Medical professionals outline efforts to improvement to wellness during a discussion at the annual meeting of the National Governors association in Atlantic City. Speakers also weigh in on childcare, equity and training people in the field of Mental Health. [inaudible conversations] welcome to the National Governors association 2023 here to open the session is executive director of the National Governors association, bill mcbride. [applause] good morning. So happy to see so many of you after the wild night we had last night. Maybe some of your it here yet. I dont know. On behalf of all of us at the National Governors association, a very warm welcome to all of you. We are so excited that so many people made the journey to Atlantic City for our annual summer meeting. Since 1908, this was the bipartisan price of the leaders of 55 states, commonwealth and territories in the United States and we are so happy to be here in Atlantic City for the 2023 annual meeting which is our 150th annual meeting this year. [applause] i would like to thank new Jersey Governor Phil Murphy, first Lady Tammy Murphy and leaders from Atlantic City for hosting us. Lets hear it for them. [applause] they have been so friendly. I would also like to thank our nga partners for your ongoing support, efforts to make this years meeting a success. We have a Great Program over the next two days for you. As we all know, nga chair governor phil murphys decision to focus on Youth Mental Health for his initiative is extremely timely. Mental Health Challenges among young people have been climbing for years, even before the pandemic. In 2,019, the American Academy of pediatrics reported, quote, Mental Health disorders have surpassed physical conditions as the most common issues affecting adolescents. Since the start of the pandemic the situation only grew worse and more serious. Since governor murphy launched the Initiative Last year, under his leadership, weve made tremendous progress. Im pleased to welcome him to the stage to provide an update for all of you on what weve accomplished in the last year. Lets give a warm welcome to the governor of new jersey, our host, governor phil murphy. [applause] thank you. Thank you, bill. Lets hear it from bill mcbride and Extraordinary Team of the National Governors association. [applause] welcome to the iconic Atlantic City, new jersey, for the National GovernorsAssociation Annual meeting. I am honored to call this meeting to order. If we have proven nothing else between last night and this morning, in new jersey, we can say. [applause] governors from across america are gathered in new jersey this week to further the worthy goals of the National Governors association. I want to give a shout out to the great governor of the empire state, governor kathy hochul, great to have you. And the governor of the commonwealth of massachusetts, the state in which i grew up in, this gets me know votes in new jersey, i remember im a member of the red sox nation. Joanna is with us. The nga thanks you all and all the other governors who were introduced last night. An incredible honor to have each of you here. It means a lot that you would make the trip to Atlantic City. The nga is committed to leading Bipartisan Solutions that improve americans lives through State Government, ngas annual meeting serves as an ideal forum for governors to come together to work on the most urgent issues impacting our states, our territories and our country. As governors, we have to solve problems that affect each and every one of our states, there are no democratic or republican problems, only issues that affect real people, the residents of our state. I often tell people when governors get around the table to talk we can find consensus because our residents depend on us to do just that. Weve worked to address our nations crumbling infrastructure, we offered best practices on keeping our schools and communities safer, and collaborated on critical priorities Like Public Health and economic recovery. The nga annual meeting offers another opportunity for all of us to share best practices and Work Together to solve the challenges our states are facing. This mornings first Plenary Session which will kick off in a few minutes will focus on my nga chair initiative as bill alluded to, strengthening Youth Mental Health, as well as the companion effort that my wife, first Lady Tammy Murphy, has been championing to address maternal and infant health. I am eager to unpack the Youth Mental Health initiative as we know this topic transcends party lines, too many young people are struggling right now. Before we delve into this topic i would like you to help me welcome our host, the chairman of hard rock international, the ceo of seminal gaming, jim allen. We are committed to grateful a. [applause] jim is a dear friend, we are to medically grateful to him in the entire team at the Hard Rock Hotel for the work they have done to prepare for this weeks meeting and to showcase the beauty and charm of Atlantic City. Folks, please help me welcome jim allen. Jim . Good morning, everyone. Welcome to the Atlantic City hard rock. I had the fortune to work with governor murphy for six years or so but now i see that we have our first disagreement. I am a yankees fan. All kidding aside, sincerely welcome to the first lady, all the other governors in the audience, just a few moments on behalf of hard rock and my local partners. Michael and joe, joe you met last night, and jack barnes. Even more significant, the seminal tribe of florida, the super majority owner of hard rock on a global basis is real quickly, hard rock is not a casino company. We are one of the Largest Entertainment Companies in the world. This year we are approaching 9 billion in revenue and we are going to be in 70 countries. We employ over 50,000 individuals. I have heard some comments this morning about what you noticed, it is the Worlds Largest collection of music memorabilia. We now do over 40,000 Live Music Events on a global basis. New jersey has our own Bruce Springsteen and the east street bland, they played the london festival last weekend in hyde park. We build these relationships on a longterm basis. Also, i am chairman of the American Gaming Association on a global basis. I think this slide, theres only two of them. I wont belong. Is very relevant. When i started my career back in december of 1979, further down the boardwalk, it was a real question when governor burns signed into law the casino act for Atlantic City. If we look at the business today, it is not casinos as its sole initiative. It is entertainment destinations. Theres 991 of them in the United States. 2 billion employees. And revenues over 260 million in annual tax and revenue shares of 40 one billion dollars. We as an industry or your partner. We look as we come into states at how we can educate, create jobs for people in all walks of life. We think that is something very important. The industry has one hundred billion dollars in annual revenue. This is a study out of the American Gaming Associations. This year alone four of ten individuals either has or is planning to be in a casino environment. I leave you with two thoughts. Number one. We as an industry, whether it is myself as chairman and ceo of hard rock, caesars or mgm, draft king, we are unified one hundred that the biggest challenge we have in the United States is the topic of illegal gaming. Whether it is offshore, whether it is in strip centers with hybrid games and we want to work with you as the leaders of your state to eliminate these games. Bill miller, ceo of the American Gaming Association, and i are working at the federal level, specifically the department of justice and working with other Law Enforcement agencies. When you see these numbers, we know factually that we are in excess of 500 billion a year on and offshore gaming bets are occurring that are not regulated and all of us, as operators, us leaders of states, we are always looking to see how we can create more revenue. I said to the speaker of the house of the state of florida, it is right in front of us. It to tremendous Revenue Source and we as an industry are one hundred embracing the Regulatory Environment to do it right. Thats something thats very important not just on behalf of hard rock but on behalf of the association. I leave you with hard rocks motto, we are a company that has been around for 52 years. In todays world, the National Governors association should focus on things like mental awareness and how we can help our youth, those things are so important, our mottos help in that particular conversation. Our mottos can help because this is the National GovernorsAssociation Summer meeting. Dollars won. Love all, serve all, save the planet and take time to be kind. When michael, joe, jack and i looked at the first years numbers in the hard rock Atlantic City, we bought this building, we all know who used to own it. More than one billionaire used to own it. They closed it, they laid off 3000 people. I kept nothing to do with the ownership. I kept our Hard Rock Cafe open, 268 jobs, the governor and i were just referring to. We care. Our first year, we said we want to do something for the employees. We are not going to just give bonuses to the exempt employees but to all employees, union, nonunion, all walks of life. Our diversity programs are the best in the industry. Im the only chairman and ceo that ever, my 12 board members, i have six females, four people of color, we are diversified. Its not all white males. It used to be. I think as we look at today as we move forward not just as Business Partners but coming together, all is one means something. My only request today before you leave Atlantic City, before you leave the hard rock, go down the big escalator and you will see behind it the original handwritten lyrics of john lennons imagine. I stand here this morning imagining if we as individuals of all walks of life, all parties of political belief can come together and accept the lyrics of that song and accept our mottos of hard rock. Thank you so much for allowing me a few moments to welcome you to the legendary hard rock Atlantic City. Please enjoy. Well done. Thank you. Jim mentioned he started in this industry in 1979. Those who dont know, gambling was legalized in the first state outside of nevada in new jersey in 1978. When i say jim has seen it all that is literally the case. Let us dive into our agenda. As i mentioned, the Plenary Session on Youth Mental Health serves as culmination of our yearlong nga chairs initiative, they serve as the culmination of the yearlong focus on maternal and infant health. I want to welcome the governor of the great state of connecticut who joined us. When we kick off the addition of last july hosted by janet mills, we knew this would be a hot topic. Ive been blown away by conversations, meetings and site visits weve had in the past year and we have worked across the aisle to raise awareness of Youth Mental Health and develop a playbook to help our nations youth. We are honored to unveil strengthening Mental Health in the governors playbook which is intended to serve as a resource, governors, states and other policymakers used to take actionable steps to address Youth Mental Health challenges. We know this playbook is needed. The cdc released data showing suicide rates among 24 age group, in 2,020 one. Earlier this year the cdc issued a study on Mental Health trends over the past decade among schoolage youth that found 1 3 of teen girls considered attempting suicide which was an increase from 19 in the prior decade. Faced long wait lists for an appointment. If theres even a pediatric therapist in their area. Emergency rooms are overwhelmed. The painful truth, we all heard the stories and we all know too many examples from our own lives and communities, these stories harden our resolve to address the Mental Health crisis facing our countrys youth. The playbook we are releasing today stands, the governors and states, Effective Policy Solutions that strengthen Youth Mental Health. The playbook over the past year with the series of roundtable events held across the country where we brought to gather 500 parents and educators and Mental Health professionals, policy makers, Community Leaders and other experts in the Mental Health field. The playbook unpacks the four pillars that guided our cares initiative. Addressing prevention and resilience building, increasing awareness in reducing stigma. Ensuring access and affordability, quality treatment and care and finally training and supporting caregivers and teachers. The playbook breaks down those four pillars into 13 areas, with 35 specific policy opportunities for governors and states to focus on including ways to out locate funding, support legislative initiatives, and engage with stakeholders. The playbook shares numerous examples of effective policies implemented by states. The examples can serve as a roadmap for other states so policymakers can rip out the pages of somebody elses playbook, replicate ideas and benefit from the knowledge of what is happening and what is working in other states. If i may, i want to share two of the many examples taking place across the country. My friend to my left there arent many people who can get to my left, nga vice chair, utah governor spencer cox, here with first lady abby cox. He has worked with policymakers in utah to implement the safe apps which connects students at the touch of a button to licensed counselors, providing immediate emotional support and a safe place to report bullying and threats of violence. Counselors logged 1 million interactions in the last year, saving an estimated two lives every single day. In colorado, the governor is working on bipartisan policies to improve Behavioral Health system and give young people the tools they deserve to help manage their Mental Health including the innovative i matter colorado. Org which offers six Mental Health consultations for students. Those are just two of many powerful examples contained in the pages of the playbook. Importantly, the playbook is meant for all american states. It has been developed by experts to provide actionable ideas that can make a positive difference. Forum here on out we are focused on spreading the word about this new resource, the work of this initiative to continue after todays meeting concludes. Part of the ongoing work will be discussed momentarily as we welcome a group of distant wished panelists to speak more about the playbook and a broader work to address Youth Mental Health. I would like, if i may, to take a moment to share the latest video in a series we created over the past year to raise awareness about Youth Mental Health and the work governors and states, to face this challenge. Thank you for previewing this new video. When you are chairman of the National Governors association you get an initiative. Our initiative is strengthening Mental Health among our youth. The issue of our time has not gotten enough attention. New Jersey Governor Phil Murphy is focusing on Mental Health. s chairs initiative is so incredibly important to. This initiative reflects how americans are coming together to prioritize the Mental Health of our youngest children. We need to reach people. So important, so timely, several years have been rough on all of us, especially our students. We heard how sometimes theres a disconnect between policy and what is happening in the real world. Struggling with a Mental Health issue today, doesnt care about her politics. Dont care what party you belong to. This is an issue, how we can make sure kids have the support structures they need to succeed is so important. Doesnt matter if it is a state, red steak, purple state, we have huge challenges. We should be making sure policies are supporting institutions that strengthen families and health our youth. We need Proven Systems that work, the fact that governor murphy is bringing experts in to help educate us, to make sure all governors have access to past policies in our respective states to meet the needs of our young people is quickly important. Protecting our kids is our most sacred obligation. As parents and as policymakers. As we land this july in Atlantic City having got around the country, salt lake city, utah, santa monica, california, detroit, michigan, philadelphia, pennsylvania, lots of work in between, im incredibly proud to present a playbook for all american states on how to tackle and push back on Mental Health crises among our youth. Everyone is looking for a clear, distinct way to bring Mental Health resources to scale and i think a playbook would allow us to come together, ensure we have the best minds and best resources on this topic. Why we are proud to support tammy murphys chairs initiative to strengthen Youth Mental Health. This initiative is helping bring together state and governors from across the country so we can Work Together on an issue that is of critical importance to americans from all walks of life. I think this playbook is just what we need to galvanize the Advocacy Community and state leaders, parents and educators and all those who coming contact with youth to move this forward and make sure young people are getting the care they need. It is a full years worth of work and we believe that it has all the elements that any american state needs and could deploy to get the Mental Health of our precious young people as strong as it can possibly be. I could not be more proud to present that playbook. Okay. I want to thank all the governors who took part in this video, so many other governors who joined us at the roundtables we held across the country this past year. One guys opinion, isnt it nice to see democratic and republican governors coming together in these crazy times. I want to thank everyone who has been supporting and working on tammys companion initiative of supporting maternal and infant health. Tammy has done an outstanding job leading this initiative which has been a focus in each roundtable event we have held this past year. Outstanding job leading this initiative which is also been a focus on each roundtable event, that we have held this past year. The issues and it is not a coincidence of Youth Mental Health and maternal and infant health, share so much common ground. Many of these challenges we see and it makes sense that we continue to consider these issues together and develop shared solutions that give children in our states the support they need and deserve to get the best start in life. Before i go on i want to welcome then great governor of pennsylvania, josh, great to have you, buddy. [applause] i also wantt to acknowledge boh rihanna keys and stephanie lagos on our team for the joy they work that they put in this past year. [applause] and i want to thank point of personal privilege of the Boston Consulting Group who helped us at every step of the weight and so many of you out there. [applause] so today were also releasing a playbook on ways governors and states can address maternal and tammy willth that share more about the momentarily when we are joined by a panel of esteemed experts who will help us explore the themes of our initiatives in their playbooks. So without further ado lets begin with our panel of distinguished experts, which will be moderated by doctor betancourt, Senior Vice President for u. S. Social impact at Sesame Workshop. That explains some of the characters up on our seats by the way. The Nonprofit Organization behind sesame street. She directs the development and implementation of community and Family Engagement initiatives at sesame street and a background includes expertise in bilingual reading, Early Childhood education, special education and ongoing work to address the physical and Emotional Health and wellbeing of children that will lend tood the conversation that she moderates on Youth Mental Health and maternal and infantnt health. Please join mean in welcoming doctor betancourt and our distinguisheder panelists. Come on down. Welcome. [applause] excuse me, elmo. [laughing] okay. Thank you, everyone. And thank you for the privilege of being here. Its an incredible effort and incredible time. Im joined here by governor and first lady of new jersey, thank you. And then also to the incredible gentleman who are really representing the underground work. Im going to do some brief introduction for them. First im going to start off with sean robbins was executive Vice President and chief corporate officer for the blue cross lucile association. Hence i will call the blues. I heard that the best way to address. The National Federation of 34 independent committee based on locally operated blue cross and blue shield companies. Today one in three americans is covered by the blue system. As a as a member of the bluem executive leadership team, sean directs all the policy communication efforts as well as an overall accountability for the blues brand. Additionally he oversees the blue Strategic Partnership initiatives including a newly announced partnership with the boys and girls clubs of america and Clinical Affairs to accelerate innovation and write meaningful and lasting improvement of health care consumers, payers and providers. Im not going to go over to our next panelists, doctor sree chaguturu. Thank you. Im sorry your butt we also indicated that we would address each other byis first names, whh is wonderful. He is executive Vice President and chief medical officer of cds health. He leads the cds Health MedicalAffairs Association spanning at me, cds caremark, cvs pharmacy, meant clinic, womens health, advancing the highest possible clinicaln quality standards, increasing access to care, improving Patient Outcomes and reducing overall healthcare costs across the cvs enterprise. Im going to really stop their formal moment because of time and effort. But if we were here will be spinning a much longer time introducing this incredible panel. Im going to start off now the discussion of going to take the pleasure of really, governor evers lady, your initiatives really story one year ago and as you set the stage with the video, you started this focus and ideas importantly. Its been a big year and learned a lot. What is one of the things that stands out most or surprised you most in contributing to the best practices that are represented in this playbook . And im going to start off first with the first lady. And i share your passion in starting from the very beginning with Maternal Health and infant health. Please let us know. Thank you. Thank you, jeanette. I just want to quickly say its the wealthiest country in the world. I think we should all rightly assume that every mother and baby has the same chance to be born into joint and health, and sadly thats not the case. For those who do not know, the United States is 55th in the world for Maternal Mortality rates. We lag behind every other developed country, and that differential is only growing. The situation is even more dire and time particularly thoughtful about this ass i think about yor group and who the owners of this hotel, its even more dire for black, hispanic, American Indians and our alaskan native mothers who have a rate of two to three times that of a white mother to die for maternal related complications. So the worst part of that is, or the best part is, as we pivot to what weve been doing is that over 84 of those deaths can be prevented. The last year weve had the luxury of traveling around the country, salt lake city, to sacramento, not sacramento, santaa monica, to detroit, philadelphia and now finally here in Atlantic City. We have met with stakeholders. We have met with moms. We have heard from their lived experiences and we have now worked with boldly go and many others to develop a playbook that some of you have in front of you that has 32 action steps. And these are very very tangible pieces of work and im very excited about it. I would say to you that the most surprising piece of this is not necessarily surprising as much as it is an affirmation, that no matter where we went, the matter of the religious background, the amount of theec social economic status, the matter what community we were in there is a genuine concern people of mothers and babies and people want to lean in and make this right. And so im really heart warm to know that we as as a countryl want to fix this. Thank you, firste lady. Governor murphy, you also had some learnings along the way quite a bit. Can you do some of those reflections for Youth Mental Health . In the interest of the clock, the biggest reflection or reaction that ive had anything this is ultimately a a good thi, is that strengthening Youth Mental Health is not doctoral calculus. We knowacn exactly what we needo do. I think the same could be said of infant Maternal Health. We know exactly what works. The question is, can we share best practices . I mentionn utah, colorado, two examples of initiative. I have no history with the we now do. They are not embedded in this playbook along with actions taken in many other states. Share best practices, execute execute execute. There is i think the reality of funding on some of these steps. I mentioned we where four pi, 13 subgroups, 35 specific steps. Some of those are little free of charge. I think the same thing is true in the infant and maternal side. Some of it costs money pics of the question is do we have the willos to execute and when we nd to find, do we have the will to find. I view all about, this is unlike pandemic we dont have a vaccine and you are struggling in the dark to find the answer. Thats not the case with either of these initiatives. We know exactly what you need to do. We just have to get out there and do it. That is being inflected, your recommendation also into the practices to the partners we have here. What i would like it from sean and sree is little bit about your learnings and your programs as well. Im going to start off with sree and really begin on Youth Mental Health. Could you tell so bit about that and your work . Sure, id be happy to. And thank you so much to the first lady and government, the National Governors association for taking on this critically important topic, youth health and Maternal Health. For the National Governing association for picking up this critically important topic. Youth health and Maternal Health. Briefly let me just have a cbs health and ill dive into how are dressing these topics. Cvs health a celebrating 60 years now. The Community Pharmacy nearly 10,000 pharmacy locations and 85 of americans are within five miles of the cvs locations. In addition to our pharmacies we have Health Care Benefits nearly 25 million individuals. Pharmacy benefits for the care mark, 100 million individuals. And, totality that is one and three americans to have Health Benefits and health care services. Like cvs health. We are proud of being able to leverage those assets to help support improving american health. Such as our most recent covid response. When we talk about Mental Health, part of my role which i had the opportunity and position to go around and talk to clinicians in our various clickss conversation exit with whenever mayo clinic providers in chicago, just two days ago. She brought up as were talking about this topic, she said look i was taking a school physically other day and in that school visit will we go through all of these issues that need to be addressed to make that the student is healthy for school. At the end of the school physical, i said to the student who was accompanied by the mother who is a middle School Teacher that look, we just talked a lot about your physical health and physical and i just want you to know that you should know that you can talk to anyone if you ever have any issues about what you are feeling on what you are thinking. We are here to help you, regardless of those issues. The teacher, the mother, was also a teacher. She loved that comment and so the next day she went to our class and so that same comments. Remember, were here to take care of. You reach out to us at the time that you want. She did not think too much about it. She was just doing her part as a teacher. Later on at the end of the day, astern come up and said i have been thinking about hurting myself. If you hadnt so that i would not have known that i could reach out to my teacher. Its also they wouldve thought about for addressing my issue i thought the story was very powerful for me, really talks about stigma and also providing tools. Cvs health as we think about addressing stigma weve invested alongside the Trevor Project to make sure the lgbt youth are given the resources in awareness about how to reach out for counseling. Weve implemented a program in a pharmacy called butane mark where we are providing real images of body positivity to ensure that individuals know it is okay to be who you are and comes in many forms. We also initiative our own colleagues called stamp a stigma in every month we highlight a colleague who is overcome Mental Health to share that story. Most recently shared a story of an individual who is just overcoming a crystal method section. He was able to overcome an addiction with her family unable to become employed and work out cvs health. To show that there is a good side on the other end of addiction. And then briefly on tools and tactics, we are empowering clinicians with something called the echo project where we educate individuals about different tactics and tools and we have a program called a Company Called resources for a living which provide employees assistant Program Benefits for 40 million individuals across the country and that is for employees but also for caregivers because we know we need those totality and we provide Care Management services for at risk children using the analytics to defy chance of suicidality and intensifying our cameras werent outreach as individuals and also with minutes clinic weve created a Mental Health service so you can say counselors and 24 7 virtually and in select states in person. Ultimately, what weve done is put the bill together as a Bold Initiative for ex now members, but we are starting by 2025 to reduce suicide by 20 . Please feel now that we have achieved 18 reduction, but our work is not done. Working on stigma roles against tactics will continue to work towards thank you, cherie. I see looking at the sahara stickler never targets. And on the. Grant thank. Yale im gonna return to you, sean, as well, and work. Good morning and thanks for having us. Candidly, the responsibility to partner with providers for an 15 million americans. But more than the numbers that this is a personal issue for many of us in this room. This is not a powerpoint it is not abstract. It is not a charge or graph in this touches us, Mental Health particularly with using a lot of different personal ways. So, candidly, i come to this conversation more from a perspective of my role as a father and a husband and a caregiver than i do as a Vice President of blue cross blue shield. With lacrosse or blue shield we feel like we have a platform and responsibility with covering 13 million americans about the person and the stories that we all bring into the center of this work but at the politics i appreciate the governor firsts work and making this about partisan issue. Its not blue or purple for that matter. The thing ill leave you with ali star is, a framework for thinking about all of this work. And why this moment is really important. For the first part of the 20th century, our Health Care System was designed around making people come to it. The 21st century has to be entirely about making the Health Care System go to people and meet them where they are. And where kids are and where hes ours really different today. Then why atwise when the Health Care System was built over the last century. And the architecture of that. Start with the concept that the center is about shifting in pivoting where health care becomes a system of going to you and me think its where they are. Not making the case come to the Health Care System. Kids go to teachers, community organizations, they go home to their families and their mothers and their fathers. These equipping, teaching, educating kids to navigate their Mental Health issues and waste our differences then making them go to practitioners and offices is very different in a very fundamental shift at how were looking at delivering care. Number two, we want to create and we want to reduce demand for Mental Health in this country. There are supply issues, those are accusing those are today. How we fix long term demand by reducing Mental Health issues means we have to go upstream where kids are in particular with the work that Sesame Workshop does at infringing up to six years old becomes really critical periods. So, going upstream we are pivoting. We are going upstream and then working at integrating the care in places back to where the kids are. Last week or two weeks ago when asked a Major Partnership with the boys and girls club, thinking about health care differently. We blew cross blue shield on our providers uterus where the kids are, and in the case of the girls boys and girls club there are three and a half million kids who go to Boys Girls Clubs effort in this country. We are working with the boys and girls club investing 12 million over four years to train 40,000 frontline staff at the boys and girls clubs to become trauma informed. Make the centers trauma informed. So that we can equip themselves to deescalate and triage in a row children the Health Care System. More intentionally. That will touch through enough million kids of the next four years. That is a very small piece of a much larger challenge. But it is an example of how were trying to shift how we think about making people come to us and ask the Health Care System going out to communities and that is the reality of the blues as far as our precip put in this country, covering 115 million people. They are partners to governors when we go up as local community organizations. We cannot start as a National Organization start in the 1930s and 40s. As local community organizations. We really think that we need to use our National Scale and pivot to local implementation with our local partners like here in new jersey are setting up again and meeting case where they are, textbased chats. Similar to the programs were hearing about in utah for example where the kids are on the phone and this is how they connect. They connect with their peers and connect with their teachers. We are not scheduling an appointment all the time you come to a Mental Health care practitioner. But really rethink how were building a system of Mental Health is really critical. Having that very much of us versus them coming to us frames the work were doing not just with the boys and girls club but all the work were doing across the blues. Thank, you at the workshop we often call this a circle scare. What youre describing is the Community Going where teachers and individuals and everyone is. That brings a connection next. Im gonna stay with you for a moment. And look a the first lady as they pointed that theyre looking at maternal and infant health care. And look at what you are doing. And the emphasis on that continuing. Can you tell us a little bit about that as well . As the governor mentioned, there are convergence points between maternal and infant health and Youth Mental Health, youre absolutely right. In the case of maternal and infant health it is a travesty in this country that you are 2 to 3 times more likely to die as a mother because you are not white. That should not exist in this country. And we have to stop that. So one of the things we are doing is we have committed over next five years to try to reduce severe maternal morbidity. Clinical term. We want to reduce up by 50 in this country. The challenges, i will tell you honestly, the country is going in the wrong direction. On maternal and infant health. So one is the things that we are trying to do, back to putting care to where people are, not expecting care for people to magically come to the Health Care System, but looks like in minnesota for example, funding duelists shoulder to shoulder with birthing people and mothers. Really critical. We see increased Health Quality outcomes, reduced costs. So Higher Quality and lower costs and it is culturally appropriate care. Okay . We are partnering with the march of dimes naturally to provide high training inside doctors offices. We have had 30 states, thousands of physicians. You have seen the National Headlines of very affluent people of color who have either passed away, their infant son passed away, orban challenged in the birthing process. This is not an issue that is demographically constructed. In commerce did. This is an issue that touches all people across all classes. Whether his partner on the ground in places like minnesota are partnering nationally with times, over the next 5 to 15 years were working to stop out this discrepancy. In some cases the 2 to 3 times is actually an understatement. We think it could be worse. Pacific islanders, native american women, black women, they are all 2 to 3 times to 67 times more likely than people of color of their skin. The last piece i will say illnesses this work weve been doing in washington, d. C. You cannot say but you cannot measure and historically, measuring from a clinical perspective this work has been very challenging and very difficult. And candidly we have an integrated Measurement System when it comes to capturing the true identity of individuals within a system. So we are working with National Minority form to reintroduce an industry led partnered with government measurements system that snaps a clean chalk line not just a private industry solution. It is not just a State Government solution. It is not just a federal government solution. This is mobilizing all the resources that we all have to take care of a system out into the communities side by side with people and not make people come in to an antiquated Health Care System. Thank you. Thank you, shawn. Really. And now, i turn to you because i know, as being part of the health care community, you have similar sort of systems and approach. Its interesting to see the commonalities even though we havent really spoken together on it. I would love to hear from the cbs perspective really on maternal help. I will start with a personal perspective. I started my clinical career 20 years ago training at mass general where i continue to practice internal medicine. One of the worst things do here in a hospital is code blue because that means someone is having cardiac arrest. That they need to be resuscitated. When you run down, you run down as a team to go resuscitate generally, elderly individual who has multiple comorbidities, in already for a heart attack or some serious condition. I remember in my second year residency running down to one of these codes, and to my young shot, seeing a young woman who had just given birth who was having cardiac arrest because a uncontrolled hypertension during her pregnancy. She passed. That was one of the most shocking moments in my training to see a young woman who wouldnt be there for her child. Unfortunately, that happens 3 to 4 times a day in this country, which is just should never happen. And we are at a rate that is worst than russia. I think we can all agree that we should not be worse than russia on anything. So when we think about how we actually address this from a cbs alpha perspective, it starts first with Family Planning and ensuring theres that with Family Planning, resources, and after family landing there is two major levers clinically that we are really leaning into, which is hypertension control, Blood Pressure control, as well as vaccinations. Through our services with medical clinic, or our pharmacy, we are able to provide those services directly to individuals in direct care provision. But also in Health Benefits, what we are using is advanced analytics to identify which of our members would be at high risk for high Blood Pressure for would be facing a vaccination gap in care. Then we reach out to, then what is a Consumer Company blur also reaching out to them in a way that fits their consumer needs. Some people are want to know they can get it in a very easy location in their community. Others are more financially motivated. This is lowcost, no cost to use, that some people want to digital, some people wanted physical mail. So really taking in analytics, but putting it could soon paint driving the hypertension and vaccination rates. In addition, once we identify those individuals we deploy Care Management resources, underscore manager, who then follows and tracks those highrisk individuals through their pregnancy to help support them through their journey. Lastly, as you mentioned sean, its important for us to invest in communities because it cant just be done through the private sector. So we need targeted investments for communities where there are higher rates of Maternal Mortality to help support Community Based organizations. It wont be just as alone. This is both a personal and professional initiative for us. Thats interesting how each of you share personal stories, because we see the impact of these issues across everyone. Also, how you are sharing really that focus on data, individualization, community, and really gathering at all points, whether up here or down in communities. So thank you. Thank you both for that work. Now, back to the governor and first lady. Weve heard so much from these two organizations. They do great work in strengthening about both these issues. And what we hear on the ground, that state levels, what i would love to know a bit more about is these playbooks. They contain so many exciting examples of innovation and best practices, both on Youth Mental Health and maternal infant health. Governor and first lady, i would like to hear a little bit about your takeaways for all of us, with things that you are particularly excited about that you are seen coming out, both from a policy and impact point of view. First lady, i think i will start with you. Because you said the foundation with maternal and infant health. Thank you, jeannette. Theres 32 action steps. You can cherrypick. You can do one, you can do all 32, its really up to the states. I would say there are probably three categories that i would put them in. One, no cost. Ensure that all your Emergency Rooms are asking patients when they present if they have delivered a baby in the last 365 days. Its very simple, that is one. Secondarily, medicaid. There are numerous opportunities across the field of medicaid. I would say the next one is expanding medicaid for up to 365 days post delivery. If you havent done that, please, im hoping you will consider that in your state. Secondarily, we talked a little bit about doulas. There is a suggestion that you reimbursed for doula care through medicaid, particularly Community Doula care because that is very culturally sensitive and they are embedded in the communities. Its very simple. Then the last one, which is really my favorite, and i think it goes hand in hand with what shawn was saying about the 21st century approach to delivering care. That is universal nursing home visitation. This is a gamechanger. This enables a nurse to go into a home within the first two weeks following delivery, to not only check on the mom, who normally is not seen until six weeks post delivery, but to check on the baby. You take all the stress away from the mom and a baby having to travel to enough this trump in office. You also know all the obstacles that doctor and that office is not going to normally know. Like, is that mom wearing their sunday finest to get to the office . Did they change buses three times . What is their actual on the ground living existence . Do they need connections to other resources whether its wifi access, or Food Security . Its just a way to really expand all the resources that are already available across all of your states. There is a lot. I hope you will take the playbook and give someone on your team a chance to look through it and see what opportunities there are two really change this scourge across the entire nation. Thank you, first lady. Now, i will turn to you, governor murphy. I want to jump on something jeannette said in sean and sree direction. Another remark on our crosscountry tour, and that is there is nothing like hearing lived experience. Yes. The very specific stories of moms, kids, folks, family members, who have lived through it. There are a whole bunch of experts who have joined us and many of them attended each and every one of those stops. There are many of them in the room with us today. That does not diminish from their enormous value, but theres nothing like a lived experience. Again, weve got four pillars. We break it into 13 subgroups, 35 recommendations. Its hard to know, frankly, where to start, but i will give you two. Two civil ones. Lets get these kids when they are young. Dont assume you can get to this when they are already formed. The earlier, which is why these are companion initiatives, and i know that is near inter to your heart. In her heart. Secondly, christian ormondbythesea, our great commissioner church of Children Family services, i will give a jersey experience, would be really good for a long time getting good tickets. In terms of Mental Health issues. 2 of our, case we have 1. 4 million kids in school i think in new jersey. Would not be very, good and this is particularly pronounced since the pandemic of casting a wider net of kids who are not advocating the stress that they were underneath and so were not going to change that in new jersey, in terms of keeping the 2 hyper focus but also throwing a broader net. Part of that is a little bit like the boys and girls clubs. John mentioned training folks who were not Mental Health specialists. Mostly in this case educators. To spot the signs where they can then proactively deal with the challenge and preemptively deal with a challenge. So those are the two. Gets them early, and cast a wider net and i think if we get each of those things, we probably be in a dramatically better place. , jeanette can i highlight the governor with your last comment, going off a schedule just a touch. One of the items identified in the governors opinion piece in the Washington Post a few weeks ago on this issue i want to speak personally about this, im a product of the foster care system. And i think about your role as governors when the foster care system. Those are not always the happy authorities in the foster care system. I was a lucky one and 80 of kids in foster care have a diagnoseable Mental Health condition. And im thankful and grateful that it didnt but those kids are kids trapped in the system oftentimes, and thats aou place for governors and state legislators can directly lean in and had great effect. Governor i thank you for raising that issue and some of the work youve done because its a population that sometimes gets left out ofg this conversationy states in particular have an opportunity to make a difference. Wo [applause] one of the things i would like to highlight on that if you dont mind is presenting a little bit about Sesame Workshop and the work that we have done and expose all of it to our muppets. We had the pleasure of being a nonprofit Global OrganizationWhose Mission is to help all children grow smarter kinder stronger but are social in fact, work has been to deliver the gaps that we often see as governor murphy and first lady and sean and sree indicated. How do we fill the gap of Early Childhood . One of the things we have found in Mental Health in childrens Mental Health is very, very strongly that there is a gap and awareness in knowing what is the essential foundation in providing skills needed for Young Children to foster their wellbeing, their emotional wellbeing, and also as you all indicated the idea of the Tipping Point of emotional distress. How do t we capture that early . How dond we do prevention rather than intervention . We have created resources and we continue to great resources that are helping those systems that you all have identified. Weve also adapted also how do we get that wonderful image that you all connected with the brand, with the sesame street muppets, how do we get into communities and how to reconnect . We look at that circle of care. We look at integrating with an healthcare system, within the childd welfare system that we actually created a muppet who had experience in the foster care system and parental addiction. And also how do we address the Early Childhood system and the Mental Health system. We look forward to being here and maybe having discussions on how maybe sesame. Workshop can help states and bring our knowledge, our evidence come our resources and our connection and trust to all of you. Im going to now turn really to the governors and everyone, and get some last thoughts here as we are going forward. Because were a little bit lor on time and i wish we could have less thoughts but i can hear several things g that emerge from all of you, that is very much based on the. Pillars you all indicated in both of your playbooks, that id of data, of connection, and lived experience, going into communities and access, equitable access. But i do want to hear from the governors, if theres any questions, thoughts on the experiences or practices that you are also experiencing in your space and based on a philosophy and recommendations from the playbook. Thank you, governor. Thank you. Thank you. Co first, let me commend the governor and first lady, these are the issues also plaguing our states so im sure thats the case for so many of us. There is a Mental Health crisis, special because of isolation and we do continue of course to see really tragic numbers on maternal fetal mortality. Ith would add for those were gog to decide interstate would it take this challenge up, also add on top of the excellent points that zip code has tended to be as impactful as genetic code these days. And so in our states were people are struggling come where our communities are struggling, zip codes where people have the greatest Health Disparities and poverty numbers are probably where youre going to get the biggest bang for your dollar, intellectual buck as you go and deploy resources. For us its in very rural areas and does also of course tend to overlap with people who have been disadvantaged with less economic opportunity. So again zip code seems to be as great or greater than genetic code, but everybody is suffering at the right now so thank you for taking these challenges up. My pleasure. Thank you. Thank you so much. [applause] other thoughts . Yes. Governor cox, thank you. Thank you to the esteemed panel. Again, thank you to governor and first lady murphy for your courage in taking on this issue. This playbook is incredible. Im already texting my people back in utah about some things we are not doing here. I did want to bring up what issue, has cut up and touched on and i love to offline talk to any other governors or going through this. We are going through, part of the problem when it comes to Mental Health generally is just a lack of workforce in this space. The need is there but we just dont have the workforce. And what we found we just did a comprehensive review of licensure in utah a Mental Health work. And what weve discovered is we just have a terrible system. We have 5000 kids graduating in the the state of utah every year with bachelors degrees, in psychology and they cane do absolutely nothing with those bachelor degrees. Trying to change and align so we are giving people, not Everybody Needs a psychiatrist, right . And yet we have kind of a brick mortar structure, we are doing more postpandemic with online visit and things like that but sometimes people just did a friend to talk to pick sometime suggested somebody who has a little bit of training. Not allll of the training, and w to align those pieces better we are going to go to the process. I know were getting a lot of pushback because anytime you start messing with licensors, somebodys ox is getting gored and somebody will not like that. So if there are other governors that invented throughng this journey i would love to hear from you. I would love to share with what we are doing and the report we just issued because it fits nicely with what youre doing. Again, thank you for this playbook. We need this desperately. Let me just jump on this spencer real quick and and of the clock is not our friend. Number one, you are not alone. This is a huge issue. And exacerbated even further by anything josh alluded to this, in many cases the psychiatric lane is cash on the barrel. Really limiting in this exclusivity in terms of the actual families that can partake of their services here and secondly one of the most powerful one of the reasons i love this guy is one of the most powerful lived experiences that we heard in the entire year was from him personally, that kick this off in salt lake. So to you and abby thank you for hosting us then and for everything you do. I think we are hearing same commonalities again about how do we diversify reach come services, and again reduce stigma. Anything else from the governors . Would love to hear. I know this is not a shy group. Governor polis. How doom you, i know many ofy fellow governors very datadriven and we have our challenges in the physical health side but laying on how we compare success rates and some of her procedures across different hospitals, costs. But when you look at the Mental Health space how do we have that accountability for results . And there so much out there. The standards of care are not as tight as a generally are on the physical health side. Theyre sort of more variety. How do we reward what works, punish what doesnt work, eliminate moral hazards and actually focus on better Patient Outcomes as opposed to some perpetuating the system . I think we should defer to i think at least on Health Service not to get too academic but we use the framework of structure, process and outcome measures. As you mention of the measure become very hard to measure equally across because of theh variability in how we collect that data on a statebystate basis. But still ae lot of what the playbook as is also integrating the structures, are you following through with thesell structures and processes. We need to do better job as a sean mentioned and collecting data on a private sector and Public Sector but also recognizing we shouldnt over in dexterously outcomes. Thats what ultimately matters but alsoo to measure are we implementing these tactics and how good are we at doing that. If we look at experience in Health Services, heart attack care, that was 20 200 years , exactly what we did, it was time to aspirin and that focusing on a process actually lead to the better outcomes. This is a20 good challenge thate need to all address. Its useful or maybe it is a useful at. You can decide if its useful for yourself. I think what also as a language intersite have to start to either kate between this broad term of Mental Health and Mental Health conditions to utah governor comments, not all Mental Health conditions require acute intervention. And so we as a system have to get better at figuring out what are severe and acute, what are lowgrade anxiety, how do we do with again equipping boys and girls clubs, equipping teachers and Frontline Community providers. Candidly kids go to peers first. They dont go to you and me. I had to make teenagers. They dont come to me to talk about the Mental Health first. They go to their peers first. So how do we equip an entire generation of kids on Mental Health first ate in a you and i were trainednt on cpr . I would love to see a country where every child is turned on Mental Health first aid the same way we were. [applause] thats great. So again the supply second the work for site is more than just about the license credentialed Mental Health practitioners in the system. Its an all hands on deck approach. I would add just one second that this idea also a looking the kind of approach that we use at Sesame Workshop. We gather lived experiences and we also connect with parents and caregivers, and getting information both on prevention as well as when theres so collecting qualitative data is weekly as quantitative data. Governor, i know were going to close. We have seven seconds. The countdown is on. Thank you all very much. [laughing] a great job. Thank you. [applause] i think you guys are going this way. Great job. Really appreciate it. [inaudible conversations] [inaudible conversations] [applause] these folks come folks, were going to go right, i think well go right into the next panel, right . So again i hope you all get a chance to read each of these playbooks and hope they give you the same benefits that we have seen. Were going to goto right into a discussion that ned lamont will lead uss as he is the cochair of the nj Public Health and Disaster Response task force to lead a policy discussion on managing multiple crises at once. Once. His cochair is vermont governor phil scott and kind of poetic in a sad way that he is not here because he hes getting withe Disaster Response right now in the great state of vermont. So with that i think im going to turn things over to governor ned lamont. Thank you. [applause] [inaudible conversations]