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Beyond the immediate fiscal and operational effects of COVID, we have seen longer term and more concerning trends that effect the overall ability of the nonprofit community mental health sector to recover. Most significantly, we are seeing youth with much higher symptoms, more significant trauma, and more difficulty functioning – many in acute crisis. This has resulted in significant pressure on the MH Workforce, and we are seeing many people leave psychotherapy roles because of the effects on their own mental health and wellbeing. The staff attrition and accelerated retirements have had a significant impact on NYFS, and on our revenue. Additionally, we have higher percentage of clients that miss sessions due to illness, which especially in our day treatment program, means additional lost revenue. While NYFS was responding to the new fiscal and operational realities created by the pandemic, staff also recognized the need to quickly respond to community distress. Despite operational challenges, NYFS staff provided the following presentations and services free of charge to residents in the City of Roseville and the Roseville School district to aid residents during this extremely difficult time. Presentations and support services included: “Covid 19 and Mental Health” online presentation in English with Spanish subtitles for parent group participants at Roseville Area Middle School “Depression in Adolescents” online presentation for a Roseville Area High School staff Facilitation of an African-American Healing Circle at Fairview Alternative High School following the murder of George Floyd “Parenting in a Pandemic” and “Parenting After a Pandemic” online presentations to families in the Roseville Area School District. “Self-Care for Teachers During Covid” online presentation shared with teachers in the Roseville Area School District. NYFS staff also attended a community event in honor of Principal Brian Koland, handed out mental health resources, and spoke to community members grieving his loss by suicide. Responding to community need, we added new services specifically to address them, at the same time we adjusted current programming for the same reason . However, COVID created a unique set of programmatic and funding challenges, and we have not able to return to a “pre-COVID” financial model for several reasons. The NETS program is one example: Bridging the gap between hospitalization and outpatient therapy, NETS provides daily support for youth ages 11-17 with intensive mental health treatment needs, Early in the pandemic, the program was temporarily closed, reopening in November 2020 with a smaller cohort, causing a 72% decrease in revenue, a loss of $297,506. Through cutting expenses and CARES Act funds we brought the net loss down to $87,787. Now, we are seeing a marked increase in the intensity of symptoms- many are suicidal and suffer from severe anxiety, paralyzing panic attacks, and/or debilitating post -traumatic stress symptoms. Workforce shortages have made the medical transport they need unreliable, but the program relies on attendance for reimbursement, causing further erosion of funding. Families are often unable to provide transportation at all. In addition, if participants are more than 7 minutes late, then the session is not reimbursable. NYFS leadership was aware of changing realities in insurance reimbursement and the business model was going to be altered before COVID, but the pandemic exacerbated the situation. In addition, it created an urgent need to adapt in so many other ways that capacity was stretched to the limit. Now under new leadership, NYFS has conducted a recent operational review. We estimate that overall, our insurance reimbursement levels are generating only about 70% of the revenue they should. To address this, we have outsourced our billing are in the process of re-negotiating all of our insurance contracts to maximize reimbursement rates. We anticipate this process will take 6-12 months. Attachment F