Legislature(2009 - 2010)CAPITOL 106
04/09/2009 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB188 | |
| HB168 | |
| HB223 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 188 | TELECONFERENCED | |
| *+ | HB 168 | TELECONFERENCED | |
| *+ | HB 223 | TELECONFERENCED | |
HB 223-TRAINING FOR PSYCHIATRIC TREATMENT STAFF 4:31:00 PM CO-CHAIR KELLER announced that the final order of business would be HOUSE BILL NO. 223, "An Act relating to the qualifications for residential psychiatric treatment center caregiver staff; and providing for an effective date." The committee took an at-ease from 4:31 p.m. to 4:36 p.m. 4:36:57 PM CO-CHAIR KELLER acknowledged that there had been ongoing discussion and negotiation about HB 223. He opened public testimony. 4:39:12 PM CO-CHAIR HERRON moved to adopt the proposed Committee Substitute (CS) for HB 223, Version 26-LS0842\C, Mischel, 4/8/09, as the working document. REPRESENTATIVE HOLMES objected for the purpose of discussion. MYRA MUNSON, Attorney, The Boys and Girls Home of Alaska, said that the Committee Substitute (CS) set a new level of caregiver qualification for residential psychiatric treatment centers (RPTC). She noted that there were currently three caregiver standards, and she explained the requirements for each option. She reported that HB 223 allowed for a fourth qualification option. 4:45:47 PM REPRESENTATIVE HOLMES asked for a clarification for the new qualification. 4:45:52 PM MS. MUNSON explained that page 2, line 26 should not contain (1), and that this would allow someone without the four year combination of education and experience to work during the hours that another qualified caregiver with that four year combination was at work. 4:46:54 PM MS. MUNSON referred to Section 1 (c) and noted that an amendment would mirror the regulation except to also allow that the training be approved by the department, not merely provided. She pointed to Section 1(d) which provided a definition of caregiver. 4:48:34 PM REPRESENTATIVE HOLMES removed her objection. There being no further objection, Version C was adopted as the working document. 4:49:08 PM PAT HEFLEY, Deputy Commissioner, Office of the Commissioner, Department of Health and Social Services (DHSS), said that he recognized that the health care workforce had one of the highest vacancy rates in Alaska. He emphasized that this bill was for a residential psychiatric facility for kids, and that these were very tough kids. He acknowledged that the Bring the Kids Home program was working very well, and that about 66 percent of the kids were home in Alaska. He said that many of the facilities had problems recruiting employees to be in frequent contact with the kids. He said that DHSS had a concern with the use of statute for changes in qualification standards. He noted that the facilities had the ability to ask for a variance, and that there was not a need to drop the standard. He expressed concern that incident reports would increase. He said that only recently had he been apprised of this urgency, though he was aware of a shortage of staff. He said that DHSS agreed that there was a problem, but did not agree with a change in statute as a solution. 4:57:09 PM STACIE KRALY, Chief Assistant Attorney General, Human Services Section, Civil Division (Juneau), Department of Law (DOL), said that she had not seen the CS, but that the primary concern for DOL was that there were already processes in place to solve the issues. She opined that there were quite a few legal problems with the original bill. She reserved any further comments until she had an opportunity to review the CS. 4:59:01 PM REPRESENTATIVE SEATON asked what the optimal limitation to the number of applicants was qualified within Section 1(b)(4). MR. HEFLEY said that it was important to have experienced staff, and he acknowledged that experience was learned. He expressed his concern for having too many inexperienced staff at any one given time. 5:01:46 PM STACY TONER, Deputy Director, Division of Behavioral Health, Department of Health and Social Services (DHSS), in response to Representative Seaton, opined that no more than 10 percent of the staff should be this inexperienced. 5:02:09 PM BEVERLY WOOLEY, Director, Division of Public Health, Department of Health and Social Services (DHSS), in response to Representative Seaton, said that it was difficult to determine, and this allowed for the variance process to work well. She explained that the variance request came through her office, and it allowed review for the specific needs and situations. 5:03:44 PM CO-CHAIR KELLER asked if there was a comparable standard in the other states where Alaska had sent the youth. MS. TONER, in response to Co-Chair Keller, said that the Alaska standard was comparable to other states, but that this was a big change to the existing requirements. She noted that there was no reference to supervision in HB 223. 5:05:39 PM CO-CHAIR KELLER offered his belief that supervision was addressed in Section 1(b)(4)(C). MS. TONER noted that the wording, "to work at the center only during hours in which an individual is on duty at the center," did not address supervision. 5:06:24 PM REPRESENTATIVE CISSNA said that it was her desire to make the atmosphere at the RPTCs more homelike. She related her experiences working at Alaska Psychiatric Institute (API). She described the RPTC current atmosphere as "much more severe," with a higher level of violence, and an increased sense of hopelessness, all of which required a much higher level of supervision. She stated that she wanted HB 223 to result in shorter, safer, healthier patient residential placements. 5:10:05 PM REPRESENTATIVE LYNN remarked that his year teaching severely emotionally disturbed kids was good preparation for his work at the legislature. 5:10:41 PM CO-CHAIR KELLER asked how many kids were in RPTCs outside Alaska and ready to come back to Alaska if beds were available. MS. TONER, in response to Co-Chair Keller, said that there were 164 kids still outside Alaska. 5:11:05 PM REPRESENTATIVE COGHILL referred to Section 1(c), and asked the cost for the department to provide "training for caregivers." MS. TONER pointed out that the fiscal note was $400,000. 5:11:59 PM CO-CHAIR KELLER asked if it was a given that DHSS provided this training for RPTC staff. MS. TONER replied that there was a residential care child certification training for behavioral rehab service facilities through the Office of Children's Services. She explained that this training brought staff to the Medicaid standards and Medicaid treatment requirements. She allowed that the proposed HB 223 would also use this same "Bring the Kids Home" venue for training. 5:13:36 PM REPRESENTATIVE SEATON referred to Section 1(b) and asked if paragraphs (1), (2), and (3) were each a separate requirement. MS. WOOLEY said that four different tiers of qualification were created. 5:15:39 PM MS. WOOLEY reiterated that the variance process was currently in place for any immediate needs. She explained that the regulatory process allowed full public process and input. She expressed her concern with HB 223 as "a quick fix." 5:16:47 PM REPRESENTATIVE COGHILL agreed that he was "no big fan of pulling regulation out and putting in statutes," but that he was troubled by the difficulties for navigating the system. He asked for suggestions to a remedy for hiring qualified care. MS. WOOLEY, in response to Representative Coghill, agreed that the regulations were overdue for a revision. She offered that the front line providers should be involved in the process. She also suggested that the university system could offer classes for qualification. She noted the difficulty in balancing the staff qualifications, the safety and protection of the kids, and the priority to bringing the kids back to Alaska. 5:20:47 PM REPRESENTATIVE SEATON asked how many current variances there were throughout the state. MS. WOOLEY said that about 37-38 were granted over the last few years. 5:21:48 PM REPRESENTATIVE SEATON commented that only one variance had been allowed for a RPTC. MS. WOOLEY said that there had only been one request, and this was a reason for the DHSS surprise to this recent crisis. 5:22:12 PM JIM MALEY, President & CEO, Alaska Children's Services (ACS), reported that ACS employed 250 staff, with 96 direct care staff, who would be included under these regulations. He expressed his disagreement with the statement from DHSS, and he said that this had been a long standing challenge. He observed that hiring direct care staff was always a problem, and he gave examples of staff shortages and the resulting problems. He said that he had asked DHSS for a variance, but that he was told that it would be denied. He reported that ACS had developed a competency based training model for residential child care workers. He offered the use of this model at no cost to the state. He expressed discomfort at this venue for discussion, but he offered his belief that DHSS had not viewed this as a high enough priority to make changes to the regulation. He reported that staff shortages diminished the opportunity to bring more kids back to Alaska. 5:26:48 PM MR. MALEY, in response to Co-Chair Keller, repeated that he had approached DHSS about a variance, and was told that it would not be granted. 5:27:04 PM REPRESENTATIVE CISSNA asked about the difficulty for hiring and retaining staff. MR. MALEY replied that there were a number of factors, which included staff pay. He said that an intensive training program could develop the competency for staff to work with kids, and he opined that there was a difference between this training and getting an education. 5:30:27 PM REPRESENTATIVE SEATON asked what the most common Bachelors degree was for applicants. MR. MALEY responded that it would be either psychology or social work, although there were occasional applicants with environmental and therapeutic recreation degrees. 5:31:15 PM REPRESENTATIVE SEATON asked if a required degree in social services would be more restrictive for hiring. MR. MALEY replied that it would not be a significant restriction. He commented that he was supportive of regulations, but that he had been frustrated with the responses he had received. 5:32:27 PM JEFF JESSEE, Chief Executive Officer, Alaska Mental Health Trust Authority (AMHTA), Department of Revenue (DOR), expressed concern with the legislation. He stated that the points were well taken, and that there was agreement that the licensing and staff qualification for RPTCs needed to be reviewed. He noted that the Fairbanks RPTC had not asked for a variance. He suggested that it was better to work through the regulations than to change through statute. He said that the full assurance from DHSS to quickly address these issues was most important. He expressed concern with the minimum level for staffing in the current CS. He pledged his support to the Bring the Kids Home work group. 5:38:23 PM KATE BURKHART, Executive Director, Alaska Mental Health Board (AMHB), explained the background of the AMHB, and noted that the AMHB was also an advocacy group which solicited public comments on mental health issues. She stated that AMHB could not support the current version of HB 223. She said AMHB had not received any comments from parents that they would support lesser qualified caregivers at the RPTC. She suggested that the committee solicit consumer discussion. She said that AMHB recognized the necessity to balance the provider staffing needs with the need for quality treatment. 5:40:42 PM MS. BURKHART declared that AMHB supported the regulation process, which involved the public. She allowed that this staffing problem was pervasive throughout the mental health arena. She stated that all the variables involved in work force shortages, including wages, benefits, and stress, needed to be addressed. 5:43:22 PM MR. HEFLEY acknowledged that there was a problem, but he suggested that resolution not be through statute. He said that there was not resistance from DHSS. He reiterated that DHSS was not aware that there was an issue. 5:44:20 PM FRANCES PURDY, Executive Director, Alaska Youth & Family Network (AYFN), said that she had solicited comments from parents involved with RPTCs. She reported that parents had commented that the turnover issue was related to pay, not qualifications. She urged the committee to continue with the regulation process. She stated that this was not an issue of education, but an issue of competencies. She shared that the university was developing "best practice standards." She declared that many issues, including cultural competency, the stigma of mental health, and de-escalation of confrontations, were new and required ongoing training. 5:47:53 PM MS. MUNSON said that she was sympathetic to the DHSS and AMHTA concerns. She stated that this problem deserved a quick solution. She allowed that DHSS had set very high standards for care providers, which could make it difficult to find adequate caregivers. She questioned whether the high standards created the best protection for children, as the issues were most often about: how much protection, how much money to spend, and how to find workers willing to do this difficult work. She explained that, prior to drafting this legislation, she had reviewed the states with Alaskan children enrolled in RPTCs. She stated that the Alaska standards were higher than any of the other states, and she offered some comparisons. She declared that she was not trying to minimize the important and essential role of the direct care providers. She stated that the original intent of the bill was to exactly replicate the existing regulation, so that there would not be any service disruption, and then to add an additional standard. She referred to the amendment [labeled C.3] [Included in the members' packets.] and explained that it included on-site supervision, or mentorship, by someone who met the specifically listed requirements. She reiterated that it was the experience of residential child care in the setting, not the education, which was most critical. She said that these entry level jobs often led to an increased interest, and continued education. She noted that the ratio of supervisors to caregivers was one to six. 5:59:15 PM MS. MUNSON said that variances were on an individual by individual basis. She said that any RPTC which was planning to open could not ask for a variance until they were hiring. She explained the importance for any new RPTC to be aware of the qualification guidelines in advance. She acknowledge the desire of the DHSS to make the regulatory process a priority, but she noted that the regulations had been in effect since 1998, and that all the testifiers to the process had suggested that all the levels of care needed to be reconsidered. She cited the difficulty for ACS to maintain all of their units, even with a large workforce to draw experienced personnel from. She expressed the urgency for action, and she expressed her concern that Alaska was sending kids to other states with lower standards than Alaska. She suggested to fix this caregiver problem immediately, and then to move forward and deal with other problems. She suggested making this a temporary bill for one year, with a provision for DHSS to undertake a regulatory process. She noted that this would allow for uninterrupted care, and would give guidance for the development of new standards. 6:07:19 PM CO-CHAIR KELLER closed public testimony. 6:08:10 PM REPRESENTATIVE COGHILL noted that there were amendments still to be proposed which could affect the fiscal note. He stated that he wanted to keep moving forward with the legislation, but that he was hesitant about the approach. 6:08:47 PM REPRESENTATIVE SEATON reflected that there were problems which had existed for years. He said that the legislature made laws, not regulations. He did not want to rush forward, but preferred to hear more suggestions for options within the variance system. 6:10:42 PM REPRESENTATIVE CISSNA said that the serious problems began decades ago. She explained that previously when there were no services in Alaska, the kids were sent out of state. She opined that, even now, state policy did not give a priority to these issues. She stated that the preventative approach achieved great results at a fraction of the cost. She counseled to "take the time to do this right." She offered her belief that there was a pressure "to fill those beds." She emphasized that there was not a rush for quality or for safety of kids. She suggested that the House Health and Social Services Standing Committee put pressure on DHSS for solutions. [HB 223 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| CSHB 188 Sponsor Summary version N.doc |
HHSS 4/9/2009 3:00:00 PM |
HB 188 |
| CSHB 188 Version N.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 188 |
| HSS188pkt.PDF |
HHSS 3/26/2009 3:00:00 PM HHSS 4/9/2009 3:00:00 PM |
|
| HB223pkt.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 223 |
| HB168pkt.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 168 |
| HB 188 Sectional Version N.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 188 |