My name is Michael Gordon. I am a recovering addict. My clean date is 06/06/2008. I writing this letter because it my duty as a health professional to bring to the table how important it is that we change the barrier crime law. I have spent countless hours and days working with other addicts who trying to find their pathway into recovery. The frontlines are thin because the people whom society deemed unworthy because of some past mistakes cannot work in the field that they could do the greatest good. I did not know when I received my sentence in 1990 for distribution of crack cocaine. I would be serving a life time sentence. Luck for me I don’t have a barrier crime, yet today after getting my GED, going to college and graduating with honors. I still can live in certain areas or have certain jobs. I went from the crack house to the White House and still that not enough for Virginia to forgive me of my past mistakes. We need more people who has made a deep commitment to change to share their experiences with others who are suffering!!

My name is Teri Morgan and I am the Executive Director for the Virginia Board for People with Disabilities (VBPD). I write to you this afternoon to provide public comment on HB 327 dealing with the State Rental Assistance Program for the Settlement Agreement Population. The Virginia Board for People with Disabilities is in support of this bill. Legislation such as this will have a positive impact on individuals with disabilities. The State Rental Assistance Program assists in providing opportunities to individuals within the settlement agreement population to find rental housing that meets their individual needs. The program allows individuals the ability to choose where they live, whom they live with, and who supports them providing needed independence. VBPD is in support of HB 327.

My name is Michael Gordon. I am a recovering addict. My clean date is 06/06/2008. I writing this letter because it my duty as a health professional to bring to the table how important it is that we change the barrier crime law. I have spent countless hours and days working with other addicts who trying to find their pathway into recovery. The frontlines are thin because the people whom society deemed unworthy because of some past mistakes cannot work in the field that they could do the greatest good. I did not know when I received my sentence in 1990 for distribution of crack cocaine. I would be serving a life time sentence. Luck for me I don’t have a barrier crime, yet today after getting my GED, going to college and graduating with honors. I still can live in certain areas or have certain jobs. I went from the crack house to the White House and still that not enough for Virginia to forgive me of my past mistakes. We need more people who has made a deep commitment to change to share their experiences with others who are suffering!!

Comments Document

Attached, please find written testimony on behalf of the Pyramid Healthcare, Inc. family of companies in opposition to HB 434, which would require that any residential substance use disorder treatment facility licensed by DBHDS must prepare and record a certified discharge plan upon a patient’s discharge or withdrawal from the facility. While we provide discharge-planning services for our clients and believe this is crucial to ensuring long-term recovery, we oppose the bill as written. To be clear, discharge planning is essential to ensuring our patients are able to sustain long-term recovery. Currently, we provide discharge planning services for our clients; however, the language of the legislation duplicates existing safeguards, puts additional administrative burden on providers, and invites punishment to high-quality providers serving vulnerable patient populations. As part of our existing agreements with regulators, accreditors, and payers, we regularly undergo various audits throughout the year of our processes, procedures, and documentation for our clients, including related to discharge planning. As such, creating additional layers of administrative requirements related to discharge planning are unnecessary duplications of existing procedures.

We do NOT want privates to be able to complete TDO evaluations! This will destroy all the work we have done to keep people OUT of the hospital. I have worked in a CSB most of my 32 year career.

Strongly oppose!!

I stand opposed to HB608.

Strongly opposed to this. We work diligently to provide services in the least restrictive environment. As a result, we have significantly decreased our TDO rate in our area. If this were to pass for a pilot, undoubtedly other providers would begin to seek the same privileges to TDO individuals. We feel that it would ultimately reverse the work that we have done and this would not be in the best interest of the individuals we serve.

I stand opposed to HB608 for the reasons stated in the other comments of opposition.

Greetings and thank you for considering my comments. I would oppose this legislation that would allow for prescreening evaluations to be completed by private agency personnel even under a pilot program such as what is proposed. One of the foundational components of the TDO process is that the evaluation is completed by an unbiased professional, one that is not connected to the ED that the individual presents in or to the hospital to which they are placed. This provides a protective factor for the individuals that we serve to help ensure that they are evaluated objectively and their best interests are pursued. The CSB is required to see all individuals who present for evaluation and there is a concern that this program could result in hospitals choosing who they see and who they refer to the CSB for evaluation based on payor source. Changing this process would also allow a private entity to have a direct route to the state hospital system in a time where we as CSBs are being encouraged to do everything possible to minimize admissions to those facilities. My belief and I believe as history as shown, there will be an increase in state bed utilization as a result of this in a time where we already are experiencing bed shortages due to high levels of forensic TDOs, staffing shortages, etc. There has also been the statement made that the magistrate is one who determines the TDO and while they may issue that TDO order, that decision is based upon the information provided by the evaluator and recommendations for placement facility. In summary, I do not feel that this is a solution to the bed shortage that we have. Our CSB has been able to add many components of the crisis continuum including a Crisis Receiving Center, 23 hour program, mobile crisis team, care centers in each of our hub areas that are walk-in, one of which is open 24/7 (the others are open 7 days a week, 12 hours per day), Partial Hospitalization Program in each of those locations, expanding our youth CSU by four beds, expanding our adult CSU to 16 beds in the next couple of years, and a host of other services that support individuals in crisis. We have seen our TDO rates drop significantly over the past few years as we have rolled out these services and we continue to see a decline for this current fiscal year. As an alternative to the proposed legislation, I encourage you to explore ways to support programs such as the ones that we have implemented that are proactive in preventing individuals from presenting in the EDs for evaluation and actively work to keep individuals in our communities, in their homes, and with their families and support systems.

Strongly opposed.

Strongly opposed !!!

Strongly oppose

Greetings Health and Human Resources Subcommittee members, As the Executive Director for District 19 Community Services Board (CSB) I am concerned about the impact this bill and a similar senate bill will have on catchment areas across the state. D19 CSB catchment area includes the cities and counties of Colonial Heights, Emporia, Hopewell, Petersburg, Dinwiddie, Greensville, Prince George, Surry, and Sussex, respectively. Currently CSBs/BHAs are designated by the Code of Virginia as the single point of entry into the publicly funded system and this legislation provides a bypass for private hospitals. As currently written, the legislation is silent on whether these facilities will be required to conduct EVERY evaluation or if they will still rely on the CSB system. Ultimately If these bills pass, private hospitals will be able to evaluate only those individuals they want to evaluate and send those whom they do not want in their facilities to state hospitals. This includes the ability to admit to their facilities only those with insurance and send anyone who is uninsured or underinsured to the state hospital. Virginia’s CSB/BHA public safety net has been established to treat all regardless of insurance coverage or ability to pay. This allows for the civil commitment process as established by the Code of Virginia to be accomplished without the prospect of monetary gain but with the individuals rights and due process at the fore. CSBs/BHAs work closely with private hospital systems, law enforcement, local judicial systems, and community stakeholder’s to ensure that Virginia’s most vulnerable citizens have the treatment needed from the initial notification of a crisis, during the civil commitment process, coordination of TDO placement and care while waiting for a bed (private or public), participation in the commitment hearings, and all of the ancillary tasks related to aftercare and liaison services to successfully assist individuals who are subject to this process with transitioning back to the community. In closing, having more individuals complete evaluations will not address the bed crisis issues, ER boarding, or the burden on law enforcement to maintain individuals while they are waiting on a bed. Continued effort to build out Virginia’s Crisis system and diversion to lower levels of care, and prevention efforts at the community level will decrease reliance on emergency treatment for those in of behavioral health services. Please see the attachment for specific examples regarding why this bill should be opposed. Respectfully, Terrelle Stewart, LPC, CPSC Executive Director District 19 Community Services Board

I strongly oppose HB 608. I would like to refer the reader to review the comments in item # 11 of the attached Department of Planning and Budget 2024 Session Fiscal Impact Statement, which are also listed below: "According to DBHDS, prior to legislative changes several decades ago, the practice of non-CSB designated clinicians conducting emergency evaluations was permitted. Multiple criticisms of the commitment process emerged during this time period, including inadequate screening that resulted in numerous TDOs and admissions to state hospitals and a lack of community services and supports to prevent unnecessary hospitalization. At the time, the law mandated examination by an independent physician or a psychologist. Subsequently, a series of studies was conducted by the Institute of Law, Psychiatry and Public Policy (ILPPP) at the University of Virginia in 1988, DBHDS in 1990, and the Joint Legislative Audit and Review Committee (JLARC) in 1994. After the JLARC study, the General Assembly required that in all cases, only an evaluation conducted by a community services board (CSB) could lead to the issuance of a TDO and required the CSB to determine the place of hospitalization. The requirement was designed to ensure consideration of less restrictive interventions and avoid unnecessary TDOs."

Strongly Oppose

Opposition to HB608 Temporary detention; certified evaluators, report. HB608 Financial Impact Statement itself addresses many concerns Fiscal Impact Statement o Pilot for One Provider carries a fiscal impact to the Commonwealth o Indicates that the addition of non-CSB evaluators into the behavioral health care system “adds additional. administrative burden” to ensure that non-CSB evaluators are consistent in evaluation protocols across the civil commitment process o States if enacted, DBHDS anticipates an increase in the # of individuals who are evaluated and admitted to a state hospital, leading to increased census pressures throughout the system. o Addresses the history of who prior legislative changes were made decades ago due to concerns of inadequate screening by non-CSB clinicians resulting “numerous TDOs and admissions to that hospital and a lack of community. services and supports to prevent unnecessary hospitalization.” • This has been evaluated numerous times without such recommendation, including detailed in Study in December 2021: PLEASE READ THE REPORT Report on Item 320.II of the 2021 Appropriations Act Report on Who Should Conduct TDO Evaluations in Virginia https://rga.lis.virginia.gov/Published/2021/RD828/PDF . ALSO, Highlighted PDF Version attached. o This Bill ignores the study and concerns of representatives throughout the system regarding complexities that this. would unwind among other conflicts. • Individuals conducting evaluations as part of this pilot have no incentive to explore less restrictive alternatives above The fact that this pilot will give a private facility the ability to directly access state hospital beds in every part of the state which means although this is a pilot, it has statewide impact on bed access. • The pilot does not guarantee that this private facility will accept ANY TDOs and if it does accept TDOs, they can pick and choose based on insurance status and acuity. • Part of the reason the state made the CSBs the single point of entry in the first place was to ensure that the least restrictive alternative was always the first consideration. • This creates 2 legal tracks for law enforcement and magistrates must navigate and does not address concerns of ensuring that less restrictive alternatives are considered. • Inconsistent with GA investments in STEP-VA, counters recommendations of J-LARC Study only months ago.

While I do support change in the code regarding those who can initiate the TDO process, I cannot support this legislation and am baffled by how a bill benefiting only ONE provider could gain any traction. But I'm sure the bill's sponsors came up with this out of the kindness of their hearts; it would be illegal for a nonprofit to influence legislation in the traditional American way. The GA has had documented for them the inefficiencies of our system for well over a century and these have gone unaddressed. Having an objective 3rd party who advocates for or against what the US Supreme Court has referred to as a serious deprivation of liberty is one of the few things that has been working within our system. Having dealt first hand with the provider in question they have not proven themselves to be competent, compassionate, or unbiased toward any client that would be affected by this bill. Many within this organization have referred to the CSB as incompetent because they choose to disagree with their uninformed and untrained opinions, and I believe this has more to do with degrading the CSB's power rather than helping those in need. So while I do support busting up the monopoly that the public system has over this niche field of mental health treatment, there are better and more creative ways to do so that are consistent with national standards of care and what has shown to work in other states. There are experienced, competent, and licensed private providers of community crisis services that are available now should the GA choose to use them for this purpose.

Bill contradicts recent study directed by the legislature (Dec. 2021: Report on Item 320.II of the 2021 Appropriations “Report on Who Should Conduct TDO Evaluations in Virginia”). It addressed the complexities & concerns of bias & conflict of interest. https://rga.lis.virginia.gov/Published/2021/RD828/PDF Can a bill that a private hospital asked to be patroned really ignore & contradict recommendations of study directed by legislators incl. professionals of all vantage points by simply justifying as a PILOT? Contrary to Code & referenced as a concern for a hospital system with a FINANCIAL INTEREST in the outcome of the eval. FINANCIAL IMPACT STATMENT - A bill is patroned FOR ONE Private Provider, has a FISCAL IMPACT to the entire Commonwealth. Who has not considered impact to those local systems that will be encumbered. Lack of transparency DOES NOT benefit our system. Anticipate upcoming budget requests to provide TDO incentives for hospitals that accept TDOs. ONE PROVIDER requests to amend long standing CODE purposely allows ONLY CSBs to conduct preadmission evals. An authority affects individuals’ liberties, in many ways. Be clear, the system MUST respect the liberties of each individual. PROVIDER/VHHA stated that it is NOT A CONFLICT, because the Magistrate orders the TDO; not the evaluator? That is not what the CODE states & again addressed in the report. The Magistrate must have reliable, unbiased recommendation that EVALUATES LEAST RESTRIVE ALTERNATIVE without bias of financial interest. PROVIDER/VHHA stated this helps law enforcement “get back on the street”. Incorrect & disingenuous. This does not create a quicker path to a bed identified in JLARC & Gov. Prompt Placement Task Force. Delays in the system are to acquire a bed, not an eval. It DOES EMPOWER ONE PROVIDER to hold & direct LE anywhere in the state w/ authority to identify the TDO Facility. Their OWN or State Hospital while LE forced to hold those they chose not to admit. Allows a private facility to direct & further tax locally funded public resources. Provider & patron referenced cutting down delays waiting for duplicative assessment. NOT duplicative, that dismisses the very liberties needing to be protected. Statements about wait time for an eval inaccurate & purposefully misleading. Please speak to stakeholders, other hospitals, police, magistrates. CREATES 2 legal tracks for LE & Magistrate at request of ONE PROVIDER w/ a $ interest. Bill's OWN FINANCIAL IMPACT STATEMENT anticipates a strong likelihood of more TDOs (loss an individuals’ liberties) including to the State Hospital w/ waitlists. Requires significant adjustments or exceptions to Enhanced Certified Prescreeners Guidelines initiated in 2016 by the Deeds Commission to ensure liberties are protected & least restrictive alternative considered. For ONE PROVIDER. his lacks attention to the safeguards put in place to ensure liberties are protected. To accomplish this request of ONE PROVIDER, also require significant adjustments &/or exceptions in many areas including regulatory standards including Dept. of Licensure & changes to local, regional & statewide protocols. Directly contradicts efforts & GA’s own investments in STEP-VA & is inconsistent with the moving toward a Crisis Now System & Gov. Right Help Right Now. Counters recommendations included in the last 2 JLARC studies. Reckless.

Bill contradicts recent study directed by the legislature (Dec. 2021: Report on Item 320.II of the 2021 Appropriations “Report on Who Should Conduct TDO Evaluations in Virginia”). It addressed the complexities & concerns of bias & conflict of interest. https://rga.lis.virginia.gov/Published/2021/RD828/PDF Can a bill that a private hospital asked to be patroned really ignore & contradict recommendations of study directed by legislators incl. professionals of all vantage points by simply justifying as a PILOT? Contrary to Code & referenced as a concern for a hospital system with a FINANCIAL INTEREST in the outcome of the eval. FINANCIAL IMPACT STATMENT - A bill is patroned FOR ONE Private Provider, has a FISCAL IMPACT to the entire Commonwealth. Who has not considered impact to those local systems that will be encumbered. Lack of transparency DOES NOT benefit our system. Anticipate upcoming budget requests to provide TDO incentives for hospitals that accept TDOs. ONE PROVIDER requests to amend long standing CODE purposely allows ONLY CSBs to conduct preadmission evals. An authority affects individuals’ liberties, in many ways. Be clear, the system MUST respect the liberties of each individual. PROVIDER/VHHA stated that it is NOT A CONFLICT, because the Magistrate orders the TDO; not the evaluator? That is not what the CODE states & again addressed in the report. The Magistrate must have reliable, unbiased recommendation that EVALUATES LEAST RESTRIVE ALTERNATIVE without bias of financial interest. PROVIDER/VHHA stated this helps law enforcement “get back on the street”. Incorrect & disingenuous. This does not create a quicker path to a bed identified in JLARC & Gov. Prompt Placement Task Force. Delays in the system are to acquire a bed, not an eval. It DOES EMPOWER ONE PROVIDER to hold & direct LE anywhere in the state w/ authority to identify the TDO Facility. Their OWN or State Hospital while LE forced to hold those they chose not to admit. Allows a private facility to direct & further tax locally funded public resources. Provider & patron referenced cutting down delays waiting for duplicative assessment. NOT duplicative, that dismisses the very liberties needing to be protected. Statements about wait time for an eval inaccurate & purposefully misleading. Please speak to stakeholders, other hospitals, police, magistrates. CREATES 2 legal tracks for LE & Magistrate at request of ONE PROVIDER w/ a $ interest. Bill's OWN FINANCIAL IMPACT STATEMENT anticipates a strong likelihood of more TDOs (loss an individuals’ liberties) including to the State Hospital w/ waitlists. Requires significant adjustments or exceptions to Enhanced Certified Prescreeners Guidelines initiated in 2016 by the Deeds Commission to ensure liberties are protected & least restrictive alternative considered. For ONE PROVIDER. his lacks attention to the safeguards put in place to ensure liberties are protected. To accomplish this request of ONE PROVIDER, also require significant adjustments &/or exceptions in many areas including regulatory standards including Dept. of Licensure & changes to local, regional & statewide protocols. Directly contradicts efforts & GA’s own investments in STEP-VA & is inconsistent with the moving toward a Crisis Now System & Gov. Right Help Right Now. Counters recommendations included in the last 2 JLARC studies. Reckless.

I am the Crisis Dir. for the Hpt-NN CSB. The CODE purposely allows only CSBs to conduct preadmission evals. Despite many formal workgroups & thorough studies, including by DBHDS in Dec.2021, no recommendation to provide private hospitals w/ an exception was made. Instead, concerns related to conflict of interest & complexities such action would result. The authority this private hospital system is requesting, is a challenging & complex process & MUST respect the liberties of each individual, balance the legal & ethical demands w/ the clinical needs, & DOES deprive an individual of their liberties. To accomplish this request of ONE provider, in addition of changes to the code, also requires significant adjustments and/or exceptions in many regulatory standards & local, regional & statewide protocols. Significant adjustments or exceptions would be needed for the orientation, training, oversight, & supervision of Certified Pre-screeners initiated in 2016 by the Deeds Commission which are not practical & according to the Bill’s Financial Impact Statement, at cost to the Commonwealth, based on a ONE provider’s request. The Code addresses financial considerations which is directly contrary allowing an evaluator determining that an individual can be invol. hospitalized, having a financial interest in the outcome. Aside from the obvious concerns, there will be upcoming requests to provide financial incentives to hospitals accepting more TDOs. Approval of this bill or any substitution allowing this to occur: Directly contradicts efforts & GA investments in STEP-VA; is inconsistent with the goals of moving Va. toward a Crisis Now System & Gov. Right Help Right Now; counters recommendations included in the last 2 JLARC studies; allows a provider to refer to the state hospital; & an ability to directly tax locally-funded public resources including LEO, magistrates, justices, public defenders, & CSB. On Tuesday, the provider shared a rationale to assist with “Workforce Shortages” & that a similarly credential clinician would already working with clients would avoid “duplication”. Instead, it complicates roles of other local publicly funded resources by creating 2 legal tracks based on their request & w/o considering impact on the public servants. The CSB has met all performance contract guidelines & delays in individuals accessing care are due to the inability to acquire an accepting bed. The provider’s proposed use of this clinician’s role as stated is working in a dual role, also serving as the unit’s therapist while providing pre-screening duties, is inappropriate & devalues the importance for their convenience. In order to evaluate what may be needed to allow provider to be a certified prescreener, an alternative pathway for an allowance lacks attention to the needs of a prescreener, including respect to the local orientation and knowledge of resources for ALL & threatens safeguards put in place by the Deeds Commission to ensure protections for liberties. Nor could such a pathway place the adequate emphasis on ongoing supervision, oversight & significance of recommendations made in this process. Despite CSB playing such a critical role at all aspects of the BH system, at no time were we approached on consulted on the impact or potential consequences. Clearly, private entities have a role in our system, but not one that allows them to silo while encumbering public resources. this direction would be dangerous & egregious.

The Code of Virginia mandates that pre-screenings be completed only by individuals employed by CSBs and that an entity shall not have financial interest in the evaluation of an individual for psychiatric hospitalization. This bill defies both of these requirements in favor of supporting the request of one provider. This provider has stated that their goal is to support CSBs workforce challenges and move individuals needing care through the system more quickly. However, there was no conversation with us on how CSBs can be supported, and we disagree with these comments. Our CSB staff completed 3,945 pre-screenings last year; lack of access to a pre-screener was not an issue. Please refer to the 2021 DBHDS study on "Who Should Conduct Pre-screenings" for its recommendations and the recent JLARC study that points to the need for private hospitals to admit more people. This shows where the problems lie, including the fact that State hospitals have operated above 100% capacity while many private hospitals operated well-below. The pre-screening process is not the issue. We need hospital beds, and we need to have people be admitted to those hospital beds without bias. Please do not combine these issues—these are separate concerns and a not very veiled attempt by one provider to gain control to the entire behavioral healthcare process. Advancing this bill at the expense of the public is unacceptable to our community and our Commonwealth. We know that the people with the highest need will be served by our public system, while those with less intense needs will be selectively filtered through this private hospital system. Furthermore, our trained staff will be sought after with offers of higher pay. This will give this hospital system even more control in selecting who they serve while utilizing public funds to do so. This action will effectively dismantle our community safety net. We have information from two recent JLARC studies and a 2021 DBHDS study on the pre-screening process that do not indicate a need to do anything different with the pre-screening process. However, the JLARC study does place emphasis on the need for private hospitals to increase their admissions. Giving them more control to our public system compounds the current issues we are trying to overcome with the private hospitals and takes us backwards in our efforts to resolve issues to access. Previous legislators saw the need to keep pre-screening separate from service provision for this very reason. DBHDS’s own impact statement points out issues with this pilot which will also result in increased cost to our public system— again, to support a private provider. When we look at all of this, the only reason we can see that this is being done is that this provider lobbied for it. The guise of supporting our CSB is inaccurate. Advancing this bill by using the term “pilot” should not be downplayed. Pilots are made to be continued. We ask that you look beyond the benefit to a single provider and consider the damage that the passage of this bill will do to our system. This will be followed by one thing after another until our entire system is uprooted. We do not want to take this step back when so much has been done to move us forward.

The Code of Virginia establishes CSBs as the single point of entry into the publicly funded behavioral healthcare system, and mandates that pre-screenings be completed only by individuals employed by CSBs. This provides the opportunity for anyone who presents with a behavioral health crisis to have equal access to prescreening and when needed, follow-up care. Further, the Code of Virginia establishes that parties involved in the completion of the pre-screening shall not have financial interest in the pre-screening process. The Hampton-Newport News CSB serves over 12,000 people annually. We respond to six hospitals and completed 3,945 pre-screenings last year. We have outstanding staff who have propped this system up through all of the challenges, ensuring that people who need services were responded to, working countless hours to search for elusive hospital beds, while some private hospitals picked and chose who to accept at a time when they knew state hospitals were overflowing. CSBs endured the brunt of the anger and frustration from patients, families, and community stakeholders, to be met with this bill that shows that our work is not good enough. Please consider the recommendations of the recent JLARC study that points to the need for private hospitals to admit more people. This provides empirical data that shows where the problems lie. The pre-screening process is not the issue. We need hospital beds, and we need to have people be admitted to them without bias. Advancing the advocacy of one provider at the expense of the public is unacceptable to our community and our Commonwealth. Private hospitals have a place in this system, but this is not it. We know that the people with the highest need will still fall in our care while those that can be directed to other programs within a private hospital system will be chosen to financially support those programs. Furthermore, our trained pre-screener staff will be sought after with offers of higher pay which will impact the ability to keep our pre-screener positions filled. The result will be that the public will be filtered to one location rather than being provided equal access to pre-screening when and where it is needed. This will effectively dismantle our safety net. We believe the intentions of this bill are good, but no one consulted with our CSB on this matter. I assure you, as we have gone down this road in the past, the outcome will not be beneficial for the individuals we serve. Had the goal been the placement of pre-screeners within a psychiatric emergency department, this could have been done in conjunction with our CSB while remaining within the Code of Virginia, rather than by circumventing the established process. The ability of private entities to lobby with legislators for public funds intentionally cuts CSBs out of the conversation and eliminates necessary partnerships. We ask that you look beyond the benefit to one provider and consider the damage that the passage of this bill will do to our system. There is a reason that past legislators saw fit to put these safeguards in place as defined by the Code of Virginia. This action sets a bad precedent that will embolden private entities to continue to seek public funds while advancing motives that are in direct conflict with the Code of Virginia. We do not want to take this step back when so much has been done to move us forward. Thank you for your consideration of this important matter.

Comments Document

Opposition to HB608 Ryan Dudley Hampton-Newport News Community Services Board

§ 1-240.1. Rights of parents. A parent has a fundamental right to make decisions concerning the upbringing, education, and care of the parent's child. The Virginia Supreme Court enshrined this right to parents. This committee has got to stop usurping parents in Virginia for their right to know. Do you really want your 13 yr old to make medical decisions on their own, and then you will be responsibile for the follow-up costs when something goes wrong. Protect your children and grandchildren and vote not for this horrific bill. Children belong to parents, not to the State of Virginia. Eileen Roberts, Parents For Life parentsforlifeva.org Protecting teens, empowering parents

My name is Michael Gordon. I am a recovering addict. My clean date is 06/06/2008. I writing this letter because it my duty as a health professional to bring to the table how important it is that we change the barrier crime law. I have spent countless hours and days working with other addicts who trying to find their pathway into recovery. The frontlines are thin because the people whom society deemed unworthy because of some past mistakes cannot work in the field that they could do the greatest good. I did not know when I received my sentence in 1990 for distribution of crack cocaine. I would be serving a life time sentence. Luck for me I don’t have a barrier crime, yet today after getting my GED, going to college and graduating with honors. I still can live in certain areas or have certain jobs. I went from the crack house to the White House and still that not enough for Virginia to forgive me of my past mistakes. We need more people who has made a deep commitment to change to share their experiences with others who are suffering!!

The National Shattering the Silence Coalition is a non-partisan volunteer organization of peers and families of adults with Serious Mental Illness (SMI). Our Virginia legislative advocacy strongly supports the "core" components of mental health service delivery as defined in this bill and its passage for individuals with psychiatric illnesses such as Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major Depression, and neurocognitive disorders with psychotic features, such as Post-ICU Syndrome (PICS). Our organization supports special needs Medicaid 1115 SMI waiver funding in support of these "at risk" populations requiring intensive care in specialty clinics, such as the proposed neurocognitive specialty clinic, in the home and in the community.

I have had the five needle protocol done to me several times in order to help battle stress and anxiety. Every time, I have walked away with a feeling of well-being and calm that has lasted for a few days. Many times this has been the impetus to look at my problems with a more calm and clear perspective.

Good Morning, I am currently working on my doctorate PhD in Naturopathic, Drugless Medicine, and have been a holistic practitioner, licensed massage therapist (LMT) and health educator for over 30 years. As part of my practice, I am a POCA (People’s Organization for Community Acupuncture) Auricular Acupuncture Technician (AAT, AAT-RT)as well as a registered trainer for the technique. I have seen such benefit in this safe and effective treatment professionally as well as personally. Expanding this legislation to allow this protocol to be utilized to promote behavioral health and to include those effected by tragedy and trauma, such as our military and first responders, would encourage early access to critical incident stress management resources and improve the health of fellow Virginians. For over 8 years, I volunteered with VBEMS (now known as Virginia Beach Rescue) as a first line responder, NREMT, EMT-B, and my husband is a retired Marine with 23 years of combat operational service. The 5NP has been instrumental in our wellness. Please consider approving the legislation so that I, and others, may expand our work to better people’s lives with 5 quick pokes! Thank you for your time and attention.

I am writing in support of this bill to broaden treatment access through auricular acupuncture. Currently in Virginia, the 5 Needle Protocol (5NP) is restricted to licensed acupuncturists and trained providers who work only in the context of a chemical dependency setting. We have seen the 5NP change the field of drug treatment, and through a simple change of language to § 54.1-2900 and § 54.1-2901 we can broaden treatment access for all behavioral health needs. This change would allow for the 5NP to be further utilized as a tool for prevention, instead of a path toward recovery. Beyond the primary intention of assisting in substance use disorder, 5NP can help with stress, anxiety, depression, and PTSD. So many of us deal with these issues on a routine basis, and so many of you have experienced the relief that the 5NP brings. We have an opportunity to help further reduce these symptoms and the consequences that often stem from creating self-coping habits that can potentially be destructive.The passage of HB 1278 will allow 5NP to be an alternative form of care for all Virginians, but especially the overworked and high-intensity jobs of our healthcare workers, law enforcement, and first responders. As we address substance abuse disorder, along with the daily stress of first responders providing care to persons experiencing this disorder, we have an opportunity before us to expand treatment access. The Wellness Wagon in Roanoke is one such provider doing extraordinary work. Please support this bill. Thank you.

Angela M Dobbins Acupuncture Detoxification Specialist I first received the 5 point needle protocol in my twenties. It was my first time receiving a treatment that truly eased my mind and brought me back into my body. As an early childhood trauma survivor, survival mode and the peak of my nervous system became a mental loop for me. The 5 point protocol helped me ease my mind without putting pills or other harmful substances into my body. Last year I decided to take the course to become certified in NADA. My knowledge deepened as I learned more about what this protocol was actually doing for and with me. This was/is my body doing the work to calm itself with the help of 5 tiny pins. To administer this treatment and watch people go from 10 to calm is nothing short of a miracle. It restores an edgy nervous system and sanity. When I was a child, I lost my father to suicide. He grappled with depression and anxiety which lead to substance abuse. Most who suffer from addiction need assistance because they also suffer from trauma, depression, anxiety and so much more. If tools like these were readily available in situations which warrant relief, there is no doubt in my mind, that lives would be saved. We all know someone who suffers mentally and or emotionally. This tool is a key that has the potential to unlock numerous closed doors. Us key holders are happy to administer this treatment for FREE…this is life saving.

I am writing to support the expansion of the legal use of the five needle protocol for chronic pain. I am a Registered Nurse and an Accu-detox specialist. Working with our veteran population and interacting with them daily as we find ways to help them better manage their chronic pain conditions and other mental health issues is mind blowing. Seeing the benefits that the Five Needle protocol has helped hundreds and thousands of these veterans better deal with stress, anxiety, sleep issues and chronic pain is out of this world. When a veteran tells you thanks to NADA, I can sleep better or that I no longer stress or worry over issues of life or even telling you that they are at a better place mentally and emotional thanks to the protocol bring tears to your eyes. The use of the 5 Needle protocol in our in our Integrative pain program at Central Virginia VA Healthcare system has changed lives. Veterans who had lost hope found hope and are thriving in that new found hope that there is something that can help them. Even after graduating from our Integrative Pain program they have continued to thrive. You do not want to be one the one that takes away something that has been helping with veterans live a fulfilled life even in the presence of chronic pain. I therefore believe that this protocol enhances the effectiveness of other integrative modalities offered for pain management, sleep issues, depression and anxiety. It is in expensive and has no risk associated with its application. It would be of great benefit to expand its use in Virginia for individuals suffering from chronic pain, anxiety, depression, sleep issues and not only substance use recovery. Thank you in advance for passing this bill and helping us help our veterans and others who so very much need this Five Needle protocol to have some quality of life and better manage their chronic pain conditions and other Mental health challenges. Respectfully, Claudia Kem-Bumbala

Greeting VA representatives - I commented earlier, and am creating a second one on behalf of my patients. I shared with them this information and they wanted their feedback to be heard. Below are their comments: "Acudetox is very relating and calming. I have had it done multiple times." "I have had 2 sessions, very relaxed. I became tearful the 2nd time and it was cathartic & would do it multiple times." '"Full body reset, I felt myself truly relax for the first time. I would recommend this highly." "An excellent way to release emotions and tension regardless of the reason"

Good- morning, First, I wanted to say how grateful I am to be included in this movement (HB1278) for Auricular Detox Specialists. I instantly became a believer in acupuncture while being treated for Trigeminal Neuralgia which led me to the knowledge of the 5 NP and how it is beneficial to individuals. Through experiencing this treatment, after 35 minutes I felt renewed, re-energized and most of all at ease. I then became educated on how the 5NP was brought forth for treatment of addictions, traumas, PTSD etc. etc. I too have my own story of survival and wish I would have had the knowledge for this type of medicine free, side effect free and less evasive treatment for the human body. I became such a believer and so intrigued I had to become an ADS so that I may help others heal while giving back with my own story of healing. This would allow the awareness to spread for such a simple, peaceful treatment and give people an alternative way to naturally help heal their bodies. Sarah Baxley ADS – In Training Roanoke Virginia

As a Mental Health Survivor and Advocate, I can say one thing with confidence: no two people are exactly alike in their depression or their addiction. Why, then, would we limit someone's access to a treatment modality which so many people have found relief from? I have only had the opportunity to experience this form of treatment a couple times in my life, but, each time, I have noticed an improvement in my overall mental health. For me, the impact is not long lasting, but, because of how quick acupuncture is to administer, it is not to make some time for this to be done, and, then continue about my daily life. What IS hard, is finding someone who can administer this for me, and, being able to afford to pay it out-of-pocket. In this day and age, we need to be using all of the tools in our arsenal to help people get well and stay well. Medications can only do so much, require trialing, and, come with many side effects- some, which can follow you for the remainder of your life; I see no reason to not make this more accessible to the general public.

I would like to express my support for HB1278 to expand usage of the 5 needle protocol and allow its use in more behavioral health care settings. This protocol has brought my nervous system back to a steady baseline and I have been relieved of depression and anxiety symptoms. Medication has not given me the long lasting relief that the auricular acupuncture has brought to my life. It is my hope that all Virginians in need, may benefit from this protocol.

Hello committee members and delegates. I support the passage of HB 1278, which expands access to the five needle protocol (5NP) beyond the restrictions of chemical dependency treatment programs. This simple, safe, inexpensive treatment is easy to learn and beneficial to many. I am a trained ADS, but because I don't work in a mental health or substance abuse treatment facility, I am currently unable to freely offer this treatment to members of my community seeking relief from trauma, grief, anxiety, depression, stress, sleep problems and other mental health issues. It can be done seated on a chair in a living room, on a porch, in a community room, in the school staff room, a fire station, and in an emergency, just about anywhere. Five needles in each ear, in five very specific location on the ear, and 30 -40 minutes sitting quietly is all it takes. It costs less than $1 per treatment. Sterile needles along with clean needle technique makes the 5NP extremely safe. And the treatment is so calming and relaxing - I wish you could try it for yourselves! Thank you for taking the time to consider HB 1278 and thank you for your service to the citizens of Virginia.

Comments Document

I support the passage of HB1278 that will expand the use of 5 Needle Protocol to treat behavioral health issues. I am an acupuncturist who was trained in this procedure when I attended acupuncture school. Over the past 15 years I have seen this safe, simple, and powerful treatment provide relief to people suffering with substance use disorder, anxiety, PTSD, trauma, anxiety and more. Research has shown that this treatment is effective in treating burnout in healthcare workers (see attached from The Journal of Trauma Nursing). Just imagine when we are able to use this treatment to benefit some of the hardest working Virginians such as healthcare workers, first responders, and teachers. All Virginians will win with the passage of HB1278

Honorable Health and Human Services - Behavioral Health Committee Delegates : I write in support of HB1278, Auricular acupuncture; use of the five needle protocol. As a licensed acupuncturist in this state of Virginia with active board certification through National Certification Commission or Acupuncture and Oriental Medicine, I strongly believe that broadening the possibilities to provide this low cost, extremely safe and effective therapeutic protocol is in the best interest for all residents of this state. Currently in Virginia, this 5 needle protocol (5NP) is restricted to licensed acupuncturists and trained providers who work only in the context of a sanctioned drug treatment program. While this has been a good start, it falls short of allowing communities greater access to the 5NP. Under current legislative language, people only have the opportunity for this caring and cost effective treatment if they are also seeking addiction care. While many people already successfully benefit from this 5NP as an effective adjunct therapy for a range of substance addictions, this procedure is also quite useful for a much wider range of psychological/behavioral/spiritual traumas. During 9/11, 5NP providers reached out to support first responders and came to appreciate its effectiveness in treating trauma at large. The underlying benefits come from the 5NP treatment of psychological/behavioral/spiritual traumas that lay at the root of many problems people struggle with. This is why we seek to expand access to this protocol and where it can be practiced. The language additions as presented by Delegate Eric Zehr address this issue by broadening treatment access for all behavioral health needs. Scientific research supports the utilization of the 5NP for behavioral health. Feel free to learn more here: NADA Protocol for Behavioral Health. Putting Tools in the Hands of Behavioral Health Providers: The Case for Auricular Detoxification Specialists. The simple language addition to § 54.1-2900 and § 54.1-2901 would allow for treatment under the general field of behavioral health thus allowing 5NP practitioners to support first responders, healthcare workers, victims of disasters, military veterans, and whole communities that may need this valuable, inexpensive treatment due to tragedy. Having supervised, assisted, and lent my ears for practice needling in a number of 5NP training sessions both prior to and through the COVID disruptions these past several years, I would like to affirm that the students who attend these classes already bring a wide range of professional skills and a passion to expand and incorporate this procedure into their already considerable repertoire. They are always curious, open to new ideas, and eager to put this new skill to use. Whenever I have worked with these folks, I have also gained valuable therapeutic insights and strategies. Your support would be greatly appreciated. Thank you for time. Best wishes always, Stephen Kirbach

I am an ADS at a mental health facility, and the positive response I get from the people I service is clear, below are a few: "I have been having a rough day and was going to ask for medication just before I came to this group, but now I feel even better than if I had taken meds" "This sounds weird, but I feel like the acupuncture gets me in a more positive frame of mind. It makes me feel hopeful" "I have enjoyed this so much, I am definitely going to be adding this to my treatment program, I want to get it weekly when I get out" The most consistent question I get from patients is, 'where can I get this when I leave?'. This bill would support our patients who are struggling to continue to receive the 5 Needle treatment as they transition into outpatient services. I am grateful for this bill and am truly excited about the benefit this can have for our community. Thank you for your time, Kari Decker, MS, CTRS, ADS

I wish to speak to the efficacy of 5 point protocol. Three times when I have found myself spiraling into anxiety, I have arranged to receive “pins in my ears” from a trained practitioner. The resultant calm has each time been almost immediate, surprising, but true,that something so simple could have such profound effect. Dorothy S Clifton, LCSW (retired)

I appreciate the opportunity to provide comment on HB1278, and I am thankful that Delegate Zehr has chosen to carry this bill. The 5 needle protocol provides so many benefits. I know this because I have experienced it first hand. As a former law enforcement officer and emergency management professional, I have been in many situations throughout my career that have stretched the limits of my professional and personal capacity. The risks and toll that these lines of work take on individuals is well documented, and can lead to many physical and mental health conditions that can lessen quality and length of life. The 5 needle protocol has helped me lead a better life, one with improved mental health and less stress from my years of public service. The minor modifications to this area of the Code of Virginia to clarify that behavioral health is included in the 5 needle protocol's area of beneficial influence will simply provide this service to more that need it. There are no downsides to this proposed bill, and I hope very much that you will support it moving forward.

As an ADS (Acupuncture Detoxification Specialist), I have first-hand seen the relief that many individuals receive from the 5-Needle Protocol (5-NP) treatment. I am adamantly in support of the expansion of this treatment; so many Virginians would benefit from this low-cost, and very safe modality. Beyond the primary intention of assisting in substance use disorder, the 5-NP can help with stress, anxiety, depression, and PTSD. So many Virginians deal with these issues on a routine basis. We have an opportunity to further help reduce these symptoms and the consequences that often stem from creating self-coping habits that can potentially be destructive. HB 1278 has the potential to allow the 5NP to be an alternative form of care for all Virginians, but especially the overworked and high-intensity jobs of our healthcare workers, law enforcement, and first responders. We have an opportunity to make this treatment more accessible to all Virginians and be a positive example for other States to follow.

As a trauma informed Tuina massage therapist and caring citizen, I urge you to carefully consider amending the Virginia regulations that limit access to the NADA 5 needle protocol to only those participating in a chemical dependency treatment program. The beneficial attributes of this safe, inexpensive, easy to administer, and effective treatment extend beyond chemical dependency. The reduction of anxiety, improvement of sleep, decreased pain, and connection with others, increases the potential for healing. We live in troubled times and many people suffering from behavioral health issues need easy access to affordable care and support. Personally, in Floyd County, Virginia, I am equipped to offer the NADA 5NP in my clinic on a donation basis. Many of my clients would benefit tremendously if this could be included in their treatment plan. In addition, I imagine the EMTs in our Rescue Squad being trained to give and receive the 5NP to reduce the affects of trauma related to their profession. I also work with our aging seniors at Warm Hearth Village and there is solid data to support the efficacy of the NADA 5NP to aid with pain management, insomnia, emotional outbursts, agitation and general depression that many people experience near the end of life. Scientific research supports the utilization of the 5NP for behavioral health. With legislative support, we can broaden treatment access for all behavioral needs. The expansion of regulations governing the administration of the 5NP would help create a healthier society, and we all would benefit. Thank you for your time, service and attention. With care, LoraLeigh Giessler LMT, RSME/T, ADS

As an acupuncturist, I work with patients each and every day that are battling PTSD, stress/anxiety, addiction, and many other mental/emotional struggles that see significant benefit from auricular acupuncture. This is a service that should be widely utilized, especially considering Virginia’s overwhelming opioid crisis. Patients are begging for help and support with these struggles, and the 5-Needle Protocol is an inexpensive, effective way to enhance these patients’ lives. I hope that you will strongly consider supporting this bill as it will enhance the lives of so many and revolutionize the way we approach treating addiction in a more holistic manner.

While completing Acupuncture Detoxification Specialist training, I had the opportunity to provide 5NP treatments to individuals in an inpatient residential drug/alcohol treatment facility. On one occasion, a noticeably anxious woman requested to be last to receive the treatment as she wanted to see how others responded to having needles placed in their ears. As requested, she was last to receive the treatment. Within 10 minutes, she went from being fidgety and unable to sit still to falling asleep. While watching peace come over her, I thought of how beneficial the treatment could be to those experiencing grief, MST, PTSD, and so many other behavioral health conditions; the list is truly endless.

Hello, please register my support for HB 1278, expanding access to the extremely helpful, safe, drug-free therapeutic benefit of the 5-needle acupuncture protocol. As a licensed acupuncturist, I recognize that this protocol is something that can be safely taught in a short course and stands alone as a treatment for the stresses and impacts of all sorts of mental and behavioral health conditions. This Bill 1278 will greatly expand access to a low cost, high yield treatment modality that can support not only recovery from substance use disorders, but also emotional trauma such as PTSD and depression. Thank you for supporting mental health across Virginia. -erin mckelvy, L.Ac. Migrants' Rest Acupuncture, Christiansburg VA http://migrantsrestacupuncture.com

Comments Document

Regarding Bill 1278 HB1278 Auricular acupuncture; use of the five needle protocol. The Five-Needle Protocol (5NP) was developed in the 1970’s as a community-based response to the heroin crisis in the Bronx. Because of its focus on drug treatment, 5NP is often called “acudetox.” After 9/11, the same treatment protocol was effectively used to provide relief from trauma for firefighters, other first-responders, and survivors. Acupuncturists Without Borders employ the 5NP for disaster relief all over the world. In 5NP, thin, sterile acupuncture needles are placed in five specific acupuncture “points” in each ear, after which the person is asked to sit quietly for 30-40 minutes, usually in a group setting. The calming effect is almost always immediate. Currently, Virginia has an exemption allowing non-acupuncturists to be trained and provide the 5 Needle Protocol in the context of a chemical dependency treatment program. This suggested amendment in HB1278 would eliminate the restriction of a treatment setting (chemical dependency treatment program) as it disrupts the continuum of care and availability of this treatment to address Virginia’s staggering behavioral needs. Whether people seek 5NP for trauma or substance use problems, and regardless of the substance involved, the same 5 points will be used. Because no chemicals are involved, there are no contraindications. Therefore, no intrusive inquiries are needed before administering 5NP, making the Protocol particularly effective for people dealing with trauma or stigmatization, who are often reluctant to verbalize concerns. The Five-Needle Protocol is extraordinarily safe. Adverse outcomes are very rare and easily managed. The cost of 10 needles (5 needles in both ears) , alcohol wipe and cotton ball is 70 cents per treatment. Because 5NP is non-diagnostic, people with no health background perform as well in training as health professionals. People who successfully complete NADA (National Association Detoxification Association), POCA (People's Organization of Community Acupuncture) or an equivalent training would be exempt from regulatory requirements for acupuncturists as long as they only use the 5 ear points that are the basis for 5NP training. Because no new regulatory structure is created, the cost of the proposed changes to Virginia taxpayers will be negligible. The 5NP is an effective first line intervention and can be taught to community members especially those in rural areas where needs are often high but geography and socioeconomic barriers exist. 5NP also can be utilized in drug courts, jails, rehabilitation centers, public and private healthcare settings to address the surge in drug use, homelessness, school shootings, and natural disasters. Now more than ever we need to increase the availability of this simple, low cost yet effective behavioral health treatment. Scientific research supports the utilization of the 5NP for behavioral health. Feel free to review the article attached entitled: NADA Protocol for Behavioral Health. Putting Tools in the Hands of Behavioral Health Providers. Your support would be so appreciated. Thank you for your time and service.

I am writing to support the expansion of the legal use of the five needle protocol for behavior health. I have seen first hand the utility of this treatment technique for individuals suffering fgrom addiction, trauma, disregulation, anxiety, and depression. This protocol enhances the effictivity of most other therapies without interfering with the modality. It is inexpensive and simple to both provide and to learn. The protocol ought to be available to all Virginians suffering from behavioral health challenges, not only to individuals in substance use recovery.

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Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.

January 31, 2024 Respected House Health and Human Services - Behavioral Health Committee Members: I am writing to state my utmost support for passage of the 2024 Virginia House of Delegates Bill NO. 1455. I am most hopeful that passage of this bill will codify and underwrite the establishment of the Virginia Memory Project (VMP) as a population-based, statewide Alzheimer’s Disease and Related Disorders (ADRD) registry. I am passionate about the VMP. To be sure, national and statewide data on ADRD incidence, prevalence, and cost is chilling. More personally, as a Geriatrician, I have cared for many Virginia patients and families with ADRD. I thus have seen over and over the suffering these devastating disorders inflict. I see the VMP as a leader and a cutting edge innovation in Virginia’s battle against ADRD. In establishing the VMP, Virginia becomes only the 4th state to boast a statewide ARDR registry. Benefits are multiple, first as a means of examining ADRD distribution and determinants, and second by offering crucial insights on unmet needs for purposes of planning of medical and social services, examining ADRD-related socio-demographic disparities, and supporting ADRD research. Moreover, the VMP goes above and beyond registry” functioning as usual.” In its intentional design to allow self-reporting by ADRD caregivers and persons with undiagnosed cognition issues, it gives voice to constituencies that would otherwise be overlooked. With its linkages to education, support, and access to care, the VMP is of immediate benefit and help to its enrollees, thereby becoming the first and only “ADRD registry with a heart”. Although there is excellent return on investment, the VMP needs monetary support-for staff, consultants, infrastructure for data entry and management, structures and processes to ensure accuracy and confidentiality, and the capacity to generate accurate and timely reports. That such support would be forthcoming for the VMP via House bill 1455 would indeed be a huge win for this Commonwealth. Sincerely, Daniel Bluestein MD, MS, CMD-R, AGSF-R, Certificate Added Qualifications-Geriatrics Adjunct Professor, Virginia Geriatric Education Center/Virginia Center on Aging Virginia Commonwealth University College of Health Professions Professor Emeritus Department of Family & Community Medicine Eastern Virginia Medical School