So I'm Kathleen Kilborn, I'm the new executive director at the Center for Health and Learning and the Vermont Suicide Prevention Center and we are delighted to be here today both live stream for our larger audiences and for our friends in Montpelier locally as well. We have a fantastic lineup of speakers both from the field stakeholders, people with lived experience and so you'll hear a variety of perspectives today about mental health wellness and the need for services as well as suicide prevention and awareness. So this is really about educating one another, collaborating, sharing ideas, suggestions, what works, pooling resources and we're very excited to bring you what's going on now that's going well and then next steps in what we can continue to do together when we collaborate. So it's my pleasure to introduce to you Kirk Postoate who is the director of the Vermont Suicide Prevention Center. You'll hear from a number of speakers and then we're going to try to save time at the end for the speakers to all be up front and have some Q&A if there's any questions in the audience. Great. Thank you. Kirk, I'll turn it over to you. Thank you Kathleen, get the mic set up. Good afternoon everyone. My name is Kirk Postoate and I'm the director for the Vermont Suicide Prevention Center through the Center for Health and Learning. Welcome to Vermont Suicide Prevention Coalition's legislative engagement session. The coalition is a diverse group of stakeholders who have come together over the past decade to address suicide in our state. The coalition has membership from our school, healthcare, higher education, state government, business, faith-based and private citizen populations to name just a few. The coalition meets three times a year to hear about efforts to improve awareness and prevention, to share cutting-edge best practices, and to foster a group of concerned partners who support each other in this challenging work. The coalition identifies some key priorities each year to be presented in the legislative session and that is our purpose for coming together today. We want to help our legislators better understand the good work being done to improve suicide care and therefore decrease suicide deaths through time in our state. Today's theme is suicide prevention in the Vermont community of system of care. We're so glad that you've decided to join us today and we have a great array of presenters as Kathleen mentioned earlier who are going to share some very helpful information to help you better understand how suicide prevention fits in to the system of care in our state. suicide prevention in Vermont is at a critical juncture right now. We have many components in place and coming into play that I believe will reduce deaths by suicide in the coming years. However, in 2021, we had the most deaths by suicide on record with 142 and the numbers for 2022 are reflecting a similar trend. Certainly there are many compounding factors that come into play and led to those outcomes, but there are also many efforts taking place right now that are creating a systematic, broad based and sustainable approach to changing this over the coming years. The Vermont suicide prevention center where I work is really grateful to be actively involved in this very important effort with our state partners and partners across the spectrum. Today I'd like to talk specifically about the zero suicide project that VTSPC is leading to help create a suicide safe system of care throughout our Vermont communities. Zero suicide is a framework based on a set of evidence based principles and practices for preventing suicide within the health and mental health care systems. To quote from the zero suicide website directly, the foundational belief of zero suicide is that suicide deaths for individuals under the care of health and behavioral health systems are preventable. For systems dedicated to improving patient safety, zero suicide presents an aspirational challenge and a practical framework for system wide transformation towards creating suicide safe systems. VTSPC, through funding from the Vermont Department of Mental Health, is currently working with all 10 designated agencies and two specialized service agencies to help them implement this nationally recognized framework. VTSPC has led this project since 2016 and through the course of that work, our participating DAs have found good success in embedding, implementing and tracking data on the key components in the pathway of suicide care, screening, assessment, safety planning, treatment and follow up care. Our new project partners now have the benefit of working in a learning community with their peers for more experienced DAs, which makes the transfer of knowledge much more efficient and effective. This year, VTSPC's work also includes a mini-grant project to connect primary care partners with their communities designated agencies to create suicide safe systems of care that are outside of organizational boundaries that break through the silos as you often hear and actually create suicide safe pathways across communities. VTSPC works with our partners systematically to implement zero suicide. First, we work with helping them build an infrastructure within their organization. This can be achieved by engaging agency leadership teams and then helping create steering committees that have broad participation across the divisions at the designated organizations to ensure that all populations from children to older adults will benefit. We organize the project work across the year to help our partners utilize tools offered through the zero suicide framework, which helps them assess where they currently are with their work and, as importantly, helps them consider where they want to go in the coming year in their efforts. VTSPC also helps our partners review organizational policies and procedures which are really key components to creating sustainable change in their approach to providing suicide care and prevention. Through our project management, we also promote workforce development by offering best practice and evidence-based trainings, technical assistance to guide our partners' efforts through time and evaluation and quality and support to help our partners continue to assess, study and improve their suicide safe pathways. The final aim of the work is to embed these evidence-based practices from zero suicide into clinical practice and organizational policies. VTSPC also works with our partners in aligning their electronic health records with their suicide safe pathways and several of our more seasoned partners now have electronic health records that directly reflect the suicide safe pathways that are happening in daily work, which is a critical connection and it makes the care outcomes for those they serve better and also for the staff involved. It's a simplified process to follow, so we're really pleased with that. Our role in supporting project partners in their quality improvement efforts helps them build the capacity to collect and submit client-level data as part of the zero suicide project evaluation plan. The collection of client-level measures is a crucial aspect of understanding the impacts of the zero suicide work conducted by both our DA project partners as well as our mini grant project partners. In terms of broader program evaluation, the examination of the aggregated data from project partners helps assess the overall effectiveness of the changes they are collectively implementing. So as you can gather, there are many facets to the work being done to implement zero suicide in our mental health and healthcare systems. This work has led to better coordinated and more sustainable systems for suicide prevention over the past several years and these efforts will continue. Looking to the future, what can be done to further implement this systematic approach to preventing suicide in our community-based systems of care? Vermont Suicide Prevention Coalition membership identified some key components of this work moving forward in the coming years. I'd like to share a few of the items that Coalition members suggested that we gathered from them last fall. Expanding training for evidence-based treatments such as dialectic behavioral therapy, cognitive-based therapy, suicide prevention specific, as well as collaborative assessment and management of suicidality. Those all have great acronyms, but I won't share those. To the mental health professionals to bring a broader set of these type of treatment options for suicide prevention. Offering access to ongoing suicide prevention awareness trainings, also known as Gatekeeper, with the focus on cultural considerations to best serve certain demographic groups such as older Vermonters, LGBTQ Vermonters, middle-aged men and new Americans joining the fabric of our communities. Creating data management systems through the creation of a data dashboard to manage suicide prevention across time, both within and between organizations. Expanding zero suicide to community-based service organizations who provide care management and care coordination for vulnerable populations across our communities such as area agencies on aging, visiting nurses associations, SASH and others like that. And finally, asking and looking for additional funding for designated agencies and specialized service agencies to manage internal zero suicide activities that promote suicide-safe pathways of care within their organizations. So there's good work being done right now and there's good work to be done in the coming years and I am confident that the efforts being made across sectors will help us turn the curve on suicide in a positive direction. We have many dedicated partners who work collaboratively every day to help bring the best suicide prevention efforts to our system of care in Vermont and we at the Vermont Suicide Prevention Center are so grateful to be part of this effort. As I mentioned earlier, we have many great presenters today. Right now, we're going to share a video of Chris Allen, the new director for suicide prevention from the Vermont Department of Mental Health. And then we'll have some of our other esteemed presenters join us after that. So again, thanks for being here everyone. Good afternoon and welcome to the Vermont State Legislature Education session presented by the Center for Health and Learning. Without their assistance, we wouldn't be able to host this event. Thank you to Kathleen and Kirk and the rest of the CHL team for this wonderful event. My name is Chris Allen and I'm the new director of suicide prevention at the Vermont Department of Mental Health. And I'm honored to be in this role. One thing that I've noticed in my short tenure here is that the strength of partnerships with other organizations, departments and agencies is critical to addressing suicide. One partnership that I would like to highlight is with the Vermont Department of Health on the FacingSuicideVT.com site. On this site, anyone will be able to access resources, hear stories of Vermonters struggling with their mental health and find ways to give help and get help. Something that we've been trying to implement within the state is the Zero Suicide Framework. It's not just a framework, but it also offers tools and best practices for those struggling. It begins with the premise that suicide is preventable. It looks at how people can access services in the appropriate level of care, ensuring that there will be individuals that are trained in suicide safe ways. We value input from peer groups in designing how these services will look. Another initiative to be aware of is the Governor's Challenge. Service members, veterans, and their families are identified as a group at high risk of suicide. Governor Phil Scott signed on to this challenge in May of 2022. Currently, there are three work groups that are focused on identifying service members, their veterans, and families, and screening for suicide risk. The next group is looking at promoting connectedness and improving care transitions. The third work group is looking at increasing lethal means safety and safety planning. Through these work groups, we're able to look at how to implement various strategies to get Vermonters the assistance and help that they are needing when they are wanting it. Another resource to be mindful of for neighbors, community members, students, grandparents, anyone is the 988 Suicide Prevention Lifeline. In July of 2022, this lifeline changed to a three-digit number. At any point 24-7, you're able to call this number and it will be answered by a trained professional equipped to handle the crisis or provide any resources that may be needed. There are also chat and text options, too, should that be more comfortable for individuals. Comfortable for individuals to reach out by. Since this number was implemented in July of 2022, Vermont has consistently answered over 80% of calls by Vermonters. This is an important measure to look at because we want Vermonters answering calls by Vermonters that are in crisis. They are best equipped to handle these calls based off of understanding where the individual is coming from, being familiar with the area, and also knowledgeable about the resources that are specific to Vermont. We achieve a higher quality and better outcomes when these calls are answered in state. An individual that calls this number does not only have to be in crisis. It could be an individual that is concerned about someone else. And with that concern, they're able to access resources and educational materials that the trained clinicians are able to access and share. Please do use this resource as it is important to the health of not only you, but also your neighbors. I'm honored to speak at this education session. And should there be any questions afterwards, please do not hesitate to reach out to me or the CHL team to pass along to me. Thank you, and I appreciate you listening to me. And thanks, Chris. He couldn't be here because we were just at the Governor's Challenge conference in Washington, D.C., and most of the folks were coming back later this afternoon. For those of you who are not familiar with that, sorry, the Governor's Challenge is the effort that the state's undertaking now to work with service members, veterans, and their families specifically as part of a national effort to reduce suicide in that population. So coming back with some really great knowledge and steps to take towards helping in that area moving forward. I'm going to now introduce Michael Hartman, the CEO from the Moyle County Mental Health Services, who's going to share with us his perspective on suicide prevention and the designated mental health system of care, one of our longtime partners with Zero Suicide Project work. Well, let me offer a good evening, I think is where we're at. It's kind of one of those times a day. Is it evening? Is it not? I wanted to just remark for a second about the room we're in because it's a very interesting situation. I realized that this was the room that we did one of the first Zero Suicide meetings in, I believe, 2015. And it was folks from my agency, from the Howard Center, and from Northwest Counseling and Supports who came together at the invitation of the CHL folks to meet with Mike Hogan, who was the past commissioner of mental health in New York and Connecticut, and in Ohio too, I believe. And we came together to really talk about this as can we really do anything about this? And sitting or standing here now and looking at what we've done, it's really been quite amazing from my perspective. I think that one of the most dramatic pieces is really how much more we know and understand about suicide than we did that day. And we had a number of doctors in the room, a number of us. I was a crisis worker at that point for at least 30 years, and there were other folks with similar backgrounds. And yet really about suicide, we were nearly ignorant in terms of what we know now. And I want to just kind of briefly run over where I think we've come from to where we need to go. And that is that you know, in the beginning of this, it really, I started doing crisis services in the mid-80s. And that was really response to suicide many times. It was response to somebody already having died by suicide. And it was often helping family members or other people cope with that death. And then we really concurrently, but growing from that time period, was really started learning how to do some intervening activities, training staff to be more adept at recognizing risk. And that was mostly looking at age and substance use and other kinds of pieces like that. And then now being in this place where we're really talking about what we can do when somebody comes into a primary care office and be able to talk with them about their health and have suicide or risk of suicide being part of that assessment. And it sounds simple when I say it, but at the time that was really not any, even on our radar then, about a place that we would consider doing intervention. Even though the data has been clear for quite some time, that one of the last professional people to have contact with somebody before they die by suicide is a physician or a nurse practitioner, some primary care person that they have contact with. So we have really learned that it's not about reacting to that crisis that may be at the far end of this, but how to intervene to have that crisis not ever occur. And the numbers that we are talking about are stupendous. There was just an article I was trying to really search my phone very quickly to find the source, and I'm sorry I should have had it earlier. But a recent, very recent study in the last week or two reported new numbers for the number of people impacted by death by suicide because it used to be considered the number six. And it's actually, I believe now over 100 when they go back and really track who gets impacted by a suicide death. And the number of deaths that Kurt spoke to, 142, would mean that it could be up to 20,000 people affected one way or another by a suicide death. And when you do that aftermath of a death by suicide, you realize that that's easily the number. We have dealt with my crisis team recently responding to a death of a school personnel at a high school. And literally, it was the whole high school that had an immediate impact. And then it's all their parents. And then it's all their siblings. I'm not sure what magic you were using here to try it now. Try it now. A little closer. A little closer. I can't. Okay. Thank you. So, you know, I think that we get the scope of this issue now. It's huge. It's wide. But there's hope and promise that as we keep learning more and more information than we ever had at our fingertips about what we can do, it's become very apparent that most of it is pretty simple. It's not complex. It's not go and go to school for eight years. And maybe you could figure it out. It's really your next door neighbor. You could ask them two questions, three questions, and you could find out that they were at risk or in trouble and that you could take the next step. And that's really what we're trying to do in our particular county. We've had the good luck of just being, I suppose, really right people at the right time in the right positions. And we've been able to tie together our federally qualified health center, our mental health center, and our emergency department into a solid team along with, and this is pretty unusual, the private community of therapists in our area. And we have trained over 100 people. And Lamoille County is a whopping 27,000 people. It's very tiny. And, but we have trained 100 people plus in our area who are private therapists, who are working in the emergency room, who are working at home health, who are working in schools, just about every setting that exists in our area. And those folks understand how to do a basic suicide screening, asking up to six questions and as few as three to determine if somebody may be a more significant risk than they might have appeared initially. And they are learning how to do that in a medical setting, where there are 15 other questions and 15 other purposes to be in a room. And so we have been able to be effective that way. It hasn't made suicide go away as an issue. When we started this, Lamoille County was the highest suicide rate in the state in the mid teens. Then we thought we were like being magical, almost frankly, because it went down to one of the lowest in the state. This year, as Kurt mentioned, this year being calendar year 22, it was the second highest again. And it was three times higher than it's been the last two years. So it's very, very difficult not to look at the numbers and say, how could we ever get to zero? But the reality of it is, is these practices and what the state government and the Center for Health and Learning and, growingly, the designated agencies, private therapists, psychiatrists, and soon to be in your neighborhood, every primary physician, will be able to pose questions that make the difference between somebody walking away and saying, I guess nobody can really help me. And somebody saying, I got some help and I can tell you my own recent experience with an acquaintance of mine really emphasized to me the value of how powerful that can be. That somebody who really needed to have that moment to say, I need help. And because of the training that I have, I was able to help facilitate that. But that's just as easy for anybody to do by just learning the basics of this. So I want to put my hats off to Center for Health and Learning because I happen to be a commissioner of mental health at the time when the first UMatter grant came around and we started talking about this for real. And it's been an amazing adventure. And we've already now recently gone through a director at Center for Health and Learning, have a new director in Kathleen, and that starts the next push to make this much more broad in every community in the state. Very possible, very hopeful. And I appreciate the folks who are here in hearing this and the folks who are online listening to us. Just remember that it's pretty easy, you know, within six hours of exposure to material, you can know what things to ask for. And you can find out maybe how to work a microphone, I'm not sure. Maybe not be able to find that out. But in any case, thank you. And I'm appreciate very much that you decided to take some time to listen to these kinds of concerns. Master of mice. Thank you so much, Michael. See if we can get this turned back on. Hello, hello. Hello. There we go. All right, next we'll have Dr. Rebecca Bell, who's joining us from University of Vermont Medical Center. And she is going to speak to us today about mean safety and the critical importance of considering that in suicide prevention. Thanks. So what's the magic here? Just hold it. Okay. Who's going to, someone's going to wave, right? If my microphone goes out. Okay. All right. Well, thank you for having me. My name's Becca Bell. I'm a pediatric intensivist at UVM Children's Hospital. And I care for infants, children and adolescents who are critically ill or injured and require intensive care. I'm also an associate professor at the Larner College of Medicine in Pediatrics. And I work with the Vermont Child Health Improvement Program on injury prevention. And through that work, I sit on the Vermont State Child Fatality Review Team. And what this team does is we review all unexpected childhood deaths in the state. And the two areas of preventable child death that we see in our state are in the infant age group, its sleep-related deaths, and in children and adolescents, it's suicide. And so that has what brought, brought me to this work. I sit on the Vermont Suicide Prevention Data Work Group. And so it's through this lens that I'm here to talk about specifically suicide death prevention. And I'll talk a little bit about how there's a little, there's a little bit of an uncoupling between those who experience suicidal ideation and make suicide attempts, many of which I care for in the intensive care unit, and those who die from suicide in Vermont. They are not necessarily the same population. And so understanding that will help us address this issue. We have many, many approaches that we need to employ to help all the people in our state, specifically when we're talking about moving the needle on suicide death in Vermont. We need to talk about access to firearms, because that is how Vermonters are dying from suicide in Vermont. So firearms are the most common method used in suicide deaths in Vermont. This is true for every age group, even children in Vermont. And it is more common than all other methods combined. And this makes sense when you think about it. Farms are the most lethal method. And when we think about lethality in medicine and suicide attempts, we think about the inherent deadliness of the method. We think about ease of use, how familiar someone is with the method that they're using. And we think about the ability to abort mid attempt, which firearms do not allow for at all. And in fact, we have more firearm deaths in Vermont than we have visits to ERs for firearm injury, which means that, again, these are very like inherently lethal methods. So in Vermont, we have a higher suicide death rate than the national average. Again, this is true of all age groups. And when we think about addressing this problem as healthcare providers, we want to think about what can we, what are the predictive factors here so we can address those? So what are the predictive factors at a population level, and also at an individual level, at individual patient level, so we can help folks. And what is a bit frustrating about this is that those predictive factors that seem the most obvious tend to actually not predict the outcome of suicide death, either at a population level or at an individual level. So what do I mean by that? So you will hear from many folks, and you know this to be true, that we have many young people and adults in Vermont who are struggling with mental health. There is a lot of pain and suffering and despair right now. This is true before the pandemic. This was exacerbated by the pandemic. This is a huge problem, and it's getting worse. But when we look at our, that sort of level of mental health illness and despair and suffering, it is actually less in Vermont, less prevalent in Vermont when we then compared to other states. But we have a higher suicide death rate. So in Vermont, we participate in the youth risk behavior survey. Every state in the country does this. Every other year, we have all Vermont middle schoolers and high schoolers telling us a whole bunch of things, including things like episodes of serious depression over the last year, episodes of suicidal planning and suicide attempts that have happened in the past year. Again, these numbers are too high. The absolute numbers are too high. But in Vermont, our young people are reporting this consistently at a lower level than other states. We have a higher death rate though. I'm going to do this seamlessly, I think. So unfortunately, the things that come to mind most often is that we can predict who might die by suicide. And we really can't. We want to do this as healthcare providers. We want to be able to pick out who is most likely to die. But level, these levels of mental health issues in the state, is it still going out, right? See, I was too confident. Yeah, there we go. I have to be more humble. The microphone wants me to be a little bit more humble. I think maybe I'm even holding it too long. Okay, how's that? Good. So, okay. So at the individual level, what we do know about people who use a firearm in their suicide attempt are oftentimes when we compare those folks to those who've used a different method, what we find is that they are more likely to do to make their attempt, they make their attempt more impulsively. So they've thought about it for a short amount of time. They are less likely to have a history of mental health issues. They are less likely to have made prior suicide attempts. So when we think about how we can identify these folks in our communities, our loved ones, how do we identify that? And it is a very understandable human response to want to think about why this happened when somebody dies by suicide. We want to think about what somebody was thinking about what the intent was. But we've been learning over the years that what we know is that the method used is actually the most predictive of a suicide death. So again, it's not about their intent to die.  We actually find the opposite that people who have survived such attempts are oftentimes doing this more impulsively. They thought about it for a short amount of time. And they're more likely doing it in response to a very temporary, but at the time, important crisis. So like an interpersonal crisis. So, you know, in the cases that we review, it's an argument with a parent or a friend or the end of a relationship or something happens at school or social media. So the question is, can we identify when that's going to happen? And prevent that? Or do we say we need some universal measures that we employ? Because I can tell you, I can't tell you when an adolescent is going to have a crisis. I don't think any parent of an adolescent can. And so what we need to do is create an environment of safety, because we can't prevent young people or our loved ones of any age from experiencing a crisis, but we can prevent them from dying during one. If we can keep them safe, give them some time and space. And so this effort to reduce access to lethal means is just that. It's to say someone experiences a crisis. They might have a plan in their mind. That microphone works now. It's like taunting me out there. So, what we want, so when, if we can, should I try this now? Yeah, it should work. Okay. All right. Here we go. So, how's that sound? Oh yeah, that sounds good. Okay. So, if we can reduce the lethality of the attempt. So, one way to do that is if somebody has in their mind that they're going to use a firearm in a suicide attempt and then they cannot get that firearm. We know that sometimes that's enough. It's the plan is thwarted and they don't make any attempt at all. Sometimes they'll choose, they'll substitute a less lethal method. Any method is less lethal than a firearm. And in that case, that gives us time to help them. And I can say that the adolescents that I care for who are in the ICU with very serious suicide attempts usually from ingestions of medications, these are very serious attempts. They, we can help them. They wake up. We have a chat. They tell me about what college courses they're signing up for. I mean, they have a plan for the future. But what they tell me is in the moment, I was experiencing a lot of pain and I wanted the pain to go away. And so, I, you know, took this medication. But then they were able to then get some help or somebody found them and they were able to come to us.  So, when I care for a young person who's made a very serious attempt, I mean, it is when we can help them, we can save their lives.  And so, this is an effort that we are very serious about in the medical community. So, we do know that if a firearm in the home is kept unlocked, sorry, if the firearm is kept unloaded, locked with ammunition stored separately, all of these things can help reduce either unintentional injury, firearm injury or death, suicide attempt or death and or and an assault. So, we talk a lot about safe storage of firearm in the home. This is something that we have not been very good at as healthcare providers. We have felt uncertain about how to do it. We haven't gotten great training on this. We don't want to alienate our patients. We sort of have stayed away from this. But we do know that talking about this as well as giving safe storage locks or safes or lockboxes actually does help change behavior. And so, I'll share a little bit about some of the work we've done here in Vermont and that includes an educational module mostly geared toward healthcare providers through the Vermont Child Health Improvement Program on how to have this conversation, how to ask the question, how to have an open-ended discussion. And that has led actually to some national work. And I was able to work on a module called Safer. This is through the American Academy of Pediatrics. It is geared, again, towards healthcare professionals. It is free. It is accessible to anyone who wants to take it and look at it. And they were actually able to hire real actors to do the counseling scenarios. And my colleague, Dr. Elliot Nelson, who's a retired Vermont pediatrician, helped consult on the pediatric counseling and access to lethal means, which, again, is a free accessible module. How do we have these conversations? We have done some follow-up studies on pediatricians who've taken the module to assess their level of confidence and assess their counseling frequency after taking the module. And we have seen some good short-term results, but we need longer term. So that's talking about how we keep the home safe, but in terms of storage. But there are times where we really do think the best thing to do is to remove the firearms from the home. In some cases, this is on a temporary, voluntary basis. And I will say the last time I spoke at this event, I talked about how we didn't have a place to do that or accessible places to do that in Vermont. So when I was counseling a family and the family said, yes, we're ready to remove the firearms from our home, how do we do that? I didn't have an answer for them. So, but I'm pleased to say that through a lot of work from the Vermont AG's office, particularly Carolyn Hanson has done a ton of work on this, as partnered with Vermont State Police and federally licensed firearm dealers in Vermont. We now have eight locations where people can voluntarily temporarily store their firearms. All of this information is now on the firearm storage web page through the Vermont State Police has an interactive map. It also talks about extremist protection orders, relief from abuse orders. So all the information is on like one page that we can now send our friends and family and our patients to. And then two weeks ago, the US Attorney's Office in partnership with many agencies, including the Health Department, Department of Mental Health, Vermont Fish and Wildlife, Vermont State Police, Vermont Sheriff's Association, and the UVM Medical Center. And I was so pleased to be part of this effort, has put out some PSAs to the Vermont community about both gun locks, which are now being cable locks, which are now being distributed throughout Vermont at the normal places you would expect them to be, but also places like libraries and other community centers. And also PSAs about, again, removal of firearms from the home in a time of crisis. So I think I want to end by just acknowledging and recognizing the work that has been done by the legislature already this year. This is like, we talk about this every year. I'm so happy that people are here and are so engaged and involved. And I didn't say this at the beginning, but I am also in leadership in Vermont Medical Society. So I'm the president-elect of the Vermont Medical Society. We represent over 2,000 Vermont physicians. We have been, in addition to doing this work, really advocating for some legislative changes. And I really want to thank, in particular, the House Health Committee, in which we have some leadership here. And I know there's a further suicide prevention bill. And we really support these efforts around waiting periods and safe storage in the homes. So thank you. And there's still a lot of work to be done. But with partnership, I think understanding this connection to access to firearms and understanding that in order to move the needle on suicide deaths in Vermont, this is an area that we really need to focus on. So thanks very much. Thank you so much, Dr. Bell. It was great to have you present on such an important topic. And next we have Dr. Ben Smith, the director of the UVM-CVMC Emergency Department, who's come tonight to speak about suicide prevention from the perspective of a hospital emergency department. So thank you so much. Hello. And thanks, everyone, for inviting me here today. My name is Ben Smith. I am the director of the Emergency Department at Central Vermont Medical Center, which is just up the hill from here. I've been an emergency doctor in Vermont for almost 17 years and an ED doc for 20. I'm here to briefly describe the role that emergency departments play in suicide prevention. We're an integral part of that system of care, and we take a lot of pride in being there for anyone 24-7, 365, anyone regardless of your ability to pay, regardless of your color or creed, regardless of what your complaint is or your particular situation. It's not only the value set that draws many of us to emergency medicine, but it's actually enshrined in federal law. We see everyone who comes through our doors and assess them for emergency conditions, and that is core to our role and our position in the system and something we take incredibly seriously every day. We have, in our emergency department, and most across the state, policies, procedures and regulate and practices that support the effort of suicide prevention. We universally screen all patients who come to us for care for suicidal thinking. Earlier was mentioned a series of screening questions, and we use those for every patient that comes to our emergency department. We partner with our designated agencies. We have an incredibly dynamic and powerful relationship with them. The screeners are my personal friends at this point. We work with them every single day. They're often in the ER at all hours of the day of night, and they screen patients. They work with us to coordinate care, to safety plan for the patients, and it's a very powerful relationship. They do amazing work. Our staff in the ER are trained in de-escalation techniques. They're trained in trauma-informed care. They're trained on counseling for access to lethal means, all of which are cutting-edge techniques that have been referenced in various ways today in our emergency departments. They're useful not only for suicidal patients, incidentally, but for all patients struggling with all different forms of mental illness. We're lucky at our hospital. We also have psychiatrist who are available to consult on our patients. We're one of the few hospitals in the state that actually has that capacity in person, so we of course make use of that. We've built safe spaces in our departments, and that's true of many of the ERs around the state over the last 10 years that have changed their physical plan to develop safe spaces for the management of these situations. In the emergency department, we intersect with people's lives when they are often at their most vulnerable, and it's an absolutely critical opportunity to pick up on perhaps previously unrecognized depression or suicidality, and we take that role incredibly seriously, as I've said. Emergency departments are an integral part of suicide prevention, but I think the most important impression that I'd like to leave with all of you today is what our system actually looks like from the vantage point of the emergency department and the patients, our friends, our neighbors, our community members who come there for care or in their crisis. And I'm going to be frank. It's a grim picture because we simply don't have places. Once we've done our work of assessment, identification, stabilization, risk stratification, care coordination, we then come to a point where we simply don't have places to care for these patients, whether it's an inpatient bed, whether it's a safe treatment space in the community that's supported. There's all different levels that can be employed depending on the situation of that particular patient and that particular family. We have some lived experience in the room I know with prolonged emergency department stays for just this reason. So while we are integrally placed to screen and briefly stabilize patients to evaluate them for medical stability, for example, if they've had an overdose or they've injured themselves, we are not staffed or structured to provide longitudinal care for these or frankly for any other patients. It's not just mental health. It's not what emergency departments were designed for. Yet that's precisely what is happening now. Right now around the state, if recent history is any guide, there are roughly 30 patients right now waiting in emergency departments, sometimes for days, sometimes even for weeks for an inpatient or a safe treatment space to help them with their mental illness. Most of them are waiting for more than 24 hours, some for, as I said, days or even weeks. Every one of us who practices in emergency departments has this experience on a daily basis.  They look back at us in disbelief as we tell them yet again that there's no place for them. There's no room at the end. You'll just have to stay here and they look at us and say, well, how long, doctor? How long is it going to be? And I have to say, I don't know. I don't know. They ask us, why? How? Is this really good? So we take our role incredibly seriously. We play an integral role in the system. There's incredible work that's been testified to that's going on on this issue around the state. It's amazing work, incredibly heartening. But there's much work still to be done. And if we're to take suicide prevention seriously, we desperately, desperately need to invest in treatment spaces in patients and otherwise to support this population when they get to a point when they need that care. And we don't have enough of it right now. It's kind of an emergency. Thank you for your time. Honored to be here. Thanks for the attention of the legislators. Really appreciate that and all the work that you are doing. Aware of that and really appreciative. And thanks to everyone for being here and Kirk and your team for doing this work. Thank you, Dr. Smith. I appreciate you sharing your perspective with us tonight. Next we have Thomas Moore who's coming to us from the University of Vermont and specifically the chitted and accountable community of health. He's going to speak to cash a bit about suicide prevention in the community itself. So thank you so much, Thomas. Thanks, Kirk. Can you hear me? That works. Hi everybody. My name is Thomas Moore. I am the Senior Community Health Liaison in the Community Health Improvement Department at the UVM Medical Center. And I took on this role. I worked at Howard Center for nine years before that. This was a new role that was created so that there would be an individual that was primarily focused on what's called the chitted and accountable community for health. And the chitted and accountable community for health is based on a model that came out of Obamacare. So there are other ACHs in other locations across the state, but our work focuses on chitted and grand dog county. And so when I came in, the most recent, the 2019 Community Health Needs Assessment had just been finished and identified the top health priorities in the community. And the first one was mental health. And so cash decided that they wanted to focus on suicide prevention as a part of mental health. And in order to do that, we created three action teams called the Reducing Stigma Action Team, Screening and Intervention Action Team, and the Social Connectiveness Action Team. And so I'd like to tell you a little bit about the work that has been done over the past three years to focus on those three areas. And so starting with the Screening and Intervention Action Team, the first thing the team wanted to know was how many primary care facilities or practices in the community are currently screening for suicidality and are using evidence based screening, not screening, but intervention tools. And the survey results were not great, and we found that there were really little to few primary care practices that were using such tools. And so the team worked on developing a training, which I'm coming to find out there's other trainings out there that have been done as well, to train primary care providers on the use of the CSSRS, which is the Columbia Suicide Severity and Rating Scale, the CALM, Counseling on Access to Lethal Means, and the Stanley Brown Safety Plan. And we've had some good results so far. We've only worked with five different practices, but what we did is we recruited two experts from Howard Center that work in First Call and recorded them role playing using these different tools and then created a basically a 45 minute training for providers because we found that practices really have little to no time to sit and receive a training. And so we've had good results thus far in terms of providing a 45 minute training. And what's really neat is we've worked with our IT department at the Medical Center and are able to track the use of these tools through Epic. And so we're able to see if the training is provided the results that we want, knowing that it may not be the training that is the only variable, but we hope that it's contributing to an improvement thus far. And so another part of the training that takes place with the practice is establishing a Suicide Safe Pathway to Care. The Quality Manager for the Howard Center is on our team, and so we work hard for the primary care practice to develop a relationship with Howard Center so that they know exactly what's going to be offered when they call, say First Call for example, because there are, as others have mentioned, not that many places to access really. And so so far that's been going really well in terms of the primary care practices understanding I guess better as to what they can expect when they do support a patient in that manner. One last aspect of this team that's been really interesting is utilizing the Zero Suicide Organizational Self Study and working with the practice to assess their current practices and their workflows to see what needs to be done in order to screen, support, provide a safety plan, and support through a pathway to care. And the practices have been very open to being humble and vulnerable and saying we're not doing this well. And so they've done a lot of work in terms of setting up effective workflows and embedding those activities into their practice. So more to come on that, we are currently recruiting other primary care practices to engage in this training and after hearing information tonight I think that we could beef up this training with other resources that are out there. The social connectedness action team Kirk let me know in time too if I go on too long. That particular action team kind of struggled off the bat to figure out what exactly do we want to do because when you think of social connectedness you think of hosting a party or something like that. And we were able to find out and we'll not find out but meet up with a doctor down at Dartmouth who had been conducting research on loneliness with older adults based on their UCLA loneliness scale results. And as Dr. Pepin and Dr. Pepin produced some really convincing results in terms of doing a value-based intervention and so we met with Dr. Pepin and to the best of our ability with the resources that we had at the time partnered up with SASH and also partnered up with the UVM Integrative Health and Wellness Program and recruited health coaches, recruited an expert consultant and then worked with SASH staff to identify participants who had a UCLA loneliness scale score of six or lower that was the threshold. And so we did a pre and a post assessment and had individuals meet with their health coaches weekly. We provided supervision to the health coaches. It was only six weeks which we got feedback at the end that all the participants wanted it to be longer and they really wanted a group scenario but the scores did go up or up. Yes, they got better. Excuse me. So we're currently working on doing a round two and providing group support as well in order to address loneliness and support connectedness knowing that that does contribute to suicidality. And then the last thing that I'll talk about real quick is our reducing stigma action team. The first thing that the team wanted to do was figure out how to measure stigma being that it's kind of a nebulous thing to measure out in the community and so the team did a lot of research and found an evidence-based tool out from Australia. It's called the Suicide Related Stigma Scale and took this scale and turned it into a survey and then used Front Porch Forum to gain responses from community members and then worked with a doctor who analyzed the results and said yes you got a statistically significant sample and here are the results and we got some interesting results to keep in mind while supporting different populations based around reducing stigma. One of the populations was the Vermont National Guard because one of our team members are part of the Vermont National Guard and have experienced Guard members who have died by suicide and so working with that group has been very beneficial and then now the team is turning its attention to an occupational sector the construction industry that based on recent data shows it's the number two industry that in terms of the rate of suicide and so we've been working with PC construction to provide a training and have partnered up with the Center for Health and Learning for that training to take place on-site out at the beta technology site with a hundred crew members which will be really exciting we're going to get some data around that but I just want to reiterate what others have shared and want to thank everybody for their time I'd love to talk with you more if you'd like to after this but we're doing the best that we can out there and hopefully making some some kind of difference so thank you thank you Thomas okay we have one final speaker today we have Karen Carrera who is the training coordinator for the Center for Health and Learning one of my esteemed colleagues and she's going to come up tonight and share some of her personal lived experience with you all so thank you so much Karen thank you Kirk all right I'm glad they're the microphone issues aren't aren't there anymore but I can I can project Sennie said I don't need a microphone well I wish I had notes and you know my computer with me because everything I wrote here I could write maybe two or three more pages just being inspired from what I hear and what people are talking about and then knowing you know the parts of what I do at CHL and having conversations and building awareness we're so excited to be a part of that construction working project but I'm here tonight in a different kind of way so thank you for staying till the end and thank you for your time and effort towards this really important work my name is Karen Carrera I've been a clinician for over 20 years I worked in inpatient outpatient and residential programs I helped build an art space school for neurodiverse young adults I sit on the board and co-chair committees for several suicide prevention organizations in New England and I currently hold a position in mental health and suicide prevention education and training I'm a person with lived experience I'm a lost survivor and I'm a caregiver to someone who struggles when I think about it the common denominator for all of my roles and for everyone who sits here tonight is the role of being human and humans no matter the age color race religion education are struggling in 10 days in 10 days I will be experiencing the 20th birthday of my son Nathan his heavenly birthday in 24 days I will mark five years since he died by suicide March 26 2018 two weeks before his 15th birthday Nathan was smart funny talented sensitive and when he died deeply sad he lived with life threatening food allergies on top of all of that for which he had doctors tests appointments ed visits and many many Epi pens I as his caregiver found those doctors helped to coordinate care took him for tests read food labels spent a lot of time with the grocery store reading food labels wrote letters and notes advocated for him talked to insurance providers called 911 injected him twice with Epi pens and kept him safe I tell you this tonight because the process of keeping him alive and safe with the food allergy was clear and the coordination of care to do so was smooth straightforward supportive and effective he did not die from his food allergy his mental health journey unfolded extremely fast and we saw expedited help from his primary care physicians therapists counselors school personnel his medication providers we had all the numbers national numbers local numbers on the fridge in our wallets around he talked about not fitting in not feeling good enough not having a purpose I told him I loved him and valued him every day each time we cried together and with that never would I or any of his providers have thought that he would have ended his life I didn't know what I didn't know then and the systems that were there to help me that were supposed to be there to help me didn't know either my daughter now 16 has struggled greatly in the aftermath of losing her brother in her journey I have again accessed primary care therapist counselors school staff school supports crisis teams mobile crisis teams emergency departments hospitals first responders I've filled out binders worth of forms spent hours on the phone left messages that were never returned experienced numerous shortfalls med errors wait lists provider turnover and the like navigating the system of mental health is not straightforward and it is not easy even when you kind of work in it its function relies on parents and caregivers to be vigilant advocates to do the thinking to do research find options to ask more questions than you get answers and demand appropriate care when I know more about the sensitivities of medication interactions and counterproductive combinations and have to insist that it is considered in meetings with their care team it's just wrong I know I am not alone in this experience in this critical time we have a significant opportunity and responsibility to the people of Vermont to do better that but that's not to say that things are in Vermont aren't doing people aren't doing good things you know I don't want to misspeak about that there's so much good work happening in Vermont and I'm lucky to be a part of a team who's really at the forefront of doing that work I'm grateful to have that perspective but I know that there's so much more we can do zero suicide requires a system wide approach to informed coordinated effective preventive prevention and intervention some of the things I think about when you know in the work and and come across all the articles and information that I know about you know workforce development retention and incentives to keep trained and experienced clinicians and therapists in Vermont that's really important the stories that experiences I've had and the stories that my friends tell me and colleagues tell me is and actually you know we got information when we did one of our trainings for an EMS group and a national statistic is that one of the obstacles for EMS providers connecting to adequate care is that the clinicians that they are connected to don't have the experience enough to relate to what has happened in their day to day and so they feel like it's just they're not connecting and and they're moving on so you know we have also an issue with insurances and things like that and clinicians coming right out of school sometimes going right to private practice but then that doesn't allow them to have the experience of of you know working in a clinic or working with a team and getting that lived experience of those people doing the work so there's some thought there's lots of thought around what we can do you know to support that and to support them because I know they all want to do good work I know that continued coordination with EMS police mobile crisis call centers and ex eds right finding the funding the resources and the infrastructure strategies for the 988 system Vermont is doing so much to be at the top in the forefront of that because I know many other states don't even have these conversations unfortunately it's a national live system and there are states that are not even having these conversations so thank you for Vermont for Vermont for doing that school engagement and the lives of the kids right connecting the schools the teachers the counselors there with the kids and the families as humans not the test scores the mandates the protocols research shows that school connectedness back to what we're talking about about you know older adult connectedness but school connectedness is a major protective factor and prevention element for youth if a kiddo can say I have a trusted adult at that school even if when they leave they're going home to something that that isn't so great they look forward to going back to school and create and creating that safe space within that school so the trainings that we do and the schools that are having the awareness trainings that we're providing are helping them with language and confidence what we're doing is we're empowering these teachers to say the word suicide to ask the hard questions when we're not we're in this work all the time so those words kind of lose you know that impact sometimes but for someone who doesn't say that word all the time that's a scary word there's fear around that the more we train the more we educate the more we empower we decrease that fear which then decreases the stigma seems like a simple equation to me and I feel very grateful to be a part of that process to help people feel empowered to decrease the fear and decrease the stigma lastly to borrow from tonight's program suicide is leading public health problem in vermont more of a mantras died by suicide in 2021 than in previous years with an average of two to three residents lost every week the number of vermonters experiencing social isolation economic stress adverse health impacts and mental health challenges is increasing it's everywhere your support is necessary to strengthen a cohesive system of suicide prevention and care throughout the state I hope my words have met you in where the work that you do and what you can bring to your work tomorrow I thank the legislation for doing the hard work and the having the hard conversations to bring this forward um and I am grateful to be able to stand here and share my son's story and to have an audience that will listen and if we save one life we save one life thank you very much thank you very much to karen and all the previous speakers um really inspiring to listen today and learn um due to the time uh we are um we were going to do a formal q and a but I think uh given the time we have refreshments that many people haven't enjoyed yet and we'll take an opportunity to ask do questions in a smaller less formal setting so um if you are here live please feel free to stay a little longer ask questions to some of our present presenters or speakers or make connections with people you want to um be sure to stay in contact with after this one of the common traits that we heard today was about not working in silos but working collectively across the continuum and if this event can help to do that um then we've accomplished a good part of the mission so um please do feel free to stay if you're here live and to people on the facebook stream um thank you for joining us we appreciate it uh if you have questions or comments you can put them in the chat we do have someone monitoring that for you at home and we'd also be happy to help if you are here a couple things yes we can validate your parking for you if we haven't logistics right to there's a qr code on that back table where sonny and i are sitting and if you don't get our newsletter but you'd like it just pass your phone on that qr code there's like five simple questions and it's going to ask you what information you'd like what information you don't want um and how we can help there are also numerous help cards as you see on our screen um we have these in a few sizes we have some posters with us if you'd like to put a poster up in your place of employment or your agency we can share those with you um the help cards are actually on every seat there's also a zero suicide brochure that you're welcome to take with you um but we do have extra wallet cards with us so one of our goals at chl is actually to get a wallet card into the purse or wallet of every vermonter because um you might need it for yourself you might need it for a friend or relative and neighbor a co-worker as karen points out we are all human and this is hard right now and so um i'm happy to share several wallet cards if you'd like take them and pass them out help us tomorrow we'll be at the vermont flower show where they see 11 500 people we are there with intention to share resources to answer questions to go where people are and not just expect people will seek us in the moment of crisis but to go upstream and and we will be exhibiting at several conferences events in places where people are gathering so that that information becomes accessible to more people um so thank you for being here today thank you for championing with us this really difficult work and uh i could not be more proud of all the speakers on our team and um as several speakers have said today we are doing good work and there's so much more work to do so thank you for partnering with the vermont state suicide prevention center and chl in continuing that improvement thank you very much


Teaching the steps and how to solo, and seeing the kids succeed and figure out how to do it, and then finding a love for it, and then going to a festival and seeing some of them win awards for it, and just seeing them grow and get so much more confident in their playing and in their selves is really neat to see. It's the passion for the kid, not the group, but the individual as in there are 30 individuals in a room that makes her a great teacher. I've never seen someone give so much of themselves, especially at such a young age. Nothing seems to overwhelm her. My favorite thing about teaching is working with other teachers, working with the kids, and seeing them grow and seeing them find this love for music and this passion and just watching and seeing where they go with it. It's awesome.


Good morning everybody. Happy day 15 of the challenge. You are officially at the halfway mark You did not come this far to only come this far. You got this. You're halfway there Please let me know down in the comment section below how you guys are doing What revelations that you've had about yourself over the last basically two weeks and what you're looking forward to in the upcoming 15 days, but as of today it is November 15th That's the good thing about November with a 30-day challenge is that there are 30 days in November So it makes it easy for us to mark the days. So once again, you're half you're at your halfway mark You didn't come this far to only come this far After the 10-day mark you started making your bed up every morning if you didn't already And your last meal should be between 5 and 7 p.m. This allows your digestive system at least 12 hours of rest between dinner and breakfast You're doing the 45-minute bar again today, which is the first exercise you did on your very first day So I did this intentionally. I want to know if you notice doing it today Are you stronger? Do you have more endurance? How is it changed over the last two weeks? How was your body adapted in your mind adapted and changed over these last two weeks? You have your five-minute cold shower and all meditation and today This is very special day because Tuesday is actually Hanuman's day It is the day of war and so it's also the day of Mars and it's funny in India My teacher won't do do anything that has to do with like a razor or a knife on Tuesday, so he doesn't shave on Tuesdays right because he's it's very Auspicious or inauspicious to actually use what would be considered a weapon on a day of Mars or a day of Hanuman Who is the warrior? Monkey God and the Hindu mythology So I say here in Hindu tradition Tuesday's Hanuman's day below is the video from esoteric Atlanta Whereby speaks of Hanuman and his representation representation of courage Please watch this video because you will have some questions in your journal entry today to reflect on your own courage So here's the link I've talked about this story a lot with the Ramayana and what Hanuman actually represents as he's going up against Rabana, who is the Ten-headed demon who can't be slain and basically this whole story is just basically about how much guts it takes to actually Walk the spiritual path not once in the history of mankind has spiritual spirituality been easy It's not supposed to be easy because we only grow when there's friction And so you're gonna relisten to that answer all your questions today You're at the halfway mark. How you feeling what has surprised you the most about this experience What have you learned about yourself? What has shocked you the most about your experience? What is motivation? What is discipline? What is the difference between the two? We spoke about that at the very beginning and as you guys know motivation Motivation is nothing We need discipline because that's what you're what once the honeymoon phase is over. That's when the real practice begins, right?  How have you changed to look through people in the eyes and smile at them? Same all night time routine now tomorrow The 16th day Wednesday halfway point You didn't come this far to only come this part of this bar make your bed up your last meals should be between 5 and 7 p.m You're gonna either do the 45 minute bar again or the half primary series of ashtanga yoga with ashtanga nurse And you're gonna do the all meditation once again now tomorrow is gonna be a big day A big day of working through deeper childhood Traumas so there's no better way to start looking at your own childhood traumas than the story of Kwan Yen from the Sophia code It's a 60 minute video. I have the link here. I want you to watch that again or lay down and listen to that again You're gonna have your food journal tomorrow's journaling and the topic of childhood trauma is a heavy one If you feel you need professional guidance, please find a trauma therapist in your area This exercise is only meant to explore certain wounds that need healing Have you ever thought about your childhood trauma? Can you think of one experience in particular that has shaped you as an adult? What do you need to do to try to heal the little boy or little girl in you? Can you forgive the adult who hurt you? Have these childhood traumas been projected by you as an adult in what areas did you project your childhood wounds onto others? Can you forgive yourself for this? What is the greatest lesson from the reading of the Sophia code with Kwan Yen now at some point tomorrow? Preferably after you've exercised after you've done your journaling your meditation.  Can you allow yourself? Permission to believe that you deserve to be healed. Can you allow yourself permission to believe that you deserve to be loved? Can you give yourself permission to believe that you deserve to be here on the earth right now? If it helps you can replay the Kwan Yen activation while doing this activity This activity can be repeated as many times as need be after you complete this exercise What was your experience? Please write as much as you can Just as you wrote a letter to a person you admired a few days ago today You need to write a letter to yourself, but not your adult self your inner child Write a letter to the little boy or little girl you once were Tell that child how much you love him or her Tell that child how special he or she is and how much the world is going to need him or her when he or She grows up tell that little boy or little girl that any trauma or hurt that happened to him or her was not his or her fault Remember the child you once were that child is a fractal of God Created by the most high and there is nothing that child can do to separate himself or herself from the love of God You can either write this letter to yourself in your journal to reread daily or you can fold this letter up and mail it to yourself Look three people always and smile at them. So yeah tomorrow guys Do what you can today looking at Hanuman and looking at that courage of Hanuman because tomorrow the 16th is going to be another big day Another big activity. All right, and it takes a lot of courage to go through childhood trauma It takes a lot of courage to look these wounds in the face These wounds that become attached to our ego that shape our ego, which again is the fault sense of self We play in the ego will never reach spiritual enlightenment. And so you are all very brave to do this It's going to be hard But hopefully through the hard work there is liberation and once again If you do feel like you need professional help Please reach out to a healer or a therapist whichever you feel is best for you if it gets overwhelming All right, you guys I would love to hear again down the comment section below if you care to share what you've learned about yourself What's something that surprised you about this challenge all that good stuff a little bit later today? I'm going to be filling with Emmy that that episode will probably air either later this afternoon or Tomorrow where we're going to go deeper into Reiki and yoga because our yoga course the intensive is starting this Sunday We saw one seat left one seat left for all the people who are already registered You will be receiving your manual and your first week's homework and some other stuff links to the zoom all that kind Stuff at the end of the week probably on Saturday is when you'll receive all of that So be looking out for that on Saturday for all that information to be mailed to you So we can be ready for class on Sunday. All right, you guys. I hope you're having a wonderful day and I'll talk to you soon


Anthony Edwards cubic on the vortex wolves. That's nice. Oh, wow. Next card's great. It's 50 next one is a Galactic Paolo Ben carol Let's go. Oh, no magic. Oh, no magic good teams win great teams cover Monster for the magic going into a mag Paolo galactic


Croatia ditching their own currency for the euro. They don't make sense. They don't make sense because they're globalists. And TJ, that's the news that we got this morning. I believe it was this morning. Croatia deciding to adopt the euro by January 1st, 2023. If I was Croatian, I'd be so effin' pissed. Okay. Croatia, by adopting the euro, just gave up its own sovereignty. Over in its own economic, political system.  That is one of the dumbest things, the dumbest things I've ever seen any country do. What a time for Croatia to screw over Croatians. Croatia, from what I understand, has been an amazing place to live and vacation and enjoy life for a number of years. This is the peak of Croatia. Croatia, as of 2023, is on the downturn. 10 years from now, Croatia is gonna be most likely the living standard would be a lot lower and it would have gone through a couple of economic turmoil, events, possibly get involved in proxy warfare as well.  What a disaster.


Hello everyone, I'm John Furrier here at Palo Alto at our CUBE headquarters. We're here with John Del Santo, Senior Managing Director at Centra for a CUBE conversation. John, welcome to theCUBE, good to see you. Thanks John, great to be here. So we were just talking before we came on camera about Centra and all the stuff you guys are doing. You guys are in the cloud heavily. We've been following you guys have probably one of the most comprehensive analytics teams out there and global SI market and just how the world's changing. So it's pretty fun and looking forward to this conversation. So I got to ask you first before we get started, I want to jump in with a ton of questions. What is your role at Centra? You're in the Bay Area. Take a minute to explain what you do for Centra and what's your territory. I've got the best job at Centra. So Centra's got close to half a million people right now and my job is I'm responsible for our business on the West Coast, across all of our industries, et cetera. I've been here 32 years so I've seen a lot of things happen in the Bay Area and I now have the responsibility of making sure that we're doing great work for our clients and we're doing great work in the community and that we're providing great opportunities to the thousands of people that work for us here in the Bay Area and across the West Coast. So it's a lot of fun. Obviously West Coast is booming and for tech it's been a hotbed and obviously the industries across the board now is global. I got to ask you because you've been around multiple ways of innovation and a Centra's been, had their hands in enabling a lot of value creation for clients. You guys have a great reputation. It's a lot of smart people but the ways are always kind of different in their own way but sometimes it's the same. What's different about the way we're living now because you can almost look back and see the major inflection points now. So the PC revolution, client server, interoperability, networking stacks, one standard. Then you saw the internet come. Now you got Web 2.0 and now you've got the whole global. You've got things like cryptocurrency and blockchain. You have multiple clouds. You have a whole new game changing dynamic going on with IT infrastructure combined with open source at a whole another level. So how is this wave different? Is it like the, how would you compare? Well, I think all the technologies that have waved through my career at least have been real enablers for the business model that the companies had at the time and that they evolved. What we see now is epic disruption. So the waves now are, we have digital native companies that are just disrupting the heck out of the industry or the company that we're trying to help. And so it's now about pulling all those technologies together and really figuring out a new business model for a client, figuring out a new distribution channel, a new product that's maybe native natively digital. And so it's very, very different, I feel, than it was five, 10, 15, 20 years ago through some of the other waves. Talk about things going on in the Bay Area before we get into more of the global things because I think the Bay Area is always kind of a leading indicator.  Some cool things happen. You've got things like the Gold State Warriors got a stadium that's being built. I'm watching the World Series with the Red Sox and you see Amazon Statcasts. You're seeing overlays. You're seeing roads around. All these things are changing the work and play. The Bay Area's got a lot of leading indicators. What are some of the projects that you've been involved in? What's happening now that you think's worth noting that's exciting that piques your interest? Yeah, I mean, we work across every industry and we do a ton of work in tech but I actually find some of the more interesting projects are the ones we're doing for healthcare companies in the Bay Area, some of the utilities in the Bay Area, some of the big resource companies, some of the financial services institutions because like I said before, all of those industries have disruption coming or have been disrupted and so we're doing some work right now around patient services and healthcare and pharma that is really interesting. It's meant to change the experience that a patient has that you and I have when we interact with our healthcare providers or the whole industry. And so those kinds of projects are really interesting because a lot of these industries are old and sort of have a big legacy of state and model that they need to transform from so they need to move fast and what we kind of describe it as a wise pivot, they sort of need to move but they need to make sure they're moving at the right time. They can't hurt their existing business but they got to pivot to the next business model and that's happening in lots of places and you're right, I think it is happening a lot in the Bay Area and the West Coast is sort of a bellwether. I want to get your thoughts on some of the moments that are going on in tech. You mentioned before we came on camera you worked for Apple in the old days and Tim Cook was just recently tweeting yesterday that had tweets going around privacy was at this big GDPR conference. The role of regulatory now is in changing some of the West Coast dynamics used to be kind of fast and loose West Coast, innovate and then it gets operationalized globally with tech, tech trends. What's the tech enablers now that you see that they're involved that actually have to deal with regulatory and is regulatory an opportunity? You mentioned utilities, finance, those are two areas you can jump out and say, okay we see some of their privacy is another one. So you have a perfect storm of tech and regulatory frameworks. How's that impacted your job in the West Coast? Well, I mean, GDPR is we live with every day and clearly we're doing a ton of work in Europe and I think that's one of the advantages Accenture has is being a big global company and being able to take lessons learned from other parts of the world that are likely to come to the United States, et cetera. But I think the combination of tech and regulatory are going to be merging together here pretty quickly especially when we talk about AI and data privacy and that sort of thing. But it's definitely been an evolution. Great to hear Tim's point of view on what Apple thinks. And it has been really fun in my life to see Apple in the 80s, when I worked there, they were a client of mine in the 80s. I worked with Nex Computing in the 90s and then obviously they're a big partner of ours now. So it's been a really interesting evolution. What are some of the growth accomplishments you guys have in the Bay or actually has been growth here for you guys? Obviously we've been seeing it. Well, I think the amount of tech driven disruption or digital transformation we call it is growing like crazy. So 20 years ago we were doing a lot of e-commerce work. We kind of shied away from doing Y2K work and a lot of our competitors saw that as a big opportunity. We didn't think it was a lot of value for our clients, fixing old systems. And so we pivoted to e-commerce in a very aggressive way. And I would say now that's evolved even further where more than close to two thirds of our business here on the West Coast is what we call the new which is cloud security, digital analytics. And I really think it gets down to, we were talking a little bit earlier about the data. And so we have more data scientists than we've ever had and we probably hire them one or two every day out here on the West Coast and it's about the data. Data is driving our consulting business, it's driving our technology business, it's driving what we're doing with AI obviously and things like that. So the transformation's been pretty tremendous. So take a minute to explain the data. You mentioned a lot of things. You got data and then you got cloud and you mentioned earlier you got kind of cloud first companies. You got born in the cloud, born in AI, AI first, data first, these new companies that are essentially disrupting incumbents. Also your clients that are kind of born before the cloud and they got to transform. Is digital transformation one of those things or both of those things? How would, how does digital transformation translate to the clients that you guys work with? Well, every client has a unique set of needs depending on where they came from. We do a lot of work with the digital natives. We do a lot of work with the unicorns out here on the west coast. And their needs are different. They need to learn how to scale globally. They need help in the back office. They need help sort of maturing their business model. We do a lot of work with legacy, financial services companies, healthcare companies, that sort of thing. They need to figure out how to sort of pivot to digital products or digital interactions with their customers. We have a very large business now in Accenture Interactive around helping to find customer experiences for clients. And we think it's our mission to sort of help our clients really redefine that relationship with their customer, their supplier, their supply chain. And the experience is a key part of that given expectations as well. Yeah, we have a lot of CUBE conversations around IT transformation as well. And, you know, out at CIO, big time firm, you won't say the name because it's a little out of them, but he said, we've been outsourcing IT for so many years, but now we got to build the core competency internally because now it's a competitive advantage. And they have to ramp up pretty quickly. Cloud helps them there. And they need partners that can help them move the needle on the top line of the business, not just cost control and operational scale, or whether it's horizontally scalable scale out or whatnot, top line revenue. This is what the bread and butter of the companies are. So how are you guys engaging with the clients? Give some examples of how you're helping them with a digital strategy to drive their business. How do you engage them? Do you do the standard sales calls, engagements? Do you bring them to a technology center? As the world starts to change, how do you guys help those clients reach those top lines? Yeah, a perfect client for us. We're really good at helping clients cut costs and get really efficient and be good with their peers on cost structure. We love a client where they want us to help them with that and they want to pivot the savings to the new part. The way, one of the things that triggered a thought when you mentioned that was we like to bring our clients into our innovation hubs. So we've had labs here in the West Coast for a long time. We now have 10 innovation hubs in the US. We have a very large one in San Francisco now and so we'll bring a client into our innovation hub and really roll up our sleeves with the client and over a week or two weeks or three period of time, you really brainstorm on how, you know, envisioning their future for their company, build a minimal viable product if we have to out of our rapid prototyping capability and really envision what the target and state of their business could be, of their product could be or their customer interaction. And we'll model it. Rather than sort of do a study, do another study, do a PowerPoint presentation, let's roll up our sleeves and figure out how to really pivot your business to the new and then take it from there.  Yeah, so we'll have, you know, any given day we'll have at least two different clients in our location doing either a couple of day workshop, a multi-week workshop and it's co-creation. It's us collaborating with our clients to figure out a solution. A good example is we had one of our large clients from the West Coast in there recently and we're trying to figure out how to use drone technology to drive analytics in, you know, over a geography to provide better data than to minimize risk. And we've got a number of co-creation projects now going on with them to figure out how do we take that into a solution that not only helps their business but maybe is a commercially available system. Yeah, our Wikibon research team brings us all the time with IoT and security. You're starting to see companies leverage their existing assets, which is physical as well, which is digital, and then figure out a model that makes them work together because these new use cases are springing up. So what are some of those use cases that you guys see happening? Because you mentioned drone, because that's an IoT device, essentially. There's all these new scenarios that are emerging. And the speed is critical. It's not like you can't do a study. There's no time to do a study. There's no time to do these things. You got to get some feet on the ground. You got to have a product in market. You got to iterate. This is the DevOps culture. What a success. We did a project for a big ag company, not actually a West Coast based company, but they came to our labs to look at it. And basically what we did was we covered an area that's basically size of Delaware in terms of drone video. We were able to drive analytics from that and 10 times faster figure out for them where the forest was weak and where it wasn't, where they had to worry about vegetation, where they might have disease issues or other risks they were facing them. And those analytics we were able to drive a lot faster. And so rather than manually going around this huge, you know, huge square mile set of geography, they were able to sort of do it through technology a lot faster. Yeah, just a side note, I was talking to Paul Daherty and interviewed him. He's, we were celebrating, covering the celebration, your 30th anniversary of your labs. And one of the interviews I did was a wacky idea which made total sense was during like a car accident or a scene where there's been a car accident, they send drones in first and they map out the forensics first. And he's like, okay, who would have thought of that? I mean, these are new things are happening that are changing the game one on the road because they'll open up faster. They get the data that they need. They don't have to spend all that physical time laying things out. This is not just a one off. This is like in every industry. Absolutely. Is there an industry that's hotter than another for you guys? You'll always hear oil and gas, utilities, financial services, it's kind of the big ones. What are some of the hot areas that you guys see the most activity on this kind of new way of taking existing industries and transforming them? You know, I don't know if I could pinpoint an industry early on, I mean, because I see, you know, what we're trying to do with anti-money laundering and banking is really moving the ball forward. But we're doing patient services and pharma and healthcare is pretty aggressive. Even some of the things we're doing for some of the states and governments around, you know, citizen services to make sure that, you know, because all of us have expectations now on how we want to interact with government and, you know, our expectations are not being met in just about every department, right? So we're doing a lot of work with states around how to, you know, kind of provide a better experience to the citizens. So I don't know if I could pinpoint an actual industry. But one of the fun ones we just, you know, that we're involved with out here in our patch is one of the big gaming companies in Vegas. We are doing a lot of video analytics and technology. And again, it's something like 20 times faster to be able to detect fraud, being able to figure out what's going on at a gaming table and how to provide rewards quicker to their customers, keep them at the table faster or longer. He's got a nice stack of chips always going down. Get him a comp room, he's feeling down. Look at his facial expressions. I can almost imagine, I mean, this is the thing, I would agree, I think this every vertical we see is being disrupted. Just mentioned public sector is interesting. We were riffing at an Amazon event one time around, you know, who decides where the self-driving cars, these towns and cities don't have the budget or the bandwidth to figure out and reimagine the public services that they're offering the citizens. The consumerization of IT hits public sector. And they need help. So again, every industry's going on. Okay, well I want to step back and get some time in for analytics because you guys have been investing as a company heavily in analytics in the past 10 years. Past, I think seven years, you guys have been really, really ramping up the investment on data science, analytics. Give us an update on that. How is that going? How has that changed? And what's the update today? Yeah, it's a good point. I mean, again, you mentioned the labs being here for 30 years, a lot of our data scientists and big machine learning and big data folks, frankly, started the labs here years and years ago. And so we've now got one of the largest analytics capabilities, I think, of any services company globally. We called it applied intelligence. It's a combination of our analytics capability and artificial intelligence. And we basically have an analytics capability that's built into all the different services that we provide. We think it's, everything's about analytics, just about. I mean, clearly you can't do a consulting project unless you've really got a unique analytical point of view or unique data around assessing a client's problem. You really can't do a project or implement a system without a heavy data influence. So we are adding, you know, frankly, I think every day I'm improving more analytics headcount into our team on the West Coast in lots of different practices. And it sort of spans industries, it spans all the platforms and that sort of thing. We're the largest with most of the big data players. You know, I think one of the consistent trends with AI, which is now being the word, artificial intelligence AI, is kind of encapsulated the whole big data world because big data is now AI because of the implementation of it. You're seeing everything from fraud, you mentioned anti-money laundering, you know your customer, these kinds of dynamics, but you get the whole dark web phenomenon going out there with fraud. All kinds of underground economies going on. So AI is a real value driver across all industries around, one, understanding what's happening, and then how to figure out how applications to development could be smarter. This is kind of relatively new concept for these scale out applications, which is what businesses do. So how is that going? Any color commentary on the impact of AI specifically around how companies are operationally changing and re-imagining their business? Well, I think it's very early days for most of our clients and most big companies. I think we've done some recent surveys that say something like 78% of our clients believe that AI is really, really important and they're not at all prepared to deal with or apply it to their business. So I think it's relatively early days. We, there's a huge fight for skills. I mean, so we're building our team and that sort of thing. We're also classic Accenture. We grow skills pretty well too through both on the job training and real training. And so I think we're seeing sort of baby steps with AI, there's a lot of great and expanded solutions out there that we're able to apply to business problems as well. But I think we're in relatively early days. It's almost as if, you know, the old black box garbage in garbage up, you have good data and you got to understand data differently and I think what I'm seeing is a lot of data architect going on, figuring out how do we take the role of data and put it in a position to be successful is kind of like, cause then you use AI. That's great, but what about what we missed this data set? You got to have fully exposed data sets. So this is all new dynamics. So you have to iterate through it and you'll have solutions that'll start and restart. All right, so final question for you. Tell us about this technology hubs again. So you have the labs, get that. So how many hubs do you have, technology hubs? Well in the U.S. there's 10. But I would say in the West Coast it's really San Francisco and Seattle right now. With San Francisco being our flagship. And frankly it's a flagship in the U.S. We've had the 30 year presence of our labs here on the West Coast and we've had design studios on the West Coast. We've had our, what we call liquid studios which is a big rapid prototyping sort of capability. We've had our research, et cetera. We've pulled all of those locations. So our lab started in Palo Alto, went to San Jose and is now in San Francisco. We've pulled all those locations together into what we're calling the innovation hub for the West Coast. And it's a five story marquee building in San Francisco and it's where we bring our clients and we expect to have literally, I think last year we had 200 and something client workshops and co-creation sessions there. This year I think the number's going to go to 400. And so it's really becoming a fabric of all of our practices. How important is the co-creation? Because you have a physical presence here and it's the flagship for the innovation hub. And it's an accumulation of a lot of work you guys have done across multiple things you've done. Labs, liquid labs, all that stuff coming together. How important is the co-creation part as a mechanism for fostering collaboration with your clients? Co-creation's certainly hot. Your thoughts on co-creation. Great question and I would tell you, Accenture's kind of gone through waves as technology's gone through waves and so we were always an enabler for our clients' projects and we did a lot of project work. I think we're in a wave now where we're going to be the innovation partner. We continue to sort of be named the innovation partner or the digital partner for certain clients. And we're going to do that through co-creating with them. And it's not just at their site, et cetera. It's going to be co-creation in our labs where we're taking advantage of the hundreds of data scientists and computer researchers and technical architects that we have in our labs to create something that's new and fresh and purpose built for their particular business model. So we think co-creation is a huge part of the formula for us being successful with our clients over the next 10 years. And so that's why we put this infrastructure in place. Expect it to expand and to be sold out and that sort of thing. But it's a good way for us to build capability and really, really viable solutions for our clients. So it's not just a sales development initiative. It's an operationalized engagement and delivery mechanism for these guys. Exactly, exactly. I mean, it has its self-markets, but it's not about marketing. It's about, you know, we'll have tours and we'll have little tourism through our center. And so clients will say, well, look at that maker lab. Look what you're doing with that client. I want one of those, right? I need to do that in my business, even though I'm in a different industry. So it's not really a marketing tool per se. It's a way for us to interact with clients. Well, it's a showcase in the sense of where you can showcase what you have and if clients see value, they can go the next step. It's an accelerated path to outcomes, reimagining businesses. Okay, final question. What have you learned from all this? Because now you guys have a state-of-the-art engagement model, delivery model around cloud, all these things coming together, perfect storm for what you guys do. As you guys look back and see what you've built and where it's going to go, what are the key learnings that you guys came out of the West Coast team around pulling it all together over the years? What's the key learnings? Well, I think that our clientele is just thirsty for innovation and innovation now. It's not about sort of let's envision the future and we'll get to it some other day. It's what can we do right now and what journey, you know, what glide paths are the way on to change our business. So the pace is just radically different than it used to be. And so it's about changing, you know, rapidly changing, putting real innovation on it and collaborating with clients. And at a pace that we've never seen before. I've been here 32 years and I've just never seen the pace of change. That's great, John. So I think some of them are really appreciated. We'll get a quick plug-in. What's coming up for you guys? What's going on the West Coast? What's happening? Well, we're in event season right now. So we just finished all the, you know, we're wrapping up Oracle Open World. We just won five awards at Oracle Open World. We just did an acquisition on the West Coast to beef up our Oracle capabilities. We've got re-invent and we have all kinds of events coming up, but it's been a pretty busy season. So cloud and data has certainly helped rise the tide for your business? 100%. I mean, the cloud is taking an extension from, you know, kind of in the back of the office and put us into the front office over the last 10 years. Well, certainly it's awesome. It's re-leveling the playing field, allowing companies to scale out very rapidly, bringing in DevOps culture, new kinds of modern application developments, real value being created. Super exciting time. Thanks for coming in and sharing the time. John DelSanto here in theCUBE for CUBE Conversations, Senior Managing Director, Ascension. I'm John Furrier here in theCUBE Studios for CUBE Conversation. Thanks for watching.