Yale Psychiatry Grand Rounds: November 12, 2021

November 12, 2021

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"Crisis, Opportunity, and Building Back With Resiliency"

Mehul Dalal, MD, MSc, MHS, Community Services Administration, City of New Haven

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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.