Yale Psychiatry Grand Rounds: November 12, 2021
November 12, 2021Information
"Crisis, Opportunity, and Building Back With Resiliency"
Mehul Dalal, MD, MSc, MHS, Community Services Administration, City of New Haven
ID7155
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- 00:00Uhm well thanks everyone for coming and
- 00:04I think a very exciting talk today.
- 00:08Moodle is the community services
- 00:10administrator of the City of New
- 00:13Haven has been since January 2020,
- 00:16which I pointed out,
- 00:18gave him two months to settle into
- 00:20the job before before COVID hit up.
- 00:23Prior to that, several just highlights
- 00:25working as the chronic disease
- 00:28director at DPH for seven years.
- 00:31And medical director of Quality improvement
- 00:33in the New York City Department of
- 00:35Health and Mental Hygiene for two years.
- 00:37And in terms of his training started at Brown
- 00:40and actually guys degree in neuroscience,
- 00:43so I think there's always been a
- 00:44little bit of a fascination for
- 00:45the kind of work we do for mobile.
- 00:47MD Mount Sinai resident in NY.
- 00:50You guys masters in health services
- 00:53here at Yale and is currently an
- 00:56adjunct assistant professor in the
- 00:57Department of Internal Medicine.
- 00:59He's going to be talking to us about
- 01:01all the wonderful things the city
- 01:02of New Haven's been doing,
- 01:03many some of them,
- 01:05in conjunction with our department
- 01:07and people in our department.
- 01:09I'm very exciting, really.
- 01:10Looking forward to this.
- 01:12I hope to have plenty of time for
- 01:15conversation questions afterwards,
- 01:16but with that I will turn
- 01:18this over to Doctor Delong.
- 01:23Uh, thank you Michael for
- 01:25that generous introduction.
- 01:26Uh, appreciate the partnership that
- 01:28we have with you is always come.
- 01:31I, I really appreciate this opportunity to
- 01:34speak at the Yale Psychiatry grand Rounds.
- 01:37I had a conversation with with Mike last
- 01:41week, professing a bit of apprehension,
- 01:44but he told me this is a friendly crowd,
- 01:46so I'll hold him to that.
- 01:50III would presume this is not
- 01:52the usual type of a grand rounds
- 01:54lecture that is received.
- 01:55If my memory serves me correctly
- 01:56from my days attending grand
- 01:58rounds and internal medicine,
- 01:59but I really hope to share with
- 02:01you a bit of a glimpse of what
- 02:03goes on and and really hear from
- 02:05you on what kind of connections
- 02:06you see between your work and and
- 02:09what we're trying to accomplish as
- 02:11a as a small municipal government.
- 02:13Frankly facing a number of challenges
- 02:15that are not unique to New Haven
- 02:17but nonetheless very important.
- 02:19And and of course,
- 02:21a lot of intersections with the
- 02:23work that you do,
- 02:23and the patients that you potentially see.
- 02:26I'm going to share my screen.
- 02:27Hopefully technology doesn't get
- 02:28the better of me 'cause I have like
- 02:30two or three different screens up,
- 02:31so let me see if that works.
- 02:44It's coming up the whole.
- 02:46Great, uhm, there you go. Perfect
- 02:50great. I'm glad that worked.
- 02:52So the today's talk is titled
- 02:56Crisis Opportunity and
- 02:57Building back with resiliency.
- 03:00And I actually don't have
- 03:01a whole lot of slides,
- 03:02so I'm hoping that we'll have some
- 03:05time for interaction and discussion
- 03:07towards the end of the presentation.
- 03:09But I do want to give some context.
- 03:12And of course,
- 03:13share with you the learning objectives.
- 03:18I have no financial disclosures.
- 03:21So today, hoping to cover the following
- 03:24one to understand the organization and
- 03:26roles of the City of New Haven Health
- 03:29and Human Services infrastructure.
- 03:31I think it really just as a.
- 03:33Basic level setting idea.
- 03:37It struck me that you know people don't
- 03:39really have a sense of what we do,
- 03:40what the parameters are,
- 03:41what are you know,
- 03:42what our roles are in the limitations are,
- 03:44so I do want to share with you
- 03:46what our Health and Human services
- 03:48infrastructure looks like.
- 03:49Second, to understand the city of New
- 03:52Haven's response to pandemic era challenges.
- 03:55I'm actually not going to focus so
- 03:57much on directly on our COVID response,
- 03:59but really, this is a more of an era
- 04:03rather than a specific public health issue,
- 04:06because, as we'll see,
- 04:08the sequella of this public health issue has
- 04:11had both social and economic ramifications.
- 04:14And three, uh,
- 04:15I want to talk a little bit about our plan
- 04:18to set up a new department within the city,
- 04:21termed the New Haven Department
- 04:23of Community resilience, really,
- 04:25in an effort to.
- 04:27Center ideas of resiliency and
- 04:30institutionalized.
- 04:31Those in city government and I'll
- 04:33just give a caveat here.
- 04:35I know because this is an academic audience,
- 04:38I don't mean the term resiliency and it's
- 04:41academically derived framework sense,
- 04:42although it does have carry notions of that,
- 04:45it really is a more of a general use
- 04:49term and speaks to actually the English
- 04:53language is lack of of verbiage to describe.
- 04:58Populations that are vulnerable.
- 05:01Like you know,
- 05:02we we typically tend to talk of,
- 05:04you know, vulnerable populations,
- 05:06or at risk populations,
- 05:08but to set up an entire department
- 05:10with the nomenclature of vulnerability
- 05:12felt a little off,
- 05:14so we decided to to talk about
- 05:16resiliency rather than vulnerability.
- 05:20So just with that caveat,
- 05:22in terms of the department.
- 05:25So let me dive into some of
- 05:27the organizational context.
- 05:28Uh, you know, I'm a administrator
- 05:31by profession here and so.
- 05:34Org charts are always a
- 05:35part of the day to day work,
- 05:38and but I'm I'm putting this
- 05:39off as a programmatic org chart,
- 05:41not necessarily a HR or personnel or chart,
- 05:47just to give you an idea of what.
- 05:50Programs department initiatives.
- 05:52Uh, my administration covers
- 05:55and I will mention,
- 05:56just for context I the as the Community
- 06:00service administrator and one of
- 06:02three what they call coordinator
- 06:04positions at the department.
- 06:05In other cities,
- 06:06these positions are known
- 06:07as deputy mayor positions,
- 06:08so I report directly to the mayor
- 06:11on these initiatives so it just
- 06:12gives you a context of the the the
- 06:15the profile that Health and Human
- 06:17services has in this administration
- 06:19in other administrations.
- 06:20Health and Human services.
- 06:21Sometimes as one layer down the
- 06:25other coordinator positions are our
- 06:27economic development administrator
- 06:28and our Chief Administrative officer,
- 06:30who we actually just yesterday announced
- 06:34our nomination to serve as our our next CEO,
- 06:38which is very exciting.
- 06:40Under the Community Services Administration,
- 06:42our you know our Health and
- 06:44Human services programs which
- 06:45includes the Department of Health.
- 06:47It includes the youth and
- 06:50Recreation department,
- 06:51are elderly services department,
- 06:52and sort of the catchall category which
- 06:54anyone who's in organizational work
- 06:56knows that there's always a catch.
- 06:58All category of administration and programs.
- 07:02What I've displayed here is actually
- 07:05an old organizational chart,
- 07:07and I did that for a reason in
- 07:09that I wanted to share with you.
- 07:11Why we've decided to expand and add
- 07:15this new Department of Community Resilience?
- 07:17The orange highlighted boxes here are,
- 07:20you know,
- 07:21categories that just seem to grow
- 07:24and with need and community demands.
- 07:29Over the last two years.
- 07:31As I'll explain in subsequent slides,
- 07:33special projects.
- 07:35That category includes our Community,
- 07:37crisis response and our reentry services.
- 07:40And homeless services has really been
- 07:43a high focal point during the pandemic,
- 07:46and we're hoping to.
- 07:48Actually capitalize and use what has
- 07:50happened and how that homelessness
- 07:52services system has just been disrupted
- 07:55in the pandemic to try to transform
- 07:57how services are delivered in New Haven.
- 08:00With the reduction of reliance on on
- 08:03congregate shelters and an increased
- 08:06emphasis on moving towards permanency
- 08:09for individuals experiencing homelessness.
- 08:12And I'll just give a quick
- 08:14rundown of some of the programs.
- 08:16For context.
- 08:17Our Department of Health has an
- 08:21Environmental Health division,
- 08:23which has regulatory oversight
- 08:26over restaurants and inspections.
- 08:30They've played actually pretty
- 08:31important role during the pandemic
- 08:34in terms of enforcing our both
- 08:36our state and local ordinances.
- 08:39Relate to the pandemic,
- 08:40such as mask requirements.
- 08:42We have a large nursing division
- 08:45that operates and employs nurses
- 08:47that are at every public at every
- 08:50New Haven Public school.
- 08:52As well as a separate clinical department,
- 08:54they played a very large role
- 08:56in respond to the pandemic,
- 08:57not just in terms of with students,
- 08:59but they've been actually redeployed
- 09:01and reallocated to help with
- 09:04vaccinations and and earlier in the
- 09:07testing regime that we had set up.
- 09:10We have a health programs division which has
- 09:12a number of different programs including.
- 09:16You know our health promotion programs?
- 09:20Ryan White programs and our
- 09:23vital statistics division,
- 09:25as well under the Department of Health,
- 09:27our Youth and Recreation Department has
- 09:29what we call the Youth Connect program,
- 09:31which has a specific focus
- 09:33on high risk youth.
- 09:35Each high risk youth member
- 09:37that's enrolled in the program is
- 09:39assigned a dedicated navigator.
- 09:41We who's responsible for engaging on
- 09:43a regular basis and and navigating
- 09:46youth to the appropriate services.
- 09:49This is all built on the framework
- 09:51of positive youth development,
- 09:52so it's really again emphasizes
- 09:54not so much a deficit model,
- 09:56but really a strength model
- 09:58building on their strengths.
- 09:59How youth at work employs a between
- 10:04250 and 300 youth during the summer
- 10:07and some even year round and again.
- 10:09This is an evidence based model
- 10:12that is linked with reduced
- 10:14involvement in in high risk or
- 10:16criminogenic activities among youth.
- 10:19So we try to offer this employment as much
- 10:22as possible in the city for for youth.
- 10:25It includes all our recreation programs,
- 10:27which some of you if you live in New Haven,
- 10:28and certainly if you have young ones,
- 10:31may have participated in these
- 10:34includes our summer youth camps as
- 10:36well as youth activities year round
- 10:39in conjunction with the schools.
- 10:40We also have a number of Community
- 10:43grants that we run out of the
- 10:45Youth and Recreation Department
- 10:46moving on to elderly services.
- 10:48We have operated 3 senior centers.
- 10:51Of course,
- 10:51those I've actually had
- 10:53been closed for the last.
- 10:54Almost two years and we plan
- 10:56to open them up this month.
- 10:57Finally, after many,
- 10:59many months of being closed,
- 11:01we have some tax benefits administration
- 11:04that the Senior Services department.
- 11:07Engages in and also quite a bit of
- 11:09navigation case management for seniors
- 11:11that that call us and need help.
- 11:13Our admin and programs section here.
- 11:18As I mentioned,
- 11:19the special projects and homeless
- 11:20services has really expanded in scope
- 11:22and scale over the past two years,
- 11:24but we also have some exciting work
- 11:26happening in food systems and policy
- 11:28which focuses on the sort of systems and
- 11:31structural issues along with food justice.
- 11:34I know some of you,
- 11:36some of the team and I don't know
- 11:38if they're on this particular.
- 11:40Some meeting that have been
- 11:42involved in that work,
- 11:44really.
- 11:45It's less of a focus on direct food
- 11:47assistance or emergency food assistance,
- 11:49although that is a piece of
- 11:51it that really about setting
- 11:52up a more sustainable system
- 11:54across a variety of domains,
- 11:56including environment.
- 12:00You know environmental impact jobs and
- 12:04local food sustainability across the city.
- 12:08We have our financial empowerment
- 12:10work which works directly with
- 12:12individuals who are not typically
- 12:15engaged with basic financial services
- 12:18such as having a bank account,
- 12:20understanding credit scores,
- 12:22understanding basic budgeting.
- 12:24This is a different model than financial
- 12:26education which is not shown to be effective.
- 12:29Where you.
- 12:29Just give people information on how to do a
- 12:34banking or basic financial literacy skills.
- 12:37This is really is an engaged counseling
- 12:40based approach where individual set
- 12:42goals and our financial empowerment
- 12:45counselors help them achieve those goals.
- 12:47It's based on a model that was studied
- 12:49a I believe launched in New York City
- 12:52and now facilitated by the cities
- 12:54for Financial Empowerment Fund.
- 12:55Uhm?
- 12:57We also administer some committee development
- 12:59block grants as part of that division,
- 13:01and of course the the trains have to
- 13:03run on time and the clock stuff to be
- 13:05set correctly so we have a small but
- 13:07mighty operations and administration
- 13:09team that helps all of this this run.
- 13:14I'll just focus in on the next this slide.
- 13:16Here it's just there are new and expanded.
- 13:18A organizational chart for which includes
- 13:21our new Department of Community Resilience.
- 13:24I have a notation here just about
- 13:25just to give you a sense of scale
- 13:27of the whole administration.
- 13:28It's about 120 FPS.
- 13:30This doesn't include our temporary
- 13:31and seasonal workers that can
- 13:33actually balloon that number,
- 13:35but as I mentioned with the youth
- 13:37and seasonals being involved by
- 13:39another 3 to 300 to 350 individuals.
- 13:43We have a budget of approximately
- 13:4528 million a year.
- 13:47The new Department of Kenny Resilience
- 13:48and I'll go into this little more detail,
- 13:50will include a newly established office
- 13:53of violence prevention focusing on
- 13:55community gun violence prevention.
- 13:57It will include our community
- 14:00crisis response efforts,
- 14:01which is our non police civilian
- 14:04response team and Michael Rowe
- 14:08from from your institution has been
- 14:10leading leading up that effort with
- 14:13of course the support of my concern,
- 14:15IAC, our reentry programs.
- 14:16Will be part of this new department.
- 14:19Uh,
- 14:20our homeless services expanded
- 14:21and with the new strategy will be
- 14:24part of this new department.
- 14:26We the we aim to launch a
- 14:29citywide mental health.
- 14:31Coordinated initiative also that will
- 14:33be part of this new department and
- 14:36the coordination around some of our
- 14:38harm reduction work will be integrated
- 14:40into this new department as well.
- 14:45So let me switch gears and just take a step
- 14:48back in time as Doctor Sarniak mentioned,
- 14:53I took this job coming on in January of 2020.
- 14:58And it's not like we didn't
- 15:00know COVID was around.
- 15:01As the name suggests,
- 15:03COVID-19 was named in 1920, nineteen.
- 15:08Uh, it just wasn't top of mind,
- 15:11uh, and it certainly wasn't
- 15:12part of my expectation that this
- 15:15would be an all consuming, UM.
- 15:17A crisis when I accepted the job,
- 15:21but when Mayor Elicker offered it
- 15:24but it became clear within a couple
- 15:27of weeks in January that that
- 15:30this was going to be something we
- 15:32didn't have an understanding of.
- 15:33The scale and scope of it,
- 15:35but we knew it was going to
- 15:37be something most likely,
- 15:38and I liken it really to sort
- 15:41of being able to, you know,
- 15:43being of the vantage point of
- 15:46knowing that there was a title.
- 15:48Wave. Or a tsunami really.
- 15:51Tidal wave is probably a misnomer.
- 15:53A tsunami that was set off
- 15:55somewhere in the distance.
- 15:57And we knew somehow in some
- 15:59way we'd be impacted, uh,
- 16:01but you know,
- 16:02while that tsunami was approaching,
- 16:05things were kind of going on as normal.
- 16:08Up course, there's a lot of chatter
- 16:09in the public health sphere,
- 16:11but otherwise things were,
- 16:12you know, proceeding as normal.
- 16:15And you know the moment that it really
- 16:18hit us locally here at least we had
- 16:21a little little premonition of it
- 16:23when there was the model UN conference.
- 16:25That was a folks will remember
- 16:27this that was hosted by Yale and
- 16:30was cancelled on account of the
- 16:32of a student from China coming
- 16:34down with flu like symptoms.
- 16:35That,
- 16:36uh,
- 16:36that moment I realized that at
- 16:39least internally,
- 16:40people were springing to action because
- 16:43we understood that it could have been a.
- 16:46A quite a severe you know or important
- 16:51of important public health implications.
- 16:53This is when the chatter started
- 16:55with the Department of Public Health.
- 16:57The conversations internally on what
- 16:59kind of system we will set up when
- 17:02the crisis and the and and COVID
- 17:06would eventually hit our shores.
- 17:08That turned out not to be COVID.
- 17:10At least we don't think,
- 17:11although you know,
- 17:11subsequent studies have shown that
- 17:13there it might have been circulating
- 17:14as early as January, February.
- 17:16Uhm,
- 17:16but that did not was not the moment
- 17:19that most people remember what most
- 17:22people remember when COVID hit was a sudden.
- 17:26A shutdown of services in in March
- 17:28of 2020 really the second and
- 17:30third week in March of 2020 when we
- 17:33gathered in the mayor's conference
- 17:35room and had to make a call one day
- 17:37in advance of when the mayor and
- 17:39the governor did of whether to to
- 17:42to shut down our public schools.
- 17:44And we kind of understood the gravity
- 17:47of the situation at the time.
- 17:49And although there were some public
- 17:50health folks that were saying,
- 17:52well, you know,
- 17:52you just shut it down for a couple days.
- 17:54Let the virus passing this.
- 17:55This sounds quaint right now and then
- 17:58you can reopen them once the the way
- 18:00the pandemic and the virus recedes.
- 18:02That was actually part of the conversation,
- 18:04but I think in the back of my our minds,
- 18:06we knew that that decision was
- 18:07going to be a very significant one,
- 18:09and that potentially a long
- 18:11long term and long lasting one.
- 18:14But at the end of the day,
- 18:15we did not have a playbook.
- 18:17And that's what that was.
- 18:20That's something that sticks
- 18:21with me to this day.
- 18:22Uhm, I remember having conversations
- 18:25with public health professionals both at
- 18:28the state and national level and their
- 18:30response to us again, seems quaint.
- 18:32Now, was that we do have a playbook.
- 18:34Just use the influenza pandemic playbook.
- 18:37That was developed.
- 18:38You know.
- 18:39Probably I don't know the exact term,
- 18:40but in 1999, twenty one years ago,
- 18:43I remember poring through that
- 18:45playbook and it did not inform.
- 18:48Or help us understand what kind
- 18:50of actions that we would need
- 18:52to take to address COVID-19.
- 18:54In effect we were flying blind blind.
- 18:56We had really zero visibility.
- 18:59Or minimal visibility on the scope,
- 19:02the severity or the scale of the crisis.
- 19:06You know we were relying on
- 19:08symptom based reporting.
- 19:09We did not have a data infrastructure
- 19:12infrastructure set up at the outset
- 19:15to to monitor and track and acquire
- 19:18the appropriate information,
- 19:20and I guess the only saving grace
- 19:22is that we were all in it together.
- 19:24Flying blind and we.
- 19:26I think we acted as best as we.
- 19:30Knew how and according to our you know,
- 19:33intuitions and our public health
- 19:36background on how to address this
- 19:38in the early days of the crisis.
- 19:40Uhm?
- 19:40One of the the other moments that
- 19:43sticks with me is a understanding
- 19:46the implications of these four
- 19:49populations that are vulnerable.
- 19:51Very specifically,
- 19:53their homeless population,
- 19:54and I'll get to this a little bit more later.
- 19:57But obviously it was having
- 20:00individuals housed in congregate
- 20:03settings was a recipe for disaster.
- 20:06Again,
- 20:06not knowing at the time how severe and
- 20:10how many individuals could be impacted.
- 20:12So I remember a group of folks,
- 20:15volunteers or homeless service providers,
- 20:18people who were just willing to stand
- 20:20up to the to the stand up and and
- 20:23and help got together and develop.
- 20:26They complicated but.
- 20:27Rapidly executed logistical plan to
- 20:29move people out of congregate settings.
- 20:32And we're talking, you know,
- 20:35between 200 and 300 individuals
- 20:36that were up until Middle March,
- 20:38using Congress settings for their
- 20:40primary place of shelter and moving
- 20:43them into non congregate spaces,
- 20:46namely hotel rooms and many late nights.
- 20:50Many, many tough conversations.
- 20:52But I think we were ultimately
- 20:54successful in moving folks into those
- 20:56facilities over the course of a.
- 20:58A couple of weeks.
- 20:59And in fact,
- 21:00that is something we're maintaining.
- 21:01This is a model that we're
- 21:03maintaining to this day.
- 21:04This winter we aim to house folks
- 21:05not in congregate spaces primarily.
- 21:07There'll be some congruent in in in,
- 21:10sort of minimal settings, but in general,
- 21:12the individuals who are experiencing
- 21:14homelessness in New Haven will have
- 21:16the opportunity to move into non
- 21:18congruent settings hotel based settings.
- 21:22And again, I just think that it was
- 21:27another aspect of this was, you know,
- 21:29a team of medical professionals.
- 21:30I think some of them may have been
- 21:32involved with the Yale Department
- 21:34psychiatry in some way came together
- 21:36and helped us put together a protocol
- 21:38on a playbook to run a COVID-19 respite
- 21:43Center for individuals experiencing
- 21:45homelessness and didn't have another.
- 21:47Another place to go. And again,
- 21:50that was a huge effort and appreciate.
- 21:52All the volunteerism that went into that,
- 21:53including staffing the center 24/7.
- 21:57Uh, again. We didn't know what to expect,
- 22:01so we planned for a surge capacity.
- 22:03Based on, you know, basic modeling
- 22:05that we did in terms of the impact.
- 22:07We thought it may have on the
- 22:10homeless population.
- 22:11We anticipated that we could have
- 22:12seen up to 4050 cases at a time.
- 22:16Luckily, we never got to that amount.
- 22:19We in fact only really had to
- 22:21accommodate about 15 individuals
- 22:23throughout the course of the pandemic,
- 22:26but I think at the end of the day it
- 22:28was very important to have a dedicated
- 22:31COVID-19 isolation facility respite
- 22:32facility for those experiencing homelessness.
- 22:35Again,
- 22:35I applaud the individuals involved.
- 22:38It was done without a real playbook.
- 22:40It was done ground up.
- 22:45So, beyond the public health and
- 22:48disease implications of COVID-19,
- 22:50there was obvious social and
- 22:53economic implications. Uhm and.
- 22:58Again, one of the most memorable ones
- 23:01and impactful ones was this call
- 23:03for change in the summer of 2020.
- 23:05Uhm, whereby we had the the the
- 23:12murder of George Floyd but many
- 23:15others preceding George Floyd.
- 23:17And a call for police reform.
- 23:20In the context of this global
- 23:22pandemic and economic upheaval.
- 23:25Uh, and this is something that you know I,
- 23:28I haven't seen anything like this before
- 23:30in terms of a rapid social movement and
- 23:32and and translation to actual policy.
- 23:35You know within months there was
- 23:37a police accountability bill
- 23:38passed the state legislature.
- 23:40We can talk about how this feels again
- 23:42feels different with the lens of history
- 23:44and the and the backlash to these this.
- 23:46This movement and related movements.
- 23:49But at the time there was a real sense that
- 23:52folks were calling for fundamental change.
- 23:54To how we thought of policing.
- 23:58Ultimately,
- 23:59you know we at the city level.
- 24:02Our job is to integrate,
- 24:03you know, feedback from various
- 24:05stakeholders and understand the
- 24:06existing systems and structures.
- 24:07So we we did not,
- 24:09you know,
- 24:10go the Minneapolis route or some of
- 24:12the other cities rounds and and on the
- 24:15spectrum of you know, abolishing police.
- 24:17But we really took not.
- 24:18And you know we took and and
- 24:21and modern or approach.
- 24:23But button and approach in terms of.
- 24:26Uh,
- 24:26holding police accountable to higher
- 24:29standard training police where it
- 24:32made sense and really took a stock
- 24:34of how really was the the police
- 24:36relationship and and with the New
- 24:38Haven community and in general it
- 24:40was not like it was in other cities.
- 24:42We had overwhelming overwhelmingly.
- 24:45Citizens tell us they had relatively
- 24:49good experiences with police.
- 24:51Very, very important.
- 24:52Exceptions are part of that,
- 24:53but when we did a 360.
- 24:56The review of that we ultimately
- 24:59thought our Police Department was an
- 25:01asset in helping us along this journey,
- 25:03rather than a detractor.
- 25:04And I know that there are, you know,
- 25:06obvious philosophical debates
- 25:07to be had about that,
- 25:09but ultimately that's the reality of of
- 25:11of how things are currently in New Haven.
- 25:14There's a lot of the police
- 25:15still have a lot of goodwill.
- 25:17Uhm,
- 25:17so in addition to proposing a
- 25:20alternative to police response
- 25:22in cases where it made sense,
- 25:25we we took the approach of having
- 25:28police being held to a higher
- 25:30standard and training police to
- 25:32also be competent at dealing with
- 25:35certain certain types of calls
- 25:37for service that that that could
- 25:40go wrong and could go badly.
- 25:47So just some numbers in New Haven in terms
- 25:51of you know what we're seeing in terms of
- 25:54the scale and the scope of the problem.
- 25:57The COVID-19 era has exposed
- 25:59long-term vulnerabilities that are
- 26:01complex and highly highly related.
- 26:03There are 400 persons experiencing
- 26:05homelessness in New Haven.
- 26:06About 50% of those are black
- 26:08or African American.
- 26:10Some of those returning from incarceration
- 26:1280% have a substance use history,
- 26:1564% do not have a GD or high school diploma.
- 26:18Diploma, 71% or not employed and 36% more.
- 26:22There are experiencing homelessness.
- 26:24We have approximately 40% of
- 26:27individuals with substance use disorder.
- 26:30Also have a coca ring mental illness.
- 26:33And according to a recent survey from
- 26:36the Connecticut Department Public Health,
- 26:39although recent meaning,
- 26:40I think it's been a couple years on now,
- 26:43about 60% of New Haven adults
- 26:45have experienced childhood trauma,
- 26:48and I believe that's defined by by two
- 26:50or more adverse childhood experiences.
- 26:53Overdoses were up 15% in 2020.
- 26:56This trend is continuing up in 2021.
- 27:00Well,
- 27:00I guess that's a little bit of miss number.
- 27:02It's it's level, it's it continues.
- 27:03Hi, it's still still higher than 2019 levels,
- 27:06although it's not as a luckily the
- 27:09the trend line hasn't continued
- 27:10to increase as much as before.
- 27:12Uhm,
- 27:13of course the highest risk for overdose
- 27:15deaths are those who are housing insecurity.
- 27:17Those with untreated mental health issues.
- 27:19And we also see in the data which is
- 27:22reflected nationally that there's
- 27:23a convergence in terms of opioid
- 27:26overdoses and opioid overdose related
- 27:28death among black and African American
- 27:30rates which are converging on on
- 27:33what was traditionally more higher
- 27:35in in in white populations are
- 27:38homicides have also been up.
- 27:4123 homicides to date in 2021 we
- 27:45had 20 homicides total in 2020,
- 27:48which represented a significant increase
- 27:50from our homicides in 2019 and,
- 27:53although almost exclusively,
- 27:55the homicides have been between
- 27:59individuals who are known to each other.
- 28:04Reverberating impact and trauma of
- 28:06these homicides in the community
- 28:08is is very real,
- 28:09and every time we have a conversation
- 28:12about community gun violence with
- 28:15community members and experts alike,
- 28:18we understand that the these homicides
- 28:20are not just a policing issue.
- 28:23Although that's part of it.
- 28:24But there's driven by this underlying
- 28:26unmet social, emotional,
- 28:28economic needs in the community.
- 28:35So we've actually undertaken a series
- 28:37of responses to this evolving set of
- 28:40challenges and and needs of the community.
- 28:43Again, not focusing so much on the
- 28:45public health response directly,
- 28:47but some some of its related challenges.
- 28:50Uh, in the summer of 2020.
- 28:53Uh, we announced that we would be
- 28:57exploring a framework to set up
- 29:00a Community crisis response team.
- 29:02This is the non police alternative response.
- 29:04A team that would be a pillar of our
- 29:09first response system and we started.
- 29:12You know our our framework planning
- 29:15informal community engagements,
- 29:17key stakeholder interviews and
- 29:18research into other other what other
- 29:21municipalities had done in in this.
- 29:24And what they've succeeded in.
- 29:26In the fall of 2020, uh,
- 29:28we rebranded and relaunched a coalition
- 29:31focused on opioid overdose reduction,
- 29:34rebranding as the Harm Reduction coalition.
- 29:37It was the initial impetus for this
- 29:39as many folks may here remember
- 29:41was a K2 overdose event on the
- 29:44New Haven Green in 2018,
- 29:47and that was the impetus to farm
- 29:50the Overdose Response Coalition
- 29:51that had sort of been paused.
- 29:53As administrations were switching back.
- 29:56In 2019-2020,
- 29:58but we reactivated it and now
- 30:00is a very robust and active
- 30:02coalition of over 16 individuals.
- 30:0530 members.
- 30:05I know some of some of you on this call
- 30:08participate in it as a harm reduction
- 30:10coalition and we actually engaged a
- 30:12national funder and national public
- 30:15health organizations vital strategies
- 30:17to help US staff this coalition with
- 30:19the harm reduction coordinator.
- 30:21That position is currently open by the way,
- 30:24hint, hint.
- 30:26So if anyone's interested in coming
- 30:27on board and helping with this, uh,
- 30:29that would be a great opportunity.
- 30:33And, uh,
- 30:33this this coalition has been very
- 30:36active over the past year and a
- 30:38half past year or so in initiatives
- 30:40throughout the city.
- 30:41Uhm, uh?
- 30:43We launched officially our reentry
- 30:45welcome center hosted by project more,
- 30:48a nonprofit with deep history
- 30:50in the in the New Haven area,
- 30:52helping those who previously
- 30:55incarcerated to date,
- 30:56we've had very successful outcomes.
- 30:58They've seen approximately 100 clients
- 30:59at the reentry Welcome Center,
- 31:01which is a wrap around drop in Center
- 31:04for those with incarceration history.
- 31:07Importantly,
- 31:07those who are immediately returning
- 31:09from incarceration incarceration
- 31:11can actually have a hand,
- 31:13you know, sort of a warm hand off.
- 31:15In a welcome right at the moment
- 31:17that they dropped off,
- 31:18given that the hours and logistics work out.
- 31:21Uh,
- 31:22or they can be referred anyone
- 31:24with an incarceration.
- 31:25History can be referred here for,
- 31:28for wrap around services assessments
- 31:29and wrap around services.
- 31:31In any case,
- 31:32100 clients have been seen over the past.
- 31:36Almost almost a year,
- 31:39it's about 10 months now.
- 31:41And this resulted in only one
- 31:43individual being rearrested that
- 31:45did not get re incarcerated,
- 31:48so an amazing success rate.
- 31:49I know it's anecdotal,
- 31:50it's only one,
- 31:51but I'm hoping that continues where you know,
- 31:54by comparison,
- 31:55the National Statistics and studies
- 31:57show that there's you know at least a,
- 31:59I believe,
- 32:00a 30 a third of a chance of every
- 32:02incarceration in a three year period.
- 32:04So we're really, really happy about those
- 32:08those outcomes to date on those. Uhm?
- 32:15In uh, the. Early part of this year we
- 32:21also announced that we are taking a
- 32:25new approach to homelessness services.
- 32:27This is on the heels of many many
- 32:30resources coming down to help us with
- 32:32this from the federal government and
- 32:34we we aim to assuming we can find the
- 32:40appropriate facility and the sighting.
- 32:42To really reduce our.
- 32:45Reliance on congregate type facilities,
- 32:48where, uh, where the model is, folks.
- 32:51You know, line up and walk in to
- 32:53try to get a bed on a daily basis,
- 32:56and then they they have to leave
- 32:58the facility every morning.
- 32:59We really want to try to transform
- 33:02that system to to a much more humane
- 33:06and dignified version of services.
- 33:08The need for emergency shelter will
- 33:11never go away in the immediate future.
- 33:14But that type of service I think we
- 33:15have the potential to really think
- 33:17differently about what it looks like,
- 33:18especially based on experience
- 33:20with housing individuals in hotels
- 33:23over the past year and a half.
- 33:26That can be a site where you know
- 33:29folks that really have a much more
- 33:32humane and sort of way to be.
- 33:35Sheltered and get connected
- 33:37to services and get put.
- 33:39Get put on a pathway to more
- 33:42permanent housing solutions.
- 33:43Uhm?
- 33:45We established so in the spring of 2021
- 33:48we establish an interagency workgroup
- 33:50to address increases commit gun violence.
- 33:53We established and announced plans to
- 33:54launch an office of Gun Violence that has
- 33:56officially been established now and now.
- 33:57We're looking to staff that up as well.
- 34:01We also launched a post trauma Response
- 34:04team which would supplement some of the
- 34:07post trauma response that was already
- 34:08going on through your child studies.
- 34:10While working with Clifford beers
- 34:12to give a sort of a more community
- 34:16oriented approach to responding
- 34:18directly to the neighborhood,
- 34:20canvassing folks who may have
- 34:22been impacted by the trauma.
- 34:24Potentially not.
- 34:25First hand necessarily,
- 34:26but but just by being virtue of their
- 34:29proximity to to some traumatic event.
- 34:31Uh, we launched that in the summer of 2021,
- 34:35uh? In, uh, I'll send this summer 2021.
- 34:40We engaged with the perch.
- 34:43CMHC yelled department psychiatry,
- 34:45Communicare Consultation Center and
- 34:48its consortium of organizations to
- 34:52really help us with the community
- 34:54engagement and planning piece of the
- 34:57crisis response team and very glad
- 34:59to say that's making great progress.
- 35:02We've had a number of listening sessions.
- 35:03I'm happy to talk a little bit more
- 35:05about that in the Q&A that had been very.
- 35:07Informative and revealing onto community
- 35:11input and what what the community
- 35:13wants to see out of this team.
- 35:15Uh,
- 35:15and we're hoping to actually have a
- 35:18team a pilot team in the field by the
- 35:20early part of next year with this is,
- 35:23we're very excited about that.
- 35:25And in the fall of 2021 the board
- 35:27of Alders reviewed and approved the
- 35:29creation of a new city department.
- 35:31This doesn't happen very often.
- 35:33I believe the last department
- 35:35was created over a decade
- 35:37ago and it really kind of showed the
- 35:40support and focus on making sure
- 35:42the city has some institutional
- 35:44structure to address these issues.
- 35:46For the long term.
- 35:50Some of the opportunities I alluded
- 35:52to earlier came down in the form
- 35:54of federal aid or are still
- 35:57coming down form of federal aid.
- 35:59We have a $2 million plus
- 36:02investment from the CARES Act,
- 36:05which was passed in 2020.
- 36:08And we're using it to really
- 36:10double down on permanent housing.
- 36:12We've supported agencies to place over
- 36:14600 individuals who are experiencing
- 36:16homelessness into permanent housing
- 36:18situations and units in in the
- 36:21ways that makes sense for them.
- 36:23And I mentioned this strategy
- 36:24on non congregate sheltering.
- 36:26We really,
- 36:26really are aiming to move to
- 36:28find an appropriate spot for
- 36:30non congregate spaces.
- 36:34The American Rescue Plan gave
- 36:36us 115 million in direct aid.
- 36:39Most of that has not been allocated yet.
- 36:41It's subject to a community input process
- 36:43and now will soon go before the board
- 36:46of Alders in in terms of approvals.
- 36:48But the parts that have been allocated or
- 36:51the six million for summer reset programs,
- 36:54which included some violence prevention
- 36:56work that I alluded to earlier,
- 36:59and it includes 8,000,000 for the
- 37:02approved department of Community.
- 37:04Resilience.
- 37:08In addition to that,
- 37:10the state and federal funders are
- 37:12signaling signaling continued interest
- 37:14in supporting these type of efforts
- 37:17and what I termed Community resiliency.
- 37:19Representative Rosa De Lauro has has.
- 37:24That included a $2 million pilot program
- 37:28specifically specifically earmarked for
- 37:30our Community crisis response team project.
- 37:32We hope we hope to see those dollars
- 37:34in the early part of next year.
- 37:36It's really, you know,
- 37:38really important that that was highlighted
- 37:40by Representative Laura as an approach
- 37:42that we have in this taking were
- 37:44receiving an additional 4.8 million
- 37:46in funds to address homelessness and
- 37:49facilities to address homelessness.
- 37:51Again, building on that that plan I
- 37:53alluded to earlier about non congregate.
- 37:54Sheltering and permanent shelter.
- 37:57Permanent solutions.
- 37:58The Biden administration's build
- 38:00back better bill.
- 38:02I think that's what they call it.
- 38:03Sounds like a lot of these,
- 38:04but uhm, another B5 billion, UM.
- 38:08There is a 5 billion proposed investment
- 38:11in community violence prevention
- 38:14initiatives and a 70 million.
- 38:16I hope this is still in the bill.
- 38:18I don't.
- 38:18I haven't verified recently because it's
- 38:20things tend to get a little obscured
- 38:22in the negotiations at federal level,
- 38:23but I but I know it was proposed
- 38:25that there was a 70 million new
- 38:27and first time investment or harm
- 38:29reduction initiatives as part of the,
- 38:30at least in an earlier iteration
- 38:32of that bill.
- 38:33Even our state elect allegation
- 38:35has been very supportive.
- 38:36They've been supported.
- 38:39Supported bills to introduce a statewide
- 38:41reentry programs and financial support
- 38:44for reentry programs statewide.
- 38:51So our challenge at the city,
- 38:54knowing all of this was happening
- 38:55both in terms of the trends and needs
- 38:57of our population as well as the
- 38:59resources that were available to us,
- 39:01was capitalizing, coordinating and not
- 39:03to let this opportunity go to waste.
- 39:08And try to build some lasting,
- 39:11durable infrastructure within the city
- 39:13that can help facilitate some of this,
- 39:15and I'll emphasize that you know.
- 39:18I see it this the primary role of this,
- 39:21uh, uhm effort. The creation of
- 39:24the new department as a convening,
- 39:28facilitating monitoring strategy role.
- 39:31Not a direct service role.
- 39:32We will continue to lean on direct
- 39:35service providers and and and send
- 39:37resources to direct service providers,
- 39:39but this is just fills a gap in that,
- 39:41you know, sort of municipal leadership role,
- 39:43which I think is so important too.
- 39:46Continue to focus on these issues for
- 39:49the long term rather than you know,
- 39:51kind of flashing in and out
- 39:54as grants become available.
- 39:56You know, you know,
- 39:58as I say I need.
- 39:59I need someone on my team that's waking
- 40:02up every morning worried about how
- 40:04these programs will be sustained and
- 40:06and and I just didn't have that before
- 40:08and now I have the opportunity that so
- 40:11as I mentioned in the previous slide,
- 40:13these this new department will fold
- 40:15in existing personnel programs and
- 40:17budgets from our reentry initiative or
- 40:20Community Crisis program initiative or
- 40:22homeless Services department and and
- 40:25a harbor duction coordination work.
- 40:27It expands to including.
- 40:29Programming from the Office of
- 40:31Violence Prevention and a new
- 40:33office of Community Mental Health.
- 40:35That's the one I'd love to consult with
- 40:37folks on this call on this webinar
- 40:39about at some point in the future
- 40:42'cause that one really is something
- 40:44that's not well defined yet and can
- 40:46can really use some some input.
- 40:48And once I have that stacked up,
- 40:50I think it will be very important and
- 40:52will appreciate the partnership with the.
- 40:54The department on that.
- 40:56Uh,
- 40:57and we will add a data management
- 40:59resource to make sure that you know
- 41:01all of these programs are supported
- 41:03in a in a standardized cross cutting
- 41:05way to support transparency,
- 41:07data report data and reporting.
- 41:09We have to, you know.
- 41:10Again,
- 41:11they we have to show these programs
- 41:13are working.
- 41:14In order for them to have a chance
- 41:16of sustainability.
- 41:23I don't know why there is a blank slide
- 41:25here, but I'll just move past that.
- 41:30This was just a refresher.
- 41:32II shared the slide earlier these so the
- 41:34Department of Community Resilience, UM,
- 41:36will include the Office Violence Prevention,
- 41:39crisis response, reentry,
- 41:40homeless services, mental health
- 41:42and harm reduction coordination.
- 41:46And we really have some.
- 41:47You know, some aims and goals and
- 41:49values to live up to as part of this.
- 41:52Uh, and I really look forward to
- 41:54to actually bringing on a, uh,
- 41:56a capable and passionate department head.
- 41:59Another shameless recruiting plug.
- 42:02I know many folks are having
- 42:03recruiting issues here,
- 42:04but I I think someone with a.
- 42:09I towards policy the the you know
- 42:12the ability to navigate their local
- 42:15government and really the passion to pull
- 42:17pull these types of programs together.
- 42:19We can have a really, really, uh,
- 42:21probably once in a lifetime opportunity
- 42:23to to work on this in New Haven,
- 42:26so I'm really hoping to get a good
- 42:28leader to have this new department
- 42:30up the values and objectives here
- 42:32that we are hoping to live up to is
- 42:34reducing our reliance on coercive and
- 42:36punitive approaches to social problems.
- 42:38I think we here.
- 42:39This everyday you can't arrest yourself out
- 42:40of homeless since you can't arrest yourself.
- 42:42I've gotta use problems.
- 42:43Can't arrest yourself about
- 42:44out of mental health crises,
- 42:46so we're really helping to elevate
- 42:49that approach and bring that too.
- 42:51That sort of bread and butter.
- 42:54Approach to city services.
- 42:57We want to focus on data,
- 42:58evidence,
- 42:58outcomes and transparency.
- 43:03And making sure that we're we're
- 43:05honest about what we're doing
- 43:06and what's working and what's
- 43:08not working and then of course,
- 43:09correct if we need to.
- 43:11Uh. For all too long,
- 43:14I think uh government as well as.
- 43:19Human Services agencies have been sort of,
- 43:22and it's easy to fall into this sort of
- 43:24deficit based model of saying I'm trying
- 43:26to correct a problem I'm trying to solve
- 43:28a problem and that kind of translates into
- 43:30how individuals and communities are treated,
- 43:32so the aspiration for this department is to.
- 43:36To employ an asset and strengths based
- 43:39approach to individuals and communities.
- 43:41And I hope that kind of trickles into
- 43:44all the different programs that that
- 43:46we that fold into this new department.
- 43:48Uhm? To adopt A committee oriented
- 43:52approach to to mental health.
- 43:54Really, I think the the key factor here
- 43:57is that as a municipal government,
- 43:59we really can and do carry the responsibility
- 44:02for all population approach to mental health.
- 44:05In the same way the Department of
- 44:07Health Carrizal population.
- 44:08Anyone who's within our borders we
- 44:11consider them a account we consider
- 44:14ourselves to be the accountable unit.
- 44:17Uhm, and that.
- 44:22That approach that the Health
- 44:24department employs.
- 44:26Parts of it can be translated into
- 44:28a mental health strategy as well,
- 44:30and I think some of the thought
- 44:32partnership I appreciate.
- 44:35Mike Sarniak and Kyle.
- 44:36For some of that partnership
- 44:38on that in the early thinking,
- 44:40integrating harm reduction
- 44:41across service lines.
- 44:43I think that's really important.
- 44:44We've done had some success with
- 44:46this already, but again, it's.
- 44:48It's also an approach in philosophy in
- 44:50terms of how we approach individuals
- 44:52that use drugs and and trying to sort
- 44:55of infuse that throughout our service.
- 44:58You know, infrastructure and landscape
- 44:59I think will be an important priority.
- 45:01And of course with violence prevention.
- 45:02Setting long range plans for violence.
- 45:04Production, you know,
- 45:05using a model of,
- 45:06you know focusing on prevention,
- 45:08social services.
- 45:11Acute response to to violent events
- 45:13as well as making sure that aftercare
- 45:16is robust for folks who need it.
- 45:18And I believe that is my
- 45:20last slide, so I will, uh,
- 45:22I don't know how you do fissel,
- 45:24facilitate the discussion,
- 45:24but I guess I'll turn it back to you.
- 45:26Mike Sarniak, if that makes sense.
- 45:28I'm happy to take any questions.
- 45:31Sure, thank you very much from hope
- 45:34really thought provoking about where
- 45:36the city has been and where it's going.
- 45:38I'm throwing up first for somebody
- 45:41else before I start hugging the time.
- 45:44Uhm OK sandy bacon.
- 45:48Or any considerations for sobering centers.
- 45:51Emergency departments are being
- 45:52used by patients by ambulance and or
- 45:54by police for simple uncomplicated
- 45:56alcohol intoxication because they're
- 45:58not appropriate community services.
- 45:59For patients struggling with
- 46:01alcohol use disorders,
- 46:02we currently have a number of high
- 46:04utilizers of acute need services.
- 46:06It would be better served at
- 46:07a less acute level of care.
- 46:09This would also help with Ed overcrowding.
- 46:11He
- 46:12the answer is a resounding yes.
- 46:14Uh, we see, uh in in conjunction
- 46:17with standing up our our community
- 46:20crisis response team we we feel it's
- 46:23very important to have what what,
- 46:25what we're doing an alternative destination.
- 46:27I don't know if that's going to
- 46:28be the terminology that sticks,
- 46:29but that that's for lower lower acuity,
- 46:33mental health and substance use cases
- 46:35that don't need to go to the ER or in
- 46:37some cases may end up at Manhattan jail.
- 46:42Create. Uhm, while we're waiting,
- 46:45I don't know Trish, I don't see anybody
- 46:47hand up right now so I could answer.
- 46:49Question is that right? No hands up.
- 46:50OK, I was interested because we have
- 46:54been working very closely with the
- 46:56city about your experience so far.
- 47:00You can summarize.
- 47:01About the listening sessions where
- 47:03you've gone out in the community
- 47:05and ask people what they want.
- 47:07I'm which a novel process.
- 47:10Unfortunately,
- 47:10it's it's nice for the say you be doing.
- 47:13It's important for the city doing this,
- 47:15and I know it's early in
- 47:16their last summaries to come,
- 47:17but just overall impressions at this point.
- 47:21Yeah,
- 47:21I mean, I think, uh.
- 47:26There's a couple of things I can mention.
- 47:28I think you know and it sort of
- 47:30varies on the type of format.
- 47:32I know the listening sessions have
- 47:34been done in different ways as focus
- 47:36groups of those who've been involved
- 47:38there was virtual sessions and there
- 47:40was also in person sessions and I
- 47:42haven't attended the focus groups,
- 47:44but do the nature of the fact that
- 47:45they are for specific population,
- 47:47but in terms of the community
- 47:50listening sessions.
- 47:51I think it was really important
- 47:53and then specifically speaking to
- 47:55the one that happened in person
- 47:57to understand the sort of.
- 48:01Expressions of.
- 48:06I've tried, I guess expressions of
- 48:08trauma or unmet trauma that people
- 48:11brought forth about their experiences
- 48:13with first response, like you could.
- 48:15You could kind of palpably.
- 48:17You see, when people were speaking to
- 48:21this that they had, you know, powerful,
- 48:24potent experiences around calling the
- 48:26police or doubts about calling the police.
- 48:30And like you know they would
- 48:31say that you know I did.
- 48:32I just don't know if it's
- 48:33the right thing to do.
- 48:34I don't want to get anyone hurt,
- 48:35or if they did have an encounter like how,
- 48:38how important a positive encounter
- 48:40is for someone who's in crisis
- 48:42and we heard we heard, you know,
- 48:45we actually heard positive things
- 48:47about police encounters as well.
- 48:48That you know and sometimes where
- 48:50in some cases where they said you
- 48:52know the police handled this in the
- 48:53way that I wanted it to be handled,
- 48:55and they appreciate the professionalism,
- 48:57but in some cases we've heard
- 48:59that you know the response and
- 49:00this is not just police,
- 49:02even EMTs or or fire department.
- 49:04They just felt like in the moment
- 49:06of crisis they weren't heard.
- 49:09So yeah, I mean I, I think that's sort
- 49:11of my not my main impression like that.
- 49:12Just the this how close.
- 49:15This hits home for a lot of folks and
- 49:17and how important it is for folks.
- 49:19Have the opportunity to speak about it.
- 49:35There is a hand up now, OK?
- 49:40Speak away, Millie.
- 49:43Yes, I just wanted to piggyback onto
- 49:46what doctor Delao said I was at the
- 49:49community in person meeting at Hill
- 49:52House High School and it was very
- 49:55moving to see the mix of people.
- 49:59It really seemed to represent
- 50:01the ethnic mix that we are in New
- 50:05Haven and to hear people stories
- 50:08spoken so honestly in their
- 50:10desire for something to happen.
- 50:13And the hope that it can happen.
- 50:15So I'm very impressed with what this can be.
- 50:22And Doctor del,
- 50:23I hope your employment pitch works and you
- 50:27get some great people on the team with you.
- 50:31So thanks to everybody who's doing this.
- 50:36Yeah, and the one thing I one thing
- 50:38I will mention you reminded me Millie
- 50:40about a couple of comments there,
- 50:42which I think raise raise an
- 50:44important point of sort of self
- 50:46reflection for the mental health
- 50:48field is sort of the that there is,
- 50:51even if we're not sending the police wear
- 50:53which has a certain kind of known sort of,
- 50:56you know, authority and power structure.
- 50:57Mental health professionals also are
- 51:00part of that power structure and can
- 51:03potentially impose harm on folks as well.
- 51:05So I think that was an important piece.
- 51:07That that that's just it's it's it
- 51:08will be important for this team to
- 51:10also be reflective of the dynamic
- 51:11that they bring into the situation.
- 51:13Just because they're not police doesn't
- 51:15mean that they they can't cause
- 51:16some sort of traumatic experience.
- 51:30So I did have one other question.
- 51:32Well more statement.
- 51:34I'm cousin looking at your
- 51:36new resiliency program.
- 51:37To us it looks a lot like she may social
- 51:41determinants of health or mental health,
- 51:43and they're lined up there.
- 51:45I think one of our findings at
- 51:47CMHC over the past year and a half
- 51:49has been kind of food insecurity,
- 51:51becoming a big issue.
- 51:53It was always a very large issue
- 51:55for the people we work with.
- 51:57But that there really being times
- 52:00where it seemed extremely precarious
- 52:02and I don't know about policy wise.
- 52:05Anything you think of in terms of trying to?
- 52:10Beef that up for certainly people we
- 52:12work with another people in New Haven.
- 52:17Yeah, I mean we do have the,
- 52:18you know, I think there's a
- 52:20couple of components to it.
- 52:21One is ensuring that our our
- 52:25emergency Food Assistance program is,
- 52:27you know, robust and we do have,
- 52:30you know, actually,
- 52:31New Haven has a really great existing
- 52:34network of partners under the operating
- 52:37under the sea fan community Community
- 52:39Fudacz II have so many acronyms.
- 52:42I really do apologize even
- 52:43though that I should know them.
- 52:44I don't see because I only
- 52:46referred to by acronym.
- 52:47So someone on this.
- 52:48Column shirt will know and can drop it
- 52:51in the chat the so there is a robust
- 52:54network of providers in the emergency
- 52:57food assistance pays that space,
- 52:59so I think from, uh,
- 53:00you know from the city standpoint
- 53:02I just we want to be supportive and
- 53:05make sure that we are supportive
- 53:09and doing every week and everything
- 53:11we can to to to make sure that
- 53:13system remains robust and can
- 53:14address anyone with emergency food
- 53:16assistance needs on the policy level.
- 53:18You know I,
- 53:19we really do have this opportunity,
- 53:22because, again,
- 53:22we've received a grant from the
- 53:24Department of Agriculture to.
- 53:26To really rethink our own local food
- 53:28system and how we address food insecurity.
- 53:31Whether that's true,
- 53:32you know you know urban agriculture
- 53:35initiatives and.
- 53:37You know, you know,
- 53:40having the the the city
- 53:43infrastructure support you know,
- 53:45smaller cottage businesses and food
- 53:46provision that are lower costs.
- 53:48I think there's a lot of potential there.
- 53:50You know there is there stuff in
- 53:51the city level that we need to.
- 53:52We need to get out of the way in
- 53:54terms of regulatory regulations.
- 53:56Is there any Technical Support
- 53:57we can provide to folks who are
- 53:59typically not part of the the,
- 54:00you know,
- 54:01kind of the the Community food
- 54:03system and food business world
- 54:05that we can help with?
- 54:06So that's the opportunity that our
- 54:08food systems and policy division
- 54:10and that challenge that our phone
- 54:12system Poly division is taking on.
- 54:14They have a community Advisory Board
- 54:15or we have a community visor board
- 54:17of over 60 individuals that are
- 54:19participating in that and they'll
- 54:20be working through those challenges
- 54:22to ultimately develop a master plan
- 54:24for urban agriculture from the City
- 54:26of New Haven in the next year or so.
- 54:29So that's that's the way
- 54:30we're addressing that,
- 54:31and I'm happy to connect folks
- 54:33with the appropriate contact in my
- 54:34department if they're interested.
- 54:37Cole has his hand raised well,
- 54:40I think we have a question.
- 54:42From the chat, five well OK Bob.
- 54:47Hi thanks Doctor Dalloul for
- 54:50really interesting talk.
- 54:51I wanted to follow up on my
- 54:55question about food insecurity.
- 54:59As you are probably aware of
- 55:02Philadelphia as well as other.
- 55:04Municipalities have embraced
- 55:06something called a healthy corner
- 55:10store initiative and since we had
- 55:12you're shaking your head so that's
- 55:14good so you know we have not only
- 55:17food insecurity but we also have
- 55:19food deserts and so you don't
- 55:21have to walk that far from CMHC.
- 55:23Actually,
- 55:24it's right across the street
- 55:26from our our community garden.
- 55:28Where is bodegas and little corner stores,
- 55:31and you know you walk in the store and
- 55:33you see it's just basically unhealthy stuff.
- 55:36And so I was wondering if you could
- 55:39comment on that initiative and to
- 55:41what extent New Haven might try to
- 55:44do something along those lines.
- 55:47Yeah, so I haven't been involved too
- 55:49much in New Haven, so I'll speak to my
- 55:52experience and as the chronic disease
- 55:54director where we actually launched
- 55:55the initiative wasn't in New Haven,
- 55:57but we we partnered with Bridgeport.
- 56:00It. It's a really good idea.
- 56:04The execution of of having healthy
- 56:06foods in in small businesses and corner
- 56:09stores is actually where the where you
- 56:12know most of the challenges lie and.
- 56:18And without the appropriately,
- 56:20I guess I can't overestimate or
- 56:23underestimate the amount of.
- 56:25Technical Support logistical
- 56:27support that you know.
- 56:29The smaller businesses small food misses
- 56:32need to actually have a sustainable.
- 56:35A business plan that that can
- 56:37stock healthy foods and stop them
- 56:40appropriately stocked them in a
- 56:42way that that reduces spoilage.
- 56:44There you know, there's simple things
- 56:46such as you know refrigerator access,
- 56:49the correct type of refrigerator like
- 56:51there's there's a host of sort of these.
- 56:53You know what seems like small bore
- 56:55logistical challenges that you know
- 56:56if you're big grocery chain, yes,
- 56:58you're going to have the resources to do it,
- 57:00but in the corner store environment
- 57:02it is actually very challenging
- 57:04and requires a sustained.
- 57:05Attention over a long period of time,
- 57:08especially if you're hoping ultimately
- 57:09that these will be self sustaining
- 57:12in terms of the business model.
- 57:14So that's that not to be like
- 57:15not to be discouraged by that,
- 57:17but that that was sort of our experience
- 57:19in working in those types of initiatives.
- 57:21Is that if it's under resourced or
- 57:23if one key champion kind of decides
- 57:25to move on to a different role,
- 57:27it's hard to sustain.
- 57:30Devil is in the details.
- 57:31I I hear you so thanks.
- 57:35And so from the chat section,
- 57:37Charlotte Niche,
- 57:38a Connecticut Food alliance network.
- 57:41This is the acronym and
- 57:44for ten or bombers back.
- 57:46Thank you for being here.
- 57:47Could you tell us more about how you
- 57:49became interested in public health
- 57:50and working in the public sector?
- 57:53Uh, yeah, sure I had to do that so that,
- 57:55uh, probably. I was probably interested
- 57:58since I entered medical school.
- 58:01Uhm, I just the first.
- 58:04The first few days of basic science
- 58:07classes I think spurred me to think
- 58:10differently about what else I could
- 58:13learn to keep myself stimulated.
- 58:14And and luckily where I went
- 58:17to Med school at Mount Sinai,
- 58:19they offered a concurrent masters
- 58:21of Community Medicine program,
- 58:23so I'd without planning to when
- 58:25I enrolled in medical school,
- 58:26I decided to give that.
- 58:28Uh, a world.
- 58:30So I ended up, you know,
- 58:32being involved in in a dual
- 58:34degree program at Mount Sinai,
- 58:36getting my Indiana and a Masters in
- 58:38medicine as part of that Masters program.
- 58:39It took, you know, typical,
- 58:42you know MPH type classes,
- 58:44although they would wasn't called an MPH,
- 58:46but also had a the fortune
- 58:48to have a couple of.
- 58:52Experiences doing public health work abroad.
- 58:57And that, you know,
- 58:58once you go go abroad at the
- 59:00impressionable young age of 23 or 24,
- 59:02it kind of kind of hooks you for life.
- 59:04So I, I knew I was going to
- 59:06do public health at that time.
- 59:08Did my residency in primary care at NYU
- 59:12and then I guess another turning point was,
- 59:14you know I was sort of attracted by the glory
- 59:18of academia enrolled in the RWJ program.
- 59:22Its previous iteration here at Yale,
- 59:24and was it took.
- 59:25It took a few years but I was disabused
- 59:27of the notion that academia was
- 59:29the right fit for me and I really
- 59:31wanted to do applied work and and
- 59:34then ended up working at the New
- 59:36York City Department of Health.
- 59:38Under very, very strong mentorship of
- 59:41some public health leaders you know,
- 59:44Tom Frieden had left by then.
- 59:45But he was his.
- 59:46His shadow is large over the New
- 59:48York City Health Department,
- 59:49Tom Farley and other,
- 59:50you know,
- 59:51important prominent leaders Sonya Angel.
- 59:53They were all at the Nexus of
- 59:54exciting public health work and
- 59:56and I was hooked since then.
- 01:00:02Fantastic thank you. I. Trish,
- 01:00:05anyone else that looks oh wait,
- 01:00:08one more hand. Kyle Peterson.
- 01:00:12Kyle
- 01:00:15thank you very much.
- 01:00:16Thank you Doctor Bell.
- 01:00:17It's wonderful to hear you present again
- 01:00:19and and see how this is all emerging.
- 01:00:22My question has to do with financial health
- 01:00:24and I know you mentioned the financial
- 01:00:27empowerment work that the city is doing.
- 01:00:29One of our colleagues anti Harper
- 01:00:30who I think you may be met 'cause
- 01:00:32she's affiliated with Perch has done
- 01:00:34a lot of work on financial health
- 01:00:37and its relationship to mental health
- 01:00:39and overall health and well being.
- 01:00:41So I'm wondering to what degree do you
- 01:00:43think that that that financial empowerment.
- 01:00:45Work in the city could also come to bear on
- 01:00:49this new department of Community resiliency.
- 01:00:52It seems like in a city where we have
- 01:00:54such high poverty rates and where we know
- 01:00:57that the financial stresses are also
- 01:00:59having being expressed in health outcomes,
- 01:01:01that that would be an
- 01:01:03important area to address.
- 01:01:05Yeah, that's a really
- 01:01:06important point that you know.
- 01:01:07I guess that's the danger of the
- 01:01:08showing org charts that it is.
- 01:01:09It is that things visually looks siloed,
- 01:01:12but there's a lot of integration
- 01:01:14even already happening,
- 01:01:15so we the financial apartment is
- 01:01:18already integrated with some of our
- 01:01:21service providers that provide.
- 01:01:23Programs for individuals
- 01:01:25experiencing homelessness.
- 01:01:26There's there's referral pathways there.
- 01:01:28We have referral pathways
- 01:01:29with the Housing Authority,
- 01:01:31so I I think you know,
- 01:01:32there's plenty of opportunity for integrate.
- 01:01:34There's referral pathways with
- 01:01:35our reentry population,
- 01:01:36so it's all actually, you know,
- 01:01:38to an extent already communicating.
- 01:01:41I think there's always opportunity
- 01:01:43to do more coordination and
- 01:01:44communication and and expansion.
- 01:01:46I'm actually hoping to expand the
- 01:01:48work of the Financial Empowerment
- 01:01:49Center using using RP dollars an.
- 01:01:52To really make it much more robust,
- 01:01:55it's actually a pretty small department.
- 01:01:57Here we we only have like a
- 01:01:58couple of counselors and they
- 01:01:59can only carry certain caseload.
- 01:02:01I think there's potential do a lot more
- 01:02:04integration with existing services,
- 01:02:06so I I I see it integrated in in many ways.
- 01:02:14Now that does appear to be it. K.
- 01:02:18Well, once again thank you so much Mahal.
- 01:02:22Really thought provoking.
- 01:02:23I think there's a lot going forward
- 01:02:25that the department of people in
- 01:02:27the department can be interested
- 01:02:29in partnering with the city.
- 01:02:30I'm so thank you and we look
- 01:02:33to hear more about this.
- 01:02:34My future great
- 01:02:35thank you. Appreciate the opportunity.