President Dr. Carolyn Lopez calls the meeting to order at 9:00 AM, with a quorum of board members present.

To start, Deputy Commissioner Fikirte Wagaw provides the Commissioner’s Updates, on behalf of CDPH Commissioner Dr. Allison Arwady. She will provide city COVID response updates, the Black Chicago state of health report, and an update on Healthy Chicago Equity Zone RFPs.

Last Friday, the City of Chicago reopened fully, allowing businesses to operate without limits on mask mandates, social distancing & etc, though are still encouraged to make their own decisions regarding customer safety.

Per federal guidelines, mask mandates & social distancing will still be required in healthcare, transit, taxis, congregate settings like jails and shelters, as well as educational settings. The City still recommends masking indoors and where social distancing is difficult.

Vaccination data to date: slightly over 50% of all Chicagoans have received 1 dose, and slightly over 40% have received 2 doses. Of 12-17 year olds now recently approved for vaccination, 34% have received 1 dose. Vax rates increase to 64% over 18 y.o. & 72% of elderly residents.

Racial disparities persist: ~60% of white & Asian residents have received 1 dose, while 43% of Latinx and 36% of Black residents have done so. The City has been sending out field staff block by block to the South Side to educate, encourage, and sign up eligible Chicagoans.

In particular, home vaccinations are available for elderly and disabled Chicagoans. The City has also been pursuing workplace engagement and talking to employers to encourage vaccination.

The State of Health for Blacks in Chicago report was released yesterday, the first of its kind. chicago.gov/city/en/depts/…

It uses black Chicagoans as the sole reference point for assessment to examine life expectancy & other health measures, noting a overall 9.2 year life expectancy gap between black and other Chicago residents. The release was intended to coincide with Juneteenth.

Updates to the Health Equity Zone RFP. CDPH has taken a place-based approach to meet Healthy Chicago 2025 goals for racial equity & COVID rapid response. They've identified 6 target regions with high health needs that warrant hyper-local approaches to health inequities.

They've started by identifying COVID vaccine disparities but will begin to address other public health axes affecting each of the 6 regions. The initial funding available is $30 million over a 4 year contract.

Questions invited for the Commissioner's Report.

Carmen Vergara asks about goal vaccination rates & how the Health Equity Zone RFP application process is being made equitable for all potential applicants.

Wagaw replies that Chicago is trying to meet the same federal goal of 70% vaccinated rate but cannot definitely answer on the likelihood of meeting this goal

Re: Equity Zone RFPs, CDPH has standard eligibility criteria that include orgs needing to be located in the City, being in good standing with city, state, and federal authorities. Agencies with limited fiscal ability can subcontract, and preference will be given to nonprofits.

Dr. Steve Rothschild notes that the adolescent vaccine approval was done expediently, perhaps faster than anticipated. Efforts to secure approval for a pediatric (12 y.o.) also seem to be accelerating; how do they intend to message around pediatric expansion?

Wagaw answers that they CDPH is maintaining a focus on partnering with CPS, with funds already secured to do so (consistent with other large cities' efforts) They are currently partnering with schools to provide on-site vaccinations, esp. in more underserved communities.

Dr. Matt Davis adds that there have been some recent concerns about myocarditis in vaccinated adolescents and advises caution in clinical trials for <12 yo subjects as well as how to message these concerns to the public.

Davis asserts that he is not surprised by the quick uptake in adolescent vaccinations since children are generally the best-vaccinated population, attributable to the combined oversight of parents, schools, and pediatricians.

Dr. Janet Lin requests further inquiry into the leading causes of disparities in the State of Black Chicago report & their upstream root causes, namely chronic diseases as #1 and gun violence as #2. She also asks about the potential need for vaccine booster doses in the future.

Wagaw agrees that this is an important next area of focus, along with gendered health disparities in the black community.

Re: boosters, it's too early to say, though Dr. Arwady does not predict boosters will be needed for Fall 2021.

Dr. Horace Smith recalls complaints in earlier board meetings about prior lack of federal funding around vaccine messaging in black communities. He laments that traditional messaging structures have not worked since black communities don't trust the messages or messengers.

Next on the agenda, Board President Dr. Lopez invites the 2 presenters today. This is atypical for a board meeting but she felt it was important for the board to be aware of the strategic planning process currently underway and to meet the promise of addressing behavioral health.

Laurie Call & Samantha Lasky of @IPHIonline lead the first presentation on strategic planning for CDPH. They give a primer on Strategic Planning, i.e. the process of using a data-driven approach to identify organizational roles & goals for decision making over the next few years.

Key aspects of the CDPH strategic plan are identified, namely applying an anti-racism lens, incorporating trauma-informed and culturally responsive perspectives, and performing audits on communications, surveillance, and finances relative to peer public health departments. https://t.co/ChhDFwGOdj

The Strategic Planning Committee (SPC) is currently in the process of performing SWOT analysis, which includes review of secondary data, i.e. Healthy Chicago report, financial & performance data; and soon to collect primary data, i.e. staff surveys, focus groups, interviews, etc. https://t.co/70Llt3xtYZ

SPC is also developing a draft of a revised mission & vision that will be shared with the board in the near future. Their goal is to finalize the entire Strategic Planning process by mid-December 2021, with early data analysis results planned to be presented at the next meeting.

Questions invited. Dr. Horace Smith says he is "always critical about these types of things", noting that the presentation Is very specific about defining committee members & processes but wishy-washy in identifying stakeholders; none are currently listed in the presentation.

Stakeholders generally come from the communities of interest but may have trust & representation issues relative to public health, which has often had a paternalistic history. They need to be included early on & have input on defining who is a "stakeholder" in the first place.

Call replies that SPC has been doing behind-the-scenes work to identify such stakeholders and collect input. She intends to have a list of specific individuals soon.

Board Member Rosa Martinez Colon also seeks clarification on the process of identifying stakeholders and advises the board to leverage their own existing community connections to assist this process.

Dr. Steve Rothschild requests creation of a Strategic Planning dashboard that will assist the Board in tracking their progress and milestones relative to identified goals.

Next, CDPH Deputy Commissioner Matthew Richards presents the behavioral health report. He states an emphasis on expanding publicly funded mental health (MH) care that all people can access regardless of ability to pay, health insurance, or immigration status.

Expanded mental health has been a big focus for the Mayor's office, with a tripling of the MH budget from $12m previously to $35m this year. https://t.co/MxZEoKrhfn

33 new Trauma-Informed Centers of Care have been opened in vulnerable communities icrisesdentified by an aggregate index of financial hardship, uninsurable, serious victimization rate, and 911 calls for mental health.

$250-350k will be given to each facility, with greater amounts for those partnering with community orgs & FQHCs. This is intended to expand MH capacity to a goal of 20k residents, or a 400% increase from previous. Actual data on service utilization will come out by July.

The new funds have been utilized for physical renovations at mental health clinics (Lawndale Mental Health Center pictured) as well as expanding Telehealth during the pandemic and services for children & adolescents' mental health needs. https://t.co/gh9rHtIbe7

Next goal is to strengthen mental health crisis prevention by recognizing MH crises as healthcare events that warrant healthcare rather than law enforcement responses. For the 1st time, MH professionals will be embedded in 911 call centers and in physical dispatches when needed.

The call centers should have expanded capacity to deescalate crises over phone to avoid dispatches, and when dispatches are required, more behavioral health-trained responders will be sent, avoiding use of sirens or bright lights.

911 calls related to substance use will have peer educators involved. Overall they seek to expand the referral network for community resources & care coordination for all non-medically unstable cases that don't warrant emergency department resources.

CDPH also seeks to expand team-based care for those with severe mood, substance use, or schizophrenia-spectrum disorders currently underserved by the clinic-based model of care (i.e. lacking resources to make scheduled clinic appointments)

Funds have been made available for interdisciplinary mental health teams through orgs like Thresholds, Heartland Alliance, and others to work in community settings as well as integrate more services in settings that the homeless frequent, like shelters or the CTA.

These efforts should reduce the need for unnecessary 911 calls and police dispatch; they wish to provide a full package of services to meet health & social needs, which Richards hopes will eventually include stabilization housing to directly address homelessness.

Lastly, CDPH hopes to operationalize the 211 phone number for more comprehensive service connection health, human & social services. They will also launch a mental health awareness campaign this summer to address stigma and implement behavioral health teams at all CPS schools.

Board member Joel Johnson asks if CDPH has thought about how to recruit a new generation of mental health professionals given current personnel shortages and human resource limitations. He also recommends door to door outreach in the mental health awareness campaign.

Richards answers that a job fair is planned to increase awareness for out-of-work or new grads about public mental healthcare roles, while also noting a larger issue around incentives toward private practice in MH care, esp. for those with higher degrees.

The mental health awareness campaign is intended to be both high-tech & "high-touch" with funded hyperlocal efforts engaging community orgs, faith-based communities, and block clubs to spearhead this campaign.

Board member Debra Wesley also asks how to address the particular experiences of loss that many children have been facing due to COVID and violence.

Richards emphasizes CDPH's priority on partnering with CPS to reach the majority of children in school settings, while also making sure block clubs and other community orgs know about available resources. CDPH is focusing on funding teams that can go out to affected communities.

With no other business, Board President Lopez adjourns the meeting at 10:30 AM.

Thank you for tuning into my coverage of the Chicago Board of Health meeting for @CHIdocumenters! Notes & live tweet threads of other meetings can be found at chicago.documenters.org/agencies/chica….