Good morning. This is the Senate Health and Welfare Committee. It is April 22nd, and it is Earth Day. And just I reserve the rightest chair to make a comment that the health and welfare of people is directly correlated and connected to the health and welfare of our planet. And I remember the beginning of Earth Day when I gave my first talk, and I hope that some of you also remember that and the significance of celebrating our, the healthy planet that we should have. We're working here to bring things together and I know that as we look at some bills, perhaps coming up. We will be again linking our environment with our public health. So thank you all for being here today we are going to begin by looking at H 210. And we have some folks here to help us improve the bill give comments on the bill. So, we have a draft up on our web page and I know that Katie has been our Ledge Council has been working hard on the bill she'll be here with us a little bit later but right now we'll just we'll begin and hear testimony and again committee I think our rules, end of end of session rules we want to listen and sort of restrict our comments and our questions as much as we can we did such a good job yesterday. Very proud of you on me. So, let's, let's go right ahead then. Hillary Wolfley is here. Why don't you introduce yourself for the record, and we'll listen to your testimony. My name is Hillary Wolfley I'm the associate director of the Vermont program for quality and health care and I'm very happy to be joined by our executive director who will be delivering the testimony Kathy Fulton. We were unsure just I'll let Kathy, but as to who would be showing up so we're very happy to be joining you this morning and I'm going to pass it off to Kathy. Thank you. Thank you, Hillary. Can everyone hear me. Yep. Yes, we can. Good. Good morning chair lions and members of the Senate Health and Welfare Committee and thank you for this opportunity. Vermont program for quality and health care is submitting this testimony, requesting that committees consideration related related to the following section of draft bill h 210 section 252 d six. And VP QHC would like to ensure consistent funding is provided to support efforts to improve the equitable delivery of care across the continuum of health care services here in Vermont. Most immediately, and in partnership with Dr. Maria Mercedes Avila, VP QHC began offering a baseline health equity training series for health care providers and professionals called structural competence and cultural humility to address disparities and inequities. In January of 2021, VP QHC received funding to coordinate three of the baseline trainings for health care providers, also including mental health providers. And within just a few weeks of posting the trainings on our website. All available training dates had been filled beyond capacity, and our waitlist grew to over 80 interested participants. VP QHC was able to secure funding to coordinate an additional eight baseline trainings, but we anticipate that these training sessions will fill quickly as well. And to date, two of the baseline trainings have been completed. The training series has received excellent feedback from participants with all participants indicating that as a result of the training they are able to demonstrate increased self awareness of racial ethnic and class biases. Additionally, all participants reported that as a result of their participation in the training, they will be able to incorporate structural competence and cultural humility into the services they provide. VP QHC is looking to expand this training series to meet this demand and offer at no cost to the participant, an additional series of baseline and advanced health equity trainings over the course of the next year. We are anxious to identify additional funding as soon as possible as there is willingness and readiness among the community of health care providers and professionals to start this journey now. VP QHC believes that health equity, health equity and equitable health care is quality health care. Equity is included as one of the six domains per quality that was identified by the Institute of Medicine from its quality chasm series back starting in 1999. And our testimony has a table that outlines those domains of quality. So we very much appreciate the committee's attention and dedication to advancing this essential and much needed work here in Vermont. And that's that's our testimony here this morning chair lions, and I believe I just saw a message that Nellie has it posted on your website. And we have additional details and information on health equity available on the VP QHC website as well. Thank you so much and I understand the work that you're doing I do have a quick question that might inform any changes we make to the bill. And that is the work that you're doing seems or could be consistent with CEUs through the Department of Health and others and so I'm my question is, are you coordinating with the, the OPR or Department of Health in the administration of this. Yes, absolutely. I believe the mechanics is that we go through the a heck up at UVM, but we're absolutely and for quality professionals, we write directly at VP QHC can submit to the National Association for health care quality for CEUs as well. And we are the Department of Health is overseeing our contract for this work currently. So there. Yeah. Okay.  Thank you. Very helpful. Thank you very much. You're very welcome. And we're just going to move right along. We greatly appreciate the time and effort that you put into your testimony. So we're going to continue along and hear from. I don't see more cues here. We're going to move along to which are to hear from Wyndham County. Good morning. Good morning. Why don't you introduce yourself for the record and then we welcome your testimony. Sure. So I'm here on behalf of the broader borough area BIPOC health justice committee. And we also submitted a written testimony. Another hat that I wear that I'm not technically representing here but it is going to be relevant to my testimonies on the second vice president at the Wyndham County branch of the NAACP. And I thank you for being here and if it's okay I want to start my testimony. Great. So I want to talk about this sort of from the work that we did that was done with the BIPOC vaccine clinics in southern Vermont which I helped architect the model for. And we were able to vaccinate over 1100 people that were 80 to 85% of whom were BIPOC about 95% were in a household with BIPOC. And the reason why we were so successful for for several reasons. One, we were able to collaborate in Justin Wyndham County alone with over 36 organizations that do community work, whether with the homeless or people who identify as LGBTQ plus we basically were able to work with a lot of community partners. We were able to fund people to actually have calls and to help schedule people for this for the clinics. And to note one of the more important collaborations was with the Department of Health, especially the health equity and community engagement team and our directors of public health for our counties. And other success, other reasons why we were successful is because we were able to have the one to one sort of conversations with our community members and being able to identify what are the things that are that are preventing you are creating a barrier for you to getting this vaccine. And among them we saw a transportation be a really big one, not understanding the effects of the vaccine or being able to understand that they were free being being not able to be to register for it because whether they did not they didn't know how to fill out a form they didn't speak the language. They didn't know where to go there were so many lengths it was confusing. And we were on top of all that we were able to provide a lot of different resources for them, whether they be links to people to call for people to call, we were partnered up with UVM to create an education session so we were basically on the ground doing this work. And the reason why we were able to do this is because we had money. We had partners, and we had the backing of the Department of Health. And when I look at this bill. I see this model and the success of the model that we've had with the BIPOC clinics being able to be backed by a state strategy. I'm excited that this bill went to the Senate, but I worry that right now the it says that the Office of Health Equity will be created when financially able to or one fiscally possible something like that. And that worries me because that means there's no real, it doesn't seem to me that there's real accountability of when this Office of Health Equity will be. And we need, we need some type of state strategy and we need it soon because those of us on the ground we know we know what needs to happen. We are with the people. We know the things that we need to solve and it's not just in healthcare. It ranges so many different types of aspects and we need to be able to have those conversations. And we need money to have those conversations. And basically the end of my testimony just hoping that there's accountability around funding for collaborative partnerships and some type of timeline of when this Office of Health Equity is supposed to start. Thank you. Good. Very, very well said and good points that you've made. Very short question, Senator. Thank you, Senator Lyons. I just wish you thank you so much for your testimony. And you're able to stay on there is a new draft that includes a couple amendments that speak directly to your concerns, including a date certain by which the office needs to be included and some more fun money, more information about funding so stay tuned and happy to answer more questions after we get to the draft. Excellent. Thank you so much, Senator. Okay, right, we're we're all looking forward to our new draft, but it's important for us to hear confirmation of any of the changes that we're making so your, your comments are very well taken. So on to Joanne Crawford of the abnaki agent agent. Sorry, nation. Joanne is not here yet. Oh yeah you're here. I can't stand zoom. We need to be in our committee room and you need to be walking up and sitting down in the chair in front of us so we can have a discussion so thank you for being here. Thank you so much for your testimony. Yes, thank, thank you for inviting me here today to provide testimony, and I am providing testimony today as an individual. I am a Mrs. Koi abnaki. And I wanted to just bring up a couple of items regarding the language and content of the bill. The first is on page two section for a the down towards the bottom of the section of section a. There are some races lumped together in a group called other. I think that is inappropriate for this type of bill because this bill is striving to make everybody visible and everybody in it and be inclusive. And I, and I, and I think using other races is kind of counter to that purpose. May I ask you how you might improve that language.  There's no way that this bill like this page to section for a got it. Thank you. Okay. And also, there's some amazing information in here as statistics provided on many groups, but there is a lack of health and social statistics for the Native American community. I think adding that information is only going to strengthen this bill and also if when the commission is, you know, created is also going to be a great starting point for them and providing some base information to work with. So I would love I really would like to see more of the Native American information included. In any way that you can help us access some of that data. At this point, we're looking to pass this bill out. If possible, by tomorrow. Oh, wow. I can check with it. I would have to go through the Vermont Department of Health for sure. And I can see what they can try to pull together by the end of the day tomorrow is that we'll we'll we'll work together on that we'll see what we can add in at this point. This is crunch time for the legislature but I your comments are again would help improve the bill so we'll see what we can do. I don't need to put this burden on you. Our job. So that that is all I had. Thank you so much for inviting me to be here today. Well, thank you. Terrific. All right. And we're now going to continue get my agenda back. Why don't we just go, we'll go to Kristen Murphy and then I do see that Mark Hughes is here. So we'll we'll go. Mark, if you are hearing me, you'll be after Kristen. So Kristen, welcome. Or Susan, are you speaking on behalf of the organization? Susan Aronoff. No, Madam Chair, Kirsten Murphy will be joining. However, I told her that she was seven of seven, and she has something else. So I would suggest just starting with Mark Hughes, and I will email her right away and let her know that she's up. Terrific. Thank you. Perfect. Mark, are you here? Kristen is in the waiting room so we'll. Mark, are you, would you like to go now or there? Why there you are. Move ahead. Good morning, Madam Chair. Welcome. My name is Mark Hughes. I am the executive director of the racial justice alliance and justice for all C3 and C4. Can you hear me? Hang on a second. That was a someone was unmuted. Please go ahead. No problem. And I would like to first of all thank the committee for allowing me to appear before the committee, the racial justice foundation, which is doing business as the racial justice alliance. Our mission is to secure sustainable power and to ensure agency provides security for black descendants of enslaved folks and while embracing their history and preserving their culture. Our current major priorities are eliminating historically oppressive and exploitative obstacles in existing disparities and wealth and in home ownership and wellness. Providing targeted protection and economic relief during the COVID-19 pandemic, instituting and maintaining a programmatic and sustained approach to support cultural empowerment for black descendants of enslaved folks. Within our organization, there is a lot of stuff going on. Some of that stuff is outreach and education. Some of it has to do with cultural empowerment and there's also community engagement and support. A lot of programming going on. One is also initiatives and platforms and initiatives which brings me here. We are the creators of H 210. We came into a house and introduced H 210 with a group of us. I think some of our board of directors and others, probably about five of us. In H 210's current state, we cannot support it. There's a little background as well. One of the things that we're also doing at the same time that we're doing this work is something that we call a wellness working group.  Our work involves creating and managing what we refer to as disruptive initiatives. There are a lot of clinical strategies that we are able to leverage in the lives of folks such as peer to peer networking, such as affinity groups and various other strategies. There's also a long range strategy that we're working on for black led alternative approaches to creating healthy wellness and outcomes. We initiated the statewide BIPOC vaccination program here in Burlington. That is ongoing and I believe there's been upwards of maybe somewhere around nearly 2000 people vaccinated here in Chippin County. So we too, instead of going back and repeating what which he was saying we have similar relationships to include contract with the health department. We're also working with the Chittenden County Health Emergency Group. It was us in Chittenden County that put forward the health is emergent public health emergency, Madam Chair. You're in Chittenden County so you see a lot of stuff is going on here so also in that work. There has been a lot of progress in collaborating a lot of organizations around the health is a health racism as a public health emergence. Excuse me emergency emergency here. There's, there's also a lot of collaboration that we're doing with various agencies here in Chittenden County on on health and wellness work. Not the least of which is, you know, relationships with the region, Chittenden County regional planning and North various other organizations so. Um, yeah I wanted to just talk a little bit about the policy. You know, clearly the work here. I just wanted to side notes I forgot to mention is the work here also led to you know through the racial equity inclusion and belonging work where we in addition to working to establish the racial equity executive director at the statewide level we also were able to establish a racial equity inclusion and belonging director here. Recently there's also a health equity, a health equity manager that has been hired for the city as well. So, when we put forward on age to age. We also put forward Jr age six, which is the state joint resolution resolution of the state declare racism as a public health emergency as well. And I think that's currently in a house general of no human services from not mistaken. Happy Earth Day. I want to certainly acknowledge that because without that. So, none of this conversation is worth having got to acknowledge Earth Day today so I want to do that. It's sort of age 210 is concerned. We were not happy, we were not pleased with the with what came out of committee and house, it was, it was unacceptable. I mean, it was transparently, you know I had a direct conversation with the chair, as well as our representative, who brought the policy who introduced the policy. And we expressed emphatically are discontent with the outcome of the policy in the house. The reason why was is because few things, the, as it was introduced the policy sought to establish an office of health equity in the Department of Health to advise that is to say again, the policy established an office of health equity in the Department of Health to advise the commissioner of health and governor and the general assembly on the matters of health equity effect in Vermonters. It also established the health equity advisory commission to provide the office of health equity with recommendations and guidance, as well as awarded grants for the promotion of health equity, and it provided a provision for data collection to better understand health disparities in Vermont, as well as requiring additional and additional two hours for continuing medical education on cultural competency in the practice of medicine. The bill received widespread support, huge support. We, this is the best bill that we feel we put forward and is the only bill that crossed over. We also put forward a bill on home and land ownership. We supported a bill on home and land ownership we put forward a bill on economic equity. So there's a number of policies that we put forward and I won't go through all of the details but this is the one that crossed over and this is the one that we were most proud of and this is the one that we thought was most important and this is the one that we feel that we feel is most urgent in light of the fact that yes, right now, as a nation, due to COVID-19 bearing bear all of the inequities that exist across all of the determinants housing and education employment. This is access but economic development home and land ownership, for example, even the so called criminal justice system. There's so many disparities that converge up on the wellness of people and specifically first and worst black and brown people in our nation. This is a national health emergency. Now is a time to act. We were very concerned that this policy was moved somewhat to the back burner so to speak. And there has been a delay now that this policy effect, effectively represent and I apologize because I did not see your latest iteration of the policy until just as I was getting on the call so I can't really speak. I'm not talking about the very, very latest iteration, but it happens all of the time so it's not, it's not that, you know, not that pressing I think we can reconcile that easily. So, so this this is a this is a big deal this policy is a really big deal to the racial justice alliance and in our constituents. And as you know what we're seeing here is is that, you know, as passed by the house. Clearly, there is no office of health equity being created here. Vermont needs someone in leadership who is experienced in the area of health equity to address health inequities and to prevent for example situations that were created by Vermont's vaccination roll out in other types of situations for example like the testing. There's no debacle that happened here in in it in Madam chair. Imagine being on Riverside Avenue and Manuski's there and the old North ends there. So, this is a pretty hot spot. This is my neighborhood. So, this is not just, you know, you know, I think my chief constituent is me, I guess is what I'm saying. So, I can really I don't just relate to the people that we represent I am the people that we represent. So this is near very very near and dear to me personally. Under the original plan for my prioritize people in nursing homes, age 75 and over nationally 70% of people who reside in nursing homes are white. So I think that's one of the problems with these policies and it just goes on and on and I can go deeper into that I'm going to skip that and go into the next Madam chair, go ahead. I was just going to say, in the interest of time, if you could really zero in on the your comments on the bill itself, your suggestions for improvement, and you have already and we hear you. Please go right ahead but try to. Yes, I should be accustomed to this because usually when it's super duper important to us, then time is that of the essence to my best to get get there. Unfortunately if you can expand the day for us we'd be more than happy for that. Well already did I woke up at four. So here's what I'll do is I'll just try to pick up the pace a little bit and get through. Get through some things I didn't want to give a shout out to Senator coming so because she for so long represented me in Washington County so. Hi. The other piece of these the other pieces that I was concerned about was is that we're concerned about here is is that I'm as past it tasks the advisory commission with the work is already been. That's already been completed by by us in terms of how we presented age 210, all of that. And again, that's just an explanation that stuff was already in there. It also implies that it's, you know, when it's fiscal, fiscally practical to create an office of health equity and that's this is really where I'll dive into the bill. And it also, you know, again just another expansion of the executive director of racial equities responsibilities to which is, you know, it is what it is. And you can put on her plate but I won't speak for that. The bill itself I have here. And I want to start with that last comment is is, you know, when the bill came out of committee it was amended five times and even the funding on it was stricken at the end of the day. I think the appropriations felt it was worthy even to be funded. There's, there's a. I think those are all of the areas that we are concerned about. I think the hugest area that that we believe could benefit this bill. If we move back into the bill, the creation of the office that's in the original language. The original bill that we submitted the original language we submitted from cover to cover we stand on today, even after all of the deliver liberations. And it does create and quite well I might add an office of racial equity. I think that's why I wanted to flag the idea about when fiscal, physically, I can say that able to create that that office with, you know, a, you know, two to $3 billion coming into the state, and the health department now in line for another $20 million which is almost inevitable with this latest grant that they're applying for. If we are not able to complete to create this office now, if we're not able to create it now, and if this our obstacle is money, then we will never create this office madam chair. So, if there are other reasons why we are not creating this office now, I would love to be a part of those deliberations and help that conversation move forward. So we're talking about money right now. This is really a ridiculous conversation given the gravity of the situation that we're working with here. So I think that is the, the largest challenge that we have only step through the policy real quick. Again, as we're. We have the version of policy that you have so I'm going to have to ask for just a little bit of leniency here. But there is a language on I'm going to call it out as section see one under powers and duties. Clearly we're challenged with the fact that the powers and duties from the original policy was stricken but I think that's pretty obvious. We would we would prefer the original language on policies and duties, but the inserted language, which was amendment to over in the house is problematic as well. Provide guidance on the development of the Office of Health equity. This is point one, I apologize this point one of that section. I apologize if you're with me please. Okay, it says provide guidance on the development of the Office of Health equity which shall be established based on the advisory commissions recommendations, as soon as fiscally Again, it's not just so much that it's a money money that it's an issue it's also time that's an issue Madame chair, because what we're talking about is is the time to be determined there is not a date specific that we're not only are we not establishing this office but we're not establishing a date specific time to to establish an office of this level of importance. Mark, I'm, I'm, you're now running over. So what I would like is go through your list. And, as you know we are going to be looking at a new draft today we haven't seen it yet either so we're all, but we do have ideas about what's in there because we've asked for a date certain on the equity office so let's let's hear this 2023. Yeah, let's hear your, let's hear your thoughts please go ahead. Yeah, I'm right right now what I'm doing, Madam chair and I can. I don't, I haven't had the time to pull all of this together but I did get up pretty early to review all of these policies except for the one that I didn't see this morning I'm doing the best I can right now to provide you the input. So I'd ask, as, as the creators of this policy that you provided just a little we need to see to allow me. I am, I am Mark, go right ahead. Thank you want to hear it. Thank you. So yeah, so the, the, the whole part down here about, you know, in section. In section. F, I said, item F of section one, you know, this, this entire section by the way was the 11th hour amendment in the house from from the whole item one including all items ABCD and F this is all an attempt of the house to try to correct this policy before it got out of the door, they failed. Okay, the, this, this entire section but it's, it's even problematic down item item F where it says the timeframe and necessary steps to establish the office again we're talking about timeframe advice to make recommendations to the Office of Health equity wants established including input on and there's rules. So there's a lot of I'm sorry I read too far, but there's a lot of problems with this entire section. And it speaks to the point I was making. There's, we talked a little bit about the grant section that that was taken out I'm just going to go ahead and close up because I get the sense that I'm, I think you get the point. If you were able to look at the original policy I really do think you're you hear me and I think you're listening to me. I don't want to belabor it too much but I don't want to make the mistake of getting off the call without, you know, covering at least, you know, most of what it is I came to tell you okay. So, again, in with amendment for in section and item F under meetings. There's another amendment where there's a lot that was stricken in terms of the quorum and the, the meetings that we had a public quorum. And there were it would be required that a certain member, number of members of the folks from the public would be there and that is in item F. It would have been what was stricken out of two and three. Also, you know, there's there's more there on on the amendment for a second page and two and three where there was an advisory commission, some language there, talking about the selection that a chair that was inserted. The, the entire policy, you know, is is problematic because it does not accomplish what it is that we sought out to accomplish now it doesn't, you know, provide the grants it doesn't provide the commission. It does not provide a timeframe when the commission is going to actually be established it doesn't, you know, it doesn't provide the authority that that was requested. So problematic throughout. And I would just conclude. You know, by just saying that. Madam chair, what we did was is the original state of this policy that we introduced in the house. Just to say once again, you know, we stand on it. We think that this is the best policy that we produced this year. We think it's the most urgent policy. We do not feel that the policy that came over from the house accomplishes what it is that we sought out to accomplish. We do not believe that the policy and I just reviewed the policy that's dated today that's up on your website that came back from lunch console. We do not believe that it achieves what it is that we sought out to achieve. We cannot support this policy in its existing form. This policy, it is absurd to suggest that somehow or another that we're talking about this thing not being fiscal fiscally viable. At a time such as this, and it's ridiculous to somehow imagine creating a department as important as this on a timeline that is not even date specific. At a minimum what we could do is is, you know, here on the, I think the most important part of probably any policy is maybe that very last page where it says effective date. And at least what we can do is is make sure that we call out the fact that this department is, and if we're not ready to pull a trigger on it then adjust the effective date. But in this current state. I urge this committee to stop this policy right where it is, or else correct it so we can move it forward so it can achieve the very important work that we sought out to get done. I appreciate your time. And I thank you so much for the opportunity to testify before you today. Thank you, Mark. Thank you very much. And if you do, if you have, if there are more hours in your day. I'm sorry, but I never are. It would be helpful to have some short comments that we can add to our the testimony from you that would be very helpful. And I do want to make one comment about all the money that's coming into the state and one of the things that is hard for us to realize as it is for everyone. It's one time money. And what we want to ensure is that when we establish very soon, when we establish the office of equity in our government that it has funding going forward and it isn't one time funding. We want to make sure it doesn't fall apart. So that that's the challenge with the money and I know it's hard for all of us to appreciate that. For those of us sitting in this committee to appreciate that because we'd like to be probably a little more aggressive sometimes on a lot of things. But so, again, Madam Chair, I do appreciate having the opportunity to come by and testify. And, and I appreciate, you know, the explanation certainly definitely heard a lot of that from the governor to so it's at some point or another, I think that, you know, as we're determining our priorities and as we're being fiscally responsible and also, you know, trying to figure out how to make these very difficult things come together. And from our perspective, as, as a African American man who lives on Riverside in Burlington. I would just say that our sense of urgency kind of supersedes that philosophy that you just put down. We'll do what we can do. Hopefully we can meet somewhere in the middle. Thank you for your time, Madam Chair. We're working on it Mark. Thank you so much. Take care. Thank you. You too. All right, so we also have with us today. Chris and Murphy, you are here, I think. Yes, I am here. And I know that are you have Max. I would like to be joined by Max Barrows. I'm hoping he's in the waiting room or he's here. He's here. Excellent. Wonderful. So you just go ahead and then you can introduce Max when you're that's that's great. So much Max is going to be kind of sandwiched in the middle of my testimony. For the record, my name is Kirsten Murphy and I'm the executive director for the Vermont developmental disabilities council. And just for a quick context, because you do have some new committee members.  They exist in every state and territory in the country. We're charged with ensuring that people who have a developmental disability and their family members have a voice in creating the policies that impact their services and therefore their lives. And we use that voice to protect the rights that people with disabilities have to make their own choices and we advocate for supports that enable people with disabilities to live independently. As contributing members, it fully included in their communities. So to be clear, we receive no state funding we are federally funded and I have kind of unique permissions. I'm not on behalf of the council but certainly obviously not on behalf of the agency of human services, even though I am a state employee. I always like to be clear about that. I want to say from the start something I said when I testified in the House Healthcare Committee that I, I truly believe this is one of the most important pieces of legislation. The most important piece of legislation that I will have the honor of classifying about in my fairly long career and disability rights. And the reason hearkens back to a quotation I often use from Dr Martin Luther King, which is this of all the forms of inequality injustice and health care is the most shocking and inhumane. That's right. There's something very fundamentally wrong. I'm sorry to hear that there are folks in the BIPOC community who who understandably, you know, would like would like to see things move faster. I don't have time in government to understand that that patients is often is often something that that's needed but overall I would say that we really the disability community is is very happy to join with the LGBTQIA community and the BIPOC community, because I would like to share the three groups is that the in equities and health are rooted in historical injustices and prejudice. Of course, no one group is more worthy than the other but I am glad to see disability brought into this conversation because it is often left out and because disability will impact one in five Americans. So we are by far the largest health disparity group in the nation. And that of course has health, not only health and sort of welfare implications but cost implications for our health care system to because our role is to encourage the voice of people with disabilities. So I would like to have my colleague Max Barrows to say a few, a few things about his experiences in health care I don't think you need a lot of convincing that these are important issues but I, I think it's helpful to hear from Max, our outreach director Green Mountain self advocates so I will let Max go ahead and, and take a few minutes if you will. Thank you. Thank you Chris and thank you madam chair for this. I'm Max Barrows. I am the outreach director for Green Mountain self advocates. I am a person with a disability. I am on the autism spectrum. I would like to report H210. Here are just a few of the barriers people with disabilities face accessing health care. Number one, we often have a hard time understanding information. All of the big words used in the medical field do not make it easy for us to follow along. Even the information is just shared verbally. I need instructions written down in plain language. Number two, we need more training for health care providers on communicating with people with disabilities. When they find out that I am autistic, they often make assumptions about what I can and cannot do. It is well worth the time to directly involve people with disabilities in making decisions about our health. When we are supported to be in control of decisions about our lives, we get better results. We are healthier. Number three, it is difficult for us to use programs designed by public health departments because most are not for people with disabilities or accessible for people with disabilities. They are not accessible for people with disabilities. And especially for people with intellectual disabilities. And number four, now I want to share a quote from Chris, a person with an intellectual disability. He gets psychiatric meds from a doctor because he does not have access to a therapist. He said, quote, when I show my emotions or tell people how I feel, I often just get more meds and quote. The problem is, there are not enough therapists with experience working with people with intellectual disabilities. This is something experienced across the state. And in closing, speaking as a black man who is autistic, I want to thank you, Madam Chair, for listening and thank you for taking action to eliminate health disparities. And please, I encourage you strongly to keep this in mind when you move forward with your work or the work that has to be done. Thank you so much, Max. Appreciate your comments. I'm going to just pick up where Max left off briefly established the council's history with this issue and then move to a recommendation. So roughly 10 years ago, I noticed emerging research findings suggesting that the health status of people with disabilities was much worse than what one might have even kind of been intuited from general observation, poverty, lack of access to transportation and recreation, poor diet, the common use of medications to control behavior, all combined to make it pretty clear that obesity, poor oral health, even diabetes were high. But up until that point, this was not well studied. Really, not by public, I have a background in public health, not by public health people. The question I had was lifestyle alone enough to explain why people with disabilities experience say cancer rates that are twice that of the general population that did not seem likely to me, nothing about having an intellectual disability by itself organically explains why heart disease, for example, is is is much higher for people with developmental disabilities. At that time I was just moving to Vermont and beginning my work at the council here I had come from the New Hampshire's DD council. And Vermont had a large federal grant you'll remember the SIM grant the systems innovation model grants. So the council applied and received some money to do a qualitative study in collaboration with Green Mountain self advocates to look at the experiences of Vermonters with developmental disabilities when they were encountering the healthcare system. And the reports that came out from people suggested that the root causes of these marked health disparities among people with disabilities were indeed complex. They included as Max said a lack of provider education. We all training about developmental disability and disability in general still takes place in medical education in the context of pediatric medicine, even though most people with intellectual and developmental disabilities live well into adulthood and adult doctors, including Dr. Levine who was probably didn't know someday he would be commissioner living express to us their desire to serve people with IDD but also their frank discomfort, because they did not have a lot of information and training in how to interact appropriately. We heard a lot of stories about lack of access to care and here I would note again Max touched on health information that is almost never presented in cognitively accessible way appointment times that are far too short for somebody who has communication challenges. The fact that frankly referrals and screenings that should be routine at certain ages for people are much lower for people with disabilities like mammograms and colonoscopies. And we also heard we heard shocking stories frankly about lack of physical access. So including stories about wheelchair users who routinely came to clinics and found no wheelchair accessible scale or high low table. People in in in rural Vermont but resort towns well funded towns, who in fact use a veterinarian because it was the only available place to weigh their son. Their son had never actually been examined outside of his chair, unless he was all the way in Burlington at our major to share care hospital. The unacceptable level of care. Really at the root though, appeared to be ableism, right so let's think for a minute about the lack of referrals for things like colonoscopies. It's not uncommon for a physician or nurse to think that the more humane course would be to skip say doing a pap smear for someone who might need extra time and teaching to understand what's happening. Some advocates often reported to us that they are not asked about adult health issues like sexual health and the providers frequently communicated with parents and staff rather than directly with the adult. So with these findings in mind, we took our paper shared it with the Department of Health and the Department of Health was able to receive a CDC grant. I'd like to think our paper was some help in that I'm certainly not the only only reason but a five year CDC grant to do a deeper dive into the data, and to do some work on making their public health systems more accessible to people with disabilities. They're coming to the end of that grant they've done wonderful work. I highly recommend their August 2018 paper, which has many many statistics that I think are all embedded in this bill many of them so I don't need to really rehearse those here for you. I want to just move to a few recommendations about the bill, which of which we are obviously very supportive. I just say you got some testimony earlier this week about the need to change the language around defining BIPOC populations. Not not defining people in terms of not being white so I think that needs to be cleaned up certainly, and the need for a date certain is also very very important and I understand you're working on that. I'm not sure I never come to a committee and ask for something for the DD council. That is, I don't think in my career I've ever done that and today I am going to make that ask. I do believe because of our longstanding history with this issue that we need a seat on the advisory committee. As always I prefer to a seat go to self advocacy group. I think those are that's very important too. But I do think that in this instance the council has something very important to bring to the table so I would recommend adding adding language that simply puts on the list the executive director of the Vermont developmental disabilities council or just me, I would probably exercise the ability to be that person. There's a second reason for that and that is that we have a special agreement a set of assurances that the agency of human services signs every five years in order to receive the federal money that supports DD councils. And in those assurances, and this isn't really binding on the legislature but it is on on on the agency of health and human services. AHS promises that the council will participate. In the planning designer redesign and monitoring of state quality assurance systems that affect individuals with developmental disabilities. And I believe that having a seat on this advisory committee and whatever whatever it's called it helps to fulfill that responsibility and we stand ready to do that and to provide our, our federally funded staff time to be strong participants in that process. And with that, I will give you back. I will yield time now back to the committee. Thank you again, you're, you're always very clear and bring us sound data so I really appreciate this and max thank you for being here with us, and sharing your, your thoughts. Obviously, together you've done a great deal of work for the disabled community in our state and we, we really appreciate it. I'm very familiar with the Green Mountain self advocates and I hear from various folks on, not on a daily basis but at least once or twice a week and have communication with them and you have really helped them express themselves very well. Thank you for your work. I also have a daughter who works with in the in this area and has worked in this area and so understands greatly what's going on so. Thank you so much senator appreciate it. All right, so let's we'll move on. Kaia Morris is here so welcome. Are you here. Good. Thank you. Welcome back to the legislature in the time of zoom. And the time of zoom is something very unique. Absolutely. So I appreciate you. Welcome into the space today and we have an opportunity to speak about this bill so I'm for the record, my name is Kaia Morris, and I am the movement politics director for rights and democracy Vermont. I do want to clarify I'm here representing rights and democracy while I also sit as a co chair of the justice transitions subcommittee of climate council and as a commissioner with a Vermont commission on women but today's test. So my testimony is informed by the work that I do in all those spaces. However, I'm speaking on behalf of rights and democracy today. I had to do a little bit of a quick update on the latest draft of the bill. I looked at both as passed by the has introduced in the house and then as. Can you kind of, I'm getting some strange noise is that you or as I don't see any other people on muted but as you're turning pages. I don't know what's going on. Seriously, I don't. So pages, your pages are close to your mic. And so when you move the paper, your mic. Yeah, we're getting a thunderstorm. So definitely. Absolutely. I do apologize. While I am very much in support of climate goals I often need paper copies of things as a means for processing and my own brain processing so I can't just use the screen at this point. Okay, so in looking at the current version of the bill there's definitely some updates that I think that are very important. It is without question. If for those who are not familiar rights and democracy is a by state organization, supporting the needs are a real goal we look at ways and instituting policies and procedures and mechanisms to take folks that are on the margins of the seats of decision to bring them into the center of those seats of power, and of determining the actions that our states will take our communities, our municipalities will take that directly impact their very lives. So within the work that we do understand that rights and democracy came into being because of the failure of our ability to pass health care for all in a meaningful way so health care is at the heart and soul of so many individuals who come into this movement within this democracy so we are absolutely invested in what's going to be happening within this bill. So there is an incredible amount of promise I know that I don't need to continually give you the statistics about the health disparities between different groups within Vermont and the difference that they have and experiences within the health care system, and what those feel like as far as being situated within a social determinants of health, as we call it. What is really necessary about this bill is that it is taking a really unique turn and having those individuals that are coming from those impacted spaces as the thought leaders as the experts to determine and to shape a new sector of our government that is needed. So I want to ask those that have a particular technical expertise that is assumed to have a wisdom and an inherent historical knowledge of how the current system of our health care system the current system of health care delivery is failing. So many members of our population. I appreciate that I saw that were updates that I will speak to so I'm going to try to be gentle as I turn my pages but I have to do so. So, I saw that there was the update around quietly as I can to get to the highlighted spots. So it's moving into the, I think, out of the findings know so within the legislative intent and purpose, but I found it very interesting the subsection seven on page 11 that was added there to talk about the definitions of racial categories and I did see the testimony previously from UVM where they were speaking about, you know, why are we centering whiteness in this, and I thought that was an important critique. I'm not quite clear. And I don't know if, as we're putting it into statute it might be important to deliver on that promise, how we will achieve the creation of new definitions to better reflect racial and ethnic identities and categories. I'm not even clear who does that who does that work is that coming from the advisory commission is that coming from the Office of Health Equity. Is that coming from the legislature. So if we are going to do that, recognizing that it does have impacts back to census data, how we're tracking health outcomes that we're still very clear as to what that actually needs. And who has ultimate responsibility for ensuring that that gets done. So it might be, it might be a helpful thought exercise to name those out. Moving towards page 13 I appreciated the components there I know that Senator Rom has been fighting doggedly to try to ensure that we're thinking about language. How we have language translation services and ensuring that that is that all communications are appropriate and are accessible to all. So I thought that was an important inclusion that I did appreciate. Because I'm looking at the commission itself. One of the other pieces that I did like that was changed from as it came over to the Senate was the inclusion of an end date for when the group will be established. And I know that may feel off people might want to have it come closer to a year. What I can tell you is that in even within the work that I'm doing externally in the community and within the just transition subcommittee, asking folks that are coming from the community communities to do work on behalf of the state is incredibly exhausting. It is labor intensive. It is grossly under compensated, and many of these organizations and entities are extremely limited. And who they may be able to provide as an opportunity to appoint. If it is not a private citizen than an employee. But recognizing that it might take quite a bit more than what we might think of a standard meeting while they're only meeting once or twice a month, but then there's work outside of that work. And as well as the fact that they typically have other job duties and responsibilities that they have to carry within their everyday lives so to move at the speed of trust of a group this size, many of whom have never been in the same room together. It is appropriate to really give that space so that folks can work in a collaborative fashion and make sure that we're not losing anybody in this very long list of voices that's here. So, while I do that that's ultimately up to the advocates who created this bill, I think to kind of speak to what they feel about that speed but just my observations are that moving on these really truncated time frames that move at the speed of government rather than the speed of government is making these impacted folks that want to do this work, not step into it or to leave it, because it proves to be more harmful than helpful to both themselves and the communities that they're representing. So just as a kind of caveat to keep there that I think is important. What I also saw in here. On page 19, I wanted to just make a quick note about that on page 19, some section six, where we're talking about the distribution of grants that I assume will either come from funds brought from the Department of Health. Perhaps it is a set aside that comes from the ARPA funds. I'm not sure how that grant funding will be situated. But what I find that's interesting about this and important to consider is one of the reasons why this is important for this particular advisory commission to do this rather than just trusting within a particular institution like the Department of Health, for example, is that we don't have that representation in the Department of Health. We do not have this breadth of diversity of voices of those who are both writing, approving, executing, implementing and determining the success or failures as we like to couch them and one of the two categories for that work being done. So this is a unique opportunity to ensure that those that are most impacted actually have a voice in determining who gets those funds, how they will be utilized and whether or not it will actually deliver on what is being purported. So that is a slight shift and I think it's an important way to yield power, and to recognize the importance of voice within these conversations. I'm trying to be gentle, gentle. So some of the other things that I had noted, I'm still, there's a, wait, I don't, it's not highlighted here. Pardon me, I have to go to a different document. When I'm looking at the duties for the Office of Racial Equity within there, there's still something that feels slightly discordant to me about the way that it's written that that office is going to oversee until, until the Office of Health Equity is established. It reads to me when I'm reading the bill more that they're essentially convening the group that they're there to convene the group to help support and perhaps maybe the initial infrastructure, but that they're not the lead themselves, especially if the group is self-electing a chair. So I don't know there's just something slightly that it's listed as though they're overseeing this work. I don't, there's a nuance I think in responsibility that I would want to see shifted there I think. Hi, can you, can you point to the page and the, you know, the language that you're specifically concerned about. We'll put our brains to it. I appreciate it. Page 20. Is it under the meetings piece? Anyway, look for it and you don't have to do that right now but at least if you could send us a little note. Yes, yes, I do have it listed in a different document so I may be able to get there fairly quickly. As I highlighted in my old version before I saw this one today. Okay, so it was right before the report of continuing education area. It was just this one random sentence that was kind of thrown in there. Well, you know, go ahead and we'll find it.  Appreciate that. Thank you. Thank you. Okay, so my other pieces then to so around the continuing education piece that's a really, really important one, just as a point of information. Before I made my decision to leave the legislature literally on one of those really touch point days of my story when we were dealing with the threats that came on the computer I was literally meeting with the Vermont hospital association and the Vermont Medical Society to talk about this very thing. And they were trying to initiate a whole range of activities everything from internal surveys to find out where attitudes and beliefs are to starting to implement actual trainings. It's very loosely named, but only in the report section and so both the commission is is named as advising on this training, but then that advisement comes through the formation of a report, which are two different processes. I don't know what happened to that work. I have no idea what happened to that work and those initiatives that those groups have pushed forth since then. The same way that we're placing a culpability by directly naming those who are participating in the commission. I would like to see some measure of accountability for those organizations that do have a duty to do this to execute these trainings that they are collaborating somehow with this call it with this commission, other than just in the creation of a report. So, what I'm hearing you say is I think we're going right straight back to our initial initial testimony this morning from VP QHC, where they are doing some training and collaboration, or at least in coordination with the Department of Health on racial equity for practitioners. Your suggestion to identify those folks like the VP QHC and and put some of this into statute so it becomes something that we can provide oversight. I think so it's a little bit clearer for the commission itself, we've made given them a charge that they're supposed to advise them somehow on this. So, but where does that relationship began or end and who are they having the relationship with, is it just, you know, is this just strictly within the state of Vermont, we're talking just within state government, are we talking about external groups. So, and if those external groups are doing that this group should have a sense of what the heck they're doing, whether or not it's working and if these are even the most effective mechanisms for doing that. This could be a really important opportunity to bring the folks that have an interest in creating this work, and those who are trying to do this work to get them in better alignment. So, I want to be clear about this so I have the fortune of having one of the few African American primary care physicians in the state of Vermont, and it's fairly new to Vermont himself, and is very interested in wanting to create more training as he sees a revolving door for health practitioners I know that was something we dealt with down in Bennington County, all the time, it was like, literally a ticking up how long is that female black doctor going to say, give her about a year. So he's seeing people leaving and not wanting to stay and wanted to be a part of this so it is something that does have a real urgency to it as well. So I would like to see a little bit more. I think there was some language either in the bill or proposed to the bill and we'll try and circle around and, and look at that because I think you're absolutely right it makes a whole lot of sense, if it's not there, not there it's invisible. So, thank you. I think this is has incredible promise and I would look forward to how else this will happen so if we are creating this health equity. Essentially, this office of health equity. What will that rollout be. So once we do the ribbon cutting how does the community know about what this office is supposed to do, and how they will interact with this office. Is there anything else further than that that we want to see because this commission is going to continue after the office is established. But I'm still looking again for that same way we think about a climate plan needs to be understood by the whole state of Vermont. How does this health equity initiative, resonate back to the people who call for it to begin with. So I'm not quite sure what would be a great mechanism for that but it's just an additional thought that I have that might be helpful to name. Okay. Terrific. Anything else. Yeah, so I heard a little bit of the conversation around the art funds and thinking about that what is the way that that is I like the way that it was renamed. It's clear in the previous version that the commission is looking at specific ways that that will be spent to address the health equity issues happening within impacted communities. But so I think that the restructuring of that sentence is a little is better is better. It could probably even be a little bit tighter again, recognizing the scope of work that this commission is going to have to do, which is massive. As much specificities can be given can be very helpful. Yes, I think that's all I have because I believe that we covered most everything else I apologize I'm going back to my old notes and not looking at the current version just to make sure I'm not missing anything else that wanted to be brought up. But does anyone have any other questions for me while I surf through my I think we're good you know I think if you have. We're going to be going through the bill and trying to spruce it up a little bit so if you have comments, please send them along but you understand legislative time probably better than most, and we are at the end of it. Yes. Yes, also, you know also knowing listen, I, you know, I appreciate the look into the bill that you've taken. We also know that something like this is, this is the beginning and it's, it's going to be improved over time regardless of what we do today. Honestly, so. Thank you. Thank you. I appreciate it. Thank you. Thank you so much. Thank you for the advocates that brought this forth. Much appreciated. All right. We're good. All right committee. Nellie is is Katie available. I think she said she was so I'm going to suggest committee that we take five minutes of stretch time. We need that. And then we'll have Katie come in we can go through all the Katie bills with us, including this one. Thank you.


Hey guys, welcome back to another week of what's for dinner. My name is Andrea with food inventory adventures and food Our what's for dinner videos come out every single Tuesday, and I hope you guys are all doing well and staying safe So just like in past weeks. I am using what we have in our freezer Fridge and pantry. I'm trying not to go to the grocery store just using what I have so tonight for dinner We are having this artisan crafted bacon cheddar macaroni and cheese that I picked up from walmart And this was in our pantry. I've had it for a while and then we are also having some canned green beans And we're just using the winco brand and then in our freezer. We have a bunch of wings and so I just baked them And then I poured the juice off of them and then I actually I seasoned them and baked them Then I poured all the juice off of them and then I put them in a bowl and I tossed them in this Korean barbecue seasoning And this wing sauce that I picked up from Aldi a while ago that's been in our pantry as well And then I put them in the broiler and here they are here are our wings So this is what we are having for dinner tonight and we'll see you guys next time Hey guys, so for dinner tonight, we are having wonton soup and we are using these dumplings We really like them. They are from Costco. They are beef bulgogi dumplings and I really don't have a recipe for this soup I just added in this 32 ounce container of chicken broth stock. Excuse me that I picked up from I think I had it from Aldi So we're using that and then I had some jarred mushrooms. So I used that and then I just added in soy sauce Asian chili sauce sesame oil and just some other seasonings And this is it quick and simple dinner using stuff that we had on hand. See you guys next time Hey guys, so we are having another meal from our pantry I had this In my pantry. It is street kitchen Asian scratch kit Red Thai curry three simple steps. All you do is add chicken and vegetables to it and And I'm just serving it over some jasmine rice And then we are also having some pork egg rolls And I got these from Tom them a while ago and they were in my freezer. We needed to use it So I just baked them in the oven and here they are And I forgot to mention that I got this from Walmart a while back ago So this is what we are having for dinner tonight and we'll see you guys next time Hey guys, so for dinner tonight, we are having some grilled cheese burgers Howard grilled out for us today So this is my plate and he toasted my bun on the grill and I just added some bacon to it I'm not really into Like condiments on my burger like ketchup and mayo and mustard and all that stuff. So mine is just a plain burger and then I baked some french fries in the oven for us And the french fries that I use are these orita fries and they were in our freezer. So using those This is Howard's plate and he has this thing kind of burger that I do But he added tomatoes on top. He doesn't like his bun toasted I actually had to go to Kroger yesterday to pick up a few things and I was going to film it But it really wasn't enough to film And so here's his plate and then he always adds ketchup onto everything. So I'm sure he'll be adding this on So this is what we are having for dinner tonight and we'll see you guys next time Hey guys, so for dinner tonight, I decided to make us big Like fried chicken salads and so for the chicken we are using these chicken bites from Sam's I've mentioned that we've had these before but we're not crazy about them at all And so we've been eating them by having them with salads. So that's what we're having tonight on the salads I have some boiled eggs some cheddar cheese and then of course the fried chicken So I baked it and then I just chopped it up and then Howard is going to have this hidden valley bacon ranch and then I'm going to have the Caesar salad In my freezer, I had some whipped topping from winco and in my pantry. I had this Key lime cheesecake no bake mix and it calls for a brick of cream cheese. And so I decided to make A little dessert for us. So this is what we are having for dinner tonight and we'll see you guys next time


The Colts are trading quarterback Carson Wentz to Washington for a package of picks that is thought to include two third round picks sources tell ESPN and Adam Sheffield. So yesterday Aaron Rogers goes back to the pack Russell Wilson gets traded from Seattle to Denver in a blockbuster trade that none of us could have expected Bobby Wagner gets released from the Seahawks in now on this March 9th 2022. Carson Wentz is officially out of the Indianapolis Colts organization and over to the Washington Commanders. Carson Wentz is a commander. What does that mean for the quarterback position here in Indianapolis? There's Jimmy G still out there. Mitchell Trebisky is out there. James Winston is out there. Whatever the case the Colts are moving on from the Carson Wentz experience.


Hyper for the clips but tomb gold Six at ten Jalen Clark rookie autograph for the wolves There we go wolves Now the gold another one Hot color in this one here, man. I Have to send you a refund CBR. What's the order number?


The main problems of teaching formal and informal language. The difference between formal and informal grammar is very apparent both in everyday life and during one's time as a teacher of English as a foreign language. These differences, I believe, play an important part in why many language learners find it so difficult to understand and become fluent. The problems that teachers encounter. As a native English speaker and an ongoing learner of Spanish I find myself struggling with these differences as well. Much of the English grammar we learn in school in America is grammar that the person knows they are likely to use very sparingly. This is why most students fail to truly pay attention in their literature class. People speak more commonly in short form and with well-known slang, especially in the United States. This issue makes it difficult to explain formal grammatical rules to a new learner because, most likely, the explainer has had little day-to-day use with the formal rules. The problems that learners encounter. Also the difference between formal and informal grammar rules makes it hard to learn a language because most speakers that a learner might talk with on a day-to-day basis will not understand fully their own language's grammar rules. I myself speak with many of my Colombian friends and I find myself frustrated at times because different friends will correct me in opposite ways and I become lost on which grammar rule or suggestion is correct and which is misunderstood. I feel this is even more apparent in the Spanish language. The rules seem to be much more formal than with English speaking and word usage. English is much more compact and, combining the fact that English speakers love to speak quickly and cut words short, formal rules become seldom followed and slang begins to take over. The Dilemma That Teachers Face. As a Tefal teacher, whether working in Colombia teaching English to native Spanish speakers or teaching English in Asia to native speakers of other languages, I always push to teach my students both formal and informal grammar, with an emphasis on informal grammar. The problem with teaching informal grammar more than formal grammar is that formal grammar is what is tested by governmental and institutional bodies in order to test language-speaking aptitude. Therefore, if I spend too much time teaching informal grammar, even though it is more useful in everyday language use and more helpful to becoming fluent in the language, the students will become less likely to achieve their desired scores on their standardized tests. Finding the Right Balance in the Future. I will strive in every class to teach both informal and formal language together while teaching and informing students how words will be tested while also informing the students and how the language or vocabulary for the particular day is used in day to day practice. I believe this greater understanding of how words are used in day to day practice, informally, will give each student more comfortability and confidence to use the language and practice their skills more often. I will use the skills learned from my Tefal course as well as my experiences as both a student and instructor to help teach kids both types of grammar and increase their English learning confidence. Are you ready to teach English abroad? Speak with an ITTT advisor today to put together your personal plan for teaching English abroad. Send us an email or call us tollfree at 1-800-490-0531 to speak with an ITTT advisor today.


Hopefully, what in this talk I will answer is, what is Cascada? A lot of people have heard about it. I'll give you a run-through on that. What is real-time AI? What do I mean by that? I'm going to give a quick demo of a RAG app. If you don't know what that is, I'll explain it and show you how we can leverage AI in an app with five minutes of development time. And then I'm going to go through the importance of open source. A little bit about myself. I am a committer and on the PMC for Apache Cassandra. Last year, I was the PMC chair for the project. I've also been PMC chair for Apache tiles. And I've been passionate and involved in open source for a number of decades now. I thought for this presentation that I would go back to my first patch, but then I realized I have no idea what my first patch in open source was. It could have been something to bugzilla. It could have been a Linux driver. Otherwise, it was around the time that NetBeans was first open sourced and that the NetBeans platform came out. At work and my day job, I have been engineered by training and at heart, and I still try to code at least a day a week in my evenings, if I can, when the family lets me. But then I was a consultant for 10 years, primarily on Apache Cassandra. That led me to work with some of the largest deployments in the world. And then just this year, I've been moved into product. I'm still trying to figure out what product people do. But the position that I was put into was VP product open source, which is kind of odd because open source, especially what I'll talk about later, true open source, is not something that a company controls. And that is something that product people often have trouble getting their head around. And so my role is to kind of help communicate how companies invest and contribute to an open source, which is not controlled by them, how product works with that dynamic. So it's really more like open source operations. People will say, oh, is it Ospo, or open source program office? I don't like to think about it like that. I like to think about it more like operations in that if all of the company's efforts and contributions and coordination with open source and all of the other vendors and companies contributing to the projects is invisible, it's successful.  A little bit more about the company that I work for. Datastax, Datastax is known for being one of the big contributors behind Cassandra in the early days. We are no longer that. Apple is probably the biggest contributor now. Contributor of individuals contributing, I should say. And we also have companies like Netflix and Intel and Amazon and Microsoft and Instacluster and Avian or offering up contributors into our community. What we do at Datastax is we offer Cassandra in the cloud. More than that, we offer a modern application layer data platform and the key components that we see that you need in a data platform in your application stack today, the database, streaming and machine learning. I'll go into a little bit more of that later. This is built on open source products. As a company today, our strategy is we don't hold IP. We're not interested in proprietary versions of our open source products. Everything that we do is open source. Everything that we code, we open source. We give you the freedom to operate. So you can put these components together yourselves or you can get us to operate it for you. Our job, our mission is to be the best at operating this. Essentially, we are just a utility. Our job is not just to be good at operating it but to run it cheaper and more efficiently than anyone else can and that incentivises you to take that off your shoulders. Okay, so I'm gonna break the talk up into four sections. Cascada is what you turned up for is on the title of the talk. Then I'm gonna go through generative AI and RAG apps and then I'm gonna talk about real-time AI, bringing those two things together and then finally talk about putting it into production. So Cascada was a startup a couple of years ago. It came from the ML engineers in Google and they saw that the real missing piece and almost half of business value to ML platforms was not the batch training of models and then putting it into an ML platform but actually more real-time stuff. And this has kind of opened up the doors to what we call feature engineering instead of feature stores and so on. They left Google started a startup and then last year data stacks acquired them and the first thing that we did was open source the project. So you can now find the project on GitHub. It has lots of features. It's quite a mature product already considering how young it is. I won't have time to go through all of them. On the feature list, probably my favourite is the native time travel. For ML platforms, this is a missing piece for a lot of people's stacks and with regulation coming up, the need for accountability and auditing on ML platforms is going to hit a lot of people hard and Cascada does it very nicely and cleanly. Okay, so jumping in, this is gonna take us back to basics. So excuse me. But if you think about a timeline to begin with, it is just discrete points on a timeline with some values grouped by entities. X-axis time, Y-axis, some value, entities grouped by colour here. First thing that we want to do with that is aggregate it. So here we're just saying, what's the sum of each entity over time? So we're just taking it from a discrete timeline to a continuous timeline. Again, this is pretty traditional and general way to visualise this type of data. So here the question for us is how much did each user spend over time? So we're gonna do that in Cascada. We can start somewhere basic. This is just, we're taking the purchases and we're interested in the amount column of that object and we're summing it. And that's how you're gonna get those values over time. What about if we want to window the aggregation? Again, this is not complicated. Let's say we're interested in how much has each user spent this month? All we do here is into the sum function we pass in the window and we just say it's since the beginning of the month. Again, nothing complex, super simple. Here comes one of Cascada's tricks. What about if you want to do window aggregation but not based on time? So for each user, how many page views have occurred since the last time there was a purchase? So here you can see that we're looking at what were the page views and counting them and then when there was a purchase, what was that value? In Cascada, we do that with, we're first working with page views, objects. We count them since there was a purchase. We can do this in SQL too. It's a little bit more complicated. This is not something that I'd really want to be handed off. If I was starting a new job and they were like, this is what we wrote, I'm gonna help. So we don't want that. Okay, what about joins? What is the average product review or score at the time of the purchase? So here you can see we're interested in average review scores over time and then when an item was purchased by someone. In Cascada, this is, we're taking the reviews object, we're interested in the score column and now we want to associate that with a reviews object and its column item, taking the average and then looking it up at that point when the purchase happened. Super simple, this is written in Python, one line. We can do an SQL too, it gets even more complicated. There's stuff in this that I didn't even know existed in SQL. Yeah, SQL can do everything, just don't make me ever do that, don't want it. It's not just SQL, people often say, oh, but Spark Streaming can do this type of stuff. Well, we went and looked up an existing implementation of Spark Streaming that did churn prediction over time and we took 63 pages of Spark code and rewrote it in two pages with Cascada. So you can see when it comes to doing declarative reasoning over timelines because Cascada is an abstraction layer or library that is built for doing this from the ground up. It used to have a custom DSL language on top called Fennel and just a couple of months ago that was rewritten to be, or Python, native Python, just to meet developers and the audience where they are. The engine of Cascada is all written in Rust and the data processing part of it is done with Apache Arrow. So that's gonna take advantage of the GPUs where we can. So performance, everyone likes a benchmark for the value that it is, but we took a few examples. We compared it with DuckDB, which is known to be very fast for this type of stuff. And you can see that Cascada was consistently faster and in some cases an order of magnitude faster. So hopefully already you can start to see, this is super simple, it's fast and it's quite likely going to make things possible or feasible where they weren't before in your job, at your work, in your solutions. Okay, so jumping into the next section. Cascada was originally written with predictive ML in mind. So, you know, like with Cascada on an ML platform and inference with an inference model, you could do something like, you know, within three or four clicks in a user session, you could pinpoint what the intent of their session was. So for example, if they went into a retail website, you could say, is this user really going to buy something and what category are they going to buy or are they just browsing or, you know, so you'd be able to do those things quite quickly where that's typically not what ML platforms do, they can give you recommendations but they're based on yesterday's data. 2023 hit, GPT came out, everyone's product roadmap got wiped and everyone's like, hell, what are we going to do with AI and generative AI? Open up a whole new world of possibilities. What we're seeing a lot of happening is these rag apps retrieval augmented generation. I know with our customers across the US, there is just this mad rush to implement AI chat bots before Thanksgiving. And they're basically following this architecture. So you take all of your in-house data, all of your proprietary or in-house data and you vectorize it or you create embeddings of it, you go put it into a feature store or a database which has a vector search. Then when a user comes along and asks a question, you vectorize that question or do an embedding on that question and then on that vector, you do a vector search, that gets you close or nearest neighbor, what we call approximate nearest neighbor results for that question in your internal knowledge database or in-house data or that user session and all their history. It can be from multiple areas. But what you're doing essentially is then when you go to write the prompt that you're going to send to the GPT or your large language model, you have a prompt template, you have the original question from the user but you're enriching that prompt with all of your in-house data that's a close match to the original question. Not only does this prevent hallucinations, it binds your large language model answers to stuff which is your business domain or data domain. So let's go through this in a super quick example and I'm going to try and do this in five minutes. So if I jump into data stacks and I'm going to use for this Astra, which is our Cassandra hosting in a cloud, I'm logging in with my Google account. I've already created a database called rag chatbot DB and the example that I'm going to follow is, I just went back, I jumped over it. Is this example here? So you'll find it quite quickly. This takes us to a Jupyter notebook which I've already got opened in a tab. So I've created a database ready to go for us. I've created a key space ready to go for us. So let's get going. So is it connected? Yep. So first thing to do is I need a few Python libraries. Get that going. I've already done it. This is usually where my wifi decides to drop out but it's looking good. Import some Python libraries. The next step is to connect to the Astro database. I need a token. We get that token by going to connect and then just generate token. And that will give you just a small JSON object and one of the fields in there has this Astra CS. I've already got this so I'm just going to copy it. And then I'm going to get my open AI key. So if you go to platform, open AI, I've already logged in, you go to account and you can go to view API keys. I've already got API keys. I'm going to just copy that, okay? Then I've got a key space name. I already showed that, okay? With a token, I'm just going to use the token user which tells the client to use the token based approach and then I'm going to need a secure connect bundle. So this is a Astra comes with just a little zip file that contains the keys to make connection easier. I've already downloaded that. That's my connection bundle there, good to go. To create the embeddings, I'm going to use the ADO2, create a session. I've got that table in the database already, drop it. Looked like I did, let's try it again. Okay, so I'm going to create the table. The table I'm going to create is an ID, that's just a UID or something. The title of the document, the context of the question, the question being asked and all the possible answers. So what I'm going to do, you'll see here, I'm going to download the Stanford question answering data set or the squad, data set from hugging face. And so this table model is a okay schema for that data set. And then against each question and the different answers it has, I'm going to create this field which is just of a vector type of one and a half thousand dimensions. Okay, done, download the data sets. Again, most of this stuff is like stuff you do one off. So it's not actually development time, development time. Probably comes down closer to a minute. Okay, let's put it into a panda and take a look at it. You can see the data there, title, context, question, answers. I know that this data set has duplicates, so let's remove them. Okay, so now we're going to create an embedding for each question and put it into our Astrodata base. This will take about a minute, I think. Again, it's a one off. The next steps that we're going to do is say for example, that's your internal data. And then you've got a chatbot and the user goes into the chatbot and they ask a question. So we're going to take that question here. When was the College of Engineering and University of Notre Dame established? And then we're going to create an embedding off it. And then with that embedding, we're going to put it into a SQL statement which is selecting that table and we're looking for results which are ordered by proximity to that vector and just three. And then what we're going to do while that is still running, this is our prompt template. So we're going to create a prompt where the role or GPT, we're telling it you're the chatbot helping customers with questions. The user is asking this question and then we have assistant content and we're putting in what we looked up to be our three closest internal questions. And then asking GPT 3.5. Let's see if I finish that. Done, okay. So that's our vector that we created. I create the select statement. This looks like a vector but it's actually, if I go to the top, that statement. Let's find three closest questions in our in-house data. So here we go, three questions related. Let's create that prompt and run it. And the answer is the College of Engineering at the University of Notre Dame established in 1920. So five minutes give or take and you can see most of it was just set up. Okay, so moving on. How do we bring these two things together? I mean, we see here in 2023 and with these RAG apps and generative AI, again, something very simple, very powerful in our industry. We know this. A lot of people are struggling to kind of figure out exactly how do I use this in our business? What is the value? If you go to any local AI startups, you know, the level of creativity I'm seeing in the startup community right now is phenomenal. I haven't seen anything like it. And I had a few of those meetups. You'll meet all of your local angel investors and product people who are desperately looking for their early cash and engineers. So it's all happening. But what about combining these two things together? We take a few example questions that we could ask a bot. You know, when will my package arrive or recommendation, what should I watch tonight and why or financial assistant is a good time to buy Bitcoin? And you can, when you think about, you know, how best to answer those questions, you can see that they often do touch on real time based information. You can't be working with yesterday's information. You can't be working with your database data at large. You're interested in what's happening in your streaming processes in your application stack as they happen. Let's take a bit more of a concrete example. Say for example, in the Astro portal, we created a chat bot, which was to help operators and users of Astro database with their database. And so here we have a user comes along and he's like, why am I query so slow? And, you know, with our in-house data, all of our support documents and support pages, you know, we could probably come up with a pretty good static answer. Hey, Ben, queries can be slow for many reasons. For example, the servers may be under heavy load or your query may be involved, may involve significant computational costs. Yeah, it's pretty lame, really. That user was obviously doing something then and there and their problem was related to their current session or today. So if we take real-time context and we put that in there, we can say, well, you know, their average query analysis is about three milliseconds. We know that's their norm. And at the moment, they're seeing queries which are taking around seven seconds. And if we take a look at their recent queries, you know, we can see that there's information, we can see what they're doing wrong there. And we can say, hey, Ben, it looks like your queries are doing full table scans. Try and select a key or use an index on that column if you're developing it. An example that I've got to run through is that combines both these technologies is an example, is an app that we've got on GitHub. It's under the Cascada organization called BeepGDP. And the idea here is to create a Slack bot which notifies you of messages or threads that are happening that you would typically be interacting with. This should resonate with most of you. And at least personally, I find Slack more and more frustrating that the more accounts that I'm in, the more channels there are at work, there are hundreds of channels. Now, I mean, like to try and actually stay on top of it, you're spending half an hour every day just scanning through, trying to get all the threads read. It's impossible. Really great way of just bringing you to the messages as they happen. So what are we gonna do here? We're gonna take a export dump of our Slack account and we're gonna put it into Parquet files and then we're gonna create timelines of all the messages and all the threads over all the channels. And then we're going to, in a predefined format, put them in to prompts, which are, and then do fine tuning into a GPT account. Fine tuning isn't something you typically need to do from what I've seen so far. 90% of the time playing with your prompts will get you what you need. But there are a few use cases here and there where fine tuning is the right thing to do. Here, because the structure of the data that we're working with is so specific, it makes sense. What that then allows us to do is that we then create a Slack bot that listens to messages and it will recreate them in that same predefined format and put them in as a prompt. And then the response from GPT will be, these are the people that would typically be responding to this thread or message. And then you can go send a notification to those people. If you go to that GitHub project, it's really only two files. We have an example export dump for you if you just wanna play around. Not everyone has admin access to Slack accounts. And then the fine tuning notebook is just that top half of the diagram, transforming the data into parquet files, putting it into timelines, then putting each thread into predefined format and then feeding it into open AI for the fine tuning. And then this beep GDP Python file which is the Slack bot that listens. Okay, read me. I think I've explained that already, I hope. The key part in the notebook is this section here. Again, it's super simple but the message is we're just basically trying to key them and join them on the channels and the threads. And in the beep GDP file, which again I think it's like 100 lines of Python or 200 lines of Python, it's very small. The main function is this one which is handles conversations and the conversations hand comes in. It does exactly the same thing. That's our predefined format, that is the prompt that goes in and we get the answer for. Okay, so whole new world of possibility. We can do lots of cool stuff with this. I think this year what we've seen is and the data scientists are a bit shaken up and they should be, the democratization and the commoditization of data science and machine learning. You can see here now that any old developer can come along and do quite complex machine learning or AI types of stuff in a few lines of code. This is great for us but this possibility is open to everyone. What everyone is streaming ahead with this year. What about when you put it into production? I think this is where people are gonna hit the hurdles. Development has now been made very simple. Once you're in production, I think that's where we're gonna find our challenges and it's certainly what we're seeing already with the people who are deploying these apps. First up, how do we see the application stack changing? We're seeing more and more the data tier as the critical foundation in every application stack. If you ask me, I would say that the definition of digitalization and digitalization projects this year has fundamentally changed. Last year, digitalization was about the automation of processes and tasks. This year, digitalization is simply about getting analog data digital under one data control plane, one data platform. You need your data to be democratized, access to all of its consumers, under one governance plane, one access plane. This is data mesh in a way. Maybe a better term that I've heard is data-centric engineering. Everything on top, okay so what you've seen now I've used different integrations, different frameworks to kind of set up, but I think what we're seeing with the business logic and with the user experience is it's becoming very cheap. Now we haven't seen kind of many autonomous agents, AI agents come out yet and this notion of you can just go to a GPT and say here's my product specification with an engineering specification with these how I want you to test and do chaos testing and security testing and privacy testing just doing all of those specifications to GPT and say write me that program. But a lot of people are pretty confident that's where we're going and going quickly. So all the stuff on top is becoming very cheap and very automated. Simple and quick to change. What's not quick to change is the stuff on the bottom and what a lot of people don't have is a proper data platform in the application stack that will scale. What I think we're going to see is what happened in 2010 with Mobile First and the explosion of data and how it blew up anyone's hope of using an RMS system in the data warehouse or data laking or analytics. We're seeing that going to happen in the application stack and so you are going to now start to replace the legacy databases, the RMS systems with modern data platforms that can serve any consumer no matter what format or API or traffic shape or SLOs they require. That is why at DataStacks we have built this data platform. That is what we're trying to deliver to people. We are active in the open source community and the things that we're working on, you can find Astra and Cassandra plug-ins to LangChain. There's also this LangStream project that's come out which allows you to I think in a lighter way do a streaming approach alternative to LangChain. We have Stargate which is like a coordinator layer on top of a Cassandra cluster that gives you REST and GRPC and GraphQL and document APIs. So again, your data can be accessed by anyone and we've got this CASIO framework which helps people put LangChain or LamaIndex on to Cassandra. And lastly, not least, we've got one of our engineers is working on this JLama which is a LamaIndex rewritten into Java and he's already getting an order of magnitude better performance in Java which is kind of like blowing him away. I don't have the reasonings to that. It could just be a cleaner design. Who knows? I know he's now relying on JTK21. Okay, bringing it back to Apache Cassandra. I think you've kind of seen where I've tied this into the loop and that the data platform we need to take different approaches. This is just one technology that you could be implementing in a data platform and when I talk about a data platform, I'm not saying you can just go take your RDMS technology and go replace it with some other database like Apache Cassandra. A data platform today requires lots of different components put together. One of the things I want to touch on though is the NoSQL moniker. So the NoSQL moniker came from one of the committers in the Cassandra project and it's kind of been misinterpreted along the way. When the moniker was first mentioned, what it meant was, look, we're taking a monolith database, the RDMS systems and we're going to rewrite them into microservices. Now microservices wasn't a word back there back then. Distributed computing is a better idea but microservices people understand. And databases are some of the most complicated technology in our industry. So we knew that we wouldn't be able to replicate an RDMS's feature set in one year or two years or three years. We had to start somewhere and we understood that, well, sometimes you can share the partition data in the application layer if your data domain naturally shards that way. But it's more often than not a dead end and if we could do that partitioning for you, that was the longest path in the future. The problem with that was that we had to break relationships and so that's where NoSQL came from. NoSQL was about that journey about rewriting a complex piece of technology into distributed computing. Unfortunately, other databases came along like MongoDB. It's a great database. I'm not going to diss it. But they were like, look, we've got a database too and it's got a different interface than SQL. So we're NoSQL too. And so that's kind of led us into this trap that NoSQL means about the user interface, that you have a different feature and it's also kind of led us down the wrong path, I believe, that every time you have a different, a need for a different feature in your data, you think you need to go choose a different database. What we're doing with Cassandra is implementing vector search. We did that in four days. We got feature parity with Pinecone with one developer coding in four days. We have performance, both latency, relevancy, accuracy, and throughput. Double that of Pinecone. Half latency, double throughput. And we understand that the people who can keep their data at their source of truth and just create the embeddings or the vectors there, they don't need to copy data to a search engine, they don't need to copy data to the analytics platform, et cetera, are going to win. It's not just the cost of savings with storage, it's the cost of savings of moving that data and massaging it, or having to work with yesterday's data and different schemers. Organizationaly, everything is much simpler. That was that slide. I think I'm up for time. Lastly, I want to note, in December, we have a Cassandra summit in San Jose. The next foundation is hosting it. Please come and join us there. You can see from this slide, Cassandra 5 is coming out with a ton of new features. We have ACID compliance. We're now strictly serializable at the spanner level. We can do leaderless global strict serializability using commodity clocks with a single round trip. That is the Accord consensus protocol that came out of Apple. Vector search, unified connection strategy tries throughout our structure. Thank you. If you've got questions, find me outside. There's also these cards on the poster outside. You find these cards, grab one, they've got the QR code, log in to Astra easily and give it a whirl. If you want to try any of these things, it comes with a lot more examples. So I saw just the basic examples. There's a lot more there. If you want to check them out.