04/02/2016 01:30 PM House HEALTH & SOCIAL SERVICES

        HCR 21-RESPOND TO ADVERSE CHILDHOOD EXPERIENCES                                                                     
                                                                                                                                
2:42:11 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced  that the next order of  business would be                                                               
HOUSE CONCURRENT  RESOLUTION NO. 21, Urging  Governor Bill Walker                                                               
to  join with  the Alaska  State  Legislature to  respond to  the                                                               
public  and  behavioral  health  epidemic  of  adverse  childhood                                                               
experiences  by establishing  a  statewide  policy and  providing                                                               
programs to address this epidemic.                                                                                              
                                                                                                                                
2:42:40 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 2:42 p.m. to 2:43 p.m.                                                                       
                                                                                                                                
2:43:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR offered  a  PowerPoint presentation  titled,                                                               
"Adverse  Childhood Experience,"  [referred  to  slides 1-9]  and                                                               
reminded the  committee that these  issues had been  discussed in                                                               
committee   previously.     She  noted   that  Dr.   Hirschfeld's                                                               
presentation  discussed  the  origins   of  the  ACEs  study  and                                                               
developing an ACEs  score and she said she would  skip over those                                                               
topics.   Previously, members had  been asked to take  their ACEs                                                               
score and  pointed out that in  asking people to take  their ACEs                                                               
score it rises awareness and  assists in understanding the issues                                                               
better.   Key findings within  the Alaska work is  that childhood                                                               
trauma is far more common, it  lasts over a lifetime, and impacts                                                               
generations.  Research has shown  that approximately $1.4 billion                                                               
is spent every  year in Alaska on substance  abuse related issues                                                               
from treatment  to the court  system to law enforcement,  and she                                                               
referred to  Dr. Hirschfeld's presentation regarding  some of the                                                               
cost  reductions that  can be  associated with  reducing Alaska's                                                               
ACEs scores.                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR   explained  that   HCR  21  calls   on  the                                                               
legislature  and the  governor to  work  together to  do more  on                                                               
policy level changes.  Last  year, the legislature worked hard on                                                               
Erin's Law  and Bree's  Law, and  the legislature  discussed ACEs                                                               
through  those  bills.    She then  stressed  the  importance  of                                                               
keeping  that   conversation  going   this  year,  to   keep  the                                                               
conversation going as  more awareness needs to  be developed with                                                               
education and  some of  this can  be done  without funding.   She                                                               
pointed to  slides 6-9, and  advised that  these are some  of the                                                               
opportunities  for prevention,  and that  during the  interim the                                                               
committee  will  continue  looking  at policy  alternative.    In                                                               
working through the implementation of  Erin's Law and Bree's Law,                                                               
she wants to  make sure the legislature is part  of the effort to                                                               
build a  statewide network of  people concerned about  the issues                                                               
and come together.                                                                                                              
                                                                                                                                
2:45:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR advised there are  27 letters of support from                                                               
organizations  across the  state, such  as the  Children's Trust,                                                               
Suicide   Prevention   Council,   Mental   Health   Board,   Best                                                               
Beginnings,  and  also   approximately  200  hundred  individuals                                                               
signed petitions  from different  early learning  conferences she                                                               
attended, from the Dr. Felitti event,  and from the "Go Blue Day"                                                               
Child  Abuse Prevention  rally  yesterday.   In  bringing all  of                                                               
these  groups together,  she  noted  that her  hope  is to  bring                                                               
together  a network  of people  to determine  that it  isn't just                                                               
about spending more  money on something, but more  about having a                                                               
deeper  understanding  of these  ACEs  issues,  and its  impacts.                                                               
ACEs  is about  connecting the  dots  and within  the letters  of                                                               
support  there are  individuals working  on mental  health, early                                                               
learning,   substance  abuse,   or   suicide   prevention.     In                                                               
understanding  ACEs it  brings a  new opportunity  for connecting                                                               
the dots  between the negative  health outcomes and  looking back                                                               
at  the  origins  and  determining  what  the  origins  of  those                                                               
problems are.                                                                                                                   
                                                                                                                                
REPRESENTATIVE  TARR  referred  to  an additional  slide  in  the                                                               
committee  packets  from  the All  Alaska  Pediatric  Partnership                                                               
regarding  ACEs  accumulation  and  read,  "Young  Alaskans  have                                                               
acquired HALF  of their accumulated ACEs  by the age of  3."  She                                                               
explained  that  it  speaks  to   the  importance  of  the  early                                                               
intervention   programs.       As   Dr.   Hirschfeld   discussed,                                                               
pediatricians and  other health  care providers can  be frontline                                                               
in that effort, and she added  that early education folks such as                                                               
Best  Beginnings are  working on  early education.   There  was a                                                               
time it was believed there was  a protected wall around the fetus                                                               
and that the  mother smoking and drinking was okay.   It was also                                                               
believed that  children in the pre-verbal  times were unimpressed                                                               
by things,  and that  events could be  happening around  them and                                                               
there wasn't a big impact.   To put this in context, she related,                                                               
the study  referenced was  published in  1989, and  when thinking                                                               
about how recent that's been for  people to learn about that data                                                               
and  then start  doing their  own research,  there really  hasn't                                                               
been an opportunity to implement  it into the state's policies in                                                               
a manner  that can  be implemented to  have a  tremendous impact.                                                               
This slide shows that a lot of  the bad stuff is happening at the                                                               
time people  previously believed  children would not  be impacted                                                               
by the  behaviors around them,  or even  be aware of  violence or                                                               
substance abuse, she said.                                                                                                      
                                                                                                                                
2:49:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  related that  building awareness is  part of                                                               
the  effort  that  can  be accomplished  without  funding  a  new                                                               
program,  and  through the  efforts  this  month of  child  abuse                                                               
prevention  and organizations  hosting many  different activities                                                               
sharing  information and,  hopefully, get  more people  involved.                                                               
Working with  educators and practitioners  and the  government in                                                               
creating policy alternatives is the next step, she remarked.                                                                    
                                                                                                                                
2:49:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FOSTER   expressed  his   support  and   that  he                                                               
appreciated  Dr. Hirschfeld's  presentation and  learning of  his                                                               
efforts in his practice in Nome  as it makes it more tangible for                                                               
him.                                                                                                                            
                                                                                                                                
REPRESENTATIVE TARR related that  these are long term investments                                                               
and as  Dr. Hirschfeld related,  within every step along  the way                                                               
the state has  opportunities to work with children  when they are                                                               
in school, and  that there are screening tools  when meeting with                                                               
families.  One  big opportunity is just in  changing the language                                                               
when  there is  a  child  with behavioral  problems.   The  child                                                               
acting out is  not asked what is wrong with  them, but rather the                                                               
child is asked what happened to  them.  Things like this give her                                                               
hope  and that  even  without  a lot  of  funding, moving  toward                                                               
something  where   most  of  it   is  simply   understanding  the                                                               
opportunities, and  the different places  that can be  engaged in                                                               
sharing this information.                                                                                                       
                                                                                                                                
CHAIR SEATON  noted his appreciation  for both  presentations and                                                               
that he  found Dr. Hirschfeld's  comments interesting  because he                                                               
was  unsure  how much  the  medical  community and  quasi-medical                                                               
community   had  been   involved   with  those   types  of   care                                                               
coordination efforts with  families.  He related that  it is good                                                               
to hear  that they  are not  just looking at  the child,  but the                                                               
situation the child is in.                                                                                                      
                                                                                                                                
2:52:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FOSTER  moved  to  report  HCR  21,  labeled  29-                                                               
LS1398\A out  of committee  with individual  recommendations with                                                               
no fiscal notes.                                                                                                                
                                                                                                                                
CHAIR SEATON  objected for  discussion and  read into  the record                                                               
the language on page 3, lines 14-22, as follows:                                                                                
                                                                                                                                
          BE IT RESOLVED that the state's policy decision                                                                     
     acknowledge  and take  into account  the principles  of                                                                    
     early   childhood  brain   development  and,   whenever                                                                    
     possible, consider the concepts  of toxic stress, early                                                                    
     adversity, and buffering relationships, and be it                                                                          
          FURTHER RESOLVED that early intervention and                                                                        
     investment  in  early  childhood  years  are  important                                                                    
     strategies to  achieve a lasting foundation  for a more                                                                    
     prosperous and  sustainable state through  investing in                                                                    
     human capital; and be it                                                                                                   
          FURTHER RESOLVED that the Governor join with the                                                                    
     Alaska State  Legislature and  address the  presence of                                                                    
     adverse  childhood  experiences  as  factors  for  many                                                                    
     societal  issues and  to  fund  research for  statewide                                                                    
     solutions.                                                                                                                 
                                                                                                                                
CHAIR SEATON opened public testimony                                                                                            
                                                                                                                                
2:52:20 PM                                                                                                                    
                                                                                                                                
TREVOR STORRS, Executive Director,  Alaska Children's Trust, said                                                               
the  Alaska Children's  Trust  is focused  on  the prevention  of                                                               
childhood  abuse  and  neglect.    He  related  that  the  Alaska                                                               
Children's  Trust  is  also partnering  with  groups  around  the                                                               
concept of reducing trauma and  building resiliency in the child,                                                               
the  family, and  the community.   He  noted that  what has  been                                                               
presented today  is a complex  issue and what the  committee does                                                               
with this information  is not about enacting  one specific thing,                                                               
but it is  the framework to help promote the  concept of reducing                                                               
trauma  adversity to  not only  the  child, but  a community  and                                                               
cultures within  Alaska.   When these  issues are  addressed, not                                                               
only  does  it  save  money,   it  builds  communities  that  can                                                               
withstand trauma which  is a natural part of the  circle of life,                                                               
but child abuse and neglect are  not a natural part of the circle                                                               
of life.   It is resiliency  that glues that circle  together and                                                               
the role  of the community is  to be certain the  glue being used                                                               
is the strongest and best glue so everyone benefits, he said.                                                                   
                                                                                                                                
REPRESENTATIVE TARR asked  Mr. Storrs to send  information to the                                                               
committee members about the Resiliency Initiative.                                                                              
                                                                                                                                
MR. STORRS agreed.                                                                                                              
                                                                                                                                
2:56:37 PM                                                                                                                    
                                                                                                                                
DON  ROBERTS described  himself  as an  adult  survivor of  these                                                               
adverse   childhood  experiences   and   in   listening  to   the                                                               
presentations  he noted  that  the system  tends  to forget  that                                                               
there are  many adults dealing with  this in their lives  with no                                                               
resources available to them.  He  agreed that the programs can be                                                               
initiated, but  they are for children  and families and he  is 58                                                               
years old.  He took the ACEs test  and had a score of 7, although                                                               
it would  have been  higher if  it asked  a few  other questions.                                                               
Adult programs need to be integrated  so when adults get into the                                                               
system they are  not just sidelined due to no  services out there                                                               
because the  legislature didn't put  it in,  he related.   Due to                                                               
his  adverse   childhood  experiences,  having   intimate  family                                                               
relationships is  troublesome because he  doesn't want to  be the                                                               
kind of parents  he had where basically his  childhood was filled                                                               
with  anger and  violence.    He opined  that  this  needs to  be                                                               
included in the  legislation.  There are other  services, such as                                                               
peer  support  services that  are  not  necessarily part  of  the                                                               
mainstream clinical experience people should  be able to use and,                                                               
he opined,  peer support  services are  often given  short shrift                                                               
when they  tend to be far  more effective in helping  people deal                                                               
with these issues in their lives.                                                                                               
                                                                                                                                
CHAIR SEATON offered  support for his testimony  and related that                                                               
there  is  definitely no  one  point  in which  addressing  these                                                               
issues can be stopped.                                                                                                          
                                                                                                                                
3:00:28 PM                                                                                                                    
                                                                                                                                
PATRICK  ANDERSON,  Senior  Research  Fellow,  Sealaska  Heritage                                                               
Institute, said  he is a  Senior Research  Fellow in the  area of                                                               
childhood trauma and health restoration,  and has been engaged in                                                               
research and advocacy around  adverse childhood experiences since                                                               
2008  when he  was  the  CEO of  an  Alaska  Native Rural  Health                                                               
System.  As a consequence of his  advocacy he is a member of both                                                               
the  American Indian  and  Alaska Native  Task  Force on  suicide                                                               
prevention  and  president  of  the  Native  American  Children's                                                               
Alliance  (NACA), assisted  in the  drafting of  this resolution,                                                               
and that his ACEs score is  6.  He described the understanding of                                                               
the  existence of  real and  identifiable childhood  trauma being                                                               
linked to adult health and  negative behaviors as an exciting new                                                               
arena of  public policy.   He then  referred to  Dr. Hirschfeld's                                                               
presentation and said that if  childhood trauma can be identified                                                               
early in a  child's life it can be addressed  before it becomes a                                                               
true  problem  and  prevention  becomes  a  real  option  because                                                               
parents can be  taught how to avoid the behaviors  that cause the                                                               
development  of this  trauma in  children.   He  referred to  the                                                               
perception   that  the   resolution  addresses   early  childhood                                                               
prevention only,  but that was  not the  intent.  He  referred to                                                               
HCR 21, page 3, lines 14-16, which read:                                                                                        
                                                                                                                                
          BE IT RESOLVED that the state's policy decision                                                                       
     acknowledge  and take  into account  the principles  of                                                                    
     early   childhood  brain   development  and,   whenever                                                                    
     possible, consider the concepts  of toxic stress, early                                                                    
     adversity, and buffering relationships, and bit it                                                                         
                                                                                                                                
MR. ANDERSON pointed out that  it is directed toward adult health                                                               
and  behaviors as  well as  early  children's brain  development,                                                               
health, and behaviors.  He advised  he has spent the last four or                                                               
five years  looking for a  systemic approach that  addresses both                                                               
the parenting generation's behaviors  and children's behaviors in                                                               
a family  and community  context.  Mr.  Anderson opined  that the                                                               
goal  is  to  introduce  a program  that  effectively  identifies                                                               
behaviors early enough to begin  the healing process.  Within the                                                               
City of  Nome, where Dr.  Hirschfeld practices, there has  been a                                                               
discussion in  the last few  years around ACEs that  has advanced                                                               
to  the  point  of  serious consideration.    During  the  recent                                                               
convention  of   the  National  Congress  of   American  Indians,                                                               
presentations  were  offered on  the  topic  including a  plenary                                                               
presentation by  Dr. Vincent  Felitti.   Tribal groups  in Alaska                                                               
have started the process of  understanding and using ACEs and are                                                               
following  examples  from  the  lower-48.   Dr.  Ann  Bullock  is                                                               
employed by  an Indian tribal  health system  addressing diabetes                                                               
through programs  that identified and treated  traumatic or toxic                                                               
stress.   Dr. Donald  Warne is an  American Indian  physician who                                                               
has  been  active  through the  Great  Plains  Tribal  Chairman's                                                               
Health Board in addressing ACEs and  there are many other who are                                                               
following their lead.                                                                                                           
                                                                                                                                
MR. ANDERSON  referred to the  Behavior Risk  Factor Surveillance                                                               
System (BRFSS)  and emphasized  that Alaska Natives  have a  4 or                                                               
more  ACEs at  a rate  which is  almost double  that of  the non-                                                               
Native population according  to BRFSS.  As a result,  many of the                                                               
Alaska  Native  communities  view  this area  as  a  priority  to                                                               
address.    When  Dr.  Felitti  was  in  Juneau,  they  took  the                                                               
opportunity  to  meet  with   Governor  Bill  Walker,  Lieutenant                                                               
Governor  Byron  Mallott,  Commissioner   Dean  Williams  of  the                                                               
Department  of  Corrections,  and  Jay Butler  the  Alaska  Chief                                                               
Medical Officer.   They  briefed Governor  Walker on  this issue,                                                               
made him aware  of the legislation, and asked  Governor Walker to                                                               
support it.   Mr. Anderson opined that this  resolution has great                                                               
potential for  encouraging a wider  discussion of ACEs  in Alaska                                                               
and  if  it  leads  to more  programing  to  address  prevention,                                                               
earlier intervention,  and healing that  would be fantastic.   He                                                               
then asked  that the committee pass  HCR 21 out of  committee and                                                               
encouraged the adoption of the resolution by the legislature.                                                                   
                                                                                                                                
3:05:58 PM                                                                                                                    
                                                                                                                                
MAUREEN HALL, School Nurse, said she  is a school nurse in Juneau                                                               
and  she fully  supports this  resolution because  [nurses] daily                                                               
see children on  the frontline in their offices.   These children                                                               
typically have a  high ACEs score, and are seen  most often which                                                               
carries  over into  adult  medicine when  they  leave the  school                                                               
setting.  These individuals, she  said, are the heaviest users of                                                               
the health  care system,  are most apt  to have  poor educational                                                               
outcomes, and end  up engaging with the  criminal justice system.                                                               
As far  as the savings being  20 years down the  road, she argued                                                               
that the  savings will be  immediate because those  children will                                                               
not be as sick as their peers  when they have a lower ACEs score.                                                               
It will prevent a lot of  the adversity and they'll be healthier,                                                               
and be  better able  to learn once  they do get  to school.   She                                                               
pointed  out   that  this  is  important   in  raising  awareness                                                               
throughout  our state,  and she  would like  every school  in the                                                               
state  become  a trauma  informed  school,  as well  as  Alaska's                                                               
communities.   By every police officer  and teacher understanding                                                               
how  the  adverse  childhood experiences  affect  a  person,  she                                                               
opined  that  it  would  go  a long  way  toward  preventing  and                                                               
increasing awareness, and helping  that person be more successful                                                               
down the road.                                                                                                                  
                                                                                                                                
CHAIR SEATON  removed his objection.   There being  no objection,                                                               
HCR 21,  Version 29-LS1398\A, with  no fiscal notes,  passed from                                                               
the  House   Health,  Education  and  Social   Services  Standing                                                               
Committee.