: I think those

7 outcomes are more to do with the clinical

8 programming and the clinicians who are at

9 the -- not to say that my clinicians at other

10 sites aren't also excellent. But the

11 clinical program which has been developed

12 along -- for quite a while and has very

13 innovative approaches, I don't believe that

14 that quality will diminish in the new

15 setting.

16 SENATOR ORTT: What is the estimated

17 savings?

18 COMMISSIONER SULLIVAN: The estimated

19 savings is about $3.5 million annualized, of

20 which we've already invested about a

21 million and a half in the community services.

22 SENATOR ORTT: And what's the total

23 cost of the build-out?

24 COMMISSIONER SULLIVAN: There are

1 actually two numbers. The cost to do the

2 build-out in Buffalo will be about

3 $12.5 million.

4 SENATOR ORTT: It's never good to have

5 two numbers, just as an accounting rule.

6 COMMISSIONER SULLIVAN: No, no, I

7 meant to say there were two numbers on the --

8 for West Seneca. One is short term at

9 West Seneca, which would be probably somewhat

10 comparable, in the range of $12 million to

11 $14 million.

12 But West Seneca is a building that is

13 also -- hasn't really been refurbished in

14 basic infrastructure since -- for many, many

15 years. So there's another price tag on

16 capital, which would increase another

17 $40 million to bring it up to what it would

18 need to be if you were to stay at West Seneca

19 indefinitely. That was the one I was talking

20 about. The numbers are the -- only one

21 number for Buffalo.

22 SENATOR ORTT: Are there registered

23 sex offenders currently in BPC?

24 COMMISSIONER SULLIVAN: Yes. At the

1 time that we -- there would be no, and this

2 is an absolute commitment, there would be no

3 registered sex offenders at BPC at the time

4 we would move children. And it's about a

5 two-year -- if this goes forward, about two

6 years. So we have time to move all -- any

7 individuals who are from Buffalo. And we

8 would not ever have them again.

9 SENATOR ORTT: So it's your commitment

10 to the parents and everyone here in this room

11 that you would move those individuals --

12 COMMISSIONER SULLIVAN: Yeah,

13 absolutely. Absolutely.

14 SENATOR ORTT: Moving to, I guess,

15 broader children's health, children's mental

16 health, it's my understanding the proposed

17 savings on the children's side in the current

18 budget is because of delayed implementation

19 of Medicaid redesign proposals, is that

20 accurate?

21 COMMISSIONER SULLIVAN: Yes. Yes.

22 SENATOR ORTT: If the focus is on

23 redesign to expand capacity and access to

24 services, it's been under design, I believe,

1 for four years?

2 COMMISSIONER SULLIVAN: Yes -- I'm

3 sorry, I didn't understand --

4 SENATOR ORTT: It's been under design

5 for approximately four years, right?

6 COMMISSIONER SULLIVAN: Yes. Yes.

7 SENATOR ORTT: Now we're saying we're

8 going to have to wait another year for

9 services. Don't you think there's a need to

10 invest in some of these crisis services today

11 while we wait for the federal side to get

12 their act together?

13 COMMISSIONER SULLIVAN: Well, just to

14 explain a little bit, the commitment on the

15 part of the Department of Health and the

16 Governor to expand children's services is

17 considerable. So when the expansion happens,

18 which means when we begin the services for

19 the six new SPA amendments and other waiver

20 services, it's estimated that it will be up

21 to $30 million additional investment for SPA

22 and $30 million additional investment for

23 children's services for waiver services.

24 So that's $60 million. That's not

1 predicated on any savings, that's pure

2 expansion. So that money is still there, and

3 that money will happen.

4 However, it is also true that because

5 of a delay, largely because of some of the

6 uncertainty at the federal level, children's

7 managed care will not happen until October of

8 this year, and the SPA services until July.

9 So there is a period of time to save dollars

10 from those projected expansions.

11 And yes, those dollars have been used

12 to assist DOH in dealing with some of the

13 global cap issues.

14 SENATOR ORTT: Has OMH developed a

15 plan for how to spend the $10 million in

16 subsidies for housing?

17 COMMISSIONER SULLIVAN: Yes. Yes.

18 And that will enable us to try to bring

19 closer to the need the already existing

20 supported housing. We'll probably be adding

21 about $500 to the subsidies in downstate.

22 And for SROs, which is single-room

23 occupancies, a little over 600 upstate and a

24 little over 700 downstate.

1 This is important because to find

2 apartments now, especially in certain parts

3 of the state, is extremely difficult. Our

4 distribution of the dollars is based on HUD

5 market rate and the difference between the

6 cost of an apartment and the difference

7 between the subsidy and HUD market rate. So

8 that's how we decide where to put the money.

9 SENATOR ORTT: Commissioner, under the

10 current budget, how many state-operated

11 outpatient clinics would be closed?

12 COMMISSIONER SULLIVAN: Truthfully, I

13 don't know.

14 What we're going to be doing is

15 looking at, across the board, all the state

16 clinics. We're doing what I think every

17 other healthcare system is doing, looking at

18 our efficiency, looking at our productivity,

19 looking at if there's anywhere where there's

20 duplication of services or services could be

21 better designed.

22 So we will start that process, after

23 the budget, to look at those clinics. We

24 will decide which ones may be appropriate for

1 closing. Some may be consolidated, some may

2 be enhanced. I mean, we need to look at the

3 needs in the community. It will be a process

4 that will involve community as well as us --

5 we're not doing this without input from the

6 communities where our clinics are.

7 And even if a clinic were not all that

8 productive, if it is the only clinic there --

9 which we have in some in parts of the

10 state -- that clinic will remain. Our major

11 focus is to make sure access is preserved,

12 and we will not in any way close any clinics

13 where we have any question that access would

14 be impaired.

15 SENATOR ORTT: Thank you,

16 Commissioner.

17 CHAIRWOMAN YOUNG: Thank you.

18 Chairman Farrell.

19 CHAIRMAN FARRELL: Aileen Gunther,

20 chair.

21 ASSEMBLYWOMAN GUNTHER: The first year

22 I was chair of this committee, the Executive

23 Budget included Regional Centers of

24 Excellence, a plan to close and consolidate

1 state-operated mental health facilities. We

2 held hearings across the state and were

3 successful in negotiating compromises that

4 held for a number of years. OMH can close a

5 bed only after it has been vacant for

6 90 consecutive days. And when a bed is

7 closed, OMH will invest $110,000 per closed

8 bed into community-based services.

9 Yet now I see in the Executive

10 Briefing Book -- and this has to do with

11 Hutchings -- a proposal to transfer operation

12 of the children and youth beds from Hutchings

13 to a yet-to-be-named hospital, though we do

14 hear some rumors. To the best of my

15 knowledge, there is no information in the

16 Article VII bills and no information anywhere

17 else on the motive and the means for

18 transition, with the exception of an

19 anticipated savings of $900,000.

20 What is the impetus for this? Why is

21 this happening?

22 COMMISSIONER SULLIVAN: First of all,

23 these are very -- I have to say these are

24 still very preliminary discussions with SUNY

1 Upstate.

2 The impetus for it is that basically

3 at this point in time we have a census of

4 about 23 children that we can accommodate at

5 Syracuse. In that area of Syracuse, with the

6 work -- talking with Syracuse, Upstate

7 University, it looks like we could -- they

8 would be committed to possibly enhancing that

9 to a count of about 30 beds that would be

10 available.

11 One of the issues in that area is

12 commercial insurance, commercial insurance

13 for youth. There are no other child beds in

14 this area, and the commercial insurance has

15 always, traditionally, been very reluctant to

16 enable individuals under commercial insurance

17 to be hospitalized at state hospitals. So

18 part of the impetus for this is to expand the

19 availability of children's beds to the wider

20 community. That will not only include

21 Medicaid, but will include commercial payers.

22 Also, Upstate has a wonderful

23 reputation with children's services and I

24 think, as an academic institution, could help

1 us recruit. Recruitment is always an issue,

2 both for psychiatrists and nurses anywhere.

3 I think it will help with that as well.

4 Also, they have some very innovative

5 ideas about programming, et cetera.

6 So I think this is a move that could

7 really benefit the community and the

8 children. And it's very preliminary, and

9 that's why we're putting it out there now, so

10 people know that these are under discussion.

11 There will be no decrease in services; in

12 fact, there's a possibility of an expansion

13 of the beds.

14 ASSEMBLYWOMAN GUNTHER: So one of the

15 issues is the recruitment of registered

16 nurses because of the level of pay right now

17 and --

18 COMMISSIONER SULLIVAN: Yes.

19 ASSEMBLYWOMAN GUNTHER: And so if it's

20 SUNY or -- so that there would be an

21 increased level of pay to registered nurses,

22 and that would be more of an encouragement to

23 come and work?

24 COMMISSIONER SULLIVAN: Yes.

1 ASSEMBLYWOMAN GUNTHER: So you

2 reenvision the location of all these

3 services. Let's imagine, for the sake of

4 argument, that on Monday the operation of

5 these 30 beds is transferred to SUNY Upstate.

6 We're just using that, we're not sure yet.

7 On Tuesday, SUNY Upstate decides to close

8 these beds. It seems to me that this could

9 be the scenario. OMH has just saved itself

10 $3.3 million in community reinvestment, and

11 the community has lost access to critical

12 beds.

13 What are you doing to prevent this

14 scenario?

15 COMMISSIONER SULLIVAN: Throughout the

16 state, whenever there is an attempt or an

17 interest in closing beds, that has to come

18 before the Behavioral Health Services Council

19 and then ultimately before the Health

20 Planning Council, and there has to be --

21 there are hearings and basically there is

22 input, considerable input from OMH.

23 So we have had this issue for a

24 variety of issues. Sometimes it's a clinic,

1 sometimes it's inpatient beds. And if those

2 beds were needed, we would do everything

3 possible to keep them open, and we've been

4 successful in keeping them open against

5 pressures, at times, from voluntary

6 institutions.

7 ASSEMBLYWOMAN GUNTHER: Just on a side

8 bar, I know that, you know, as far as my

9 Assembly district, it's very, very long. And

10 we had a call from a mother who the child had

11 suicidal ideation. And we called Rockland

12 Psych; to get an inpatient, there was -- we

13 called Four Winds, we called Rockland Psych,

14 and we couldn't get that child placed.

15 So the mother, who had three other

16 children, had to sit with this child, because

17 of the suicidal prior attempt, for close

18 to -- for two to three days before she ever

19 got a bed.

20 So, you know, sometimes I'm like kind

21 of confused when I get calls like that

22 personally -- and also people know that I'm

23 the chair and I have a lot to do with mental

24 health. But there are children waiting in

1 the wings. I know, representing Sullivan

2 County, how many pediatric beds we have, I

3 know how many pediatric beds are at

4 Four Winds and the catchment areas.

5 So I think when a child has suicidal

6 ideation -- and we are recognizing those

7 diagnoses much earlier than you and I when we

8 were in a hospital situation.

9 COMMISSIONER SULLIVAN: Mm-hmm.

10 Mm-hmm. Mm-hmm.

11 ASSEMBLYWOMAN GUNTHER: So, you know,

12 sometimes it's -- I don't understand. And,

13 you know, when we talk about the outside, the

14 community -- you know, if -- and in some

15 areas, maybe New York City. But you travel

16 to the middle of upstate New York, and you

17 know what, the psychiatrists are few and far

18 between, our department of healths, our

19 community departments of health don't have

20 much money to have a psychiatrist, social

21 workers. They're few and far between. Even

22 our schools have very few.

23 And I think that the closure of

24 beds -- and sometimes when a child is in

1 crisis, they need that inpatient stay. And

2 also I think it not only educates the child,

3 but it also educates the parents on what to

4 do when you leave that facility.

5 So we're doing a lot of closures at

6 this point, and I just -- you know, I want to

7 know about the community reinvestment. I

8 know that we talk about it, but I like nuts

9 and bolts. That's what I'm all about. Like

10 exactly where is the money going, and exactly

11 how are we going to deal with the increase in

12 the diagnosis and the incidence of mental

13 health? And we all know it takes a lot of

14 years.

15 And now people are talking about a lot

16 more, but -- we have an increase, but yet

17 we're not -- we say we're increasing in the

18 community, but there's other people out there

19 that I'm not really feeling it.

20 COMMISSIONER SULLIVAN: Well, the

21 increase in services from reinvestment has

22 really been considerable. We've instituted

23 about -- an additional 250 home-based crisis

24 service waivers. So we've increased

1 home-based crisis waiver services. That's

2 the most intensive outpatient, home-based

3 services.

4 We've also opened up four respite

5 centers. We've increased mobile crisis

6 capacity for children and youth. And we've

7 increased clinic slots across the state. And

8 there's a whole breakout of exactly where

9 this has happened and where the dollars have

10 been invested.

11 If you put the right kind of community

12 services out there, it doesn't mean you need

13 an inpatient bed, by any means. But you

14 certain can decrease the number of inpatient

15 beds that are necessary, and you can often

16 reach more people in the community.

17 So these services are real, they are

18 up and running for kids. And I think we can

19 give, you know, the listing of exactly where

20 they are. That's in the report, so we can

21 show exactly where those services are.

22 And of the reinvestment dollars, at

23 this point in time $61 million is actually

24 being spent serving those additional 20,000

1 individuals, and we've allocated $69 million.

2 So the other $8 million is out there to be

3 actually implemented within the next year.

4 But these services are real and they're going

5 out.

6 And sometimes it can also take a

7 little time for the community to readjust a

8 little bit with the services and inpatient

9 beds. But yes, you're right, that when a

10 child needs an inpatient bed, it should be

11 there.

12 ASSEMBLYWOMAN GUNTHER: Really

13 quickly, we have a $5.5 million community

14 reinvestment. Where has it been invested?

15 And the other thing I wanted to know

16 is about the reduction of the OMH

17 underutilized and low-performing clinics.

18 What's happening with that?

19 COMMISSIONER SULLIVAN: Well, the

20 clinics, we haven't -- we're going to be

21 looking at all our clinics.

22 We're actually -- when we've done a

23 very brief across-the-board look, it's looked

24 like some of our clinics are underproductive.

1 So now we're going to be delving down into it

2 to be sure, and we're going to be making sure

3 that if we do any changes in the clinic

4 structure, it's to make it more efficient and

5 more accessible to our clients.

6 So nothing has been done yet. We're

7 going to begin looking at that and studying

8 that right after the budget.

9 ASSEMBLYWOMAN GUNTHER: Thank you.

10 CHAIRWOMAN YOUNG: Thank you.

11 CHAIRMAN FARRELL: Thank you.

12 CHAIRWOMAN YOUNG: Thank you,

13 Commissioner.

14 Just a few questions. So you

15 referenced -- you talked a little bit with

16 Senator Ortt and with Assemblywoman Gunther

17 about the 85 clinics, and you said you don't

18 know whether or where certain clinics would

19 be closing.

20 COMMISSIONER SULLIVAN: Right.

21 CHAIRWOMAN YOUNG: So there's this

22 administrative action proposed by the

23 Governor. But if there were clinics that

24 were deficient, underperforming in the past,

1 why weren't they dealt with, and why now this

2 wholesale approach?

3 COMMISSIONER SULLIVAN: Well,

4 actually -- it's a good question. I think

5 that we have known for a period of time that

6 perhaps our clinic system could be more

7 efficient. I think we've been preoccupied

8 with dealing with lots of other things,

9 including some of the reinvestment

10 transitions on the adult side. And so we

11 have started to look at the clinics.

12 I think that, you know, our clinic

13 system serves very complex patients and some

14 seriously mentally ill patients. But we also

15 have a wide network of community-based

16 clinics out there also that can sometimes

17 serve the same population. So we're looking

18 at it. We're looking at it at --

19 CHAIRWOMAN YOUNG: Excuse me,

20 Commissioner. Are you looking, then, to

21 shift services provided by the state to these

22 nonprofits? Is that the plan?

23 COMMISSIONER SULLIVAN: Not

24 particularly, no. There might be some areas

1 where, if we were to close or reduce the

2 clinic, we would be confident. We wouldn't

3 do that unless we were confident also that

4 there were enough services in the area. And

5 some of those services we will be looking at

6 will also be the community-based.

7 CHAIRWOMAN YOUNG: So you and I have

8 had many, many discussions about lack of

9 mental health services across the state.

10 There are places that are totally

11 underserved. There are so many people who

12 have mental health concerns who can't get

13 treatment, and they may be in an urban

14 setting, they may be in a suburban setting,

15 they may be in a rural setting. And so, you

16 know, I get a little bit concerned when I

17 think about the possibility of actually

18 losing services that are being provided right

19 now.

20 So in the event there are clinic

21 closures, what would be done to make sure

22 that there isn't any loss of access? Because

23 access is key.

24 COMMISSIONER SULLIVAN: Absolutely.

1 CHAIRWOMAN YOUNG: Actually, we need

2 to expand mental health services, in my

3 opinion.

4 COMMISSIONER SULLIVAN: We'll be

5 working with the communities where the

6 clinics are. And we'll be working with the

7 local government units, we'll be working with

8 the providers in those communities. And if

9 there's any question that we cannot close the

10 clinic or reduce the size of the clinic

11 because of access issues, we will not.

12 CHAIRWOMAN YOUNG: Okay, thank you.

13 Now, also in the Governor's proposal

14 he's looking to reduce the number of

15 state-operated residential beds by 140 and

16 replace them with 280 community-based

17 scattered-site supportive housing units. And

18 we've talked a little bit about that today

19 also.

20 But does this represent kind of a

21 future trend of shifting these state-operated

22 services into other nonprofit providers? And

23 you kind of said no, there was no plan with

24 the 85 clinics. But is there a plan with

1 this FTE reduction?

2 COMMISSIONER SULLIVAN: I think it's a

3 different issue with the housing. There have

4 been federal moves, on something called

5 Olmstead and others, that basically

6 individuals with mental illness should be in

7 the community.

8 These institutions -- I shouldn't call

9 them institutions. These residences are very

10 institution-like, so they are really not

11 embedded in the community. So for good

12 clinical reasons, it makes sense to -- if we

13 can -- move some of those beds into the

14 community so individuals can be fully

15 integrated.

16 Also, it's more economical. But it

17 also serves to really fulfill some of the

18 federal mandates to kind of be moving

19 individuals who have spent a long time on our

20 campuses in housing out in the community.

21 For the 140 beds that we will close,

22 we will be able to open up 280 supported

23 apartments with the services that individuals

24 need and really help integrate them more into

1 the community.

2 CHAIRWOMAN YOUNG: Thank you.

3 Switching gears now a little bit, the

4 Governor proposes increasing collaboration

5 between OMH and DOCCS, the Department of

6 Corrections and Community Supervision, in the

7 treatment of sex offenders. And the Governor

8 anticipates that this will result in sex

9 offenders completing treatment programs

10 before the end of their prison terms,

11 resulting -- theoretically -- in a decrease

12 in the transfer of individuals to OMH secure

13 facilities for treatment. So I have a couple

14 of questions about that.

15 First one, how does the current

16 treatment protocol for sex offenders in the

17 correctional facilities compare to the

18 treatment of these same individuals in OMH

19 facilities?

20 COMMISSIONER SULLIVAN: The basic

21 clinical structure of the kinds of groups,

22 the cognitive work, et cetera, will be the

23 same. Basically, these individuals have --

24 in the past would have waited until they were

1 leaving prison to then be examined to decide

2 whether or not they needed to go into civil

3 commitment. We're now moving, in essence,

4 the same kind of programming into the prison

5 so those individuals, if successful, may not

6 need to go to civil commitment. They are

7 still evaluated at the point that they would

8 be leaving their sentence, whether or not

9 they would need to go to civil commitment.

10 CHAIRWOMAN YOUNG: So you're saying

11 that DOCCS' treatment protocols are different

12 than OMH's right now, but you're looking --

13 COMMISSIONER SULLIVAN: No, they're

14 very similar. They will be very similar.

15 They will be very similar. There's some

16 difference --

17 CHAIRWOMAN YOUNG: They will be, but

18 you're saying they're different now?

19 COMMISSIONER SULLIVAN: No.

20 Basically, this kind of intensive treatment

21 for sex offenders is not there right now in

22 the prison system.

23 CHAIRWOMAN YOUNG: That's my question.

24 COMMISSIONER SULLIVAN: Yes.

1 CHAIRWOMAN YOUNG: So it's not there

2 at DOCCS right now, so how will it get --

3 COMMISSIONER SULLIVAN: Well, we've

4 already -- I'm sorry, it is there. We've

5 started with the special prisoner-based

6 program. That has started, and we will be

7 expanding it. But before that, it was never

8 in DOCCS. So it's been about a year and a

9 half or so. Before that, it was never in

10 DOCCS.

11 CHAIRWOMAN YOUNG: Okay. Thank you.

12 So currently there is a statutory process

13 where certain sex offenders nearing the

14 completion of their prison term are assessed

15 for risk and for mental abnormalities. And I

16 know you're very familiar with that.

17 Under the Governor's proposal, will

18 prisoners in the DOCCS system who have

19 completed their treatment program and who are

20 pending release from prison undergo an

21 assessment from OMH to determine whether

22 there's a need for referral to the New York

23 State Attorney General to seek civil

24 management?

1 COMMISSIONER SULLIVAN: Yes.

2 CHAIRWOMAN YOUNG: There will be.

3 COMMISSIONER SULLIVAN: Yes.

4 CHAIRWOMAN YOUNG: Could you expand on

5 that, please?

6 COMMISSIONER SULLIVAN: Basically,

7 they will have the same examination done as

8 they would have had had we not had that

9 program in the prison. So everyone who would

10 leave would still be examined by one of our

11 qualified psychologists and psychiatrists to

12 determine whether or not civil commitment is

13 necessary.

14 CHAIRWOMAN YOUNG: Okay, thank you.

15 And finally, I wanted to ask about

16 telehealth -- and as you know, I've been very

17 involved in bringing telehealth services

18 across the state -- but expanding it into

19 telepsychiatry, because, as we spoke about

20 earlier, it is so crucial to get more

21 services into the communities for people with

22 mental health concerns.

23 Could you tell me about what's going

24 on at the agency right now?

1 COMMISSIONER SULLIVAN: Yes. Thank

2 you so much for your support for this. It's

3 really wonderful, and we're very excited and

4 engaged in expanding telepsychiatry across

5 the state. We have reviewed the regs so now

6 telepsychiatry can be billed in multiple

7 settings through Medicaid.

8 Basically, our clinics, we have

9 several clinics in -- OMH clinics in the

10 rural areas where we are doing telehealth.

11 There are several -- through DSRIP, we have a

12 number of emergency rooms who are taking on

13 telehealth, so that basically individuals can

14 be examined remotely in the emergency rooms,

15 helping to make decisions about admission or

16 discharge.

17 We have looked at the -- we are

18 looking at telehealth for nursing homes, to

19 be able to kind of do evaluations.

20 So I think we're looking for

21 telepsychiatry in just about every area that

22 it could be utilized. The science shows that

23 it is just as effective as having

24 face-to-face interviews, especially for

1 consultations and evaluations. And we are

2 also looking at it for ongoing treatment. In

3 certain clinics we're beginning to pilot so

4 that telepsychiatry can be a psychiatrist who

5 would continue to see, through

6 telepsychiatry, a client on an ongoing basis.

7 So we're very excited about expanding

8 telepsychiatry across the state.

9 CHAIRWOMAN YOUNG: Great. And so I

10 have partners in the Assembly who are very

11 interested in expanding telepsychiatry. So

12 we do have legislation, but we'll be talking

13 to you about that in the future.

14 COMMISSIONER SULLIVAN: Great. Thank

15 you.

16 CHAIRWOMAN YOUNG: And I do want to,

17 finally, associate myself with the strong

18 support that was displayed by Senator Ortt in

19 keeping services constant, the way they are,

20 at the Western New York Children's Center. I

21 think that is such an important issue. And

22 you've been in discussion with us now for a

23 couple of years about it, but our position

24 hasn't changed. And we believe very strongly

1 that things should not change in the manner

2 that -- moving it to the BPC. And I just

3 want to reaffirm that.

4 So thank you very much.

5 COMMISSIONER SULLIVAN: Thank you.

6 CHAIRMAN FARRELL: Thank you.

7 We've been joined by Mr. McDonald.

8 Next, Mr. Kearns.

9 Oh, and Didi Barrett is here. I'm

10 sorry, there she is.

11 CHAIRWOMAN YOUNG: And, Mr. Chairman,

12 I'd like to point out -- I just noticed that

13 we've been joined by Senator David Carlucci.

14 ASSEMBLYMAN KEARNS: Thank you,

15 Mr. Chairman, for giving me this opportunity

16 today.

17 Thank you, Commissioner. I'll be

18 brief with my remarks.

19 As you know, we've been talking about

20 the Western New York Children's Psychiatric

21 Center for over three years. And I want to

22 thank the chairman of our Assembly committee

23 for coming out to Buffalo and doing an

24 excellent job in meeting with the parents and

1 advocates.

2 Recently, I sent out a survey and

3 within three weeks, I've received 1200

4 responses. And what I can't understand is

5 why we are doing this. Why are we trying to

6 fix something that isn't broken? The

7 community, the professionals, going back to

8 1965, the New York State Planning Committee

9 stated that the units for children should be

10 separated from the mainstream of adult

11 patients in separate buildings or cottages.

12 But my question is this. One of the

13 things that they're concerned about,

14 especially the families, is the safety of the

15 children going into these facilities. So if

16 you could just answer this one question:

17 Right now, how many adults convicted of

18 sexual assault are housed at the Buffalo

19 Psychiatric Center, as we move those children

20 and close down that facility in West Seneca,

21 which has been rated one of the top

22 facilities in the state, the lowest

23 reinstitutionalization rate?

24 The Western New York delegation -- why

1 are we doing that? And if you can answer

2 that question, currently today, right now,

3 how many convicted sexual predators are

4 within that facility?

5 COMMISSIONER SULLIVAN: Right now

6 there is one sexual predator -- one person

7 convicted of sexual -- inpatient in Buffalo

8 Psychiatric.

9 ASSEMBLYMAN KEARNS: Were any moved

10 prior this year? How many were there this

11 year? Were any --

12 COMMISSIONER SULLIVAN: I believe we

13 had four. So we have moved three.

14 ASSEMBLYMAN KEARNS: And will any be

15 able to have access to that facility, even on

16 an outpatient basis?

17 COMMISSIONER SULLIVAN: Yes. There

18 are some -- I think there are four on an

19 outpatient basis. And basically our

20 commitment, and I truly -- this is an

21 absolute commitment -- is that none of those

22 individuals will be there in the event that

23 we move West Seneca to Buffalo.

24 ASSEMBLYMAN KEARNS: I just want to go

1 on the record and I want to thank the

2 chairman for giving me this latitude of

3 speaking on this issue on behalf of the

4 Western New York community, on behalf of the

5 families.

6 I could read testimony after testimony

7 of people that don't want this facility

8 closed. You know that. I just think it's an

9 abomination. I had an opportunity to ask the

10 Governor himself. And my final question is,

11 have you asked the Governor -- is the

12 Governor aware that this facility is going to

13 be closing?

14 COMMISSIONER SULLIVAN: The Governor's

15 office has been briefed about this. And I am

16 charged with bringing to the Governor -- to

17 discuss all your concerns that have been

18 stated over the various periods of time. So

19 I will be discussing those concerns, and they

20 will be reviewed with the Governor's office.

21 ASSEMBLYMAN KEARNS: The Governor

22 himself?

23 COMMISSIONER SULLIVAN: With the

24 Governor's office.

1 ASSEMBLYMAN KEARNS: The Governor

2 himself?

3 COMMISSIONER SULLIVAN: It's my

4 understanding, when I hear from the

5 Governor's office, that that is my -- that's

6 the place I speak to. So with the Governor's

7 office.

8 ASSEMBLYMAN KEARNS: Well, thank you,

9 Mr. Chairman, for that, for giving me that

10 time.

11 I just want to leave you with this,

12 and I hope you remember. There's a road

13 going into that facility called Hope Way.

14 And when the kids leave, after leaving, they

15 leave their handprints on the wall and they

16 leave encouragement for future people. Just

17 think of that as we go forward and we discuss

18 this issue.

19 COMMISSIONER SULLIVAN: Thank you.

20 ASSEMBLYMAN KEARNS: Thank you.

21 Thank you, Mr. Chairman.

22 COMMISSIONER SULLIVAN: And I do

23 appreciate your concerns. But just to state

24 one more time, that our goal here is to

1 really serve even more individuals in Western

2 New York. A thousand additional families

3 could be served. I just wanted to just

4 emphasize that. Thank you.

5 CHAIRWOMAN YOUNG: Thank you.

6 Senator Akshar.

7 SENATOR AKSHAR: Commissioner,

8 welcome. It's always good to be in your

9 company. Welcome today.

10 I want to bring you to the Southern

11 Tier; specifically, to the Greater Binghamton

12 Children and Youth Services. The last time

13 we spoke, you said there were no plans to

14 reduce the amount of bed space. And I see in

15 the Executive's proposal this year, in 2017,

16 there's a plan to reduce the bed space by

17 three.

18 Can you just explain to me what has

19 changed, so I can properly represent your

20 position, and the Governor's, to the

21 constituency that I serve?

22 COMMISSIONER SULLIVAN: Thank you.

23 Basically, whenever we've reduced

24 beds -- and that includes the beds in

1 Binghamton -- it's by our agreement with the

2 Legislature, that those beds have been vacant

3 for 90 days. I think when we were there, we

4 didn't have any beds that were vacant for

5 90 days. When those beds do become vacant

6 for that period of time, we do close the

7 beds.

8 But we're doing it very gradually. If

9 we should notice that at some point we needed

10 to reexpand those beds, we would. But at

11 this point in time, we have not had to expand

12 or replace those beds. They've been staying

13 vacant. So there was a difference at that

14 point.

15 SENATOR AKSHAR: So currently the need

16 is not there?

17 COMMISSIONER SULLIVAN: Currently the

18 need is not there, yes. Thank you.

19 SENATOR AKSHAR: You made a reference

20 a few minutes ago to in making decisions you

21 look at the economics of it, right, in making

22 those decisions. And from a macro

23 perspective, help me understand when we're

24 talking about savings and reinvestment, in

1 your mind, the savings that we find, are we

2 properly reinvesting those dollars into the

3 system?

4 Because clearly there is a need to

5 provide mental health services throughout

6 this great state. And I would respectfully

7 offer, to something Senator Young said a few

8 minutes ago, we need more of it. So in your

9 mind, are we properly reinvesting those

10 dollars?

11 COMMISSIONER SULLIVAN: Yes, I think

12 we are. And we're not doing it in isolation.

13 All the reinvestment planning has been done

14 with the local communities and with the LGUs

15 in those areas. So, for example, a lot of

16 the reinvestment has gone towards supported

17 housing, which individuals who are leaving

18 the psych centers, that decreases the need

19 for beds because our patients don't have to

20 wait as long in the psych center to get the

21 housing.

22 We've also opened up, for children,

23 respite beds. For adults, we've also done a

24 lot of mobile crisis work. When you have a

1 mobile crisis team or a mobile integration

2 team that wraps services around an

3 individual, that can avoid admissions, and

4 avoid admissions both to the state but also

5 to the voluntary hospitals. So it really

6 enables us to enable those beds to close

7 because we have the right services, including

8 clinic services, which have expanded also in

9 some areas.

10 But those crisis mobile integration

11 teams and the ability to have the right

12 housing for individuals has made a

13 significant difference in our ability to have

14 less inpatient beds. Individuals who are

15 better can now leave sooner and get into

16 apartments and have the services they need

17 wrapped around them and not get readmitted.

18 SENATOR AKSHAR: So the reinvestment

19 in terms of the services is from a global

20 perspective --

21 COMMISSIONER SULLIVAN: Yes, it is.

22 SENATOR AKSHAR: -- it's ensuring that

23 we're paying the staff the appropriate amount

24 of money so they can continue to work and

1 provide the service that the people need, and

2 that the beds are there and the facilities

3 are there.

4 COMMISSIONER SULLIVAN: Yes. Yes.

5 SENATOR AKSHAR: Thank you,

6 Commissioner.

7 CHAIRWOMAN YOUNG: Thank you, Senator.

8 CHAIRMAN FARRELL: Didi Barrett.

9 CHAIRWOMAN YOUNG: Before that, I

10 would like to announce that we've been joined

11 by Senator Todd Kaminsky.

12 Thank you.

13 ASSEMBLYWOMAN BARRETT: Hello. As you

14 probably know, I have in my district the

15 Hudson Correctional Facility, which is now

16 the younger facility for 17-year-olds and

17 18-year-olds.

18 I'm wondering -- we had a visit

19 recently there. I was pretty alarmed to see

20 that they have a solitary program there

21 which -- in fact, the young man that was in

22 solitary had come directly from a psych

23 facility. I'm wondering how much you're

24 working with that population or intend to be

1 working with that population to make sure

2 that mental health services are a significant

3 and robust part of that program.

4 COMMISSIONER SULLIVAN: We are working

5 very closely to make sure that the right

6 mental health services are there and to

7 evaluate the needs of the individuals that

8 are there, and to hopefully have the use of

9 solitary as little as possible.

10 I think that we had received funding

11 and planning and we're continuing to look at

12 what kind of innovative services we could put

13 there to really make a difference in the

14 lives of these youth. So yes, we are looking

15 at it very closely, and we will continue.

16 It's still a relatively new program, but we

17 are invested in these youth because it's a

18 critical point in their lives.

19 ASSEMBLYWOMAN BARRETT: And it's sort

20 of hard to imagine that anybody who's dealing

21 with emotional issues and isn't an

22 adolescent, basically, which is what they

23 are, it would be appropriate for them to be

24 in solitary. Do you have a position on that?

1 Have you --

2 COMMISSIONER SULLIVAN: You know, I

3 think the use of solitary is really something

4 that the Department of Corrections is very --

5 we have not taken an absolute position. But

6 clearly, we would want to keep as many

7 individuals out of that environment as

8 possible.

9 ASSEMBLYWOMAN BARRETT: Well,

10 especially when you're focusing on a program

11 that's addressing youth, and youth in this

12 stage. And, I mean, mainstream, normal,

13 healthy, if there's such a thing as --

14 adolescents, you know, act in a lot of

15 impulsive ways. So it just was astonishing

16 to me to see that going on there. And I

17 would encourage you to sort of be as active

18 and engaged in that facility and making sure

19 that that is used as little as possible.

20 COMMISSIONER SULLIVAN: Yes, we will.

21 Thank you.

22 ASSEMBLYWOMAN BARRETT: Thank you.

23 CHAIRWOMAN YOUNG: Thank you.

24 Senator Brooks.

1 SENATOR JACOBS: Commissioner, could

2 you address any initiatives in the plan that

3 you have as far as veterans who are in need

4 of mental health services?

5 COMMISSIONER SULLIVAN: Yes. You

6 know, throughout our system, actually, our

7 entire clinic system across the state, we

8 serve about 20,000 veterans in various pieces

9 of our service system.

10 But we also do a lot of training of

11 clinicians, because working with veterans

12 requires a special skill set. So the

13 department has done a lot of training with

14 staff across the state to work on that.

15 And then we have also begun to have

16 some of our housing dedicated to veterans

17 with serious mental illness. And I was just

18 at a lovely opening on Long Island for

19 housing really specially earmarked for

20 veterans with serious mental illness.

21 And also, in our research institutes,

22 we are continuing to do work on how to spread

23 good practices for the treatment of PTSD.

24 So I think we are trying to do a great

1 deal for veterans. I think you can always do

2 more. But we do have them involved in many

3 ways in our system of care.

4 SENATOR BROOKS: Okay, thank you.

5 CHAIRMAN FARRELL: Assemblywoman

6 Jaffee.

7 ASSEMBLYWOMAN JAFFEE: Thank you,

8 Commissioner.

9 A question in general. One of the

10 things that I hear on a regular basis in the

11 community is lack of psychologists, access to

12 counseling, social workers that provide

13 assistance in terms of mental health. And

14 this is a major issue for our communities.

15 And for instance, I was approached

16 regarding the mental health issues for a

17 kindergarten child. And in Rockland

18 County -- and I understand this is in

19 general, throughout the state, there are

20 areas -- there was not one psychologist that

21 could respond to the needs of that child. We

22 had to reach out into New York City to see if

23 we could find some staff, somebody who could

24 respond and assist the family and the child.

1 This is a very serious issue

2 throughout the state, not just in Rockland

3 County, because I've reached out to inquire.

4 Can we put forward some initiative, some

5 effort to encourage our youth to move into

6 that area of psychology, encourage our SUNY

7 schools to provide that kind of training?

8 Can we put together a financial initiative to

9 be able to encourage them to move forward in

10 those areas, perhaps, you know, beyond their

11 college degree to a master's or a Ph.D.?

12 We need to provide that support for

13 our children and our communities, our

14 families. So I just wanted to raise that as

15 a really major issue.

16 COMMISSIONER SULLIVAN: Thank you very

17 much. I think the workforce issue is

18 critical in mental health. And it has -- I

19 obviously agree with you that we don't have

20 enough individuals going into the training

21 and then coming out of the training. So I

22 obviously agree with you, I think we will be

23 very happy to kind of consider workforce.

24 You know, we recently, with one of our

1 state psych centers, are working with Mercy

2 College to have some of their students kind

3 of rotate through our services. So, for

4 example, a social worker might then pick

5 mental health versus something else that a

6 social worker could be involved with. And I

7 think we have to do much, much more of that.

8 We have to expose students to the wonderful

9 work that you can do in mental health. Often

10 they don't even get to see it, and so they

11 choose other things.

12 So I absolutely agree with you. I

13 think it's a critical workforce issue and

14 something that the whole nation is facing.

15 And I think working with the universities is

16 very important, and we'll be glad to work on

17 that.

18 ASSEMBLYWOMAN JAFFEE: So maybe we can

19 work together and get this moving forward. I

20 will reach out.

21 COMMISSIONER SULLIVAN: Yes, that

22 would be terrific. Because I do think

23 it's -- and incentives, I think, do help. So

24 we should talk, we should work and see what

1 we can do. That would be terrific. Thank

2 you.

3 ASSEMBLYWOMAN JAFFEE: Okay, thank

4 you.

5 CHAIRWOMAN YOUNG: Thank you very

6 much.

7 We've been joined by Senator Patrick

8 Gallivan. And just so every Senator knows

9 what the order is, next is Senator Kaminsky,

10 then Senator Carlucci, and then Senator

11 Gallivan.

12 So Senator Kaminsky.

13 SENATOR KAMINSKY: Thank you. I

14 really want to echo Assemblywoman Jaffee's

15 comments on workforce development. For me,

16 it's a real priority. When you talk to

17 hospitals, they can't find providers. And it

18 really adds to the whole atmosphere of mental

19 health kind of being put in on the back

20 burner constantly in terms of how it's

21 treated all over.

22 And I heard a really great story on

23 the radio about how the State of Oregon has

24 an incentive program where it doesn't -- you

1 know, in other words, I heard your comments

2 before about workforce development and was

3 encouraged, but I think we need to put a

4 little muscle into it. And what Oregon does

5 is it has an incentive program where it will

6 pay for your education if you are committed

7 to doing certain work in the mental health

8 field for a certain period of time for a

9 municipality or another governmental entity.

10 And I think it makes a lot of sense to

11 encourage people to go into fields where we

12 need them to go. And we hear all the time

13 from professionals in the field who say, Why

14 is this the only area where it's better to be

15 on Medicaid than have commercial insurance?

16 And why is this the only area where you can't

17 find a mental health provider?

18 And I think, you know, wanting to

19 expose students is nice, and we should

20 certainly do that. But I think we're going

21 to have to put a little money where our mouth

22 is here and I think that helping develop some

23 type of incentive program might be a way to

24 go. At least studying what another state has

1 I think is a thing that we should do.

2 And like Assemblywoman Jaffee, I

3 certainly stand ready to help in any way I

4 can, because I think it's a huge void that

5 I'd love to help fill.

6 COMMISSIONER SULLIVAN: Yes, I

7 absolutely agree.

8 And I also think, on the commercial

9 side, there is an issue of payment too. So I

10 think people are not that interested

11 sometimes in going into a field where

12 sometimes the commercial rates and the

13 payment are not what might really entice

14 people to do this kind of work.

15 Just as example, in our clinic system

16 Medicaid pays better than commercial payers

17 in our clinic system. So there has been this

18 disparity in mental health, not just in terms

19 of parity for service, but parity for payment

20 for decades. Centuries, perhaps. And I

21 think that has to be looked at. Because it's

22 enticing people to come into a field. We

23 want to get them excited and do the work, but

24 we also have to, especially sometimes on the

1 commercial side, think about payment that is

2 kind of on par with what you would get for

3 other specialties.

4 SENATOR KAMINSKY: Sure. And whether

5 it's the financial issues or insurance issues

6 or other issues, I would like to suggest that

7 you think about coming up with a task force

8 on how to come up with ideas on this. I know

9 that we would certainly like to be a part of

10 it. I'm sure it would be a good bipartisan

11 way to start thinking about this. Because I

12 think having a commission put forth some

13 serious recommendations is necessary soon,

14 and I hope I can work with you on that.

15 COMMISSIONER SULLIVAN: Mm-hmm. Thank

16 you.

17 SENATOR KAMINSKY: Thank you.

18 CHAIRWOMAN YOUNG: Thank you, Senator.

19 CHAIRMAN FARRELL: Assemblyman

20 McDonald.

21 ASSEMBLYMAN McDONALD: Commissioner,

22 good to see you.

23 Thank you, Mr. Chairman.

24 I guess where I want to go with this

1 question -- I think it's budget related, to a

2 degree. Obviously there's a lot of

3 facilities, a lot of psychiatrists that are

4 employed in many of the programs that you

5 run. And at the same token, when I listen to

6 families, when I listen to patients, there

7 seems to be a challenge in regards to

8 patients being able to access a

9 psychiatrist -- particularly in the Medicaid

10 population, but I think it could be across

11 most disciplines or most insurance options.

12 So I guess my question, are you having

13 a hard time attracting psychiatrists to

14 practice in the facilities that the agency

15 runs?

16 COMMISSIONER SULLIVAN: You know,

17 across the country, actually, there is

18 difficulty in recruiting and training

19 psychiatrists. This has probably gotten

20 worse in the last 10 years than it was that I

21 recall, going back, partly I think because

22 there has been some increased awareness of

23 the need for psychiatrists, but also -- so

24 the shortage has gotten worse.

1 In our hospitals and in our clinics,

2 we have had difficulty sometimes recruiting

3 and retaining psychiatrists. One thing which

4 we are very happy about, and we think will

5 begin to bear fruit, is that we now have a

6 loan repayment program for psychiatrists that

7 if they stay with us for five years, they

8 will get a significant amount of dollars

9 towards their loans from medical school,

10 which are quite high.

11 So we had just started that last year,

12 and we're beginning to get some bites from

13 psychiatrists interested in working with us,

14 to join us. I think that those are the kinds

15 of incentives that can sometimes work to help

16 get psychiatrists into the system.

17 That, and also we are working very

18 hard on just trying to make sure that

19 psychiatrists understand what the public

20 sector is. It's not something that they

21 often have experience with when they're

22 training, so it's not their first thought

23 about a job. So we're doing that. But also,

24 I think, the loan repayment plan, which we've

1 put in the budget, I think will be very

2 helpful.

3 ASSEMBLYMAN McDONALD: You know, one

4 of the concerns I have is -- and I practice

5 healthcare on a daily basis still. I see a

6 lot of pediatricians, I see some primary care

7 practitioners really probably practicing at

8 the uppermost limit, if not maybe over what

9 their experience has been.

10 And are there any programs or

11 protocols to help those providers get that

12 additional support? Because I can tell you

13 candidly, some of these medications are not

14 to be prescribed indiscriminately, they are

15 very precise, they're very particular, they

16 need a lot of monitoring and following up.

17 And I'm just -- I'm concerned, primarily, for

18 those primary care practitioners.

19 And listen, this is not a rant against

20 psychiatrists. It's a thankless job. They

21 do a wonderful job. But it takes time, a lot

22 of time. And what are we doing to support

23 our community providers that are out there?

24 COMMISSIONER SULLIVAN: You know, one

1 of the biggest shortages is child

2 psychiatrists.

3 And something that we have had now for

4 probably about three years, and we're

5 expanding, is something called Project Teach.

6 And Project Teach is open, free -- we pay for

7 it. It's any pediatrician across the state

8 can call for a consultation with a

9 psychiatrist.

10 The psychiatrist hubs -- and we're

11 using telepsychiatry for this -- the

12 psychiatrist hubs are located at usually

13 multiple universities across the state. All

14 the pediatrician has to do is say they want

15 to be involved. We offer a little training,

16 but just as much training as they want to

17 have. We'll train them a lot or a little.

18 But they can call and get a

19 consultation with that psychiatrist and talk

20 about, you know, the child that they're

21 seeing and what the recommendations are.

22 It's been great. We have about 3500

23 pediatricians now; we're planning on doubling

24 that. And we have been serving -- oh, over

1 10,000 families is our goal, to go up, to

2 keep increasing.

3 It was a model actually in

4 Massachusetts that we kind of stole but has

5 been very successful in spreading the

6 expertise of child psychiatrists especially.

7 A similar model is something we're

8 thinking of to help primary care adult

9 practices too. We haven't put that in place

10 yet, but we're thinking about that. And

11 we've been talking with some DSRIPs about

12 maybe considering that. Because again, it's

13 a very successful model in terms of providing

14 the expertise and spreading across a wide

15 group of practitioners.

16 ASSEMBLYMAN McDONALD: One final

17 question; I know my time is short.

18 You know, another key component of the

19 overall provision of mental health services

20 is psychologists. And myself, I've been

21 advocating looking at allowing psychologists

22 who have received additional high-level

23 training to have prescriptive authority on a

24 close formulary of medications. My intent

1 being there's a lot of unmet need. There's

2 also a greater recognition that there are

3 mental health concerns that are not being

4 treated. And we're at least getting over

5 that stigma, thanks to a lot of the work that

6 your agency has done, and many others.

7 Does the agency have a position on

8 giving prescriptive authority to certificated

9 psychologists for a limited scope?

10 COMMISSIONER SULLIVAN: No, we don't

11 have a position on that at this time.

12 ASSEMBLYMAN McDONALD: Okay. Thank

13 you.

14 CHAIRWOMAN YOUNG: Thank you.

15 Senator Carlucci.

16 SENATOR CARLUCCI: Thank you, Chair.

17 And thank you, Commissioner, for being

18 with us here today and answering our

19 questions.

20 As you know, New York State has had a

21 strong commitment towards research and

22 finding ways to improve the quality of life

23 of people living with mental illness. Could

24 you give us a brief status on the state of

1 research with OMH, and particularly how that

2 relates with the agency in general, but also

3 particularly to the Nathan Kline Institute?

4 COMMISSIONER SULLIVAN: Yeah, we have

5 actually two institutes. One is the

6 Psychiatric Institute at Columbia, in the

7 city, and then the Nathan Kline Institute in

8 Rockland.

9 And I think it's a -- I'm extremely

10 proud of this, and I think New York State

11 should be. We are one of the states that has

12 continued these institutes and supports these

13 institutes so that they can do the important

14 work of behavioral health research.

15 Nathan Kline, while not quite as large

16 as Columbia, has gotten some of the most

17 highest-rated grants and is in a position to

18 right now be doing tremendous work relative

19 to geriatrics, to cultural competency.

20 They're also doing some work on -- working

21 with communities about setting up the

22 appropriate services in communities.

23 So they do basic community work, but

24 then they also do some laboratory work to

1 look at things like what are the basic causes

2 of things like depression and schizophrenia.

3 Similarly at Columbia, which is one of the

4 highest-grant-funded institutions in the

5 nation for mental health.

6 And so between both our Psychiatric

7 Institute and Nathan Kline, I think we

8 provide more in terms of psychiatric research

9 than any other -- than large groups,

10 including even some of the big universities

11 you hear of across the country.

12 So we're very proud of it, and it's a

13 mixture of basic science, applied work. One

14 of the things our research institutes do is a

15 Center for Practice Innovations, and they

16 have come up with a whole host of curricula

17 which we spread out to best practices to all

18 our clinics and across the state, best

19 practice innovations.

20 So really our institutes are terrific,

21 and I think that we have, thanks to the

22 Governor, have been able to continue to

23 support those efforts.

24 SENATOR CARLUCCI: So we would agree

1 that money invested in research, we see that

2 proliferate as other grants are added to

3 that. Is there any move in this budget to

4 increase investment to our institutes?

5 COMMISSIONER SULLIVAN: There's

6 nothing in this budget that increases. But

7 there's nothing in this budget that decreases

8 either. So I think that the commitment is

9 strong.

10 And you're absolutely right, for every

11 dollar that we invest, there's about anywhere

12 from $5 to $6 in grants that is built upon

13 that dollar that we invest. And our

14 institutions have been great in doing that.

15 SENATOR CARLUCCI: So if you were to

16 invest -- increase aid to our institutes and

17 to research in general, where would you

18 prioritize?

19 COMMISSIONER SULLIVAN: That's a

20 difficult question, because there's so many

21 needs. I think that there's a lot of work

22 going on now in imaging, there's a lot of

23 work going on in cultural competency, there's

24 a lot of work going in community-based

1 services, and in even some genetics, on the

2 genome, looking at a certain markers.

3 So it's very wide. And I would have

4 to actually pull together my research people

5 and say what's your -- you know, what do you

6 think is the most important.

7 SENATOR CARLUCCI: Thank you,

8 Commissioner.

9 CHAIRWOMAN YOUNG: Thank you.

10 CHAIRMAN FARRELL: Assemblywoman

11 Gunther.

12 ASSEMBLYWOMAN GUNTHER: I'd like to

13 talk about the COLA and the lack thereof.

14 So it's been a decade since the state

15 has committed to a COLA in the budget outside

16 the 0.2 percent last year. And, you know,

17 when we talk about adequate care and we talk

18 about a living wage, I just -- this was also,

19 they generated -- it was generated in the

20 Legislature.

21 So what are your plans to increase the

22 salary for people working in non-for-profits

23 in the OMH community?

24 COMMISSIONER SULLIVAN: Well, first, I

1 think -- I just have to say that I do think

2 that the Governor's commitment to the minimum

3 wage is extraordinary, and millions of

4 dollars are being invested in that. Some of

5 those dollars will be coming to mental

6 health, I think it's about $3.5 million, to

7 support the minimum wage.

8 At this point in time, there is

9 nothing in the budget for the

10 not-for-profits --

11 ASSEMBLYWOMAN GUNTHER: I just want to

12 interrupt. Is that for like the

13 non-for-profits, the minimum wage?

14 COMMISSIONER SULLIVAN: Yes, that will

15 include --

16 ASSEMBLYWOMAN GUNTHER: When will that

17 be coming?

18 COMMISSIONER SULLIVAN: There's about

19 $3 million in the budget to support the

20 minimum wage uptick for this year, in this

21 budget.

22 But your other question about more

23 than that, there isn't anything in the budget

24 that would address the COLA. The COLA is not

1 in the budget this year.

2 ASSEMBLYWOMAN GUNTHER: The other

3 thing I wanted to talk about, stigma. Last

4 year we had the tax checkoff. And how much

5 money did we accumulate, and what are we

6 doing with it?

7 COMMISSIONER SULLIVAN: There was

8 about $75,000 that came in from the tax

9 checkoff. And we got a group of stakeholders

10 together to decide what to do, and I think

11 we'll be sending out very shortly an RFP for

12 a little -- what the stakeholders decided was

13 to do 15 small grants of $5,000 each that

14 would go to individuals to work on stigma,

15 whether it was education or working with

16 families, working with institutions. But to

17 work on stigma.

18 So small grants. We're looking for

19 innovative proposals. And if some of those

20 small grants look like they are successful,

21 then perhaps next year, when perhaps we'll

22 have more money that will come in -- we would

23 love to get more -- those could be expanded.

24 But that's the plan for the dollars at this

1 point. And that should be starting very,

2 very soon.

3 ASSEMBLYWOMAN GUNTHER: I misspoke a

4 little bit when I said minimum wage. There's

5 a compression issue. And there's also -- to

6 pay a DSP what we consider minimum wage, to

7 keep those folks in this profession -- what

8 I'm talking about is additional, beyond and

9 above that. Because this is truly not a

10 minimum wage job.

11 And what are we really doing to keep

12 these professionals in the profession? I

13 think that's what's really important here. I

14 misspoke. Because I know that, you know,

15 we're doing it in increments in upstate

16 New York. But we're talking about a group of

17 non-for-profits that really have been starved

18 over the years.

19 And keeping somebody in the DSP

20 profession, and then you add in the Justice

21 Center with it, it's really, really

22 difficult. It really, really is, you know,

23 in OPWDD and in OMH. But right now, you

24 know, I think that, you know, minimum wage is

1 just not going to make it. You know, in

2 order for people to take care of people in

3 facilities and so forth, and in the

4 community, you know, we need to invest more

5 money in that.

6 COMMISSIONER SULLIVAN: You know,

7 there isn't anything in the budget in this

8 year that would address that, an addition to

9 the minimum wage. I think that the

10 Legislature -- this is an important issue,

11 and I think that the Executive will be, as it

12 always does, working with the Legislature on

13 the issues that they feel are important over

14 the course of the budget negotiations.

15 ASSEMBLYWOMAN GUNTHER: Can we use any

16 of the DSRIP money for this?

17 COMMISSIONER SULLIVAN: Oh, that's

18 something that I think you would have to talk

19 to the Department of Health about. The DSRIP

20 dollars are really within the Department of

21 Health.

22 ASSEMBLYWOMAN GUNTHER: Have you

23 suggested it, just because it's so important

24 to this field?

1 COMMISSIONER SULLIVAN: I have not,

2 no.

3 ASSEMBLYWOMAN GUNTHER: Thank you.

4 CHAIRWOMAN YOUNG: Thank you.

5 Senator Gallivan.

6 SENATOR GALLIVAN: Thank you.

7 Good afternoon, Commissioner.

8 I'd like to talk about, as you can

9 imagine, the Western New York Children's

10 Psychiatric Center. I apologize that I

11 wasn't here for all of your testimony, but I

12 was at a hearing on the issue of raising the

13 age of criminal responsibility in New York

14 State.

15 Among the proposals, the Governor's

16 proposal, is -- the Governor's proposal deals

17 with a couple of different things:

18 Programming, certainly the courts, Family

19 Court jurisdiction. It also deals with

20 housing. And one of the biggest things that

21 the Governor has called for and that people

22 have testified to is to remove 16- and

23 17-year-olds from adult prisons. Not just

24 separating them by sight and sound in the

1 same facility or the same campus, but

2 physically getting them into a different

3 building, into a different structure, and

4 away from the adults.

5 And as you know, I of course disagree

6 with the decision to close the facility and

7 merge it with the Buffalo Psychiatric Center.

8 But for the life of me, I just can't

9 understand on one hand how the Governor can

10 be calling to get convicted criminals out of

11 prisons at 16 and 17 years old and give these

12 juveniles their own facility, and at the same

13 time close the West Seneca Children's

14 Psychiatric Center, where we have kids that

15 are among the most troubled in the state, we

16 have a facility -- the professionals there

17 are among the best in the state, if not the

18 country. By the various metrics where you

19 measure their success, they perform extremely

20 well, if not among the best in the state --

21 and we're putting them back in an institution

22 that they were removed from 40 years ago

23 because the experts at the time said that

24 they should be separated.

1 I am just -- I am completely troubled

2 by it. I still have yet to hear any clinical

3 reason for it to take place. And nobody has

4 been able to present that these kids would be

5 better off in that adult setting.

6 We have conducted a number of

7 hearings, as you know. And of course I

8 attended the forums that you put on to hear

9 input from people. Many stood up and made a

10 plea or an appeal to you to keep it open.

11 But I've heard from children and

12 former patients, families, parents, the

13 professionals that work there, various mental

14 health professionals and organizations,

15 members of the community, and every single

16 member of the Western New York legislative

17 delegation who is opposed to this. And I

18 just don't understand how this can be done

19 when there's so many opposed and there is no

20 clinical reason for this.

21 COMMISSIONER SULLIVAN: I appreciate

22 the --

23 SENATOR GALLIVAN: That is not a

24 question. I understand --

1 COMMISSIONER SULLIVAN: I know, I

2 know. And I certainly --

3 SENATOR GALLIVAN: But please comment.

4 COMMISSIONER SULLIVAN: -- I

5 appreciate it.

6 The goal here is really to enable a

7 system of care, to enable Mental Health to

8 provide the services that a community needs.

9 In terms of the quality of care, I do

10 not believe there will be any difference in

11 the quality of care -- I know we disagree on

12 this -- in relocating from West Seneca to

13 Buffalo. I think that the plans that we

14 have, the clinical staff, the way it is

15 designed, which is extremely youth-friendly,

16 will provide the same great outcomes that

17 West Seneca has always had.

18 Why do it then? We'll do it because

19 by doing it, we are enabling over $3 million,

20 $3.5 million in investment in community

21 services in that area which are desperately

22 needed.

23 I think when you look at healthcare,

24 this is something that is happening in

1 healthcare across the country. People are

2 trying to design systems of care that can

3 make those precious healthcare dollars reach

4 as many people as possible while still

5 providing quality care. That's why we're

6 doing it. I know we disagree, but that's why

7 we're doing it.

8 SENATOR GALLIVAN: I understand.

9 What if we are able to find sufficient

10 funding to cover that?

11 COMMISSIONER SULLIVAN: I think the

12 issue here is spending the dollars well. I

13 mean, I always like extra funding for things,

14 I'm not saying not. But it doesn't make

15 sense to me to not be using dollars in a way

16 that can provide the best service to the

17 widest group of patients and to really serve

18 the community.

19 SENATOR GALLIVAN: I have to respect

20 the rules of timeliness here, so I'm at the

21 end of my time.

22 I do want to say, though, that I do

23 appreciate that you've always been positive

24 in getting back to our office and dealing

1 with any of the questions that come up, even

2 though we continue to -- or I continue to

3 disagree about this issue and we'll still

4 continue to work through the budget process

5 to reverse the decision.

6 Thank you.

7 COMMISSIONER SULLIVAN: Thank you.

8 Thank you.

9 CHAIRWOMAN YOUNG: Thank you.

10 Chairman?

11 CHAIRMAN FARRELL: Assemblyman

12 Santabarbara, to close.

13 ASSEMBLYMAN SANTABARBARA: Okay, thank

14 you.

15 I just want to talk a little bit about

16 stigma. We all know there's a tremendous

17 delay, sometimes as much 10 years, between

18 the onset of symptoms and people actually

19 seeking treatment. And we hear that it's one

20 of the biggest factors in this delay.

21 Two years ago we passed a tax checkoff

22 box for mental health stigma. And are there

23 plans now to utilize this resource to combat

24 stigma? And what other actions is OMH taking

1 to encourage people to actually get the

2 treatment?

3 COMMISSIONER SULLIVAN: The tax

4 checkoff was about $75,000. We're hopeful

5 this year there will be more. And the plan

6 is to send out 15 small $5,000 grants to an

7 RFP for either local providers, some of our

8 peer groups, some of our individuals to come

9 with a proposal so that we can seed an

10 anti-stigma approach. And then, based on

11 some success with that, we may be able to use

12 money that would come with the anti-stigma

13 checkoff this year to enhance those programs.

14 So we're really very excited about

15 this. We decided to do this with a group of

16 stakeholders which included some providers,

17 included clients and recipients, included

18 families, as to how best to use the $75,000.

19 On the issue of stigma, you're

20 absolutely right, it's a huge issue. I

21 think, my experience -- I've been in this

22 field a long time -- it's getting better, but

23 it's nowhere at all where it needs to be.

24 People are still afraid of seeking services.

1 One of the key things that we are

2 doing, though, with individuals -- you're

3 absolutely right about this lag in time of

4 getting treatment. And that lag is

5 particularly onerous for individuals who are

6 diagnosed with schizophrenia. So we have

7 something called the first-episode psychosis

8 program in the state, which we are growing

9 across the state. So that when someone has

10 that very first episode -- because usually

11 they have the first episode and then they get

12 lost for exactly the time period you're

13 talking about -- to engage the family and the

14 client to keep them in school, to keep them

15 working, not to get lost to the system and

16 lose their community supports, which is what

17 has unfortunately happened.

18 So right now we have that in 13 sites

19 across the state. We're going to continue to

20 expand it, hopefully to be able to reach

21 everyone who has that first experience of a

22 psychotic episode, so that they can get the

23 kind of services they need to get into

24 treatment early and continue their lives and

1 not get separated, which is a very critical

2 issue.

3 ASSEMBLYMAN SANTABARBARA: Thank you.

4 Just moving back to the workforce, the

5 state workforce, according to the stats that

6 I'm looking at here, 35 percent of OMH

7 employees are working overtime. So just

8 curious how you're addressing this while also

9 eliminating 353 FTEs.

10 COMMISSIONER SULLIVAN: Basically,

11 we're lowering 353, but it would have been

12 453. So 100 are being retained to basically

13 try to deal with the overtime issue.

14 Overtime is complicated. One of the

15 issues is an increasingly acute number of

16 patients that are coming into our hospitals,

17 a lot of one-to-one observations, as we call

18 it. We need to redesign what we do in terms

19 of clinical care so that that may not be as

20 necessary, although you always have to order

21 it if you need it.

22 The other is hiring time. There's a

23 number of Lean projects that the state has

24 taken on to get people on-boarded quicker.

1 Overtime becomes a real issue if you're not

2 really quickly replacing one individual after

3 the other. And we're also working closely

4 with Civil Service about having exams in

5 perhaps a more timely manner so that we can

6 begin to fill positions quicker.

7 So -- and the other is working with

8 some staff -- I think about 10 percent of

9 staff are out sometimes on leave because of

10 injuries in the workplace. It's all very

11 high in healthcare, higher in psychiatric

12 care. And we're doing a lot of work with

13 teamwork and other things to reduce that so

14 there will be less happening so people won't

15 be out on leave.

16 So there's a number of initiatives,

17 and 100 coming back.

18 ASSEMBLYMAN SANTABARBARA: And just

19 sticking to that topic, so you see a need --

20 is there a need to increase salaries? And

21 what are the stats on the retention, keeping

22 employees?

23 COMMISSIONER SULLIVAN: I think

24 it's -- salaries are very volatile in the

1 mental health field right now, whether it's

2 for nurse practitioners or psychiatrists or

3 nurses. Whenever you have staff shortages,

4 salaries go up, kind of supply and demand.

5 So we are looking into multiple pieces

6 of the puzzle as to where we may need to look

7 at salary increases.

8 CHAIRMAN FARRELL: Thank you.

9 ASSEMBLYMAN SANTABARBARA: Okay.

10 CHAIRWOMAN YOUNG: Thank you,

11 Commissioner. That concludes our questioning

12 today. So we truly appreciate your

13 participation, and I'm sure we'll be talking

14 with you very shortly. So thank you so much.

15 COMMISSIONER SULLIVAN: Thank you very

16 much.

17 CHAIRMAN FARRELL: Thank you.

18 CHAIRWOMAN YOUNG: Our next speaker is

19 Helene DeSanto, acting executive deputy

20 commissioner of the New York State Office for

21 People with Developmental Disabilities.

22 Thank you. Welcome. We look forward

23 to hearing what you have to say.

24 ACTING EXEC. DEP. CMR. DeSANTO:

1 Thank you. Good afternoon, Senator Young,

2 Senator Savino, Assemblyman Farrell, Senator

3 Ortt, Assemblywoman Gunther, and other

4 distinguished members of the Legislature. I

5 am Helene DeSanto, acting executive deputy

6 commissioner for the New York State Office

7 for People with Developmental Disabilities,

8 OPWDD.

9 Thank you for the opportunity to

10 provide testimony about Governor Cuomo's

11 2017-2018 Executive Budget proposal and how

12 it will benefit the more than 136,000

13 New Yorkers with intellectual and

14 developmental disabilities who are eligible

15 for OPWDD services.

16 Under the Governor's leadership, OPWDD

17 continues to make significant strides in the

18 transformation to a more integrated,

19 person-centered system of services and

20 supports for the people we serve. This year,

21 the Executive Budget proposes $4.3 billion in

22 state funding -- $7.3 billion including

23 federal funds -- to support integrated,

24 community-based services and OPWDD's

1 oversight of state and not-for-profit

2 providers.

3 OPWDD's ongoing systemwide

4 transformation is informed by an

5 unprecedented level of engagement over the

6 past two years with individuals, families,

7 our nonprofit provider partners, and you, our

8 partners in the Legislature. This feedback

9 has led to significant new investments in the

10 2017-2018 Executive Budget.

11 This year's budget proposes

12 significant new investments in integrated

13 OPWDD services, including $120 million in

14 all-shares funding to expand services for new

15 and currently eligible individuals;

16 $27 million in all-shares funding to support

17 provider agencies' compliance with new

18 minimum wage standards, $24 million in new

19 funding to support people's transition from

20 developmental centers to appropriate

21 community-based settings, $15 million in

22 capital funding to expand affordable housing

23 opportunities for OPWDD-eligible people, and

24 a $21 million investment in expansion of

1 OPWDD's successful START program, our crisis

2 response, intervention and treatment program.

3 In addition, as part of OPWDD's

4 ongoing transition to managed care, the

5 budget provides for OPWDD to access

6 Department of Health resources to cover the

7 administrative costs associated with managed

8 care. OPWDD is committed to reinvesting any

9 savings that are realized from its transition

10 to managed care back into services for people

11 with developmental disabilities.

12 New York funds and operates the

13 nation's largest residential support system

14 for individuals with intellectual and

15 developmental disabilities -- a $5.1 billion

16 annual investment. More than 37,000

17 New Yorkers currently live in OPWDD-certified

18 housing, such as group homes, and another

19 4,200 are eligible for rental vouchers that

20 assist them to live independently within

21 their communities.

22 Still, the need to expand residential

23 opportunities for the people we serve is a

24 major focus for OPWDD. Many families remain

1 concerned that there won't be an available

2 housing opportunity when their loved one

3 needs one. With the Governor's support,

4 OPWDD has developed a multiyear housing

5 strategy designed to meet the identified

6 demand.

7 In the next three years, OPWDD

8 anticipates that approximately 4,900

9 individuals currently living at home may

10 require a certified residential opportunity

11 and another 1,400 will seek more independent

12 living arrangements than rental subsidies and

13 other uncertified options can provide. OPWDD

14 will meet this demand using a mixture of

15 existing and newly developed opportunities

16 which will be accessed based on a

17 person-centered process.

18 OPWDD will also participate in the

19 Governor's $20 billion affordable and

20 supportive housing plan and, as mentioned

21 previously, access $15 million in capital

22 funds to help develop independent housing

23 opportunities in communities throughout the

24 state.

1 Before taking your questions, I would

2 like to acknowledge the concerns related to

3 the people who are the foundation of our

4 service system for New Yorkers with

5 intellectual and developmental disabilities,

6 our direct support professionals. We are

7 engaged in regular and ongoing dialogue with

8 our provider partners on solutions to address

9 their workforce concerns.

10 While the budget includes $27 million

11 in state and federal funding to support

12 increases in the minimum wage for direct

13 support professionals, we recognize the need

14 to continue our focus on efforts that will

15 address recruitment and retention of a highly

16 qualified and stable direct support

17 workforce.

18 Thank you for your continuing support

19 and advocacy. We look forward to working

20 with you, our partners in the Legislature,

21 and all of our stakeholders to achieve real

22 and lasting systemwide transformation on

23 behalf of our friends, neighbors and loved

24 ones with intellectual and developmental

1 disabilities.

2 I welcome your questions.

3 CHAIRWOMAN YOUNG: Thank you,

4 Ms. DeSanto. And I do have a few questions.

5 My background is -- I worked at an

6 agency for people with disabilities for many

7 years before I ran for state office, and this

8 whole issue of managed care has me concerned

9 because it's so undefined right now. And you

10 only referenced it in passing in your

11 testimony. And we've tried managed care

12 many, many times over the past many years in

13 the state, and it's never worked.

14 So the Executive proposes to

15 transition all the developmental disabilities

16 population over to managed care within the

17 next five years, and it would start with the

18 development of regional care coordination

19 organizations which would initiate enhanced

20 coordination of care, according to what we've

21 heard so far. And after you develop these

22 organizations, the Governor would transition

23 to a fully capitated rate structure for

24 reimbursement and for voluntary enrollment, I

1 believe, which would start in 2019.

2 But those were the only details that

3 we have on the entire plan, so can you

4 provide more specifics as to how you would

5 impose managed care for habilitative services

6 that people with developmental disabilities

7 require? Because as you know, there are many

8 people out there that are vulnerable

9 citizens. They depend on getting the

10 services that they currently have. And so

11 how would you handle this?

12 ACTING EXEC. DEP. CMR. DeSANTO: Thank

13 you. So we are looking at a variety of

14 strategies and working with our provider

15 community to really ensure that we put

16 together a good plan to transform the system

17 and to move to managed care for the

18 population that we support. And as you

19 referenced, the plan would begin with

20 voluntary enrollments in 2019. So we have a

21 couple of years where we really are working

22 with our provider community and moving toward

23 a care coordination approach, which is a

24 central aspect of a managed care system.

1 CHAIRWOMAN YOUNG: So it's voluntary

2 to start. Would it become mandatory at a

3 certain point?

4 ACTING EXEC. DEP. CMR. DeSANTO: At a

5 certain point it would, over a five-year

6 period beginning in 2019.

7 CHAIRWOMAN YOUNG: So it's voluntary

8 to start for what length of time?

9 ACTING EXEC. DEP. CMR. DeSANTO: It is

10 voluntary to start for -- I want to say it's

11 two years, and then it begins to go into a

12 mandatory approach after that.

13 And it would be rolled out in

14 geographic parts of the state. Where we have

15 greater readiness, probably downstate, we

16 would begin earlier than moving upstate, is

17 the thinking currently.

18 I think what I just want to mention is

19 that what we really see as the benefit of

20 moving to managed care is the flexibility

21 that it will offer us, which is a greater

22 degree of flexibility in our service system.

23 It's where we've been trying to move our

24 services in a transformational approach, and

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1 it certainly holds the promise of some

2 savings that might accrue that would enable

3 us to do further investment in some needed

4 services.

5 So I think that that's kind of the

6 big-picture view of it.

7 We do have a small demonstration

8 project in New York City right now that has

9 been operating for about a year now, and so

10 we have some ways in which we are looking at

11 how best to make the transition and sort of

12 learning from some experience there.

13 CHAIRWOMAN YOUNG: Okay. Thank you.

14 And I'm sure we'll be talking about this as

15 time goes on.

16 You referenced the direct care

17 workers, and we've been very concerned about

18 the minimum wage increase and the fact that

19 there's now a gap with, for example, fast

20 food workers and direct care workers. And

21 you reference a little bit about the

22 recruitment issues. But working, especially

23 with people with severe disabilities, is a

24 very, very, very difficult job. And if you

101

1 could choose between flipping burgers at

2 McDonald's or having to change diapers or

3 maybe taking care of someone who may act out,

4 may bite you, may hit you, whatever it is,

5 most people would probably choose working at

6 a fast food restaurant.

7 So it's always been difficult to

8 recruit direct care workers. I think it's

9 becoming impossible to be able to recruit

10 them, and I wanted to get your thoughts about

11 it, because the Governor includes

12 $14.9 million in state funds, $27.4 million

13 gross, to fund the cost of not-for-profit

14 providers under OPWDD impacted by the

15 scheduled increase in the minimum wage. But

16 as I said, providers are no longer able to

17 offer a better wage than other businesses,

18 and providers are really concerned.

19 I've been hearing about this -- in

20 fact, my office just sent me a resolution

21 that was passed by the board of an ARC in my

22 district, and I just got that this morning.

23 So the Governor's created a situation where

24 the developmental disability providers may

102

1 have a tougher time -- they are having a

2 tougher time in recruiting staff.

3 And, you know, one of my concerns also

4 has to do with the fact that quality of care

5 can be compromised if we don't have the right

6 staff members on board. So how are we going

7 to address this? Because I don't see that

8 it's really being addressed right now.

9 ACTING EXEC. DEP. CMR. DeSANTO: So

10 first I want to reiterate, I think, a point

11 that you made which acknowledges the fact

12 that we have very strong support from the

13 Governor, with the $27 million investment

14 this year to make sure that our providers can

15 meet the minimum-wage standard. And I know

16 that that was certainly a great interest to

17 our providers as minimum wage was rolling

18 out.

19 However, we know that that's not, you

20 know, perhaps going to solve all of the

21 issues around recruitment and retention for

22 this workforce. And you're correct, I mean

23 it's a very -- you know, it's a very

24 demanding job, and it is -- the very

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1 foundation of the services that we provide is

2 built upon that direct support workforce, day

3 in and day out.

4 So we have been working with our

5 providers to really look at what kinds of

6 issues they are having with recruitment and

7 retention. We have had a working group

8 established to look at things such as

9 compensation. But, in addition, things that

10 also contribute to workforce satisfaction in

11 our field that have to do with the training

12 that they receive, the career ladders that

13 are available within human services agencies,

14 and some of the things that really, I think,

15 are unique and distinguish the job of direct

16 support in our field compared to maybe some

17 of the other entry-level jobs that you were

18 referencing.

19 So we're looking at a whole variety of

20 factors. And we are, you know, certainly

21 more than willing to work with you during

22 this budget process to see if there are more

23 things that really should be done.

24 CHAIRWOMAN YOUNG: I appreciate that

104

1 answer very much, Ms. DeSanto, but I -- you

2 know, and it's good to look at the entire

3 picture, but unless you can pay somebody a

4 good wage, they're just not going to be that

5 interested in that job. Because you know

6 what, they have to support their families

7 too. And I know you understand that, so

8 thank you.

9 CHAIRMAN FARRELL: Finished?

10 Assemblywoman Gunther.

11 ASSEMBLYWOMAN GUNTHER: Okay, we talk

12 a lot today about percentage changes,

13 millions of dollars here, thousands of

14 dollars there, service cuts, rates and bed

15 values. We also talk in many acronyms --

16 dSRIP, APG, CCO. All this is really talking

17 about people, vulnerable people who need our

18 support to live their lives to the fullest.

19 We are talking about people who take

20 care of those people, their families,

21 friends, and direct support professionals who

22 dedicate, and I repeat dedicate, their lives

23 to providing critical, invaluable care.

24 Why was the $45 million that was

105

1 requested to address the minimum-wage issue

2 and compression issue not included in this

3 budget?

4 ACTING EXEC. DEP. CMR. DeSANTO: Well,

5 what I would say is --

6 ASSEMBLYWOMAN GUNTHER: Remember, I

7 have to say that it's hard, it's hard for

8 me -- you know, I grew up in middle-class

9 America. And when I look at the number

10 $159 billion, and then I look at $45 million

11 to support people that otherwise are going

12 to -- they'll quit their profession.

13 You know, they're trying really hard.

14 And the other side of that equation is most

15 of them are women, and many of them are

16 single women. Many of those are women with

17 children that are also -- could be single --

18 working not one but two jobs. And then you

19 layer on top of it the Justice Center, the

20 Justice Center, and the intimidation that

21 people feel.

22 You know, they have love for their

23 consumers, but they need to feed their

24 family. And so $45 million in terms of

106

1 $159 billion -- I'm not an accountant or a

2 mathematician, but I know it's like spitting

3 into the ocean.

4 ACTING EXEC. DEP. CMR. DeSANTO: So,

5 you know, what I would reiterate again is

6 there certainly is a good amount of dollars

7 that are devoted to the direct support

8 workforce in this budget, as well as a lot of

9 other important initiatives. And I agree

10 with you that, you know, it certainly is an

11 area that needs consideration and focus. But

12 within the limited availability of dollars

13 and the big picture, I think that the budget

14 was not, as it was constructed, did not

15 include the dollars that you're referencing.

16 So at this point I think we can

17 continue to discuss and work together as the

18 budget process goes forward to see if there

19 is, you know, a way to address those

20 concerns.

21 ASSEMBLYWOMAN GUNTHER: You know, we

22 have discussed it over the years. It's been

23 every not-for-profit that I can think of has

24 come in and discussed this issue with so many

107

1 people, have pleaded for these increases.

2 And I think that again, we're talking

3 about a very vulnerable population. You

4 know, I have -- I know one agency, a

5 not-for-profit that talks a lot about our

6 disabled community that's being cared for for

7 much, much more money and out of state.

8 And the fact is, why aren't we looking

9 to save money bringing those people from out

10 of state? And we know where these agencies

11 are, that they're paying probably 40 percent

12 more to send them to out of -- and we do have

13 what we need in New York State to care for

14 these folks. But once we place somebody

15 there, they seem to stay there forever.

16 And I'm saying that we could save

17 money, and it would be better for a family to

18 have your loved one here. But there are ways

19 to save money.

20 But right now, the DSP, there are a

21 lot of professionals, a lot of them go to a

22 lot of classes, they really do. And tie in

23 the fact that the Justice Center comes in and

24 there's an allegation, and then they decide

108

1 what level of allegation it is. And what

2 happens is there's an investigation. The

3 performance improvement person starts the

4 investigation, they send it up to Albany, to

5 the Justice Center -- sometimes people are

6 out six to nine months without any kind of

7 resolution to the issue, and a lot of the

8 times not guilty.

9 And, you know, between that and not

10 giving these not-for-profits -- they're going

11 to go broke. And I think that it should be a

12 priority in the State of New York to make

13 this happen.

14 ACTING EXEC. DEP. CMR. DeSANTO: Thank

15 you.

16 ASSEMBLYWOMAN GUNTHER: That's it, eh?

17 I know. Okay, thank you.

18 CHAIRWOMAN YOUNG: Thank you.

19 Senator Ortt.

20 SENATOR ORTT: Good afternoon. At the

21 risk of beating a dead horse, I'm going to

22 beat a dead horse. Is it OPWDD's contention

23 that DSPs deserve to only make the minimum

24 wage?

109

1 ACTING EXEC. DEP. CMR. DeSANTO: Well,

2 I would say certainly not. We certainly are

3 happy that we are able to bring all of the

4 employees to minimum wage who are not

5 currently there. I think you may know,

6 Senator, that there is a good percentage of

7 the direct support workforce that are already

8 above minimum wage, which is a great thing.

9 But we certainly recognize the type of

10 work that the direct support professionals

11 do. We have had cost-of-living increases

12 over the years because we've recognized, you

13 know, the importance --

14 SENATOR ORTT: Do you know when the

15 last one was?

16 ACTING EXEC. DEP. CMR. DeSANTO: Yes,

17 it was -- actually, the last one was 2015.

18 And there was one the year before that, 2014,

19 both of those being 2 percent. And there was

20 a small cost-of-living adjustment last year,

21 which was based on the CPI, which I think you

22 probably may --

23 SENATOR ORTT: 0.2.

24 ACTING EXEC. DEP. CMR. DeSANTO: --

110

1 recall. Yes, that's correct.

2 So, you know, what I would say to you

3 is no, we would certainly never suggest that

4 our direct support professionals don't

5 provide a very valued service. That really,

6 you know, we would want to do everything we

7 can to ensure that we have adequate

8 recruitment and certainly retention of our

9 workforce.

10 SENATOR ORTT: I'm sure it's not lost

11 upon you or the folks at OPWDD that what

12 we're really talking about, though, here

13 today isn't just the DSPs. We're talking

14 about the people that they service. Because

15 when the wages are low and you've created --

16 because we created a more urgent situation.

17 This was already a problem with recruitment

18 and retention, but now through the state's

19 action last year, and the fact that the

20 Governor was very eager to be out there in

21 front for minimum-wage workers -- and it

22 sends a priority, or it's a signal that the

23 priority certainly is not within this group.

24 And I think that if you listen to the

111

1 speakers who are going to be coming after you

2 who have been in this field for years -- much

3 longer than I've been serving in the Senate,

4 maybe longer than you've been in your current

5 position -- they will tell you that the

6 feeling within the developmental disability

7 community amongst families, amongst workers,

8 non-for-profits, is that quite frankly this

9 administration simply does not prioritize

10 this area.

11 And you can look at the funding. You

12 termed "strong support," $27 million. That's

13 certainly your description. There is not one

14 speaker coming later this afternoon that

15 would term that as strong support. They

16 would look at it as no support, because they

17 would say that the COLA has been deferred,

18 there is no cost -- the $45 million they're

19 looking for. And ultimately, you can't

20 recruit these people.

21 What happens is you get probably a

22 subpar, I'll just say it, a lower-quality

23 worker. It's like any other job or any other

24 industry. You know, someone's going to fill

112

1 the job, but they may not be as good as the

2 people that were trying. And these are

3 people who are working with people's

4 children, very vulnerable people, as you

5 know.

6 So I think when you hear these

7 questions and you hear the concerns, it's not

8 just because -- it's not just the workers,

9 although we want them to have a livable wage,

10 but the good ones, you know, the reality is

11 they're going to go -- they're going to find

12 that wage somewhere. They'll leave this

13 field, they'll go to Burger King, they'll go

14 to Wendy's, they'll go somewhere. They'll go

15 work for a school district.

16 But the person who can't go anywhere

17 is the individual who they're servicing.

18 See, they're stuck. So they need that person

19 to earn a livable wage, so they can continue

20 to provide the service and the care they

21 need.

22 So you're certainly free to comment,

23 but I think that that's a very important

24 point.

113

1 ACTING EXEC. DEP. CMR. DeSANTO: Yeah,

2 I mean, certainly we realize that ultimately

3 it is all about being able to support the

4 people that are reliant on our services. And

5 we know that it's a field where the very

6 health and safety of individuals, day in and

7 day out, rests with our direct support

8 professionals. So there's no question about

9 the valuable role that that workforce plays.

10 And I have to say to you, Senator,

11 that we do talk with providers, parents, and

12 many stakeholders that carry the very message

13 that you are speaking about. So we are

14 acutely aware of it. We certainly also have

15 a lot of service needs that are very well

16 resourced in this budget for which we're very

17 grateful, and we get the support of the

18 Legislature again and again, year after year,

19 for a lot of the service dollars that we do

20 need.

21 So I think we have to continue to work

22 together on this issue and really look to see

23 what can be done that might be able to

24 address the kinds of concerns that you're

114

1 referencing.

2 SENATOR ORTT: I have two more

3 questions -- three more, I guess.

4 According to your report by

5 Comptroller DiNapoli, OPWDD lost 4,341 state

6 employees, or 17.5 percent of its workforce,

7 between 2007 and 2015. How has this

8 reduction affected overtime within the

9 office?

10 ACTING EXEC. DEP. CMR. DeSANTO: Okay.

11 So in the time period that you reference,

12 there was a great deal of progress made in

13 reducing our institutional population, and a

14 lot of the workforce reduction that you

15 reference had to do with being consistent

16 with the loss of services that were provided

17 on our campuses and the move, of course, to

18 more community-based settings, which was a

19 goal certainly of OPWDD and continues to be.

20 During the last year, I'm very happy

21 to say, we have seen a reduction in our

22 overtime hours of 13 percent. So what you

23 will see in the coming reports from the

24 Comptroller will show that we've had a lot of

115

1 success in overtime reduction just in the

2 last year. And we've achieved that by

3 focusing on a number of areas.

4 One of them is getting employees in

5 the door, as we have ongoing vacancies, more

6 quickly, being more efficient in the hiring

7 process for our state direct support

8 workforce. We've also worked to reduce times

9 that people are on leave, because, you know,

10 people on leave obviously results in overtime

11 and takes away from days on the job.

12 And so with those strategies we've

13 been quite successful in seeing overtime

14 reduction. And, you know, we do monitor it

15 very carefully, pay period by pay period, and

16 we look to see also that people are not

17 working extreme schedules. So we also have

18 seen a reduction, and a good reduction, in

19 the amount of overtime hours that any one

20 particular employee might be working within a

21 pay period. And that's also an area where

22 we've seen some success.

23 So we'd love to continue to have

24 conversations with you throughout the year to

116

1 kind of show you the tracking that we're

2 doing and the success that we're having.

3 SENATOR ORTT: The reason I'm asking

4 is because the proposed budget calls for

5 elimination of an additional 253 FTEs. I

6 mean, one would have to believe that that's

7 going to increase overtime costs on current

8 employees. And I guess my question is, why

9 eliminate these positions instead of maybe

10 utilizing them to reduce overtime instead?

11 ACTING EXEC. DEP. CMR. DeSANTO: Yes,

12 well, the positions that you reference are

13 directly related to a decreased census in

14 certain locations in the state.

15 And whenever we have an institution

16 that closes or other downsizing, I'm very

17 pleased to say that we work with the

18 unions -- and we have not had certainly any

19 layoffs, as I'm sure you know -- but we also

20 work very hard to keep people in jobs right

21 in the geographic location where they

22 currently work. So, for instance, for people

23 who were working in a location where an

24 institution may close, they would go into

117

1 work in locations in the community of that

2 same facility.

3 But the reductions that you reference

4 are related to workload, if you want to say

5 reductions in services that are

6 state-operated in those areas.

7 SENATOR ORTT: The last and -- I have

8 to be respectful of our time as well -- my

9 last question at the current time is

10 regarding respite, which I have no doubt

11 you're familiar with, and respite rates.

12 So there is a gap, if you talk to

13 folks at the ground level, between respite

14 that's authorized and respite that's

15 utilized. Because the rates in many cases

16 simply do not -- you know, providers are

17 losing money on respite and, ergo, they're

18 not offering it.

19 For many families, respite is a

20 lifeline without in-home supports or without

21 placement options. And so I hear from family

22 member after family member, We need more

23 respite, we need actual respite that's

24 offered in the area.

118

1 We need to look at respite

2 utilization, which -- there is that gap. Can

3 you explain the gap or speak to the gap and

4 tell me what OPWDD is looking at to offer

5 more respite? Because I really think this

6 would do a huge -- it would perform a huge

7 function to reduce that tension on the

8 placement side if you had respite, which

9 would be the community support.

10 ACTING EXEC. DEP. CMR. DeSANTO: Yes,

11 and that's absolutely correct, Senator. You

12 may recall that when we did our report a year

13 ago, now, in February on the residential

14 request list, that was one of the very

15 significant findings.

16 We had families who were on that

17 request list -- that you all I think are

18 aware of -- tell us that if they had

19 available to them more respite opportunities,

20 they would not necessarily be looking to have

21 their family member move, at least not yet.

22 And we have done a lot of work in the last

23 year, really, looking at respite -- the fees

24 that providers are paid, and doing some work

119

1 in that area to better define some of the

2 respite services and to work on the different

3 respite payments.

4 And that's a work in progress. We

5 actually have been working with all of our

6 providers to gather information. We have

7 another webinar with our respite providers

8 later this week. At that, we'll talk with

9 them some more about the different ways that

10 we're working to fund the amounts of payment

11 that providers receive, particularly for

12 individuals who have high needs.

13 We're trying to recognize within our

14 rates a better approach to meeting high

15 needs, because as you might imagine, a family

16 with a family member at home who has these

17 high needs, they're particularly needy in the

18 area of having respite. We are looking at

19 ways in which we can ensure that people

20 receive the respite services that they're

21 authorized for and receive them in a more

22 efficient and timely manner. So we're doing

23 a number of things in that area as well.

24 SENATOR ORTT: Thank you.

120

1 ACTING EXEC. DEP. CMR. DeSANTO:

2 You're welcome.

3 CHAIRWOMAN YOUNG: Thank you.

4 CHAIRMAN FARRELL: Thank you.

5 Assemblyman Crouch.

6 ASSEMBLYMAN CROUCH: Thank you.

7 What's the status of the workshops at

8 this point in time? The Governor proposed

9 eliminating the sheltered workshops back in,

10 I think, 2013, and the doors were shut as far

11 as any new intake. What's the status at this

12 time?

13 ACTING EXEC. DEP. CMR. DeSANTO: So

14 the status of the workshops is that we have

15 been working over the past year and a half

16 with providers to go more toward an

17 integrated business model, and providers are

18 working on plans. We have actually received,

19 from most of our 80 workshop providers, plans

20 for them to go forward with the transitions

21 that we discussed.

22 And you may know that providers do

23 have a period of years to make that

24 transition, so it is until the year 2020 that

121

1 providers would have to make those

2 transitions happen.

3 We have done an awful lot of work with

4 our workshop providers. We do get good

5 feedback that our providers of workshop

6 services are, you know, moving along toward

7 the types of services that we had been

8 planning with them, and actually we get some

9 very good family, individuals, stakeholder

10 feedback as well at this point.

11 So I think we're well along the way to

12 the point where we were originally discussing

13 with our goal for the workshop programs.

14 ASSEMBLYMAN CROUCH: So will they

15 ultimately close, then? Or this business

16 plan will salvage the workshops?

17 ACTING EXEC. DEP. CMR. DeSANTO: It

18 will ultimately transition the types of

19 services that are offered there to make them

20 more integrated, and we also have come up

21 with some different services within our

22 system that will ensure that people who are

23 there in the workshop will be able to

24 continue to receive the types of day-to-day

122

1 supports that they were interested in.

2 So I think we did a lot of work, given

3 all the input that we received from members

4 of the Legislature and our stakeholders, to

5 really get to a place that I think people are

6 satisfied with in terms of the transition.

7 ASSEMBLYMAN CROUCH: Is there intake

8 now, then? Or is the intake still stopped

9 until you've come up with this other plan?

10 ACTING EXEC. DEP. CMR. DeSANTO: At

11 the point at which the plans are approved,

12 the intake continues to go forward. So I

13 think we're at a point where we're able to

14 begin to receive people again into those

15 types of services that they're looking for.

16 ASSEMBLYMAN CROUCH: So you are taking

17 new people in?

18 ACTING EXEC. DEP. CMR. DeSANTO: We

19 are in the process of reviewing the plans,

20 and when we have an approved plan, that is

21 the point at which we would be taking people

22 into the services.

23 We also have, though, a number of

24 services that have been introduced over this

123

1 past year and a half, and people have

2 continually been received into those

3 services. So there's been no one who has not

4 had a service available to them.

5 ASSEMBLYMAN CROUCH: What about the

6 people from 2013 to 2017 that would have

7 liked to have gotten into the workshops for

8 services, what's happening with them? Are

9 they currently just sitting at home, or are

10 they able to receive some different type of

11 service?

12 ACTING EXEC. DEP. CMR. DeSANTO: They

13 are receiving services, so that we had always

14 had available a variety of services that

15 people could be offered.

16 We now have a community pre-vocational

17 service that might be available to some of

18 them, if that would be their choice for what

19 they would want to go into.

20 We have a new service called Pathway

21 to Employment that enables people to explore

22 the types of jobs that they may be interested

23 in, and we have a number of people who went

24 into the Pathway program.

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1 And of course we have our supported

2 work program, so some people may have chosen

3 to go right into the supported work area.

4 ASSEMBLYMAN CROUCH: What if the

5 individual does not want to leave the

6 workshop? If they're perfectly happy with

7 their job at the workshop, are they able to

8 stay?

9 ACTING EXEC. DEP. CMR. DeSANTO: Yeah,

10 sure. So the whole goal of the workshop

11 transition was to create opportunities within

12 that same type of setting, but to get that

13 setting to be a more integrated type of

14 employment than what it had traditionally

15 been. So we had always been committed to not

16 telling individuals who were currently

17 working there that there was a point where

18 they would have to leave that setting, and

19 that has not happened.

20 CHAIRWOMAN YOUNG: Thank you.

21 ASSEMBLYMAN CROUCH: Is there money

22 to -- I'm just -- I have one quick question.

23 Is there money allotted to help these

24 transitions to the workshops?

125

1 ACTING EXEC. DEP. CMR. DeSANTO: There

2 is certainly funding that is connected to the

3 various types of services that we're speaking

4 about, and we have worked with our providers

5 on their transition plans and the transition

6 processes.

7 We do have a good amount of federal

8 dollars that are referred to as Balancing

9 Incentive Program dollars, or BIP is the

10 acronym there, and those dollars were

11 provided for the very reason of

12 transformation and transforming services into

13 more integrated services. So a number of

14 providers received dollars that related to

15 this very issue of workshop transition and to

16 assist them in that regard. So there were

17 investments made there.

18 ASSEMBLYMAN CROUCH: Thank you.

19 CHAIRWOMAN YOUNG: Thank you.

20 Senator Krueger.

21 SENATOR KRUEGER: Thank you.

22 Good afternoon. Just to reiterate

23 what already has been said just one more

24 time, you can't stop the COLA from going

126

1 forward at the same time as we've increased

2 minimum wage and the pressure on providers to

3 actually get people to work for them and stay

4 in these very difficult jobs. It's a

5 lose-lose proposition. So you've heard it a

6 million times here today, so just please

7 urge -- go back to the Governor and say this

8 is just not an option that can be considered.

9 You talk about, in your testimony,

10 when you add up 4,900 individuals currently

11 living at home may require a certified

12 residential opportunity and an additional

13 1,400 will seek more independent living

14 arrangements than rental subsidies and other

15 uncertified options can provide -- so that's

16 6,300 people, I think, that you're saying are

17 in need of residential facilities.

18 So I represent Manhattan, parts of

19 Manhattan. I get visits and calls from

20 people all the time begging for help to get

21 residential placements -- not next year, but

22 now. People who have been waitlisted, people

23 in their 50s, 60s, 70s, 80s caring for OPWDD

24 adult children who can't do it anymore and

127

1 live in hopes of finding a secure, safe place

2 for their adult children to move to.

3 Of these 6,300 that you're defining,

4 when are we getting them into the correct

5 placements? And, two, give me an estimate of

6 how many of those are in New York City,

7 because I feel like we have a desperately

8 high waitlist.

9 ACTING EXEC. DEP. CMR. DeSANTO: Sure.

10 So in developing the multiyear strategy, we

11 looked at various points of information. You

12 probably know we have that large residential

13 request list which is statewide and is just

14 that, it's a list where at some point people

15 have requested or said that they may have an

16 interest in residential support.

17 But then what we also have in our

18 regional offices is a process, a very dynamic

19 process whereby we receive information from

20 families and/or their case managers that are

21 probably the people that you described, who

22 are saying "I am ready now, and I need

23 services now."

24 So each of our regional offices,

128

1 including our regional office in New York

2 City, maintains that list and they work on an

3 ongoing basis with providers in their area as

4 vacancies in our system come up, or to

5 develop new residential opportunities that

6 may need to be created. And, you know, you

7 might realize that in such a large system as

8 we have, which is 37,000 individuals, there

9 is a good amount of turnover on an ongoing

10 basis within a system so large as ours.

11 So it's a two-pronged process of

12 looking at how to make sure that we make the

13 best use of that large system that we have

14 invested in. And it's a very large system in

15 New York City. You're probably aware of many

16 of our providers there who operate many

17 different types of residential supports, as

18 well as, as I said, looking at the creation

19 of new opportunities.

20 Now, I know that many families are

21 concerned, that they feel that there's a need

22 for a greater number of new opportunities to

23 be created. And so part of this multiyear

24 strategy actually does increase the number of

129

1 new opportunities that are created for family

2 members who are caring for a loved one at

3 home.

4 This past year, we devoted $10 million

5 on a dedicated basis to individuals who have

6 family members that they're caring for at

7 home, and we had a stakeholder process where

8 people recommended to us how to invest those

9 dollars around the state. And we're coming

10 to a conclusion of that process, which should

11 see approximately 170 new opportunities of

12 various types created around the state in

13 various areas.

14 I mean, I could certainly arrange to

15 sit down with you and more specifically look

16 at our New York City information that we

17 have. And we'd love to hear what information

18 you have, because we always want to make sure

19 that we are as accurate as we can be and that

20 we're being responsive in all parts of the

21 state.

22 SENATOR KRUEGER: So just globally,

23 you have 37,000 residential slots in OPWDD.

24 You have stated there's approximately 6,300

130

1 units needed by people on lists. And you

2 talk about turnover. How many people turn

3 over in your system per year?

4 ACTING EXEC. DEP. CMR. DeSANTO: About

5 -- I'm trying to do the math quickly in my

6 head. It's about 1,800, I believe, that

7 would turn over within that existing system

8 of 37,000.

9 SENATOR KRUEGER: So current demand

10 is, at minimum, three times what your

11 turnover is.

12 ACTING EXEC. DEP. CMR. DeSANTO: Well,

13 over that three-year period. So the 6,300 is

14 anticipated over a three-year period to be --

15 SENATOR KRUEGER: Over a three-year

16 period.

17 ACTING EXEC. DEP. CMR. DeSANTO: Yes.

18 That's correct.

19 And the other thing I just want to

20 point out is that we also have other types of

21 housing supports now that we did not have for

22 many years. For many years it was a

23 one-size-fits-all system where we would

24 create your classic group home, for lack of a

131

1 better way perhaps to say it, but not a lot

2 of more integrated or individualized

3 opportunities such as apartment types of

4 settings, vouchers that help people who want

5 to live more independently to do that. And

6 now we have those types of options that

7 people are accessing to a much greater

8 degree.

9 When we did that outreach a couple of

10 years ago to the people on our list, we

11 actually found that many of them were telling

12 us they wanted to know about these new and

13 different types of opportunities. They

14 weren't just necessarily saying, you know,

15 that the group home was the only option that

16 they would consider. So there are people on

17 that list, you know, who are capable and

18 really desirous of having different types of

19 opportunities that we're now able to also

20 develop that were not there before.

21 SENATOR KRUEGER: Not to play the

22 devil's advocate totally, but I assume those

23 people actually, then, can get those services

24 so they wouldn't be on this list.

132

1 ACTING EXEC. DEP. CMR. DeSANTO: Well,

2 actually, people with all levels of need are

3 on our list. But certainly some people may,

4 as you experience or say that people tell

5 you, wait longer than others. People who

6 need a highly specialized service, obviously

7 that sometimes could take longer to match

8 people to.

9 SENATOR KRUEGER: Thank you,

10 Commissioner.

11 ACTING EXEC. DEP. CMR. DeSANTO: Thank

12 you.

13 CHAIRWOMAN YOUNG: Thank you.

14 Assembly?

15 ASSEMBLYWOMAN GUNTHER: Michael

16 Cusick.

17 ASSEMBLYMAN CUSICK: Thank you.

18 Thank you. I'm going to just -- I'm

19 going to follow up on the Senator's question

20 on housing. Housing seems to be one of the

21 bigger issues in the OPWDD community, not

22 only in Staten Island, where I represent, but

23 statewide when I meet with folks here up in

24 Albany.

133

1 I see in the testimony about the

2 housing strategy that's put forward by your

3 agency. I just want to start with the

4 Executive's proposal of including $15 million

5 in capital investments to supportive housing

6 for people with disabilities. Could you just

7 run through with us as to how that's going to

8 work? What's the timeline on that? And

9 could you also -- how many affordable housing

10 units currently exist in OPWDD?

11 ACTING EXEC. DEP. CMR. DeSANTO: So

12 currently we have 4,200 people who receive

13 some kind of housing subsidy. And within our

14 funding we do provide housing subsidies to

15 help people with their rental and other

16 housing-related costs. They access housing

17 supports of all kinds.

18 So they may be out there renting an

19 apartment that's not necessarily one that was

20 specifically created through an affordable

21 housing funding, but many of them are also

22 part of the affordable housing initiatives.

23 I can't tell you exactly the number of

24 supportive housing apartments that are out

134

1 there today, but the way the process works is

2 that there is a request for proposals process

3 that we engage in, and we receive proposals

4 from developers that are interested in

5 creating these affordable housing units. And

6 we have a whole review process that we engage

7 in that looks at the proposal itself, the

8 need in the area, and so on.

9 So within the coming year we will be,

10 as we have in the past couple of years,

11 soliciting those proposals and making those

12 approvals for those supportive housing units

13 to be created --

14 ASSEMBLYMAN CUSICK: And this is

15 capital money to construct these facilities,

16 right?

17 ACTING EXEC. DEP. CMR. DeSANTO:

18 That's correct.

19 ASSEMBLYMAN CUSICK: And is there a

20 mechanism yet in place, or is that still in

21 the planning stages of identifying which

22 counties will be selected for -- to dovetail

23 on the Senator's comments, $15 million

24 doesn't seem to be a lot, particularly for

135

1 the entire State of New York. I'm sure we

2 could use $15 million alone in Staten Island,

3 hint, hint.

4 (Laughter.)

5 ASSEMBLYMAN CUSICK: But that's what

6 I'm concerned about, is how is the process

7 going forward in identifying which counties

8 and what areas qualify or have the greatest

9 need.

10 ACTING EXEC. DEP. CMR. DeSANTO: So as

11 we solicit the proposals, you know, we look

12 at who is interested. And, you know, we

13 don't necessarily get a proposal from

14 developers in every part of the state. But

15 we look at those proposals, what they're

16 proposing to do, you know, how it fits in

17 with our priorities. And there's really a

18 whole review process that we undertake, you

19 know, to determine where to make the

20 investments.

21 ASSEMBLYMAN CUSICK: Is this in effect

22 right now, or is that still being planned on?

23 ACTING EXEC. DEP. CMR. DeSANTO: For

24 this coming year, it's in the planning

136

1 stages, but it will go forward fairly soon.

2 We also, as was mentioned briefly -- I

3 think that we will be able to have our

4 providers make applications for the

5 $20 billion in the Affordable Housing

6 Initiative of the Governor.

7 ASSEMBLYMAN CUSICK: And that was last

8 year's -- in last year's budget, correct, the

9 $20 million in affordable housing? How much

10 of that $20 million is actually going to

11 OPWDD for supportive housing for people with

12 disabilities?

13 ACTING EXEC. DEP. CMR. DeSANTO: Well,

14 it's actually $20 billion, I believe.

15 ASSEMBLYMAN CUSICK: Twenty million?

16 ACTING EXEC. DEP. CMR. DeSANTO:

17 Twenty billion. In the Affordable Housing

18 Initiative that I'm referring to, which is in

19 addition to the $15 million that we were

20 speaking of a moment ago.

21 And I think, when you say how much of

22 that is available, it really depends on how

23 the process progresses with applications from

24 our providers. So there's not a set amount,

137

1 not a set-aside amount.

2 ASSEMBLYMAN CUSICK: Well, again, I

3 know my time is running out, but I just want

4 to stress how important this is, this issue

5 of supportive housing for people with

6 disabilities.

7 We have families, as mentioned before,

8 who are growing older and they're frightened

9 as to figuring out what's going to happen to

10 their child, who is also getting older, and

11 where they're going to live, who's going to

12 take care of them. And I really think that

13 we're in an emergency situation here and we

14 need to come up with not only -- not only go

15 through with the existing money that we're

16 mentioning here, but we need to come up with

17 more money.

18 Thank you.

19 ACTING EXEC. DEP. CMR. DeSANTO: Thank

20 you.

21 CHAIRWOMAN YOUNG: Thank you.

22 We've been joined by Senator George

23 Amedore.

24 And our next speaker is Senator

138

1 Kaminsky.

2 SENATOR KAMINSKY: Good afternoon.

3 ACTING EXEC. DEP. CMR. DeSANTO: Good

4 afternoon.

5 SENATOR KAMINSKY: I speak to a lot of

6 parents of children who are -- or young

7 adults, I should say, who are no longer in

8 school, and they're very worried about aging

9 out and whether there will be appropriate

10 dayhab facilities and other programs that

11 will meet their needs. Some wait very long

12 on waiting lists only to find that, for some

13 reason, either the program is cut or it

14 doesn't qualify for some reason.

15 I'm hoping you could tell me what

16 assurances I could give to those parents that

17 OPWDD is working hard to provide appropriate

18 services for those deserving individuals.

19 ACTING EXEC. DEP. CMR. DeSANTO: Thank

20 you. You know, certainly every year we work

21 with a group of individuals and their

22 families across the state who are graduating

23 from school, and we work very hard to try to

24 find out early on in the process of

139

1 transition so that we can do appropriate

2 planning.

3 We have, in our new service dollars

4 each year -- and again, thank you for all of

5 the support we have had over the years with

6 those new service dollars -- a percentage of

7 that money is utilized to look at the varying

8 needs of people leaving school. So we look

9 to make sure that we have the right kinds of

10 adult day supports, whether it be employment

11 for some or for others that need a more

12 structured kind of day habilitation

13 experience.

14 But we try to ensure that we have the

15 right services in the localities where they

16 are needed, and our regional offices work

17 very hard to make sure those transitions

18 happen in a timely manner and that the

19 services that are needed are developed and

20 available.

21 SENATOR KAMINSKY: I'd love to

22 continue to work with you on making that an

23 even more efficient process.

24 When it comes to the adult housing

140

1 situation, I really echo the sentiment of a

2 lot of my colleagues. And I think when you

3 talk to parents who are now themselves

4 getting older, they're really worried that if

5 something happens to them, who is going to

6 take care of the children that they love so

7 much? And they're especially worried that

8 there's going to be a gap between the time

9 that something is ready for them and the time

10 when, God forbid, something happens creating

11 an urgent situation.

12 So I was hoping that you could address

13 that and tell me what steps that your agency

14 is taking to make sure that it's a much more

15 streamlined and efficient process and that

16 these parents can know that New York will

17 step in if they can no longer take care of

18 their children.

19 ACTING EXEC. DEP. CMR. DeSANTO: Yes,

20 and that is the reason why we did create the

21 multiyear housing plan that we have this year

22 in the budget. We used a lot of information

23 that we have gathered over a period of a

24 couple of years that really tries to look at

141

1 where families are located, who needs the

2 services, where we have individuals living

3 with caregivers who are getting older, and

4 try to factor that in in the development of

5 the plan to meet the needs of the 6,300 over

6 three years.

7 We think that's a good number, and we

8 hope that we're going to be able to identify

9 and work with these families over this period

10 of years to provide them with more confidence

11 for a more planned and timely transition and

12 availability to residential supports. So

13 that really is the goal.

14 We have heard -- as you have,

15 obviously -- our stakeholders raising a lot

16 of concerns. And within the plan there is

17 the development of new opportunities in

18 addition to the use of existing

19 opportunities, and that's been something we

20 have heard from families that have been

21 concerned about the development of new

22 residential settings that they may find to be

23 more appropriate or more fitting the needs of

24 their family member. So that was recognized

142

1 within the plan.

2 SENATOR KAMINSKY: Okay. Well, that's

3 good to hear. And to the extent we could

4 emphasize that more, I look forward to

5 working with you. And whether it's on the

6 funding end or on gathering information on

7 what's going on in Nassau County or anything

8 else, I look forward to working with you to

9 make that a priority.

10 You know, this, to families, is the

11 only thing that they think about when they go

12 to sleep at night, and I'd love to help make

13 them feel more secure, as much as I can.

14 ACTING EXEC. DEP. CMR. DeSANTO: Sure,

15 we appreciate that. Thank you.

16 SENATOR KAMINSKY: Thank you.

17 CHAIRWOMAN YOUNG: Thank you.

18 ASSEMBLYWOMAN GUNTHER: Assemblywoman

19 Miller.

20 ASSEMBLYWOMAN MILLER: Hi.

21 ACTING EXEC. DEP. CMR. DeSANTO: Hi.

22 ASSEMBLYWOMAN MILLER: I represent an

23 area with Senator Kaminsky. And being the

24 mother of a handicapped child myself, I seem

143

1 to attract lots of questions from peers and

2 fellow family members that have children with

3 special needs. And something that I've been

4 asked a lot about is self-direction.

5 So I have a couple of questions about

6 self-direction. It seems to be something

7 that's troubling many people -- myself

8 included, because my son is 17. So there

9 seems to be some slowdown, for lack of a

10 better phrase. This program, if you're lucky

11 enough to find a Medicaid service

12 coordinator, which there are a sparsity of,

13 then you would have to get a broker. And

14 from what I understand, the family member can

15 train to become a broker, or you can hire a

16 broker, and there is a lot of question about

17 the follow-up of these brokers.

18 Obviously you would, you know, expect

19 that you can trust a family member who's a

20 broker, but what is the follow-up of a

21 non-family-member broker? Are they monitored

22 at all? Six months later? A year later?

23 Because I've heard nightmare stories of some

24 families who have gotten a broker and then

144

1 that broker takes their case and then that

2 broker disappears, and their budget is never

3 launched.

4 And then if you are lucky enough to

5 get the Medicaid service coordinator and the

6 broker, there seems to be a significant

7 problem getting to the third step, the fiscal

8 intermediary. And there's a moratorium -- in

9 fact, a list came out just today of the most

10 recent fiscal intermediaries and the

11 moratorium placed on these fiscal

12 intermediaries that's saying they're not

13 taking on new cases until further notice.

14 So what are these families supposed to

15 do? What are we supposed to do when we can

16 not effectively transition our children?

17 ACTING EXEC. DEP. CMR. DeSANTO: So

18 I'm sorry, you know, to hear that you

19 experienced and that you're hearing that

20 others are experiencing difficulties with

21 self-direction.

22 We have been doing a lot of work on

23 ensuring that the fiscal intermediaries are

24 appropriately compensated, because there was

145

1 an issue around payment to them that we've

2 been working on. And also trying to work

3 together on broker services with those that

4 are providing them.

5 We do have over 10,000 people who are

6 at some point in self-direction plans and are

7 self-directing, many of them very

8 successfully so. So what I would offer to

9 you is if you would want to have an

10 opportunity for us to come and have a meeting

11 with some families around self-direction, we

12 have done that successfully in some other

13 parts of the state where we have some people

14 who are really quite knowledgeable in

15 self-direction. We've gotten wonderful

16 feedback when we've had those family

17 meetings --

18 ASSEMBLYWOMAN MILLER: I would

19 appreciate that. I think --

20 ACTING EXEC. DEP. CMR. DeSANTO: And I

21 think that that might be a good next step,

22 perhaps.

23 ASSEMBLYWOMAN MILLER: I think that

24 would be wonderful, but I also fear that --

146

1 and this is a concern of mine personally, but

2 I think for many families. Self-direction is

3 wonderful for a population, but as with many

4 things in this population of the disabled,

5 it's not one-size-fits-all. It's far from

6 one-size-fits-all. I happen to have a child

7 who does not fit most, and this will not work

8 for him. It does not work for many families.

9 And what happens if it is working for

10 you very well, and then something happens?

11 What happens if something happens to the

12 caretaker? Or what happens if a baseline

13 changes? There are so many variables, so

14 many places where this can fall apart -- and

15 then what happens?

16 ACTING EXEC. DEP. CMR. DeSANTO: Yeah.

17 And I, you know -- certainly we have heard

18 concerns of families very similar to what

19 you're expressing.

20 I know that we have very actively been

21 thinking about the type of thing that's

22 referred to as a safety-net kind of

23 availability for people who are in these

24 types of service arrangements. But I would

147

1 also really just echo and reinforce what you

2 were saying, is there really is not a

3 one-size-fits-all approach for people.

4 Hopefully you're not experiencing

5 situations where families are only given a

6 certain option, because we really do want to

7 look at each person's individual needs in a

8 person-centered way and try to --

9 ASSEMBLYWOMAN MILLER: But when you

10 look at the alternative, which is removing

11 the workshops into an integrated -- which is

12 what the state is doing -- we're not left

13 with too much in the middle.

14 ACTING EXEC. DEP. CMR. DeSANTO:

15 For -- you're saying for the day supports,

16 when your family member might leave school?

17 ASSEMBLYWOMAN MILLER: So that's a

18 scary future.

19 Thank you.

20 CHAIRWOMAN YOUNG: Thank you very

21 much.

22 Senator Brooks.

23 SENATOR BROOKS: Thank you. Good

24 afternoon.

148

1 ACTING EXEC. DEP. CMR. DeSANTO: Good

2 afternoon.

3 SENATOR BROOKS: We've been conducting

4 a number of community meetings in my district

5 over the last few weeks, and in many of the

6 meetings we have people with developmental

7 disabilities coming forward and indicating

8 that the county has cancelled various bus

9 routes they were using for transportation,

10 making it impossible for them to get to

11 certain meetings. And in some cases their

12 providers are unable to get to where they

13 are, because they're individuals on reduced

14 income.

15 How does your agency monitor changes

16 in the environment as far as the elimination

17 of transportation or other issues along those

18 lines?

19 ACTING EXEC. DEP. CMR. DeSANTO: In

20 terms of -- I'm sorry if I'm not maybe

21 catching exactly the question. In terms of,

22 you're saying, discontinuation of certain

23 types of service?

24 SENATOR BROOKS: Well, in this case,

149

1 bus routes have been cancelled by the county,

2 that people no longer have a means of

3 transportation to get anyplace.

4 ACTING EXEC. DEP. CMR. DeSANTO: Yes,

5 I see. Well, we provide funding within many

6 of our service types that include

7 reimbursement to providers for

8 transportation. So I can't say that we

9 directly monitor, if you will, public

10 transportation changes, although we certainly

11 hear about it as a service coordination

12 function that we perform.

13 So what we would try to do in those

14 instances where we become aware of a

15 difficulty that someone may have in getting

16 to a service is work with that particular

17 provider of the service to see if there's a

18 way that we can provide assistance, either

19 through some type of adjustment to the rate

20 that the provider receives -- you know, we

21 try to look to see if that's a possibility,

22 if we become aware of it.

23 SENATOR BROOKS: Okay. So if a

24 municipality or a city or a county was

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1 considered eliminating transportation that

2 provided a service to disabled people, they

3 have no obligation to let you know of those

4 changes?

5 ACTING EXEC. DEP. CMR. DeSANTO: Not

6 that I'm aware of.

7 SENATOR BROOKS: Should they?

8 ACTING EXEC. DEP. CMR. DeSANTO: A

9 public transportation entity wouldn't, that

10 I'm aware of, need to call us and say, you

11 know, we're changing a bus route. They may,

12 often because they know the providers that

13 individuals are traveling to -- so that may

14 happen informally, but I don't know of a

15 requirement for that to happen, if it's a

16 county or other type of transportation

17 service.

18 Unless it's a Medicaid service -- I

19 don't know if you're referring to a Medicaid

20 type of transportation or if it's more like

21 some other type of vendor.

22 SENATOR BROOKS: Well, what we ended

23 up with -- probably a half a dozen informed

24 me, that came forward that had disabilities,

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1 where the bus service had been eliminated and

2 they had no way to get anywhere.

3 ACTING EXEC. DEP. CMR. DeSANTO: So,

4 you know, maybe we could be in touch with you

5 and work on the specifics of what you're

6 referencing.

7 SENATOR BROOKS: Okay. Great, thanks.

8 ACTING EXEC. DEP. CMR. DeSANTO: Okay.

9 Thank you.

10 SENATOR BROOKS: Thank you.

11 CHAIRWOMAN YOUNG: Thank you.

12 ASSEMBLYWOMAN GUNTHER: Ellen Jaffee.

13 ASSEMBLYWOMAN JAFFEE: Thank you.

14 What did -- you raise an issue

15 regarding similar proposals that I understand

16 are being made revising the respite rate

17 reimbursement, directly in discussion with

18 many of the organizations, huge

19 not-for-profits that really provide services.

20 I'm truly concerned, because they believe

21 that it would negatively impact their ability

22 to serve the children with disabilities and

23 for respite services.

24 So one of the organizations -- and

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1 this is repetitive in terms of the many

2 conversations I've had -- they do provide

3 respite for children with disabilities ages

4 about 6 to 11. Also they provide -- those

5 are after-school programs for them. They

6 also provide respite during school vacations

7 for the preschool children with disabilities,

8 before and after their programs, their

9 special education programs. And the families

10 truly need these kinds of services, because

11 their childcare programs generally do not

12 provide properly -- the care for these

13 children. So it is an issue.

14 The current proposal for the rate of

15 reimbursement for before- and after-school

16 respite and vacation respite will be cut --

17 it cuts them almost $8 an hour, which is what

18 is being proposed at this point. And --

19 which is significant in terms of the programs

20 being able to be sustained. However, when

21 they give them Saturday or Sunday respite

22 programs, they are getting funded for that,

23 which is very strange in how that

24 determination has been made.

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1 So, you know, it is really very

2 serious. The adult respite programs also

3 would be reimbursed at a higher rate. So the

4 change is going to be an enormous loss of

5 almost 30 to 40 percent in funding to these

6 major not-for-profit organizations and force

7 them to close programs, and the parents are

8 then left with very little opportunities to

9 provide that -- they're working to provide

10 that after-school programs or even vacation

11 programs. So it's not a luxury, it's

12 something that really is desperately needed.

13 So I wanted to raise that issue. And

14 in the conversations, I took some notes and

15 I -- in my conversations with the

16 organizations -- I wanted to share that

17 concern.

18 ACTING EXEC. DEP. CMR. DeSANTO: Thank

19 you for sharing it.

20 I'll just say very briefly that we

21 have been working very hard to ensure that

22 there are no interruptions to respite

23 programs. We have heard providers' concerns

24 about some of the changes that are happening

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1 to the rates, and honestly, some of the rates

2 are actually going to be better for

3 providers.

4 And there are new categories of

5 respite within our rate structure, and I

6 think in some instances we're really working

7 to make sure providers know which service

8 they provide and how it fits into the rate

9 structure.

10 Because we think there's also a lot

11 of -- I don't want to call it misinformation,

12 but people don't yet totally understand the

13 way these respite programs are now going to

14 be falling into categories and funded. So we

15 have been doing a lot of work with providers,

16 both individually and also collectively.

17 I think I mentioned earlier we're

18 going to do a webinar with them again -- this

19 is the second time, but later this week --

20 and we've done a lot of outreach to make sure

21 that those providers who are concerned that

22 they will not be able to continue to provide

23 the service, that that, you know, does not

24 happen.

155

1 Certainly we agree with you that it's

2 just a crucial service and we can't afford to

3 lose one program of respite. So we're

4 thinking --

5 ASSEMBLYWOMAN JAFFEE: I also just

6 want to follow up on the conversation earlier

7 regarding the assistance to ensure that we

8 have the salaries for our workers within

9 these facilities. They're really essential.

10 They're required to have certification,

11 they're required to -- even the teaching

12 assistants have to have certain

13 certification. And their salaries are in

14 many cases almost at the poverty level,

15 literally.

16 So we need to provide that kind of

17 funding so that these really dedicated

18 educators in these programs are provided with

19 the funding to be able to assure that they

20 have the salaries to maintain them. Because

21 what happens is they leave, they go to the

22 public schools where they can get the health

23 insurance as well. So -- and this is very

24 high need areas and programs.

156

1 So I just wanted to share that in

2 terms of the funding availability for the

3 programs, the not-for-profits.

4 Thank you.

5 ACTING EXEC. DEP. CMR. DeSANTO: Yes.

6 Thank you.

7 CHAIRWOMAN YOUNG: Thank you.

8 Senator Savino.

9 SENATOR SAVINO: Thank you, Senator

10 Young.

11 Good afternoon, Commissioner.

12 I'm sure that you've heard from many

13 of my colleagues about the concern about the

14 staffing issues, so I'll try and not be

15 repetitive. But I just want to make the

16 point that I know for the last six years,

17 every year the Governor's call letter to the

18 agencies is asking them to submit their

19 budget with a zero, a zero percent growth

20 budget, which -- astounding enough as it is,

21 but even in light of that, this agency

22 somehow or other, after seven years, is

23 spending $134 million less than it was when

24 the Governor first took over, in an agency

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1 that is dealing with probably the most

2 vulnerable of our citizenry.

3 And now we have the added complication

4 of the increased minimum wage. And I have

5 said this many, many times: The fact that we

6 even consider this work as minimum wage work

7 is appalling enough as it is. The direct

8 support professionals should be recognized

9 for the fact that they are in fact

10 professionals. And we're not taking care of

11 widgets, we're not putting hamburgers in a

12 bag, we're taking care of incredibly

13 vulnerable populations.

14 But we're not providing sufficient

15 resources to this nonprofit sector who we

16 rely on to take care of our most vulnerable

17 population, to be able to do so and to be

18 able to retain and train and keep these

19 direct support professionals. And the

20 reality is that we're looking at a vacancy

21 rate and a turnover rate in some of these

22 agencies that just in the past two years has

23 jumped from 7.76 percent to 11.8 percent.

24 Now, I can't imagine that that's not

158

1 going to get worse, the pressure on these

2 agencies to not just meet the minimum wage.

3 Because we're not providing sufficient funds

4 for it is going to make it even harder.

5 There's the wage compression issue

6 that they're now going to have to deal with,

7 and I foresee a real crisis in this sector if

8 we are not -- if we don't adequately provide

9 funding for it.

10 So I'm just curious as to -- as the

11 person who's sent here to justify the budget,

12 how do you guys explain to the Governor's

13 office that his demand for a zero-growth

14 budget is, one, unrealistic for the

15 population that you're serving here and, two,

16 really does a tremendous disservice to the

17 workforce and the work that they do?

18 I mean, as a state, we can't on one

19 hand say that, you know, working in a fast

20 food restaurant and taking care of the

21 developmentally disabled are equal work.

22 They are not. They just simply are not. And

23 I think it's time that we recognize that and

24 we begin to adequately provide funding for

159

1 the workforce, because if not, we know -- you

2 know, I used to be a caseworker -- when you

3 disrupt the workforce and you disrupt the

4 care providers, it has a serious effect on

5 the people that you're taking care of. If

6 they're in occupational health and if there's

7 a setback emotionally, there's a setback.

8 So I'm just curious as to how you

9 think we're able to provide this type of

10 service to people who really depend upon it

11 with basically no money.

12 ACTING EXEC. DEP. CMR. DeSANTO: Well,

13 you know, I would say again that there

14 certainly is a significant investment that's

15 made this year to ensure that we can meet the

16 minimum wage requirements for our providers.

17 I think that's an important step.

18 There is a lot of support in this

19 budget for many types of services, and over

20 the years we certainly have made investments

21 in this workforce for the cost of living.

22 But certainly we recognize and agree that the

23 direct support professional job is a very --

24 it's a very demanding job, and it is critical

160

1 to the services that we provide.

2 So we certainly want to go forward and

3 do everything that we can, looking at

4 compensation and other factors, to make sure

5 that the workforce that's needed can be

6 recruited and that there's good retention in

7 our direct support workforce. I think we

8 certainly would agree with that. We'd want

9 to work with you on that going forward.

10 SENATOR SAVINO: Well, I'm sure you

11 believe that. The problem for you, I guess

12 someone in your position, is that your agency

13 is not making that known to the bean counters

14 at the Division of Budget. Because they

15 certainly don't realize -- they either don't

16 realize it or don't believe it, or they

17 believe that with a zero-growth budget for

18 the past seven years that you're able to

19 accomplish all of these things for the most

20 vulnerable population without needing any

21 extra money. And I don't -- I just don't

22 think that that's realistic.

23 And I think that it becomes incumbent

24 upon you and your team to convince the

161

1 Governor's office that they're wrong, that

2 asking you for a zero-growth budget is just

3 unrealistic, unfair, and quite frankly, it's

4 inhumane to the population that you're

5 serving.

6 So while there might be in this

7 budget, and I think that's still debatable,

8 the funding to provide -- I'm going to stop

9 soon -- for the minimum wage, it doesn't

10 accommodate for what we know is the wage

11 compression issue for the people who are

12 right above it. And that continues to

13 denigrate the workforce. Because why would

14 anybody want to stay if they can work

15 somewhere else, in a fast food chain

16 restaurant, and go home every day after an

17 eight-hour shift and not have to worry about

18 whether or not a consumer that they were

19 taking care of is suffering or not?

20 Believe me, if it were up to me, I

21 would not want to do this work. You have to

22 worry about the Justice Center, you have to

23 worry about the people you're taking care of.

24 It's just -- it's unrealistic to think that

162

1 we're going to be able to recruit and retain

2 quality people to stay in this job if we

3 don't acknowledge the work that they're

4 doing.

5 So I just ask that you and those of

6 you who really know this work fight a little

7 harder for the people who really, really need

8 it. Thank you.

9 ACTING EXEC. DEP. CMR. DeSANTO: Thank

10 you.

11 CHAIRWOMAN YOUNG: Thank you.

12 ASSEMBLYWOMAN GUNTHER: Assemblywoman

13 Rosenthal.

14 ASSEMBLYWOMAN ROSENTHAL: Thank you.

15 First thing, I agree with Senator

16 Savino, as probably all of us on this board

17 do.

18 I want to ask you about START, OPWDD's

19 increased community-based crisis intervention

20 and prevention services for people with

21 intellectual and developmental disabilities

22 and co-occurring mental health and behavior

23 health needs.

24 Last year the State Legislature

163

1 appropriated $50 million for the budget for

2 START, and this year OPWDD is requesting

3 $12 million to expand START in the downstate

4 region. Can you describe how START is

5 working, and maybe explain how many people

6 have been served both upstate and downstate?

7 ACTING EXEC. DEP. CMR. DeSANTO: Sure.

8 So the START program, as you referenced, is a

9 program that assists people who have

10 behavioral health needs in addition to

11 developmental disabilities. And I think

12 we've all seen that many of these individuals

13 can have crisis situations that hopefully can

14 be avoided through a more proactive and

15 therapeutic approach, which is what the START

16 model brings about.

17 So we began the START program both in

18 the Hudson Valley and in Western New York.

19 Those are the most established START

20 entities. We went into New York City last

21 year, we'll go into Long Island this coming

22 year, and then, finally, we'll go back

23 upstate to the Southern Tier and Central

24 New York area.

164

1 I don't have the exact number of START

2 participants; there are hundreds of them.

3 But we do have some information to show that

4 we are able to prevent people who had

5 previously had to go to hospital situations

6 to be supported when they were in crisis,

7 we've been able to prevent that type of thing

8 from happening. So we are seeing a lot of

9 success as we continue to implement the

10 model.

11 One of the things that we will be

12 setting up soon are crisis centers which are

13 actually -- you might relate to them more as

14 respite types of settings, where people can

15 go actually for short periods of time who

16 need that type of ability to get away from

17 the situation that they live in in order to

18 become stable. So we are seeing a lot of

19 success with the model, and we're very

20 pleased that we'll be able to be supported to

21 continue to move it into other parts of the

22 state this year.

23 ASSEMBLYWOMAN ROSENTHAL: So it's in

24 the five boroughs in the city, but how is

165

1 it -- how are the personnel divided?

2 ACTING EXEC. DEP. CMR. DeSANTO: Well,

3 it's just this past year was when we really

4 began to get up and running in New York City.

5 And so I'm not sure when you say the

6 personnel -- or how does it go about serving

7 all of the five boroughs?

8 ASSEMBLYWOMAN ROSENTHAL: Right.

9 ACTING EXEC. DEP. CMR. DeSANTO: Yes.

10 We have a couple of different providers who

11 are engaged in the services there. I'm

12 sorry, I don't know off the top of my head

13 the number of staff that are dedicated in the

14 boroughs, but we divided it up into two areas

15 in New York City to be able to meet the --

16 what we anticipate to be the number of people

17 who will need to be supported there.

18 And it's really just kind of beginning

19 to get off the ground, so maybe we could at a

20 later point in time report back to you on

21 some of the -- some of what we're finding

22 there in terms of numbers of people and their

23 needs.

24 ASSEMBLYWOMAN ROSENTHAL: Right. I'd

166

1 appreciate that. Thank you.

2 ACTING EXEC. DEP. CMR. DeSANTO: Thank

3 you.

4 CHAIRWOMAN YOUNG: Anyone else?

5 ASSEMBLYWOMAN GUNTHER:

6 Mr. Santabarbara.

7 ASSEMBLYMAN SANTABARBARA: Yes, thank

8 you.

9 I have a question about rate

10 rationalization. We heard from a provider

11 agency recently about their experience with

12 the rate rationalization. And this was an

13 upstate provider, their budget runs from

14 January to December. In November of 2015,

15 they were notified of an anticipated rate

16 which would have been retroactive to July of

17 that year. On December 31st they were

18 notified by OPWDD that their rate was

19 actually higher than that anticipated rate,

20 giving them a surplus. So since the new

21 rates are based on the previous odd-number

22 year, when the rate for 2017 is figured from

23 the previous odd-number year, they're going

24 to see a different rate, a lower rate. So

167

1 they're kind of going to be penalized because

2 of that delay in providing that information.

3 So I just wanted to ask, have you

4 heard of this happening before? How often

5 does it happen? And are there plans to

6 address this sort of disconnect?

7 ACTING EXEC. DEP. CMR. DeSANTO: Yes.

8 So rate rationalization was a move in our

9 system that was something that CMS, our

10 federal agency, required, which was to go to

11 cost-based rates. And we had previously had

12 something called budget-based rates.

13 With a cost-based rate, as you kind of

14 referenced, the amount of money that you

15 receive for a service is based upon cost

16 reporting that you provide to the state. And

17 then at some point in the future it's

18 reconciled in one way or another with your

19 actual costs, and your rate change is based

20 upon that.

21 So it has certainly been a significant

22 change for our providers in terms of how they

23 had been operating, and it was also a

24 significant change for New York State to be

168

1 administering the rates in this way. So

2 hopefully we're getting to a point where we

3 are more timely in giving providers

4 information about the rates and how they will

5 be changing.

6 They, by the way, are telling us

7 feedback about how they feel. The process

8 maybe could be adjusted to work better for

9 them, and we are working with our providers

10 as well as the Department of Health, which is

11 actually responsible for rate setting. For

12 our providers, we're engaged in many ongoing

13 conversations about this, both with our

14 providers and the Department of Health, and

15 we have several proposals in front of us from

16 providers as to what they'd like to see in

17 terms of some changes to the system.

18 ASSEMBLYMAN SANTABARBARA: Okay. So

19 we can look to see some changes to address

20 this in the near future?

21 ACTING EXEC. DEP. CMR. DeSANTO: We

22 are considering ways in which they would like

23 to see us make improvements in that.

24 ASSEMBLYMAN SANTABARBARA: Okay.

169

1 Thank you.

2 ACTING EXEC. DEP. CMR. DeSANTO: Okay.

3 CHAIRWOMAN YOUNG: Well, I think we're

4 all set. So thank you so much for testifying

5 today, and we truly appreciate it.

6 ACTING EXEC. DEP. CMR. DeSANTO:

7 You're very welcome. Thank you for the

8 opportunity.

9 CHAIRWOMAN YOUNG: Thank you.

10 Our next speaker is Arlene

11 Gonz·lez-S·nchez, commissioner of the

12 New York State Office of Alcoholism and

13 Substance Abuse Services.

14 Welcome. Okay, glad to have you here.

15 We have a copy of your testimony, and you can

16 start any time, Commissioner.

17 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank

18 you so much.

19 Good afternoon, Senator Young,

20 Assemblymember Farrell, Senator Amedore,

21 Assemblymember Rosenthal, and distinguished

22 members of the Senate and Assembly

23 committees. My name is Arlene

24 Gonz·lez-S·nchez, and I am commissioner of

170

1 the New York State Office of Alcoholism and

2 Substance Abuse Services, known as OASAS.

3 I want to begin by thanking you for

4 your support of our mission at OASAS and for

5 giving me the opportunity to present

6 Governor Cuomo's 2017-2018 Executive Budget

7 as it pertains to OASAS.

8 As you know, OASAS oversees one of the

9 nation's largest addiction services systems.

10 It includes more than 1,600 programs that

11 assist nearly 100,000 New Yorkers on any

12 given day. In addition, more than 336,000

13 school-age young people receive prevention

14 services annually.

15 Before I discuss the specific details

16 of the upcoming OASAS budget, I want to

17 highlight what we have accomplished in the

18 past year.

19 In 2016, I served, together with

20 Lieutenant Governor Kathy Hochul, as co-chair

21 of the Governor's Heroin and Opioid Task

22 Force. The Task Force held listening forums

23 statewide to hear from individuals, families,

24 providers, and community leaders about their

171

1 local needs for combating this epidemic.

2 With your support, Governor Cuomo signed

3 landmark comprehensive legislation

4 recommended by the task force to end the

5 opioid epidemic.

6 Our collaborative efforts have, among

7 other things, ended prior insurance

8 authorization, to allow for immediate access

9 to inpatient treatment, as long as such

10 treatment is deemed necessary by a physician.

11 In addition, utilization review by

12 insurers can begin only after the first

13 14 days of treatment, so as to ensure that

14 every patient receives at least two weeks of

15 uninterrupted care -- of course, if it's

16 deemed necessary by a physician.

17 To expand access to Naloxone, we now

18 require insurance companies to cover the full

19 costs of Naloxone when prescribed to people

20 who are addicted to opioids, as well as to

21 their covered family members on the same

22 insurance plan.

23 To reduce unnecessary access to

24 opioids, we have limited initial opioid

172

1 prescriptions for acute pain to no more than

2 a seven-day supply, with the exception for

3 chronic pain and other conditions. To ensure

4 that prescribers understand the risks

5 presented by prescription opioids, part of

6 their ongoing continuing medical education

7 requirements will now include three hours on

8 addiction, pain management, and palliative

9 care.

10 And to improve consumer awareness

11 about opioid risks, we now require

12 pharmacists to provide educational materials

13 to consumers about the risk of addiction,

14 including information about local treatment

15 services.

16 With the $25 million increase in the

17 current year's budget, we have launched a

18 number of new initiatives. We awarded 80 new

19 residential treatment beds and 600 new opioid

20 treatment program slots. We issued

21 procurements to fund 10 new regional

22 community coalitions and partnerships, as

23 well as 10 new peer engagement programs and

24 10 new family support navigator programs. We

173

1 now have a total of 20 of each of these

2 programs statewide. Additionally, we opened

3 seven adolescent clubhouses and nine recovery

4 community centers.

5 As you can see, we have been very busy

6 advancing our key priorities and implementing

7 new programs to address this crisis, but

8 there is still much more work to be done.

9 The Governor's 2017-2018 Executive

10 Budget proposes $693 million that will allow

11 OASAS to continue to support existing

12 prevention, treatment, and recovery services.

13 In addition, this will allow us to expand our

14 key initiatives by adding eight adolescent

15 clubhouses, bringing the total up to 15

16 statewide; adding five new recovery community

17 centers, for a total of 14 centers across the

18 state; increasing treatment beds and opioid

19 treatment capacity; and continuing to advance

20 the Combat Addiction Public Awareness and

21 AntiStigma Campaign.

22 This budget supports OASAS' ability to

23 respond to needs identified by our

24 constituents throughout the state, including

174

1 the opening of ten 24/7 access treatment

2 centers and the development and planning of

3 two new recovery high schools.

4 The Executive Budget also includes

5 funding to support additional gambling

6 treatment and prevention services. These

7 funds come from the slot machine and gaming

8 table fees charged to all new casinos

9 operating in New York State.

10 So to conclude, Governor Cuomo's

11 2017-2018 Executive Budget enables us to

12 further reinforce our treatment system, boost

13 our statewide prevention efforts, and

14 strengthen our recovery programs so that all

15 New Yorkers have access to the system of care

16 they deserve.

17 We look forward to your continued

18 partnership as we advance these priorities.

19 Thank you for your time today.

20 CHAIRWOMAN YOUNG: Thank you,

21 Commissioner.

22 Our first speaker is Senator George

23 Amedore, who chairs the relevant committee.

24 Senator Amedore.

175

1 SENATOR AMEDORE: Thank you, Senator

2 Young.

3 And thank you for being here today,

4 Commissioner. It's always great to see you.

5 No question that the Senate has taken

6 a lead in the addiction issue that we face in

7 the State of New York, and we have also

8 focused in on the heroin/opiate epidemic, and

9 it certainly remains a top priority.

10 I do have a few questions for you

11 today about and with the current Executive

12 Budget proposal. And as you have said in

13 your testimony, last year, after the addition

14 by the Legislature, we had approximately --

15 there was approximately $190 million that was

16 dedicated to the heroin/opiate fight.

17 Now we see the Executive Budget

18 proposing around $200 million. We also

19 understand that last year's appropriations

20 were not fully spent, nor are all of the

21 programs up and running. So can you tell us

22 which and how many of the programs authorized

23 last year have not yet been online, made

24 online?

176

1 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I

2 could certainly get you a list of those, but

3 what I will tell you is that all the dollars

4 that were appropriated have been committed.

5 So there may be a handful of programs

6 that are in the pipeline. And as you know,

7 sometimes the RFP processes really are

8 lengthy. But for the most part, the programs

9 are out the door. I mean, we've been very

10 busy around the state, you know, opening all

11 kinds of different types of support services

12 throughout the state. But I'll be more than

13 glad to give you the list of those that are

14 in the pipeline. But within the next couple

15 of months, all of the programs will be out.

16 SENATOR AMEDORE: Okay. Well, can you

17 tell us how much of the $200 million in this

18 year's budget is actually new funding, or is

19 some of it remaining in last year's budget?

20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.

21 Thanks for the question and the opportunity

22 to explain those numbers.

23 So the $200 million actually

24 represents -- based on admission information

177

1 that we have of folks coming into our system

2 in this year, we have projected that

3 47 percent, which comes out to $200 million

4 of our funds for treatment, will be dedicated

5 to treat this epidemic. That's where the

6 $200 million comes in.

7 If you notice, last year the figure

8 was 189 -- but due to some cash flow and

9 timing issues, the real figure was 174.

10 So when you add the $30 million, which

11 is the projection of how much we're going to

12 spend more, that comes out to that 204.203

13 that's in the book.

14 SENATOR AMEDORE: Okay.

15 I'd also like to know when we can

16 expect to hear the results of the initiatives

17 that we've already put in place. Last year

18 we had a whole array of new initiatives.

19 Given prior years, more money added to the

20 budget to fight addiction problems, there

21 seems to be a lack of either finding the

22 results -- because we continue to see reports

23 showing more overdoses, more Naloxone being

24 used, more admissions to the ERs with people

178

1 who have to go through the detox process.

2 So can you elaborate a little bit

3 about that?

4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Sure.

5 So, Senator, I guess what I could say

6 is that we have implemented really innovative

7 programs, and most of them haven't even been

8 operational for a full year. You know, some

9 of them have been operational for a couple of

10 months, so it's hard to tell the impact. We

11 anticipate that by the end of, I guess, next

12 year or this year, we will have better

13 information.

14 But, you know, the peer support

15 programs that we have put in place, which is

16 going to be crucial to work with individuals

17 that, you know, have been reversed, have had

18 an overdose reversed -- instead of being sent

19 out into the community without that

20 additional support, these individuals will

21 now work with that person to bring them into,

22 hopefully, a crisis intervention center,

23 where they could get the treatment that they

24 need.

179

1 So it's going to take a little bit to

2 really feel the outcomes of these new

3 innovative models that we're putting in

4 place. But I believe that we are going to

5 see a great improvement in the service.

6 SENATOR AMEDORE: Well, we always

7 would like to see some type of measurable

8 results when we're talking about hundreds of

9 millions of dollars being spent, taxpayer

10 dollars being invested in helping the service

11 providers and helping the peer-to-peer

12 services, whether in the multipronged

13 approach that we've been talking about and

14 investing in in the state, whether it's

15 prevention or treatment, recovery services

16 that we haven't seen before.

17 This last year's budget was huge in

18 recovery services, which I'm grateful for,

19 and also with the law enforcement side of

20 this issue. But we have to get to a point

21 where it's very tangible in the forms of

22 measuring the results so that we can best

23 find where we should be targeting the

24 necessary funds.

180

1 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: And I

2 agree. And all I can say is that we too are

3 very interested in -- and we are monitoring

4 and we will document outcomes, because I

5 agree. I mean, we have to know that we're

6 putting monies in the right direction and in

7 the right services. So we will do this.

8 SENATOR AMEDORE: Commissioner, can

9 you elaborate a little bit and explain the

10 recovery high schools that the Governor has

11 proposed in the budget?

12 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Sure.

13 So the recovery high schools is an

14 innovative, multiservice high school model

15 where adolescents or young adults that are in

16 recovery could go to continue their education

17 in a fairly sober, safe, supportive

18 environment where they could develop the

19 supports necessary that they need to succeed,

20 not only academically but also vocationally,

21 educationally, and in the community. And

22 that's the intent of these sober homes.

23 SENATOR AMEDORE: Okay, so I believe

24 there's two being proposed, one upstate, one

181

1 downstate. But how would the state site

2 these recovery high schools? Would there be

3 local community input?

4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: There

5 will be community input. There will be local

6 community input, SED, family members, young

7 folks in the community. Of course, yeah.

8 SENATOR AMEDORE: Okay. And how would

9 students be protected and kept safe such that

10 these schools do not -- so that they will not

11 become targets from drug dealers or hindered

12 by other students in recovery?

13 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,

14 that's specifically the idea why we're

15 calling them recovery schools. They will be

16 in a setting where they'll be with other kids

17 that are in recovery, there will be supports

18 there, there will be counselors, there will

19 be teachers -- it's not part of the

20 mainstream school environment.

21 SENATOR AMEDORE: So once a student is

22 admitted to the school, will he or she stay

23 there until graduation --

24 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes.

182

1 SENATOR AMEDORE: -- or will they

2 return to their home school once they get to

3 a point --

4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: No.

5 The idea is to stay in the recovery high

6 school until they graduate.

7 As a matter of fact, there's a great

8 model in Boston that has shown that

9 75 percent of the young people that have gone

10 through the recovery school have maintained

11 sobriety, and 80 percent have actually

12 graduated and gone on to college. So it

13 seems to be a very, very good model for both

14 academic as well as sobriety in keeping --

15 recovery.

16 SENATOR AMEDORE: I want to kind of

17 shift the topic a little bit from heroin and

18 opiates and still stay on addiction.

19 We in the State of New York now are

20 starting to see the casinos opening, as well

21 as a new one that's going to open on

22 Wednesday right here in the Capital Region,

23 in Schenectady. What is your agency doing to

24 proactively respond to the possibility of

183

1 increased gambling addiction?

2 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So, as

3 you well know, the Governor has ensured that

4 we get -- this year we're getting

5 $3.3 million from the fees that are attached

6 to the table machines and the gaming

7 machines, a total of $3.3 million once all

8 the four casinos are open.

9 And the idea is to use that money to

10 develop what we're calling Gambling Resource

11 Centers, or Centers of Excellence, that will

12 particularly work with individuals who have

13 problem gambling issues. They will be able

14 to do assessments, they will be able to do

15 counseling and target in on those individuals

16 primarily.

17 SENATOR AMEDORE: Okay. Well, my time

18 has expired here, but I want to thank you for

19 your testimony.

20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank

21 you.

22 CHAIRWOMAN YOUNG: Thank you.

23 Assembly?

24 ASSEMBLYWOMAN ROSENTHAL: Okay. I'm

184

1 Assemblymember Linda Rosenthal. Thank you

2 for being here, thank you for your work.

3 I'd like to say at the outset that the

4 amount of money in the budget for OASAS is so

5 low when there is a heroin and opioid crisis

6 ravaging the state. And we hear all about

7 that, that -- even in press releases, that

8 there is such an epidemic, yet the amount of

9 money budgeted for treatment, recovery, all

10 of that is pitifully low. And I just want to

11 register my shock that it continues to be so

12 low.

13 And I would urge everyone to try to

14 put more funding here. Those who have access

15 to a lot of funding should direct it here,

16 because this is a scourge that is killing

17 future generations. We know that. We see

18 kids earlier and earlier getting addicted to

19 drugs, whether it's opiates, pills they steal

20 from their parents' or their friends'

21 cabinets in the bathroom, or when they

22 graduate to heroin on the street. It's

23 really kind of reprehensible.

24 So -- but thank you for your work on

185

1 this issue. I wonder if you could tell me a

2 little bit about the development of community

3 treatment beds. Can you tell me how OASAS

4 determines where to place the new beds, and

5 what types of beds are being developed around

6 the state?

7 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.

8 So we get input from local government, we use

9 also statewide national data, CDC data as

10 well as our own data that we collect from the

11 communities, and we develop a sense of where

12 the needs are for not only treatment beds but

13 programs in general. That's how we actually

14 determine where programs are needed.

15 ASSEMBLYWOMAN ROSENTHAL: So I've

16 heard many stories, particularly from upstate

17 regions where people have to travel long

18 distances in order to access available

19 treatment beds. Is there any form of

20 transportation aside from, you know, their

21 support system's car, their friend's car,

22 their family's car, their own car? Is there

23 any kind of transportation within the state

24 for people who decide now is the time that I

186

1 have to go get myself to a detox center, a

2 treatment center?

3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We

4 don't have any type of transportation per se

5 in our system, but I'll get back to that

6 thought of something that we're envisioning

7 doing as we move forward.

8 But, you know, I want to remind

9 everyone that we do have that link on our

10 website that now, by the way, includes all of

11 our treatment programs. Last year when I

12 testified in front of you, it was only

13 including inpatient beds. Now it includes

14 all treatment services. So that gives people

15 an idea of where the beds are or where the

16 treatment programs are available.

17 At any one time, you know, when you

18 look in that system, you see that there is

19 treatment available throughout the state.

20 Now, I have to be honest and say that

21 treatment is not always right down the block

22 from the individuals, and that's what we also

23 take into consideration as we move forward in

24 doing our planning.

187

1 But to answer your question, the state

2 does not provide any type of transportation

3 per se. But those 24/7 centers that I

4 mentioned -- that are part of this new

5 initiative going forward that we're looking

6 to establish 10 of -- will be sort of like a

7 hub where individuals, when they are ready,

8 when they've said "I am ready, I need

9 treatment," they could go to that location

10 and they will be assessed, they will be

11 stabilized and then referred to whatever

12 other treatment they need.

13 In other words, now, right now, what

14 I've been hearing -- and I'm sure you hear

15 the same -- as I go throughout the state is

16 that, you know, people don't decide that

17 they're ready to go into treatment between

18 9:00 and 5:00. Most of the time, it's on a

19 Sunday at 3 o'clock in the morning, and the

20 only thing really available is your local

21 emergency department.

22 So we want to change that. And we're

23 proposing those 24/7 -- 24 hours, seven days

24 a week -- hubs that will provide that level

188

1 of care.

2 ASSEMBLYWOMAN ROSENTHAL: And where

3 would they be located?

4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We're

5 going to do an RFP, and it's going to be

6 determined based on need. So wherever the

7 greatest needs are, that's where we plan to

8 develop the programs.

9 ASSEMBLYWOMAN ROSENTHAL: But it's 10

10 throughout the state?

11 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:

12 Throughout the state.

13 ASSEMBLYWOMAN ROSENTHAL: Yeah. I

14 mean, that's -- it's a good idea, but 10 is a

15 paltry number when you look at how many

16 people are coping with substance abuse

17 disorders.

18 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I

19 agree. But, you know, we have to start

20 somewhere.

21 ASSEMBLYWOMAN ROSENTHAL: Well, that's

22 certainly true.

23 So we did a quick search on the

24 dashboard to see where there were beds

189

1 available, and here are just a few examples.

2 Within a 50-mile radius of Rochester,

3 there are 30 beds available. And within a

4 50-mile radius of Utica, there are 44 beds

5 available. I mean, it sounds like a very

6 small number. Can you speak to that? I

7 mean, the dashboard is good if you meet the

8 criteria for the open bed. But if you don't,

9 then you have to go further, or not go at

10 all.

11 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,

12 I guess it would help me to understand what

13 level of treatment we're talking about. That

14 would be helpful. I mean, the fact that we

15 have 40 beds and 33, we have capacity within

16 the system for treatment beds. Not everyone

17 needs that level of care, so --

18 ASSEMBLYWOMAN ROSENTHAL: Okay. Can

19 you talk a little bit about residential

20 redesign, and how many providers have been

21 approved and what services they're providing

22 and where they're located?

23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.

24 We have a total of I want to say 26 or 29

190

1 providers that are -- can apply for this

2 redesign. To date, I believe we have maybe

3 13 or 14. I don't have the numbers, but I

4 will give them to you.

5 ASSEMBLYWOMAN ROSENTHAL: Okay.

6 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: The

7 idea of this redesign is to establish a

8 one-stop shopping in our treatment continuum.

9 Currently people go into, let's say, an

10 outpatient clinic. They are a residential

11 program. They stay there and they need to be

12 there from point A to point B.

13 What the redesign does is it really

14 addresses the need of the individual once

15 they come in the door. In other words, if

16 the individual does not need three or four

17 months of stabilization before they go into

18 the next level, then they just get a month of

19 stabilization, go to the next level, which is

20 integration, and then work on going back into

21 the community. It's a really

22 patient-centered model that looks at the

23 needs of the individual.

24 Currently what we do is that if a

191

1 person comes into most of our treatment

2 programs, they have to stay there for, let's

3 say, a year or 18 months, and they go through

4 that same process. But there are individuals

5 that don't need that level of care. And so

6 that's what the redesign does. It really

7 focuses on the need of the individual that

8 comes in the door. It focuses on the level

9 that they need, and then graduates the

10 individual out of the program.

11 ASSEMBLYWOMAN ROSENTHAL: Okay. I

12 want to ask you about Naloxone. Can you say

13 where you think Naloxone should be available?

14 For example, pharmacies have it, doctors have

15 it, and more and more just regular people are

16 getting access to it because you never know

17 when you might need it.

18 What areas do you think need to have

19 more access or cheaper access to the kit?

20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,

21 I think that we're all -- the Department of

22 Health has -- well, Dr. Zucker and myself

23 feel that, you know, everyone -- we're

24 aggressively out there talking about

192

1 Naloxone, and wherever people are interested,

2 we are there to do the training. So if it

3 was up to me, I think Naloxone should be

4 available to everyone and anyone who wants it

5 and who may need it.

6 ASSEMBLYWOMAN ROSENTHAL: Okay, I see

7 my time is up. That's it for right this

8 moment. Thank you.

9 CHAIRWOMAN YOUNG: Thank you,

10 Assemblywoman.

11 Commissioner, I had a few questions.

12 As you know, last year the Governor's

13 proposed budget had $164 million in funding

14 for the heroin and opioid crisis, and the

15 Legislature worked with the Governor in the

16 final enacted budget to increase that amount

17 to $189 million.

18 Could you please provide a

19 clarification, because I didn't really hear

20 it when Senator Amedore was asking. The

21 Governor is characterizing in his budget that

22 there's $30 million in new programming. It's

23 not clear what's new and what's being carried

24 over and being billed as new from 2017. I

193

1 believe that Senate Finance has asked for a

2 clarification a few weeks ago; we haven't

3 received it yet.

4 So could you please tell us today

5 which programs are new and which ones are

6 existing or being expanded on?

7 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,

8 so I -- in my testimony I indicated the

9 clubhouses, the peer support programs, the

10 prevention, the recovery support services --

11 CHAIRWOMAN YOUNG: Weren't those in

12 the 2017 budget, though?

13 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Part

14 of them were, yes. And then we added

15 additional ones in this past year.

16 But what I could do is provide you a

17 list that will show you exactly where we are,

18 which is what I agreed to do with the

19 Senator, so that it's clearer what programs

20 are in the works and which have already been

21 operationalized.

22 CHAIRWOMAN YOUNG: Thank you.

23 How many people have been served so

24 far in the programs from the increased

194

1 funding that we provided last year? Or this

2 year, 2017.

3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I

4 don't have that number, but I will get that

5 to you.

6 CHAIRWOMAN YOUNG: Okay, thank you.

7 The Governor also proposes that the

8 increased funding will be used for 10 new

9 regional 24/7 urgent access centers that

10 offer substance abuse disorder services, and

11 the formation of 10 new community coalition

12 programs. There was a federal grant for the

13 community coalition programs that was awarded

14 in 2014 for 10 counties. Just to be clear,

15 is this that federal funding, and it's been

16 held off and now it's finally being utilized?

17 Or is this new funding?

18 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: No,

19 this is new funding.

20 CHAIRWOMAN YOUNG: Okay. Thank you.

21 You've launched the overdose

22 prevention kits and Combat Heroin and Talk to

23 Prevent campaigns. Can you explain how

24 you're measuring the effectiveness of the

195

1 campaigns? You know, are you tracking

2 websites, unique individuals, people taking

3 action? How are you --

4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So

5 there's a couple of ways. I mean, it's a

6 little tricky to get actual data, but what we

7 do is we track how many hits we get on our

8 website. We also have the HOPEline that

9 really usually gets a lot of the referral

10 calls, and we monitor those calls.

11 And we also monitor by word of mouth

12 what people are telling us. You know, I walk

13 around and people say, We've been seeing the

14 campaigns, your PSAs, you know, in the

15 theaters, on the radio. It's really working,

16 people are really coming out, opening, they

17 feel comfortable -- so there are various ways

18 that we are monitoring the effectiveness of

19 the campaign.

20 And I have to tell you, you know, I

21 really feel that the campaign has made such a

22 huge difference. I don't know if you feel

23 the same way as you see it, but you know,

24 recently there's been a large number,

196

1 primarily of parents that before would never

2 come out and talk and say, My child -- or my

3 loved one, or my husband, my sister,

4 whoever -- has a problem. I've been getting

5 more and more of those calls.

6 Confidentially, of course.

7 But I think it's because the campaign

8 is out there and people are getting to

9 understand that there's no reason why you

10 should be ashamed. This is a disease, and

11 we're here to help. So a lot -- some of it

12 is a little anecdotal, but we do have some

13 numbers, and if you would like I will share

14 that with you as well.

15 CHAIRWOMAN YOUNG: I'm glad to hear

16 that. And generally -- oftentimes agencies

17 provide a report to the Legislature on

18 results of certain funding or programming

19 that we're doing, so I don't know if there's

20 something you could do along those lines so

21 that we would have that information. That

22 would be helpful.

23 The other thing is I represent a very

24 rural area, and access to services is always

197

1 a challenge. I was at a school a few months

2 ago to honor the football team, and the kids

3 said to me, very matter-of-factly, "Another

4 one died last week." Meaning one of their

5 classmates died from an overdose. And it was

6 horrifying, because it's gotten to be so

7 routine for them.

8 But you talk about stigma and that

9 sort of thing. It's the feeling, in the

10 rural counties especially, that the figures

11 are severely underreported. And I think it's

12 for a variety of reasons as to who's actually

13 dying from overdoses. It is a stigma. Maybe

14 there's -- maybe the overdose caused heart

15 failure, and it's being reported that way

16 rather than a drug overdose. Maybe it's the

17 families don't want to have that.

18 But, you know, in Cattaraugus County

19 we had a meeting a few months ago, and they

20 were talking about a very low figure of

21 people actually dying from overdoses. So is

22 there any other way that we can have more

23 accuracy in what's being reported?

24 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,

198

1 as you know, the Department of Health is the

2 one who gets and coordinates that data. I

3 think that's a question that we should talk

4 to Dr. Zucker about.

5 CHAIRWOMAN YOUNG: I know we also

6 think, you know, that the days of silos --

7 but especially for a crisis like this -- that

8 it should be your agency and the Department

9 of Health working together on these issues.

10 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: And I

11 didn't want to give you the impression that

12 we weren't. We are. But the issue of not

13 being reported -- I think there may be some

14 lag time in the reporting, and the one who's

15 really looking at the accuracy of the report

16 is the Department of Health, which is why I

17 raise that.

18 But yes, we work hand in hand with the

19 Department of Health to get the data. But I

20 think it may be a good thing to raise with

21 Dr. Zucker, he may have additional

22 information that I don't.

23 CHAIRWOMAN YOUNG: When your agency is

24 deploying resources for certain programs, do

199

1 you look at that data as to how you make

2 decisions on where funding should go?

3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes.

4 CHAIRWOMAN YOUNG: Okay. So that's

5 why it's so crucial, and that's why I'm

6 raising it. So I think that getting

7 everybody on the same page would be very

8 helpful. And I appreciate you saying that

9 DOH, they understand that. But I think we've

10 got to work together on these issues.

11 So thank you.

12 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank

13 you.

14 CHAIRMAN FARRELL: Mr. Oaks.

15 ASSEMBLYMAN OAKS: Yes, thank you.

16 One of the things that we're seeing,

17 just to follow up some on Senator Young's

18 questioning related to the opioid crisis that

19 we have, is finding that some of the

20 ambulance providers and other first

21 responders who now have been given or have

22 access to Narcan so that they can provide

23 that to individuals who might overdose -- the

24 costs of that are escalating as we're seeing

200

1 more use of that.

2 And so I guess the question would be,

3 then, are your resources coming from the

4 state which we budgeted last year, are those

5 being used for those purposes, actually of

6 reimbursing or providing the Narcan to those

7 providers?

8 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes,

9 absolutely. We do -- on our own do a lot of

10 training through our addiction treatment

11 centers, our own facilities, and everyone

12 that comes to the training leaves with a kit.

13 So yes, we continue to support those kits,

14 yes.

15 ASSEMBLYMAN OAKS: After they're used

16 and if there's ongoing issues, for instance,

17 an ambulance might come into contact with

18 that a number of times -- after they've been

19 trained and stuff, are those costs then back

20 on those individual departments? Or is the

21 state involved in reimbursing them?

22 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Again,

23 that would be a question for DOH, because

24 this is where the dollars are. The Narcan

201

1 kits are there, so I would think that that

2 would be an -- and if it involves ambulances

3 and hospitals and EMTs, it would be under

4 DOH, not under my department.

5 ASSEMBLYMAN OAKS: Thank you very

6 much.

7 SENATOR KRUEGER: Senate?

8 Senator Kaminsky.

9 SENATOR KAMINSKY: Good afternoon,

10 Commissioner.

11 I'd like to echo the sentiments of a

12 lot of my colleagues. I'm in Nassau County,

13 in Long Island, and it's -- we're in some

14 very troubling times. The quick anecdote

15 that I like to tell, because it so succinctly

16 sums up the problem, is there's a principal

17 of a local middle school who's maybe a year

18 older than me -- so in the scheme of things,

19 hasn't been around all that long -- and she

20 told me that she went to the funerals of

21 three former students over a previous summer.

22 So we're really struggling with this crisis,

23 and we look forward to continuing working

24 with you on that.

202

1 Along those lines, one of the issues

2 we hear from a lot of our first responders in

3 my area -- that's for the most part volunteer

4 firefighters and police officers -- is that

5 they're administering Narcan -- so for

6 example, the City of Long Beach, where I'm

7 from, had about 40 separate incidents where

8 Narcan was administered last year. Many

9 times they're giving Narcan to the same

10 person over again, and no one is really sure

11 once it's administered what then happens to

12 the person, what then happens to the patient.

13 In other words, are they then

14 enveloped in some type of system that will

15 guarantee them some type of access to

16 treatment or support going forward? And so

17 we're definitely encountering people who need

18 help in the very first and obviously most

19 critical incidents, and I'm worried that

20 we're losing connection after that.

21 And I'm wondering if you could talk

22 about what your agency is doing to ensure

23 that we're able to not just save people when

24 they're in the most urgent need, but get them

203

1 to the healthy recovery that we're hoping

2 for.

3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So

4 thank you. So that's what the peer navigator

5 program is all about. It's about having

6 peers working with the local emergency

7 departments in a particular region so that

8 when an individual is brought into the

9 emergency room after having been reversed,

10 that peer is automatically called. And then

11 that peer will start engaging the individual

12 during the 12 to -- six or 12 hours that that

13 individual is in the hospital being

14 stabilized.

15 Traditionally what happens is they

16 stabilize the individual, they may or may not

17 give them a referral to a treatment program.

18 The reality -- we know the reality, that

19 individual is not thinking about going into

20 treatment, he's just thinking about where am

21 I going to go and get my next hit, because

22 they don't want to go through withdrawal.

23 So that's why the peer is so

24 important. The peer will then engage that

204

1 individual, it would be that warm handoff

2 that will get that individual into a crisis

3 intervention setting and work with that

4 individual to convince that individual to go

5 into treatment rather than to go back into

6 the neighborhood and we know what happens.

7 SENATOR KAMINSKY: Certainly on

8 Long Island I would encourage us to meet

9 more, especially with the emergency room

10 providers, the hospitals -- I'm not really

11 sure at this very moment that they are up to

12 speed on what they should be advising people,

13 and I am hearing firsthand from some people

14 in the emergency rooms that people are just

15 kind of being discharged and kind of walk out

16 into the night.

17 So I'd love to work with you on

18 getting people together and making sure

19 everyone knows where they need to be.

20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:

21 Absolutely. Thank you.

22 SENATOR KAMINSKY: One great thing I

23 think that your agency has done is provide

24 local funding for the different community

205

1 coalitions. And I say all the time that it's

2 a problem that can't be -- you know, I used

3 to prosecute narcotics cases. We can't

4 prosecute our way through this. It's going

5 to take everybody pulling together -- our

6 churches, our schools, our community leaders,

7 student involvement, and certainly law

8 enforcement too. And you have provided

9 really nice grants to have these community

10 coalitions.

11 So down by me, whether it's Long Beach

12 or Rockville Centre, you are getting

13 religious leaders, school leaders, students,

14 law enforcement all together around the room

15 to figure these problems out. And I think

16 it's tremendous. And you definitely see

17 certain communities grappling with this

18 better than others, and I appreciate that and

19 hope you make them more available and

20 widespread, because a lot of communities

21 would love to avail themselves of that

22 resource.

23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We're

24 thinking of expanding as well in this coming

206

1 year, so thank you. It's great to be --

2 SENATOR KAMINSKY: Sure. And lastly I

3 do want to especially point out that this is

4 a critical area that has had good bipartisan

5 collaboration, and needs to.

6 So first of all, I want to thank

7 Senator Amedore and Senator Akshar, who -- on

8 either side of me today -- certainly Senator

9 Boyle on Long Island. You know, there's not

10 time for partisanship here. We're drowning,

11 and everybody needs to pull together to help

12 here. So we all need to work together.

13 Please count on me as a resource for

14 whatever your agency needs, whether it's

15 information or anything else, and I hope we

16 can all work together to fight this. The

17 worst part of my job so far has been talking

18 to parents who have lost loved ones, and they

19 tell you about those last moments. And if

20 you're not moved by that or you're not

21 willing or resolved to do everything you can

22 to fix the problem, then you don't belong

23 here.

24 So I want to try, and I'd like to work

207

1 with you to continue to do that.

2 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank

3 you.

4 CHAIRWOMAN YOUNG: Thank you.

5 CHAIRMAN FARRELL: Thank you.

6 Assemblyman Cusick.

7 ASSEMBLYMAN CUSICK: Thank you,

8 Mr. Chair.

9 Commissioner, it's good to see you. I

10 want to first thank you and your team for

11 being on Staten Island many times. You're no

12 stranger to the folks I represent and the

13 people on Staten Island and to the issue of

14 the opioid and heroin epidemic that's going

15 on throughout the state.

16 But in my district and throughout

17 Staten Island, it's been -- you've worked

18 with all the elected officials, and the

19 Governor's resources have been very helpful.

20 And I just wanted to publicly acknowledge

21 that, because it's important that people know

22 that we need people in government to help us

23 in this epidemic.

24 My colleagues have talked about the

208

1 funding and where we're going with a lot of

2 these numbers. I wanted to ask a question on

3 treatment. Treatment is a big issue. I

4 think that treatment is the important cog in

5 this fight against the epidemic. We have

6 many qualified treatment facilities

7 throughout New York State, New York City, and

8 many dedicated professionals in that field.

9 A question I have for you is

10 particularly after we cut down on the usage

11 of opioid pills, prescription pills, with

12 I-STOP and the increase in heroin use -- are

13 there numbers that we know of, has there been

14 an increase in people seeking treatment in

15 the last year or two?

16 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:

17 Actually, our data has shown that people

18 seeking services, inpatient services, have

19 increased for heroin and opioids and actually

20 decreased for all the other substances. So

21 yes, we have seen an increase in people.

22 ASSEMBLYMAN CUSICK: So we have seen

23 it working --

24 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes.

209

1 ASSEMBLYMAN CUSICK: And we have seen

2 the --

3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes,

4 absolutely.

5 ASSEMBLYMAN CUSICK: That's very

6 important. I know that many of my colleagues

7 have been talking about seeing that the

8 funding that we put together is working, and

9 that's what I'm very interested in knowing,

10 is are people seeking treatment and are

11 people using it. And that's good to hear.

12 On that point too, one of my

13 colleagues brought up -- a couple of my

14 colleagues brought up Narcan. And Narcan has

15 been used as a tool -- particularly there are

16 many overdose cases in our borough and

17 throughout New York City. The question on

18 Narcan is how many folks who are administered

19 Narcan, how many of those -- are there

20 numbers that are available that show how many

21 of them then go to treatment after they are

22 saved from an overdose?

23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I

24 could see if we have that data. I'm not sure

210

1 right now if we actually do, but I will

2 certainly be collecting that. I mean, that's

3 something we need to be looking at, and

4 certainly moving forward we are going to,

5 so --

6 ASSEMBLYMAN CUSICK: Right. Because

7 again, I think it was my colleague Senator

8 Kaminsky that brought up that there are many

9 people who are being administered Narcan many

10 times, and I think it's -- we need to know

11 how many folks. Because we all know, and we

12 have -- on Staten Island, we have many of

13 these Narcan training events, and hundreds of

14 people come because it's mainly parents of

15 families who are scared to death. But we

16 point out that this isn't -- this saves them

17 from the OD, but from that point they need to

18 go get treatment.

19 And so I think if you could get us

20 those numbers, that would really be important

21 to us, particularly in this budget process

22 coming up.

23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I

24 think moving forward we'll have better

211

1 numbers because that's exactly what the peers

2 will be doing. And as you know, the peer

3 program has just started to become

4 operational.

5 Certainly we could get numbers from

6 the EDs where they say, you know, we've

7 released them and we've given them a

8 referral. The question is not so much the

9 referral, the question is if they make it to

10 the referral. So that's where the peers

11 would be ideal in collecting that data.

12 ASSEMBLYMAN CUSICK: And I just want

13 to add to the chorus here that the Senate and

14 the Assembly and the Legislature, in adding

15 money in last year's budget, I've seen the

16 dividends, I've seen the product of it.

17 We just opened up an adolescent

18 clubhouse in Staten Island. You've been out

19 on Staten Island, there have been many

20 roundtable discussions, but there is a strong

21 need for more funding. And I will urge my

22 colleagues -- I don't think there needs to be

23 much urging, but we will fight for more

24 funding.

212

1 Thank you.

2 CHAIRWOMAN YOUNG: Thank you,

3 Assemblyman.

4 Senator Krueger.

5 SENATOR KRUEGER: Good afternoon,

6 Commissioner.

7 So I represent a section of Manhattan,

8 and my district has a task force working with

9 the police department and the Department of

10 Homeless Services to deal with street

11 homelessness issues. We hear constantly from

12 the police and Department of Homeless

13 Services that there are homeless people who

14 need drug treatment who ask for it, who say,

15 Yes, I'll come in off the streets to go to

16 it, and they rotate through a three-day detox

17 and they can never get a slot in a

18 residential drug treatment program.

19 Now, these are going to be

20 Medicaid-eligible people, not private

21 insurance, and they're going to be people who

22 historically probably had a lot of trouble

23 getting any kind of medical records because

24 they are in fact homeless and on the streets.

213

1 There is often an overlap between mental

2 illness and substance abuse for people on the

3 streets. Both agencies are begging, How do

4 we get these beds that we need if you're a

5 street homeless person in New York City?

6 So you have funds for new residential

7 programs, you have a commitment to help

8 people with longer-term residential treatment

9 when the short-term models aren't working.

10 How do I get these folks into treatment?

11 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So to

12 that I'd like to say that we are working hand

13 in hand with the Department of Homeless

14 Services in New York City, together with OMH

15 and ourselves, to identify shelters.

16 I believe there are a number of

17 shelters that have been identified as

18 high-needs shelters that do have a high

19 number of mentally ill and addiction

20 individuals. And we're in the process of

21 developing or -- not developing, we are

22 working through the process of assigning

23 shelters to our community-based

24 organizations. As a matter of fact, I'm

214

1 going to say two months ago or so I had a big

2 meeting in the New York City office where I

3 brought our community-based providers, our

4 addiction community-based providers, together

5 with the shelter operators so that they could

6 get to know each other so that when an

7 individual appeared at the shelter that

8 needed our services, that they knew who to

9 communicate with, whom they could reach out

10 to.

11 And so, you know, we have just started

12 establishing that relationship. Because I've

13 been hearing that, you know, there are

14 homeless individuals that need SUD

15 services -- but interesting enough, the

16 shelters didn't know that we had

17 community-support SUD providers that were

18 there to provide that service. So --

19 SENATOR KRUEGER: So I'm still

20 confused. So this is -- if someone goes into

21 a shelter, they can get referred into one of

22 your residential facilities?

23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We

24 have -- what we have is community-based

215

1 providers that will either go out into the

2 shelters to do assessments off-site, because

3 now we're able to go out of the four walls of

4 the clinic and do assessments, and if we find

5 that there are people that are appropriate

6 for clinical treatment services, we could

7 refer them and treat them because of Medicaid

8 and so on and so forth.

9 So we have identified individuals that

10 will be, for the lack of a better word,

11 attached to a particular shelter, and they

12 can go once, twice -- you know, I don't know

13 the details of how often they'll go to the

14 shelters and do the actual assessments of

15 individuals and identifying the individuals

16 that may need additional care and engage them

17 to go into care.

18 SENATOR KRUEGER: Okay. So I think

19 we're talking about two different

20 populations. Because if you're somebody who

21 is homeless and in the shelter system, there

22 may be one pathway. But there are enormous

23 numbers of people who are homeless on the

24 streets who will not go into the shelters

216

1 because of the combination of being mentally

2 ill and substance abusing.

3 So the Department of Homeless Services

4 has a separate system of outreach workers who

5 coordinate with the police precincts, and

6 those people don't seem to be getting any

7 access to residential treatment.

8 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.

9 So I need to be made aware of where, who,

10 and -- who they are. Because we too are

11 having -- we do outreach as well, now. The

12 peers are also going out and doing outreach

13 to the people in the street, like you say,

14 not people in shelters, people especially

15 around the 125th Street area, that whole

16 area, doing outreach to actually engage some.

17 But if there're others, please let me

18 know. I'll be more than glad to see how we

19 could be helpful.

20 SENATOR KRUEGER: Great. So you have

21 people who can come out, work with the

22 outreach teams and the police, and direct

23 people into treatment who say they want it?

24 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We

217

1 have providers that will be able to do that,

2 yes.

3 SENATOR KRUEGER: So the peer

4 counselors, I think that's the term you use,

5 they actually have the authority to move

6 people into treatment slots?

7 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: They

8 don't have the authority to move them, they

9 have the ability to engage them and get them

10 to agree to come into treatment, and then we

11 will provide the treatment that they need.

12 SENATOR KRUEGER: Okay. So yes, I

13 would love to know who in your office can

14 coordinate with us on the --

15 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:

16 Absolutely.

17 SENATOR KRUEGER: We actually have

18 people who say, I want this, and nobody can

19 get them in -- not Department of

20 Homeless Services, police department,

21 nobody. So we want that access.

22 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Great.

23 SENATOR KRUEGER: Thank you.

24 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.

218

1 CHAIRWOMAN YOUNG: Thank you.

2 Anyone?

3 CHAIRMAN FARRELL: Assemblyman

4 McDonald.

5 ASSEMBLYMAN McDONALD: Thank you,

6 Mr. Chair.

7 And Commissioner, thank you for your

8 great work. You and your team are always

9 very responsive to our needs. And, as I

10 always say, it's very difficult to catch the

11 wave when it's already been three or four

12 feet ahead of you. So we're working on it,

13 day by day and program by program.

14 I think Member Rosenthal kind of

15 started to get into this, and you -- I think

16 you called them hubs, these urgent access

17 centers?

18 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes.

19 ASSEMBLYMAN McDONALD: So I'm not

20 terribly familiar with them. Are they

21 currently in place in the state?

22 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: No.

23 This is a brand new model that we're

24 introducing as part of this Executive Budget.

219

1 ASSEMBLYMAN McDONALD: Okay. I

2 remember -- is that what you were mentioning

3 as the hubs to --

4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Yes.

5 ASSEMBLYMAN McDONALD: Okay. And I

6 remember you saying that, you know, that's

7 going to be statewide, you're going to put up

8 an RFP to kind of see where the need is, and

9 then hopefully that will work out.

10 I guess the question is, do you

11 envision this being run by -- who are the

12 eligible entities? Is it a nonprofit, is it

13 a hospital system, is it a medical practice?

14 Do we have an idea of what it would be to --

15 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: We

16 don't limit it, but I think the -- I think we

17 would like it to be a community-based

18 provider, but it's not limited to a

19 community-based provider. We're welcome to

20 see what proposals or responses we get.

21 Different areas may have different needs, may

22 have different setups, so we don't want to

23 limit any of the options that we have in

24 place.

220

1 ASSEMBLYMAN McDONALD: So is there

2 going to be -- and so I imagine it will be

3 not only for a physical site but also

4 staffing?

5 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Oh,

6 yes.

7 ASSEMBLYMAN McDONALD: Right?

8 Obviously. And is there going to be any

9 minimal clinical requirements for like a

10 nurse to be on duty? Or is it just going to

11 be clinical coordinators, is it going to be

12 social workers --

13 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,

14 it's going to be a clinical model. So, you

15 know, we'll develop the model as we go along.

16 But if it's a 24/7 urgent care, I don't know

17 that you're going to require to have an MD on

18 site.

19 ASSEMBLYMAN McDONALD: Right.

20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: But

21 there will need to be access to an MD in the

22 event that you get an individual at three in

23 the morning that has to be stabilized, or a

24 nurse practitioner or a physician assistant

221

1 as we move forward. So it is going to be a

2 clinical model, but it's also going to have

3 other kinds of supports as well.

4 ASSEMBLYMAN McDONALD: And I imagine

5 it could be, you know, there are real -- in

6 the other medical world, there are urgent

7 care centers which are kind of like more a

8 family practice or primary -- you know,

9 emergency but not an emergency room.

10 Would they be excluded from that? Or

11 would they be able to -- or has that not

12 gotten that far enough down the road yet?

13 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: You

14 know, I haven't thought about that. But, you

15 know, we have to look at the model and see.

16 If it works in certain areas because of the

17 limitation of the providers or the limits of

18 what we have in place, it may not be a bad

19 idea.

20 Right now we're not excluding

21 anything. We're open to proposals.

22 ASSEMBLYMAN McDONALD: Good. Thank

23 you.

24 As you mentioned earlier in your

222

1 testimony, there's a lot of different impacts

2 from last year's legislative session. One

3 was a leaflet that pharmacies are required to

4 give patients which is very complete, it

5 covers -- it's a great collaboration between

6 your agency and the Department of Health as

7 to really the dos, don'ts, the wants and

8 needs.

9 You know, one of the things that I've

10 always harped on is that the heroin epidemic

11 has been fueled by legally prescribed opioids

12 that are in the households. And that is part

13 of the information that's on those leaflets,

14 which is good.

15 The question that comes up is,

16 patients many times are saying, Well, what do

17 I do with this? How do I dispose of them?

18 And as we all know, pharmacies can take them

19 back. A lot are hesitant to, because you

20 have to worry about reverse distribution of

21 the drugs, the whole nine yards. Are there

22 any programs that are being supported through

23 OASAS to assist the community or the

24 community pharmacies or healthcare providers

223

1 to help facilitate disposal of legally

2 prescribed prescription drugs, to get them

3 out of the waste stream? Because as we know,

4 70 percent of heroin addicts started with

5 those prescriptions.

6 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: No.

7 OASAS does not, but I understand that maybe

8 DOH may, because this really does fall under

9 their jurisdiction. But we currently do not.

10 ASSEMBLYMAN McDONALD: Okay. Thank

11 you.

12 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank

13 you.

14 CHAIRMAN FARRELL: Thank you.

15 CHAIRWOMAN YOUNG: Thank you.

16 So just -- we can go through the

17 lineup. Next is Senator Krueger. Wait.

18 Senator Brooks, that's right. Senator

19 Brooks, then Senator Akshar, and finally

20 Senator Ortt.

21 So Senator Brooks.

22 SENATOR BROOKS: Thank you.

23 First, to a point that's been made by

24 a number of the members, I think the problem

224

1 is being greatly understated. As a first

2 responder, we're seeing it on an

3 ever-increasing basis, and there are a number

4 of cases where we have people that we're

5 visiting multiple times. I think it's

6 important that we really get a handle on how

7 big this problem really is if we want to

8 address it and if you're going to prepare a

9 budget that's going to address the problem

10 itself.

11 But I think it really is still hidden

12 in many cases, and a lot of attention has to

13 be given to quantifying just how many cases

14 are out there.

15 But to move to a different area for a

16 moment, can you address programs that you're

17 currently undertaking to address veterans in

18 terms of problems with substance abuse?

19 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So we

20 currently do have a variety of

21 veteran-specific programs. Off the top of my

22 head I can't tell you exactly where they are,

23 but we do have programs that are specific to

24 do treatment and also recovery services. But

225

1 I must say that all of our programs, all of

2 them, serve veterans.

3 I mean, if we have -- we ask the

4 question "Who do you serve" as part of the

5 data that we collect on a regular basis, and

6 often all of the programs seem to have

7 several veterans in there.

8 So we do have programs that are

9 specific for veterans. Also, for women vets,

10 we have at least two residential treatment

11 programs for women vets. And we also have

12 for males, but I don't have them off the top

13 of my head. But --

14 SENATOR BROOKS: Well, when you have

15 reports that, as you put it, all of them

16 involve veterans, isn't that a signal to you

17 that you need to look at that group and

18 concentrate on what's happening with them?

19 The fact that they appear on every report to

20 me would suggest that you might want to have

21 a program that's geared at that segment of

22 our society directly.

23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: And we

24 do, we do have -- and I'll be more than glad

226

1 to share the number of specific vet programs

2 that we have in the system. But I think, and

3 maybe I'm opening a can of worms here, there

4 is an issue with TRICARE where veterans can

5 go and get their treatment, and that usually

6 hampers veterans coming to our system,

7 because the military won't pay for the

8 services.

9 But setting aside from that, we do

10 have specific programs for vets. And if

11 you'd like to get a list, I will be more than

12 glad to give them to you.

13 SENATOR BROOKS: Okay. Thank you.

14 CHAIRWOMAN YOUNG: Thank you.

15 Assembly?

16 CHAIRMAN FARRELL: Assemblyman

17 Santabarbara.

18 ASSEMBLYMAN SANTABARBARA: Yup thank

19 you.

20 Just a quick question about some

21 concerns of doctors not having training or

22 time with the increased amount of treatment

23 they've had to do with opiate use. I just

24 wanted to ask if we were keeping track of how

227

1 many doctors are actually authorized to

2 prescribe the medication for assisted

3 treatment.

4 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: If we

5 have a number -- I believe we do, yes.

6 ASSEMBLYMAN SANTABARBARA: And is that

7 something we could find somewhere, that you

8 can report to us?

9 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I

10 could give you that report.

11 ASSEMBLYMAN SANTABARBARA: All right.

12 Thank you.

13 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: You're

14 talking about doctors in our system? Or

15 outside of our system?

16 ASSEMBLYMAN SANTABARBARA: Actually,

17 both would be good, just to keep track of how

18 many people are actually authorized to

19 prescribe the medication needed.

20 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.

21 Sure.

22 CHAIRWOMAN YOUNG: All set?

23 Okay, Senator Akshar.

24 SENATOR AKSHAR: Great, thank you,

228

1 Madam Chairwoman.

2 Welcome, Commissioner. It's always a

3 pleasure to be with you, and I publicly want

4 to thank you and your team for being so

5 receptive when we have issues in the

6 Southern Tier.

7 Let me start with community-based

8 providers. You're very familiar with

9 Fairview Recovery Services in the

10 Southern Tier. And are we addressing the

11 cost-of-living adjustment anywhere in the

12 Executive's proposal? Fairview, for an

13 example, has had a 70 percent, 70 percent

14 turnover in 2016 because of the low pay. Are

15 we dealing with that issue specifically?

16 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,

17 Senator, there's no cost-of-living increase

18 in any of the budgets. There's no reason why

19 it would be in my budget.

20 So the answer is no, we don't have a

21 cost-of-living increase or a cost-of-living

22 adjustment in our budget. You know, I do

23 want to emphasize the fact that we understand

24 and we take our workforce very seriously.

229

1 It's not to say that we undermine the work

2 that they do, that we don't value the work

3 that they do. It's quite the contrary,

4 especially in the addiction system.

5 But at the same time, the Governor has

6 put in millions of dollars in the budget to

7 address the minimum wage. And I understand

8 that the minimum wage and what we're talking

9 about, the cost of living, are somewhat

10 different from where I stand. We in our

11 system have $5 million that was put in to

12 address the minimum wage in our

13 community-based organizations.

14 So what that is telling me that's

15 currently -- even with the COLA adjustments

16 that we have had, as you've heard, you know,

17 in the last three consecutive years there's

18 still -- it's quite -- there are still quite

19 a few people that are doing way below the

20 minimum wage in our system of care. So, you

21 know, I support the fact that these

22 individuals have to be brought up to the $15.

23 With respect to the cost-of-living

24 adjustment, what I could say is that, you

230

1 know, I will continue to monitor the

2 agencies, work with the agencies, as I have

3 done in the past, to ensure that they can

4 still function within our parameters. And I

5 look forward to continuing my discussion with

6 the Legislature with respect -- you know, in

7 the context of the budget discussion.

8 SENATOR AKSHAR: Thank you.

9 What happened to the Technical

10 Assistance Unit that used to help providers

11 with documentation compliance? One thing I

12 hear from providers is that, you know, the

13 regulatory requirements are somewhat

14 difficult and OASAS doesn't provide case

15 model documents that accompanies the new

16 regulations. Do you do that? Am I being

17 given good information?

18 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,

19 I'm not sure that's accurate information. I

20 mean, if there's anyone that needs technical

21 assistance, we're there to give technical

22 assistance, so --

23 SENATOR AKSHAR: Do you still have a

24 particular unit called the Technical

231

1 Assistance Unit?

2 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Not

3 per se. But our field office will be able to

4 assist.

5 SENATOR AKSHAR: Let me ask a question

6 about Narcan that's been brought up by

7 several of my colleagues. I, for one, am a

8 proponent of ensuring that there is more than

9 enough Narcan in the community. Senator

10 Young mentioned statistics being

11 underreported.

12 Is there somewhat of a concern that,

13 you know, first responders are required to

14 fill out certain documentation so we know it

15 was deployed, on whom -- because we're

16 putting so much Narcan into the system, could

17 we be underreporting statistics? We have to

18 set some form of benchmark in order for us to

19 determine whether we're successful or not,

20 right?

21 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Right.

22 I agree. And again, I think that's a

23 question better suited for the Department of

24 Health, as they are the ones that get the

232

1 actual documentation.

2 SENATOR AKSHAR: Okay, let me make

3 just two more points, if I may. I just want

4 to publicly bring up retrospective review, as

5 we've discussed in our conversation last

6 week. I just want to put that on the radar

7 and ensure that it stays on the radar and

8 that we do our due diligence in ensuring that

9 insurance providers are not abusing that,

10 because the last thing I'd want to see is

11 healthcare providers being reluctant to

12 provide that service that we're working so

13 hard --

14 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:

15 Absolutely. And that's what we're focusing

16 on this coming year, to really look and make

17 sure that all the regulations that have been

18 put into place are being implemented. And

19 like I said to you, if you get any actual

20 cases, please report them to us.

21 I think what's been happening is that

22 sometimes the providers also do not submit

23 enough information to the managed care

24 company, enough so that the managed care

233

1 company can make a true evaluation and

2 determination of the case, in which case then

3 they will say, Okay, so now I'm going to go

4 retroactive.

5 So I think we need to be open to both

6 sides and we need to monitor that both the

7 insurance managed care company as well as the

8 providers are doing each their share. And

9 like I said, if you find instances where that

10 is occurring, please let us know. We would

11 like to intervene immediately.

12 SENATOR AKSHAR: Thank you. I know my

13 time is up. I have one last question, if the

14 Chairwoman would be so kind.

15 The Criminal Procedure Law allows for

16 asset forfeiture, and a portion of that asset

17 forfeiture by law enforcement requires a

18 portion of that money to go into the

19 Substance Abuse Services Fund. My question

20 is two parts. Do you know how much money is

21 currently in the Substance Abuse Services

22 Fund? And if so, what is it?

23 And then the second part of my

24 question is, how much money in this year's

234

1 executive proposal for OASAS is coming from

2 the Substance Abuse Services Fund?

3 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: So the

4 first question is, you know, the actual

5 amount fluctuates from year to year, based on

6 court proceedings and what happens in the

7 courts.

8 And in terms of how much money comes

9 into OASAS, we fund our campaign out of that,

10 we do some of our peer supports, we do some

11 of our SBIRT interventions. I don't have the

12 exact number, but I will try to get that

13 number for you.

14 SENATOR AKSHAR: The only reason I ask

15 is because, you know, obviously we have such

16 a major issue. It's an epidemic, that we all

17 agree upon, and there's no sense in leaving

18 money sitting in that account if we don't

19 have to. In my humble opinion, we should be

20 spending it.

21 I want to thank you for your service

22 and all your work on this issue. It's

23 incredibly complex, and if there was a simple

24 answer, any one of us up here or you or your

235

1 team would offer to solve it. I agree with

2 Senator Kaminsky, it's a community issue that

3 requires a community's response. I think

4 we're there, we're all headed in the right

5 direction, and we need to continue to do

6 that.

7 So again, I publicly thank you for

8 everything that you're doing.

9 CHAIRWOMAN YOUNG: Thank you, Senator.

10 Senator Ortt.

11 SENATOR ORTT: Thank you very much,

12 Commissioner. I think I'm last, so I'll try

13 to be brief because I know we still have

14 several other speakers who have to go

15 through.

16 First of all, I want to thank you for

17 your assistance over the last two years,

18 because I served as a co-chair of the task

19 force, going around the state, doing a lot of

20 good work, having a lot of good

21 conversations, some of them challenging. But

22 I want to thank you for your assistance.

23 You know, it's more of a statement,

24 and maybe you can offer a response. I know

236

1 it's been brought up already a little bit,

2 but I think it's important to note, when you

3 leave here today, one of the real challenges

4 that I feel as a legislator and that I hear

5 from a lot of folks in my district and across

6 the state is when it comes to the beds and

7 the funding for the beds, and even funding

8 for in-community -- you know, supports in the

9 community or services in the community, many

10 of these seem to exist on paper, but they're

11 not getting -- whenever I talk to folks in

12 the community, they're still having a hard

13 time getting into inpatient treatment.

14 And so while we can point to these

15 beds and the existence of these beds and the

16 existence of this funding for it, you know,

17 I'm a big believer that if it's not -- if

18 people aren't seeing it, if it's not getting

19 to the areas that it's needed, then it's

20 almost like it didn't happen.

21 And so I just think it's very

22 important that we get these funds out the

23 door as soon as possible and get these beds

24 online as soon as possible. Because you

237

1 certainly understand that there is a list, a

2 waiting -- you know, a waiting tide for these

3 services as we sit here and speak today.

4 I don't know if you want to comment on

5 that. If not, that's okay.

6 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: No, I

7 guess what I would say is I agree

8 100 percent, and that's what we have been

9 trying to do.

10 In terms of some treatment programs in

11 certain areas, you know, we have a big

12 challenge with community opposition which,

13 you know, I didn't raise. But, you know, I

14 really need to raise it, because that's a

15 reality for a lot of the things we do.

16 Just this past year, trying to open

17 certain programs in certain areas was really

18 extremely difficult. So I just want to put

19 it in the context that of course we want to

20 get the services out, that's what we're

21 interested in. And we will continue to try

22 to do that to the best of our ability.

23 SENATOR ORTT: Is this budget -- and

24 it may have been touched on; I don't think it

238

1 was. You know, across the state there's been

2 programs -- I know it was mentioned about

3 prisoners, you know, folks who are in prison

4 who are recovering addicts. And one of the

5 drugs or treatment that I've been very

6 interested in is Vivitrol. And I know there

7 are pilot programs, I know here in Albany

8 County and other parts of the state that

9 certain sheriffs are doing it in their

10 prisons, you know, for certain prisoners.

11 Is there any interest or any funding

12 to assist localities, local sheriffs, with

13 some kind of program like that? You know,

14 one thing that interests me about Vivitrol is

15 that it's not a narcotic, and there's not

16 addictive qualities -- you know, no one's

17 going to get addicted to Vivitrol, but

18 unfortunately sometimes you can become

19 addicted to methadone or another type of

20 narcotic.

21 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Right.

22 Right. So we are providing funding.

23 Currently I think we have 19 or 17 programs

24 with local sheriffs throughout the state.

239

1 And we are providing funding for personnel to

2 carry out these programs in the Vivitrol.

3 SENATOR ORTT: And how is that funding

4 decided and then handed out?

5 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: How is

6 it decided?

7 SENATOR ORTT: Like, where is it

8 going, over the 19 counties?

9 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Well,

10 it's voluntary, so if there's a sheriff that

11 says, I would like to implement this program,

12 they speak to us. And we have a set amount

13 of money that we have been funding all the

14 other programs who want to keep it within

15 that parameter, and yeah, we will support

16 them if we're able to.

17 SENATOR ORTT: If you're able to as

18 far as the parameters or the funding?

19 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: The

20 funding.

21 SENATOR ORTT: Could I get a list of

22 the 19 that are being funded right now?

23 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Sure.

24 SENATOR ORTT: And where they are?

240

1 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Sure.

2 Sure.

3 SENATOR ORTT: And are you familiar

4 with the proposal, the House of Hope proposal

5 in Erie County?

6 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:

7 Fairly, yes.

8 SENATOR ORTT: Okay. Are you fluent

9 enough to speak to it, at least whether you

10 think it's a worthwhile model to pursue or

11 not?

12 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: I'm

13 not at that point yet, no.

14 SENATOR ORTT: Okay. I would

15 encourage you to take a second look at it.

16 You know it is supported, of course,

17 by Avi Israel, whose Save the Michaels of the

18 World obviously is -- he knows this topic

19 probably as well as a lot of people who've

20 spent their whole lives in it. But I think

21 it's something that could be looked at as a

22 potential model or pilot program or something

23 the state could partner with to support, kind

24 of like a self-direction on the OPWDD side.

241

1 This would be obviously on the --

2 COMMISSIONER GONZ¡LEZ-S¡NCHEZ:

3 Absolutely. Avi has been a great supporter.

4 And yes, I am familiar but don't have the

5 details. But I will be looking into it.

6 SENATOR ORTT: Please do. Thank you.

7 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Okay.

8 Thank you.

9 CHAIRWOMAN YOUNG: Thank you,

10 Commissioner. We appreciate your testimony.

11 COMMISSIONER GONZ¡LEZ-S¡NCHEZ: Thank

12 you.

13 CHAIRWOMAN YOUNG: The next speaker is

14 Jay Kiyonaga, executive deputy director,

15 New York State Justice Center for the

16 Protection of People with Special Needs.

17 Welcome.

18 EXEC. DEP. DIR. KIYONAGA: Thank you.

19 CHAIRWOMAN YOUNG: How did I do with

20 the pronunciation of your name?

21 EXEC. DEP. DIR. KIYONAGA: I think you

22 did better the first time. It's Kiyonaga.

23 CHAIRWOMAN YOUNG: Oh, I did? okay.

24 Sorry about that.

242

1 EXEC. DEP. DIR. KIYONAGA: Jay is

2 fine.

3 CHAIRWOMAN YOUNG: Okay.

4 EXEC. DEP. DIR. KIYONAGA: Good

5 afternoon. My name is Jay Kiyonaga. I am

6 the executive deputy director of the Justice

7 Center for the Protection of People with

8 Special Needs. I would like to thank you for

9 the opportunity to testify today regarding

10 Governor Cuomo's 2017-2018 Executive Budget

11 proposal for the Justice Center.

12 Under the leadership of

13 Governor Cuomo, and with the full support of

14 the New York State Legislature, New York

15 became the first state in the nation to

16 create an independent state agency dedicated

17 to safeguarding people with special needs.

18 Before the Justice Center, there were no

19 consistent definitions of abuse and neglect

20 across the systems providing care to service

21 recipients. There was no mandated reporting

22 of abuse and neglect. Many systems lacked

23 independent investigations of abuse and

24 neglect, and police and district attorneys

243

1 did not have the dedicated resources to

2 effectively investigate and prosecute these

3 very challenging cases.

4 Today, approximately 1 million adults

5 and children who receive services are now

6 protected by the Justice Center. On June 30,

7 2013, the Justice Center began serving as the

8 state's central reporting agency for

9 incidents of abuse, neglect and other serious

10 incidents. The Justice Center works closely

11 with six state oversight agencies who are

12 responsible for licensing, operating and

13 certifying the services provided to these

14 individuals.

15 Our primary responsibility is to

16 ensure that people with special needs are

17 protected from abuse, neglect and

18 mistreatment. We recognize that the Justice

19 Center may have created anxiety for some

20 providers and staff members. However, it is

21 important to remember that our investigations

22 are triggered by someone calling the

23 Justice Center to report that abuse and

24 neglect may have occurred. We have a legal

244

1 obligation to investigate these reports, and

2 we make our best efforts to minimize any

3 disruption of services that may result from

4 our investigations.

5 Our efforts over the past three and a

6 half years have made facilities and programs

7 safer for both individuals with special needs

8 and the dedicated men and women who provide

9 services. Still, abuse and neglect in these

10 settings continues to be a serious problem.

11 In 2016, the Justice Center received

12 reports of over 10,000 suspected cases of

13 abuse and neglect. Most of these reports

14 were made by staff members, service

15 recipients, or their family members. Every

16 one of these incidents is thoroughly

17 investigated. Approximately one-third of all

18 abuse and neglect cases result in a

19 substantiated finding. In many cases, the

20 Justice Center identifies areas of concern

21 and works with State and provider agencies on

22 corrective actions to prevent future abuse.

23 Now, people receiving services and

24 their family members can take comfort in

245

1 knowing that employees who are found

2 responsible for the most serious or repeated

3 acts of abuse and neglect may no longer work

4 with service recipients in settings under our

5 jurisdiction. Since 2013, more than

6 300 staff members have been placed on a Staff

7 Exclusion List. The workers on this list

8 have committed offenses such as hitting,

9 choking, punching and sexually abusing

10 service recipients. Permanently removing

11 these workers from the service system

12 promotes a safer environment.

13 Workers who report abuse and neglect

14 can now be certain that their reports will be

15 taken seriously. Workers who are named as

16 subjects of an allegation can have the

17 confidence that a professional independent

18 investigation will be conducted. They can

19 also be confident that their legal and union

20 rights will be honored, and that they can

21 appeal any finding made against them.

22 The Governor's Executive Budget

23 supports the Justice Center's comprehensive

24 system for incident reporting,

246

1 investigations, employee discipline and

2 prosecutions. With the support of state

3 funds, the Justice Center has accomplished a

4 number of goals since it began operations:

5 We conduct approximately 94,000

6 pre-employment checks each year to ensure new

7 employees do not have a criminal history that

8 would jeopardize the safety of people with

9 special needs;

10 We ensure that mandated reporters and

11 others can easily report allegations of abuse

12 and neglect by maintaining a toll-free

13 hotline, which is staffed 24 hours a day,

14 7 days a week;

15 We educate mandated reporters about

16 their responsibilities;

17 We support high quality and timely

18 investigations across the state through the

19 operation of 15 regional offices;

20 We promote quality investigations by

21 offering extensive training for investigators

22 employed by the Justice Center, as well as

23 investigators working for state and private

24 providers;

247

1 We hold workers who engage in criminal

2 conduct against vulnerable service recipients

3 accountable. In 2016 alone, the Justice

4 Center led 69 prosecutions. We also

5 collaborate with local district attorneys by

6 notifying them of alleged abuse and neglect

7 occurring in their jurisdiction, and by

8 providing assistance in prosecuting these

9 cases;

10 We promote efforts to prevent abuse

11 and neglect by collaborating with our

12 Advisory Council and stakeholders. This has

13 resulted in a model abuse prevention policy

14 for providers, along with guidance on best

15 practices to promote abuse-free environments

16 for people with special needs.

17 In 2016 alone, the Justice Center's

18 Individual and Family Support Unit provided

19 support and information to over 3,500

20 individuals and families.

21 During our first three years, emphasis

22 was necessarily placed on establishing an

23 incident management call center, an

24 investigations unit, and a prosecutor's

248

1 office. There will be continued attention

2 given to process improvements in these areas,

3 including efforts to complete quality

4 investigations in less time by adopting

5 administrative changes. For example, we are

6 working to implement protocols to assess,

7 within 72 hours, whether a report of alleged

8 abuse and neglect should, based upon

9 additional facts, warrant further

10 investigation.

11 During 2017, a greater emphasis will

12 also be given to other components of the

13 agency and its mission. With the support of

14 existing funds, such efforts will include a

15 focus on abuse prevention and statewide

16 outreach initiatives for workforce members.

17 With your continued support, we have

18 been able to meet our mission of protecting

19 the health, safety, and dignity of some of

20 New York's most vulnerable people. The

21 Justice Center looks forward to working with

22 our partners in the Legislature, the state

23 oversight agencies, and all of our other

24 stakeholders to continue to strengthen

249

1 protections for people with special needs.

2 Thank you for the opportunity to

3 provide testimony. I would be glad to answer

4 any questions you may have.

5 CHAIRWOMAN YOUNG: Thank you, Jay.

6 How is the system different than it

7 was prior to the Justice Center?

8 EXEC. DEP. DIR. KIYONAGA: I think the

9 system is very different now, as opposed to

10 before the Justice Center. First of all,

11 there are standardized definitions of abuse

12 and neglect across all the service delivery

13 systems under the Justice Center's

14 jurisdiction. There are strict mandated

15 reporting requirements for custodians. We

16 operate a 24/7 hotline to receive those

17 reports of abuse and neglect. And we have

18 investigators to investigate the -- to

19 provide independent investigations of any

20 alleged abuse and neglect in the system.

21 CHAIRWOMAN YOUNG: So thank you.

22 Specifically, are all individuals who

23 engage in abuse or neglect identified,

24 prosecuted, and banned from providing

250

1 services to people with special needs?

2 EXEC. DEP. DIR. KIYONAGA: Are all

3 people who abuse people with special needs

4 identified?

5 CHAIRWOMAN YOUNG: No, are -- well,

6 are they -- those who engage in abuse or

7 neglect, are they identified, prosecuted and

8 banned from providing services to people with

9 special needs?

10 EXEC. DEP. DIR. KIYONAGA: If someone

11 reports abuse and neglect of a service

12 recipient, it is fully investigated. And if

13 it warrants criminal investigation or

14 criminal prosecution, we would pursue that,

15 either alone or with a local DA.

16 CHAIRWOMAN YOUNG: Conversely, has the

17 triage process that the Justice Center uses

18 experienced misclassifications of the

19 appropriate actions that have resulted in

20 incidents of abuse or neglect that should

21 have been avoided?

22 EXEC. DEP. DIR. KIYONAGA: I think

23 early on, there was misclassifications. We

24 had a very short time frame to get our call

251

1 center up and running and staff trained and

2 accustomed to the electronic case management

3 system we had.

4 But we've worked very closely with the

5 state oversight agencies to better define the

6 types of activities that would fall into a

7 reportable incident, whether it be abuse and

8 neglect or a significant incident. And there

9 are procedures for providers or state

10 agencies to contact the Justice Center to

11 review the information we receive to see if a

12 reclassification is appropriate.

13 CHAIRWOMAN YOUNG: Staff who are being

14 investigated as a result of a complaint may

15 be placed on administrative leave or

16 terminated, and the length of time for

17 investigation forces providers to hire new

18 staff, and employees then can be left in

19 employment without pay until the situation is

20 resolved. So this may lead to a significant

21 amount of time.

22 The question is, what actions has the

23 center taken in response to the numerous

24 complaints regarding the length of time for

252

1 investigations?

2 EXEC. DEP. DIR. KIYONAGA: We've taken

3 a number of actions since June 30, 2013, to

4 try to ensure that we provide a quality

5 investigation in a timely manner.

6 Some examples of that would be

7 additional investigative staffing. We've

8 added a lot more staff out in the regions.

9 We've also instituted more regional offices

10 to make sure that our investigators can

11 arrive at the destination, a facility where

12 they need to do the investigation, in a more

13 efficient manner.

14 As I said in my testimony, we also

15 have instituted a 72-hour protocol which

16 we'll be rolling out broader over the new

17 year. What that does is when we get certain

18 reports of abuse and neglect, we -- before we

19 launch an investigation, we work with the

20 provider to gather more information to see if

21 we can determine whether or not a

22 reclassification is appropriate.

23 CHAIRWOMAN YOUNG: Thank you. So

24 anything you can do to expedite the process I

253

1 think would be very beneficial.

2 There also have been numerous

3 complaints that the Justice Center has a law

4 enforcement approach for all investigations,

5 regardless of the nature of the complaint.

6 And this has led to fear and anger among

7 provider staff.

8 How do you respond to these

9 allegations, and what actions have been

10 taken? Because obviously if it's a really

11 serious, serious allegation versus something

12 that may be minor -- I think that in the

13 past, all of the allegations have been

14 treated the same, and it's led in some cases

15 to people feeling like there was an

16 overreaction. So what have you done to

17 change that?

18 EXEC. DEP. DIR. KIYONAGA: Clearly we

19 take every allegation of abuse and neglect

20 very seriously, as we should. I think that

21 things have changed since before the Justice

22 Center. I think that our investigations are

23 more formal and more focused and independent.

24 I think that's different than what the system

254

1 was used to before.

2 And I assume you're talking about, you

3 know, private providers. But I can assure

4 you that a very small percentage of the cases

5 that are reported to us end up being a

6 criminal case; about 1 percent lead to arrest

7 or a prosecution. And so the other, you

8 know, 10,000 or so are going to be handled on

9 our administrative side.

10 And again, those would not involve our

11 criminal administrators generally, they would

12 be our administrative investigators. And on

13 the private side, if the Justice Center is

14 investigating, it's going to be a fairly

15 serious allegation of abuse and neglect. We

16 do delegate investigations back to providers

17 to investigate. They all come back to us for

18 review and final determination, but the

19 lesser allegations of abuse and neglect on

20 the private provider side are usually

21 delegated back.

22 CHAIRWOMAN YOUNG: Okay, thank you.

23 CHAIRMAN FARRELL: Thank you.

24 Questions?

255

1 ASSEMBLYWOMAN GUNTHER: Yes.

2 Thank you very much for coming today.

3 So I have a few questions, and I just want to

4 understand like the proper reporting process.

5 ASSEMBLYMAN McDONALD: Aileen, hit the

6 microphone.

7 ASSEMBLYWOMAN GUNTHER: Oh, sorry. We

8 have to do sharing around here. Okay, thank

9 you very much.

10 So first of all -- I just want to ask

11 you just a few questions. First of all, how

12 has the existence of the Justice Center

13 improved the quality of care for vulnerable

14 people?

15 EXEC. DEP. DIR. KIYONAGA: Well, with

16 respect to abuse and neglect, clearly, for

17 those victims, about 4,000 substantiated

18 cases a year, I think that they feel that

19 they would have justice as a result of

20 Justice Center investigations and the

21 creation of the Justice Center.

22 ASSEMBLYWOMAN GUNTHER: Well, before

23 your existence, when you say 4,000, can you

24 tell me about that? I mean, were they --

256

1 tell me the process before the Justice Center

2 was created.

3 EXEC. DEP. DIR. KIYONAGA: Sure. I

4 mean, each agency had different processes.

5 The definitions for abuse and neglect varied

6 across those different systems. And also the

7 reporting requirements were very different

8 across the systems.

9 So with the Justice Center, there was

10 consistent definitions of abuse and neglect,

11 there was consistent reporting

12 requirements -- you know, specifically the

13 mandated reporting requirement -- and then

14 there's a call center to centrally receive

15 all of those reports.

16 With respect to how we prevent abuse

17 and neglect, I think I mentioned in my

18 testimony that we do 96,000 pre-employment

19 criminal background checks each year --

20 ASSEMBLYWOMAN GUNTHER: I'm going to

21 interrupt you. Give me your definition of

22 abuse and neglect. What is your -- like are

23 there different categories? Like let me

24 understand the definitions of Category 1,

257

1 Category 2, and Category 3.

2 EXEC. DEP. DIR. KIYONAGA: I mean,

3 abuse and neglect is defined in the statute.

4 There are four categories of abuse and

5 neglect. So when -- abuse and neglect is a

6 general definition. But once an abuse and

7 neglect allegation is substantiated, our

8 counsel's office assigns a category in

9 accordance with the law.

10 Category 1 is going to be the most

11 serious case of abuse and neglect, where

12 there is usually serious injury. These

13 things may even rise to a criminal level.

14 Category 2 isn't as serious as Category 1,

15 but there's a great risk of harm or serious

16 injury. Category 3 is abuse and neglect but

17 does not rise to the level of Category 2.

18 And then Category 4 is more of a systemic

19 issue. Category 4s are levied against a

20 provider and reflect when there is either no

21 individual culpability determined or there's

22 a systemic problem that allowed that abuse

23 and neglect to happen.

24 ASSEMBLYWOMAN GUNTHER: If you would

258

1 just allow me to -- you know, I have gone

2 from place to place to kind of find out about

3 the Justice Center and about non-for-profits.

4 And, you know, before the Justice Center was

5 created, a good non-for-profit had a quality

6 improvement, and someone that already did

7 some sort of research. And normally, I mean,

8 if you ever got surveyed by a state agency,

9 they were prepared for a survey and kind of

10 knew. And of course there are things that

11 are outliers and do go wrong.

12 So I'm just going to tell you what

13 I've learned just from talking to different

14 people. And I think it's -- I find this is

15 something that we're going to improve the

16 quality of care across the board, and that's

17 why I'm here and that's why you're here.

18 So they said inconsistent

19 categorizations, a lengthy wait of time for

20 an investigation, re-delegation without

21 notice. Lack of direct communication.

22 Agency staff must still contact all relevant

23 parties, but with significantly less

24 information.

259

1 There's precious time needed to

2 collect evidence; it's lost during this

3 phase. So between Phase 1 and Phase 2, often

4 people's image of what they saw or like, you

5 know, three people might remember it just a

6 little bit different if they're the witness.

7 They said the communication at the

8 Justice Center is inconsistent. And I'm

9 telling you this and going through this

10 because I think that we definitely care about

11 the developmentally disabled community, and

12 we care about these investigations and we

13 believe in quality of care. But we're also

14 talking about very poor non-for-profits,

15 people that are DSPs, and their feelings.

16 And I think that, you know, we can only get

17 better and this is, to me, a class in how can

18 we improve the quality of care and the

19 quality of work we're doing.

20 The timeliness of collection. The

21 agency, in allegations of physical abuse,

22 sexual abuse, suspends the target of the

23 investigation. Which I guess you have to.

24 About the length of time of staff

260

1 suspension, they also talked about sometimes

2 six to nine months. And after it's all said

3 and done, they're found not guilty of

4 whatever they were accused of, and it kind of

5 goes on and on.

6 Just to give you an instance, the

7 Justice Center has taken seven investigations

8 at a certain place. And the inception was

9 June 30th of 2013. Of the seven

10 investigations, four are currently complete.

11 If you're guilty or not guilty, only four are

12 currently complete. And between the

13 initiation and a closure letter, 153 days.

14 So that's a long period of time.

15 So my question is, to you, after like

16 me going out to the different agencies, what

17 do you think you really did to really improve

18 the quality of care? And also, what did we

19 do to improve the quality of the workforce

20 that are taking care of people with

21 disabilities?

22 EXEC. DEP. DIR. KIYONAGA: Again, our

23 mission is to protect people with special

24 needs, fully investigate reports of alleged

261

1 abuse which are reported to us, in a timely

2 and thorough manner. And again, I don't know

3 the details, you know, which providers or

4 which cases you're referring to there. I'd

5 be more than willing to talk to you about

6 that in greater detail separately.

7 But we are -- I think our interests

8 are aligned. You know, I do want to make

9 this system safer. We do want to make sure

10 that people who shouldn't be working with

11 people with special needs are not doing that

12 in the future. And, you know, that's the

13 mission of the Justice Center. We abide by

14 the statutory requirements that were passed

15 by the Legislature and signed by the

16 Governor.

17 And again, there's a number of ways

18 which I could explain that I think that the

19 system is safer. I mean, quality of care --

20 I mean, abuse and neglect is only one part of

21 quality of care, and I think you sort of went

22 into the whole, you know, QA area there. But

23 we have broad mandates there.

24 And again, prevention is something

262

1 that we're also very concerned about. I

2 mean, I'm concerned that an investigation is

3 very reactive. Right? Someone may have

4 already been abused. And not that we

5 shouldn't take it seriously, and not that we

6 don't, but prevention is also something

7 that's important. Which is why for every

8 abuse and neglect case that is reported to

9 us, we ensure that the provider and the state

10 oversight agency do a review to see if

11 there's any corrective action that's

12 required.

13 And I think that sort of speaks to the

14 QA piece you were just referring to. We want

15 to make sure, if there's any compliance

16 issues that need to be addressed -- and a lot

17 of times that is like training or other

18 things like that -- that the provider and the

19 state oversight agency is working to

20 implement those so people will be safer.

21 ASSEMBLYWOMAN GUNTHER: So

22 statistically, how have you decreased the

23 incidence, and what education have you

24 provided? So sometimes we find things that

263

1 are really, absolute mistakes, they weren't

2 done intentionally. What do you do to, like,

3 retrain people? Or what is your -- do you

4 bring a program into, you know,

5 non-for-profits to tell them what to do and

6 what your feelings are and what the

7 corrective action should be?

8 EXEC. DEP. DIR. KIYONAGA: Well, I

9 think every allegation of abuse and neglect,

10 whether it's substantiated or not, is an

11 opportunity for improvement. And that's why

12 we require that providers and state agencies

13 look at every case, regardless of whether

14 it's unsubstantiated or not, to see if there

15 isn't some corrective action that could make

16 that facility safer.

17 ASSEMBLYWOMAN GUNTHER: Do you have a

18 quality improvement or report that you could

19 share with all of us so that we would see

20 like the efficacy of the office and also like

21 the changes, the improvements over the last

22 three years?

23 EXEC. DEP. DIR. KIYONAGA: We issued

24 our annual report recently, and that has some

264

1 statistics about the outcomes of our

2 investigations.

3 It also talks about a number of the

4 other things that the Justice Center does

5 beyond abuse and neglect investigations, and

6 that is, you know, we do forensics reviews,

7 we do this corrective action plan monitoring.

8 We have a prevention work group. So we do do

9 a number of other things beyond our primary

10 role, which is to investigate abuse and

11 neglect.

12 ASSEMBLYWOMAN GUNTHER: Thank you.

13 CHAIRMAN FARRELL: Thank you.

14 Senator?

15 CHAIRWOMAN YOUNG: Thank you.

16 Senator Ortt.

17 SENATOR ORTT: Jay, earlier it was

18 asked of you do you think it's --

19 CHAIRWOMAN YOUNG: Mic.

20 (Discussion off the record.)

21 SENATOR ORTT: Jay, earlier you were

22 asked by Senator Young about are things

23 different today than before the Justice

24 Center. And you said yes, and you listed

265

1 some, I think, things that are important, but

2 there are also things that -- there are

3 things that we talk about here in Albany, you

4 know, like that are, you know, the

5 definitions of this and this. Not that

6 that's not important, but I think on the

7 ground level a lot of people don't see the

8 difference. Or, if they see a difference,

9 it's worse. Okay?

10 And what I mean by that is so, you

11 know, when I talk to families, when I talk to

12 providers, people on both sides of sort of

13 the issue, on the one hand people will say,

14 you know, the Justice Center, the

15 investigations take so long. I think by your

16 own testimony, you said most of the reports

17 come in from staff. Two-thirds of them are

18 unfounded. That seems to be a high number.

19 And I say that in a variety of ways.

20 One, that's a large number of things

21 that your folks are having to spend time on

22 that turn out to be unfounded. And I guess

23 my question would be, why do you think that

24 is? What is your assessment on why

266

1 two-thirds are unfounded? Why are you having

2 such a high number or volume called in that

3 are unfounded?

4 EXEC. DEP. DIR. KIYONAGA: I mean, I

5 can't explain it case by case. You know, I'd

6 have to review those. But generally there's

7 a few reasons why a case may be

8 unsubstantiated. In our statute, it's

9 substantiated or unsubstantiated.

10 You know, sometimes there are false

11 reports that are made to us. We know that.

12 It just didn't happen. That's what our

13 72-hour protocol is trying to get to. We do

14 realize that sometimes things are misreported

15 or falsely reported, and we think that

16 through, you know, a quick review and some

17 basic facts, maybe we can avoid the need for

18 a lengthy investigation. Because you're

19 right, you know, I don't want to investigate

20 something that should never have been

21 classified as abuse and neglect in the first

22 place. Because, again, it is my resources or

23 provider resources, and obviously it's a

24 stress on the system that we would like to

267

1 avoid. So again, our 72-hour protocol is

2 trying to get to that.

3 But the other reasons I think that

4 things are unsubstantiated is maybe we just

5 can't find enough evidence to substantiate

6 that case. Our evidentiary standard is

7 preponderance of the evidence, which is more

8 likely than not to have happened. Sometimes

9 we just can't get there.

10 So I think that those are really the

11 two major reasons. Either something may have

12 been misreported or overreported, and then in

13 some cases our investigation just cannot

14 achieve the evidentiary standard required to

15 substantiate that allegation.

16 SENATOR ORTT: Let me ask you, so your

17 folks have training, obviously -- a lot of

18 them are law enforcement background or some

19 type of investigative background --

20 EXEC. DEP. DIR. KIYONAGA: Twenty

21 percent have a law enforcement background.

22 SENATOR ORTT: Okay. Do any of them

23 have a background in the jobs that they're

24 investigating -- you know, in human services,

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1 working with folks that might have a

2 developmental disability or something along

3 those lines?

4 EXEC. DEP. DIR. KIYONAGA: Yeah. I

5 mean, beyond the basic educational

6 requirements and the investigative

7 requirements, experience requirements, a lot

8 of our investigators, many of them, have

9 actually worked in the facilities which we

10 oversee. A lot of them also have family

11 members or loved ones who have disabilities

12 as well.

13 I mean, that's what we're looking for.

14 We really want investigators who understand

15 the systems, understand our mission, and if

16 they don't -- and most do -- we also provide

17 training. And we also look to the state

18 oversight agencies and providers to provide

19 training to our folks too.

20 SENATOR ORTT: I think it would be

21 helpful to see that grow, just because -- you

22 know, I think one of the things that

23 certainly would be a benefit, not only to you

24 and your folks but also to the people that

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1 we're trying to service, is if the folks who

2 are doing the investigating had at least some

3 understanding -- you know, real world

4 understanding. Obviously, some of it's

5 gleaned over -- I'm sure over years as they

6 do this work. But if they come into it with

7 some background in some of these areas --

8 because as you know, it's a very -- in ways,

9 it's a very unique level of work and sort of

10 what goes in and the individuals they're

11 working with. So I think that's -- I would

12 like to see that number or that percentage

13 increased, not just education in a classroom,

14 but real-world experience.

15 Do you know how many -- roughly how

16 many people currently might be out on

17 administrative leave as the result of a

18 Justice Center investigation?

19 EXEC. DEP. DIR. KIYONAGA: I don't

20 know.

21 SENATOR ORTT: Okay. Is there a

22 way -- I mean, can you -- is that data

23 available?

24 EXEC. DEP. DIR. KIYONAGA: We don't --

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1 I don't -- I don't have access to that data.

2 SENATOR ORTT: You don't have access

3 to that data?

4 EXEC. DEP. DIR. KIYONAGA: Yeah, we

5 don't collect that data. Let me put it that

6 way.

7 SENATOR ORTT: And I know a lot has

8 been made about the amount of time that it

9 takes to conduct these investigations. What

10 would you -- I may have missed it. What

11 would you say is an average time? Or what

12 is, I guess, a time that you would like to

13 see an investigation concluded?

14 I realize -- I mean, I know that you

15 could give an answer that says, Well, every

16 one is different. But, I mean, is there a

17 certain time frame that you think is a

18 reasonable amount of time to be able to make

19 a determination to either close an

20 investigation or prosecute?

21 EXEC. DEP. DIR. KIYONAGA: I would say

22 our goal is to complete a thorough

23 investigation as quickly as possible. I

24 mean, that's what we owe -- we owe that to

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1 all of our stakeholders. Whether it's the

2 victims or the families or the provider or

3 the subject of the investigation, a thorough

4 investigation as quickly as possible.

5 But as you had said, there's a wide

6 range of cases we get there. And, you know,

7 I don't want to necessarily put a time frame

8 on any individual case. I mean, again, if --

9 as I said earlier, if it's a false report and

10 we can determine that very quickly, you know,

11 someone is accused of doing something and

12 they're not even at work that day, we should

13 be able to close that very quickly. And I

14 would hope that, you know, my staff or the

15 agency staff would close that as quickly as

16 possible.

17 On the other end, you know, some of

18 these criminal cases can take a while. You

19 know, they can take over a year in some

20 cases. And so, again, we have a wide range.

21 But we do have -- you know, we are working

22 with the law of large averages here, right?

23 We are talking about 10,000, 11,000 cases a

24 year.

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1 The statute speaks to, you know, a

2 60-day time frame; I think people are aware

3 of that. Again, they say that we should

4 strive to complete a case within 60 days.

5 And if it's not completed in 60 days, we need

6 to make a note of the reason in our database,

7 in our case management system, and we do do

8 that. But obviously since people are looking

9 at 60 days, you know, I guess we would try to

10 achieve things within 60 days.

11 SENATOR ORTT: How much assistance do

12 you get from local DAs? I mean, how much

13 cooperation do you get from local DAs in your

14 investigations? Or how much do you seek?

15 EXEC. DEP. DIR. KIYONAGA: Well, I

16 mean, we notify DAs of any allegation of

17 abuse and neglect that occurs within their

18 jurisdiction. They get those reports daily.

19 We have multiple touch points, multiple

20 collaborations with local DAs from there on.

21 Again, if we're investigating and we

22 think that the case rises to a criminal

23 level, our criminal investigators are

24 prosecutors and will be working with local

273

1 law enforcement and/or that DA to vet that

2 case. And again, if it's going to be a

3 criminal prosecution, you know, we're going

4 to collaborate and coordinate with that local

5 DA to make sure that they're aware of the

6 case.

7 And again, we would encourage local

8 DAs to prosecute these cases. I mean, this

9 is a crime that has happened in their

10 jurisdiction, so first and foremost, you

11 know, we would encourage them to do that.

12 But if for whatever reason they aren't and we

13 feel strongly about that, we'll work with

14 them to allow us to prosecute it.

15 SENATOR ORTT: Does that happen a lot,

16 where the local DA makes a determination not

17 to and you feel strongly enough to move

18 forward?

19 EXEC. DEP. DIR. KIYONAGA: I don't

20 know if it happens a lot. I'm sure there's

21 instances. I mean, when you look at our

22 statistics, I think that in 2016 there were

23 over 110 prosecutions, and I think we did a

24 majority of those. But local DAs, they do

274

1 their share. I mean, I think we'd like to

2 see them do more. I think we always think

3 that if -- you know, given that it's a crime

4 that occurred in their jurisdiction, it would

5 encourage them to do that. But I recognize

6 that they have resource issues, we have

7 resource issues. These are very challenging

8 cases. And, you know, sometimes they just

9 don't see the inside of a courtroom.

10 SENATOR ORTT: Thank you.

11 CHAIRWOMAN YOUNG: Thank you.

12 CHAIRMAN FARRELL: Thank you.

13 Assemblyman McDonald.

14 ASSEMBLYMAN McDONALD: Hi, Jay, how

15 are you?

16 EXEC. DEP. DIR. KIYONAGA: Fine.

17 ASSEMBLYMAN McDONALD: There we go, I

18 think we're there now. Thank you.

19 And Jay, thank you.

20 CHAIRMAN FARRELL: (Inaudible.)

21 ASSEMBLYMAN McDONALD: I will. I

22 will. Thank you, Mr. Chairman. I'll move up

23 closer.

24 Thank you, as always. The Justice

275

1 Center has always made themselves available

2 to at least the members locally, I imagine

3 around the state as well.

4 And I have like a far-ranging comment

5 before I get to probably what is a question.

6 Sometimes I'm called with the whole -- the

7 Justice Center, I think, has done some great

8 things. It's established consistency in

9 regards to instances, for the most part.

10 It's established some good training, which I

11 think is important. You know, and of course

12 you're reaching across many vulnerable

13 populations, but all different types of

14 vulnerable populations.

15 So I understand the complication. And

16 I also understand, as a healthcare

17 professional, the importance of internal

18 compliance within each organization. In

19 other words, organizations do have to have

20 their own policing of their own self to make

21 sure that they have good protocols and

22 operations.

23 And at the same token, we hear from

24 individuals that we're not doing enough, that

276

1 more neglect is happening that we don't know

2 about. And in that same token, it's not

3 always easy to get good prima facie evidence

4 of that.

5 I have a very large concern for the

6 providers. Primarily it's the nonprofit

7 community that I hear from. I don't hear

8 much from the state agency organizations, I

9 hear it mostly from the nonprofit community

10 about a couple of different things.

11 First of all, you know, this approach

12 that I think was prevalent early on but has

13 kind of dissipated a little bit is this

14 marshal-in-town-type mentality, which scares

15 a lot of these $9.50 and $10 an hour

16 employees. Now, I fully recognize that's not

17 the Justice Center's issue of what people are

18 being paid, but it's a symptom of a greater

19 disease that we're not funding those entities

20 properly from the state, because they're

21 there to do the work the state can't do. But

22 at the same token, we've descended upon them

23 with this process which, when you say to a

24 21-year-old, You're guilty of obstruction of

277

1 justice, they're like petrified. And

2 honestly, I don't know if that's very helpful

3 in the process.

4 I was talking to -- and I think you

5 talked to them today as well -- a local

6 director who said that they had an incident,

7 they did everything they were supposed to do,

8 they forgot to notify the Justice Center

9 because it was -- they did everything they

10 were supposed to do, and now there's a fear

11 they're going to be rung up for obstruction

12 of justice. Which I'm sure it will be

13 addressed and dealt with appropriately.

14 But I guess, you know, the largest

15 concern I had, and I shared these

16 conversations with Jeff when he was in the

17 position before, is there just seems to be a

18 whole lot of cases and calls being reported,

19 and I don't know how, humanly, your

20 individuals are able to do it. I know you've

21 been working at it and working at it. But,

22 you know, many of the organizations have made

23 a suggestion, and I'd really like to get some

24 thoughts from the Justice Center about some

278

1 changes that they think will have a positive

2 impact -- not lessen the process, but really

3 allow your folks, particularly your officers,

4 to focus on what they should be doing. And

5 it's to look at revising Category 3.

6 Those incidents are usually the lowest

7 level of substantiation possible for an

8 individual, and they're talking about

9 allowing that to go back to the agencies --

10 obviously, in consult with the Justice

11 Center -- which would allow you to focus more

12 on the more serious cases of neglect.

13 So I'm curious to see, you know, what

14 the position is of the center on that type of

15 opportunity.

16 EXEC. DEP. DIR. KIYONAGA: Yeah, I

17 mean you raised a lot of good issues there.

18 Before I speak to the Cat 3 issue you just

19 raised, I would like to just speak to, you

20 know, our feelings about mandated reporters,

21 you know, and the staff that do this good

22 work.

23 I mean, we know that a vast majority

24 of these workers are good workers. They do

279

1 this job, as you just said, not for the money

2 but because they care about the people that

3 they work with. And I think that's very

4 important to recognize, and we do recognize

5 that.

6 And of course that creates a tension

7 for us. Because as you just said, you know,

8 these people are afraid of us. But at the

9 same time, the law requires that they report

10 to us. If I don't get the reports, I don't

11 hear about abuse and neglect, and I can't

12 protect people with special needs.

13 So to that end -- and, I mean, we're

14 in our -- we've been open about three and a

15 half years now, and during the first couple

16 of years we necessarily were focused on

17 making sure that the state agencies, the

18 executive directors of not-for-profits and

19 private providers and their QA people knew

20 exactly what was required under the statute

21 and with implementation of the Justice

22 Center.

23 Starting in 2016, and certainly

24 continuing on to 2017, we have had a much

280

1 stronger focus on hearing directly from the

2 direct support professionals. We have sort

3 of aggressively worked with the National

4 Alliance for the Direct Support

5 Professionals, we've worked with all of the

6 state oversight agencies to have direct

7 meetings with direct support staff so we can

8 hear their feedback directly. And I'll tell

9 you, it's been eye-opening. And, you know,

10 we hear it both ways, to be honest. Some are

11 pleased we're here; some will say: "I'm so

12 happy you're here. You know, I know that if

13 I report abuse and neglect, there will be an

14 independent investigation. I wasn't always

15 sure that would have happened if I report

16 internally in my agency." And we get that.

17 We've also heard that people are

18 scared of us. We heard that, you know, "I

19 don't know what to expect if I call your

20 hotline." And so we've implemented things

21 like putting a sample recording on our

22 website, or playing it for direct support

23 professionals.

24 We heard that our poster was

281

1 intimidating to people, that poster we

2 originally put out. I don't know if you -- I

3 think you probably saw it. It had a phone

4 hanging, it was red, kind of scary. We've

5 sort of shifted our view on that, and we've

6 issued new posters which really show the

7 collaboration that we expect from direct

8 support professionals and the people they

9 serve, the people with special needs we all

10 want to support.

11 So I did want to address that concern,

12 that we are aware of that and we are taking

13 sort of aggressive initiatives to try to

14 address some of those concerns where we can.

15 You also then raised -- I think which

16 was really the point of your question, was

17 the Category 3 and can we look at that. And

18 again, I think Category 3 is broadly defined

19 in the statute. But I think the real issue

20 here is that, you know, we don't assign a

21 category until something is substantiated and

22 we're closing the case. Our protocols for

23 assignment might sort of align with the

24 concept you're talking about. Like I said,

282

1 you're mostly focused on the private

2 providers. And for the private providers,

3 the Justice Center only retains those cases

4 which involve the most serious or egregious

5 allegations of abuse and neglect. Those are

6 going to be assaults with harm, they're going

7 to be something sexual in nature, they're

8 going to be some sort of potentially

9 criminal -- criminal neglect, criminal

10 action. Those are the ones we're keeping.

11 The other ones we do delegate back to the

12 state oversight agency and generally, from

13 our experience, we simply delegate them back

14 down to that private provider.

15 So I'd have to look at the numbers,

16 and maybe we could talk separately. But I

17 would guess that -- and, you know, we could

18 probably pull this -- we could probably see,

19 of the Cat 3s that are substantiated, how

20 many of those were done with the Justice

21 Center and how many were done by the

22 privates.

23 But ultimately it may also turn out

24 that something serious was alleged, you know,

283

1 we took that case on, and it turned out it

2 wasn't quite as serious. But we could

3 certainly look at that.

4 CHAIRMAN FARRELL: Thank you.

5 ASSEMBLYMAN McDONALD: Thank you.

6 CHAIRMAN FARRELL: Mr. Santabarbara.

7 ASSEMBLYMAN SANTABARBARA: Just to

8 circle back, I know we touched on this

9 before, but just in terms of improving the

10 quality of care for a vulnerable population,

11 how has the existence of the Justice

12 Center accomplished -- how are you working to

13 accomplish that goal?

14 EXEC. DEP. DIR. KIYONAGA: You know,

15 quality of care is pretty broad. You know,

16 our main mandate is really to protect people

17 with special needs from abuse and neglect.

18 And I think I can, you know, clearly point to

19 the 340 people on our staff exclusion list.

20 These are people who have committed the most

21 serious and egregious acts of abuse against

22 people with special needs. They were

23 substantiated of Category 1, which is the

24 most serious level of abuse and neglect.

284

1 They were put on the staff exclusion list

2 that we maintain. They will be on the list

3 for the rest of their lives, and they will be

4 prohibited from ever working with people with

5 special needs in any facility under our

6 jurisdiction.

7 And so it's unfortunate that someone

8 had to be abused to that level in order for

9 us to identify and take action against these

10 staff. But I think that, you know, for the

11 victims of those cases, they would say that

12 they would be safer now that this person is

13 no longer able to work with anybody with

14 special needs.

15 ASSEMBLYMAN SANTABARBARA: And can you

16 speak to the experience, particularly in

17 healthcare, that the Justice Center

18 investigators have or need to have?

19 EXEC. DEP. DIR. KIYONAGA: The minimum

20 requirements for our investigators are -- is

21 an educational requirement, and then there's

22 an investigatory experience requirement.

23 But as we interview, as we're seeking

24 candidates, we are looking for people who

285

1 have experience in the facilities that we

2 oversee. We find that that's invaluable.

3 They really do need to understand not just

4 the people with disabilities that they're

5 going to be interacting with, they really

6 need to understand the service delivery

7 systems as much as they can as well.

8 And as someone had noted, we serve a

9 broad number of different facilities. I

10 mean, a developmental center is very

11 different than a youth detention facility,

12 which is very different from a group home or

13 a dayhab. So it's hard to find someone who

14 obviously -- you're not going to find anyone

15 who sort of meets the mark on all those

16 facilities, but we do find people who have

17 worked in these agencies. A lot of our

18 people have that experience.

19 And again, if they don't -- and again,

20 they're probably not going to have experience

21 across all the types of facilities they're

22 going to encounter, or all the types of

23 disabilities -- you know, we provide that

24 training.

286

1 ASSEMBLYMAN SANTABARBARA: And my last

2 question is, of course, you know, we're

3 always looking to improve. What are some of

4 the goals you see for the future? And do you

5 have the resources to actually accomplish

6 those goals?

7 EXEC. DEP. DIR. KIYONAGA: Yeah. I

8 mean, our goals sort of remain consistent.

9 And it's consistent with the goals that you

10 guys have outlined.

11 We really want to try to make sure we

12 continue to complete all investigations in a

13 thorough manner in as little time as

14 possible. So case cycle time, case

15 completion time, that's something we're

16 always going to be focusing on and

17 monitoring. That's probably our number-one

18 priority. That's what our stakeholders want.

19 That's what you want, that's what the

20 Governor's office wants, and that's what

21 we're going to try to achieve.

22 Beyond that, I think that the direct

23 support outreach is critical. I mean, we

24 really do need to hear from our primary

287

1 stakeholder, which is the people who work

2 with people with special needs. They are the

3 people who must report to us, they are the

4 people that we interview as witnesses, and

5 they are the people that we may interview as

6 a subject in an abuse/neglect investigation.

7 So hearing their input, making changes

8 to our processes or our notifications, I

9 think is critical and something we're going

10 to continue to work on.

11 ASSEMBLYMAN SANTABARBARA: Okay,

12 that's all I have. Thank you.

13 CHAIRWOMAN YOUNG: Thank you.

14 Senator Krueger.

15 SENATOR KRUEGER: I guess -- it's not

16 a question, it's simply to point out you're

17 hearing a lot of questions and I think the

18 sense that people are concerned about your

19 existence now. And I just want to go on

20 record saying I hear both sides of it from

21 people, and I think that reflects that you're

22 doing exactly what you need to be doing.

23 These are tough issues. When people

24 who are the most vulnerable in our society

288

1 are at risk of being harmed by the people we

2 entrust their care to, it's our obligation as

3 a civilized government to make sure that we

4 are overseeing correctly, we are training

5 correctly, we are fixing the problems.

6 And the numbers, as you were asked,

7 show that there's a lot of unsubstantiated --

8 but people are going to have to do those kind

9 of reports in order for you to figure out

10 where the problems are and how you need to

11 intervene. And that hopefully, within a

12 matter of years, we're all going to be able

13 to say New York State has the model programs

14 for making sure that people who are under our

15 care, whether it's in a government facility

16 or in a community-based facility, are being

17 treated with the highest respect and that the

18 people who are hired to provide those

19 services actually know and understand where

20 the lines are.

21 So it's a very difficult job you and

22 your people are doing. I'm sure you're not

23 perfect at it. But I, for one, am very glad

24 that you're out there doing that. So thank

289

1 you very much.

2 EXEC. DEP. DIR. KIYONAGA: Thank you,

3 Senator.

4 CHAIRWOMAN YOUNG: Thank you.

5 That's it? Okay. Well, thank you for

6 coming in today. We truly appreciate it and

7 appreciate your input.

8 We have two groups who are appearing

9 together, and that's Michael Seereiter,

10 president and CEO of the New York State

11 Rehabilitation Association, and Ann Hardiman,

12 executive director of the New York State

13 Association of Community and Residential

14 Agencies. Thank you.

15 MS. HARDIMAN: Hi. Thank you. I'm

16 Ann Hardiman, the executive director of

17 NYSACRA. I'm going to turn it over to

18 Michael first this time.

19 MR. SEEREITER: Hi, good evening.

20 Thank you for the opportunity to testify.

21 Senator Ortt I think was quite

22 prescient, maybe, in his comments earlier

23 about what you are likely to hear from the

24 rest of us after hearing from OPWDD and

290

1 others about the issue of workforce. That is

2 what we are going to concentrate our comments

3 on here today.

4 These are two organizations that are

5 part of multiple campaigns that are focused

6 on workforce issues, one being the Restore

7 Opportunity Now campaign, and the other being

8 the #bFair2DirectCare campaign. We are both

9 very active in those campaigns because

10 workforce has become the only issue, in many

11 ways, that is important to us at this point.

12 The fields that we represent are in a

13 crisis mode at this point. There's a

14 recruitment and retention crisis the likes of

15 which I think we've not really seen in the

16 better part of several generations if not

17 lifetimes.

18 The service expansions that we have

19 seen in, for example, the OPWDD budget this

20 year are appreciated. However, quite

21 frankly, they mean very little if there is an

22 inability, as currently exists right now, to

23 recruit and retain qualified people to do

24 this work. If we can't hire people to do

291

1 this work, we simply cannot expand supports

2 and services.

3 Recently the #bFair2DirectCare

4 campaign wrote a letter to the Governor

5 requesting a meeting with him personally, in

6 which we outlined three pieces of the crisis

7 that we as a system face. The first piece

8 really focused on the issue of the workforce

9 and the workforce crisis.

10 We've seen, I think as several people

11 have mentioned earlier, the vacancy rates for

12 providers of services to people with

13 disabilities have increased, the staff

14 vacancy rate has increased 20 percent on a

15 year-to-year basis, from 2014 to 2015. The

16 use of overtime within these organizations

17 has increased 13.5 percent from '14 to '15.

18 And we've seen a 21 percent increase in the

19 one-year turnover rate in staff.

20 Quite frankly, those are unsustainable

21 numbers in any system, let alone those that

22 are so dependent on public resources to be

23 able to recruit and retain the qualified

24 workforce they need.

292

1 The second piece of the crisis that we

2 outlined was indeed a quality crisis. The

3 issue that relates to this is that we are

4 unable to hire qualified individuals and

5 therefore cannot ultimately end up meeting

6 the needs that are placed upon us as

7 organizations that provide services to people

8 with disabilities. Those can be even some of

9 the most rudimentary health and safety

10 quality issues.

11 And that then brings about a third

12 crisis, which I think really is the one that

13 we're starting to face across the system,

14 which is a systemwide, indeed, crisis, where

15 you have organizations that can no longer

16 provide some of those health and safety

17 bare-minimum requirements. I think that

18 there's now a position in this system where

19 the organizations that do provide services

20 are no longer equipped to be able to take on

21 new service capacity, as one organization may

22 no longer be able to provide services.

23 That's a huge issue for the State of

24 New York. The State of New York has the

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1 statutory responsibilities to provide the

2 services and supports to these populations,

3 not the providers of these supports that

4 contract with the state to do so. So as we

5 see this budget taking place, the lack of the

6 investment in the workforce is by far the

7 number-one issue. Quite frankly, we can't

8 see beyond that crisis to some of the other

9 priorities that have been articulated in this

10 budget or articulated by the administration,

11 including the move toward managed care.

12 Those become increasingly less clear as we

13 are unable to meet the bare-bones minimum on

14 a day-to-day basis.

15 We need to be able to create a living

16 wage for people who do this work. We need to

17 increase the value, the societal value of

18 this work and thereby also increase the wage

19 that is paid for this work. It is very

20 difficult work, and we need that to take

21 place in both fields that we're representing

22 here.

23 In the developmental disabilities

24 system, that's a $45 million investment that

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1 we're looking for for a period of six years,

2 over a -- each year, for a period of six

3 years. And a similar investment in the

4 mental health system of $50 million for six

5 years. That's what's necessary to bring

6 these jobs up to a living wage, something

7 that, as several of you have noted earlier,

8 does not require people to have two, two and

9 a half, three jobs just to make ends meet.

10 CHAIRWOMAN YOUNG: Thank you.

11 MS. HARDIMAN: I'll be really quick.

12 I want you to know that direct support

13 professionals wind up working more than one

14 shift, oftentimes leading to weary, tired

15 staff members delivering services. And their

16 supervisors are now working shifts. And so

17 good supervisors are really important for

18 providing what DSPs need, and they're not

19 there for them.

20 Three emblematic quick stories right

21 now that represent what's happening on the

22 ground. One, an executive director told me

23 that he and his leadership staff get together

24 every morning and decide what's going to be

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1 covered today, where are we going to pull a

2 staff person from to cover health and safety,

3 what medical appointment needs to happen.

4 The quality things that Michael talked about

5 are not able to happen in many cases.

6 The second thing is another executive

7 director telling me that the direct support

8 professional people they are hiring right

9 now, that are the pool to hire from, need as

10 much mentoring and support as the people with

11 disabilities that are living with them. And

12 that's really striking and shocking.

13 And the third thing is an example I

14 heard from one of my members. A person with

15 a disability with very complex physical

16 needs, sitting in a person-centered planning

17 session with his circle of support, said --

18 and they're talking about what he wants for

19 his life. And he said, "Well, you know, over

20 the last year, 40 different DSPs have seen my

21 private parts in the bathtub, and I want that

22 to change. I want more staff that are

23 regular, and not so many."

24 So -- he said something more graphic

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1 than I did, but it's emblematic of what's

2 going on. Yes, I won't go further.

3 So DSP work is complex and it requires

4 skills that respect the dignity of people.

5 And it's not a minimum-wage job. So we ask

6 you, respectfully, to support including

7 $45 million in the budget for a living wage.

8 Thank you very much.

9 CHAIRWOMAN YOUNG: Thank you.

10 ASSEMBLYMAN OAKS: Thank you.

11 CHAIRWOMAN YOUNG: I don't believe

12 there's any questions, and I think you have a

13 lot of people very sympathetic to your cause.

14 So thank you.

15 MS. HARDIMAN: We understand. Thank

16 you.

17 CHAIRWOMAN YOUNG: The next speaker is

18 Steven Kroll, executive director of NYSARC.

19 Greetings. Thank you for being here.

20 MR. KROLL: Good afternoon, Senator.

21 And good afternoon, everybody. Thank you so

22 much for inviting us to speak today.

23 You have my written statement, and

24 appended to my written statement is also the

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1 testimony of the #bFair2DirectCare Coalition.

2 And Ann and Michael spoke a little bit

3 about the workforce shortage. I'd like to

4 just make two points today.

5 First, any one of us has an elderly

6 neighbor or a couple or maybe a widow or

7 widower that lives down the road or you can

8 see from the house, that you've watched them

9 age, struggle as they age. So you send your

10 kids out to help them shovel the walk because

11 they're so self-reliant they shovel the walk

12 themselves. And then you see them carrying

13 the groceries up the stoop and, you know, you

14 go help them carry the groceries. And you

15 watch them age and struggle to maintain their

16 lifestyle.

17 Now, imagine if that couple or that

18 individual was the caregiver to a

19 developmentally disabled child and is not

20 only struggling with their own life but

21 struggling to support a child because they

22 can't secure residential support for that

23 child.

24 That's where we are today. We don't

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1 have to imagine that. And there are

2 thousands of them.

3 So all these parents are asking for is

4 a residential placement so their child is

5 loved, their child is safe, and the child is

6 part of a community that will take care of

7 them when they're gone. And we put them on a

8 waiting list. And they sit on the waiting

9 list for years.

10 They have no hope today unless they

11 lose all capacity, such as have a stroke or

12 they pass away, and then their child will be

13 helped. And we have tons of excuses --

14 money, bureaucracy, just plain saying no.

15 So it's late in the day, and there are

16 not a lot of people here watching the

17 hearing, though some might be watching us on

18 the web. But there's so many other things

19 that we're doing right now, whether it be

20 signs on the Thruway or waiving snowmobile

21 fees or clearing the way for hemp farming and

22 other important priorities for the state --

23 and we're leaving these parents out there and

24 hanging. So I ask, is that the kind of

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1 New York we live in?

2 So I was listening to the testimony of

3 the executive deputy commissioner, and I was

4 doing some number-crunching. So we're

5 talking about 6300 new spots over three

6 years. Well, about 1800 turn over every

7 year. So if you take 1800 and you multiply

8 it by three, we're talking about creating

9 less than a thousand new slots over the next

10 three years. So 300 or so slots a year for a

11 waiting list that's 10,000.

12 So essentially we're saying to

13 somebody who passes away that we'll find a

14 home for your child after you pass away. And

15 we've got some terrible, horrible tragedies,

16 one I described for this committee last year

17 that occurred right before the hearing, where

18 a child's family had tried to find him a

19 home -- the child was a 50-year-old man --

20 but tried to find him a home, and they found

21 a home right after mom passed away.

22 And so is that our New York? Do we

23 wait until people suffer tragedies, or do we

24 try and find homes for their -- residential

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1 supports for their children while they're

2 still well so they can -- I always like to

3 say, so they can go and visit their child in

4 their new home every evening or every couple

5 of evenings and tuck their child into bed,

6 knowing their child is safe and secure and

7 loved. Is that too much to ask for? Right

8 now, in New York, it is.

9 So that's my first point.

10 My second point is to the DSP and

11 workforce crisis. And Michael and Ann did a

12 great job of describing, and you'll hear from

13 some other speakers about that. I'll just

14 direct you to a chart in my testimony. It's

15 on the third page, it's a color chart. And

16 this chart takes two agencies, and it shows

17 in red their starting wage in 2006 and their

18 starting wage 10 years later, the minimum

19 wage in 2006 and the minimum wage 10 years

20 later, and the fast food minimum wage.

21 So the top chart is a large agency in

22 upstate New York. They paid 39 percent above

23 minimum wage to their starting employees in

24 2006. Today they pay 3 percent above the

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1 minimum wage, so essentially a minimum wage,

2 and 7 percent below the fast food minimum

3 wage, because the Fast Food Wage Board has

4 moved the wage up faster than the Governor's

5 transformation.

6 So it's very simple. We've been

7 frozen for seven of the last eight years.

8 The Governor has proposed to freeze us for

9 eight out of nine. And so you can work 70 or

10 80 hours as a DSP to take care of your

11 family. You may be on food stamps. You may

12 give it up and say, You know what, there's a

13 casino opening in Schenectady, I'm going to

14 go apply for a job as a blackjack dealer.

15 Or, You know what, it's a lot easier to run a

16 cash register than it is to support people.

17 I'd have to work on Christmas and on

18 Thanksgiving.

19 The chart below is a large New York

20 City agency. Same story. Sixty-three

21 percent above the minimum wage in 2006, at

22 minimum wage today, and 9 percent below the

23 fast food minimum wage.

24 So every agency has a different story,

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1 but these are two. We now have an average

2 11 percent vacancy rate in New York State.

3 Michael talked to you about how that's

4 continued to increase. There are agencies

5 that are now well above 20 percent. Eleven

6 percent is the average. And so Ann and

7 Michael were not kidding, where every week or

8 every morning the staff gets together and

9 says, What are we going to get done today,

10 and what's not going to happen?

11 And so people can become prisoners in

12 their own homes. Because if there's not

13 enough staff, they're not going to get out

14 into the community. They're not going to be

15 able to be involved in activities. And it's

16 going to be like institutional care in their

17 home. We're getting there, we're getting

18 there quickly. That's why #bFair2DirectCare

19 is together. And we are grateful that the

20 Legislature and the Assemblymembers, the

21 Senators, have all rallied to support. And

22 we would love the Governor to put it in his

23 30-day amendments. I don't know whether that

24 will happen or not. But if not, we just ask

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1 that the Legislature, in the one-house

2 budgets, put the money in to get us started

3 towards a living wage for DSPs, and hopefully

4 we can achieve that over the next several

5 years.

6 So I thank the members of the

7 committee for visiting with us today and

8 especially for all of your support, and I'd

9 be glad to answer any questions.

10 CHAIRWOMAN YOUNG: Thank you very

11 much, Steve. Thank you.

12 ASSEMBLYWOMAN GUNTHER: Thank you.

13 ASSEMBLYMAN OAKS: Thank you very

14 much.

15 CHAIRWOMAN YOUNG: Our next speaker is

16 Glenn Liebman, CEO of the Mental Health

17 Association in New York State.

18 Thank you for being here.

19 MR. LIEBMAN: Thank you, Senator.

20 Good evening, everybody.

21 CHAIRWOMAN YOUNG: Good evening.

22 MR. LIEBMAN: Thank you for the

23 opportunity to testify at the hearing today.

24 My name is Glenn Liebman. I'm the CEO

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1 of the Mental Health Association in New York

2 State. We're comprised of 26 affiliates in

3 50 counties throughout the state. Our

4 members provide community-based mental health

5 services to over 100,000 New Yorkers with

6 mental health challenges.

7 Our organization is also involved in

8 advocacy, education, and training. Our core

9 mission is to advocate for the greater good

10 of the mental health community and to help

11 eradicate the stigma of mental illness.

12 This is the 14th year I have had the

13 opportunity to present testimony. Over these

14 years, especially in more recent years,

15 there's been great progress made in the fight

16 to end the stigma of mental illness. Now,

17 none of us are naive. We know we have a long

18 way to go. But I really want to thank all of

19 you for all you've done in recent years,

20 especially our chairs, Assemblymember Gunther

21 and Senator Ortt, because you've all

22 listened, and you've acted.

23 In recent years there have been some

24 real hard-earned successes for people with

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1 mental health issues, through prevention,

2 education, and public awareness efforts.

3 This past year we had the passage, for the

4 first time in the country, of a mental health

5 education bill. And thank you for all your

6 leadership on that.

7 There was great reference today to

8 also the mental health tax checkoff, also

9 landmark legislation, first in the country to

10 actually talk about public awareness of

11 mental illness on income tax forms.

12 So we're really moving the needle.

13 And also what happened, which was a great

14 victory, on New Year's Eve, we found out on

15 New Year's Eve about the bill passing for

16 step therapy. And thank you, Senator Young,

17 for your sponsorship of that. That was

18 really a great victory for all consumers

19 across New York State.

20 So we're really pleased, and we really

21 think that things are -- as frustrated as we

22 all get, and I think we're all very

23 frustrated, and I'll certainly share my

24 frustration. But there is some really good

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1 progress being made around a lot of

2 mental-health-related issues, especially

3 around public awareness.

4 Usually when I come and testify I

5 usually do a slipshod approach, because we at

6 the Mental Health Association, again, because

7 we're involved in advocacy on so many

8 different levels, we talk about a lot of

9 different issues. We talk about veterans'

10 issues, we talk about mental health first

11 aid, we talk mental health education, we talk

12 about -- you name it, we talk about it --

13 crisis intervention teams. We're always

14 trying to talk about what we think is the

15 most relevant issues around mental health

16 care.

17 But like my predecessors, I want to

18 talk specifically today about the cost of

19 living adjustment and -- the COLA and the

20 workforce issues, because they're so relevant

21 to us.

22 As I referenced, this is my 14th year

23 of presenting. And in all the years, I've

24 never seen a greater need for a well-trained

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1 and well-compensated workforce. I think of

2 it -- you know, Steve did a great job of

3 talking about it from a personalized

4 perspective, but I also think about it from

5 an agency perspective. You have to run an

6 agency -- I know our MHAs across New York

7 State do this -- with the expanding cost of

8 healthcare and other ancillary costs of

9 running a not-for-profit business.

10 You have to deal, in our case, with

11 the transformation of the mental health

12 system into a Medicaid managed care

13 environment and the new expectations put on

14 the workforce -- and I'll get into that in a

15 minute, because it's not a bad -- there are

16 some things in the transition that can be

17 very positive. But again, it's all about the

18 workforce.

19 Then you're dealing with the impact of

20 the minimum wage, which we've heard about all

21 day. A not-for-profit isn't McDonald's. We

22 can't raise hamburger prices by a nickel to

23 pay for the minimum wage. Without additional

24 state funding, we would be unable to pay for

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1 minimum wage increases.

2 According to work done by our

3 colleague Doug Cooper -- who I know is

4 speaking later -- from the Association for

5 Community Living, as Michael Seereiter said,

6 we estimate that there would be about a need

7 of $50 million over six years to help pay the

8 cost of minimum wage in mental health.

9 Our colleagues in the

10 #bFair2DirectCare campaign have similar

11 numbers on the developmental disabilities

12 side. And just as an aside, they've done a

13 great job of raising this issue, they really

14 have. And, you know, credit to them for

15 working so hard and being in every community

16 in the state and talking about this issue.

17 But that's only one part of the story.

18 The other part of the story is there's

19 virtually no additional funding support from

20 New York State. In mental health we've

21 received only two COLAs in the last decade,

22 and one was last year, at 0.2 percent --

23 0.2 percent, which is akin to about a dollar

24 a week for most employees.

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1 This year again, sadly, the COLA is

2 deferred. How many more years can a COLA be

3 deferred before the workforce is completely

4 decimated? At some point the logjam has to

5 end. Our workforce can tell you, point

6 blank, that things have never been more

7 difficult in the nonprofit sector.

8 Now, we're part of a campaign called

9 the Restore Opportunities Now campaign that's

10 comprised of over 350 not-for-profit

11 organizations across the state that call for

12 crucial investments and systemic changes in

13 New York's nonprofit services sector. The

14 impact of the lack of funding for the

15 nonprofit sector is seen across New York

16 State, and they've done a wonderful report in

17 terms of poverty numbers, individuals with

18 disabilities, and food insecurity for both

19 children and adults.

20 Many of the Governor's bold

21 initiatives in the State of the State include

22 things around expansion of indigent legal

23 services, affordable housing programs,

24 high-quality pre-K for 3- and 4-year-olds,

310

1 SNAP benefits, fighting food insecurity,

2 mental health services for individuals who

3 are homeless, et cetera, et cetera -- all

4 important, and all things that are very

5 significant and that we very much support.

6 But to work on these programs and to

7 put these programs forward, you need the

8 support and tireless efforts of the nonprofit

9 sector to succeed. We must fund living wages

10 that are competitive and keep pace with the

11 increasing cost of living in the future.

12 Now again, from my own perspective at

13 the mental health association, the issue is

14 especially acute in the mental health sector.

15 The workforce, like all the other workforces,

16 are incredibly mission-driven. People know

17 when they enter the mental health workforce

18 it's not for the money, but it's for helping

19 vulnerable people get better and move forward

20 in their lives. Yet good feelings and

21 mission-driven work does not pay the rent or

22 student loans.

23 Again, we talked about Medicaid reform

24 and the integration of health and mental

311

1 health. Who wouldn't want that? As a mental

2 health advocate for many years, and as a

3 family member, we would love to see the full

4 integration of health and mental health. And

5 that's what we're moving forward with,

6 hopefully, in the Medicaid managed-care realm

7 and around DSRIP and, you know, around

8 value-based payments.

9 However, as progressive as the systems

10 of care may be, you need a sophisticated and

11 well-compensated and well-trained workforce

12 to operationalize these changes. We must

13 have a workforce enhancement if we are to

14 continue to run quality programs and support

15 for people with mental health issues to live

16 in the community.

17 I'll just talk about three

18 recommendations. The first one is fund the

19 minimum wage increase through state contracts

20 and Medicaid reimbursements.

21 The second is through the leadership

22 of you in the Legislature, there was a COLA

23 for the mental health workforce three years

24 ago. That was very helpful. We need your

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1 support to ensure that there is funding for

2 another COLA for the mental health workforce.

3 And third, and there was --

4 Assemblywoman Gunther, we appreciate you

5 asking this -- there was a discussion -- you

6 know, you asked Commissioner Sullivan about

7 workforce funding through the DSRIP waiver.

8 This is an $8 billion waiver over a five-year

9 period that has a specific set-aside of

10 $1.08 billion for workforce and enhanced

11 behavioral health services. Much of the

12 money dedicated to behavioral health of the

13 $1.08 billion has not been expended.

14 How is that money being utilized? And

15 wouldn't there be an ability to redesign the

16 waiver to ensure that the funding was going

17 to go to the behavioral health -- not

18 necessarily workforce, but behavioral health

19 in general, rather than lose the funding from

20 the waiver?

21 I think those are really important

22 questions that have to be asked, because the

23 specific language of the waiver says "This

24 funding will support health home development

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1 and investments in long-term care, workforce

2 and enhanced behavioral health services."

3 Our colleagues at NYAPRS, the New York

4 State Coalition of Children's Services, and

5 the New York State Council for Community

6 Behavioral Healthcare all support this

7 important initiative.

8 And in final comments, we know that a

9 very small percentage of the DSRIP dollars

10 have been flowed to community providers. We

11 want to make sure to incent the workforce by

12 insuring DSRIP contracts with these providers

13 for outcomes necessary to keep people out of

14 the hospital and in the community.

15 The workforce is in desperate need of

16 help and support, and utilizing the DSRIP

17 waiver can help provide resources to the

18 sector with no impact at all to the state

19 budget and to middle-class taxpayers. We

20 urge the Legislature to work with the

21 Governor on this initiative.

22 And I could go on for another hour,

23 but I'm sure you have a lot of work to do, a

24 lot of people to hear from. So thank you

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1 very much. Any questions?

2 CHAIRWOMAN YOUNG: Thank you, Glenn.

3 I think Assemblyman Oaks has a

4 question.

5 ASSEMBLYMAN OAKS: Yes, Mr. McDonald.

6 CHAIRWOMAN YOUNG: Oh, I'm sorry.

7 ASSEMBLYMAN McDONALD: So, Glenn,

8 thank you for your continued advocacy and

9 work. Going back to the DSRIP, I'm

10 assuming -- I just want to make sure of

11 this -- that organizations like your own and

12 local providers were invited to the

13 participate in the PPSs. Is that correct?

14 MR. LIEBMAN: Correct, we are.

15 ASSEMBLYMAN McDONALD: As we know, the

16 DSRIP is a very complicated process. You

17 know, there's some that feel that it's

18 primarily built for the hospital systems, for

19 capital improvements, but it is really about

20 transforming and moving towards a value-based

21 payment system and value-based care.

22 MR. LIEBMAN: Correct.

23 ASSEMBLYMAN McDONALD: So are they not

24 providing any nibbles? Or what will -- where

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1 is the shortfall?

2 MR. LIEBMAN: Well, I think -- and

3 there was just a hearing last week with the

4 Department of Health and the five PPS teams

5 across the state. And I think that the issue

6 that they heard really consistently from -- I

7 was one of them who testified -- from all 30

8 folks who testified, where the reality right

9 now is that a lot of this money is not going

10 to the downstream providers. So the PPSs are

11 holding a lot of that money, and these

12 downstream providers are getting frustrated

13 by the fact money has not flowed to them.

14 We're three years in, almost; we only

15 have two years left. We have to start really

16 working into the movement to transition to

17 value-based payment, and the only way we're

18 going to be doing that successfully is if we

19 have this funding and downstream providers

20 can demonstrate their efficacy in this new

21 world.

22 And I think, given the money -- and I

23 know many of my members are frustrated --

24 given the money, I think that we could show

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1 how efficacious we are as small

2 non-for-profits in keeping people embedded in

3 the community and not in the hospitals. So

4 yes.

5 ASSEMBLYMAN McDONALD: For example, is

6 it infrastructure? Technology? What is it

7 that providers would be asking for? I mean,

8 for those who haven't seen a DSRIP, the PPS

9 plans, they are quite elaborate. They are

10 very comprehensive. But the question is what

11 is it, what is it that they need or what

12 would -- to help them get --

13 MR. LIEBMAN: Well, I guess it's two

14 questions. I've got two answers. One is the

15 investment piece that I think the downstream

16 providers, if they could get funding for

17 their community intervention programs, the

18 things they're doing with community supports

19 in the program, whether it's peer programs,

20 crisis programs, family engagement programs,

21 those kinds -- supported education, supported

22 employment. Those are the kinds of programs

23 that keep people in recovery and moving

24 forward in their lives. And I think that's

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1 really important, that the downstream

2 providers start getting some of that funding.

3 And the other piece, Assemblyman, is

4 that we do have a workforce -- as we know,

5 we've heard from everybody, and we'll hear

6 for the rest of the night about the

7 frustration of the workforce, how they're

8 underfunded and undertrained and

9 undercompensated, that there are DSRIP

10 dollars out there -- not necessarily

11 specifically dedicated for that need. And

12 it's very hard, I get that, because you've

13 got to go through a waiver, you have to go

14 through the feds and all that -- but just to

15 recognize how important that is to be able to

16 maybe put some funding towards those

17 downstream providers as part of PPSs, who

18 would be part of the DSRIP network. It's

19 just a -- it's an idea around specifically

20 let's look at some of the funding here and

21 figure out a way to work with the

22 administration to -- you know, nobody is

23 hiding anything, but just work with the

24 administration to try to get this funding

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1 moving forward.

2 ASSEMBLYMAN McDONALD: Thank you.

3 MR. LIEBMAN: Sure.

4 CHAIRWOMAN YOUNG: Thank you. Thank

5 you so much for your testimony.

6 MR. LIEBMAN: Sure. Thank you.

7 CHAIRWOMAN YOUNG: Our next speaker is

8 Harvey Rosenthal, executive director of the

9 New York Association of Psychiatric

10 Rehabilitation Services, Inc.

11 How are you?

12 MR. ROSENTHAL: Good, Senator.

13 CHAIRWOMAN YOUNG: That's good. Thank

14 you for being here.

15 MR. ROSENTHAL: Well, thank you to the

16 chairs and the members of the committees for

17 the opportunity to submit the concerns of the

18 thousands of New Yorkers that are represented

19 by the New York Association of Psychiatric

20 Rehabilitation Services.

21 NYAPRS is a very unique and nationally

22 acclaimed partnership, very unusual in that

23 we represent the needs and bring together

24 folks with mental illnesses and the providers

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1 who work with them across the state. And

2 under this big tent we've been able to

3 accomplish so much over the last, what, 36

4 years. We've brought recovery values to the

5 center of our system, we've protected and

6 expanded funding for community recovery

7 focused services and our workforce, we've

8 advanced peer support and human rights and

9 fought prejudice and discrimination, we've

10 expanded access to housing, employment and

11 transportation, and we've helped win landmark

12 criminal justice reforms.

13 State mental health policy is a very,

14 very personal thing to me and our staff and a

15 lot of our members because, as Mrs. Gunther

16 knows, I have a mental illness and I tell her

17 every day about that.

18 So we are in the midst of one of the

19 most dynamic Medicaid and broader healthcare

20 reform transformations in the nation. Over

21 the past years we've integrated behavioral

22 health benefits within Medicaid managed care

23 plans. We have facilitated the creation of

24 new local and regional health home and DSRIP

320

1 healthcare networks aimed at helping those

2 with the most serious conditions to reduce

3 their use of hospital and emergency services

4 and to improve their health and their lives.

5 And we are moving rapidly towards a

6 value-based environment where providers'

7 efforts will either be rewarded or penalized

8 for their ability to demonstrate measurable

9 improvements in individual and community

10 health.

11 New Yorkers with moderate to extensive

12 behavioral health conditions have been a

13 central focus of these reforms, especially

14 because our community makes up an extremely

15 large percentage of those who needlessly fill

16 our hospitals and emergency rooms and our

17 homeless shelters and correctional facilities

18 and who die 25 years earlier than the general

19 public.

20 Now, I've been proud to serve on many

21 of the Medicaid redesign activities. I was

22 on the Medicaid Redesign Team, I've served on

23 the Behavioral Health Work Group, and I'm on

24 the steering committee of the value-based

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1 payment exercise. And I've done this because

2 the state has clearly articulated values that

3 promote wellness and recovery, prevention and

4 diversion and an unprecedented commitment to

5 addressing the social determinants of health

6 and addressing poverty, hunger, homeless and

7 social isolation.

8 Throughout, I believed that these

9 reforms would be building on the unique and

10 essential expertise and innovation of our

11 community mental health and behavioral health

12 systems that have decades of experience in

13 knowing how to engage and serve individuals

14 with the greatest needs.

15 Yet after years of hopeful and hard

16 work, I come here today to say that our

17 recovery sector and our workforce is as

18 threatened as it's ever been, as you've heard

19 today, even as our state reforms are failing,

20 at the same time, to serve the very

21 individuals that we understand the best and

22 who trust us the most.

23 While billions of dollars are being

24 invested in the transformation of our

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1 Medicaid healthcare systems, a shameful

2 trickle of dollars have been invested in

3 helping our recovery sector to play the

4 central role for which we were created.

5 While Medicaid redesign was intended

6 to reduce reliance on costly hospitals, it's

7 the hospitals themselves that are getting

8 billions to oversee and to work to get people

9 out of hospitals. It seems rather strange.

10 And they're meant to oversee and offer care

11 to groups that, all too often, they simply

12 don't know and don't know how to help as well

13 as we do.

14 In a landmark measure, Medicaid

15 funding has been extended to pay for recovery

16 services, the home and community-based

17 services sector that Glenn talked about --

18 employment, education, and peer support --

19 yet only a handful of individuals have been

20 able to access those services. And those

21 services have reserved $645 million, and we

22 have two years to spend it, and we're -- it

23 looks -- at this moment, it really looks

24 grim.

323

1 We've seen a succession of new funding

2 streams to build organizational

3 infrastructure, but our sector is only

4 getting $100,000 or so per agency, while more

5 traditional networks are getting tens of

6 millions of dollars. Hospitals, if you go up

7 to Albany Medical, if you go to any of these

8 organizations, they've spent millions of

9 dollars building -- you know, building

10 buildings and hiring staff. But where the

11 people are, and where the services are, that

12 money is not going.

13 Simply put, our state is allowing our

14 recovery sector to fail to keep up with the

15 rapid pace of change and to retain a quality

16 workforce on whom successful healthcare has

17 always relied. In doing so, they are

18 jeopardizing the survival of some of our most

19 important programs and organizations.

20 Now, I'm not going to tell you that we

21 need a COLA, because you've heard that with

22 every speaker. And I won't have to tell you

23 that we were denied a COLA again this year,

24 and that denied us $9 million. We absolutely

324

1 join all the speakers here in saying that we

2 must have a COLA, and we urge to work with

3 the Governor to supply that.

4 We also join our friends at the

5 Association for Community Living in seeking

6 $50.5 million in OMH funding per year, for

7 the next five years, to support the impact of

8 the incremental increases to the minimum wage

9 that were approved last session. In doing

10 so, we can also address the impact of the

11 changes to the New York State Department of

12 Labor rules for exempt employees and

13 overtime.

14 It's really important that we pay for

15 the workforce. Our work is really about

16 relationships. Our ability to engage folks

17 and get them to trust us and make the changes

18 that are necessary depends on those

19 relationships. If staff are unable to stay

20 in those jobs and those relationships, as

21 good as they are, have to end, then we are

22 betraying the folks that we're here to serve.

23 NYAPRS urges the state to set aside 25

24 percent of the $6 billion in DSRIP Medicaid

325

1 waiver dollars that, as I said, are currently

2 going primarily to hospitals and hospital-led

3 networks. Twenty-five percent is what we're

4 asking for, while tens of millions of dollars

5 are going to hospitals and not to the

6 community sector.

7 As Glenn pointed out, there was a

8 hearing last week and we learned, once again,

9 it turns out to be 1 percent of all the money

10 that's been put in this waiver is going to

11 community-based organizations, only

12 $12 million, while millions and millions of

13 dollars -- I would say billions of dollars --

14 are going to the hospital networks. We must

15 preserve the community recovery sector, and

16 those monies need to flow there.

17 We have, as I said earlier, almost

18 $600 million in waiver funds that are

19 expressly dedicated to these kinds of

20 services. And we only have two to three

21 years left, and we're not spending it. We

22 have a number of ideas to share with

23 government about that, and we urge them to

24 work with us.

326

1 NYAPRS joins our colleagues in urging

2 that 25 percent of the proposed $500 million

3 capital projects fund for construction,

4 equipment and other nonbondable purposes be

5 afforded the community and behavioral health,

6 and actually the greater healthcare sector.

7 I live in Washington County, not far

8 from Warren County, and I must say out loud

9 that Glens Falls Hospital has received I

10 think $5 million of capital infrastructure

11 grants, and they're using them to build the

12 kind of services that we already have in the

13 community and ought to be expanded. They're

14 building services instead of buying our

15 services. That's unconscionable. We're

16 eroding the service system we have while big

17 institutions are rebuilding them, and they

18 don't know how to run them. And that's why

19 we're here.

20 On reinvestment, while we laud the

21 Governor and OMH for the proposal to reinvest

22 $11 million, there is $110 million in managed

23 care savings. Very little of it is going to

24 the community sector.

327

1 So we come to you for funds for a

2 COLA, but there are funds in the budget, as

3 Glenn pointed out, that won't cost the

4 taxpayers and won't require you to find money

5 that has to go into this sector.

6 In terms of housing, you'll hear more

7 about that from our colleagues. But I'll cut

8 to the chase. While there's $10 million to

9 raise housing rates and fund 280 additional

10 beds, we join ACL in seeking $28 million more

11 to raise housing rates, recognizing that

12 critically needed housing programs require

13 $38 million a year for the next three years

14 to remain sustainable.

15 We must take care of our housing

16 programs. Our consumers rely on them.

17 Housing for the homeless. We know

18 last year that the Governor and the

19 Legislature were discussing and considering

20 the Governor's plan to allocate $2.5 billion

21 that would, in our world, build 6,000 new

22 units of supportive housing. We got very

23 little of that last year. We await a

24 memorandum of understanding between the

328

1 Governor and the Legislature to fund these

2 beds, and we urge you and your leadership to

3 work with the Governor to do so.

4 I would say criminal justice

5 reforms -- and I have to point out I'm here

6 today talking to you in the Mental Health

7 Committee, but a lot of what I'm talking

8 about is really in the Health Committee and

9 in the Corrections Committee, because that's

10 where a whole lot of what we care about is

11 housed.

12 And so I'm talking to you about it

13 today hoping you'll go back to your

14 colleagues and make changes in those areas.

15 We need that so badly.

16 Criminal justice reform, we have

17 champions here, Mrs. Gunther and Senator

18 Ortt. You've been with us, in the last few

19 years you've helped fund $3.4 million worth

20 of crisis intervention teams. We can't thank

21 you enough, but we will ask you for more for

22 the coming year.

23 I will say, because I'm really trying

24 to run through this here a little bit, crisis

329

1 intervention teams are critical because they

2 keep people out of the system and they keep

3 folks safe. So it's incredibly important

4 that we train our police, and this program

5 really works.

6 Perhaps the most compelling thing to

7 me, after the workforce, is the torture in

8 our prisons. We have thousands of people

9 with mental illnesses who are sitting right

10 now in solitary confinement, in a box,

11 23 hours a day in a box. We passed a law --

12 you passed a law some years ago, at our

13 request, the SHU exclusion law, but still

14 hundreds of folks, I think 900 individuals

15 with severe mental illnesses, are in the box.

16 That's why we're joining again with

17 our colleagues to urge your support for HALT

18 legislation that's been sponsored by

19 Assemblyman Aubry and Senator Perkins that

20 will end the torture for so many. It will

21 prohibit segregation of young and elderly

22 people, people with physical or mental

23 disabilities, pregnant women, new mothers,

24 and LGBTQI individuals. It will end

330

1 long-term solitary confinement by placing a

2 limit of 15 consecutive days and a limit of

3 20 total days in a 60-day period that a

4 person will spend in the box.

5 It will enhance conditions in

6 segregated confinement. It won't use the

7 box, it will create these new residential

8 rehab units, which are segregated, but will

9 really be trauma-informed and rehabilitative

10 in nature. So we urge you to look at that.

11 I'm out of time, aren't I?

12 CHAIRWOMAN YOUNG: You are.

13 MR. ROSENTHAL: So I will just end by

14 saying we also would like to see the age of

15 criminal liability raised from 16 to 18, and

16 that there's money in the correctional system

17 to fund the services that the kids need to be

18 in the community.

19 Thank you very much, and I'm sorry I

20 went over.

21 CHAIRWOMAN YOUNG: Thank you very much

22 for participating.

23 SENATOR KRUEGER: Thank you.

24 ASSEMBLYWOMAN GUNTHER: Thank you,

331

1 Harvey.

2 CHAIRWOMAN YOUNG: Our next speaker is

3 Wendy Burch, executive director, and Irene

4 Turski, government affairs, National Alliance

5 on Mental Illness, NAMI New York State.

6 Thank you for being here.

7 MS. BURCH: Thank you.

8 Good evening. My name is Wendy Burch,

9 and as the executive director for the

10 National Alliance on Mental Illness New York

11 State, I represent thousands of New Yorkers

12 living with mental illness and their

13 families, whose hope of recovery hinges on

14 many factors --

15 ASSEMBLYWOMAN GUNTHER: Would you pull

16 your mic closer? I'm so sorry.

17 MS. BURCH: Is this better?

18 ASSEMBLYWOMAN GUNTHER: Yes, much

19 better.

20 MS. BURCH: -- many factors, in

21 particular a safe and affordable place to

22 live, adequate services, and, when

23 psychiatric emergencies do occur, first

24 responders with crisis intervention training

332

1 and adequate inpatient facilities.

2 With me is Irene Turski, a family

3 member of someone with serious mental

4 illness, who has firsthand knowledge in

5 dealing with our mental health system.

6 Irene's family story is all too similar to

7 that of many families who have a loved one

8 with serious mental illness.

9 You have copies of our written

10 testimony, so in interests of time I will be

11 brief.

12 CHAIRWOMAN YOUNG: Thank you.

13 MS. BURCH: First I would like to

14 thank Senator Ortt and Assemblywoman Gunther

15 for their leadership, and I would like to

16 acknowledge Senator Young for her

17 championship of the step therapy reform bill

18 recently signed into law.

19 Ensuring that people with a mental

20 illness get the medication their doctors

21 believe to be the most effective is a key

22 component to recovery. Equally important is

23 having prescriber prevails in place for those

24 treating people through the Medicaid system.

333

1 Psychiatric medications are not

2 interchangeable, and many living with serious

3 mental illness having their healthcare met

4 through Medicaid. We ask that the

5 Legislature restore prescriber prevails to

6 the final budget.

7 NAMI New York State operates a

8 helpline for those seeking mental health

9 resources. A significant amount of calls

10 received deal with housing concerns. Housing

11 availability is woefully inadequate to meet

12 the needs of New Yorkers with serious mental

13 illness. I urge you to heed the figures

14 presented in our written testimony, and from

15 our colleagues at the association for

16 community living. Only with available

17 housing with wraparound services, and

18 continuity of care, can our loved ones hope

19 for the chance of meaningful recovery -- and

20 I know that's something everyone's been

21 talking about today.

22 The other issue most often brought to

23 light by our helpline callers is those with

24 serious mental illness caught up in the

334

1 criminal justice system. We must continue to

2 fund crisis intervention training for first

3 responders. We must ensure that mental

4 health courts are expanded so that the unique

5 needs of those with mental illness can be

6 addressed appropriately. We must raise the

7 age of criminal responsibility, as detailed

8 in the Executive Budget.

9 And finally, Assisted Outpatient

10 Treatment, known in New York as Kendra's Law,

11 has proven to reduce long-term

12 hospitalizations, homelessness,

13 incarcerations, harm to self, and dependency

14 on drugs and alcohol. We urge the

15 Legislature to continue to fund AOT and, in

16 fact, pass legislation to make Kendra's Law

17 permanent. Again, we acknowledge Senator

18 Young's championship of this.

19 Everyone testifying this afternoon

20 will tell you about the shortage of mental

21 health services. Kendra's Law ensures that

22 the ones who need services the most have

23 first access to the limited services that do

24 exist, including housing. And now I'd like

335

1 Irene to share a bit of her story.

2 MS. TURSKI: Thank you.

3 I speak to you today not solely in my

4 role as government affairs chair, but as a

5 family member and an unpaid advocate for

6 those with serious mental illness. This is

7 an advocacy role I did not choose. The

8 decision was made for me upon witnessing the

9 experience of my sister, who has

10 schizophrenia. She has lived within the

11 state hospital system and is now in a

12 community residence program.

13 I assure you, the only reason she has

14 been able to live in the community is because

15 she resides in a program that incorporates

16 the necessary support services to keep her

17 healthy.

18 I have three concerns for those being

19 transferred from inpatient beds into the

20 community. Number one, people coming from

21 inpatient psychiatric hospitals usually have

22 serious mental illness and have lived for

23 years under institutional control.

24 Transition from a hospital to a residential

336

1 program is challenging. One of the many

2 obstacles was ensuring my sister took her

3 medication properly.

4 People such as my sister are not

5 statistics or patients, they are human beings

6 with complex needs who are not equipped to go

7 into supported and supportive housing

8 programs that do not offer the level of

9 intensive care they would receive in a

10 hospital setting. They must have the

11 necessary support services, which are

12 provided in a community residence type of

13 housing, to teach them how and when to take

14 medications and, in the most serious cases,

15 basic needs such as personal hygiene and how

16 to feed themselves.

17 On top of this, some of them are

18 suicidal and a danger to themselves. Some

19 suffer from anosognosia and do not know they

20 are ill. Many who have been on antipsychotic

21 medications may also be suffering from

22 tardive dyskinesia, which causes involuntary

23 movements of the tongue, lips, face, trunk

24 and extremities. Tardive dyskinesia must be

337

1 addressed as early as possible, as the

2 effects can be permanent and disabling.

3 Continuity of care for this population

4 is essential. Only someone providing

5 continual care would be able to notice the

6 slight changes in a person which could

7 indicate serious ailments. Continuity of

8 care is only possible if providers can hire

9 and retain qualified and caring staff members

10 who build the types of relationships

11 necessary to drive recovery. It is

12 impossible to form these relationships if

13 staff is constantly changing.

14 Number two. We have heard that

15 housing providers received additional dollars

16 for accepting people from inpatient beds for

17 a two-year period. Since these individuals

18 usually have serious mental illness, what

19 happens after the two-year incentive? If

20 this is true, is there any monitoring in

21 place by OMH to ensure these people still

22 have homes after the two-year period?

23 Number three. Despite the excellent

24 care my sister received in her residential

338

1 program, she recently required a short

2 inpatient stay in an OMH psychiatric

3 hospital. While hospitalized, we found out

4 that because her stay was OMH funded, she

5 would lose her bed, her home, because it also

6 was funded by OMH. Luckily, this was worked

7 out, and she was able to return to the place

8 she views as her home.

9 As anyone impacted by psychiatric

10 disorders knows, the road to recovery is

11 rarely straight, and hospital usage is

12 sometimes needed. Those who need short-term

13 hospital stays should not have to worry about

14 losing their home. Hospitalizations can be

15 traumatic by themselves, and this should not

16 be compounded by the fear of not being able

17 to return to the home you are comfortable in.

18 Being displaced can be a serious

19 detriment to recovery. This is why I beg you

20 to have OMH address this practice and

21 introduce stipulations that a person's bed in

22 a housing facility be held for them for an

23 agreeable amount of time if they need

24 short-term care in an OMH psychiatric

339

1 hospital. My sister and others, who have

2 suffered a great deal throughout their lives,

3 deserve nothing less.

4 Thank you.

5 CHAIRWOMAN YOUNG: Thank you very

6 much. Thank you for your advocacy for

7 Kendra's Law also.

8 MS. BURCH: We appreciate the

9 opportunity.

10 ASSEMBLYMAN McDONALD: Thanks, Wendy.

11 ASSEMBLYWOMAN GUNTHER: We agree with

12 you. That's right, we do.

13 CHAIRWOMAN YOUNG: The next speaker is

14 Kelly Hansen, executive director of the

15 New York State Conference of Local Mental

16 Hygiene Directors.

17 Welcome.

18 MS. HANSEN: Good evening. Thank you,

19 everyone, for hanging in there. Chairwoman

20 Young, Senator Savino, Assemblymember Bob

21 Oaks, and a former boss at one point in my

22 career, Chairwoman Gunther.

23 CHAIRWOMAN YOUNG: What we're going to

24 ask everybody to do is not to read everything

340

1 verbatim, in the interest of time, because I

2 know people have been here a long time. We

3 still have a lot of speakers to get through.

4 So if you could summarize and --

5 MS. HANSEN: Understood.

6 CHAIRWOMAN YOUNG: Thank you.

7 MS. HANSEN: Thank you all for letting

8 me come and give you our testimony today on

9 the Governor's Executive Budget.

10 My name is Kelly Hansen. I'm the

11 executive director of the Conference of Local

12 Mental Hygiene Directors. The conference

13 represents the county mental health

14 commissioners. And the job of the county

15 mental health commissioner is very different,

16 and I'm going to be talking to you about

17 things that you have not heard today, so

18 there's something completely different.

19 But the responsibility of the DCS,

20 county mental health commissioner, also

21 referred to as the local governmental unit,

22 is an oversight and planning and local role

23 to ensure that the mental hygiene system, in

24 watching all the moving parts -- to make sure

341

1 that there's services, they do the planning,

2 the development and the oversight for

3 individuals in the community, adults and

4 kids, with mental illness, substance abuse

5 disorder, and developmental disability.

6 One of the things I just want to

7 stress is that the LGU is responsible for

8 services for everyone, not just Medicaid.

9 As part of this, they're very embedded

10 in the community. So the DCSs have linkages

11 to inpatient providers, clinic providers,

12 housing, shelters, DSS, law enforcement,

13 criminal justice system, judges, family

14 court, and the sheriffs. So it's from that

15 view that I talk to you about a few things

16 that are in the budget.

17 As you know, the other commissioners

18 mentioned that we've moved to Medicaid

19 managed care for the behavioral health

20 population. Harvey referenced it before; we

21 do have concerns about how that rollout is

22 working, or very low numbers of individuals

23 getting HCBS services. But the reason I

24 bring it up today is because there's been

342

1 another cut to the funding that was put in

2 place to help get the system ready. And the

3 Executive says that this cut is for one year

4 only, only because the children's Medicaid

5 state plan services have not been approved

6 and therefore would not be drawing down those

7 funds.

8 What we would like to see is that that

9 money is restored and invested in getting the

10 system -- continue to get ready, especially

11 on the children's side. There is a lot of

12 work to be done. It's a complex transition.

13 There's workforce development, there's

14 infrastructure that needs to be put in place.

15 And to us it doesn't make sense to cut that

16 funding as an investment because the state

17 plan services aren't up when it makes sense

18 to get everybody ready so when the state plan

19 services in the waiver are approved, they're

20 ready to hit the ground running.

21 So we would ask the Legislature that

22 you restore that cut in funding to the

23 Behavioral Health Transformation Fund.

24 A couple of other things we want to

343

1 talk to you about today. You've heard from

2 others that there is a proposal to look at

3 all of the OMH state-operated clinics to see

4 if they are viable, et cetera. It's a good

5 idea. They are in a tough position.

6 From the oversight standpoint for the

7 LGU, we're not opposing those closures or

8 downsizing; what we want to make sure of is

9 that that resource is funneled back into the

10 community based on what the needs are in the

11 community. We don't want duplicated services

12 and we don't want unneeded services to help

13 the state fit into specific positions that

14 they need to be phasing out.

15 So again, we're asking for a

16 collaboration with the LGU. We expect we

17 will -- we have a good relationship with OMH

18 that will continue, but we want to make sure

19 the resource isn't lost and that it's used

20 based on local need.

21 Same situation with the -- looking at

22 the closures of the higher-end housing, the

23 what are referred to as SOCRs and ROCRs.

24 These are residential facilities that are

344

1 operated by the state. Many of them are

2 located right on the state grounds of a

3 psychiatric center.

4 This is a very high level of care, and

5 it's still needed in the community. These

6 facilities or residences serve people who

7 have a repeated history of psychiatric

8 hospitalization, criminal justice

9 involvement, co-occurring substance use

10 disorders, and homelessness.

11 In turning over those slots completely

12 to supported housing with wraparound, we

13 don't think that that will fit the need of

14 what these facilities provide now. And

15 they're state-operated; people can stay as

16 long as they need the service. So from the

17 county standpoint, we want to make sure for

18 the system that that resource is not lost and

19 that we still have access to that level of

20 care in the community.

21 We also are supporting the $10 million

22 in funding to increase the rates of

23 reimbursement for the residential providers.

24 Residential is a key component for the LGU.

345

1 The assisted outpatient treatment program is

2 administered by the LGU. And as you know,

3 those individuals on court-ordered AOT go to

4 the front of the line in terms of being able

5 to access housing and the highest level of

6 case management, or now called Health Home

7 Coordination. So it's critical to us that

8 the housing providers are in place and

9 staffed to be able to serve this population.

10 Moving to another piece that's in the

11 budget, and this has to deal with the

12 jail-based restoration project that would --

13 competency restoration, that would allow

14 counties to voluntarily restore individuals

15 to competency in the jail.

16 So let me just kind of explain how

17 this works. So there's individuals who we

18 refer to as 730s. That's 730 of the Criminal

19 Procedure Law. And these are individuals who

20 have committed a felony and have been found

21 basically not competent to be able -- because

22 of their mental illness or developmental

23 disability. We get folks from OPWDD as well.

24 So there's two things. Because of

346

1 their disability, they are unable to

2 understand the charges against them and aid

3 in their own defense. What happens next is

4 they are then transferred to the custody of

5 the commissioner of the Office of Mental

6 Health or the commissioner of OPWDD, and then

7 they are moved to an inpatient forensic bed

8 at a state psychiatric center or two of the

9 developmental centers to be restored to

10 competency --

11 ASSEMBLYWOMAN GUNTHER: That's like

12 Mid-Hudson Psych Center?

13 MS. HANSEN: Yeah, it's Mid-Hudson,

14 Kirby, Rochester and Central New York. And

15 then for OPWDD it's Sunmount up in Franklin

16 County and Valley Ridge in Chenango County.

17 So what the Executive has proposed --

18 and we've had many conversations with the

19 Office of Mental Health on this, quite

20 lively. And what the Executive has proposed

21 is that these individuals could be restored

22 to competency in a jail. And the argument is

23 that the counties -- we pay 50 percent of the

24 cost on a per-diem rate for competency

347

1 restorations.

2 The Executive would indicate that the

3 counties are paying $40 million a year in

4 competency restoration costs. This would

5 save money.

6 We're taking cost completely off the

7 table here. Our first concern, and why we're

8 opposing, is that a jail is not a therapeutic

9 setting to do competency restoration. The

10 jails are not physically -- they don't have

11 the physical plant that would be able to do

12 this. They don't have the staffing, the

13 clinical staffing -- psychiatric, psychology,

14 social work, et cetera. They don't have the

15 programming to do what would need to be done,

16 four to six hours of programming, I think a

17 week, for restoration.

18 And one of the other pieces is that in

19 the jail, the jail does not and cannot go to

20 court to medicate over objection. And we

21 know that medication is one of the, you know,

22 foundations of being able to help restore

23 people to competency.

24 So -- but the other thing that you

348

1 absolutely need is the sheriff. This is a

2 sheriff's department decision. It's not the

3 decision of the mental health commissioner,

4 it's the sheriff's department. They run

5 their jails, they know their jails, they know

6 who's in there, they know what they need to

7 do.

8 So to our knowledge, and we've had

9 extensive -- there's not a single sheriff in

10 the state that is interested in pursuing

11 jail-based competency restoration. But the

12 budget books $2.2 million in annual savings.

13 So we think that's inaccurate. And

14 what we would instead like to see is a

15 more -- we'd like to see the Office of Mental

16 Health take a leadership role in terms of

17 bringing together those individuals that move

18 along the 730 process. So it's obviously the

19 sheriff, the district attorneys, the public

20 defenders, the judiciary, the LGU and others.

21 Because it would do several things.

22 It would help this wait time that we have for

23 730s. You know, the basis of this whole

24 thing is my members tell me, my county

349

1 commissioners tell me, You can't get a 730

2 bed. You have to wait. And at any given

3 time, there's 50 to 60 people waiting for a

4 competency-restoration bed. And they're in

5 our jails and, you know, with very high

6 mental health needs. And we can't get these

7 730 beds. So --

8 ASSEMBLYWOMAN GUNTHER: Can I ask a

9 question?

10 MS. HANSEN: Sure.

11 ASSEMBLYWOMAN GUNTHER: Are there many

12 competency restoration beds that are

13 available around New York State?

14 MS. HANSEN: I don't think there are

15 any open beds for 730s, I think because there

16 is a waiting list to be able to get a 730 bed

17 for competency restoration.

18 ASSEMBLYWOMAN GUNTHER: Okay. Sorry.

19 MS. HANSEN: Anyway, moving on, so

20 what we would do is ask for your support in

21 urging the Executive to first of all not take

22 a $2.2 million cut for a project that we

23 don't see any savings or any benefit to, and

24 instead be able to support a collaborative

350

1 process to help really, you know, get to more

2 the root of this and be able to treat folks

3 as we need to.

4 CHAIRWOMAN YOUNG: Okay. Thank you.

5 ASSEMBLYMAN OAKS: We have a question

6 here.

7 CHAIRWOMAN YOUNG: Okay.

8 ASSEMBLYWOMAN GUNTHER: I just wanted

9 to know about the competency restoration

10 beds. Is that Mid-Hudson Psych Center? Is

11 that a --

12 MS. HANSEN: Yes, there's beds at --

13 there's forensic beds -- and so that's the

14 type of bed the individual is in. There's

15 forensic beds at Mid-Hudson, Kirby in Orange

16 County -- or Manhattan, I'm sorry.

17 Mid-Hudson in Orange County, Kirby in

18 Manhattan, Rochester Psychiatric, and Central

19 New York Psychiatric.

20 ASSEMBLYWOMAN GUNTHER: I only know

21 the one in my area.

22 MS. HANSEN: Mid-Hudson, yup.

23 ASSEMBLYWOMAN GUNTHER: Yeah. And if

24 you were to ask me if that's a therapeutic

351

1 environment, I'd have to say "Wowzer."

2 MS. HANSEN: Well, what the Executive

3 is proposing is that we do restorations in

4 our jails instead of at a psychiatric center.

5 ASSEMBLYWOMAN GUNTHER: There's got to

6 be something in the middle that's better than

7 that. But that's my opinion, after going in

8 and taking a tour. I mean, people do the

9 best they can, but that place is a

10 thousand -- I mean, I don't know how old that

11 building is.

12 MS. HANSEN: I've never toured

13 Mid-Hudson, so I don't have a reference on

14 that. Toured many jails, but --

15 ASSEMBLYWOMAN GUNTHER: They're

16 actually regulated by the Joint Commission,

17 versus the Correctional. They're like

18 considered a hospital, so they're not

19 regulated -- they're regulated by --

20 MS. HANSEN: Not by the state

21 Commission on Correction, it's JCAHO instead?

22 ASSEMBLYWOMAN GUNTHER: It's the Joint

23 Commission. It's treated like a hospital,

24 and they get a Joint Commission inspection.

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1 So it's completely different.

2 MS. HANSEN: Understood.

3 All right, thank you.

4 CHAIRWOMAN YOUNG: Thank you so much,

5 Ms. Hansen.

6 Our next speaker is John Coppola,

7 executive director of Alcoholism and

8 Substance Abuse Providers of New York State.

9 Again, we're going to ask that people

10 stick within the deadline of speaking,

11 because we have others waiting.

12 So welcome. Thank you for being here.

13 MR. COPPOLA: Good evening. I want to

14 just start out by just sharing with you, as I

15 was looking up at the panel here, I was

16 feeling very grateful that each one of you

17 has, I think, personally become dramatically

18 more familiar with the substance use

19 disorders issue over the course of the last

20 couple of years. And based on your

21 questions, it's clear to me that you

22 understand the gravity of the issue.

23 I want to just recall that last year

24 when I testified, I came expressing a concern

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1 that we have a crisis and an epidemic, and I

2 think this year I come with the same concern.

3 And I want to point out, you know, over the

4 weekend I was at a meeting in New York City

5 with the New York Society of Addiction

6 Medicine. And as the New York City

7 Department of Health gave a report about

8 opiate-related overdoses in New York City,

9 the graph was -- the trajectory was in the

10 wrong direction.

11 So in spite of all that we've done

12 over the course of the last two years, we

13 haven't done enough to stop the acceleration

14 in the number of deaths and the amount of

15 addiction associated with heroin and

16 prescription opiates.

17 So the bottom line is we absolutely

18 have to do more. There is nothing to suggest

19 that the momentum is going to go in another

20 direction.

21 I was alarmed -- I mean, I've worked

22 in this field for many more years than I'd

23 care to share at this point, but I was

24 alarmed over the weekend when we started

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1 looking at something like fentanyl and the

2 degree to which fentanyl is now a part of

3 many of the overdose deaths. And fentanyl

4 is -- I think it's a hundred times the

5 strength of morphine. So not that that's not

6 bad enough, but carfentanil is starting to

7 appear on the scene nationally: 10,000

8 times, 10,000 times the strength of morphine.

9 And, you know, it defies the imagination to

10 think what could -- this is a tranquilizer

11 used for large game animals, right, that is

12 now finding its way into the heroin that is

13 being distributed across the country.

14 So this is alarming, and it's an

15 indication that if things are not addressed,

16 it will be a much more serious public health

17 problem, and that's hard to imagine.

18 I want to just state that, you know, I

19 personally have been to a number of wakes in

20 the last year. Most recently, a 22-year-old

21 young man, and before that, a 34-year-old

22 young man, both of whom were very productive

23 citizens and students at one point not too

24 long ago, both of whom died from an opiate

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1 overdose. And I think probably all of you

2 know somebody in your district, or more than

3 one somebody, who has been impacted by this

4 issue. And I'm sure that that contributes to

5 the urgency.

6 I want to suggest that the litmus test

7 for are we doing what we need to do is the

8 following. Is the magnitude of our response

9 to this problem on par with the magnitude of

10 the problem itself? So when the commissioner

11 spoke to you about all the new initiatives

12 that they're doing -- so whether it be peer

13 navigators or these urgent care centers, when

14 we look at them under a microscope -- and

15 believe me, I think she is doing an

16 incredible amount with extraordinarily

17 limited resources. When you start talking

18 about 10 new navigator programs, what exactly

19 does that mean?

20 So how many hospitals are there in New

21 York State? So we're going to now pick 10 of

22 them and we're going to put two or three peer

23 navigators in the emergency department to

24 help people get into treatment instead of

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1 being discharged into the street.

2 So again, that is not even remotely

3 close to being something of the magnitude

4 that is necessary. Right? So are we

5 thinking about peer navigators in every

6 single emergency department in the State of

7 New York, yes or no? Right?

8 So again, it's not going to happen

9 overnight, but 10 is not enough. And I think

10 Assemblywoman Rosenthal's characterization

11 that the funding is pitifully low is an

12 accurate assessment. It is not possible to

13 address this problem to the magnitude that's

14 necessary if the conversation's context is a

15 2 percent budget cap. That is flat out not

16 an acceptable context to have to have a

17 conversation about a raging epidemic.

18 I'd like to suggest that, you know,

19 when Assemblyman Cusick asked about the funds

20 that we've invested, are they working, that's

21 the right question. That's the right

22 question, are we pointed in the right

23 direction. Right?

24 The commissioner failed to brag a

357

1 little bit, I think, when asked a question

2 about what's going on. She literally has

3 established probably close to 10,000 new

4 medication-assisted treatment slots across

5 New York State that previously did not exist.

6 That's a thousand people that are currently

7 not on a waiting list. Right? So she's

8 really to be commended for doing that, in

9 addition to some of these other new projects.

10 But again, the magnitude is the problem.

11 And Senator Krueger, when you were

12 talking about the people that you're

13 concerned about who are, you know, in the

14 streets and not particularly interested in

15 going into what probably are absolutely

16 unacceptable living conditions in many of our

17 shelters, right, I would suggest to you that

18 we increasingly look to folks that are very

19 knowledgeable about mental health and

20 addiction services and ask the following

21 question: Do they have any expertise that

22 they could lend us as we contemplate what to

23 do with homeless people who have got serious

24 mental illness or serious addiction issues?

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1 Do they have anything to contribute at all?

2 And I would submit to you that if you

3 look at some of the housing programs in

4 New York City over the course of the last

5 five, six years, we're learning that a huge

6 majority of folks who come into housing

7 through a treatment program wind up in

8 permanent housing, wind up with jobs, and

9 wind up back in school.

10 So I would suggest to you that the --

11 if we look at how we're addressing many of

12 these sort of tangential issues that result

13 from people having serious addiction -- child

14 abuse, neglect, domestic violence, various

15 kinds of crime, et cetera -- and say is there

16 something that the addiction treatment and

17 mental health community can bring to bear on

18 this issue, I would submit that there you

19 might find resources and be able to move

20 those resources from less effective programs

21 into more effective programs, and that might

22 be a good place to start.

23 But again, I think the whole question

24 about magnitude -- it is not acceptable that

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1 anybody that is willing to sit down with

2 somebody and get into a treatment program,

3 that it's not an acceptable answer that we

4 don't have a bed, it's not an acceptable

5 answer to say that there's a waiting list,

6 it's just flat out not acceptable.

7 And again, I think when we get to

8 addressing this issue to the magnitude that's

9 required and necessary, you won't have that

10 in any of your districts.

11 I want to just highlight a major issue

12 that I think is really important, and that

13 is, you know, as others have talked about,

14 workforce.

15 It has been correctly pointed out to

16 me that, in part, waiting lists exist not

17 only because there are not enough beds,

18 period, they also exist because there are

19 empty beds that are not staffed. So

20 programs are not able to recruit the staff

21 necessary to guarantee patient safety and

22 that somebody is actually going to get

23 treatment. So there are empty beds in

24 programs because they don't have the staff to

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1 provide the treatment. That's not

2 acceptable.

3 And it's a direct result of what some

4 of my peers have talked about, which is, you

5 know, as we're putting up these demonstration

6 projects in hospitals and communities, one of

7 the -- the vast majority of the programs

8 across the state have not seen, you know, a

9 penny to help support their staff. And so

10 you adopt a new initiative with a new salary,

11 and you're paying more than the people that

12 are already working for you.

13 So we have to look at the workforce

14 issue. And we're recommending, first, that

15 we add staff for prevention in schools in

16 New York City and schools across New York

17 State as well as in the community. And we

18 have a very specific recommendation that

19 you'll see in the text.

20 Same thing for treatment, that we need

21 additional staff. So this is about

22 fundamentally what does it cost us to add one

23 staff person to a treatment program upstate

24 or downstate. Let's do the math, and let's

361

1 get the resources and let's do it.

2 And very similarly with recovery and

3 the use of peers in our system. There's no

4 infrastructure for it right now. In the

5 mental health system you've got a state -- if

6 you want to be a peer advocate in the mental

7 health system, you get free training, free

8 testing, free registration, free

9 certification. You come into the OASAS

10 system, none of that exists. If you want to

11 become a recovery peer advocate, you pay for

12 your training, you pay for your test, you pay

13 to apply, you pay for everything. Right?

14 So again, I think that that's an

15 important workforce thing. Which I think

16 when Senator Akshar mentioned the asset

17 forfeiture fund, I think if you do a little

18 bit of homework, what you'll find is every

19 single year there's a little nest egg sitting

20 in that bank account while we're in the

21 middle of a crisis. There is nothing that's

22 more unacceptable than that, to have the

23 money sitting in a substance abuse services

24 fund that's not being utilized in this

362

1 environment.

2 So I would say, if -- and again,

3 understood, we've heard it every single year,

4 this is one-time money. You know, it's money

5 that doesn't -- you know, we can't count on

6 it for next year, so let's not use it for

7 recurring costs because what if there's no

8 asset forfeiture from one year to the next,

9 we'll have a problem.

10 Okay, so let's use it for student loan

11 forgiveness, let's use it for tuition

12 assistance, training and support,

13 scholarships, things like that for the

14 workforce -- which, if the money isn't there,

15 guess what, we don't have the expense.

16 If we can afford to do it, let's do

17 it. So I think the investment in workforce

18 is huge.

19 I want to just end by saying thank

20 you. Were it not for the Senate, Senator

21 Amedore and his leadership, Assemblywoman

22 Rosenthal, Senator Young and Mr. Farrell, we

23 would not have had the $25 million in the

24 budget last year. And you are -- Senator

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1 Young, when you were asking questions about

2 this money, I think you were all on target.

3 Because if you look at it for a second and

4 say, What does this mean when the Governor

5 says we're spending $200 million on the

6 addiction crisis? The commissioner told you,

7 well, how it gets calculated is we go to all

8 of the people who are currently going through

9 treatment, we ask ourselves the question, How

10 many of those folks had an addiction to

11 heroin, and we calculate what the cost of

12 their treatment was.

13 A very different question is, How much

14 new revenue have we invested in the treatment

15 system as we have seen an increased demand

16 for treatment because of this crisis? And

17 the answer for last year was the $25 million

18 that you put in there.

19 And for this year, it looks like

20 there's an additional $25 million in the

21 OASAS budget. Coincidentally, there's a

22 $25 million increase in federal funds. So I

23 do think that there is a lot more that we can

24 be doing in the State of New York. And I do

364

1 want to end by saying thank you to all of

2 you, thank you to OASAS, and thank you to the

3 Governor as well for what has been done, but

4 so much more is needed.

5 CHAIRWOMAN YOUNG: Thank you very

6 much, Director Coppola.

7 ASSEMBLYMAN OAKS: Thank you.

8 CHAIRWOMAN YOUNG: All set. Okay,

9 thank you.

10 SENATOR KRUEGER: The Assemblymember

11 has a question.

12 ASSEMBLYMAN McDONALD: Can I ask one

13 question, please?

14 CHAIRWOMAN YOUNG: Sure.

15 ASSEMBLYMAN McDONALD: Thank you.

16 What struck me was your -- when you

17 mentioned the fact that there are empty beds

18 because of staffing. Did I characterize that

19 comment properly?

20 MR. COPPOLA: Mm-hmm.

21 ASSEMBLYMAN McDONALD: So I guess my

22 question is, if I'm looking on the Combat

23 Heroin site and I see empty beds, slots open,

24 are some of those slots because of staffing?

365

1 MR. COPPOLA: Absolutely. I mean, and

2 again, if you go to the site -- and, you

3 know, they've done an incredible job of

4 upgrading that site, because I think their

5 first attempt was better than nothing, and

6 right now it's much better than it was. But

7 if you were to have a specific concept in

8 mind -- I have an adolescent, 17 years old,

9 and I live in Batavia and I'm looking for a

10 residential treatment site, where is the

11 closest bed for that particular person? Is

12 it in Watertown, is it on Long Island, is it

13 in Albany? I mean, where is the closest

14 place to that?

15 So if you had -- for a woman who has a

16 child or for a young adult, for a working

17 person, et cetera, et cetera -- you know,

18 once you sort of -- if you understand the

19 different kinds of beds and you look at those

20 beds, some of them are beds for people who

21 are coming out of treatment or reentering the

22 community. They're not appropriate for

23 somebody who's seeking treatment or somebody

24 who needs detox.

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1 So when you say that today we have a

2 thousand beds available, okay, great, that

3 might be good. Let's drill down. Let's pick

4 up the phone call, since there's a thousand

5 beds, let's call all thousand numbers and see

6 whether the person that I need to get into

7 treatment can get into any one of them, and

8 how many are real. I mean, how many of them,

9 when I call the program, will they be able to

10 admit anybody, much less the person that I

11 had?

12 ASSEMBLYMAN McDONALD: It's a false

13 positive, in some aspects. I don't think

14 that's the intention of OASAS.

15 MR. COPPOLA: Of course.

16 ASSEMBLYMAN McDONALD: But the reality

17 is -- part of the trauma is the parent is

18 calling, trying to find someplace to put

19 their Johnny or their Jessie, and, you know,

20 they just don't know --

21 MR. COPPOLA: The tool that they do

22 have online right now is dramatically better

23 than it was, and they have the ability to

24 continue to improve it. So I'm like really

367

1 optimistic that as people go to that site,

2 they'll have a pretty good sense right away

3 about whether a bed is available that would

4 suit them.

5 ASSEMBLYMAN McDONALD: Thank you.

6 ASSEMBLYMAN OAKS: Thank you.

7 CHAIRWOMAN YOUNG: Thank you. Thank

8 you for your advocacy.

9 Our next speakers are Edward Snow, PEF

10 Regional 7 Coordinator, and Virginia Davey,

11 council leader. Thank you for being here.

12 MS. DAVEY: Thank you for having us.

13 MR. SNOW: I guess I'm going to -- can

14 you hear me all right? I guess I'm going to

15 start.

16 Before I start, I just want to say

17 thank you for taking the time tonight to

18 listen to us, and I just want to say "Wow."

19 So I know you've had a long day of listening

20 to a lot of people and --

21 CHAIRWOMAN YOUNG: So if you could

22 summarize, too, we'd --

23 MR. SNOW: Absolutely. I'm going to

24 make it relatively short.

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1 I represent the Labor Management

2 Committee of OPWDD, which is the -- I'm the

3 labor person who represents the union and

4 coordinates all that.

5 The OPWDD budget talks about a

6 $120 million investment into services in the

7 coming year. The concern we have is that the

8 services primarily are going to

9 private-sector services, yet our concern is

10 that in the past budget year, some of those

11 same services were recommended to go to

12 private agencies and they were unable to

13 perform those services.

14 Specifically, the Long Island DDSO

15 had -- there's the need to get away from the

16 ICFs under the Olmstead Act, and they moved

17 those -- the proposal was to move the Rainbow

18 Commons people to a private provider, and

19 that they would take over the services of

20 those individuals. That never occurred,

21 because they couldn't find a private provider

22 that was -- had the adequacy to do it to take

23 them on.

24 Now, in this year's budget there's

369

1 another proposal for another 100 people to

2 leave the remaining ICFs at the Long Island

3 DDSO and again be picked up by a private

4 provider.

5 Realistically, it doesn't look like

6 that's going to happen. They're still

7 waiting for the first group to be placed, and

8 now they've got a second group right behind

9 it.

10 The other issue that they're proposing

11 is that downstate, Long Island, that they

12 want to start a START program, which is a

13 crisis program to address crisis issues so

14 that you don't have to have

15 institutionalization and to aid people in the

16 community. They started that program in the

17 Hudson Valley, basically two years ago. It

18 was fully funded last year, operated by state

19 employees that were former members of the

20 Taconic DDSO.

21 This year they're proposing that they

22 want to do it again, through a private

23 provider, on Long Island. We, as the public

24 employees union, question whether they have

370

1 the ability to do, that can they find a

2 private provider to do that. We, as state

3 employees, have a history of doing that

4 service, and we believe that that service

5 should be allocated to state employees versus

6 private-sector employees.

7 Our third concern is relative to a

8 56-person ICF reduction at the Sunmount DDSO.

9 The proposal was for a five-year plan to have

10 the population between the two forensic

11 facilities, Valley Ridge and Sunmount, to 105

12 at the end of the fiscal year, March 31,

13 2017. The population at Valley Ridge is at

14 45, which is the proposal right along. The

15 population at Sunmount, as of today, is about

16 160, I believe.

17 So they want to again propose that

18 they're going to decrease the population at

19 that site, yet you've heard today from many

20 people issues about 730 beds. Those are

21 primarily the beds at Valley Ridge and at

22 Sunmount, the 730s. It does not look

23 realistic that you're going to have that

24 reduction in this fiscal year again, yet the

371

1 mode is that we push towards that.

2 The concern for the professional

3 employees across the board is that when

4 you're pushing for the privatization, you're

5 pushing to get people out of these

6 specialized beds, that you're often pushing

7 so hard to get to your goal that you're kind

8 of losing a little bit along the way. And

9 our members are concerned when that happens,

10 because sometimes people are pushed more than

11 what they should be, and they're putting

12 people and communities in jeopardy, when our

13 members believe that maybe you should slow it

14 down, that you should have a little better

15 plan at times, and that doing that, you kind

16 of safeguard the communities, you safeguard

17 the people we're serving.

18 Our system certainly -- I've testified

19 over the years, our system has really served

20 some people well in the community. It's

21 great for people to be able to move out of

22 institutions, institutional living, and move

23 into the community. That is the goal. The

24 agency has attained that goal, and continues

372

1 to, but our concern is the speed and the

2 process that's being involved to do that.

3 In my testimony there is a brief

4 discussion about the Justice Center. I

5 always kind of feel an obligation to have

6 some discussion about the Justice Center.

7 You heard a lot today about it. I was kind

8 of happy to see the executive director of the

9 Justice Center here, kind of giving his

10 points of view.

11 One of the concerns we have with the

12 Justice Center is the kind of frequent

13 allegaters {sic} -- and the director kind of

14 spoke about that today. But there really is

15 not -- within a system where you have people

16 in these specialized units, you oftentimes

17 will have someone who will frequently

18 allegate {sic} against a number of people.

19 I'll give an example that's in my

20 testimony. Recently we had, at Sunmount, one

21 of these frequent allegaters allegate that

22 nine different staff people, who were women,

23 had actually had a sexual encounter with him

24 in the hall. Now, you know it's kind of

373

1 unlikely that that happened, yet the Justice

2 Center took that call and processed that as a

3 legitimate situation. The nine people were

4 placed on restrictive duty, and that costs

5 money.

6 And our concern is that at one time

7 they had a talk of having a frequent

8 allegater program. They used it once, and

9 then, poof, it went away. So our concern is

10 that that -- that the Justice Center still is

11 in need of refining some of those issues.

12 So that's basically my testimony in a

13 nutshell. I'm going to leave the OMH side to

14 Virginia.

15 MS. DAVEY: And in the interest of

16 attaining your goal of having this be short,

17 believe me, the way I talk, reading it is

18 going to work out better for us. So I'll

19 read through it quickly, as quickly as I can,

20 and then take any questions that you might

21 have.

22 Good afternoon. Thank you for having

23 us here today. My name is Virginia Davey,

24 and I'm happy to have been selected by

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1 President Wayne Spence to speak with you on

2 behalf of the Public Employees Federation.

3 I mean the statewide labor management

4 cochair of the OMH PEF Committee. Today I

5 bring concerns, insight, and proposed

6 recommendations from those who work on the

7 front lines with the patients that we serve.

8 I cannot help but find parallels between the

9 hearing today and the daily charge of our

10 members. As the Senate and Assembly leaders,

11 you have taken on a huge task today, with

12 several people bringing their concerns to you

13 and hoping that you can say something or do

14 something to help them to feel better. Based

15 on the number of important people who have

16 landed at your doorstep, I think you have

17 experienced a bit of what our counselors face

18 on a daily basis.

19 Like today, the number of patients at

20 our doorstep is ever-increasing. One of the

21 most pressing concerns identified in our OMH

22 system is the task of serving an

23 ever-increasing outpatient population without

24 a corresponding increase in the budget

375

1 appropriations.

2 Although the shifting of employees

3 from inpatient to outpatient care served to

4 increase the numbers of counselors available

5 for outpatient, that well is quickly running

6 dry. The shift has not kept pace with

7 community needs. This has resulted in

8 caseloads that make it more and more

9 difficult to provide quality care.

10 Exacerbating the recruitment and

11 retention efforts in OMH has been the role of

12 the Justice Center. Many are opting to work

13 in different environments or worksites that

14 are less likely to put their licenses and

15 livelihood in jeopardy. Unfortunately, our

16 system is not well in this capacity.

17 This fact makes it more and more

18 unlikely that nurses who come to OMH will

19 stay at OMH. Many OMH facilities are unable

20 to meet their fill levels. Until the

21 compensation packages can compete with

22 private sector employees, we will continue to

23 suffer the consequences of understaffing.

24 More money has to be dedicated to getting OMH

376

1 online, because Commissioner Sullivan cannot

2 correct this issue on her own.

3 Although PEF respects Commissioner

4 Sullivan greatly, we still have some

5 differences of opinion related to some of the

6 proposed efforts to consolidate services

7 and/or move services into the private sector.

8 The gutting of OMH-provided inpatient

9 services and the state workforce does not

10 always settle well with PEF or the patients

11 and communities that they serve.

12 I think by now you have all heard

13 about the ongoing efforts to keep the Western

14 New York Children's Psychiatric Center a

15 stand-alone unit. OMH promised that these

16 stakeholders would be given a seat at the

17 table to determine the community need. These

18 stakeholders and this community have spoken

19 out loud and clear. At a time when we are

20 trying to get buy-in from those with mental

21 illnesses to avail themselves of much-needed

22 services, we need to provide it on their

23 terms, in their buildings, and in the

24 locations that they choose.

377

1 We ask that you help them to keep

2 their faith in OMH and the services they

3 provide. We know this cannot be done without

4 more money in the budget to offset the

5 anticipated savings potential of combining

6 the adult psychiatric center in Buffalo. The

7 stakeholders are counting on us to find a way

8 to put a moratorium on any efforts to upset a

9 system of care that they have come to trust

10 and rely on.

11 Likewise, we would ask that the effort

12 to shift Hutchings Psychiatric Center

13 services to Article 28 hospitals also involve

14 all the stakeholders. If this endeavor moves

15 ahead, it may be precedent-setting and be

16 duplicated across the state. For this

17 reason, we believe the Mental Health and

18 Developmental Disabilities Committee and

19 other supporters of healthcare should also

20 weigh in on behalf of our patients.

21 Although Article 28 hospitals may

22 provide good short-term care, longer-term

23 care may need to be left to the OMH. PEF

24 members are some of the staunchest advocates

378

1 for our patients, and we too need to be at

2 the table during those deliberations.

3 With regard to the restoration-to-

4 competency specialized units, PEF believes

5 that the care of those who are in need of

6 mental health treatment is best delivered in

7 a nurturing environment outside the razor

8 fences of a jail or a correctional facility.

9 We would gladly accept the $890,000 to

10 enhance services to not only those being

11 restored to competency but to those who have

12 served jail and prison terms and have been

13 released into our communities. This would

14 allow for a broader use of allocated funds.

15 PEF has brought issues to the table

16 regarding concerns that our staff has not had

17 proper training, resources and security unit

18 designations to best serve this patient

19 population. This solution could be a win for

20 the community and the OMH patients at large.

21 Thank you for your time.

22 CHAIRWOMAN YOUNG: Thank you very

23 much. I don't believe we have any questions.

24 Thank you.

379

1 ASSEMBLYMAN OAKS: Thank you.

2 C0HAIRWOMAN YOUNG: Our next speaker

3 is Paige Pierce, CEO of Families Together in

4 New York State.

5 MS. PIERCE: Good evening.

6 CHAIRWOMAN YOUNG: Good evening.

7 Thank you for being here.

8 MS. PIERCE: Thanks for sticking with

9 us.

10 I think everybody up here knows me,

11 but I'm Paige Pierce. I'm the CEO of

12 Families Together in New York State. We

13 represent families of kids with behavioral

14 health needs across New York State. We're a

15 family-run, family-governed organization,

16 meaning that over two-thirds of our board of

17 directors and most of our staff, including

18 myself, are parents of children with

19 behavioral health needs.

20 We have -- I've given my written

21 testimony, which is really just a two-pager,

22 so I don't need to read a ton. I'm just

23 going to highlight a couple of the bullets

24 for you.

380

1 One of the things that's most

2 important to us is the notion that, you know,

3 "Nothing about us, without us," that families

4 have lived experience as peers that we can

5 help share with other family members to help

6 them navigate the multiple systems that our

7 kids wind up in.

8 So when we have the kind of peer

9 support that Families Together's members

10 provide, we can help save money in many of

11 the systems, particularly the mental health

12 and substance abuse systems. Because the

13 families who are entering those systems are

14 at a loss, and the families who have

15 navigated them in the past have a lot to

16 offer.

17 And we have training and credentialing

18 for those family peer advocates that can help

19 all of our systems as they transform into

20 Medicaid managed care and DSRIP and the like.

21 So I want to just make sure I hit on

22 the important things. You know, families who

23 have lived experience are experts in

24 engagement. And you've heard over and over

381

1 again, with everything related to better

2 healthcare, that engagement of the recipients

3 is critical. We are experts on engagement,

4 because we know what works. We have a level

5 of trust and credibility because we're fellow

6 family members, and we can engage families in

7 a way that people with a lot of letters after

8 their name can't.

9 I tell the story often about how we

10 had a family peer advocate in a local county

11 clinic, mental health clinic, and the family

12 peer advocate was assigned to the parents

13 when they came in, and they helped them

14 navigate, helped them with everything from,

15 you know, what do you need to make it to your

16 next appointment, what kinds of barriers do

17 you have to accessing services.

18 And the no-show rate in that clinic

19 went way down once they had family peer

20 advocates working with the parents. That's

21 actual money. That's, you know, time at the

22 county level, at the clinic, being saved.

23 And we would submit that those kinds

24 of savings could be reinvested into more

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1 community-based peer kinds of services that

2 will help provide even more savings in the

3 future.

4 Kelly Hansen talked a little bit about

5 the state plan amendments that are part of

6 the 1115 waiver that New York State is

7 applying for with CMS. Until that happens,

8 OMH still has money that they had put in the

9 budget last year, and money for this year,

10 that we're asking to please utilize this

11 year. Don't wait for the federal government

12 to give the thumbs up on our application for

13 the 1115; it's not necessary. The money is

14 there, and it should be utilized now to shore

15 up our workforce, particularly our peer

16 advocacy workforce.

17 The DSRIP. You've heard a lot about

18 DSRIP today. When DSRIP first rolled out, we

19 kept saying, as family and children's

20 advocates, include us. Like I just said, we

21 can save a lot of money on the end, on the

22 bottom line. Because if you can provide the

23 kinds of services that I just talked about,

24 you won't need unnecessary hospitalizations

383

1 and ER visits.

2 They didn't spend a lot of time and

3 energy on children and families because

4 that's not their high users. It isn't a lot

5 of young people entering the ER

6 unnecessarily. But it is a lot of

7 21-year-olds, 22-year-olds, 23-year-olds.

8 And the DSRIP programs had a five-year plan.

9 So there are kids who are 17 now who, if

10 they're provided the kinds of services they

11 need, their numbers will be better five years

12 from now.

13 So we would contend, spend the money

14 early on, including on children's behavioral

15 health and family peer support. And DSRIPs,

16 insist that the PPSs utilize the existing

17 workforce within the family peer services.

18 And then lastly, I just want to say

19 that Families Together has our legislative

20 luncheon a week from Tuesday, so it's on

21 Valentine's Day, in the Convention Center.

22 And we are recognizing Assemblywoman Gunther

23 as the Legislator of the Year, and Senator

24 Ortt. And you're all invited. You all have

384

1 gotten invitations. And we would love to see

2 you there.

3 We have over 500 families who come

4 from all of your districts, and they're here

5 in Albany to meet with you, but also to hear

6 from you what it is that's happening in

7 Albany that's affecting their families. So I

8 would encourage you to come.

9 CHAIRWOMAN YOUNG: Thank you very

10 much. And thank you for your testimony.

11 ASSEMBLYMAN OAKS: Thank you.

12 MS. PIERCE: Thanks.

13 SENATOR KRUEGER: Thank you.

14 CHAIRWOMAN YOUNG: Our next speakers

15 are Barbara Crosier, vice president for

16 legislative affairs, and John Drexelius,

17 Esq., legislative affairs, from the

18 #beFair2Direct Care Coalition and the

19 Coalition of Provider Associations.

20 Thank you for being here.

21 MS. CROSIER: Thank you.

22 MR. DREXELIUS: Thank you.

23 CHAIRWOMAN YOUNG: So again, if you

24 could --

385

1 MS. CROSIER: We're going to be very

2 brief.

3 CHAIRWOMAN YOUNG: -- summarize.

4 because I just want to remind everybody, you

5 have written testimony that's put into the

6 record. So thank you again, and look forward

7 to hearing what you have to say.

8 MS. CROSIER: Good evening, and thank

9 you so much for staying. My name is Barbara

10 Crosier. I am the vice president of

11 government relations for Cerebral Palsy

12 Associations of New York State, and I am here

13 representing all nine associations on behalf

14 of the #bFair2DirectCare campaign.

15 I think most if not all of you have

16 joined us in various media events, press

17 conferences, rallies, and have been very

18 supportive of our ask. I think you're very

19 familiar with the #bFair2DirectCare. We're

20 asking for a $45 million investment over each

21 of the next six years to be able to begin to

22 start to pay a living wage for the

23 hardworking New Yorkers who support people

24 with developmental disabilities. In the

386

1 scheme of a $150 billion-plus budget, as

2 Assemblywoman Gunther said, it's a spit in

3 the ocean.

4 So you've heard about the vacancy and

5 overtime rates, which are increasing at an

6 alarming rate. Unlike state-operated

7 facilities, where Helene talked about the

8 fact that they're decreasing and they're able

9 to hire, we are going in the absolute

10 opposite direction, because we have not been

11 able to give raises and our costs are

12 increasing. House managers are working

13 overnight shifts. So it's not only the loss

14 of direct care workers, but as it moves up

15 the chain and people are having to do

16 overtime, the shifts are getting burnt out

17 sort of at every level.

18 Assemblywoman Miller asked about

19 self-direction. And I think a lot of the

20 problem with self-direction is also being

21 able to recruit and retain staff. So it

22 really -- it is across all parts of our

23 field.

24 And what we're asking for is less

387

1 than -- it's 0.0288 percent of the total

2 budget. I mean, it's a minuscule amount.

3 Attached to our testimony is an op-ed piece

4 by Margaret Raustiala, who's a mom of a

5 47-year-old man on the autism spectrum from

6 Long Island. I think many of you know

7 Margaret. I would encourage you to read her

8 op-ed piece.

9 And thank you on behalf of the more

10 than half a million New Yorkers with

11 developmental disabilities, their families,

12 and those who serve and support them.

13 CHAIRWOMAN YOUNG: Thank you.

14 MR. DREXELIUS: Hi. I'm JR Drexelius.

15 I'm the government relations counsel for the

16 Developmental Disabilities Alliance of

17 Western New York. And I'm here with Barbara

18 tonight.

19 Winnie Schiff was going to give this

20 testimony from the IAC, but she couldn't be

21 here, so she apologizes for that.

22 We're here on behalf of the Coalition

23 of Provider Associations, or COPA. COPA is a

24 collaboration of five associations -- the

388

1 Alliance of Long Island Agencies, Cerebral

2 Palsy Association of New York State, DDAWNY,

3 the Interagency Council, IAC, and the

4 New York Association of Emerging &

5 Multicultural Providers -- because we really

6 felt we needed to come together as a

7 collaboration. We represent over 250

8 not-for-profit agencies across New York

9 State. We provide supports and services to

10 hundreds of thousands of New Yorkers with

11 developmental disabilities, employ over

12 120,000 dedicated professionals, with a

13 combined operating budget of nearly

14 $5.2 billion.

15 Everything in my testimony has been

16 said tonight. Senator Savino pointed out

17 that -- how this administration can be saying

18 that they've been giving us funding increases

19 for the last four or five years when we're

20 getting $134 million in state dollar cash

21 less than we got in 2012. It's a Ponzi

22 scheme. It's alternative truths. We have

23 not. We have been starved, and we are now

24 facing a real, real crisis.

389

1 Providers of supports and service for

2 individuals with developmental disabilities

3 are facing continuing rising costs, a

4 population whose needs are growing in

5 intensity, aging parents, and caregivers who

6 need to do more for their loved ones with

7 less.

8 I share everything that's been said

9 tonight about the need for a living wage.

10 And it's not the minimum wage; it's not

11 enough. I'm preaching to the choir.

12 In terms of development, many of you

13 up there have already talked about the fact

14 that the, quote, unquote, $120 million which

15 they every year roll out -- and every year it

16 comes out of the hide of us, because it's a

17 negative number at the end of the day -- is

18 not enough. And it is not enough.

19 It also specifically doesn't -- it has

20 very unrealistic expectations with regard to

21 the number of individuals for whom low-cost

22 services are appropriate. They don't

23 recognize that there are significant

24 populations that have higher needs -- the

390

1 sheltered work kind of programs that they do

2 not want to fund. It's just mind-boggling

3 that they're living in this alternate

4 reality.

5 With respect to the OPWDD

6 transformation, while healthcare is getting a

7 $400 million pot to deal with the

8 transformation, again, there's no new funding

9 in this budget to support OPWDD's ongoing

10 transformation agenda. The testimony I've

11 got in here has many examples. I won't read

12 them tonight.

13 With respect to the Justice Center and

14 unfunded mandates and other system costs, all

15 I can say is that we haven't received any

16 increases for cost related to fuel, staffing,

17 insurance, and we have not received the

18 needed regulatory relief for the overwhelming

19 paperwork and system-approved processes that

20 are continually being added to this field.

21 We have expenses related to staff

22 background checks, the OPWDD Front Door

23 process and the Justice Center. They've all

24 grown over time. No new money.

391

1 We recently -- COPA, working together

2 with a number of other developmental

3 disability associations, surveyed the field

4 regarding the impact of the Justice Center.

5 And the report, "Justice Center: Opportunity

6 Missed," clearly articulates the detrimental

7 effect that the Justice Center has had on the

8 staff, supports, and the individuals who it

9 was established to protect. And we would

10 urge you to read that report and contact us

11 with any questions and concerns.

12 And I've been up on that panel before,

13 and I want to stop now because you want me to

14 stop now.

15 CHAIRWOMAN YOUNG: Okay, thank you.

16 ASSEMBLYWOMAN GUNTHER: Any questions?

17 CHAIRWOMAN YOUNG: All set? Okay,

18 thank you.

19 MR. DREXELIUS: Thanks.

20 SENATOR KRUEGER: Thank you.

21 CHAIRWOMAN YOUNG: Next is Christy

22 Parque, CEO and president, Coalition for

23 Behavioral Health.

24 MS. PARQUE: Good evening. I had

392

1 originally optimistically started my

2 testimony with "good afternoon," but I'll say

3 good evening.

4 And I want to say thank you so much

5 for sticking around and your commitment to

6 listening to us and partnering with us about

7 trying to find solutions to help strengthen

8 communities and strengthen the individuals in

9 those communities.

10 I'd also like to say thank you. This

11 is my inaugural testimony as the new CEO of

12 the Coalition for Behavioral Health. I have

13 testified before you all in the past, but not

14 under this hat. So I'm very honored, and I

15 do again appreciate you sticking around and

16 the good questions that you've asked my

17 esteemed colleagues who have testified before

18 me.

19 So the Coalition for Behavioral Health

20 is the umbrella advocacy and training

21 organization for New York City's behavioral

22 health community. We represent over

23 140 nonprofit community-based organizations,

24 and we serve over 450,000 consumers with

393

1 services.

2 And what I want to say to you today is

3 that I'm sitting at this seat with over

4 35,000 workers behind me in spirit. That's

5 35,000 full-time workers, we're probably well

6 over 40,000 workers if you count the per diem

7 and the part-time workers. And I don't take

8 it lightly when I come here to testify on

9 their behalf and the good work that they're

10 doing. And the people who preceded me in

11 their testimony from the developmental

12 community also testified to the hard work of

13 people that run their programs. And that's a

14 lot of what I'm going to talk about, is the

15 workforce and talk about the capacity and the

16 infrastructure that we're facing.

17 So to understand a little bit more

18 about who we are, we offer a whole range of

19 services. Our members comprise an intricate

20 network of safety providers throughout the

21 neighborhoods they serve. And we care for

22 the most vulnerable among us. It is critical

23 that this network remain strong and intact,

24 as the state stretches itself to achieve new

394

1 goals. And we support many of the goals and

2 the directions that they're going in.

3 And we serve New York City communities

4 in Long Island, Westchester, Rockland, Orange

5 County. And now we have a strategic

6 coordination for kids' work across the state,

7 and we're very excited to take that on,

8 because we realize we really need to speak

9 with one voice for those 2 million kids that

10 are on Medicaid in New York State.

11 The coalition's budget priorities

12 really reflect the reality that we're facing

13 as a sector. We strongly support the

14 measures that preserve and strengthen

15 community-based mental health and substance

16 use programs through the reinvestment of

17 resources in community-based services, the

18 continuation of viable rates under Medicaid

19 managed care, the preservation of a

20 sustainable workforce, and the promotion of

21 policies that prioritize consumers.

22 We are happy to see -- again, we

23 support the idea that the state is moving in

24 a holistic approach to serving the people

395

1 that we serve. So that means you'll hear

2 terms like social determinants of health

3 under DSRIP and Medicaid managed care. And

4 we laud that effort, because we see our

5 clients where they're at. We try to see them

6 holistically.

7 So although I'm testifying before you

8 today on substance use and mental health, my

9 members also provide housing and emergency

10 shelter, domestic violence services, and a

11 whole host of other things, because they

12 serve the clients where they're at when they

13 come in, and we know that people have many

14 facets to who they are. And so we want to be

15 able to provide services within a network and

16 within a safety net that sees them as a

17 holistic entity and doesn't shunt them off to

18 one area or a different area depending on

19 whatever challenge they're facing.

20 I want to highlight just some of the

21 specific budget asks that we have for the

22 2017-2018 state fiscal year as they relate to

23 the recently released Executive Budget. You

24 have my entire testimony, and you have a

396

1 one-pager that really summarizes well, I

2 think, the concerns and the areas where we're

3 grateful and the areas where we think that we

4 could be doing a little bit better of a job.

5 So that the main areas that we're

6 talking about, again, are infrastructure and

7 capacity access and workforce. And the

8 biggest ask on the top of that is a

9 $125 million ask for the Healthcare Facility

10 Transformation Program. The Executive's

11 recommendation for that $500 million pot of

12 money was they had set aside $30 million for

13 community clinics. And that's only 6 percent

14 of the funding. And it really fails to

15 recognize the critical role of

16 community-based organizations and the role

17 they play in making and keeping people

18 healthy.

19 In the past, hospital and larger

20 healthcare systems have traditionally

21 received the lion's share of investment funds

22 under this and other state programs. The

23 coalition is asking for your support for this

24 $125 million set-aside for our community

397

1 clinics as part of this Healthcare Facility

2 Transformation Program. We think it's going

3 to be great for your community, it's going to

4 be good for all the communities across the

5 state.

6 So to that point, I just want to say

7 we need a level playing field if we're going

8 to be able to achieve the goals of managed

9 care and DSRIP. And historically, the

10 community clinics have been underresourced

11 and overtapped for services. And so we think

12 it's time now that as we're going towards

13 valued-based payment and other models of

14 coordinating across the state with hospitals

15 and other community services, in order to

16 really see our people and serve them with

17 holistic services, we need to be prepared to

18 be able to demonstrate the services that

19 we're providing, that they have the intended

20 effect.

21 However, we need the resources. It's

22 the health information technology, it's the

23 staffing, it's the physical infrastructure in

24 some places if we're going towards

398

1 integration of physical and behavioral health

2 services. And we have been, frankly, not

3 given enough resources to get to where we

4 need to be. It's unrealistic to think that

5 we can achieve the outcomes that we can with

6 the existing resources.

7 So we're grateful for the $30 million,

8 we're grateful for the money we got last

9 year. But what we're saying is we want

10 25 percent of that $500 million. We think

11 it's fair, it's reflective of the statewide

12 groups serving people in their communities

13 with substance use and mental health

14 services.

15 I do want to -- we're grateful to the

16 Executive Budget for the extension of the APG

17 rates until 2020. We had asked for that

18 before the budget came out. We're grateful

19 for that. We think that's really critical to

20 help get us going towards a value-based

21 payment system. That's going to give us time

22 to work within our programs and bring them

23 closer to where they need to be so that we

24 really understand the impact that we're

399

1 having on the community.

2 And traditionally, as nonprofit

3 providers, we've always come back, whenever

4 there's been a cut or there's been changes to

5 our budget, we say we'll be there, because

6 we're the safety net. And now we are

7 learning to value the work that we're doing,

8 and we're really beginning to see how much

9 the impact has been on our programs and how

10 we have suffered under these cuts to be able

11 to move forward quickly in business models.

12 And we're not just talking about this

13 new paradigm of looking at people

14 holistically about evidence-based practices;

15 we've always embraced proven practices and

16 things like that. We're talking about we

17 have to evolve our business practices to

18 quickly come up to speed under the next two

19 and a half years under DSRIP.

20 I want to highlight in the package

21 there's an article that we included that

22 Politico wrote this week -- it's in your

23 package. And recently it was disclosed that

24 of the money that was made available so far

400

1 under DSRIP, which is about a billion

2 dollars, the total amount that

3 community-based organizations have received

4 is $12.6 million. That's the amount of the

5 money. So of the billion that's flowed, only

6 12 million has -- so it's about 1 percent has

7 flowed to the communities.

8 So you see, again, an example of where

9 community programs are being put to the side

10 when it comes to resources they need to come

11 up to speed and to support their programs.

12 So we encourage that there be more

13 disclosure on how those funds -- and we

14 encourage the Legislature and the executive

15 branch to push the PPSs to release more of

16 those funds back down to our communities.

17 I also want to note that in the

18 Executive Budget we had -- we're happy to see

19 $10 million to support the existing OMH

20 residential housing programs. We think

21 that's great. We want another $28 million.

22 I know my colleague who will be testifying

23 after me will be also bringing that up. We

24 need to have about $35 million over the next

401

1 three years in order to bring our housing

2 portfolio where it needs to be.

3 And what you need to understand about

4 this housing, these are people that we've

5 done the right thing by. They might have

6 come through homelessness, they might have

7 come out of prisons, state hospitals. And

8 we've been able to work with them, stabilize

9 them, build that confidence, and they have

10 strong, stable lives in the community.

11 And what's at risk now is that as

12 rents have gone up, the resources to the

13 providers have gone down because of the value

14 of the rents. So what happens is we have to

15 creep into the cost of providing those

16 services. And so it's really important that

17 if we lose any scattered-site housing, it's

18 very difficult to find more housing. So we

19 don't want to break that social compact that

20 we made with those folks about helping

21 stabilize them in the community. And so we

22 really encourage you to help us get that

23 other $28 million.

24 Also I want to talk about the

402

1 workforce. And again, other folks have

2 talked about this. We need immediate

3 investments in the nonprofit sector. We need

4 to invest in them in the short and the long

5 term. We need to have COLAs.

6 The Executive Budget defers the COLA

7 for one year. We would ask that that be

8 reinstated. Because what is the message

9 we're sending to the people who serve the

10 most vulnerable? Many of our staff

11 themselves are working poor. And what is the

12 message we're sending to them when we defer

13 even small COLAs down the road?

14 We also would like to have the

15 contracts that we have with the state for

16 human services across the state, not just for

17 the O agencies. We're asking the indirect

18 rate be moved up to 15 percent so that we can

19 actually keep our programs running, including

20 not just the operations but also the physical

21 plants of what those look like, and allowing

22 for things like training and other

23 opportunities for our staff to grow.

24 We would like to see the Nonprofit

403

1 Infrastructure Capital Investment Program

2 funded for another year, because last year

3 only 40 percent of the 580 applications that

4 were submitted were funded. So clearly

5 there's a need.

6 CHAIRWOMAN YOUNG: Okay, could you

7 wrap it up, please?

8 MS. PARQUE: Sure.

9 CHAIRWOMAN YOUNG: Thank you.

10 MS. PARQUE: And the last thing is

11 related to the minimum wage for the

12 O agencies. We are asking for $50.5 million

13 per year for five years to support the impact

14 of the incremental increases due to the

15 minimum wage.

16 And my final point is that for

17 children's behavioral health, we're asking

18 for a $17.5 million investment, which is

19 $7.5 million that was unspent last year to be

20 reinvested for this year. And the Executive

21 Budget shows a $10 million savings this year.

22 This is not the time to save money on

23 children's behavioral health. They've just

24 moved into managed care. So we ask that we

404

1 have the $17.5 million investment.

2 And as far as the opioid epidemic, we

3 heartily support that. My predecessor John

4 Coppola did a fantastic job. We support

5 everything he has to say. Listen to him,

6 he's a wise man.

7 And we look forward for working with

8 you more on that. You've done a -- the

9 Senate and the Assembly has done a great job

10 on that leadership.

11 And thank you for the opportunity to

12 testify. You have my full testimony and our

13 one-pager. And actually it's our lobby day

14 today and tomorrow, so you've probably met or

15 are meeting with many of my members.

16 So thank you.

17 CHAIRWOMAN YOUNG: Great. Thank you.

18 ASSEMBLYMAN OAKS: Thank you.

19 CHAIRWOMAN YOUNG: The next speaker is

20 Lisa Wickens-Alteri, president of Save Our

21 Western New York Children's Psychiatric

22 Center Coalition.

23 Thank you for being here.

24 MS. WICKENS-ALTERI: Hello. Thank

405

1 you.

2 I just want to -- you have my

3 testimony. And actually, I'm the president

4 of Capital Health Consulting. It's actually

5 a new firm in Albany. I am here representing

6 the Save Our Western New York Children's

7 Psychiatric Center.

8 We have been here before. In the

9 beginning of the hearing this morning, you

10 heard many members of the Western delegation

11 ask questions and pose similar issues that we

12 have raised in the past.

13 The advocates were really disappointed

14 they couldn't be here. When the date got

15 moved up, many of them have adult children or

16 children they have to have services for, and

17 they're in Western New York, so they couldn't

18 make it.

19 I'm just going to give a few bullets

20 and highlights to the testimony that we've

21 already submitted.

22 The consolidation of Western New York

23 Children's Psychiatric Center and Buffalo has

24 been put off for the past two years. But as

406

1 you heard earlier today, OMH is already

2 moving forward and the project bid is due

3 back this month. Yet the state has yet to

4 address the additional staffing and security

5 measures that need to be put in place to try

6 to prevent commingling between patient

7 populations.

8 As the plan has been laid out, it is

9 the children's treatment center placed on the

10 adult campus. New York can do better.

11 Senator Gallivan pointed to moving

12 young adults in adult prisons away from

13 adults. Others have pointed out health

14 projects that we continue to move forward on

15 that focus on the care of the pediatrics,

16 carving them out of the adult population so

17 they receive the specialty services they

18 deserve. They're not just little people.

19 We have increased the number of

20 pediatric nursing homes, moving children away

21 from adults. January 10th of this year,

22 Albany Medical Center had their

23 groundbreaking for a pediatric emergency

24 department, and the CEO, James Barba, was

407

1 quoted as saying "It's just not possible to

2 keep them completely isolated. This facility

3 will not have adults in it. It will only be

4 for kids, and that is very special."

5 Why are the children in Western

6 New York any different?

7 Today we heard a litany of reasons why

8 this consolidation just doesn't make sense,

9 but we did not hear why it is completely

10 necessary. This facility has the best

11 outcomes in the state, and continues to have

12 some. These children have lived and survived

13 through abuse at the hands of adults. We

14 have heard there will be more outpatient

15 services to stem the flow of inpatient

16 services, yet those services are inflexible

17 to meet the needs of this special population.

18 The mobile integration team is a

19 perfect example. Children are still ending

20 up in the hospital, and then the children's

21 psychiatric center. Last week there were

22 seven admissions alone -- seven admissions in

23 one week.

24 New York State has been committed to

408

1 identifying strong quality programs that will

2 care for more people, more individuals,

3 through the efficiencies that we've built,

4 with strong quality outcomes. There are new

5 innovative ideas being discussed and

6 presented on a daily basis. I'm thankful

7 I've actually worked with the Assembly and

8 the Senate on the opiate epidemic we're

9 having; we're doing a lot for children.

10 We're doing pediatric ventilators in New York

11 State, and we're opening new facilities and

12 new programs.

13 But yet here we are, putting and

14 moving more children to an adult psychiatric

15 center.

16 The advocates have presented other

17 options. Many of you have been supportive of

18 them. The Western delegation has heard new

19 options, new ideas, and the government and

20 the state has really liked the ideas.

21 They've asked us, yes, come back and talk to

22 us -- but not here. Not for this site.

23 Western New York Children's

24 Psychiatric Center currently services 19

409

1 counties. We implore the Legislature to push

2 forward for other options. We're not just

3 coming and saying "Don't move them to the

4 adult facility" -- we've actually come up

5 with other ideas.

6 And so let us make it work.

7 Private/public partnerships. Other ways to

8 put specialty services for children wrapped

9 around this so that we can actually make some

10 choices and give some other revenue streams

11 to support the program. It's a great

12 program.

13 So I ask that everyone comes to the

14 table. Hold them accountable. We hear it's

15 all moving forward, and every year you keep

16 putting a stay on it, and yet here we are

17 again. And this is it. We've got to make a

18 move.

19 So I thank you for your time. God

20 bless you for still being here. And have a

21 good night.

22 CHAIRWOMAN YOUNG: Thank you very

23 much. Thanks for all you do.

24 ASSEMBLYMAN OAKS: Thank you.

410

1 CHAIRWOMAN YOUNG: The next speakers

2 are Arnold Ackerley, administrative director,

3 and Clint Perrin, director of policy,

4 Self-Advocacy Association of New York State.

5 Thank you for being here.

6 MR. ACKERLEY: Thank you for your

7 time, everyone.

8 So I think it's important to begin to

9 understand the nature of our organization,

10 because what we've chosen to focus on is the

11 #bFair2DirectCare Campaign. So we will be

12 brief, as we know you've heard about this.

13 But I do think it's important to understand

14 why we feel it's important for our

15 organization to speak.

16 There's something unique about our

17 organization. The organization was actually

18 founded by individuals with developmental

19 disabilities, for individuals with

20 developmental disabilities. And to this day,

21 our board of directors is comprised entirely

22 of individuals with developmental

23 disabilities.

24 So as administrative director, I

411

1 report to them, and today have been asked to

2 speak on their behalf with my colleague,

3 Clint.

4 So I think it's very important to

5 understand that when we talk about the issue

6 of fair wages for direct support

7 professionals, we're really talking about a

8 direct benefit to individuals with

9 disabilities as well. So a decision, you

10 know, to fund those fair wages is really a

11 designation to positively impact the quality

12 of life of individuals with developmental

13 disabilities.

14 I think we will find that quality of

15 life for many individuals with developmental

16 disabilities really begins and ends with the

17 relationship and services that a direct

18 support professional provides on their behalf

19 each day.

20 I think it's also important to

21 understand that the capacity of individuals

22 with developmental disabilities to be

23 contributing members of their communities and

24 our economy is directly dependent on some of

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1 those services. Without a direct support

2 professional to assist them in many ways --

3 with transportation and some career

4 counseling -- they may not be able to retain

5 their positions, their jobs. They may not be

6 able to even shop and, in some cases, may not

7 be able to vote when it's time to do so.

8 And so I'll turn the floor over to

9 Clint.

10 MR. PERRIN: Hello. Hello, all.

11 CHAIRWOMAN YOUNG: Hello.

12 MR. PERRIN: I speak to you today kind

13 of uniquely. I'm probably one of the few

14 people that you've heard from today who

15 actually receives services. Yes, I'm a

16 service recipient.

17 ASSEMBLYWOMAN GUNTHER: Can you hold

18 that mic just a little bit closer? Thank you

19 so much. Because I'd like to hear.

20 MR. PERRIN: I am a service recipient.

21 And my direct support person is quite

22 important to me. I don't think I would be

23 here speaking to you today if she didn't work

24 with me. And I certainly wouldn't -- my

413

1 apartment certainly wouldn't be as clean or

2 as safe as it is.

3 That's all.

4 CHAIRWOMAN YOUNG: Okay. Well, thank

5 you for being here.

6 MR. ACKERLEY: So would I be able to

7 make one last point?

8 So I think one common experience we've

9 heard through our board of directors when we

10 reviewed this is that too many New Yorkers

11 with developmental disabilities are really

12 tired of seeing conscientious, good direct

13 support professionals leave for higher-paid

14 positions, when nearly a decade ago that was

15 not the case. It was typically, you know,

16 well above a minimum-wage position. So we

17 just ask you to consider that.

18 We do understand that the minimum wage

19 is being budgeted for. However, the profound

20 responsibilities of the position and the

21 importance of the position really merit a

22 higher wage. And that's why we have joined

23 with the #bFair2DirectCare Coalition.

24 Thank you for your time.

414

1 ASSEMBLYMAN McDONALD: Thank you.

2 Thank you, Clint.

3 CHAIRWOMAN YOUNG: Thank you for

4 participating.

5 ASSEMBLYWOMAN GUNTHER: Thank you for

6 waiting so long.

7 CHAIRWOMAN YOUNG: Yes, absolutely.

8 The next speaker is Bill Gettman, CEO

9 of Northern Rivers Family of Services.

10 ASSEMBLYMAN McDONALD: Not here. He's

11 not here.

12 CHAIRWOMAN YOUNG: Oh, I guess he

13 left.

14 Stephanie Campbell, director of policy

15 for Friends of Recovery New York.

16 Welcome. Thank you for being here.

17 MS. CAMPBELL: Good evening. Thanks

18 so much for being here. It's such a pleasure

19 and an honor to sit here and talk to the

20 folks that I actually used to work for.

21 So I am Stephanie Campbell. And as

22 the director of policy for Friends of

23 Recovery New York, I am honored to be here

24 today and discuss how we can address the

415

1 public health crisis of addiction in New York

2 State. And as many of you know, Friends of

3 Recovery New York represents the voices of

4 individuals and family members living in

5 recovery from addiction, families who have

6 lost a family member, and people who have

7 otherwise been impacted by addiction.

8 The stigma and shame that surrounds

9 addiction has prevented millions of

10 individuals and families from seeking help,

11 and we're dedicated to breaking down the

12 barriers created by stigma that have resulted

13 in discrimination and policies that block or

14 interfere with recovery. And that's access

15 to addiction treatment, healthcare, housing,

16 education and employment.

17 But I'm also Stephanie Campbell, a

18 person in long-term recovery. And what that

19 means for me is that I have not had to use

20 alcohol or drugs for over 16 years. Recovery

21 has given me the opportunity to be a mother

22 of two beautiful girls, one who is in her

23 last year at Sarah Lawrence -- right now

24 she's in Japan. I just got back yesterday,

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1 so I'm a little jet-lagged; forgive me if I'm

2 a little scrambled -- and a teenager in her

3 junior year of high school.

4 Recovery has allowed me to be a

5 partner, an employee, and a taxpayer instead

6 of a tax drain. It's allowed me to save the

7 State of New York millions of dollars because

8 somebody made the investment in me and my

9 recovery. And as a result, I went from being

10 a homeless street kid in New York City to

11 having a master's degree from Columbia

12 University and an MSW from New York

13 University. Instead of bouncing from jails

14 to institutions, I now advocate on behalf of

15 individuals and families impacted by

16 addiction.

17 And it's really funny -- I want to

18 pause here for a second -- I've had a number

19 of you who I've worked with who, when I came

20 out as a person in recovery, were shocked.

21 Right? Because I look fairly, you know,

22 normal. But the truth of the matter is that

23 there was a time in my life when that wasn't

24 my story, you know. And so to sit here now

417

1 and to advocate and to speak openly as a

2 person in long-term recovery about the

3 benefits of what happens when the investment

4 is made -- I mean, when you think about, you

5 know, the first year alone in my recovery, I

6 must have saved the State of New York, I

7 don't know, $500,000? I mean, when you think

8 about, you know, cycling in and out of

9 hospitals, emergency rooms.

10 So when we think about the investment

11 I just want to be clear that it's not just

12 the right thing to do morally and ethically,

13 right, it's the smart thing to do

14 financially. You know?

15 And so I'm not to go through all the

16 statistics. I value your time. You guys

17 know what's going on here in the State of

18 New York. But I want to mention a couple of

19 things that we are pretty clear on in our

20 recommendations.

21 The first is that -- and I don't know

22 how many of you have had the opportunity to

23 read the Surgeon General's report, but he

24 talks in Chapter 5 about the importance of

418

1 recovery support services, what he calls RSS.

2 And, you know, I believe Senator Amedore had

3 talked about the multipronged approach that

4 we need to use, right, where we address this

5 -- and it's not epidemic, by the way, now.

6 It's a pandemic. There are more people dying

7 from this disease than were lost at the

8 height of the AIDS crisis in this country.

9 And I was in ACT-UP, by the way, and

10 we were throwing ourselves in streets and

11 carrying signs and doing all kinds of stuff

12 because our people were dying because of

13 shame and stigma and the lack of resources.

14 We've now surpassed the 41,000 a year in this

15 country that were dying from the AIDS crisis.

16 We're now at 52,000 plus a year.

17 And you're going to hear momentarily

18 from two people who were in the trenches --

19 one is Pete Volkmann, who heads up the PaRy

20 program in Columbia County, and the other is

21 Kristin Hoin, who some of you have seen,

22 who's a mother who lost her child to this

23 illness.

24 We must stop investing in the problem

419

1 of addiction and start investing in the

2 solution, which is recovery. We support

3 prevention and treatment for sure, but we

4 have got to, when folks get out of treatment,

5 have supports and services available in the

6 form of recovery community organizations such

7 as the ones that you'll hear about. We need

8 to invest in recovery community outreach

9 centers so that when folks come out, they can

10 reintegrate and reenter their communities.

11 We need to have family support navigators and

12 peers. And you've heard a lot about that

13 today. But we've got to have that. As John

14 Coppola had said, and others, to have 10

15 programs in the State of New York is -- I

16 don't even have the word for it. It's

17 abysmal. It's completely unacceptable.

18 And so, you know, we're moving in the

19 direction of really pushing that adequate

20 resources -- and we're asking for $45.25

21 million this year, and that's a baseline.

22 That's bare minimum. And that would cover,

23 you know, recovery community outreach

24 centers, RCOs, youth club houses, peer

420

1 advocates and recovery coaches and family

2 support navigators.

3 But I'd like right now to turn your

4 attention to Pete Volkmann, who's in the

5 trenches as law enforcement, pulling people

6 off the streets and getting them into

7 recovery. So Pete?

8 CHIEF VOLKMANN: Thank you. My name

9 is Peter Volkmann, and I'm a person in

10 long-term recovery. My last drink was

11 September 2, 1995.

12 As police chief of Chatham, New York,

13 I made a conscious choice to stop arresting

14 people who have an addiction and to get them

15 help.

16 My part-time police department of 20

17 part-time officers, with a yearly budget for

18 the whole police department of $157,000 a

19 year, in seven months has placed 70 people

20 into treatment, with insurance approval,

21 within one day.

22 So I just did it to help people who I

23 understood. And never expecting people from

24 six different counties, as far as Utica, to

421

1 travel all the way to Chatham, New York,

2 because their parents couldn't find a

3 treatment bed. And we found a treatment bed

4 for them. We are working well with treatment

5 centers, and having an understanding of the

6 dysfunctionality of both the insurance

7 company approval process and the

8 dysfunctionality of treatment centers. And

9 the lack of treatment centers.

10 But the other piece that we found is

11 many people relapse and still come back to

12 us, and we find them a treatment center

13 again. And that's where we've collaborated

14 with Friends of Recovery New York because we

15 need help. You could put someone in

16 treatment all the time, but there's a lack of

17 continuous care.

18 It's a recovery process. I wouldn't

19 be here if it wasn't for the support systems

20 that I was lucky to have in my process. And

21 so as people are dying every day in New York

22 State, I knew no other way, as a person on

23 the streets as a first responder, than to

24 start getting people into treatment. That's

422

1 the only way to save their life at this

2 point. But we're missing that next process

3 of trying to get people into the whole

4 recovery life that I have been in.

5 So I was asked to come to speak about

6 Chatham Cares 4 U and our program that a

7 little part-time police department in

8 Columbia County, New York, has placed

9 70 people in seven months with insurance

10 approval. And the shortest time it took us

11 was 15 minutes to have a bed with approval,

12 and the longest time it took us was about

13 12 hours to find a bed. We have transported

14 somebody from Columbia County to Utica. I'd

15 rather pay my officers overtime in

16 transportation than arresting somebody.

17 The other piece that is missing is

18 we're partnering up and we're getting as much

19 help as we can. Our officers are now

20 volunteering their time because our budget is

21 shot due to this. Our village mayor and

22 village board is a hundred percent behind us.

23 But we are limited, as a part-time police

24 agency. And every person is a miracle. So

423

1 70 miracles occurred in a little village

2 police department.

3 And so I'm here to advocate and to ask

4 for you all to please help us, because too

5 many people have died. It is beyond

6 comprehension for our first responders and

7 the mental anguish that we are all going

8 through, and something just needs to be done.

9 It is that bad on the streets. I will

10 testify to that.

11 And so thank you.

12 CHAIRWOMAN YOUNG: Thank you.

13 MS. CAMPBELL: Thank you.

14 And now I'd like to introduce Kristin

15 Hoin.

16 MS. HOIN: Hi, good evening. How are

17 you? I'm Kristin, and I'm Summer's mom.

18 The last conversation that I had with

19 my daughter was on January 9, 2015. We spoke

20 about a sweater. And six days later, I

21 buried her in that same sweater.

22 I struggle to remember if the last

23 words that I said to her were "I love you,"

24 as they usually were. I then had the very

424

1 difficult conversation with her three

2 children -- Ritchie, Caden and Anthony, 13,

3 4, and 3 -- letting them know their mother

4 had died.

5 Let me take you back 12 years, a

6 beautiful sunny afternoon, and I received a

7 phone call: "Kristin, Summer is struggling

8 with heroin." Way before the current heroin

9 epidemic that we're in. The floor crashed

10 out beneath me, and the hell that is

11 addiction -- that somebody living in

12 addiction, and their families, goes

13 through -- became reality.

14 Summer went through a 12-year battle

15 with this disease, and she fought to live her

16 life in recovery for those 12 years. Part of

17 that time was lived on the street, part of

18 that time was prostituting, part of that time

19 was in jail -- interspersed with times of

20 recovery. She wanted to be sober. She

21 wanted to live her life in recovery. I have

22 handwritten journals and prayers begging,

23 begging God for her life to be lived in

24 recovery.

425

1 The irony is that Summer didn't die of

2 a heroin overdose, like all of the reporters

3 put in the paper because it's the story of

4 the moment. The reality is that addiction

5 has always been, and it will always be, long

6 after this current heroin epidemic is over.

7 She won her battle with opiates. But

8 like addiction, it was replaced with another

9 drug and another drug and another drug.

10 Periods of treatment, periods of life lived

11 in recovery, interspersed with relapses,

12 fighting her way to the top. Determined to

13 live her life in recovery.

14 Why did Summer die that day? What

15 happened? I truly believe that there were

16 not sufficient recovery resources in New York

17 State. Yes, it's difficult to get to

18 treatment. Yes, it's difficult to get a bed.

19 I can speak to 50 times that I took Summer to

20 the ER and she was kicked out for just being

21 an addict. To getting a treatment program,

22 to being kicked out. But what happens is

23 when she was successful, there was not a

24 culture of recovery to come back to. There

426

1 were no resources here to have recovery

2 community centers or family support

3 navigators. She had the desire, she had the

4 family support, but she didn't have the

5 support of New York State.

6 I myself have created the Summer Smith

7 5K Addiction Awareness Memorial Run to stop

8 the stigma that surrounds addiction, to honor

9 those we have lost, and to celebrate those

10 that are currently living their life in

11 recovery. Last year we raised $21,000, and

12 this year we are moving on and hopefully

13 we'll be raising more money.

14 Summer was a student who graduated

15 from Guilderland with amazing potential, but

16 I buried her at 31 years of age.

17 But we can't do this alone.

18 Individually, we're weak. Together as a

19 group, a community, and a state, we're

20 strong. We need our tax dollars to be

21 directed to creating a culture of recovery

22 where we don't attend and I don't have to

23 speak at overdose awareness vigils or attend

24 funerals or comfort moms who have lost their

427

1 children in Pineras {ph}, where I don't

2 become the chapter leader of a grief recovery

3 group called GRASP, for those who have lost

4 somebody due to substance abuse. We need to

5 be celebrating weddings and children's births

6 and graduations instead.

7 And I would ask you, if it was your

8 child, would you do anything less? Thank

9 you.

10 CHAIRWOMAN YOUNG: Thank you. So

11 sorry for your loss. Thank you for sharing.

12 Thank you for all the good work you're doing.

13 ASSEMBLYMAN McDONALD: Thank you.

14 Thank you, Chief.

15 SENATOR KRUEGER: Bravo, everyone.

16 Thank you.

17 CHAIRWOMAN YOUNG: Our final speaker

18 is Patrick Curran, steering committee member

19 and cochair of the Eastern New York

20 Developmental Disability Advocates.

21 Thank you for waiting.

22 MR. CURRAN: Thank you guys, very

23 much. Thank you for being here, good

24 evening, and for sticking it out. I

428

1 genuinely appreciate it, appreciate the

2 opportunity. I'll respect your time and be

3 as brief as possible.

4 And hello to Senator Krueger and

5 Senator Young and Assemblywoman Gunther, my

6 Assemblyman, Assemblyman McDonald. Thank you

7 all so much, and the other people I've had

8 the privilege of working with and knowing for

9 a long time.

10 Tonight I'm here as the father of

11 Katie Curran, a very beautiful 28-year-old

12 young woman who was born with profound

13 disabilities, during a period of time when I

14 was working in these halls and doing much

15 what you're doing right now.

16 But it's also my privilege to serve on

17 the steering committee of two relatively

18 recently founded groups, one regional here in

19 the Capital District, Eastern New York

20 Developmental Disability Advocates -- we call

21 the acronym "Any Day" -- and the larger

22 statewide group of which we are now a part,

23 called SWAN, the StateWide Advocacy Network,

24 which is a collection of, at this point, four

429

1 such groups from around the state -- DDAWNY,

2 in Western New York, GROW, in Westchester

3 County, FAIR NYC, and ENYDDA.

4 These are entirely independent parent

5 and family all-volunteer organizations, and

6 our sole purpose is to educate policymakers,

7 the media, and the public on the issues

8 affecting our children. Our only stake in

9 this process is their well-being and their

10 welfare.

11 Right now our best estimate, and it's

12 a conservative one, is that our membership

13 lists and mailing lists consist of thousands

14 of similarly situated families. And we're

15 very confident that we're representative of

16 tens of thousands of more such families,

17 which translates into hundreds of thousands

18 of New Yorkers directly impacted by the

19 issues we touch on.

20 You know, I'm not very well schooled

21 in the Bible. I do remember that the last

22 shall be first; that kind of sticks out right

23 now. But following such powerful and

24 effective testimony, as we've just heard --

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1 and really what we've heard all afternoon

2 I've been sitting here and kind of skimming

3 my notes and flipping stuff out, saying,

4 okay, they've heard all this in better ways

5 than I can say it. So I'm going to skip over

6 most of what we talked about. What I really

7 wanted to do on behalf of our groups, which

8 is what we try to do, is to put the personal

9 face on all of this. Because we're just moms

10 and dads and brothers and sisters. We don't

11 have the resources and the numbers and data;

12 we rely on providers and others for those.

13 But we can speak to the reality of both

14 dealing with the disabled day in and day out

15 and what that means, even if you've got to do

16 it at the end of a long night when you're

17 conducting a legislative hearing that's run

18 many hours late and you still have to go home

19 and change the diapers and fix the braces and

20 provide the medicines and do all those

21 things. Because everything else just doesn't

22 matter. That stuff still has to be done.

23 Then you translate that into the world

24 of the direct caregivers, who have multiple

431

1 people at the same time, trying to do those

2 same things, with almost an exponential

3 increase in the complexities and the

4 subtleties and the variations of the

5 nutrition and the pharmacology and the

6 orthopedics and the nursing care and

7 everything else that goes along with that

8 job. It's really quite extraordinary.

9 But again, you've heard it expressed better

10 than I can.

11 I think if our kids, if my daughter

12 Katie could speak, I think she'd want to

13 leave you with two concepts that stick out as

14 we try to impact people with the importance

15 of this: Toothpicks and continuity.

16 Toothpicks because if you take all the

17 stuff that government does and that

18 societally we do to help people like our

19 children, all the programs, the school care,

20 the respite, the residences, the whole nine

21 yards, the billions of dollars, the

22 bureaucracies, it's one great, grand edifice

23 of stuff that really reflects our best

24 impulses, what we're trying to do. And it's

432

1 all sitting on a foundation of toothpicks.

2 And those toothpicks are the direct

3 care workers. Because every last service,

4 every last thing that that constitutes, every

5 last dollar that gets spent ultimately

6 channels through their hands, physically, to

7 these ultimate recipients, to our kids.

8 And if they're not there, or they

9 can't do that job well, the whole edifice

10 comes crashing down. And we're very close to

11 that. I mean, it's crumbling now. It's

12 getting very difficult.

13 And that kind of segues to the concept

14 of the continuity, which you've heard

15 expressed well and for a lot of reasons. I

16 won't belabor it except I think to say that I

17 don't think there's any other form of service

18 from one human being to another in which

19 continuity is as important as in providing

20 service from a direct care worker to a

21 disabled person. And not just for the

22 mechanics. You know, most people, we talk

23 about the mechanics of it all, or what I call

24 the mechanics. The physical tending, the

433

1 medical care. You know, all that kind of --

2 all the things they have to do. And it's

3 work. Trust me, it's a lot of work. Right?

4 And it's life-sustaining.

5 But, you know, there's the other part

6 that we all kind of aspire to. You know, you

7 want to break through to these people that

8 are trapped in these bodies without the

9 ability to communicate, with intellectual and

10 emotional capacities that we don't even know,

11 because we can't get through to them and they

12 can't express. And how long it takes to make

13 those connections, to give us things we all

14 need. You know, we all need that kind of

15 personal connection and emotional contact and

16 interaction. And it takes a long time to get

17 that with somebody who's got these

18 disabilities.

19 Similarly, or even sort of

20 compoundingly, it's so much harder when

21 you're the person with a disability, because

22 your world is very small and you don't

23 understand why these things are changing.

24 You don't understand why the person who gave

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1 you the bath yesterday, as I heard someone

2 express earlier, isn't there today. Or why

3 this was moved over here. Or why you can't

4 get somebody to give you a drink of juice

5 because they give you milk every morning

6 because you can't tell them you want juice

7 instead of milk. And so you throw a tantrum,

8 and you're labeled as behavior-modified, and

9 then you don't get to go to school.

10 All that stuff. It takes years to

11 break through to that. But that's the

12 continuity that is undermined by our

13 inability, our collective inability to pay

14 these people enough money to stay in these

15 jobs for any length of time.

16 Now, I appreciate very much that -- I

17 think -- you know, I see a lot of friends up

18 here, and I know we're preaching to the

19 choir. I mean, I get that entirely. So --

20 and we thank you for that. God knows we

21 thank you for that. And we know we've got a

22 critical mass of legislative support now.

23 But here's the deal. We all know how

24 this building works. Okay? All this

435

1 support, it's wonderful. But it's not

2 enough. You know that, we know that. What

3 it takes is for you all to be able to go to

4 your leaders and say, We know we've got a

5 finite pot of resources and a finite number

6 of asks that we have as legislators and as a

7 conference and as an institution, and an

8 infinite number of needs. And so we've got

9 to make choices. Mr. Leader, we want this

10 funded and we're willing to pay for it.

11 We're willing to take this out of our pot and

12 out of our hides. And we want you, in turn,

13 to go to the Governor and say, Mr. Governor,

14 the Senate, the Assembly, we need this funded

15 or we don't have a budget. What are you

16 going to do about it?

17 And we all know that nothing short of

18 that is going to get this done. Despite all

19 the talk we've had today, and all the support

20 that I know is genuine, we all know that

21 we've got to make that hard call or this

22 isn't going to happen.

23 So that's what we're asking of you.

24 We know it's a lot. We appreciate that.

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1 We'll do everything we can, our tens of

2 thousands of families around here, we'll do

3 everything we can to support that and support

4 you in that effort.

5 Thank you.

6 SENATOR KRUEGER: Thank you.

7 ASSEMBLYWOMAN GUNTHER: Thank you.

8 SENATOR KRUEGER: And thank you for

9 being the last speaker.

10 ASSEMBLYWOMAN GUNTHER: Thank you for

11 waiting so long.

12 MR. CURRAN: I appreciate that you

13 guys are still here. It's great.

14 SENATOR KRUEGER: And this closes down

15 our budget hearing on mental health and

16 mental hygiene.

17 We have another hearing starting in

18 this room, 9:30 tomorrow morning, but

19 everybody should go home and come back.

20 (Whereupon, at 8:24 p.m., the budget

21 hearing concluded.)

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