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NH Health Commissioner Lori Weaver on staffing shortages, youth services and more

Todd Bookman
/
NHPR
Lori Weaver at an Executive Council meeting in Hampton

New Hampshire's Executive Council confirmed Lori Weaver as the new commissioner of the Department of Health and Human Services last month. Weaver, who’s been with the department for 26 years, had served as the interim commissioner after Lori Shibinette stepped down from the role.

DHHS, the largest state agency in New Hampshire, is responsible for public health, mental health, youth, housing, and other services.

Commissioner Weaver spoke with NHPR’s All Things Considered host Julia Furukawa about her priorities and goals as she settles into her new role.

Takeaways

  • Weaver says DHHS plans to address statewide staffing shortages through outreach to high schools and colleges.
  • The state’s current response to COVID-19 is working with primary care providers and pharmacies to distribute COVID vaccinations and boosters, similar to the flu vaccine.  
  • As the state builds a new youth center, Weaver says DHHS is moving away from a juvenile detention model toward a therapeutic setting for youth. 

Transcript:

So DHHS is the state's largest agency. And as the commissioner, you're balancing a lot of responsibilities. What are your biggest priorities right now? 

Looking ahead, one of the things that's really important for me as a commissioner is to make sure that as an agency, we are able to respond to the needs of those that we serve. We serve our most vulnerable people, our most vulnerable populations. As society changes, we don't move as a bureaucracy as quickly as those needs change. So that's a lot of my focus. I really want to be able to balance the continuous prioritization of needs and strategic direction, as well as being able to respond to the crisis that happens seemingly all too often.

You've mentioned that one of your top priorities is addressing staffing shortages in health care. Has the state seen improvements in staffing since last December when you spoke about this?

We at the department have seen about a 5.5% drop in our vacancy rate. We were at about 22.5% in December. We're now down to about 17%. So we have people that are coming in, people that are staying, for sure. Some of the pay raises helped with that. We know that our providers, with our Medicaid rate increases as well — that was helpful for [our staff in] mental health services or any of our providers. That has definitely been, I think, a good retention tool — as well as the bonuses for their recruitment. So we're seeing some dents, we're seeing some moving in the right direction and we're moving, so that's good. We're not staying stagnant.

The state's investing in some new facilities — the secure psychiatric hospital and a new youth development center. With the current staffing shortages, how can the department ensure that there are enough qualified workers to support both existing institutions and those that are planned?

Sure. So some of those builds are a little bit out, right? We just broke ground last week on the forensic hospital here in Concord, which is very exciting. But that facility won't be ready until mid 2025. And the Youth Development Center, that's probably even further out. We don't want to overtax what we currently have for workforce. We want to continue to build it. So looking at pipelines, looking at not only just in college, which we currently do, but also even down at the high school level. How do we get youth interested, involved in social services, even at that age, and to be able to bring people up and continually build that pipeline?

Could you tell me what that looks like?

It looks like going into schools — it's not just us, our providers are doing that, too — working with career centers, vo-tech [vocational-technical] centers, internships, having our staff go out and share what that work is actually like, to get a sense of how rewarding the work can be.

We are seeing that Covid 19 cases are on the rise again across the country. What does the state's Covid response look like at this later phase of the pandemic?

So, you know, Covid is going to be with us. It's a virus that is just like the flu or RSV, it's something we need to be mindful of every year and be protecting against, just like if you would get your flu shot or take care if you had a cold. Our response right now is really more like [having Covid care] integrated into your primary care. So you'll be able to get a Covid shot right where you got a flu shot at the pharmacy.

Recently, a report from the Office of the Child Advocate, a state watchdog for child welfare, raised some serious concerns about the placement of children in out-of-state facilities and its screening process for those facilities. Is the state planning to change anything related to its out-of-state placements?

I will say that we've spent the last five years building a system of care for children and it's a good system of care. The challenge is that we don't have a lot of workforce currently in the state. We have kids out of state right now. Last I checked last week, about 65 kids [are] out-of-state. But out of that 65, only ten are beyond New England. So we're talking about 55 youth that are within the Northeast, within the New England region. And it's important to remember that we also have kids with complex medical and complex behavioral issues that we just don't have those services for here in New Hampshire. What my department has is a responsibility to make sure that those children and families get services. So that's part of what we're charged with. Whether the services are in New Hampshire or elsewhere — of course, we want to keep families in New Hampshire. That is the goal. That is the priority. But it isn't always the case. And New Hampshire is one of the top states in reducing out-of-state placements across the country. We just reduced our juvenile justice placements by 50% and we're the lowest that we've ever been.

Could you elaborate a little bit more about what that screening process looks like for out-of-state facilities? How do we determine whether they're the appropriate place to be placing children from New Hampshire?

Our behavioral health division is charged with what we call certification, and that is going out and looking at providers to make sure that they are appropriate so that they are providing a level three service that meets what our requirements are for a level three service. And then once that certification is made, it's our DCYF group that goes out to make sure to meet with kids on a regular basis, which they do.

While the new youth development center is being built, what is the state doing to ensure that the children in its care now are being treated appropriately?

When the legislation passed, back in this spring, part of that legislation approved what we call a therapeutic model. So it's really not so much a juvenile detention facility model as it is working with kids who have significant pasts in a more therapeutic setting. We don't have to wait for the new facility to be built. We're doing that now. So that's really a clinical wraparound approach, working with these youth and hopefully [for them] to be rehabilitated and to be able to be reunited with their family or to have services out in the community.

You've spent 26 years with the department. As the commissioner now, what do you hope the agency can accomplish under your leadership? 

I'm glad you asked me that. I think I've worked for seven commissioners. I worked closely with the last three. So I sort of have that insider perspective of what works and what doesn't. And we are working in a bureaucracy. We are in a state government. I would like to be able to see our department be nimble and not be so slow to be able to respond to society's needs [as they] change. And that's a real challenge to be able to do that because bureaucracies don't move at a rapid pace. So I am planning on having a strategic direction, a strategic focus.

Our roadmap showed us the last eight months that we as the department can do that — working with our partners for voice and for advocacy, [and] working with our vendors. We need to have good partners. We need to have good relationships. We can't, as the Department, provide all those services. Our providers do that. So we need to be better business partners.

Those are the things that I'm focusing on, as well as staff retention and having the department be a place that people want to be at. Our staff are mission driven and they do great work and I want to keep them there. I want to keep them happy and making a difference.

Michelle Liu is the All Things Considered producer at NHPR. She joined the station in 2022 after graduating from Northwestern University with a degree in journalism.
Julia Furukawa is the host of All Things Considered at NHPR. She joined the NHPR team in 2021 as a fellow producing ATC after working as a reporter and editor for The Paris News in Texas and a freelancer for KNKX Public Radio in Seattle.
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