02/07/2006 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Overview(s): || Department of Education and University of Alaska | |
| HB408 | |
| Overview(s): || Department of Health and Social Services – Bring the Kids Home (btkh) | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 408 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 7, 2006
3:07 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Carl Gatto
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Paul Seaton, Vice Chair
Representative Tom Anderson
Representative Vic Kohring
COMMITTEE CALENDAR
OVERVIEW(S): DEPARTMENT OF EDUCATION AND UNIVERSITY OF ALASKA;
DEPARTMENT OF HEALTH AND SOCIAL SERVICES
- HEARD
HOUSE BILL NO. 408
"An Act relating to the definition of 'child abuse and neglect'
for child protection purposes; and providing for an effective
date."
- HEARD AND HELD
OVERVIEW(S): DEPARTMENT OF HEALTH AND SOCIAL SERVICES - BRING
THE KIDS HOME (BTKH)
- HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 408
SHORT TITLE: CHILD ABUSE AND NEGLECT/DISCLOSURE/PFDS
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
01/30/06 (H) READ THE FIRST TIME - REFERRALS
01/30/06 (H) HES, FIN
02/07/06 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
MANDIE NORRIS, Intern
to Representative Eric Croft
Alaska Legislature;
Spokesperson, University of Alaska Legislative Intern Program
POSITION STATEMENT: Presented a gift to the president of the
University of Alaska.
MARK HAMILTON, President
University of Alaska
Fairbanks, Alaska
POSITION STATEMENT: Received lauds from the University of
Alaska Intern Program delegation; and co-presented an overview
of the Alaska Statewide Mentor Project.
ROGER SAMPSON, Commissioner
Department of Education and Early Development (EED)
Juneau, Alaska
POSITION STATEMENT: Co-presented an overview of the Alaska
Statewide Mentor Project.
JOANNE GIBBENS, Program Administrator
Office of Children's Services (OCS)
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented HB 408 on behalf of the governor.
STACIE KRALY, Chief Assistant Attorney General
Statewide Section Supervisor
Human Services Section
Department of Law (DOL)
Juneau, Alaska
POSITION STATEMENT: Responded to questions on HB 408.
STACY TONER, Deputy Director
Division of Behavioral Health (DBH)
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Co-presented an overview of the Bring The
Kids Home (BTKH) program.
BILL HERMAN, Trust Program Officer
Alaska Mental Health Trust Authority (AMHTA)
Anchorage, Alaska
POSITION STATEMENT: Co-presented an overview of the Bring The
Kids Home (BTKH) program.
JEFF JESSEE, Chief Executive Officer (CEO)
Alaska Mental Health Trust Authority (AMHTA)
Anchorage, Alaska
POSITION STATEMENT: Co-presented an overview of the Bring The
Kids Home (BTKH) program.
GUS MARKS, Grants Manager
Juneau Youth Services (JYS), Incorporated (Inc.)
Juneau, Alaska
POSITION STATEMENT: Co-presented an overview of the Bring The
Kids Home (BTKH) program.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:07:10 PM.
Representatives Gatto, Gardner, Cissna, and Wilson were present
at the call to order.
3:07:56 PM
CHAIR WILSON announced that the first order of business would be
a presentation by the members of the University of Alaska
Legislative Intern Program.
3:08:50 PM
MANDIE NORRIS, Intern to Representative Eric Croft, Alaska
Legislature; Spokesperson, University of Alaska Legislative
Intern Program, presented a gift to the president of the
University of Alaska, in appreciation of the intern program.
3:10:03 PM
^OVERVIEW(S):
^DEPARTMENT OF EDUCATION AND UNIVERSITY OF ALASKA
3:10:26 PM
CHAIR WILSON announced that the next order of business would be
an overview of the Alaska Statewide Mentor Project by the
Department of Education and Early Development and the University
of Alaska.
3:11:02 PM
MARK HAMILTON, President, University of Alaska, introduced the
Alaska Statewide Mentor Project, and distinguished between the
words "cooperation" and "collaboration," stressing the root word
"labor" as significant in the work, which the involved entities
have undertaken to create this project. He explained how this
project stemmed from reports provided by teachers who described
difficulties in establishing support units within their assigned
schools. Given the retention issues, particularly in the rural
school districts, the task was to identify a means to ease these
difficulties and help the newly assigned teachers to be
"comfortable" in their positions. He reported that last year
300 new teachers were assigned mentors; master teachers of high
quality. Mentorship support involves monthly site visits,
weekly telephone conferences, and daily e-mail contact, which
helps to further the development and training of a new teacher.
Although a database type report has not been generated, the
anecdotal evidence is impressive. He stressed that by
increasing the retention factor alone, the statistics will
inevitably show an increase in student success levels. A
parallel should be drawn between the teaching and the medical
professions, he opined. The model of an intern's residency
under a master doctor for practical training and insured success
is modified here to apply to, and provide support for, the new
teachers. The University of Alaska's role is to train and
support the master teachers to be effective mentors. The school
principals who have observed the program have requested similar
assistance, which resulted in the development of a principal
"coaching program." Thus far, federal grants have funded this
project, however, he said this year the federal grants are being
cut and financial support is being sought from the state. The
direct and implied costs involved in teacher retention will
justify the funding, he said, and he predicted that Alaska will
be recognized nationally for developing and implementing this
program.
ROGER SAMPSON, Commissioner, Department of Education and Early
Development (EED), provided specifics of the projects goals,
paraphrasing from the following project summary [original
punctuation provided]:
The Alaska Department of Education & Early Development
(EED) created the Alaska Statewide Mentor Project in
partnership with the University of Alaska (UA) in
support of their shared mission to improve academic
achievement for students in Alaska. The Alaska
Statewide Mentor Project (ASMP) includes two
components:
Teacher mentoring for beginning teachers.
Principal coaching for new school principals.
The goals of the program are to increase teacher
retention, increase student achievement, and equip
principals with the skills to be instructional leaders
and effective managers. The ASMP model is based on the
nationally acclaimed New Teacher Center at the
University of California, Santa Cruz
Teacher Mentoring
Goals: Increase teacher retention and increase student
achievement.
Who are the mentors? The mentors are teachers with
extensive classroom experience, often in variety of
grade levels in urban and rural Alaska. They are
released from teaching to provide mentoring for a two-
year period.
How are the mentors trained? Mentors receive formal
training in eight three-day Mentor Academy sessions
held over two years. Topics focus on formative (in-
class) assessment tools, the analysis of student work,
and differentiated instruction.
st-nd-
What teachers receive mentoring? 1 and 2 year
teachers from participating school districts.
What does the research show? Nationally, research
shows that effective mentoring slows teacher attrition
by half while increasing student achievement. Teachers
who receive quality mentoring gain the skills of a
teacher with five years' experience in just two years.
Mentors also become instructional leaders when they
return to their districts.
Principal Coaching
Goals: Increase the retention rate of principals and
give them skills to be effective instructional
leaders.
Who are the coaches? The coaches are retired
administrators with demonstrated success as
instructional leaders. They have had experience in
many educational settings and communities in Alaska.
How are the coaches trained? Coaches receive ongoing
training through workshops and seminars in the areas
of instructional leadership, school management, human
resources, and student services.
What principals receive mentoring? Principals
participate on a voluntary basis with permission from
their district.
What does the research show? The person most likely to
influence the learning atmosphere of a school, other
than the classroom teacher, is the principal. Alaska
needs committed school leaders to accelerate its
standards-based school reform efforts.
What problems does the Alaska Statewide Mentor Project
address?
The teacher turnover rate in Alaska is very high,
especially in rural communities.
Students do not reach their academic potential
when they have novice teachers.
The person most likely to influence the learning
atmosphere of a school, other than the classroom
teacher, is the principal. Principals often have
to learn on the job without any guidance or
assistance.
The high turnover rate of teachers and principals
is negatively impacting student development and
hampering Alaska's standards-based education
initiatives.
How does the project solve the problems?
New teachers and principals are not left alone in
the first years of practice to "sink or swim,"
but instead are provided with a supportive
mentoring model that is more consistent with that
of other high-impact professions such as medicine
or law.
Research in the U.S. has shown that effective
mentoring slows teacher attrition by half,
increases student achievement, and speeds up the
rate at which a teacher reaches proficiency.
What is unique about the Alaska Statewide Mentor
Project model?
Alaska's mentor program is modeled after the
nationally acclaimed program from the New Teacher
Center at the University of California, Santa
Cruz. This model has been developed over a 17-
year period and is research-based. The model
includes:
Rigorous mentor selection
Full release of master classroom teachers so
they can mentor full-time and participate in
professional development for mentors
Structured face-to-face teacher/mentor
interaction at least monthly with weekly
follow-up e-mail and/or phone meetings
Documentation of specific instructional
goals for teachers
Ongoing mentoring for the first two years of
teaching
What are the results after the first year?
According to data from the Alaska Institute for
Social and Economic Research, the five-year
st-nd
weighted retention rate for 1 and 2-year
teachers in districts participating in the Alaska
Statewide Mentoring Project prior to
implementation was 68%.
Of 339 new teachers participating in the mentor
program in the first year, 77% returned to the
district.
3:22:40 PM
COMMISSIONER SAMPSON stated:
This is a win for school districts, for the department
..., for the University system, the state of Alaska,
and most importantly, this is a win for the young
people of Alaska. It's an absolute homerun. ...
Usually we come with an idea, that we want [the
legislature] to support, and we project what we think
the outcomes will be. With this [project] we bring
... more than an idea. ... We have one year of formal
research information that was designed from the
beginning of the program that shows, in some areas of
the state, ... the turnover rate [was reduced to] ...
zero. But in many regions ... the turn over rate [was
cut] in half. ... The easy part is getting [the
teacher] right now, the hard part is retaining
teachers that are ... effective for Alaska students.
This program does that.
3:25:17 PM
COMMISSIONER SAMPSON stressed how this program is able to affect
the teaching profession on a level beyond what any of the
existing policies allow, and provides a crucial induction into
the classroom experience. The $5 million request for this
proven program is in the governor's budget. He explained that
the funding request would allow the program to be expanded into
more districts, and covers the teacher and principal programs.
3:27:34 PM
CHAIR WILSON asked how the mentors are compensated for their
efforts, and how direct mentor contact is achieved.
COMMISSIONER SAMPSON explained that the master teacher is loaned
to the mentor program, which then pays their current salary and
benefits for the two year period, honoring any step increase
that are due. The loaning school guarantees a position for the
master teacher when they return. He reported that the model
program, in existence for seventeen years, indicates that
following two years of mentoring, 50 percent of the master
teachers return to the classroom, 25 percent move into
leadership roles as principals, assistant principals, staff
developers, and curriculum directors, and the remaining 25
percent continue in mentoring. Considering this outcome, he
opined that the money is well spent and continues to enrich the
districts in the long term and benefit from the expertise that
the teachers attain.
3:30:19 PM
CHAIR WILSON suggested that the established relationship of the
teachers involved tends to continue, given the bond developed
during the mentorship, thus informally continuing the support.
COMMISSIONER SAMPSON commented that the direct service, by the
mentors is to the teachers to whom they are assigned. However,
he said, indirectly many more teachers are served, as the
veteran teachers on site request to join the mentoring
discussion sessions. These informal opportunities and benefits
are not accounted for in the statistical data.
3:31:49 PM
REPRESENTATIVE GARDNER pointed out that on page 2, of the EED,
Alaska Statewide Mentor Project Summary paper, the turn over
rate of 23.8 percent was reduced to 21 percent in 2005, and
asked whether that should be considered significant. Further
she said that the report indicates that the non-urban districts
report a drop from 34 percent to 26 percent, and asked for
clarification on the programs effectiveness statewide.
MR. HAMILTON explained that the non-urban schools were the
primary recipients of this program, but that the statistics were
compiled to indicate statewide retention versus individual
district information, which present more impressive numbers.
REPRESENTATIVE GARDNER inquired whether it is difficult to get
teachers to take rural positions.
COMMISSIONER SAMPSON responded that it is not difficult to get
mentors to assist in rural areas, and it is part of the
interview/selection process. He explained that the newest
educators in the state commonly begin in a rural setting and
migrate to the urban schools. Describing the selection process,
he said that the mentors are chosen based on the success that
they have had in the areas which the program requires. Many of
the larger schools in a district have mentorship programs
already in place, but none have a full release mentorship, which
allows a teacher to not carry a class in order to focus solely
on mentoring.
3:36:10 PM
REPRESENTATIVE CISSNA noted the large number of new teacher
hires indicated in the handout. She asked how many were local
or Alaskan resident teachers, and whether there is an effort to
hire Alaskan residents.
COMMISSIONER SAMPSON answered that perhaps two Natives applied
for the mentoring program, which is indicative of the low
numbers of applicants from the rural areas. However, he
reported that the majority of students who are identified in the
Alaska Scholars Program, qualifying for a university education,
stay in the state. He stressed the importance of the scholars
program as a means to "grow our own."
3:38:21 PM
REPRESENTATIVE GATTO stated his understanding that the cost to
replace a teacher is about $12,000, and a higher retention level
might reduce that figure by approximately half.
COMMISSIONER SAMPSON pointed out that considering the statistics
from the largest school districts, that savings has already been
realized.
REPRESENTATIVE GATTO indicated that the 2005 percentage,
previously mentioned on page 2 of the report, does not indicate
that much of a "drop;" 21 percent is not half of 23.8 percent.
MR. HAMILTON explained that the data figures reflect statewide
figures, however, the program was not a statewide program.
Therefore, the statewide numbers are affected only slightly, but
with an expanded program, this number should change
dramatically.
MR. SAMPSON added that the first and second year teachers are
also the first to get laid off, which has happened in some
districts, such as the Kenai Peninsula; skewing the statistics.
REPRESENTATIVE GATTO offered that the Anchorage fire department
has a successful mentor program utilizing retired captains.
3:41:47 PM
HB 408-DEFINITION OF CHILD ABUSE AND NEGLECT
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 408, 24-GH2021\A, "An Act relating to the
definition of 'child abuse and neglect' for child protection
purposes; and providing for an effective date."
3:42:14 PM
JOANNE GIBBENS, Program Administrator, Office of Children's
Services (OCS), Department of Health and Social Services (DHSS),
presented HB 408 on behalf of the governor, and stated that
this bill brings Alaskan statute into compliance with federal
law. She explained that the Keeping Children and Families Safe
Act of 2003 amended the Child Abuse Prevention and Treatment Act
(CAPTA), which is the funding source for OCS's child abuse and
neglect prevention and treatment programs. The definition of
"child" is amended in HB 408 to include "an infant who has been
identified by a health care provider involved in the delivery or
care of that infant as being affected by abuse of a controlled
substance or from withdrawal from prenatal exposure to a
controlled substance." The purpose of the bill is to ensure
that health care professionals report such individuals to the
department under the state's mandatory reporting laws for child
abuse and neglect. She pointed out that, although health care
providers are already making these reports, the bill is
necessary to be compliant with federal law which requires state
statute to reflect a mandate for these reports.
3:43:58 PM
REPRESENTATIVE CISSNA asked whether: HB 408 mandates more
specific reporting; are these children likely to be taken into
custody; what system will be in place to support a state
custodial outcome; and is there a follow-up program for the
involved parent to help stem recidivism.
MS. GIBBENS explained that by expanding the term "child," the
scope of all mandated reporters, including a number of different
types of health care providers is also expanded. She stated
that OCS receives infant related calls on a regular basis and
does not anticipate an increase, save certain areas of the
state. When a call comes in from a hospital, the OCS response
will: establish a family profile for assessment purposes; make
a referral for treatment if appropriate; and ascertain the
safety of the infant and other siblings in the home. In case
work follow-up, OCS works with the hospital staff, substance
abuse counselors, and any available local programs that are
applicable; albeit a shortage of statewide programs exists. She
reiterated that this reporting is already happening.
3:47:55 PM
REPRESENTATIVE GARDNER stated that the language of HB 408
defines "child" as "an infant" born into an abusive situation
and would it not be more appropriate for the bill language to
include any child who is subject to [substance abuse] exposure,
either prenatal or postpartum.
STACIE KRALY, Chief Assistant Attorney General, Statewide
Section Supervisor, Human Services Section, Department of Law
(DOL), answered that the bill is expected to encompass children
both prenatal and postnatal who have "been exposed to controlled
substances through the mother." She explained that DOL drafted
HB 408 as a comprehensive vehicle for meeting CAPTA requirements
without making unduly burdensome requirements on providers and
to quantify what is already in practice.
3:50:39 PM
REPRESENTATIVE GARDNER inquired why alcohol is not included in
the bill.
MS. GIBBENS responded that HB 408 is intended to bring state
statute into federal compliance, which only requires addressing
illegal substances. She offered to reconvene with the
appropriate departments to consider including alcohol as part of
the bill.
REPRESENTATIVE GARDNER stated that this may be an opportunity to
address alcohol as child abuse.
MS. KRALY reiterated that the purpose of HB 408 is to comport
with federal requirements.
CHAIR WILSON inquired if including language to address alcohol
would compromise the bill comporting to federal requirements.
STACIE KRALY responded that it would not be a problem at the
federal level and pointed out that other states do include
alcohol in their legislation.
CHAIR WILSON asked what the ramifications might be of including
alcohol in the bill's language.
MS. GIBBENS stated that OCS would probably experience an
increase in the number of calls received, although they
currently receive calls from medical care providers concerned
about prenatal alcohol use and exposure. She pointed out that
OCS does respond to these calls. In answer to a question, she
clarified that OCS's federal funding is subject to the mandated
reporting of, and appropriate response to, illegal substance
abuse issues.
CHAIR WILSON announced that the bill would be held pending the
proposal of amendments.
3:54:55 PM
REPRESENTATIVE GARDNER requested the following language changes:
Page 1, line 9
Delete "child" includes an infant who has been
identified ...
Insert "child abuse" includes pre natal exposure ...
3:55:55 PM
CHAIR WILSON pointed out the CAPTA requirements contained in the
bill packet, and reiterated that this bill would be brought back
before the committee on Thursday [February 9, 2006].
REPRESENTATIVE GARDNER cautioned that "we may be opening a can
of worms" in dealing with the adult use of a legal substance.
CHAIR WILSON acknowledged that, with Alaska being the nation's
number one consumer of alcohol, its use presents many social and
medical issues in the state.
REPRESENTATIVE CISSNA reminded the committee of the need for
preventative/recovery programs for parents versus removing their
children. She stated that many parents may have the intent of
being good parents and she pointed out the need to develop means
to assist and educate them to that end.
REPRESENTATIVE GARDNER said that despite the need for emphasis
on prevention and services, it is imperative to first protect
the child and ensure their safety.
3:59:55 PM
CHAIR WILSON reiterated that HB 408 would be held and said that
it would be brought before the committee again [February 9,
2006].
^OVERVIEW(S):
^DEPARTMENT OF HEALTH AND SOCIAL SERVICES - BRING THE KIDS HOME
(BTKH)
4:00:06 PM
CHAIR WILSON announced that the final order of business would be
a presentation by the Department of Health and Social Services
on the Bring The Kids Home (BTKH) project.
4:01:15 PM
STACY TONER, Deputy Director, Division of Behavioral Health
(DBH), Department of Health and Social Services (DHSS),
described BTKH as a collaborative effort of the Alaska Mental
Health Trust Authority (AMHTA), Department of Health and Social
Services (DHSS), the Tribal entities in the state, care
providers, and the involved families.
BILL HERMAN, Trust Program Officer, Alaska Mental Health Trust
Authority (AMHTA), introduced himself as the work group
facilitator for Bring The Kids Home (BTKH) program and explained
that the mission statement of AMHTA encompasses the efforts of
projects such as BTKH; hence their involvement. The Trust
worked to include the Alaska Native Tribal Health Consortium
(ANTHC) who have been responsive to the program and become a
partner in the effort. He reported that 40 percent of the
people placed with out-of-state residential care facilities are
Alaska Natives.
MR. HERMAN stated that the Kellogg Foundation Logic Model was
used to develop the framework for BTKH. He directed attention
to the committee packet and explained slides 2-6, [pages 1-3].
Slide 2, bullets the Seven Indicators of Progress, which read:
1:Client Shift - reducing the numbers of children/youth placed
out of state; 2:Funding Shift - reduction in Medicaid/general
fund match dollars from out-of-state services, and the
corresponding increase of the same funds for in-state services;
3:Length of Stay - reduction in the average length of stay for
in-state and out-of-state residential institutions; 4:Service
Capacity - increase in the number of children/youth receiving
home and community based services; 5:Recidivism - decrease in
the number of children/youth returning to residential care;
6:Client Satisfaction - with services rendered; and 7:Client
Improvement - with children/youth exhibiting functional
improvement in one or more life domain areas at discharge and
one year after discharge. He described how the graphs of slides
3-6, track these indicators, and he provided an analysis.
4:04:48 PM
MR. HERMAN continued with slide 7 [page 4], which enumerated the
project strategies and he highlighted [in order addressed]:
Strategy 5:Home & community-based services - increase capacity;
Strategy 7:Assessment & Care Coordination - intervene; and
Strategy 3:Examine financing & policy issues - examine the
state's financing and policy issues to eliminate impediments and
assure that mechanisms are in place to encourage movement of the
kids back to Alaska. Further, he reported that the quarterly
meetings have been well attended for reviewing the project, and
that the cooperative effort has been honed.
4:06:01 PM
REPRESENTATIVE GARDNER addressed Strategy 3, and asked whether
the certificate of need (CON) requirement for facilities has had
an impact on the project.
MR. HERMAN responded that from the perspective of the trust, the
CON requirement has had a positive impact. The effort is to
treat the clients at the lowest level of care possible, which
allows them to successfully interface with services in their
home areas. He cautioned that bringing a client from a high
level care facility out-of-state, to a high level care facility
in-state, would not provide the same possibility for home
service. Additionally, he said that the CON helps to maintain a
balance and insure that facilities are not "over built" in any
one area.
4:07:29 PM
REPRESENTATIVE GARDNER asked for clarity on the impact that
results when transferring a child from an out-of-state, high
level care facility, to in-state care at the same high level;
provided that the services are available.
MS. TONER answered that the intent is to allow a client to
receive the benefits of out-of-state care, without interrupting
their program, and to have them return to Alaska for follow-up
rehabilitation; requiring care that is a "step down" and at a
level that is available in a less institutionalized setting.
This type of rehabilitation should be able to be provided in the
patient's local community and possibly in a home-based setting.
However, she said that Anchorage is expanding service levels to
provide care for some residential psychiatric treatment
services, which will be the first locked facility of its kind in
Alaska.
CHAIR WILSON stated her understanding, that despite the
intention to bring these kids home, there may be a compelling
reason not to take them out of a care facility until it is
deemed in their best interest to do so.
4:09:42 PM
REPRESENTATIVE GARDNER inquired whether the state is
concurrently establishing options which would not require client
relocation to out-of-state facilities, even for the highest
level of care needed.
MS. TONER answered, "Yes." She explained that to address this
complex issue requires a multi-pronged approach, and she
described how client needs are reviewed, prior to referral to an
out-of-state facility, to ensure that state services are fully
accessed. Further, she said:
We're trying to strengthen families, ... strengthen
providers to [to enable them to] take more difficult
children, ... expanding residential care services in
the state, and ... expanding residential psychiatric
services.
4:10:50 PM
REPRESENTATIVE GARDNER said that the process necessary to obtain
a CON and build an adequate facility is lengthy. She further
stated that a recommendation for a level of service should not
be dependent on the availability of a bed in a facility.
MS. TONER concurred that treatment recommendation should not be
based on what services are available, but on the individual
needs of the client. She described the evaluation criteria and
review process, which are utilized, along with an implementation
schedule, to assure that a patient receives the appropriate
care.
4:13:34 PM
CHAIR WILSON informed the committee that a bill to address the
concerns of the CON process would be forthcoming, and asked that
questions regarding that issue be held.
4:13:48 PM
REPRESENTATIVE CISSNA stated her understanding that a percentage
of children in out-of-state treatment programs are afflicted
with fetal alcohol spectrum disorder (FASD), and asked for
clarity on the disposition of the treatment for these clients.
MS. TONER explained that under some circumstances, there may not
be enough clients with the same affliction to justify the
establishment of an in-state residential psychiatric service.
Thus, these clients would still be referred to out-of-state
services.
4:15:25 PM
MS. TONER directed the committee's attention to slide 2 [page
1], titled Seven Indicators of Progress, and reviewed the
enumerated bullets [previously detailed in these minutes]:
1:Client Shift, 2:Funding Shift, 3:Length of Stay, 4:Service
Capacity, 5:Recidivism.
CHAIR WILSON asked about the recidivism goal of 75 percent.
MS TONER responded that the goal is to reduce the recidivism
factor "by" 75 percent, not "to" 75 percent. She continued with
the bullets: 6:Client Satisfaction, and 7:Client Improvement.
She elaborated on each point for clarity.
CHAIR WILSON inquired what the recidivism percentage rate is
today.
MS. TONER responded that she would provide that statistic to the
chair.
4:18:18 PM
JEFF JESSEE, Chief Executive Officer (CEO), Alaska Mental Health
Trust Authority (AMHTA), referred to the Seven Indicators of
Progress and explained how this "dash board of indicators" will
allow the administrators to receive continuous feedback on the
success of the program. He stressed that the information
gleaned from these indicators will be the basis for adapting the
system to be as workable as possible. In response to a
question, he agreed that the collaboration between the agencies
has been a great benefit to the project, and that each entities
interests have played a key role in establishing these
indicators. He said:
The families are interested in whether this is working
for them. They feel like they're actually being
responded to; ... they really want to look at client
satisfaction. Legislators want to look at the numbers
[to ascertain] are we doing anything with the funding;
are we getting this project under control. The
clinicians want results for the clients. They want
the kids getting better and they want ... symptomology
to go down. ... Everybody's got a piece of the puzzle
and together ... we've got a picture of the whole
operation.
4:20:29 PM
MS. TONER elaborated on the trends presented in the graphs on
slides 3-6, [pages 2-3].
4:23:58 PM
REPRESENTATIVE GARDNER asked whether the referral facilities
commonly used for patients, for in-state and out-of-state, care
are for-profit or not-for-profit institutions.
MS. TONER responded that the majority of the providers are for-
profit entities.
REPRESENTATIVE GARDNER suggested that this would indicate a
possible conflict of interest and represent a vested interest by
the providers to maintain client residency.
MS. TONER declined to say whether this would represent a
conflict of interest. However, she said it is important to
bring these clients back to Alaska as soon as possible.
MR. JESSEE opined that it does represent a conflict of interest,
particularly when there isn't good communication between the in-
state and out-of-state providers. It can be difficult to have
the clients returned to care with which the out-of-state
provider has no familiarity. He explained that there is much
work to be done to create an atmosphere of understanding, as
well as facilities, that will foster this program.
4:26:42 PM
REPRESENTATIVE GARDNER stated her understanding of the
difficulty a facility would have in releasing a client, into the
hands of an unknown entity, albeit their family. The out-of-
state care providers would not have the opportunity to know the
families, she opined.
CHAIR WILSON pointed out that the out-of-state providers would
not necessarily have an understanding of life in Alaska.
MS. TONER said that one of the greatest concerns, is that these
clients are being treated by people who don't understand village
life.
REPRESENTATIVE GARDNER related an experience to illustrate her
personal interest in this program.
4:28:23 PM
MS. TONER directed attention to slide 7 [page 4], with seven
bulleted strategies, which read: 1:Theory of change -continued
ongoing communication; 2:Strong Family Voice - in policy
development, advocacy, family education and support, and quality
control/assurance and evaluation; 3:Examine financing & policy
issues; 4:Performance & Q/A measures - continuous quality
improvement procedures are in place; 5:Home & community-based
services - develop a wide range of accessible services that
reduce the need for kids to enter residential care and ease
transition back into the community for those in out-of-home
care; 6:Work force development - build the capacity and core
competencies of in-state providers to provide services that meet
the needs of kids with severe behavioral health disorders;
7:Assessment & Care Coordination - develop "gate keeping"
policies and practices and implement regional resource
committees to divert kids from psychiatric residential care.
4:29:54 PM
REPRESENTATIVE CISSNA pointed out that establishing a work force
to conduct an effective programs is always an issue. At one
time, she reflected, the state did have a program in place,
however, eventually state funding was pulled. She stressed that
consistent funding for a program is essential to maintain a pool
of talented workers. With this concern in mind, she asked how
this program would handle financial sustainability.
4:31:40 PM
MR. JESSEE acknowledged that if a program fails to perform,
funding will be lost, and he opined that this is what happened
to the precursor to this program; the Alaska Youth Initiative
(AYI). He anticipates that BTKH is recreating the successful
aspects of the AYI model, and with the appropriate indicators in
place will be able to avoid the pitfalls.
CHAIR WILSON stated her understanding that the program
indicators will allow a means to continually problem-solve and
make necessary adjustments.
MS. TONER responded that this is a continuous improvement
process, and that each aspect of the program is being reviewed
and revised appropriately.
REPRESENTATIVE CISSNA reiterated her concern for the
sustainability aspect of the program.
4:35:17 PM
MS. TONER returned to the overview slides 8-10 [pages 4-5],
detailing the funding needs to attain strategies 2-5.
MR. JESSEE interjected that over $40 million a year is paid for
out-of-state services. He opined that this program will shift
much of that money back to in-state care, representing an
investment in the state.
4:40:07 PM
MS. TONER continued with slides 11-12 [page 6], indicating the
funding requirements and applications to accomplish strategies 6
and 7. She indicated that she would not address slide 13 [page
7], DHSS Certificate of Need, due to the late hour, however, she
directed attention to the proposed budget, slide 14 [page 7],
and highlighted the proposed funding sources for fiscal year
(FY) 07.
MR. JESSEE explained how the Mental Health Trust funding is
assumed by the state. Further, he described the matching fund
system which must be met, and he stressed that if the providers
must engage in searching for matching funds, this program will
be "stalled overnight," hence the need for state support
4:46:08 PM
MS. TONER directed attention to slides 15-16 [page 8], titled
Unduplicated Medicaid Residential Psychiatric Treatment Center
(RPTC) by Ethnicity and the Percentage Medicaid RPTC Recipients
by Ethnicity, respectively. Responding to a question, she said
that these numbers and percentages indicate totals for
recipients both in-state and out-of-state. She also
acknowledged that in the three years of statistics shown, the
number of recipients is not declining; however, she pointed out
that the in-state services are stepping up and the out-of-state
services are being used less.
CHAIR WILSON observed how the remote areas lacking services
versus the help available in the urban centers plays a part in
the cost indicators.
MS. TONER agreed, and said that expanding provider services in
the rural settings continues to be a complex undertaking. She
explained that many people relocate themselves to service areas;
usually urban areas of the state, or out-of-state.
4:49:08 PM
MS. TONER presented slide 17 [page 9], titled Recipients by
Gender, and pointed out that a greater number of RPTC recipients
are male, although not a significant difference. Finally, she
directed attention to slide 18 [page 9], titled Additional
Resources, to provide the internet address for DBH where the
BKHD information can be accessed.
4:49:51 PM
GUS MARKS, Grants Manager, Juneau Youth Services (JYS),
Incorporated (Inc.), provided an update of serves for children
under the age of ten, and acknowledged a grant and an award that
have been received through the Tlingit and Haida Head Start
program. Additionally, funding from the Mental Health Trust
Authority, the Denali Commission, and the Rasmuson Foundation is
funding a 15 bed, level 4, facility. He reported that this new
center, at Montana Creek, Juneau, will receive patients directly
from out-of-state facilities, and is due to open later this
summer. He opined that the trends indicated in the current
report should begin to change in the coming years, as
residential facilities of this caliber are established
throughout the state, reducing the need to refer patients to
out-of-state facilities.
REPRESENTATIVE GARDNER asked whether the new facility will deal
with substance abuse patients.
MR. MARX stated that 75 percent of the clients have "co-
occurring" disorders [mental health and substance abuse] and
that the staff is receiving the appropriate training.
CHAIR WILSON stated that she will be looking forward to next
year's presentation of the progress of the program. She
reflected on her six year legislative tenure and the changes in
this field which she has witnessed, during that time.
4:54:17 PM
MR. JESSEE said that the largest potential, missing partner in
this process is the educational system. He stressed that the
cooperation of the school system is important for identifying
clients. He opined that the districts work semi-autonomously
and are only intersected via legislative involvement. He
suggested that perhaps the committee members could facilitate a
means for the schools to participate in the BTKH program.
CHAIR WILSON questioned why that bridge hasn't been established;
a lack of contact, interest, or other reason.
MR. JESSEE explained his understanding of a schools financial
responsibility for special education students, which these
students represent, and the impact to a school when a child is
identified.
CHAIR WILSON stated, thus because a school will lose money if
the child is sent out-of-state, every attempt is made to
maintain them in the school.
MR. JESSEE opined that the school districts tendency is to "let
the other parts of the system take responsibility for this,
because there is a risk on their part." He stressed the need
for the school administrators to know that BTKH needs their help
to identify the children and to create services in the schools
that can assist the children and their families.
CHAIR WILSON reminded the committee that the schools are able to
receive Medicaid funding, and asked whether that has not helped
the schools to work with these children.
4:58:08 PM
REPRESENTATIVE CISSNA stated her understanding that the state
pays education costs for out-of-state children, through the
Department of Education and Early Development (EED) budget. She
surmised that the funding comes from the department, but that
the necessary participation program relates to the district
level.
4:59:21 PM
CHAIR WILSON suggested that there may also be support and
resources at the federal level which may need to be connected
into. She invited members of the committee to provide informal
suggestions to this end.
4:59:54 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:59 p.m.
| Document Name | Date/Time | Subjects |
|---|