HomeMy WebLinkAboutclosed_caption14:30:34 Or link outside of the camera. 4 months. Yeah, we didn't get to do. Okay.
14:31:07 I just play. And I saw commissioner brother 10 and he said he might be just a couple minutes late.
14:31:22 Alright, well perhaps you can join us after. We are on the swings. It's a busy time of year.
14:31:36 So. Are you all plugged in and ready over there? Can you audio? Can you hear me, Glenn?
14:31:49 Well, yes, but. What about you, Dr. Barry?
14:31:55 Dr. Barry. Can you hear? Good.
14:31:57 I can hear you.
14:31:59 Good, we can hear you. So that's a go, I guess. Yes, she put her, she put her thumb up. All right, well, let's go ahead.
14:32:18 Let's go ahead and get started if we could. I'd like to call to order this.
14:32:20 Regular meeting of the Jefferson County Board of Health. Thursday, November 16 and To start off with, let's see if there's any public comment.
14:32:31 I don't see any. Public here in Gwen is there anybody online do you know?
14:32:39 Not and I forgot to check if there were any public comment in the emails. Dr. Barry, did you notice anything?
14:32:50 Alright. Good. Well, if someone does show up within the next 15Â min, will, open public comment again briefly.
14:33:06 And, I think we're ready now for an approval of the agenda. And, I believe that there was a request.
14:33:18 From Shad Gray to, to add a kind of discussion about potential. Revamping our, or re initiating our efforts to do some good onboarding for new board members.
14:33:36 So, what I'd like to do is, recommend that we put that on as new business number 3 today.
14:33:46 And if we have a 2Â min discussion on it, at least we can sort of. Have a decide how or if for when we want to continue that effort. We just want to set some context.
14:34:02 Yes. Right. So that's why I'd like to put it on the agenda.
14:34:14 I'm happy to make a motion that we approve the agenda for today. With the addition of business item number 3, talking about Board of Health orientation for new members.
14:34:23 Great. Is there a second? Any discussion? Alright, all in favor say aye.
14:34:34 Aye. Thank you.
14:34:52 I can actually hear you fine Kate.
14:34:52 Okay. Alright. Well, I, I see that. Gray Shad has joined us. Welcome.
14:35:07 And just in case you missed it, we did put on the agenda under new business, welcome.
14:35:14 And just in case you missed it, we did put on the agenda under new business, the topic that you had, to Apple about looking at the group that was trying to improve and streamline
our process for onboarding of new board members.
14:35:24 So we'll have a brief discussion about that under new business. And thanks for bringing that. Bringing that forward.
14:35:31 Yeah, absolutely. Yeah, sorry for my, tardiness. The, calendar event had disappeared from my Google calendar.
14:35:39 That Zoom link.
14:35:45 Got to love it.
14:35:37 Yeah. The, the miracle of technology, right? Yeah, gotta love it, gotta hate it, same time.
14:35:51 Alright, well let's go on to approval of the minutes of October. 19. I'll entertain a motion.
14:35:59 Move to approve the minutes from October nineteenth and submitted. I'll second. Any discussion? All in favor, please signify by saying I or raising your thumb.
14:36:10 Thank you. Passes unanimously. Then let's go to old business and information reports. And Apple, I think that's you this time.
14:36:21 Sure is. I wanted to start with some brief acknowledgments. Just acknowledging the nourishing and breathtaking landscape that we live in in Jefferson County and.
14:36:37 Just wanna make mention of that. I feel like it's something that we need. We need to save space for and say out loud as often as possible.
14:36:45 I also, given that want to thank many people in this room and otherwise who just spent some time outside.
14:36:52 With county staff and county community members to honor Chris Goy and his time here with us on staff and his incredible impact and leadership and that We miss him greatly and
I really appreciate.
14:37:09 The commissioners pulling together an opportunity for us to be together outside in this beautiful space and acknowledge him and it feels very therapeutic as a larger family
of staff and residents to spend that time together.
14:37:25 So just wanted to acknowledge that. And that being said, I wanted to acknowledge that. The followers upon us and what fall means can.
14:37:34 You know, be referenced to the harvest and can also. Sort of be an indicator of change changing in direction and energy seasonally.
14:37:46 It can also be a signifier of endurance and perseverance and I wanted to kind of hold the simultaneity of.
14:37:56 The abundance and greatness of this area along with the grief and loss that we're feeling. Among our families and in our communities and in the world.
14:38:05 And, No matter how focused we are in meetings like this or in our day-to-day work, those larger ripples through the concentric circles of our lives out into the world or.
14:38:18 We're all holding that at the same time. It's just a lot. So,
14:38:22 I'm among colleagues and friends here and I feel like that's worth saying. And in news of public health.
14:38:29 There's no wood around here, but we seem to be highly staffed right now, which is a really great feeling and I'm looking at the smile of pinky on the screen and the smile of
Denise over here to my left and just knowing that.
14:38:49 Vacancies, recruitments and the interview process and all of the
14:38:57 Great amount of skill and focus it takes to work through these times where we are short staffed and where we're seeking and looking for right talent and good good people to
join us.
14:39:09 It's a lot of work. It's a lot of worry and it's a lot of.
14:39:13 Passion to try to help our organization be whole. And I'm feeling, I feel really positive about where we're at right now.
14:39:22 We seem to have. Seem to have a pretty full staff so whatever the listening public though there are departments that are still looking for talented people to join us so we are
still looking for talented people to join us.
14:39:37 So we are still looking for talented people to join us. So we are, we are not just, wanna say that out loud.
14:39:40 Absolutely. And I am really hopeful about some of the young folks who are coming into public health work and I'm really noticing a consistent sense of.
14:39:52 Fighting for justice and and really zeroing in on good communication skills and this constant sort of sense of like.
14:40:01 Partnership and teamwork, which I'm not sure. If they're teaching that in college these days.
14:40:10 It seems like that is a really fortunate tone that we are seeing out of the folks that are joining us.
14:40:15 So bravo for us and wishing well to all the other departments that are struggling because it does seem to see saw you know when we're when we're doing really when we're struggling
a lot another departments doing well and getting a lot of recruits.
14:40:29 It just seems to go back and forth. So for across the county. In other news. I wanted to sort of highlight very briefly.
14:40:38 Some cross-pollination that's beginning to happen. In our department around our climate change and emergency preparedness response work, which you may be gathering some ideas
about that just based on some of the content.
14:40:53 We've focused on here in the Board of Health. Regarding those issues, but I would like to formally say that it's something that I believe we are putting some very positive energy
towards to build within our health department and in our services.
14:41:09 And I think. The governmental health, government or public health system across the state is being more emboldened to take.
14:41:18 Initiative and be highly engaged. In this work and it's it's really exciting. It's very it's very rich and nuanced and it touches on a lot of things that are very mission oriented
for public health.
14:41:34 I want to Make a shout out of special kudos to Ocean and to Lara Gaslin Titro and to Laura Siddini especially.
14:41:43 And also their managers for really think-tanking around this concept of where climate change, its impacts on health.
14:41:51 And where emergency response and resilience all meet together. In the heart of what we're doing in public health.
14:42:00 So there's more to come on that, but I thought it was worth highlighting because we've been having a lot of generative conversations about that and we're moving forward on quite
a bit of it with funding from Foundational Public Health Services.
14:42:12 Yay for us. And lastly, I'd like to center some of our environmental health teams work on upcoming fee changes.
14:42:24 So I'm just gonna say a few things and then maybe have Pinky and or Lisa alongside me to answer any brief questions.
14:42:34 About this, but spice it to say, we had originally planned and you might remember in the agenda planning.
14:42:41 To bring a fee proposal up to the board of health in December at the December meeting. After the Board of County Commissioners was to repeal and replace the ordinance.
14:42:51 But on the advice of the clerk of the BOCC, we combined these 2 things.
14:42:57 So that's left really no time to brief the Board of Health in the way that we would have.
14:43:02 Unless we do a special meeting. So. The proposal that we're making. Is about increasing fees.
14:43:10 By 6.0 1% of which 3.5 6% is the CPI and an additional 2.5 4% to cover the cost of the wage increases that we've had here in the county, especially over the last 2 years.
14:43:26 Of those increases, 19%. Of an increase since 2020 and I'm sorry, 19% increase in wages since 2020.
14:43:38 That's the overall. The last 4 years. And we've only raised our fees by CPI since 2,020.
14:43:47 So increasing the fees. By 6.0 1% covers the cost of those wage increases. So the special meeting is set to.
14:43:56 Occur on help me pinky November 20 seventh Okay, Pinky, go ahead. You get your hand up.
14:44:05 Help me out here.
14:44:02 Yes. No, that's that was the part that I was gonna say because I didn't leave the date in there, which is November, the 20 seventh.
14:44:10 So I think Glenn has sent out invites to all the Board of Health to save that day for November, the 20 seventh for a joint BEOCC.
14:44:22 Hearing for these fees.
14:44:25 Okay, and do you know the time? Is it 1030?
14:44:28 I believe it's 1030.
14:44:31 Okay. So I saw Grey nodding their head. Does that mean everybody in Amanda too means you've received that email and you're aware. Great.
14:44:41 Okay. So that's all I have for today. Yeah.
14:44:50 Okay. We'll move right along then. Jefferson Healthcare Report. First call.
14:44:58 Add some comments to what Apple was saying, with regards to the good news on the climate change efforts, here in Jefferson County.
14:45:11 There was the ribbon cutting. I think it was yesterday. Either Yesterday or the day before, can't remember.
14:45:19 For the ZEV, the electric car share program that, there's now a, an electric vehicle.
14:45:30 That the community can share and it's located right in front of the Chamber of Commerce and it's free electricity for plugging it in.
14:45:40 And there's an app that people can use to, to reserve it and I can't give you all the details of that because I wasn't successful in downloading the app yet.
14:45:52 But, but it's available for use and there was a very very wonderful program really highlighting the community cooperation that was required to make this work.
14:46:08 And in fact, so far this company out of Seattle, ZEV. I think they've got only 7 electric vehicles out so far.
14:46:19 I think there's one in. Couple in Kitsap a couple on Bainbridge and so we're right on the cutting edge of of this wonderful program that's supported by federal, state, and local
efforts.
14:46:32 So it's really, really exciting. So check it out the next time you're down with the chamber.
14:46:37 And although I'm delighted to hear that you're fully staffed Apple, we're still probably about 40 staff short at Jefferson Healthcare.
14:46:47 I think people just don't realize how big we are and what the need is, but it continues to be.
14:46:54 A huge problem. Particularly during this difficult transition that we're going through with this construction project.
14:47:05 Excuse me, it's still a demolition project. That's under way. And the exciting news there is that last night at the board.
14:47:16 Meeting of the public hospital district. The board approved 3 bonds. That actually are up for sale today.
14:47:27 So we're hoping that investors respond positively today. We'll know before the end of the day whether these bonds have sold.
14:47:37 And what the exact rates will be. But 66 million dollars worth of public bonds are being offered. And at the same time, they're 46 million dollars worth of bonds that we are
going to be signing with 2 different banks.
14:47:55 And although that sounds like more money than what people might have heard in the past. The true total construction costs for the demolition and the building of the new 56,000
square feet of space.
14:48:13 The true construction cost of that is. $89,207,191 and the reason that we need to basically borrow, through bonds more than that is because in order to Get the funding for this
project, we have to pay off our USDA loan as well as another earlier bond for previous work.
14:48:49 And so it might be a little confusing when people see the total number of bonds that were that we're, floating, or borrowing.
14:49:00 But it's in order to cover the additional cost of just doing this project they're not the actual project costs.
14:49:08 And actually 7 million dollars of the total 89 million dollar cost. 7 million dollars of that is low is taxes.
14:49:21 And of that, 2 million is Jefferson County and city taxes. So in fact, there is some additional local benefit besides the survival of Jefferson healthcare well into the future
to the local economy with with the taxes.
14:49:40 And. Meanwhile, the project is going well. Currently they're doing abatement of the 65 building that's 36,000 square feet very old and they're making sure that all of the toxic
chemicals and products as best as what not are removed adequately.
14:50:02 And then, in early December, that will be, by, December that will be completed and then the actual demolition of of the 65 building will occur.
14:50:16 And in the meantime, it's just a amazing what the staff is doing to continue to provide the care that we normally provide.
14:50:25 I mean, this building as you recall is in. In the center, in the heart of the complex.
14:50:34 And so it's, it's, It's really remarkable what our staff is able to accomplish while doing this.
14:50:40 This phenomenal project. And we're really looking at the summer early summer of, 2,025 to open and if our recruitment for new providers goes well.
14:50:53 It will increase space for OBGYN. It will. Provide space for neurology.
14:51:03 So these are services that we have.
14:51:07 Through studies have determined are the most needed where people are being sent out of county. When they need that specialty service and then of course the radiation oncology
which is just a huge huge part of this project.
14:51:24 Separate essentially separate building with 7 foot concrete walls. And, so it's 7 feet thick and it's, but it's, it's gonna be truly remarkable in terms of the service, the,
Yeah, the continuing spectrum of service that we can provide to patients who have cancer in this county.
14:51:49 Yeah, very exciting. Any questions?
14:51:55 Alright. In case, but you mentioned the vacancies at the hospital. Yes. Remind me what the total workforce is at the hospital.
14:52:07 I believe we currently have 675 FTEs. But I think that that amounts to more than 850 people and one of our major major issues that we're just struggling with is to fill the
provider positions because we well nurses and providers because we still have way too many travelers.
14:52:41 These are people who come. Briefly from outside and who are willing to work, but they come at a Huge cost.
14:52:49 They are much more expensive than then hiring our own our own staff. And so that's a big thing that we're looking at in terms of trying to reduce expenses during the next year.
14:53:01 That makes the hospital our largest employer. Yeah. Looking for any kind of bond money or additional tax money.
14:53:22 And currently the only Tax that we get from, from people in Jefferson County, through their property taxes is, I believe it's about a half a million dollars and that's less
than one day of operation.
14:53:40 And for that, this community gets 24 7 emergency care. You know, obstetrical.
14:53:48 Services and everything else that we provide so Yeah, you could take a lot more. You have a lot of headroom on that levy that you do not.
14:54:01 Well, we, we do every year we have the option to increase it and we did again this year 1%.
14:54:06 But that doesn't get you very far. And in fact, if you look at other public access
14:54:15 Sorry about that. If you look at other public access hospitals and other local hospitals, per in per capita or per income.
14:54:28 They get anywhere from 5 to 10 times as much from their local communities as we get so if you look at Olympic Medical Center in Cleveland you look at all of the local hospitals
in Cleveland, you look at all of the local hospitals up in the islands, you look at all of the local hospitals up in the islands, Whitby Island.
14:54:43 All of them get at least 5 times as much, from their local community. And so, I think we need to begin to educate the community about the need for the community to step up and
and really begin to support the hospital district.
14:54:59 A little bit more in the future when we get to our next project. And there will be more because the need continues to increase.
14:55:09 Okay, so I'm wondering. As far as growing oncology services in Jefferson.
14:55:15 I don't know the answer to this, but. Is there a corollary in Cleveland or will we?
14:55:22 People flop here for that particular service, which is fine. Yeah, no, the other the other 2 neighboring counties also have do provide radiation oncology and yet we have and
I think it was about patients who last year required radiation oncology as part of their treatment.
14:55:47 But when you think about go to our website or the. The Jefferson Healthcare Foundation. And there, are some.
14:55:58 Marvelous video interviews of patients who have Who have needed. Oncology care. Who get to the point where they need radiation oncology.
14:56:13 And it's like every day 5 days a week for a number of weeks. And so here you're taking the sickest of the sick patients.
14:56:23 And you're forcing them to travel. Out of county to get that care and and most of the cost of that is being covered.
14:56:34 Thank goodness with some, some grants that are looking very hopeful from both the federal and the state.
14:56:41 So. Anyway, yeah, it's going remarkably well and we'll all celebrate when the bonds sell before tonight.
14:57:00 Thank you. Alright. So.
14:57:05 State Board of Health, Kate Dean, you want to give us an update? Sure. Yeah, just a couple quick things to report.
14:57:13 The Board of Health State Board of Health is working on their legislative statement update and I'm advocating that accepted capacity be added to that so that we are a unified
front.
14:57:28 Hearing more about today first and I did at the conference we were just that here that It is in the, the study is in the governor's budget.
14:57:38 That's great. So yeah, everything we we can do to reinforce that is awesome. Yeah, we can.
14:57:45 We need to reinforce that is awesome. Yeah, we can, that's the state board of health legislative.
14:57:50 Legislative. It's a memo. The priorities includes many, many things of interest to public health.
14:57:57 I won't go through them all and there's probably 30 items but wanted to call that one out and then also the, the school environmental health rule is finally getting some attention.
14:58:09 From a number of key players. I think that will be a conversation that might be in the form of a proviso.
14:58:16 So, as I mentioned, this rule was written in 2,000 was approved in 2,013.
14:58:22 No, 9, sorry, 9. It was 13 years ago when we started talking about it.
14:58:29 So the. New, rules for environmental health in schools updated in 2,009.
14:58:37 It's right when the recession was kind of in the depth. And so the legislature said we will not implement that rule because it would be impossible to fund and it hasn't been
touched since, which means to this day it's the rules from the 1,900 seventys that are being enforced for.
14:58:52 Schools, including new construction sometimes, which is crazy. So, you know, let's less likely.
14:59:00 The issue. It's probably more legacy problems, but. So it sounds like there is some interest in, in at least funding and authorizing a Study group, not sure what form that will
take.
14:59:17 Yeah, but a multi-stakeholder group to look at, doing an assessment of schools.
14:59:24 Updating the rules or kind of advising the state board of health and updating the rules because even 2,009 is quite dated now.
14:59:34 We've been through a pandemic and learned a great deal. New Real is almost quiet on, almost entirely quiet on air quality filtration, a lot of new information to incorporate
there.
14:59:44 And and then look at funding models because of course we don't want school districts to be on the hook for implementing a new rule.
14:59:51 So how can we take advantage of some of the environmental justice? Climate commitment actor, natural climate solutions account funding to start phasing in some much-needed improvements
in school.
15:00:08 So just great to see some traction happening there finally after many, many years of being on hold. And the other important thing I wanted to announce was our mention is that
the the, there's a new climate resilience element, pasta a bill last year affecting growth management and that requires group A water systems to be evaluated through a climate resilience
lens, largely looking at water quantity, but also water
15:00:38 quantity. This is also something that we had presented to us at a BOCC meeting recently that we have been.
15:00:45 Little bit slow in finishing our coordinated water system plan. And so it's it we agreed that we needed to continue that work county wide so that will obviously overlap with
our public health department.
15:01:02 But just in general, it seems like there's a lot of attention being given to how do we start planning for climate change and impacting our water system.
15:01:11 So I think we can expect to see more. And more of that work. In the case of the State Board of Health, we were.
15:01:19 Asked to do rule writing for the new climate resilience element. It was. The statue, the new language in the bill last year outlined really what that needed to be.
15:01:32 And so the Board of Health has the authority to authorize the Department of Health to do real writing when it is.
15:01:37 Kind of administrative in nature and so we authorized the Department of Health to do that so we will not be doing it but.
15:01:44 Stay tuned. I think that's an important feature that's going to be coming more and more too local.
15:01:51 Departments of health to be doing more careful water planning. Lastly, we had a climate change story telling panel.
15:02:01 Primarily tribal and impacted communities talking about how climate change is affecting health in their communities. It's a great presentation.
15:02:11 I do just want to call out in particular, this is also happening on the, at the Pudateson Partnership.
15:02:17 So 2 state agencies now I know of being really encouraged to think about how to incorporate, traditional ecological knowledge, sometimes called TEK, sometimes called Indigenous
Tribal Ecological Knowledge, and these are both computers on partnership and state board of health are very reliant on best available science.
15:02:39 And, so it's, it's refreshing and challenging to think about how to incorporate.
15:02:46 You know. Knowledge that has been gleaned through thousands of years of experience living close to land and incorporate that into policymaking.
15:02:55 So that will be a challenge ahead. As well.
15:03:00 But it will say, I mean, there's a real. Desire to figure that out and University of Washington is involved in this conversation too.
15:03:11 So. Any questions for Kate? I have one question this about that. Okay.
15:03:18 It's sorry I'm just wondering what's that. Are they looking at kind of, frameworks for indigenous decision making as well?
15:03:28 I mean, there's whole different policy frameworks that that are more about experienced empirical voices and.
15:03:37 I'm just wondering if they're approaching. Different ways of. Developing the policies as well as, you know, saying, oh, we're not going to just use best available science, but
also some indigenous.
15:03:48 Ecological frameworks. Yeah, I think there are a few ways that is done and the heal act switch past few sessions ago, really changed the type of consultation that all state
agencies have to do with impacted communities, including tribal communities.
15:04:06 And so I think that is being built in to the implementation of the Heal Act right now.
15:04:11 And each agency is doing that separately. With Putis on partnership, slightly different because their tribal treaty rights, which, you know, really.
15:04:20 Determine how consultation is done. And so, that partnership has Basically, travel, decision making that, We refer to the decision making as a management conference because
we have to come to agreement with the tribes on how to implement funding programming it can't happen separately or on even on a stakeholder basis.
15:04:48 It has to be on parallel track. So it's, depending on the stakeholder basis, it has to be on parallel tracks.
15:04:54 So it's depending on the agency probably it comes in different forms but it comes in different forms but it just this it feels like a brand new change of mindset that is exciting
to see and Still a lot to figure out.
15:05:07 Anything else anyone? Alright, thank you very much, Kate. Infectious disease update, Dr.
15:05:18 Very.
15:05:19 Hi there, everyone. I'm calling in remote because I am ill and you can probably tell that my voice is limited.
15:05:27 So hopefully you can hear me and I'll try to keep this brief. Thanks, on the COVID, we are starting to see a down trend in hospitalizations due to COVID.
15:05:35 19 about one to 2 per week in the last month, which is very hopeful, but we are still seeing circulating.
15:05:42 Kovat. Nineteen,inker and everyone to stay up to date in their vaccines and consider masking in crowded indoor spaces.
15:05:49 The other infections that also we encourage you to mask for are starting to show up on the peninsula.
15:05:56 We've had our first emergency department visits for RSB as well and also for flu that we haven't seen the high level of circulation of influenza yet, but we have started to
see some cases in some of those cases getting severe enough to need.
15:06:09 Emergency care. So really want to encourage folks to say up to date on all of your vaccines.
15:06:15 There are 3 available now for many of us too for those of us who aren't over 60 or pregnant or infants.
15:06:24 But your flu and COVID vaccine for most folks, RSV vaccine if you're over 60.
15:06:29 Pregnant or for our very smallest citizens, up to the age of 8 months.
15:06:37 We, all of these viruses are, prevented by good masking in indoor spaces.
15:06:44 I am I have a lovely toddler who prays me from masking in this particular indoor space.
15:06:51 So I'll keep getting some things from her. But not of them are COVID. RSB right now.
15:06:56 But to the extent that we can minimizing transmission in those crowded north spaces, and particularly among those who are most vulnerable in our society being thoughtful, how
RSB, COVID and flu can be incredibly dangerous for the very young, the very elderly, and the immunosuppressed.
15:07:13 So it's really important we do what we can to protect them. And while I don't have much voice, I do want to take just a brief moment to acknowledge another public health crisis
that is going on further from home.
15:07:27 A very good public health professor, when I was in school, said that in every conflict in every war, more civilians died and combatants and that has been true throughout history
and it's going on right now.
15:07:40 Though the scale of civilian casualties in the Israel Gaza conflict is really unprecedented. In recent history, over 4,000 children so far have died in this conflict in the
last month.
15:07:54 If you compare that to the Iraq war, we would lose 10 to 20 children a month in that conflict.
15:08:00 So that gives you an idea of a scale of what we are seeing. And in every war there is always a subsequent public health crisis.
15:08:09 Not just from the violence, which draws so much attention, but from a rise in infectious diseases and we are going to start to see that very soon in Gaza because of the shortages
of water, electricity, and sanitary conditions.
15:08:23 We are likely to see thousands more children die in this conflict if it doesn't end soon and if aid is not delivered promptly and as a doctor as a public health professional
we have an obligation to speak out when those kinds of things happen.
15:08:38 I have done work in the Global South and I have experienced working in hospitals where we lost power and oxygen and we ran out of IV tubes and in all of those cases small children
die first.
15:08:51 And nothing that I saw is anything like what my colleagues in Gaza are facing right now and so I just want to encourage all public health professionals.
15:08:59 To speak out in defense of life. We don't have a side in any conflict, but we all we should speak in support of the lives of the vulnerable and in this case, particularly children.
15:09:14 Thank you, Dr. Barry. Very important statement and. Yeah, I appreciate your bringing, you're reminding us of our responsibility.
15:09:31 Any questions for Dr. Barry?
15:09:38 Good day. And the internet's not working, which is also. A real day
15:09:50 Alright, well let's move on. And, Pinky, I think you're up next.
15:09:58 Is that right? Okay.
15:09:59 Yes, I think I am. I'll need to share screen and I know this always gets a little tricky.
15:10:08 I think the easiest thing for me to do is actually to go off to. Take my laptop down which means that there's not gonna be a camera on me while I'm speaking it's just the easiest
thing to do so I apologize for that.
15:10:22 Thank you. Well, you make that transition. I just want to say how excited I am about this agenda.
15:10:28 And I'm sure Amanda is as well. The 3 of us have been talking about. Septage and pooh for 2 years together.
15:10:36 And doing a lot of work behind the scenes and Pinky is starting to double down on that and we're gonna hear a little bit about that today but it's super important work not just
for Jefferson County but for our entire Western Washington and the state and I think This is, something that we can lead on.
15:10:58 Thank you, Commissioner. Alright, I'm gonna try to do the screen share. It's never easy.
15:11:04 When I have the 3 screens. It's never easy when I have the 3 screens. And I think the advice has always been to put the PowerPoint presentation up first.
15:11:15 Is that correct?
15:11:15 Yeah, that's a good practice.
15:11:16 Okay. But then I lose. Then I lose my Zoom screen. This is the challenge that I always have.
15:11:29 Be able to all tap back to your zoom screen and then
15:11:30 Okay, I think I got it.
15:11:41 Okay. Yeah.
15:11:48 Okay.
15:11:42 Alright, are you seeing the screen? Hey, I did it for the first time after how many years of doing soon?
15:11:51 It looks great.
15:11:53 Great, thank you. Yeah, so as Commissioner Eisenhower data, we've been doing this since the least.
15:12:01 October of 2021 is when we first came to the board of health to kind of ring the bell so to speak but actually a man to grace was ringing our bell way before that.
15:12:14 No.
15:12:14 And she said, hey, I just got word that I can't, you know, I can't take my.
15:12:20 My trucks anywhere. So we have been behind the scenes and so I'm here just to kind of remind you what has happened.
15:12:28 So first was kind of that ringing of the alarm bell. Back in 2,021, we've got a problem.
15:12:36 In September of 2022 we went to the board of county commissioners to ask for $30,000 to do a septic capacity analysis.
15:12:47 Through the city of Port Townsend through an inner local agreement. Well, they just finished that in September of 2,023 and their consultants completed the analysis and what
we'd like to do next is basically go to the Board of County Commissioners to present those findings.
15:13:07 And some of those options. And so I just kind of wanted to give us an overview today. What's out there?
15:13:16 Alright, so I want to start with a little bit of terms because I know not everybody knows all of these things and I just wanted to have a little bit of grounding.
15:13:26 So we talk about septage, that's the waste that comes out of a septic tank or a quarter potty.
15:13:31 You might see the acronym WWTP that's a wastewater treatment plant.
15:13:36 I'll refer sometimes to fog, which is bats, oil, and grease, not the fog that we get in San Francisco.
15:13:43 We're around here at times, but fats oil in Greece. SPR is our Sequency batch reactor that we have at the city of, Port Townsend or our septage goes into.
15:13:56 And then the head works is where our septage goes into. And then the head works is where our septic goes into.
15:14:02 And then the head works is where the wastewater, comes into the wastewater treatment
15:14:04 Alright, so the worst case scenario. Is that we run out of capacity with our septage. And we don't have anywhere to put it.
15:14:13 And that really is the worst case scenario and I don't Thank you, anybody really wants to envision what that looks like because the vision is not very pretty.
15:14:23 And so one of the things that we're really trying to instill here locally and then also push with our legislatures and outside of our structure is to basically elevate that
issue.
15:14:35 Through legislature, our elected officials, ecology, Department of Health. And then also start that process of funding for the capital improvements that we're going to need
to expand our septic capacity.
15:14:51 Yes.
15:14:49 Hey, can I add one more piece for context? So in 2021, Pinky and Amanda and Linda Atkins and myself mostly.
15:15:00 Amanda and Linda, I think did the phone calling of different jurisdictions just to check. To see where other folks were at on this issue.
15:15:11 And there were a number of jurisdictions, I think. You called 12 and I think 7 of them were having close to or potential septage disposal issue.
15:15:21 So it's, beyond Jefferson County, but it's, that's what enables us to elevate it to the legislature and say this isn't just Jefferson County coming along with our problem.
15:15:37 No, not at all.
15:15:32 We're talking about something that's more regional. Can I add just a little to that without, Pinky do you mind if I Yeah, and part of that research what we were told over and
over again is that when wastewater treatment facilities are built to a certain capacity, there's usually a lot of room and capacity to take on more wastewater.
15:15:53 For example, what's going on at Dissueall up State Park, they've, you know, been having to feed their waste water treatment facility because they don't have enough bacteria
and stuff to go through the system.
15:16:02 And so oftentimes municipalities will build huge waste water treatment facilities in a smaller community with a 20 to 30 year life expectancy and they're able to take septage
from rural areas during that time because it helps feed their wastewater treatment facility.
15:16:18 What happens over time is the urban growth has happened in most of the areas in Western Washington. That capacity has become limited and most of those wastewater treatment plants
are no longer able.
15:16:31 None of them are able to take fog any longer, which was what initiated this response. And there is a a singular privately owned waste wastewater facility that we take waste
to that resides in but they also stopped taking fog because they started taking the bulk of the fog from all the surrounding area in Western Washington.
15:16:56 What we discovered and trying to find a place to take the fog too was that the wastewater treatment plants were reaching capacity within the next 5 to 10 years also.
15:17:05 So that's what kind of. This off the line a little bit.
15:17:10 So at a very difficult time hearing all of that, but I caught enough of it. And the other thing that's very important to remember is that if you did, a man of grace didn't already
say it is that there's no obligation for a wastewater treatment plant to take septage.
15:17:28 They can say no. And they do say no and then that's what kind of creates a bind.
15:17:36 And so. Yeah, that's one of the issues.
15:17:43 I just wanted to let kind of people to know that haven't had that much exposure. So we're talking about when we talk about septage in this context, we're talking about typically
coming out of a household system.
15:17:57 We've got a septic system. They've got a septic tank. The septic comes out of the tank, places like Goodman Sanitation, they pump these tanks.
15:18:06 And then the next step, you know, in the process is those tanks. They basically collect it from a number of different households and it goes and I want to just say this is a
very simplified process.
15:18:19 Those trucks take it to the city of Port Townsend into that sequencing batch reactor.
15:18:26 And The other way that waste gets into the wastewater treatment plant is if you're in the city, right, it's done through the wastewater treatment plant system.
15:18:37 And through the treatment system where there is a bunch of lateral lines that go from a house to what they call a main sewer line and those get treated at this city treatment
plant.
15:18:51 Here in city of Port Townsend. There was a lawsuit way back when and they basically prohibited these trucks, the septage trucks from going to the headworks, which is why we
have this facility down at the compost facility and that facility for our growth right now is actually pretty much almost at capacity.
15:19:14 They can only take 4,000 gallons a day and so that is just a fraction of what goes to the city.
15:19:23 And I'm a man that probably has more stats on what goes out of the county. But it's basically creates a lot more transportation costs that get passed on to the consumers.
15:19:34 And again, there's no obligation for any of these other out-accounty places to take our waste.
15:19:41 And so it really makes sense for us to be able to treat as much waste as we can. In in house so to speak.
15:19:52 So prior to the nineteenth, we the 1990, s are septage ways, went into what they call the Black Lagoon out there at the transfer station.
15:20:03 That's basically it's obsolete now and it's been closed. And then we had a partnership with the city.
15:20:10 To build that compost facility, and that sequencing batch reactor where our, we're for 1,000 gallons is treated a day.
15:20:19 So they have that agreement. To take that amount and again, that amount isn't quite enough.
15:20:28 And so some of that also goes out to other areas on the Olympic Peninsula and some to the bio recycling facility in Mason County.
15:20:39 So just to clarify, Pinky, there's also a regulation within each county. For example, Plum County has a very large wastewater treatment facility in the city of Portangelis,
but the city of Portangelis only allows us to dump septage that we collect within Collum County.
15:20:58 So if I pump a septic tank in Discovery Bay that is technically in Jefferson County that waste has to be brought back to Jefferson County to be discharged.
15:21:08 It can't be discharged in Quallum County. The same is true for the city of Port Towns and the city of Port Townsend will not allow outside county waste to be dumped there either.
15:21:18 So. Really it only 2 options are the PT compost facility and the third party bio recycling in Mason County for all of Jefferson County's septic waste.
15:21:31 Whether whether my company pumps it or another competitor does so.
15:21:38 Okay.
15:21:37 And is that the only private facility in the region? So they're the only private facility in Western Washington.
15:21:45 Thank you. Can I ask one other question? Think you about this? And maybe you're gonna get there, but.
15:21:48 Sure.
15:21:51 Isn't it going to be compounded this issue as well when the port halock sewer comes online as there's a contract to take all of the biosolids from the port Hadlock sewer to
the Port Townsend facility.
15:22:04 Prioritized I believe above the septa that we're talking about so it's going to get worse here even if there's nothing else that changes.
15:22:12 I'm not a hundred percent sure about that because it's the There'll be some differences.
15:22:18 That that waste will be de-watered in my understanding and I think that.
15:22:25 God, why am I blanking on his name? It's Bob, thank you.
15:22:36 And Bob, I think that that's going directly to the compost. That it's not going to the seek this interesting battery after.
15:22:41 I, that makes sense.
15:22:42 So they're gonna have a, you know, they're gonna have the solids renewable, the liquid removal, before it goes over to the comp, it goes directly to the compost facility.
15:22:53 Okay.
15:22:53 That was my understanding. I could have that wrong, but I don't think that they're going to be in competition.
15:22:58 That's good. That's my understanding too.
15:23:04 Yeah, so they do they'll de-water it prior to going over to the compost facility.
15:23:11 Great. Thank you.
15:23:14 So there's 54 the other big issue. There's 54 food service establishments right now that have an older septic system that has a combined sewage and they're fats all the grease
that's coming out of the kitchen.
15:23:33 And those are going to get increasingly more expensive for those older restaurants. To manage just because none of the facilities want to take combined sewage and fat soil in
grease.
15:23:45 So. So, Amanda, that correct me. I mean, where is that that particularly, difficult material going now.
15:23:57 Right. Is it a truck? I think the question is it's not. Okay, I'm not able to remove it.
15:24:05 And I don't know what my competitors are doing. We do. So for example, like our downtown restaurants have small grease traps, like 100 gallons or less.
15:24:19 We do pump those. I am able to mix a hundred gallons of grease waste in with 7,000 gallons of septage waste because it, the dilutes it enough that when I take, when I take it
to bio in Mason County, they'll accept it.
15:24:35 I can't dump any of that locally, but for those 54 food service establishments I've had to try to refer them out to.
15:24:42 Competitors and outside counties. I don't know how well they're regulated. That's not.
15:24:48 For me to determine. But I don't service them because I can't. Okay. I do need to interject just briefly here. But I don't service them because I can't. Okay. I do need to interject
just briefly here.
15:25:02 Pinky, what do you think the time is going to be required for the rest of your presentation.
15:25:06 Okay. I do need to interject just briefly here. Pinky, what do you think the time is going to be required for consultant coming on at 3, supposedly at 3 30.
15:25:12 So,
15:25:12 I should be able to wrap this up. I think we're pretty much done case. I think I've got like 2 more slides and they're pretty they're pretty they're pretty easy.
15:25:15 Okay, great. Wonderful. Then let's hold off on any further questions or discussion if we could.
15:25:25 Thank you, Pinky.
15:25:30 And so one of the one of the potential solutions is looking at the expansion of the city's septic facility.
15:25:40 So the consulting came up with 3 options. And that's a forced main directly to the wastewater treatment plant, which would be at a cost of 20 million.
15:25:50 A forced mane to a collection system at 6 million and improvement to an existing system which is 3.8 million and these are the things that I want him to come.
15:26:00 To the Board of County Commissioners maybe present these findings. The other thing that I think is really important to say that the expansion of the city's septage facility
is really only one solution, but it's probably the the most neatly in packaged solution right now, but there are other solutions such as a county owned septic facility and or a private
septage facility.
15:26:26 And again, there's always pros and cons with any of these. You know the city county model works when the city county people are and commissioners and administrators are all
getting along.
15:26:39 County owned, there's issues in terms of who's going to management, how do you fund it?
15:26:47 And then privately owned, there's always, a little bit of risk on privately owned in terms of how much it's going to cost for the consumers.
15:26:55 And less control for the folks. But at this stage, I at least would like to present, or to have dance present at the Board of County Commissioners Meeting.
15:27:07 And I talked with, I talked with Carolyn and the date that he was available and the. Commissioner Eisenhower myself were available the best date was December eighteenth and
so I'm gonna be putting forward an agenda request for Dan Mayham from our H 2 engineering to come and discuss with all of these options are.
15:27:28 Got 3 more minutes. For questions.
15:27:30 Huh. So keep them short.
15:27:52 It looks like Grey has a question.
15:27:37 Alright, well I think I think we scared everybody into not asking any questions. Oh. Yeah, go ahead.
15:27:56 So you, you mentioned that the, waste would have been the water or will be the water most likely coming from.
15:28:06 The headlock. Is there an ability to de-water waste so that it can be on transported down to existing facilities more effectively because one of the things that I'm hearing
the most Is the additional like gas.
15:28:24 And where on roads and danger to to people on roads and all of that and so it seems like the simplest solution that I'm kind of just, you know, barely glancing at.
15:28:37 It seems like just to condense the stuff before we ship it.
15:28:42 Is that part of our options?
15:28:44 And I am not sure, Grey, where they are going to do that, whether they do the de-watering.
15:28:51 At the headlock facility or if they do it at the compost facility. Both have a de-watering component to it.
15:28:56 Right, But I'm asking about using that as an example. Of what to do for all of the other wastewater that's being collected that is then being driven down to Shelton.
15:29:10 Right, I think that's a wonderful question. It requires, approval by Department of a College, the State Department of Ecology to be able to do that.
15:29:22 And it's, It's a little bit costly and I will say in time my understanding is historically Jefferson County and environmental health was kind of adverse to us looking at that
as an option locally for privately.
15:29:35 So for example, if my business took on the work of doing that, it's, not impossible.
15:29:41 There are other places in the country that do that. So the short answer is yes, it's doable, there are other places in the country that do that. So the short answer is yes,
it's doable.
15:29:48 The long answer is it's probably more complex and I think it's worth exploring all our options.
15:29:51 Great. Thank you.
15:29:54 Alright, I think that yes, Kate. Yeah, I'm just curious how. I'm just curious how, I mean, if Like how important does this issue become legislatively?
15:30:09 If it seems like there is kind of a, we've been doing the work locally and there's a local fix.
15:30:15 Is does, is that still a priority as the issue broad enough statewide that it's.
15:30:19 Yeah, and I've had communications with Peter Lyon. He was the section manager at the Southwest Regional Office of Ecology. He was the section manager at the Southwest Regional
Office of Ecology.
15:30:28 He's now the program manager and this issue he knows is beyond just Jefferson County. The, as we talked about earlier, there's counties within the Puget Sound counties, but
also in eastern Washington as well.
15:30:42 And as Amanda pointed out, part of it is aging systems. The other part is that there's the Pugin sound counties that are subject to the nitrogen reduction rule and one of the
things that is high in nitrogen is septage.
15:30:57 And so ecology on one and one branch of ecology is saying hey wastewater treatment plants you have to reduce your nitrogen and be your plant really isn't designed to take septage.
15:31:09 So far they haven't like come out with a with an edict like because I think that they know that it's they've got to find a solution before they say you can't you can't accept
it.
15:31:18 And so on the other hand they're saying you know you've got to manage your septage correctly and manage it appropriately.
15:31:29 But if the they're trying to reduce nitrogen and ecologies one hand is saying We don't want wastewater treatment plants to take it.
15:31:35 That's that's a big issue. So far that hasn't happened. But with all of the nitrogen reduction around the putet sound counties, it's a it's it's a little bit of a balancing
act I think for ecology and for us as well.
15:31:49 Okay, well I think we can continue this conversation when it comes up again in December.
15:31:57 I got one other one other question, one other comment to add to that, which is that the city of per 1,000, because we are now over 10,000 person size there are some changes
to the septic discharge or the sewer plant water treatment plant discharge rules that we're going to have to follow and that will put us under stricter nitrogen rules so that's just
another piece to put into this.
15:32:21 Stew if you will.
15:32:25 Okay.
15:32:31 Yeah. Okay.
15:32:21 Yeah. Good, good. Good point. All right. All right. I think we'll leave it at that. Thank you, Libby.
15:32:37 Thank you.
15:32:37 All right Thank you. Yes, thanks Pinky. All right, let's go on and, Apple, maybe you can introduce the next topic.
15:32:45 There. Hi, Kira. Hi, what's to welcome Dr. Kira.
15:32:54 Bye. Yes.
15:32:52 I'm gonna get it right, Kira. Okay. You got it. We at Jefferson County Public Health had the great fortune to have, her join our general staff meeting back in 2021 during the
pandemic and talk with us about.
15:33:11 The. Trauma impacts from living and working through an emergency slash disaster known as the pandemic. This was during her lead role with Washington State Department of Health's
behavioral strike team, Behavioral Health Strike Team, responding to Covid-nineteen and we had really just a great response from staff, and we had really just a great response from
staff, the meaningfulness and depth of
15:33:35 the, the meaningfulness and depth of the conversation around the impacts and depth of the conversation around the impacts of disaster and emergencies and depth of the conversation
around the impacts of disaster and emergencies on.
15:33:40 The psychology, well being, mental health of everyone and not least of which the the the caring workforce, which is what I will call what we do in public health.
15:33:53 Dr. Met. Marcel is a practicing clinical psychologist and senior instructor at Seattle University.
15:34:02 Her work and research focuses on resilience and recovery from trauma. As well as disaster behavioral health.
15:34:10 She works extensively with earthquake survivors, refugees, and first responder health care workers around the world in places like Haiti.
15:34:19 Syria and right here in the Puget Sound region. So I've asked her to join us today to share more about climate vulnerability and how exposure and sensitivity and the ability
to adapt are considered in this paradigm.
15:34:34 And I really appreciate you coming and joining us. And I look forward to your presentation.
15:34:37 Yes. Hi everyone, thank you very much. Appreciate that introduction. I'm going to go ahead and share my screen and put some slides up.
15:34:48 We might not get to all of these, but I'm happy to share this slides as resources in their entirety, even if we don't have time to cover all of that material today.
15:34:55 And I'm also happy to take some time at the end to answer questions as needed. So I'm going to cover, I'm going to cover it sort of the behavioral health aspects of emergencies
and disasters in terms of best practices.
15:35:06 So for health districts and governmental agencies looking ahead at an increase in climate related natural events, which we certainly have data to support that those are on the
rise.
15:35:17 It's helpful to include at the beginning and in the preparation stage some concepts and some best practices around mental and behavioral health specifically in addition to and
not just like as an afterthought but like incorporated into the planning for how to how to recover from these big events.
15:35:34 It really does make a difference. For a scalable population perspective on recovery. So I'm going to provide the big picture on disasters where we are with climate and natural
related events.
15:35:45 I'm going to share with you some information about the various phases and the population model in terms of risk factors, common symptoms.
15:35:51 And then I'm gonna try to summarize if we have time today. A roadmap for high level things to focus on in planning to move forward from this.
15:36:01 So internationally, we have seen an increase in the number of disasters by almost a fivefold increase over the last 50 years.
15:36:10 There's more extreme weather but there's also more improved reporting so it's not just that there are more events it's more that it's also and that we are having additional
technological advantage in tracking things, having more information about things and categorizing things as well.
15:36:26 So it's It's just an increase that we're seeing. One of the results of that is an additional burden of mental health disorder.
15:36:34 Typically when we look at complex disaster incidents that have more than one impact over a fairly short period of time, we're looking at a population level increase in anxiety
disorders and depressed depression as a disorder in around anywhere between 4 to sometimes up to 10% of the population depending on the severity and complexity of it disaster.
15:36:57 Certainly in the United States with COVID as a disaster, we're looking at youth and young adults facing significant, stronger, significant impacts than than older adults are
right now.
15:37:08 But that that change is depending on the nature of the type of disaster that it is. So there's certainly more awareness about mental and behavioral health and then also to keep
in mind about resilience.
15:37:20 One of the things that's interesting about resilience is that exposure in the course of a lifetime to mild to moderate stressors and mild to moderate levels of traumatic events,
tend to provide people with the coping skills and the resources to to teach themselves to learn.
15:37:37 I'm capable of moving through the next challenge that I'm confronted with. If however the trauma is on a severe level or if the nature of the emergency or the traumatic event
is is extreme, it doesn't have that protective factor in terms of building up resilience.
15:37:54 So it does depend a great deal on the extent of the event and the nature of the emergency. Globally, this is just a graph to indicate the number of natural related disasters
and mega disasters that have happened all over the world just in the last 20 years.
15:38:10 With a lot of them happening here in the United States and also in India and China and Indonesia in terms of just just share number.
15:38:17 I know I'm moving quickly, but I want to catch, I want to cover as much information as I can in my in my time with you all.
15:38:25 In terms of the total number of people affected by disaster type, as you notice from the pie chart, drought and flood are the by far, far and away the most common examples.
15:38:35 And you might think here in the Pacific Northwest, you know, those don't necessarily apply, but, in fact, they do.
15:38:42 Floods are related in large sections to, fire. So when there's fires, wildfires, there are often floods that follow that.
15:38:50 And are subsequent to it. So flooding as we've seen on the East Coast certainly in the last year or so is a risk here.
15:38:58 As well. And then drought considering eastern Washington and the cascade range as well. So just by the numbers.
15:39:05 This is another chart to show that natural disasters are on the rise everywhere and just so that the definition is clear of what a natural disaster is in this context.
15:39:14 It's a pretty narrow definition, at least one of the following criteria must be met. So an economic loss of 50 million dollars, then insured loss of 25.
15:39:23 10 fatalities, 50 injured or 2,000 homes or structures damaged. It doesn't seem like, And seems like that's a fairly low bar.
15:39:32 But that's been the bar for quite some time. And so, so the number of incidents is on the rise for sure.
15:39:37 Now, interestingly, when it comes to behavioral health, what we need to consider in our planning and in our thought process around the appropriate level of support is that even
though the number of disasters is going up significantly and consistently, the number of survivors is is also going up.
15:39:53 The number of deaths from disaster are going down. And so people are surviving these events. We have much more advanced medical care.
15:39:58 We have more alarms and alerts to get people to safety. And so we're seeing a consistent trend of reducing a reduction in fatalities, which is great.
15:40:09 And it's also very important when it comes to keeping in mind that the mental health risks of experiencing severe disaster in the course of a lifetime become higher with every
subsequent severe exposure.
15:40:20 So, so building resilience in a scalable way and being intentional about what that means. In terms of public health is a really essential piece of the planning and preparation
for climate related change that we're going to see.
15:40:35 And despite all the data, I really just want to ground it in the fact that the human experience in disasters is way more.
15:40:41 Okay.
15:40:41 Than any number and it's way more important than any statistic. An example just of the hate earthquake, right?
15:40:48 250,000 people were lost and the total population there is only about 10 million there is only about 10 million so that is a huge percentage of the overall population and that's
just one example of a. So that is a huge percentage of the overall population.
15:40:58 And that's just one example of a mega disaster in the last 20 years. So this charge, it's not everybody's favorite, but I find it to be a helpful framework.
15:41:05 To understand the process that we go through when we are experiencing a large-scale critical incident or disaster.
15:41:12 We have various phases and we have our behavioral health ups and downs. So how does this apply to public health and in our thinking?
15:41:20 The whole process if we are left to our own devices, when we go through a calamitous incident.
15:41:26 It takes about 18 to 24 months for a human population in general to recover to baseline.
15:41:33 So however we came in with our coping skills and our symptoms before the event occurred, we go through this.
15:41:40 Upheaval process, we feel great, we feel empowered, and then we feel not so great and things are really a struggle in the disillusionment phase, that entire process takes about
18 to 24 months.
15:41:47 .
15:41:49 However, that is under the assumption that that's the only big thing that happens on a population level during that window of time.
15:42:02 Okay.
15:41:57 So the reality is much more likely to represent this concept that there is more than one impact that gets stacked on top of each other.
15:42:05 In that 1818 month window, let's say. It's pretty unusual these days for anywhere to be, to have one critical incident in more than a year.
15:42:15 So what we get when we have that, experience is called a disaster cascade. So just using the example of the pictures down below you might have a tornado.
15:42:24 Subsequent flooding and then flooding, causes disease or an outbreak of some kind.
15:42:29 Disaster cascades are common. They happen all over and what it does is it prolongs the behavioral health.
15:42:36 Impacts. It extends. The recovery time and it also tends to increase the symptoms that people experience. So it, it increases the need for health care capacity to deal with
longer-term mental health symptoms.
15:42:53 And to provide appropriate scalable support at at a large level. And you know Washington just using the pandemic again as an example Washington was I think 40 fourth in the
country.
15:43:03 For accessible behavioral health support before 2020. And it hasn't gotten better since then. So we have a lot of work to do in terms of scalable behavioral health support.
15:43:14 In terms of changes in prevalence, just just as a function of the pandemic. The darker the red color, the higher the increase in prevalence rate for major depressant, major
depression, excuse me.
15:43:29 So you can see some really significant increases. Around the world. Anywhere from, you know, one or 2% all the way up to 38 almost 40% in some places.
15:43:38 So this one is depression. This one is anxiety. Sort of illustrating the need on a global scale to include behavioral health in our.
15:43:45 In our planning for this increase in in disasters. So a minute I'm gonna take to talk about.
15:43:53 The various phases and what I would recommend become sort of thoughtful priorities for behavioral health support and resources for various response functions, right?
15:44:06 So in the first 0 to 48Â h of an event, you want to be focusing on psychological first aid.
15:44:12 It's immediate threat reduction, reducing risk for people and increasing the odds of survival by focusing on triage.
15:44:18 The interventions would be psychological first aid and then a lot of shock support. So this is just that immediate, impact phase.
15:44:26 In the rescue phase, which is usually our team jokes, we call it also the Anderson Cooper phase where he's on TV with the black t-shirt and the media is all talking about everything
and this is all the attention and the money starts to come and there's all of this attention regardless of the type of incident that happens this phase is is pretty predictable in a
lot of ways.
15:44:47 And it really is about helping your population. Adjust to what has happened. Recognizing that there are some big things that have changed resources that were available are now
no longer available and what do we need to adapt to say safe?
15:45:02 What do we need to access? In order to get those basic needs met, medication, food, shelter and things like that.
15:45:10 So sort of processing what's happened. And we don't want to be focused on in depth therapy.
15:45:17 We don't want to force people to participate in debriefing and we want to provide options so there's more nuance and I think this is a really important lesson that we took from
COVID is that nuance matters when it comes to behavioral health.
15:45:29 And from a public health lens. It's a little bit of a dangerous. Proposition to say this is what everybody needs at this time It's really helpful to consider that different
groups.
15:45:41 Yes.
15:45:40 Are gonna have different levels of access. They're gonna have different needs. And it's really important to include communication.
15:45:48 The process for where people go to get resources in multiple different languages and a lot of different like avenues in your planning for this rescue phase.
15:45:56 That's I think one of the big gaps that exists in incident command structure and management. The honeymoon phase is within the first a week or so.
15:46:08 It's usually around a month in my experience. Post impact from a disaster. This is when I would recommend that again from a public health lands that there's a focus on education.
15:46:17 There's a focus on interventions and teaching because this is when people have the energy to take it in.
15:46:23 This is when people are interested in learning more and when the people who are feeling fairly resilient want to help their community.
15:46:29 So having your resources lined up, having trainings and interventions sort of lined up and ready to go, again, to think about how to provide behavioral health at scale.
15:46:39 For these large-scale kinds of incidents. This is the time frame in the typical disaster cycle when it would be most beneficial.
15:46:47 Across the population. So you're sort of reprooritizing the focus on what are the, what are the interventions we can do now?
15:46:55 What is the training we can provide now to reduce the risk later on of an increase in suicide, of an increase in PTSD, and other diagnostics that are likely to come up as time
goes on.
15:47:11 Okay.
15:47:09 The next phase here is the disillusionment phase and this is usually around 6 months post impact. This is when symptoms start to become pretty acute and you're gonna see an
increase in emergency department visits.
15:47:23 You're gonna see, you tend to see an increase in hospitalizations. And a significant increase in symptoms and diagnostic labeling.
15:47:32 So depression and anxiety disorder are like to be the most common followed by PTSD. Kind of kind of a distant third.
15:47:41 PTSD is not the most likely likely thing.
15:47:44 The final phase of this framework, again, which is just a framework that we can use to sort of orient our thinking about what's appropriate one is this reconstruction and recovery
phase.
15:47:56 This can go on for years and it is sometimes in some cases not ever completed. But it really is important to focus on active coping, active resilience building.
15:48:06 And these are also things, ironically, And when you think about the interventions that work in this phase, these are the things that can be done now to pre position people to
have an understanding of what behavioral health supports need and what they should look like.
15:48:19 After an incident has occurred so that you've got teachers, teachers, and coaches and mentors and family members and clergy in a position to offer appropriate evidence-based
behavioral health support to the community at large.
15:48:33 So people have these tools and they have these things. Ready to go. So the same interventions you would use in the long run are really good interventions to use in the preparation
stages as well.
15:48:45 Okay, a few factors that influence the reconstruction pathway. And then I'm going to talk about interventions that we know are effective.
15:48:54 Try to summarize those for you. These are things that We like to think of as tears that influence recovery.
15:49:02 And that are really important. Behavioral health considerations. With a sort of level of functional ability after someone has been through an emergency or a critical incident.
15:49:13 So the first tier are the foundational sort of systemic tiers. These are things that include.
15:49:17 Marginalization, racism, economic status, and access to resources and health care in general. Those are the foundational things that are influencing people's well-being far
before any incident takes place.
15:49:29 The first tier above that is what we call primary disaster impacts. Those are the direct influences. The direct loss of a loved one of your home, the displacement for kids,
one of those direct factors is the loss of a pet.
15:49:43 And when families have to move or they're suddenly displaced because of a fire or flood, frequently as we've seen recently with the fires in eastern Washington, the losses of
pets and livestock and things are really, those are significant detrimental impacts for kids.
15:49:58 The the second layer here above you have your foundation and then you have your primary impacts. The secondary impacts are educational, financial, and social.
15:50:07 There's certainly also very influential, but when you consider an individual person's experience of a thing, you want to consider all 3 of those levels.
15:50:16 To try and have a nuanced understanding of what their individual risk factors. And also what their individual resources and sources of support may be.
15:50:26 It's different for each person. And also on a community level. So when you talk about common experiences, everybody goes through stress, not everybody goes through trauma.
15:50:39 They're different things, but they are very related to each other. So the distinction between stress and trauma is important.
15:50:42 It is.
15:50:44 And this, this is how I like to conceptualize it. All trauma is stressful.
15:50:49 But all stress isn't necessarily traumatic. So when people go through an emergency, we all become stressed.
15:50:55 But not everybody is traumatized. It really does depend on what you were exposed to during the event.
15:51:02 But the ability to function can be compromised by either stress or trauma. So our brain reacts in similar ways to both of those kinds of things.
15:51:12 The risk factors when we think long term. Around disaster exposure are related to those primary impacts. So did you lose a loved one? Did you have to move?
15:51:22 Is there a loss of a pet? And so far and so out through the circle. So the highest risk for long term negative mental health impacts are people that are closest to the center
of these circles.
15:51:34 We've all been exposed to things in our lifetimes across the the range of circles. But when you're talking about planning for and recovery from an event you want to be able
to identify the people who are at the closest to the epicenter of this because they are at highest risk for long-term diagnostic issues and symptoms that are strong enough to sort of
meet that diagnostic threshold for a
15:51:57 disorder of some kind.
15:51:59 Okay, additional common challenges. These are things that I know that I probably have shared with you all before.
15:52:07 The brain fog, the trouble sleeping, stomach aches and headaches. It's really important to provide again from a public health lens sort of this validation of common experiences
because my experience in doing this work would suggest.
15:52:22 That most people think that when their body and their brain is reacting in a particularly troublesome way, they tend to think it's just them.
15:52:30 And so getting this information out there to folks, getting it in their hands and saying, look, if you can't concentrate and you can't remember what you're doing.
15:52:38 That's normal under these circumstances. It's certainly happened to most of us in the context of the pandemic.
15:52:43 They have these cognitive difficulties. Sleep, I mentioned stress eating, anger outbursts, a lot of grief and a lot of internal distress being expressed as anger.
15:52:53 So right now what's happening is that we're seeing that as road rage. We're seeing that as really challenging interpersonal interactions.
15:53:00 And people really losing their temper and reacting really strongly are really aggressively. Without much thought.
15:53:05 So these are very, very normal. Human reactions based on our neuroscientific understanding. Following an emergency or disaster cascade.
15:53:15 In terms of the effect that that has on our on our physiology. On our basic biological processing.
15:53:22 So the parts of the brain that are primarily impacted here in terms of the way that it influences behavior are the Olympic system.
15:53:29 Okay.
15:53:31 And the prefrontal cortex. I know I'm again throwing a ton of information at you, but I just wanted it to, I wanted it to be there and be available so that if you had questions,
we could circle back around to it at another time.
15:53:43 The limbic system is the part of the brain that's responsible for that. That impulsive responding, right?
15:53:50 So. That aggression that I'm not I'm gonna act without thought. We're seeing that a lot right now.
15:53:55 This is something to be aware of in terms of how people are likely to interact with each other following following an event.
15:54:02 It's very fight or flight or freeze oriented. And the prefrontal cortex is the part of the brain that's logical and thoughtful and considering of consequences and that is the
the part that kind of goes offline a little bit when we're faced with the perception of a threat.
15:54:17 So reducing the experience of threat in the environment and increasing the opportunity for people to use their whole brain. To respond to a particular situation is very very
beneficial when it comes to recovery for a community.
15:54:30 And sometimes honestly, having this information just thinking, oh, like, yeah, my brain is a little bit haywire right now because I'm scared for my kids, right?
15:54:39 That could explain why I'm reacting the way I'm reacting. Just having that little bit of psycho ed information really does go a long way in validating but also then changing
behavior because once people have that insight and awareness about What's happening?
15:54:55 They are likely to be able to change it.
15:54:58 Okay, I think I just have about 5 or so more minutes, so I'm gonna briefly run through some interventions that we know work.
15:55:04 And our effective. These are the 3 categories of things that people need to recover. This is what we need to have as as a population.
15:55:14 So we need a sense of safety as a population. So we need a sense of safety and security. We need good communication practices and we need operational resilience.
15:55:19 We need to take resilience out of this buzzword category and put it into practical strategies that anybody is able to access.
15:55:28 And be able to. So sort of leverage for their own community and for their own family. So I created another acronym model to summarize these best practices that get us there.
15:55:39 They get us to safety and security. They get us to good communication and to this operationalization of resilience.
15:55:46 So last little bit here. So the first part is to identify internal strengths and external resources. This is about helping people recover from crisis by drawing their attention
to the strengths that they already have.
15:55:59 To the resources that are available. Oftentimes when we get confronted with a crisis, we focus on the problem rather than this coping skills that we can already bring to bear
or the resources that are within our community already.
15:56:12 And so a large part of public messaging is is helpful to say listen leverage the, leverage the stuff you already know how to do. You're, you're strong.
15:56:21 You can persevere. You don't give up. Sometimes it takes an outside voice to kind of reorient people to these these these resources that they already have.
15:56:31 The second piece is to develop insight and awareness. This is paying attention through Psycho Ed through just information sharing that the health department could do to some
extent on how we process disasters, how we proud the brain and the body process stress.
15:56:49 Like being aware of what the neurological impacts are and effects of going through a critical incident or a crisis of some kind.
15:56:56 This is a really big, really big step in the direction of being able to change behavior and help people regulate themselves when they interact socially with one another.
15:57:06 The third piece is Resilience Development. And this is about breaking down these 4 ingredients of resilience.
15:57:16 And making them sort of part of the part of the jargon and I want to say jargon.
15:57:22 So part of the vocabulary that most people are familiar with. So the first ingredient of resilience is purpose and that's about.
15:57:29 Helping people identify post disaster what is a sense of meaningful goal directed activity that they can engage in. When crisis happens and particularly when climate related
or weather related or natural disaster related events occur.
15:57:45 It is it's very unsettling. It shakes up the world in terms of like maybe you lost your job or maybe there's some damage to your house and it just really devastates the the
typical routine and it's essential for people to reorient themselves around what matters to them.
15:58:00 So purpose is an essential piece of that. The second ingredient of resilience is adaptability. In the model that I'm using on the side here, that's the trunk of the tree.
15:58:09 So the purpose is the fruit of the tree. What are you growing, right? The adaptability is the trunk of the tree.
15:58:14 This is about recognizing that new doesn't have to be threatening. Just because you can't do this or you can't do that anymore, you don't have access to XY, or Z.
15:58:24 Doesn't mean that's necessarily bad. It means that there might be another opportunity or a different way to look at it.
15:58:39 Hmm.
15:58:30 So adaptability and hope. Often go. Hand in hand with each other. Hope is the moss that grows on the north side of the tree where it's dark and it's always there, but people
are usually not paying attention to it in disaster.
15:58:44 Hope is the idea of look for the helpers. There are always people who are willing to help. And it's possible, especially important to note, hope is the only one of these 4 ingredients
that is influenced by lived experience.
15:59:00 So if someone is coming from a minoritized community, they may experience less hope than someone else who has had more opportunity based on.
15:59:09 Sort of systemic systemic availability of things And so hope is the only one of these 4 that is influenced in in that way.
15:59:18 The final ingredient of resilience is connection. That's the roots of the tree.
15:59:23 And those are those are our people, right? Those are our communities. Faith communities. Friends, family members, social groups.
15:59:30 Recreational sports leagues, it doesn't matter. Those are the things that we need to operationalize to improve our wellbeing.
15:59:38 Finally, almost done here. The A and ideal is active coping. This is about mainstreaming these concepts into interventions that people are using.
15:59:50 Getting these things in the hands of teachers and of anybody really who's willing to model these kinds of behavioral choices that we know have a positive impact on long-term
outcomes.
16:00:04 So with anxiety, we wanna be focused on sensory, sensory sorts of interventions, anything that's gonna orient someone to the present moment to the here and now.
16:00:13 I use the example of a frozen orange many times like using a frozen orange to deal with anxiety or panic or panic attack.
16:00:21 Is a great tool. Usually when we manipulate a cold object in our hands because we have so many nerve endings in our fingertips.
16:00:29 It really helps the brain focus on that present moment. But it's not great when someone's mad.
16:00:34 A frozen orange is not a good intervention when somebody's. They can go right through the window.
16:00:38 Yeah, right. So not good, but good in general. A hot or a cold shower, a good playlist, you know, you can listen to, etc.
16:00:46 There is a thing moving on to the next category that the American sleep association identified as revenge bedtime procrastination.
16:00:55 Yeah.
16:00:54 And yeah, I don't even have to define it. You all know what it is. All right.
16:00:58 Yeah.
16:00:59 It is when we stay up on our phones until 2 o'clock or 3 o'clock or some ridiculous hour for no reason besides the fact that we can.
16:01:07 Okay.
16:01:07 And this has pretty big impacts on sleep. Headaches and stomach aches and trouble sleeping are the 3 most common complaints that I've ever heard in field clinics.
16:01:19 Everybody that comes in. It's having trouble sleeping or they have a headache or stomach cake.
16:01:23 And you know knowing what the behavioral health influences are like why is that happening? Gives you different options for how you can intervene to improve it.
16:01:32 For people. The final category there is depression and that one is often the most tricky in terms of active coping because motivation is usually a problem.
16:01:42 So this is really about picking one thing. We call it behavioral activation, picking one thing that you can encourage someone to do differently.
16:01:50 To change the trajectory of their recovery. So these are the 3 categories again. These are the things that we know work.
16:01:57 Everything on this list is evidence-based. There's plenty of. Anecdotal and good quantitative research to back up these various applications of this.
16:02:07 When it comes to large-scale community level recovery from disasters. This is just an example of a coping plan.
16:02:15 Alright, that someone could put together if you put together a list of things you're willing to do for yourself, it increases the likelihood of doing it.
16:02:18 Okay.
16:02:22 And then this is, I think, the last part of the ideal model, which is listening and effective communication.
16:02:29 Very often in the context of disasters we focus on problem solving. Because that needs to be done. People need to eat, they need shelter, we need to solve problems for sure.
16:02:39 That's the case. However, When it comes to effective behavioral health support. And distress. Often times more often than not actually, you're not going to be able to solve
those problems for people.
16:02:51 And so the most effective intervention we can offer is to listen and attempt to understand what's going on.
16:02:54 Okay.
16:03:01 Okay.
16:02:58 If your goal is to understand the person's experience. It increases connection. And that's a really, really powerful tool when it comes to these, these types of events that
impact communities.
16:03:08 So you gotta recognize where you are with your neurobiological response and where someone else is. Apply that challenge mindset like what are my options what are my resources
and then really engaging active listing because we know that that's probably probably the 5 star we know this works kind of an intervention that we can offer.
16:03:31 Okay, bottom line. For disasters. It's really important from a behavioral health perspective to be prepared, even if that makes you anxious, right, to continue to talk about
this, continue to have.
16:03:43 Have meetings like this where you're thinking ahead to what are the likelihoods of various environmental, environmental disasters.
16:03:50 Being prepared decreases anxiety because it helps you identify what you would do if. Right? So walk the talk.
16:03:59 If you're interested in getting certified in any of these things, right, CPR or a community emergency response team or the medical reserve corps.
16:04:09 Wallserve is the state DOH one or FEMA and then educate yourself about psychological first aid.
16:04:16 This is something this is training that the Red Cross offers. There's a Unfortunately, very long Red Cross version of PFA online that's like 8Â h, but there are shorter versions
as well that are more accessible.
16:04:27 That you can get and take online. Some are free, some are not. Various programs. Designed to give people information about.
16:04:35 Best practices like what we've been talking about today in recovery for disasters. And then last but not least, we have a big wall of things in front of us to try and tackle
with the increase in disasters.
16:04:53 We know there are more coming and they will be happening more frequently. So I wanted to finish with this quote with Maya Angelou, which is that difficult is a far cry from
impossible.
16:05:00 The distance between these 2 lies hope. Hope and fear cannot occupy the same space at the same time.
16:05:06 Invite one to stay. And that's it for me. There's some references for you. Thanks very much.
16:05:11 I will stop sharing. I hope I didn't run out of my time. Apple, sorry.
16:05:16 You absolutely did not run out of time. That was amazing. And I wanna make a nod to.
16:05:25 Yes.
16:05:23 Kira's, she's teaching today and she hadn't had invited her class to listen in.
16:05:29 Some of them are here right now.
16:05:29 In the background. Yeah, so kudos to you to just extending the knowledge and the empathy around this complicated topic to your students as well.
16:05:47 Alright.
16:05:38 Thanks. And we do have time for a few questions or comments. So much there. I know.
16:05:51 Will this slide back be available to all of us. Will this slide deck be available to all of us? It is only in there. I didn't.
16:05:59 You know, purchase all of that. Okay.
16:05:57 There's a lot. I'm sorry. I'm sorry I spoke so quickly. I know I do that.
16:06:01 I'm just trying to get a fire hose worth of information.
16:06:02 No, that was it was perfect. It was perfect and great. Go ahead. You have a comment or question?
16:06:07 Yeah. Thank you so much for all that presentation and information that's so important to make available to people at this level.
16:06:18 I think, I was just having a conversation the other day that is just so incredibly germane that I thought I would ask you what your thoughts are on this kind of Secondary realm
now, we've got the real.
16:06:32 Real world example of COVID here where it started off as a very intense acute. Trauma and crisis.
16:06:42 And it has kind of petered off in a way that many people treated as though it is done. It is gone. It's over.
16:06:52 Other people are still living in it. There has not been a community wide, much less nationwide. Acknowledgement really that we went through a trauma together and I live with
a disabled person my spouse is disabled.
16:07:05 Okay.
16:07:07 And so there's a lot of things that we're not able to do anymore socially. Etc.
16:07:15 And the amount of push back that we get. From friends and from businesses when we're trying to do curbside pickup and stuff like that.
16:07:21 Yeah.
16:07:22 I can't help but think it all stems back to a lack of. Acknowledging that this is a thing that did happen and it's continuing to happen because of how we responded to it.
16:07:34 So my question is. Are there examples? Of concerted efforts not grassroots efforts to do some of the things that Memorialized other traumas like 9 11 for instance, you know
where we went back every year and we talked about it and had some observations like I remember being in you know high school and those next couple of years and into college, it was,
it was talked about and recognized and I'm not seeing that
16:08:06 happen. Here with COVID and I'm wondering is have you seen people being doing that for COVID? Is there examples?
16:08:14 Is there something that maybe public health could start to look at and see if there's something to model off of.
16:08:20 Wonderful question. I wish I had a good answer for you, but the but it's no.
16:08:30 And there are some reasons for that. I have not seen anything and neither has my team members around sort of general or universal acknowledgement of where we are and what has
happened.
16:08:38 There I have lots of opinions about why that might be the case, but how data-wise. We culturally have never been very good at grief.
16:08:47 We don't do a good job with processing grief. We try to, the pace of work culture is go, move on, just okay, and here we go, and that's part of it.
16:08:55 The other part of it is that unlike an earthquake that happens, you know, at 4 32 PM.
16:09:00 On this day, kovat came and and and followed and there were different all of these cycles and so many communities and states obviously handle things in a very different way.
16:09:11 And with different parameters around when things started and when things stopped. And when risks were high and when they were low and so there has not that I am aware of then
a collected effort on on any of those markers on that memorializing.
16:09:24 There has been on a, an individualized or like on a local scale. Like I have seen, I have seen small communities do that.
16:09:32 I've seen schools or school districts do that. Certainly same families and faith communities as well do that kind of thing where you kind of mark and process and are able to
heal through the acknowledgement.
16:09:43 Of the losses of what has happened. But I think also that there are so many people who are grieving losses of relationships with people who are still alive that we don't know
what to do with that.
16:09:54 And so it truly was a first in terms of its complexity. And its nature in terms of the type of disaster and the scale.
16:10:02 And there there has been no roadmap for it. I mean the flu of 1,900. I mean that doesn't it doesn't it pales in comparison to what we've gone through here with COVID.
16:10:11 So the short answer is no. There has not been a large-scale effort, but the reasons why.
16:10:16 I think are reflective of the complexity of this incident. Or series of incidents rather because it wasn't just one thing.
16:10:23 If you do have any. Information even if it's just a point, me in the direction of somebody who last on this small scale.
16:10:32 Yeah.
16:10:33 I would really like to see what prototypes I might be able to learn from because this is something that's Pretty near and dear to to my heart and my life.
16:10:42 Yeah, I'm happy to share that. The examples that I know of are people who focused on grief and loss.
16:10:48 They focused on acknowledging and moving through grief and loss as a reflection of that. But I'm happy to send you some material and some idea.
16:10:56 Yeah.
16:10:59 That's great. Great presentation. Thank you, Kara. Learned a lot.
16:11:03 I guess my question is kind of around the slide where you showed that. You know more and more people are surviving these.
16:11:12 These horrible horrible events and I'm wondering I guess is a corollary to that that more people are living with the trauma of these events.
16:11:24 And I'm wondering if you can touch a little bit on the the disparate impacts and how do we take this psychological first aid to a community-wide scale and maybe I'll choose
an easy emergency like Katrina, you know, where you had, you know, tens of thousands of people of color, you know.
16:11:38 As refugees at the Superdome when evacuees were the, you know, the white folks of privilege able to, you know, go to their summer house.
16:11:45 Yeah. So it's pretty, typical with large-scale environmental things that the people with resources and means are able to evacuate and have other options and people who with
fewer resources don't.
16:11:58 And so to me, it, comes back to preparing ahead of time, like getting these systems in place now so that people have at least awareness of behavioral health risks.
16:12:12 They know what the risk factors are. They know what the warning signs are and we get some early intervention going, especially with kids.
16:12:17 Regardless of the type of event so that when something happens, the people who are most affected by it.
16:12:25 Have the system to support their recovery. As readily available as possible so yeah, I don't know.
16:12:34 I don't know if that answers your question.
16:12:35 Well, I mean, that speaks to, public health or public sectors being engaged in that beforehand.
16:12:42 Yeah.
16:12:42 Because of course, we're talking about marginalized populations, they often don't have the resources, right?
16:12:46 I mean, that's the reason. They can't evacuate themselves, right?
16:12:46 Right. Right. So yeah, I do think it falls on us as a community like people on as a community, right?
16:12:56 Public health and people with decision-making to say, we need to prepare. Across these levels within the community.
16:13:03 You know, this is so simple, but I'll give you an example. And this was a district in Portland that I was working with and they had a protocol for what happens in crisis and
all of their materials were in English.
16:13:13 Right, so what happens in crisis? Like here's what to do. Here's the information, but it's not in the 500 other languages where families need it and then they didn't know what
to do and so they were going to the wrong place and that's just a perfect example of something that we can do structurally ahead of time.
16:13:28 So that people. You know, from all variety of background and experience. Have the access and the information that they need.
16:13:36 For to know what to do next. You know, that pre planning. Yeah.
16:13:41 Thanks. I'm here. I have a question. I'm just maybe it's also for my colleagues in the room as much as for you, but It struck me as you were as we were going through your slide
deck that.
16:13:53 You know, we do have, our Department of Emergency Management here and we have neighborhoods doing their end prep.
16:14:01 I'm in prepping my neighborhood, but my go bag doesn't include any psychological first aid items.
16:14:10 I mean, how do we integrate these really important concepts into the first response that we are preparing for in our communities.
16:14:21 Yeah.
16:14:21 Have you seen examples of where communities have? Around in prep or, emergency management. Incorporated psychological first aid and that kind of education and outreach.
16:14:33 Hardly ever. Unfortunately. Washington actually was the only state, which I'm proud of this fact, but we were the only state.
16:14:41 To have a coordinated state level behavioral health response to the pandemic. Anywhere of all the states. Other states did it in pieces like they had a substance abuse team
or they had a child focus team but they didn't have a overall behavioral health thing.
16:14:57 In terms of what we do about this, I couldn't agree with you more. That most traditional IMT and emergency response management planning just doesn't include behavioral health.
16:15:05 It just doesn't. Whether that's in school districts or whether that's at a state level or accounting level.
16:15:10 That's what we need to start with. It's including it as a module along with everything else that people get trained in.
16:15:15 It's not an afterthought. It's not attack on. It is essential to the curriculum of the training.
16:15:21 In my opinion.
16:15:22 My question for you, Apple, is as part of this, the team that is building, I mean, and I know you're not.
16:15:33 And for you, Apple is as part of this, the team that is building, I mean, and I know you're not emergency management.
16:15:34 I know your environmental or public health, but or do we have anybody who's leading these positions in these teams who do have the psychological first aid training and And if
not, can we ask that it be made a priority?
16:15:46 Well, I think we should send this on to people like Willie Benz and the local, 2,020, emergency preparedness folks, I think.
16:15:53 I think if we as public health sent that out. To folks and invited some dialogue. I think they would be very responsive to it.
16:16:03 Very receptive. Here too. So I have no doubt about that. I do think that you know, the strengthening of our collaborations together, the EM and public health and Maybe the local
2020 as well and our engagement with them.
16:16:16 A lot of that. Awareness gaining is happening internally to each of those departments. I think Kerry, you bringing up a really good point that is worth being reminded.
16:16:29 You know, adding this particular. Part of thinking about the response to disaster and emergency. It's not rocket science as you said earlier.
16:16:41 Okay.
16:16:41 I mean sitting sitting and listening to your neighbor as part of your in prep, which I have done very recently.
16:16:51 Is not a hard task. It's a micro version of what you're talking about because scalably it's just a neighbor of mine.
16:16:58 That person is elderly and sitting in. Listening to them through what COVID has been like has been an enormous measure of trust building.
16:17:08 It's part of the therapeutic modality really is to to witness. And to acknowledge people's experience of the distress they're experiencing around a disaster and that disaster
can be scoped many ways, right?
16:17:20 Yeah. Yeah.
16:17:21 It can be smaller or larger. I don't think that it's a big ask. For our community and the leadership in our community that's responsible for figuring out how to respond to disasters
to take this in.
16:17:35 I think it's, it's a natural element. That just hasn't had as much.
16:17:43 Attention and verbalization. So I can make that promise to this group of folks that it's definitely on my mind and that's why I asked you to come Kira because I think that you're
able to really hone in and help people see where the focus can be.
16:17:59 If we're not otherwise paying attention. I'd like to keep things moving and gray. You've got a question or comment.
16:18:10 Unmute. Yes. Yeah, I think something that I'm noticing here is just the near complete overlap in the the issues that you're describing post trauma.
16:18:25 And the most common issues that we just saw in our school business school, sorry, school, health centers.
16:18:39 Yeah. Yeah.
16:18:34 And, the top things that students are struggling with that day to day, it, the same psycho education that is solves all of this and preparing people with that before the next
inevitable trauma.
16:18:50 I think makes so much sense. So, you know, I just want to advocate and sort of an abstract way for trying to think about how to include this education not only as trauma.
16:19:05 Preparedness but also life preparedness that these are all things that we're struggling with. Both because traumas are constant and inevitable and also on due to smaller traumas
of our life.
16:19:21 Okay.
16:19:18 You know, that's a really good point and I would like to just kind of add that. The biggest push back that I get in this role and in my job that I do is teaching all kinds of
people who are not therapists, right?
16:19:30 Teachers and firefighters and whoever else they I hear the pushback is I didn't sign up to be a psychologist.
16:19:36 I didn't sign up to be a therapist. And my response to that is, well, everyone has a role to play in behavioral health.
16:19:42 Whether you want to be or not, that you're going to be managing crisis of a behavioral health nature.
16:19:47 So why not have a few more tools in the kit? That's the that's the logic that I'm working from.
16:19:51 So yeah, agreed. Thank you.
16:19:54 And everyone. No.
16:19:54 It's the same conversation when I try to convince people of carrying a laptop. So on the same page.
16:20:01 Every business is a people business.
16:20:03 Yeah.
16:20:02 Yeah, that too. That too. Thank you all.
16:20:07 Right, and I, I think you are right in your presentation to also point to the people who respond to crisis, whether they're teachers, psychologists.
16:20:15 Hmm.
16:20:16 You know, EMT people. I mean, they, we also have to struggle with trauma.
16:20:24 And so a lot of these tools that you're talking about are good for all of us because we are all potentially traumatized by the stress.
16:20:30 Yes.
16:20:31 Yeah, good. Well, thank you very much. This has been very helpful and I don't think that this will be the end of this of our conversation.
16:20:40 About the next steps in terms of sharing this information with people in our community. And I suspect that they will be very receptive.
16:20:49 We've gone a long way already and But this is an important part of it. So thank you very much.
16:20:56 Wonderful. Thank you. Yeah, it was great.
16:20:53 Let me know how I can support you. Thank you, folks. Okay. Okay.
16:20:58 Yeah.
16:21:04 Lots to digest. My gosh. Hey, big day. So, we do have a, an additional topic under new business and Greg, this might have been added before you arrived.
16:21:17 But it was a request by Grey Shad that we look again at the efforts we were making and I think led by you primarily for improving our onboarding of new board members.
16:21:30 And so the question was, I believe, where are we with that? And, Is there more that can be done?
16:21:38 And I think, Gray, I won't force this on you, but were you offering to be involved in this effort?
16:21:54 Yeah.
16:21:47 Yes, yes, I was, wanting to suggest the reconstitution of the subcommittee for onboarding.
16:21:57 Okay.
16:21:57 And that I would be happy to kind of leave that. Lead that charge. I know that the first thing I wanna do is, talk with somebody IT, etc, to find out.
16:22:11 What digital tools are at my disposal for collaboration between anybody else who joins me. So there is gonna be a goal of trying to make this relatively meetingless.
16:22:26 Okay.
16:22:28 But, yeah, just kinda wanted to open it up and see who else thought that they might have.
16:22:35 The ability to to tackle this with me.
16:22:40 Yeah, I'd be happy to, you know, stay on the committee. I think if you look at the board of health page that reflects the big kind of just putting everything in one place and
then, that, largely the work of Glen and then we basically organized it into this page.
16:22:55 I'd be happy to go further with a hybrid meeting. I'm not sure we don't have Teams or Slack or anything like that if you're talking about online kind of shared work, but happy
to do Zoom Meetings to continue the committee.
16:23:10 Absolutely, no I'm I'm not gonna try and slack or a digital collaboration tool on anyone.
16:23:20 Okay.
16:23:19 I know that that's just beyond the pale, but it is a, I have not heard a reasonable answer for how do we all work on a document together when we're not in the same place at
the same time.
16:23:30 Grey as a relatively new member to the team at the county here. I've brought up Google Docs a whole bunch of times and been told, no, no, no, no, but I in my personal life use
that all the time to great effect.
16:23:43 Yes.
16:23:43 So there's some kind of tool that anyone knows about for online collaboration. I don't know.
16:23:50 And because that's because that's my wheelhouse, what I need to learn is why are we being told no about Google Docs so that I can find a suitable solution.
16:24:08 Yeah, yeah. So that'll be the in the future though. That's just I'm just meaning to say that the my envision of this, is gonna be more about giving up little sections to people
and saying, hey, you know something about this little section.
16:24:25 Can you add here? Can you add here rather than a committing to a bunch of meetings? I'm trying to lay out the expectation for anyone else that might be.
16:24:33 Aiding.
16:23:58 Okay. Okay, Next step, we just need to identify what the next step is for. I don't.
16:24:58 So for now we have Gray and we have Commissioner Brotherton and likely Glenn and. And I thought case was on it.
16:25:06 Yeah, yes, okay. Yeah, you're asking. It was a little while ago. And I think it's a really poignant time to do that and some of the discussions I've had with Grey offline have
been, I think it's a really a while ago. And I think it's a really poignant time to do that.
16:25:26 And some of the discussions I've had with Grey offline have been have been really generative in terms of understanding what it can feel like to join a board.
16:25:28 Grey actually has numerous experiences on other boards, but I think this is a really important time to think about.
16:25:35 How we invite people in. And and sort of checking our biases in terms of what we expect people understand about how boards work and that boards are different, of course.
16:25:48 And the role that Gray is filling is new to this board. A consumer of public health and, I think it's just a opportune time to think really creatively about how we explain What
and who we are and how we work together and how you glean information or get context for topics on the board of health that you may have never heard of.
16:26:10 In your life, right? So, I just think it's a good reflective process for us to go through and those who want to be part of the ceremony.
16:26:19 Great, because we do have ad hoc, So I like.
16:26:21 Yeah, so that's the first that's the first thing is who will join it?
16:26:25 Good. Well, I recommend we take this offline at this point and, perhaps Gray, Greg, Glenn, and I could have a zoom conversation to figure out.
16:26:41 What kind of resources we need and what the approach would be. And then bring it back to this group to see if there's any additional support we need.
16:26:49 But we may not and we'll just add one more thing to it. Yeah. I've had a couple of lectures recently about like trivial governance and everything and I thank recruitment of
our tribal member to the to the board of health.
16:27:05 Can be part of that because I think that that's good. There's a lot of different ways to.
16:27:10 To approach that. Great. So Glenn, would you initiate that?
16:27:15 I suppose I would. Excellent. Thank you. Alright.
16:27:18 Thank you.
16:27:22 Could I just ask quickly, is there been any progress on the, I know we're talking with a tribal member about potentially joining.
16:27:29 I feel it in my bones. I'm gonna get a response. I've made phone calls and left messages and email, but we have made phone calls and left messages and email, but we have that
personal interaction out of the tribe messages and email, but we have that personal interaction out of the tribe out on the West End and I'm really banking on that as a meaningful interaction
and it's just may take some time to hear
16:27:46 back. So yes, I'm actively working on that. I did talk to a colleague about this at the State Board of Health and he still encouraged us to go through the American Indian Health
Commission if we have someone interested to be sure to run it through them first.
16:28:03 Alright, so. Let's see any last minute announcements in the last 2Â min we have for this meeting.
16:28:14 Can I say one more thing about Sptage? If it is very short. Sure, you know, it's a bit of a supply and demand issue.
16:28:26 And, if we reopen the conversation about pit privies, we could reduce the supply. I appreciate the brevity of your comment.
16:28:36 Dr. Barry, anything? Another any further comment for the good of the order?
16:28:44 No, I think I'm good. Thank you, everyone.
16:28:51 Yeah, Dr. Barry.
16:28:46 Yeah, alright. Well, thank you, everyone. We.
16:28:54 Thank you.
16:28:55 We stand adjourned. Thank you all. Thanks, everyone.
16:29:02 We need air. Okay. Alright. That's right.
16:29:43 And that's because of the warmth that you're in. Not the content and I'm sorry I did look through the first bit of slides that I didn't really see.
16:29:50 I was like, oh yeah, I'll do that. Okay, that's another. I actually got back to the while she's doing it.
16:29:57 She's going to get back to them while she's doing it. She's going to. IN more about that topic.
16:30:02 The Hidden Brain week last week was on this very same topic. The hidden brain, week last week was on this very same topic. Yeah.
16:30:30 Yeah, I mean, it's more kind of individual traumas, but same thing That voice. I know.
16:30:32 We've got our ISGs meeting this problem. I really wish it would be called and we're still gonna do it though right we're doing it.
16:30:36 I hope so I'm embarrassed. We're gonna be there and Oh, you mean like that?
16:31:33 Alright, bye, Commissioner. No, I can just tell you what's going on. And we, I have a hearing that runs from the eleventh to September.
16:32:07 She's your place, right?