Sign Vermont Assignment of Partnership Interest Now

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right you're not recording so let's jump in for those that have not had the pleasure of meeting I'm Morgan Cole I'm the director of children's integrated services for the state team normally and water-bearing Knapp spread throughout the state I want to thank everyone for joining I know that there's a lot going on and everyone live personally and professionally right now I think this opportunity that we've had to bring together so many of our sense riders in the CIS field all together since the beginning of all this so I'm excited about that opportunity and I really appreciate everyone taking the time to call in today as I said a couple of housekeeping things please make sure you're muted I'm hearing a little background noise so people could mute themselves great and we are recording this share a link or other ways to access the recording afterwards so that for those that weren't able to join today they'll be able to hear the information so the goal of today is really to talk about restarting in-person service delivery for CIF sir and specifically walking through guidance from the health department about what that looks like in order for it to be done as safely and rationally and gradually as possible so as implied by the word gradual one positive thing about this is that we will be able to take a bit of a phased approach that will give us the opportunity for us direct service providers to use a level of discretion in determining to some extent which clients make sense to begin seen in person and which should really continue to be served removable so all our guest Monica Ogilvie from the Department of Health in a moment but just to give a little bit of additional context this guidance was developed for home-based service delivery overall so home and community-based so this was a input from a series of partners involved in that type of service delivery working with bdh and that's to ensure that there's as much consistency as possible across those home and community-based services what that does mean is that the guidance is not specific to any particular program including CIS so part of our goal today is to walk through that guidance at a high level and then provide the opportunity for you to all ask questions so some of those we will be able to answer in the moment now and some of them are going to be things that we need to take back and then follow up on and others maybe things that haven't been considered yet and that there will be real value in having that input from you all in terms of what are the things that haven't been considered yet or gaps in and then thinking so far that we have the opportunity to follow up on and do some additional thinking and get further guidance out to you all I also just want to be clear that really our focus for today is kind of the public health aspect of that guidance so there will inevitably be very reasonable questions around some more of the administrative CIF specific details like how do i bill for services or how should this transition back to in-service in-person service delivery be reflected on client 1 plans those kinds of things are really important for us to hear and to get guidance to you on as well so we're happy to collect those questions through the chat box if they come up but we really want to maximize our time with Monica today from the health department so that we can focus on that the public health side of things so that's what will be generally focusing on and then lastly before I hand things over I know that at the forefront of many people's minds now understandably is the question of PPE of personal protective equipment and cleaning supplies and those sorts of things and that is addressed in this guidance and existing guidance on the VDH website in terms of to an extent what is appropriate to to use and how so and all of that however I know there's a lot of people wondering where is that going to come from what if I'm having challenges getting adequate PPE so I want to say at the front end is that something I anticipate a lot of questions will be around we are working on compiling resources with a CIS field around those needs unfortunately there's no one single one-stop shop for all of that however we are tracking down resources to either in some cases provide to the field directly free of charge some of that so for example we anticipate being able to provide cloth facial coverings cloth masks to all CIS direct service providers in the coming weeks and then for other things being able to give you guidance on where those can be accessed if they're not something that the state can directly provide to you so more information to come on that and I wanted to share that right at the get-go all right so Monica Ogilvie do we have you on the line now yep I'm here hi wonderful ok so I'm going to hand things over to Monica and Monica if you could introduce yourself and then I'll bring up on the screen the guidance itself if you want to refer to that at all everyone who fully received the link that was included in the calendar invite for this webinar and can bring it up great thanks well again oh man someone's got a good ringtone ok so we'll just ask that folks put themselves on mute I'll get started so my name is lana pho will be I am so my team members Monica you are cutting in and out let's see now that that is better okay I must have been my earphones my head my earbuds how about now yes that's much better okay thank you with the connection itself no no it's all good technology is so straightforward so my day job is working at CS HN however for the past 10 weeks or so I've been one of the leads for the state's contact tracing efforts and even though that's not explicitly related to this discussion to him putting that out there just so you know what my role has been in the emergency response and in case you have questions about contact tracing and what it is that the state does when they identify somebody who is positive I'm happy to address those questions right now because it really is related because the idea here is that we're trying to slowly and thoughtfully restart services so that we're not putting people at risk and so the other flip side of that is well what are we doing with the people that are positive or are in contact with somebody is positive so that we know if we'll we know for going into their homes or if we've been in contact with them so it's uh it's all sort of related so feel free to lay those questions on me too because I feel like I I spend far more of my time leaving contact tracing efforts than I do anything else right now and I think that will probably be what life looks like for the foreseeable future so um checking the trap box okay people are saying they can hear me now but one person tricia is having an echo looks like you're okay great Monica I'll keep an eye on the chat box if that is helpful to you a super helpful that'd be great and also if you can jot if you have a second to jot down questions that might come up that I don't know the answer to because that will inevitably happen so when service has shut down it wasn't exactly a coordinated effort I'm sure many of you felt this and it was just sort of like a big lump on the entire state where everything just shut down and slowed down really really quickly and there wasn't really any coordination or organization around that and that's okay we were in the face of an emergency we're trying to on the reverse end of that be a little bit more organized and thoughtful in our approach and so somehow I was the lucky recipient of the task of pulling together some guidance on how to restart our home-based delivery services our service delivery and this really started with the intention of meeting the needs for of services and service providers that are serving kids and families but I know that there are lots of different organizations and entities that are going to be serving entire families and so you'll be navigating how to apply this guidance towards maybe a child or a youth in a home you are serving and then you'll have different guidance that might inform how other providers from your organization are engaging with parents or adults in the household so those types of scenarios are going to come up and we are going to have to manage a lot more gray and unknown than we are really straightforward clear Cheerios and so I just want to need that up front because like everything throughout this pandemic it is it's it's a lot of art and a little bit of science so we just sort of put that up front but if I don't know the answer to one of your questions to him really really happy to go and find it if there is an answer so like Morgan said we've had a lot of int input into this guidance we've been meeting with agency Human Services leadership we've been meeting with some of the organizations that are delivering services on Monaco we lost you you're found that we have landed on something that will hopefully be a helpful framework in which you can plug your work so we'll be thinking mostly about the CIA s package obviously today for the purposes of our discussion ah so I'm gonna start with really the key points here which are right in the beginning you know I think many of us have identified opportunities that have come out of the this pandemic in this situation and ultimately restarting these services is going to be a massive effort in prioritization communication and collaboration so all of those things that we have worked for into into this restart practice and what I mean there is it may have been that prior to services stopping there were 10 home providers going in and supporting a child and their family and we're not necessarily going to just restart and have all of those 10 providers going into the home again as they were before the other piece to that is there wasn't always an awareness of who else was in the home on the part of the family them Sue's not on the part of the other providers nor was there ever nor was there always an identified lead provider or a lead care coordinator or lead case manager or a lead of any sort so we want to be mindful of those scenarios and circumstances because this is an opportunity for us as an as a community of service providers to engage with one another to identify who is really the the priority based on the needs of the stated needs of the family and there there might be circumstances where we need to override what the family might believe are their needs and it might come down to a safety a safety intervention so who's really the primary and who's the priority and what's the priority service and how do we communicate with one another in order to get services to the family without inundating them with humans and thereby increasing everybody's contacts and increase in risk and exposure for this virus so I will pause there for a moment and see if anybody has any questions or thoughts before I continue all right so the key points here hopefully all along just by for a second you have got a question coming through the the chat box Kate Ross is asking so does this mean we may be utilizing the primary service provider model the primary service provider model is specific to CIS right we have a primary service coordinator who plays that central role I think the question gets to the the broader point of whether or not you know there should be limits to how many people are actually going in the home and having that be more of a hard-and-fast hard and fast rule okay if there's if there's something else in there that we're missing if you want elaborate this is Danielle so the primary service per model primary service provider model is where you have one or a limited number of people going in and and other people with other expertise transfer some knowledge around delivering their service without going directly in so that person holds additional expertise through consultation and support from other experts but those experts are not the ones delivering the service the person in the home is the one delivering whatever that activity or service might be that's true premise right now okay perfect so I don't know if the primary service provider model is is terminology that's universally used throughout all of HS home services but it's really good to have that framework you know I come from a palliative care background so we work in an interdisciplinary model a lot where we sort of say who's the primary working with this family and transfer some of our skills so that we can leverage each other's expertise but not have to be everywhere and be everything to everyone all the time so it sounds a little bit similar I think that's a I think that's a great model and a great framework to work with I mean because the the the I the bottom line here is if the service and what you are doing can be provided remotely and still obtain the desired outcomes continue doing that indefinitely continue doing that until told otherwise and that's not to say that there is less value on those services that are being provided remotely you know like I'm very open and transparent about how I have felt since this has started I don't ever want to get in my car and drive to Montpelier for you know face-to-face counseling ever again it's working great on my computer and it saves me gas and mileage that's so you know it's one of those things where it's not about the value of the service but if the intention and the outcomes of what you are doing can continue to be achieved remotely then continue doing so indefinitely until told otherwise for example the team that I work with of medical social workers over at children with special health needs there are very few things that we feel like we have to do in person and so our plan is to continue work remotely for the time being until told otherwise and unfortunately I don't even have a timeline of what that might look like we're slowly entering phase 2 of this pandemic which means we have a relative amount of control over the spread and we are actively flattening the curve and working towards obtaining a vaccination but we'll be in phase two until we have a vaccine and until we start vaccinating the population so we're talking about more like months to a year maybe years plural versus weeks to months so plan and prepare and settle in to the remote work if your services and the outcomes of your services cannot be achieved remotely then we have to think about how do we then get you into the home or get your service into the home in some way shape or form and that's where the collaboration and the communication works because there might be several services that need to go into the home that can achieve their outcomes remotely so for example you know there's quite a few services through DCF where they through Family Services Division where they need to go in to do safety checks things like that they have to enter the home really to do that to accomplish that type of service but is it do they have to go into the home to do it or if there's somebody going into the home can they step in and provide some degree of assurance to family services division that you know yes the the home seems to be sound I'm speaking outside of my scope so if I'm butchering if I'm butchering the description of that service there we can we can go into that further but the idea here is that if there's multiple people that need to achieve their outcomes by having really in-person interactions with the youth and family then can those people who all need to be in the home coordinate with one another to see if there isn't some opportunity for collaboration and how that happens and then how do we bring all that information back to the team who might for an indefinite period of time not be going into the home I go we have another question around kind of the primary service provider model and an approach they're wondering do you have an idea of what that would look like with CIS nursing it's often hard to transfer knowledge to non healthcare providers and I think I'd like you to give your thoughts on that certainly but I think one thing to keep in mind is that this is not that's not going to be feasible or appropriate for all services all families are all service providers so in some cases that might be very appropriate and reasonable to do and in other cases it won't because you wouldn't expect someone to be operating outside their you know outside their scope of training and and degrees and and all of that and I think the medical instances are one good example of that but certainly there's others as well so I think you know Monica alluded at the beginning that there's going to be some areas of grey with this and and that's probably going to be one of them where there's a judgement call to be made about is this area where we can reasonably utilize that model or is it something where that service delivery needs to continue to happen separately by different providers remotely or in person yeah and I'm glad you asked that question Christina understand your dogs and birds situation in the background so thank you um you know we there's no there's not gonna be any sweeping right there's not going to be any sweeping guidance for any one service provider so we're not going to say see is nursing and now you're in go Family Services division now you were an NGO early intervention now you are an NGO it's going to be very family and case-by-case dependent because some of those nursing serve some of the supports that nurses are providing through CIS nursing might be able to have might be able to be achieved remotely but I know this would be outside of the CIS bundle but you know accessing a port and doing a transfusion a medically necessary service that obviously can't be accomplished remotely so that's something where we would have the nurse go in and provide that service so it's it's again it's going to be a very case-by-case situation it's not there's no broad sweeping guidance for any one program that they have priority or that they get first pass to start services before any other services because it's based on each family and we want to involve families and what they think is the priority service at all times and whenever that's possible so I think that that's I think that those are some pearls to hold on to here let me see what other questions we've got here let's see if we imparting knowledge from one service to give to another provider to go in and provide in-person support will we be able to bill for that time in some way Margo that's a great question and I think that that would be a great question for Morgan and your CIS leadership because I'm not exactly sure what the requirements are around killing I know that generally speaking Medicaid has allowed for a pretty supportive model of payment for telework lately telehealth yeah so I think I would put that in the the category of the kind of CIFS administrative type questions that we will definitely follow up to get you some clearer guidance on that because I recognize that that's real-time that you would be putting in to you know providing that that consultation essentially in an in advance of a visit so we'll we'll figure out how to give you the direction on that so Kelly's asked the question about is there a date that CIS would start providing new evaluations new services new referrals for some of the therapies exam for example yep you we can start doing any of that now we have the green light to slowly start visiting homes as soon as programs feel equipped and as soon as they feel like they've had time to really get grounded and what that means for them as programs as professionals and as humans that have to go back into their home own home sometimes with vulnerable population so that's an another layer here so there that can happen now but again I I would I would really implore folks to say is what's being requested something that requires an in-person evaluation obviously for things like PT ot SLP often the answer is yes is there someone else in the home that can somehow help coordinate and support the that action if the answer is no then you need to get in the home and that's completely fine but it's really good to maintain an awareness of who else is in that home because it impacts everybody's risk and to coordinate with them and see if you can't work together and Danielle I'd actually love if you could chime in for a moment Danielle has been a lot of work on our telehealth guidance particularly those related to early intervention services so she can remind us around what the the rules are with which of those services can be delivered remotely at this point which as Monica said if they can be delivered remotely they should continue to be delivered remotely unless there's a compelling reason otherwise exactly and I put my camera and I relate to the person who said they couldn't unmute because of their animals my cats decided that they need to get all the birds outside the house and climbs all over so apologize if you see a cat so the yes evaluation still should be done using telehealth as much as possible and the one guidance that we gave before is around the need to establish a 25% delay as a child nears their third birthday so if that's the case and you need support to establish that by eyes on what we talked about in the home visiting is that you can work with a service provider who may already be going into the home to serve that child for whatever reason and see if they can observe what it is that you're having difficulty observing remotely and if not then that may it may does not necessarily but it may be a compelling reason to provide an in-person portion of that evaluation but the purpose of the getting the telehealth building allowed to be done by for evaluations is to enable you to continue to be able to do those as much as as possible remotely that's got a question here from from Jenny moon around on the child care guidance stating that services can enter childcare so wondering about PPE requirements and pointing out that if children are in childcare there will be limited time for us to use telehealth with parents I think all of this really gets to the the reality that is both good and bad that there's a level of provider discretion here and the need to attune to individual families circumstances and needs so you know there's there's not blanket rules or dates of these services start being delivered in person on this date for you know these providers or these families that are there's going to need to be a level of discretion and working with families to figure out what works best - absolutely and I will my doubts of chime in because it sounds like there's a question there about what the pp requirements are the PPE requirements are outlined and what I think is actually a pretty helpful document and I don't mean that to sound snarky because we do lots of things that are helpful but there was a document created in partnership between Dale and Vth to really outline what the PPE requirements are you could Google personal protective equipment Vermont coab 819 and i think that it would probably come up but i will make sure you don't have to rely on the Google and I will ask Morgan to send out that guidance afterwards sorry we have a link is embedded in the in the guidance so I can actually bring that up on the screen I forgot we were that smart in the development of this C so it outlines really when you have to be using say like a cloth facial covering which by the way is the preferred nomenclature we're not supposed to call masks they're cloth facial coverings masks are more related to a health care like a healthcare situation like it's in a hospital situation those surgical masks that are generally disposable so that is so the PPE guidance that's come out really does lay out in what circumstances and scenarios it's appropriate and to wear a cloth facial covering when you might need more my suspicion is that for the vast majority of your services if you are entering a home where there's been somebody who is actively awaiting test results or who in the process of isolating or quarantine based on test result or exposure you wouldn't be going in the home but that to me seems like a situation where you wouldn't bother so really it's clockface recovering or you're not going in the home for the vast majority of you you know for people that are providing say medically necessary services that might be a very different circumstance so follow-up question here from Jenny moon due to us being located at the hospital in Bennington we are being told to use PPE gown mask gloves face shield and masks I will share this guidance with my supervisor but we still may be asked to wear full PPE and that sounds like that's at the discretion and the the direction of the Bennington Hospital I sure hope they're providing that PPE if that's a requirement that they're making of you so we're gonna I know that you were gonna pull up the PPE guidance but I wonder if it actually makes sense for us to take a gander at the framework that we put in the home visiting guidance restart restart home visiting Gardens great such good questions thank you so we've got another question I'm reading them out loud for the benefit of folks who might just be on the phone if it is guidance and staff refused it is not the law right I am NOT suggesting this is a good idea just wondering that's gonna be at the discretion of an employer um you know it's it's um yeah I think that's a conversation one needs to have with their employer it to refuse masks I think we would need to under the employer would need to understand a little bit more about what's behind that but no it is not a law so policy should be worked on yes policies should be worked on around the utilization and implementation of PPE PPE use all right Morgan did you pop the guidance or am I just not seeing it I believe I'm sharing the right screen um can other people see that yes I see your screen so weird I'm just saying we're a still of Morgan's face which is lovely not as helpful Monica if you click on your screen where the her face is sometimes that will reactivate the screen share that she's got up okay that's not working I don't know the team teams are still elusive to me that's okay I happened to have it up here so uh let's talk about um let's let's talk about what comes after the key points so the key points really coordination if you can do it from remotely keep doing it if you've got to go in the home let's collaborate and coordinate with our partners and that number four that all home based services must strictly adhere to all of the health and safety guidelines to limit spread so if we scroll down and we say okay where do we really see ourselves in this this restart we've got a framework here a table here with two columns on the left is the priority slash phase and on the right is the criteria the priority would fall under high moderate or low the phase is going to be phase one two and three there's also a phase zero we didn't put that in here phase zero these phases are really what are part of the national structure so what's dictated by the federal government and the CDC phase 1 is significant controlled transmission that's what we are in right now in Vermont we are tiptoeing towards phase two which is the moderate controlled transmission if things continue going the way they are we suspect to be fully in Phase two of transmission of this virus by around June one which is why June 1 was the date given for say a child's care to open up for non-essential workers so I thought you've cut out shocks your back back yeah great all right let me know if I cut out again I will continue to speak up and hope that the internet gods are behaving so phase one we're in phase one we're towards the end of phase one as you can see the criteria for services that would be continuing in phase one are the ones we're really having significant behavioral under health concerns requiring in person skilled services so again I use that example of like accessing a port you know that's not something we can do remotely some people have life-sustaining treatments that they needed to continue getting obviously those types of medically necessary services continued and then there were quite a number of especially Family Services Division type services and homeless home services or DCF that continued throughout the pandemic because again it's all about weighing that risk versus benefit of that benefit versus risk and there was clearly more risk to not be going into those homes at that time so now we're sort of moving into sort of a Phase two where we have moderate control transmission where we don't necessarily think it's um just a community wide spread where we actually do feel like we can have pretty aggressive contact tracing and to really identify those people that are positive shut them down shut down their direct contacts and hopefully keep that viral load contained so I'm just gonna pause for a second any other questions in the chat box that I should be addressing we had a question just for the benefit of folks on the phone about the differentiation between early intervention versus other services and early intervention being considered an essential service and that is considered essential due to the federal mandate to provide those services but to be clear that does not mean that it needs be or should be provided in person if that is at all avoidable so at this point there's almost no circumstances in which services should be delivered in the home correct so then we got another question did you say that phase two will start six one sorry it's cutting in and out a little bit so again a little bit of the art and science here we suspect that we will be that Vermont will be in Phase two around June one which is why we've been slowly opening up more services and why child care centers are opening up around June one so you know we look at the data every single day there's aggressive testing happening statewide especially people that are asymptomatic and that's giving us a very that's giving us a more complete picture I should say of what the viral load looks like throughout the state and fortunately we're not seeing a ton of secret positives that we didn't know about so in other words at these pop-up sites where people can just show up and get tested anyone can show up and get tested yourselves included you know you could schedule an opportunity get tested get tested walk on out of there and get your results and we're not seeing that a ton of people that are asymptomatic are positive so we don't have reason to believe that there's really a lot of community spread anymore at this time but potentially as things reopen we could see more so the plan is around June 1 we should be in Phase two and that's when we would expect to see more services open and when we can relax some of the requirements and restrictions that have been happening but it's good for you all to be aware because that means the people that you're going to visit might be relaxing their practice they might be involving more people into their circles and into their spaces and it's important for you to feel like the homes that you're going into our following Vth s and the CDC's guidance because if they're if they're not and you feel like you're putting yourself at risk then those are conversations you should have internally as an organization and certainly look for leadership support as needed so um in sort of looking at this guidance in this grid here you know we originally had some we had you originally had a third column where there were examples of work and services and ultimately decided to scrap it all together because the examples were almost fogging people down and thinking well what service which one is mine and I moderate and my face - do I get to start providing my service in Phase two you know using like the CIS nursing an example or you know my team of social workers at CS HN we're saying well what are we are we are we low priority or we phase three and again it's we're not expecting that any one service or any one program or any one team is gonna fall squarely into any one of these categories it's really looking at the risk versus benefit to that child into that family and then also to the providers going into the home so again it's gonna be a case-by-case circumstance but what we hope you can do is to look at this framework and say generally speaking do we have any services or supports that we're providing that would fall into say phase one or do most of them fall into Phase two or do some of them fall into Phase three for example a children with special health needs our medical social workers we feel strongly that for the vast majority of our families we're gonna fall into low priority for in-person visits and fall into Phase three so we don't anticipate going to do in-home visits for a long time for bread number one we can achieve all of our outcomes remotely and number two we want to create space for those folks that do need to go in the home to do so and just limit limit risk and exposure for the community as a whole so there's that added layer of sort of thinking about everybody in altruism there as well so hopefully CIS and providers can see where they generally might - this framework and then apply more of a case-by-case scenario with each one of the families they're working with I'll pause for questions I think I'm missing in the chat yes we have a question from Kelly same could evaluations be done in the home but then services provided remotely to limit risk for the family and providers so I would I would ask does the Evalia intent of the evaluation can that be achieved remotely I mean yeah this guidance that we've given to the field is that in most cases because eligibility for CIS and for early intervention specifically can be achieved very broadly we have a very low standard that needs to be met that most often that the intent can be met without needing to be in person okay so to answer your question could an evaluation be done in home and then services be provided remotely I mean I don't see I don't see why not but even that evaluation happening in the home does that evaluation need to happen in the home is there somebody else in the home that you can coordinate with and have them complete different parts of the evaluation can you leverage technology to sort of guide a human that's in the home to say can you help me with this intervention I evaluate I don't know because I don't know the specifics about your service so this is where Morgan and Daniel are going to be really helpful in applying the specificity of your requirements yeah so I think I would just echo that if if a service can be provided remotely and still have a reasonable degree of effectiveness that that should continue to happen and I completely understand that in in a lot of cases that there is you know something lost and not having that in-person service delivery in terms of you know establishing that that initial relationship and picking up on things that are harder to pick up on when you're in it through a screen but if it is possible to effectively provide the service remotely that should continue to happen for the time being if that is is not possible for one reason or another whether it's something that's not billable through remote methods or there's something in particular about that that case or that family or that service that really does demand it be delivered in person then that would fit into that second phase category where I think taking that approach of if if it's the instance of an evaluation that for some reason needs to be delivered in person in order to be effective then doing that in that approach and then following up with remote service delivery on an ongoing basis would be appropriate we've got a couple more questions here so Heather loves them pointing out we can do most evaluations via telehealth which yep Jo fraud --is sharing from a question from home visitors or comments saying sometimes we aren't aware of what other providers are in the home because the family has difficulty in knowing and sharing who's in their home is there going to be a more streamlined way of knowing what other services are involved because they keep saying finding someone else who's already going into the home and maybe they can get the information you need so you don't have to put yourself at risk who's the low man that gets to go into the home and gather info for all the other service providers so yeah there's some very real logistical challenges of operationalizing this and I think I'll let Monica share her thoughts on that and then you know I've got some thoughts specific to CIS as well it's interesting because this is where we the rubber meets the road on how well we've been doing as community providers and developing strong relationships with other community providers that we might be doing work alongside with and I don't mean that in a negative way at all but we're certainly seeing where we're certainly seeing where there are some communities that say we've always done this this this isn't really anything new we've always coordinated our home visits we're gonna continue to coordinate the home visit and just a lot less of us are gonna go so there's some where this has been a really this has had a minimal change in their general practice and then there's some where they've just said I we wouldn't even know where to begin so you know I think I think you know looping back to a patient-centered medical home if they have one available identifying if they have a care coordinator there knowing things like if they're enrolled if they're attributed to the ACO and if they have an AC if their care managed through the ACO finding out if they have a CSA gen care coordinator I mean it's it's gonna take a touch of sleuthing if you don't already know who their team is to find out who their team is and I imagine that might be a little bit more challenging for newer referrals but hopefully for families you've been working with for all along you have some sense of awareness of who else is in the home because there's an opportunity to because hopefully been working together all along Pam McCarthy I love you she says what an opportunity to really become more integrated there she is both my rose-colored glasses it couldn't agree more and then I would I hope that we all get a shared electronic health record or database through this process that would be my that would be my pandemic dream so let's see any recommendations for supervised visitation programs Amy I'm assuming that question relates to I'm assuming that question relates to DCF and supervised visits in that regard as I were talking about so actually it's a supervised visitation for families who have who have been asked by the court to have supervision due to violence or there may not be DCF involvement so I wouldn't consider myself the subject-matter expert on that I you know I think so I can jump in for something on that as well this is you know timely cuz I'm actually as a CIS team we were just talking about this morning about the the need for you know clear role delineation and what you're delivering through the C is bundled contract as part of you know children's integrated services and how that interacts with FSD involved families and and requirements and all of that so in terms of supervised visitation if I'm understanding you correctly are you referencing that as something that would be a CIS activity not per se it's not a CIS delivered its community-based so I think probably FSD you would be the right place to ask those questions that said obvious that that wouldn't be a function under the C is bundled contract however obviously there's a lot of overlap in in families that are served and particularly as we talked about you know increased coordination between different folks going into the home there there is going to be a bit of a fine line in terms of you know Monica when you spoke at the beginning of this about its FSD really needs to make sure that they can ensure a child's safety and well-being in the home and and someone's going to be going in the home to deliver a service and then can confirm that for them that may be appropriate in some cases but we also need to really make sure that there is that role delineation CIF providers are not FSD workers we do not want to put you in a position of being the while you are mandated reporters it is not appropriate for you to be asked to you know be the eyes and ears of fsd or anything like that so just being mindful of that role delineation as you go forward will be important there's a couple of other comments in there that I want to draw attention to so Jenny moon shared that we've been doing this but the nurse has been going in having her help complete the evaluation by providing her with a bag of evaluation materials and then getting on the telehealth while she's there and directing what needs to be done so I think that's a really wonderful example of that kind of collaboration and and creative thinking and jenny is also pointing out that that does put additional burden on the provider in this case the nurse going into the home who's already doing a lot and has a lot on their plate and may be feeling overwhelmed so using using appropriate judgment with that and finding the right balance will be good mana gather their thoughts from you and we've got about seven minutes left so um Monica if there's other things that you feel like you're really vital to share or other questions is that a question around she is considering masks with plastic covering so children can see mouths that is something that we've explored a little bit and I haven't been able to find a resource for that to date but we'll continue looking and I do encourage people to look into that if something is that's something that they're able to access through their organizations so those are the the masks that are have a clear portion at least which is particularly helpful in some instances and the question of would see is reimbursed for these so I do want to be oh and Donna says I have someone making these so we're going to contact me for those masks so I'll follow up with Donna but it sounds like there's there's some potential resources out there in the community around those the CIS retainer fund is set up and this is something that fiscal agents and Cas coordinators are very aware of that does have an opportunity for regions to request reimbursement for costs associated with Kovan in terms of those required in order to meet the requirements of the CIS contract and deliver services and there is a place in there to request reimbursement for PPE if that's something that is needed and the state is been able to provide so we would be considering those requests in the retainer fund applications that said there's a finite amount of money in their retainer fund it's hard to know at this point when that will run out but we will continue to get that out to regions to support them in their coded response as long as we're able and I will say that's been a hot topic with our Eddy partners the early hearing detection intervention program and certainly lots of child care providers because how are we supposed to help children develop language without the ability for them to be able to see our mouths when we're speaking with them so it's unfortunate that it's coming down to a grassroots effort but there are some happening across the state so I'd be curious to hear more about Donna's contact and we've been really we've been really impressed to hear what different communities have been able to pull together for for local child care providers and for service providers so the last thing I would highlight is you know at the end of this guidance we really are explicit in the the discussion around and recommendations around collaboration and coordination this is not going to happen successfully without it and what we would really like is for folks to be able to see is for folks to be able to communicate what it is they're doing with other service providers and to be really really concrete about this what I have said to my staff is you're not in the car all the time anymore so you have more time to be sending an email having a team meeting over Skype or zoom teams whatever and communicating what you're all doing to keep that thread constant and to keep that set thread moving so that eventually when we come out of this and we're in phase 3 we don't have we haven't just built up every single silo that we've been working so hard to break down over the past ten plus years so I would really encourage folks to be diligent about their communication with their community partners if you don't know who those are now's a great opportunity to really try and figure figure figure it out and I should I should just mention that um a lot of this is within the an advantage that CIS has is that it's very much within the existing can a model of cis and there being an expectation that the you know the primary service coordinator for a client is aware of what else is going on in the home in terms of services being delivered and providers connected with that family and is connecting with them as a parolee --it so you know regions have mechanisms for this in place granted it's it's going to take some ramping up an adaptation for the current circumstances certainly but I think there's a lot of good avenues and relationships already in existence to support that kind of collaboration and coordination and that is you know an existing expectation under the CIS model and contract so that helps right we've got two minutes left mana Connie any final thoughts that you point people towards no I would just I just would give you one final word of assurance that Vermont's contact tracing team is exceptional they are experts Luthor's they're finding the cases they're talking to the cases they're talking to all of those contacts that have had contacts with cases so we want you to have a degree of confidence that should you be in close contact with somebody who's diagnosed with kovat 19 Cobin 19 we will you will hear from us and we will give you guidance and walk you through it so you know although we really recommend that you screen people before walking into their homes and we gave you some some drafted language there if you need it that should you be put in harm's way or at risk at any point you will hear from the health department's contact tracing team and we'll walk you through that step by step we've been we've been really we've been fast and we've been doing a good job so we've got your back in that respect for sure and thank you for all your hard work and being so nimble throughout this bizarre time so in terms of some next steps we'll be having some additional conversation as a team and with our vdh partners and others to figure out what our you know additional pieces of guidance to address some of the questions that have come up then some one more than any gritty around really how does this get operationalize we'll be talking with CIS coordinators and fiscal agents on our usual weekly checking call tomorrow so that'll be further opportunity to talk about really what does all of this mean specifically for CIS in terms of operationalizing it and implementing this guidance and we will reconnect with Vth as needed for for any additional clarification and information and more to come soon but thank you everyone for tuning in and for the work that you're doing right now bye folks thanks you