Legislature(2017 - 2018)CAPITOL 106

10/26/2017 02:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
02:05:16 PM Start
02:05:50 PM Presentation: Division of Behavioral Health, Opioid Treatment in Alaska
05:31:21 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentations: TELECONFERENCED
Randall Burns, Dir., Div. of Behavioral Health,
Dept. of Health & Social Services
- Justice Reinvestment programs overseen by DBH
- Substance Use Disorder Treatment programs
funded through DBH
Cathleen McLaughlin, Center Director, Partners
Reentry Center
- Justice Reinvestment from a provider's
Commissioner, Dean Williams, Dept. of
Corections, or designee
- Substance Use Disorder Treatment inside and
outside the Walls
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                        October 26, 2017                                                                                        
                           2:05 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Ivy Spohnholz, Chair                                                                                             
Representative Bryce Edgmon, Vice Chair                                                                                         
Representative Sam Kito                                                                                                         
Representative Geran Tarr                                                                                                       
Representative Jennifer Johnston (via teleconference)                                                                           
Representative Colleen Sullivan-Leonard                                                                                         
Representative Dan Saddler (alternate)                                                                                          
MEMBERS ABSENT                                                                                                                
Representative David Eastman                                                                                                    
Representative Matt Claman (alternate)                                                                                          
OTHER LEGISLATORS PRESENT                                                                                                     
Representative Harriet Drummond                                                                                                 
Representative Paul Seaton                                                                                                      
Representative George Rauscher                                                                                                  
COMMITTEE CALENDAR                                                                                                            
PRESENTATION: DIVISION OF BEHAVIORAL HEALTH~ OPIOID TREATMENT IN                                                                
     - HEARD                                                                                                                    
PREVIOUS COMMITTEE ACTION                                                                                                     
No previous action to record                                                                                                    
WITNESS REGISTER                                                                                                              
RANDALL BURNS, Director                                                                                                         
Central Office                                                                                                                  
Division of Behavioral Health (DBH)                                                                                             
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented a PowerPoint which focused on                                                                  
opioid treatment in Alaska.                                                                                                     
JAY BUTLER, MD, Chief Medical Officer/DPH Director                                                                              
Central Office                                                                                                                  
Division of Public Health (DPH)                                                                                                 
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Answered questions during  the presentation                                                             
on opioid treatment.                                                                                                            
GENNIFER MOREAU-JOHNSON, Behavioral Health Policy Advisor                                                                       
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during  the presentation on opioid                                                             
CATHLEEN MCLAUGHLIN, Director                                                                                                   
Partners Reentry Center                                                                                                         
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:    Presented a  PowerPoint  titled  "Justice                                                             
Reinvestment Funds, An Agency's Perspective."                                                                                   
LAURA BROOKS, Health Care Administrator                                                                                         
Division of Health & Rehabilitation Services (DHRS)                                                                             
Department of Corrections (DOC)                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented a PowerPoint via teleconference.                                                               
APRIL WILKERSON, Director                                                                                                       
Division of Administrative Services (DAS)                                                                                       
Department of Corrections (DOC)                                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during the presentation.                                                                       
ACTION NARRATIVE                                                                                                              
2:05:16 PM                                                                                                                    
CHAIR IVY SPOHNHOLZ  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    2:05   p.m.                                                               
Representatives  Spohnholz, Sullivan-Leonard,  Edgmon, Tarr,  and                                                               
Johnston (via teleconference) were present  at the call to order.                                                               
Representatives  Kito  and  Saddler (alternate)  arrived  as  the                                                               
meeting was in progress.                                                                                                        
^PRESENTATION:  DIVISION OF  BEHAVIORAL HEALTH,  OPIOID TREATMENT                                                             
IN ALASKA                                                                                                                     
PRESENTATION: DIVISION OF BEHAVIORAL HEALTH, OPIOID TREATMENT IN                                                            
2:05:50 PM                                                                                                                    
CHAIR SPOHNHOLZ announced that the  first order of business would                                                               
be a presentation by the  Division of Behavioral Health regarding                                                               
the   opioid  epidemic   and   interactions   with  the   Justice                                                               
Reinvestment programs.                                                                                                          
2:07:50 PM                                                                                                                    
RANDALL BURNS,  Director, Central Office, Division  of Behavioral                                                               
Health,  Department  of  Health  and Social  Services,  shared  a                                                               
PowerPoint (via  teleconference) regarding the  Prescription Drug                                                               
and Opioid  Addiction Treatment Programs.   He directed attention                                                               
to the  "Substance Use  Residential Treatment  Program" [Included                                                               
in members' packets], stating that  the right hand column, titled                                                               
"Level of Care,"  was based on the American  Society of Addiction                                                               
Medicine criteria.   He added  that there  was also a  fact sheet                                                               
with very good  background from the American  Association for the                                                               
Treatment of  Opioid Dependence on Medication  Assisted Treatment                                                               
[Included in members'  packets].  He directed  attention to slide                                                               
2,  "Medicaid Assisted  Treatment," and  spoke about  the federal                                                               
grants  received  in the  past  few  years,  as they  focused  on                                                               
medication  assisted   treatment.     He  reported   that  SAMHSA                                                               
(Substance Abuse  and Mental  Health Services  Administration, in                                                               
the  United  States  Department of  Health  and  Human  Services)                                                               
targeted three priority areas to  combat opioid abuse on which to                                                               
focus:   the opioid  prescribing practices  to reduce  opioid use                                                               
disorders  and overdose;  the expanded  use  and distribution  of                                                               
naloxone (Narcan)  to help in  emergencies; and the  expansion of                                                               
Medication-assisted   treatment  (MAT)   to  reduce   opioid  use                                                               
disorders and overdose.  He  reported that Alaska was focusing on                                                               
the  expansion of  MAT  with  most of  its  funding, adding  that                                                               
Department of Health and Social  Services had applied for a grant                                                               
in  May  2016 which  proposed  to  target Anchorage  and  Juneau,                                                               
communities  with a  high prevalence  of individuals  with opioid                                                               
use disorders,  for expanded access  to MAT.  In  September 2016,                                                               
the department was awarded $1 million for each of three years.                                                                  
2:12:15 PM                                                                                                                    
MR.  BURNS moved  on  to slide  3,  "Medicaid Assisted  Treatment                                                               
(con't)"  and  shared  that  in January  2017,  the  funding  was                                                               
distributed to  two grantees, the Narcotic  Drug Treatment Center                                                               
in Anchorage, and  the Rainforest Recovery Center in  Juneau.  He                                                               
added  that these  centers had  committed to  an increase  in the                                                               
caseload of 250 patients over the next 2.5 years.                                                                               
REPRESENTATIVE  SULLIVAN-LEONARD  asked about  the  determination                                                               
for choosing Anchorage and Juneau.                                                                                              
MR. BURNS  replied that  the decision  was specifically  based on                                                               
data about  the prevalence  of opioid abuse,  and that  these two                                                               
communities were the most impacted.                                                                                             
2:15:05 PM                                                                                                                    
MR. BURNS  discussed the  next grant  received, slide  4, "Opioid                                                               
State Targeted Response  (STR)," and explained that  the focus of                                                               
this funding was  to increase provider capacity  in Alaska around                                                               
the  MAT,  and  to  increase  the  number  of  clients  receiving                                                               
appropriate treatment,  while decreasing  the negative  impact of                                                               
opioid use.   He reported that this STR grant  awarded two years,                                                               
$2 million  each year, of  funding to Alaska.   He shared  that a                                                               
four-pronged approach  was being  utilized to achieve  the goals:                                                               
fund  three  agencies  in high-needs  communities;  increase  the                                                               
number  of physicians,  physician's assistants  (PAs), and  nurse                                                               
practitioners (NPs) by facilitating  access to education and case                                                               
consultation;  engage Alaska's  reentry coalitions  to facilitate                                                               
access to  MAT; and  purchase and  distribute drug  disposal bags                                                               
and naloxone in remote areas of the state.                                                                                      
2:17:25 PM                                                                                                                    
MR. BURNS  pointed to  slide 5,  "Opioid State  Targeted Response                                                               
(STR)," and  noted the  areas targeted  for funding,  which would                                                               
begin  in October  2017:   the  Fairbanks  Native Association  in                                                               
Fairbanks  for   $400,000;  the  Interior  Aids   Association  in                                                               
Fairbanks for $400,000; and the  Cook Inlet Council on Alcoholism                                                               
and  Drug  Abuse  in  Kenai  for $350,000.    He  noted  that  an                                                               
additional award  for $350,000 was  set aside  for administration                                                               
by  the  Office  of  Substance Misuse  and  Addiction  Prevention                                                               
(OSMAP).  He  said there was an additional search  for a group to                                                               
target youth and young adults experiencing opioid disorders.                                                                    
2:19:58 PM                                                                                                                    
MR.  BURNS shared  slide 6,  "Prescription Drug  Opioid Overdose-                                                               
Related Deaths"  and said there  was a collaboration  between the                                                               
Division of Behavioral Health and  the Office of Substance Misuse                                                               
and Addiction  Prevention for implementation of  Project HOPE and                                                               
the distribution of Narcan kits statewide.                                                                                      
2:21:25 PM                                                                                                                    
MR. BURNS  spoke about  slide 7,  "The Strategic  Partnership for                                                               
Success (PFS)," which  was the final grant received  by the state                                                               
and was a very comprehensive  approach to opioid addiction in the                                                               
state.   The goal of  this initiative  was to reduce  and prevent                                                               
the non-medical use  of prescription opioids and  heroin among 18                                                               
-  25-year  old's by  focusing  on  three areas  of  prescription                                                               
opioids:   the social availability, the  retail availability, and                                                               
the perceptions  of harm for  risk.  He reported  that prevention                                                               
and  early  intervention  coalitions  in  Sitka,  Juneau,  Kenai,                                                               
Anchorage,  Matanuska-Susitna, and  Fairbanks  were awarded  more                                                               
than $1.5  million for each  of the next  five years.   He stated                                                               
that  the  initiative  required  these  coalitions  to  implement                                                               
evidence  based informed,  local, environmental  strategies which                                                               
could be sustained  within the local system as  well as implement                                                               
a media campaign.                                                                                                               
2:24:14 PM                                                                                                                    
REPRESENTATIVE  TARR  expressed  her  desire  to  understand  the                                                               
current state resources and how  these were being used, to better                                                               
understand  "where the  gaps are."   She  asked for  verification                                                               
that  each slide  presented a  different set  of federal  grants.                                                               
She asked  whether the  dates mentioned  referred to  the federal                                                               
fiscal year.                                                                                                                    
MR.  BURNS  acknowledged  that  three  federal  grants  had  been                                                               
referenced,   all   based   on  federal   fiscal   years,   which                                                               
specifically   focused   on   opioid   addiction   and   targeted                                                               
communities to help with this crisis.                                                                                           
REPRESENTATIVE  TARR asked  about  the relative  impact of  these                                                               
MR. BURNS expressed his agreement that it was too soon to tell.                                                                 
2:28:01 PM                                                                                                                    
REPRESENTATIVE KITO  directed attention to  slide 5 and  asked if                                                               
the  individual  grantees  were   required  to  provide  services                                                               
outside of their communities.                                                                                                   
MR.  BURNS explained  that the  primary  focus was  on the  local                                                               
community  and   residents,  and   these  were   not  residential                                                               
treatment programs.                                                                                                             
REPRESENTATIVE KITO  offered his  belief that these  three grants                                                               
covered many  Alaskans.  He  stated that he  did not want  to see                                                               
these programs focused  only on urban centers,  and that outreach                                                               
and support  needed to  be extended to  smaller communities.   He                                                               
asked  if the  upcoming youth  grant would  be required  to be  a                                                               
statewide program.                                                                                                              
MR.  BURNS   clarified  that  initially   all  the   grants  were                                                               
competitively  awarded,  and  that  only  three  communities  had                                                               
responded  to the  four grants  available.   He  stated that  the                                                               
solicitations were not limited.                                                                                                 
REPRESENTATIVE  KITO stated  that he  wanted to  ensure that  the                                                               
state provided  coverage beyond  the few  urban centers,  even if                                                               
this  necessitated a  re-write of  the grant  solicitations.   He                                                               
expressed  his  concern  that there  would  be  a  self-selection                                                               
process for  the grants to  be awarded to communities  with large                                                               
populations, which  would leave  the smaller communities  to fend                                                               
for themselves  during this opioid  epidemic.  He  suggested that                                                               
providers in the  larger communities should also  do outreach and                                                               
provide services beyond the community.                                                                                          
2:33:03 PM                                                                                                                    
REPRESENTATIVE  SADDLER  asked  about  the hub  and  spoke  model                                                               
referenced on slide 4.                                                                                                          
MR. BURNS  explained that  this was  not the  same as  the common                                                               
regional  hub and  surrounding communities,  but was,  instead, a                                                               
reference to  a Vermont  model in  which the  hub was  the office                                                               
based opioid  treatment provider  and counseling, and  the spokes                                                               
were the  office-based treatment  and case management  with local                                                               
REPRESENTATIVE  SADDLER  asked  if   there  was  any  correlation                                                               
between unemployment levels and addiction rates.                                                                                
MR. BURNS replied that he did  not have any information for this,                                                               
although it  was believed  that two key  tenets of  recovery were                                                               
housing and employment.                                                                                                         
REPRESENTATIVE  SADDLER asked  about  the use  of  vivitrol as  a                                                               
MR.  BURNS  replied that  this  was  used  by the  Department  of                                                               
Corrections  to  individuals  with  a  history  of  addiction  to                                                               
heroin,   and  that   there   was  a   study   planned  for   its                                                               
effectiveness.   He  said  there was  nothing  that prevented  an                                                               
individual from opting for vivitrol as opposed to suboxone.                                                                     
2:37:18 PM                                                                                                                    
REPRESENTATIVE EDGMON asked how these  grants were tying into the                                                               
6-year  framework for  Senate  Bill  91, and  if  there were  any                                                               
matching fund  relationships with state  funding.  He  noted that                                                               
criminal  justice reform  was largely  based  on evidenced  based                                                               
practices  and measurable  outcomes.   He  asked  if the  various                                                               
agencies   were  working   together   and   were  these   results                                                               
measurable.  He asked what could  be done to reduce recidivism in                                                               
CHAIR SPOHNHOLZ reiterated  that the purpose of  this meeting was                                                               
for  "rolling  through   the  work  that's  being   done  by  the                                                               
Department  of  Health  and   Social  Services,  particularly  to                                                               
address the  issue of  addiction and  addiction treatment  in the                                                               
State of Alaska."  She noted  that there would also be discussion                                                               
for  the  reinvestments  into  re-entry  programs  and  treatment                                                               
2:40:21 PM                                                                                                                    
REPRESENTATIVE  KITO referenced  slide  12 and  asked about  "the                                                               
universe of  need for  residential treatment  beds in  Alaska and                                                               
then what  is the plan  to try and  get to  that bed count  or is                                                               
that even known."                                                                                                               
CHAIR  SPOHNHOLZ pointed  out  that  slide 12  had  not yet  been                                                               
2:41:18 PM                                                                                                                    
CHAIR SPOHNHOLZ referenced slide 2  and asked if any partners had                                                               
been identified in Matanuska-Susitna.                                                                                           
MR. BURNS  reiterated that with  the Medicaid  assisted treatment                                                               
program,  Anchorage  and  Juneau   had  been  targeted  as  these                                                               
communities having the highest prevalence of need.                                                                              
CHAIR  SPOHNHOLZ expressed  her  surprise that  Matanuska-Susitna                                                               
did not rise  to the top for  need.  She asked if  there had been                                                               
any skewing of  the numbers with people coming  to Anchorage from                                                               
Matanuska-Susitna for treatment services.                                                                                       
MR. BURNS reported  that although this was  a possibility, during                                                               
application  for   the  State  Targeted  Response   (STR)  grant,                                                               
Matanuska-Susitna had  not applied.   He  mused that  it depended                                                               
not only  on the interest  but the  capacity of the  community to                                                               
provide service.                                                                                                                
2:44:00 PM                                                                                                                    
REPRESENTATIVE TARR  asked for an  explanation to  the medication                                                               
assisted treatment and the order for usage of each drug.                                                                        
MR. BURNS  directed attention to  the handout titled  "AATOD Fact                                                               
Sheet" [Included  in members' packets] which  explained the value                                                               
and the  differences between  Methadone, Vivitrol,  and Suboxone.                                                               
He stated that  all three provided treatment.   He explained that                                                               
daily Methadone  treatment was  highly recommended  for addiction                                                               
to  heroin  and those  subsequent  changes  to the  brain,  which                                                               
required  long  term  maintenance  to  "get  themselves  back  on                                                               
track."  He said that it  was taken each day to maintain sobriety                                                               
and  work  on   addiction.    He  explained   that  Vivitrol  was                                                               
administered as a shot, once a  month.  He reported that Suboxone                                                               
was another alternative,  dependent on the patient  need and what                                                               
works  best.   He  declared  that they  all  worked  well for  an                                                               
individual to get off addiction.                                                                                                
2:50:39 PM                                                                                                                    
REPRESENTATIVE TARR asked  if the reference to detox  was for the                                                               
early  phase  and then  MAT  was  referenced after  this  initial                                                               
recovery period.                                                                                                                
MR. BURNS explained  that the terminology was  changing under the                                                               
American  Society of  Addiction Medicine  (ASAM), and  that detox                                                               
was  now  called "withdrawal  management"  and  only applied  for                                                               
alcohol  abuse.   He  offered his  belief  that individuals  with                                                               
addictions  to  heroin and  opioids  never  really de-toxed,  but                                                               
instead   were  treated   and  managed   for  stabilization   and                                                               
CHAIR SPOHNHOLZ  offered her belief  that alcohol  withdrawal was                                                               
the only process that could kill you.                                                                                           
2:54:11 PM                                                                                                                    
REPRESENTATIVE  TARR asked  if Mr.  Burns  was describing  sudden                                                               
opioid withdrawal.                                                                                                              
MR. BURNS  replied that it  was best  to treat the  addiction and                                                               
help them to stabilize by eliminating the highs and lows.                                                                       
2:55:32 PM                                                                                                                    
JAY  BUTLER, MD,  Chief Medical  Officer/  DPH Director,  Central                                                               
Office,  Division  of Public  Health,  Department  of Health  and                                                               
Social Services, in response to  Representative Tarr, stated that                                                               
the agonist  Methadone and the  partial agonist, Suboxone,  had a                                                               
role in the withdrawal management  process; whereas, the complete                                                               
antagonist, Vivitrol,  was used after  the end of  the withdrawal                                                               
phase  as the  drug  could  induce withdrawal.    He stated  that                                                               
alcohol  withdrawal was  more dangerous  for mortality,  but that                                                               
withdrawal  from opioids  could combine  with other  compromising                                                               
health conditions for  a fatal outcome.  He said  that there were                                                               
different  methods  of  medication  delivery,  including  sprays,                                                               
shots, implants,  and a film strip  placed under the tongue.   He                                                               
said  that  more than  100  providers  in Alaska  had  prescribed                                                               
Vivitrol  at  one  time  or  another and  it  had  been  used  in                                                               
treatment for alcohol dependency.                                                                                               
2:59:05 PM                                                                                                                    
CHAIR SPOHNHOLZ  asked for clarification that  Vivitrol could not                                                               
be used  if there  was any opioid  in the system.   She  asked if                                                               
this  was   also  contraindicated  for  use   with  methadone  or                                                               
DR. BUTLER said  that if there was any agonist  in the system, it                                                               
was necessary for a very  careful transition, hence it was fairly                                                               
3:00:34 PM                                                                                                                    
GENNIFER  MOREAU-JOHNSON,   Behavioral  Health   Policy  Advisor,                                                               
Office  of  the Commissioner,  Department  of  Health and  Social                                                               
Services, introduced  slide 8,  "Recidivism Reduction,"  and said                                                               
that  this funding  was intended  to  break the  cycle of  repeat                                                               
offenders.   She  said  that the  Division  of Behavioral  Health                                                               
received $1  million in FY17,  and $2  million in FY18,  and that                                                               
the division was  able to leverage a strong  grants and contracts                                                               
infrastructure to coordinate targeted programming support.                                                                      
MS.  MOREAU-JOHNSON  addressed slide  9,  "Funds  are being  used                                                               
for,"  and reported  that the  funds were  being used  for direct                                                               
service  outcomes   through  the   Partners  Reentry   Center  in                                                               
Anchorage, and  through existing  community reentry  programs and                                                               
coalitions  in   Anchorage,  Fairbanks,   Matanuska-Susitna,  and                                                               
Juneau   to  offer   case  management   for  housing   placement,                                                               
transitional   support,   linkage    to   treatment,   employment                                                               
assistance,  Medicaid enrollment,  transportation, and  emergency                                                               
assistance vouchers.  She added  that there was funding for rural                                                               
reentry  coalitions in  Nome,  Ketchikan,  Dillingham, and  Kenai                                                               
which focused on provider capacity and community planning.                                                                      
MS.  MOREAU-JOHNSON directed  attention to  slide 10,  "Funds are                                                               
being used  for," and reported that  recidivism reduction funding                                                               
was co-funding  a two-year  study with  the University  of Alaska                                                               
Anchorage  to  assess  the  Department  of  Corrections  Vivitrol                                                               
intervention  program.    She stated  that  recidivism  reduction                                                               
funding was  funding technology platforms for  therapeutic courts                                                               
and reentry  programs to utilize  a case management module.   She                                                               
added  that there  was also  funding  through treatment  recovery                                                               
grants,  which  were  leveraged  with  criminal  justice-specific                                                               
supports and linkages to treatment providers.                                                                                   
3:03:01 PM                                                                                                                    
MR. BURNS  stated that $400,000  in recidivism  reduction funding                                                               
was  being  used  to support  housing  programs  for  individuals                                                               
coming out of prison.                                                                                                           
3:03:45 PM                                                                                                                    
REPRESENTATIVE  SADDLER referenced  the  technology platforms  on                                                               
slide  10 and  pointed  out  that Senate  Bill  91 did  recommend                                                               
expanded use of diversions, drug  courts, and therapeutic courts.                                                               
He asked if the broad band would support the existing platforms.                                                                
MS.  MOREAU-JOHNSON replied  that the  funding was  for what  was                                                               
currently in place.                                                                                                             
CHAIR SPOHNHOLZ  asked if these technology  platform improvements                                                               
would allow for a seamless coordination of services.                                                                            
MS. MOREAU-JOHNSON  stated, "yes, that  is the vision  for this."                                                               
In response to  Chair Spohnholz, she stated that  there was still                                                               
work  to  be  done  to ensure  compliance  with  regulations  for                                                               
criminal   justice   and   Health   Insurance   Portability   and                                                               
Accountability Act information systems.                                                                                         
3:05:20 PM                                                                                                                    
REPRESENTATIVE  SADDLER asked  if there  would be  a request  for                                                               
additional  funding  to  expand  to  accommodate  more  diversion                                                               
programs, drug courts, and tele-behavioral medicine.                                                                            
MS. MOREAU-JOHNSON replied, "yes."                                                                                              
3:05:46 PM                                                                                                                    
REPRESENTATIVE EDGMON asked  if there was any  information to tie                                                               
in the rising crime rates with the rising use of drugs.                                                                         
MR. BURNS offered his belief that  "the answer to that is no, not                                                               
at  this  time."    He  acknowledged that  there  was  a  lot  of                                                               
unfortunate belief  that there was  a correlation, though  he was                                                               
not aware  of any studies which  had been undertaken.   He opined                                                               
that  information about  individuals  incarcerated for  substance                                                               
abuse would offer an insight into the problem.                                                                                  
REPRESENTATIVE EDGMON  replied that this  was counter to  what he                                                               
was hearing  and seeing.   He  stated that  it was  apparent that                                                               
more  tools  were  necessary  in  the  tool  box  to  combat  the                                                               
increasing statewide  crime.   He offered  his belief  that there                                                               
was  a correlation  between  the  increase in  drug  use and  the                                                               
increase in crime.                                                                                                              
MR. BURNS reported  that the University of  Alaska Justice Center                                                               
had a research arm which would be well positioned for a study.                                                                  
CHAIR SPOHNHOLZ  asked for  clarification that  this had  not yet                                                               
been studied, and not that there  was or was not a correlation or                                                               
MR. BURNS  acknowledged that there  had not  yet been a  study to                                                               
establish any correlation.                                                                                                      
3:09:55 PM                                                                                                                    
REPRESENTATIVE KITO  offered his  belief that there  were studies                                                               
outside Alaska  which related to  an increase in  unemployment to                                                               
an increase  in crime.  He  stated that even without  studies, it                                                               
was valid to have concerns.                                                                                                     
3:10:36 PM                                                                                                                    
REPRESENTATIVE SULLIVAN-LEONARD stated  that her discussions with                                                               
public safety officials indicated a direct correlation.                                                                         
CHAIR SPOHNHOLZ  clarified that  Mr. Burns  had stated  there had                                                               
not been studies.                                                                                                               
3:11:53 PM                                                                                                                    
MR. BURNS moved on to  slide 11, "Alcohol Safety Action Program,"                                                               
and reported  that the Adult  Substance Abuse Program  (ASAP) had                                                               
received a modest  amount of funding, specifically  to train ASAP                                                               
staff on  the use of screening  tools.  These tools  included use                                                               
of local referral and services.                                                                                                 
CHAIR SPOHNHOLZ  asked for  a more  detailed description  for the                                                               
function of this program.                                                                                                       
MR. BURNS  explained that the  Alcohol Safety Action  Program was                                                               
created   for   individuals   with  misdemeanors,   primarily   a                                                               
misdemeanor DUI  (driving under the  influence), as an  option to                                                               
being placed in jail and  would include regular monitoring, urine                                                               
analysis, appointments, and drug screening.   He noted that there                                                               
was  now  risk  assessment  for  suggestions  to  the  levels  of                                                               
CHAIR SPOHNHOLZ asked if this included the 24/7 program.                                                                        
MR. BURNS replied, "it does."                                                                                                   
CHAIR SPOHNHOLZ asked if this program was currently on line.                                                                    
MR. BURNS explained that it had  been the subject of a protracted                                                               
contractual issue and was currently  only being provided to those                                                               
already in the program.                                                                                                         
3:16:48 PM                                                                                                                    
REPRESENTATIVE  SULLIVAN-LEONARD asked  about the  Alaska Justice                                                               
Information  Centers report  on  the effectiveness  of the  adult                                                               
criminal  justice  program  and  the benefits  of  investment  on                                                               
MR. BURNS replied that he had not seen the study.                                                                               
REPRESENTATIVE SULLIVAN-LEONARD  asked about the success  rate of                                                               
MR.  BURNS replied  that did  not have  exact numbers  and opined                                                               
that   the  program   had  been   "pretty  successful   with  the                                                               
individuals  who stay  in the  program."   He  allowed that  some                                                               
individuals did choose  to leave the program,  although they were                                                               
then required  to "deal  with the judge  and the  consequences of                                                               
that decision."   He offered his belief that those  who stayed in                                                               
the program and were monitored had been very successful.                                                                        
3:19:31 PM                                                                                                                    
MR. BURNS  directed attention to  slide 12,  "Increased Substance                                                               
Use  Disorder  Treatment  Services,"  and  spoke  about  the  $31                                                               
million funding  which the legislature  had added  for behavioral                                                               
health services, which had ultimately  been reduced to $6 million                                                               
for substance use  disorder services over three years.   He added                                                               
that  the   Central  Peninsula  Hospital   Withdrawal  Management                                                               
program had been  funded for six beds, with a  plan for expansion                                                               
to  ten beds.    He reported  on funding  for  the Tanana  Chiefs                                                               
Conference Sobering Center  day program, which had  expanded to a                                                               
12-bed capacity.                                                                                                                
3:22:09 PM                                                                                                                    
REPRESENTATIVE KITO directed  attention to slide 12  and asked if                                                               
there was  any information  or a plan  to identify  the universal                                                               
need in Alaska for in-patient treatment beds.                                                                                   
MR. BURNS  said that there had  not been a total  statewide needs                                                               
assessment.  He stated that a  large part of this issue should be                                                               
driven  by  regionally identified  needs.    He reported  that  a                                                               
significant  component of  the $6  million funding  was that  the                                                               
communities  share a  needs assessment  indicating  the value  of                                                               
this  service.   He  expressed  his  agreement that  each  region                                                               
determine which  service was best  for that region.   He reported                                                               
that  the  federal  grants  each  had  a  significant  evaluation                                                               
component, which the department would collect and evaluate.                                                                     
REPRESENTATIVE  KITO asked  to  clarify that  there  was not  any                                                               
information to identify  the number of beds needed  in the state.                                                               
He offered a  comment that it was difficult for  policy makers to                                                               
make  decisions  without  statewide  data  and  that  a  regional                                                               
approach  could result  in overwhelming  use  from other  regions                                                               
that had not adequately identified needs.                                                                                       
MR.  BURNS reported  that statewide  there  were 311  residential                                                               
treatment beds.   He  said that these  were tracked  for capacity                                                               
and wait lists.  He  acknowledged that the reporting was somewhat                                                               
erratic,  and that  it was  necessary to  account for  beds being                                                               
held open for someone transitioning.                                                                                            
3:27:46 PM                                                                                                                    
REPRESENTATIVE SADDLER  pointed to  the challenge that  the costs                                                               
were  the  same  to  maintain a  stand-by  equipped  and  staffed                                                               
facility.  He spoke in support  of a regional approach because of                                                               
the flexibility  and efficient utility  for demand.  He  asked if                                                               
there  was any  national  data to  determine  treatment beds  per                                                               
population, which could  be modified to the  unique situations in                                                               
MR. BURNS said that he was not  aware of any data, and he pointed                                                               
to  the  difficulties  posed  by  Alaska's  geography  and  small                                                               
communities for using national data.                                                                                            
REPRESENTATIVE  SADDLER   reported  on  the   treatment  facility                                                               
currently under construction within his district, in Eklutna.                                                                   
3:29:59 PM                                                                                                                    
REPRESENTATIVE TARR declared  that she wanted to get  a sense for                                                               
how much  money spent so  far had been  from grants.   She listed                                                               
the various  grants and  asked if there  would be  equal spending                                                               
over the next five years.   She mused that there was $6-8 million                                                               
coming in the next few years.                                                                                                   
MR. BURNS  offered to provide a  chart of what had  been extended                                                               
to date and what remained to be spent for each grant.                                                                           
REPRESENTATIVE  TARR   opined  that  this  would   allow  a  more                                                               
strategic   approach  by   the   legislature   in  its   spending                                                               
distribution.   She  asked if  the Kenai  detox program  included                                                               
beds  available  for  anyone   experiencing  alcohol  or  opioids                                                               
addiction or in treatment.                                                                                                      
MR. BURNS  replied that it  was an alcohol  withdrawal management                                                               
treatment center.   He  reported that  there were  17 residential                                                               
treatment programs in Alaska with 311  beds.  He stated that none                                                               
of  these  programs  treated  for  anything  other  than  alcohol                                                               
withdrawal.    He pointed  out  that  opioid medication  assisted                                                               
treatment did  not require residential treatment,  as it included                                                               
any necessary medication and counseling.                                                                                        
3:35:29 PM                                                                                                                    
DR.  BUTLER  spoke  about  the  Office  of  Substance  Abuse  and                                                               
Addiction Prevention  within the Department of  Health and Social                                                               
Services.     He  declared   that  this  was   a  wise   move  to                                                               
institutionalize   some  of   the  functions   for  coordination,                                                               
communication,  and community  engagement.   He pointed  out that                                                               
there was assistance from other  agencies.  He explained that the                                                               
focus  was for  both  primary prevention  and  prevention of  bad                                                               
outcomes.  He  mentioned that this would address  both the supply                                                               
and demand  side for drivers  to substance misuse  and addiction.                                                               
He  spoke   about  Adverse  Childhood  Experiences   (ACEs),  and                                                               
unemployment,  noting  that  "a  healthy  economy  makes  healthy                                                               
Alaskans."   He  brought  attention to  slide  7, "The  Strategic                                                               
Partnership for Success," which explained prevention activity.                                                                  
3:39:43 PM                                                                                                                    
REPRESENTATIVE EDGMON  asked about the  impact if Senate  Bill 91                                                               
was repealed.                                                                                                                   
MR. BURNS opined  that should the programs and  services lose the                                                               
recidivism  reduction funding,  those communities  with organized                                                               
services for those individuals leaving  prison would be affected.                                                               
He noted that programs with  federal or legislative funding would                                                               
be less affected.                                                                                                               
3:41:34 PM                                                                                                                    
REPRESENTATIVE  SADDLER offered  his belief  that Senate  Bill 91                                                               
anticipated   future   savings   because  of   a   reduction   to                                                               
incarceration  and asked  whether the  programs would  still have                                                               
the necessary resources even should Senate Bill 91 be repealed.                                                                 
DR.  BUTLER  explained  that  the  work  through  the  Office  of                                                               
Substance  Abuse and  Addiction Prevention  was primarily  driven                                                               
with federal  grant monies  and would most  likely continue.   He                                                               
pointed  out  that treatment  programs  within  prisons would  be                                                               
affected  and admitted  that  he was  unsure  what other  actions                                                               
would be a result from the repeal of Senate Bill 91.                                                                            
3:44:04 PM                                                                                                                    
CATHLEEN  MCLAUGHLIN, Director,  Partners Reentry  Center, stated                                                               
that  the  facility  was  an  open,  walk-in  center,  which  was                                                               
available to everyone.  She introduced a short video.                                                                           
3:47:19 PM                                                                                                                    
MS.  MCLAUGHLIN  directed  attention to  the  PowerPoint,  titled                                                               
"Justice  Reinvestment  Funds,  An Agency's  Perspective."    She                                                               
addressed slide  2, "Goals,"  and stated  that the  agency always                                                               
had monthly statistics with real-time  data entry available.  She                                                               
reported  that the  Center had  been around  for four  years, and                                                               
that it had  enhanced its programs in the last  year with justice                                                               
reinvestment  funds.   She stated  that  the goal  was to  reduce                                                               
recidivism and  to enhance public  safety, which she  deemed went                                                               
"hand in  hand."  She  added that it  was very important  for the                                                               
center  to  provide  timely "reentrant-centric"  services.    She                                                               
shared a  story of  a recently released  inmate.   She emphasized                                                               
that  the Center  would never  let anyone  be homeless  the night                                                               
they were released from incarceration.                                                                                          
MS.  MCLAUGHLIN moved  on  to  Slide 3,  "Here  is the  reality,"                                                               
reporting  that 95  percent of  all offenders  will be  released.                                                               
She offered her belief that Senate  Bill 91 changed the timing of                                                               
this release, not the type of people that were being released.                                                                  
3:51:16 PM                                                                                                                    
MS.  MCLAUGHLIN  shared  slide   4,  "The  CliffsNotes  Version,"                                                               
explaining that  the Partners Reentry  Center viewed life  on the                                                               
street level.   She reported  that criminal justice reform  was a                                                               
"heavy lift"  and they were  still learning at the  street level.                                                               
She  declared that  there  were three  things  vital to  criminal                                                               
justice  reform: collaboration,  cooperation,  and continuums  of                                                               
care.   She said that as  there was a lot  of competitiveness for                                                               
funding,  people did  not share  as they  should.   She explained                                                               
that  collaboration should  allow for  an immediate  referral for                                                               
someone.   She  pointed out  that they  blended their  funds from                                                               
various sources  to allow  for housing for  longer periods.   She                                                               
said that continuum  of care was especially  important for people                                                               
with  medically  assisted  treatment.    She  declared  that  the                                                               
transfer of  responsibility for  each individual  had to  be done                                                               
3:54:57 PM                                                                                                                    
MS. MCLAUGHLIN  shared slide  6, "The Center."   She  stated that                                                               
people needed  to be able to  come and go freely  without feeling                                                               
as if they were being watched.   She reported that between 60 and                                                               
100 individuals came  daily, and that people  were greeted within                                                               
a minute, no one was  waitlisted, and services were provided that                                                               
MS. MCLAUGHLIN moved  on to slide 7, "Partners  Reentry Center -"                                                               
and explained  that the cheapest  and easiest thing to  offer was                                                               
to give  reentrants purpose  and hope.   She declared  that there                                                               
were plenty  of beds available  in Anchorage and that  the Center                                                               
also provided supportive  services, such as bus  passes, and help                                                               
with  identification and  driver licenses.   She  emphasized that                                                               
the  Center did  timely  referrals  to services.    She said  the                                                               
Center was  open for groups  to come  and sign up  reentrants for                                                               
Medicaid and food stamps.                                                                                                       
3:58:49 PM                                                                                                                    
MS. MCLAUGHLIN  explained slide 8,  "Partners Reentry  Center Has                                                               
Received $250,000 in  Justice Reinvestment Funds for  2018."  She                                                               
noted that the  allocation was primarily for  direct services, as                                                               
the  Center  believed  that the  quicker  someone  could  receive                                                               
community-based services,  the higher  the likelihood  they would                                                               
not recidivate.   She  reported that the  money went  to housing,                                                               
another  case manager,  a full-time  data person,  and additional                                                               
bus passes, transportation, clothing vouchers, and bikes.                                                                       
MS. MCLAUGHLIN  shared slide 10, "Statistics,"  and reported that                                                               
since  August  2013  there  had  been  5,110  unique  individuals                                                               
served, with  109 new  clients in September.   She  explained MRT                                                               
(Moral Reconation  Therapy) which  sought to  decrease recidivism                                                               
by increasing moral  reasoning.  She stated that the  goal was to                                                               
turn a "Son of Sam" into a "Mother Theresa."                                                                                    
MS.  MCLAUGHLIN  stated that  the  average  number of  reentrants                                                               
using the services was between  329-369.  She addressed slide 11,                                                               
"Being  Meaningfully Engaged  in  Community Reduces  Recidivism,"                                                               
which listed  the components of  the drive to  reduce recidivism,                                                               
and  included:   pre-release  planning,  housing, employment  and                                                               
training,  behavioral  modification,  and social  support.    She                                                               
explained some of the difficulties of adjustment for reentrants.                                                                
4:04:51 PM                                                                                                                    
MS. MCLAUGHLIN directed attention  to slide 12, "Partners' Opioid                                                               
and  Alcohol Pilot  Project,"  and  shared a  story  of a  heroin                                                               
overdose and  the initiation of  a vivitrol program.   She stated                                                               
that  medically  assisted  treatments were  often  necessary  and                                                               
should be treated  as a tool.  She pointed  out that vivitrol did                                                               
not have  any street value and  was administered as a  shot.  She                                                               
added that  if a person  left incarceration clean,  then vivitrol                                                               
would help him/her stay clean.                                                                                                  
4:07:35 PM                                                                                                                    
MS.  MCLAUGHLIN  referenced  slide 13,  "Partners'  Opioid  Pilot                                                               
Project  Outcomes," which  reported  on the  254 individuals  who                                                               
were offered  this voluntary option to  date.  She noted  that of                                                               
the 142  individuals who  had accepted  the Vivitrol  program for                                                               
one  month or  more, 64  percent had  remained in  the community,                                                               
while 36 percent had recidivated.   She pointed out that although                                                               
vivitrol helped with  alcohol or opioids, the  effect of vivitrol                                                               
was diverted  if the individual was  still a user.   She reported                                                               
that alcohol was  one of the highly abused  substances for Alaska                                                               
Native reentrants.   Of the 112 individuals who  had declined the                                                               
Vivitrol  program, 80  percent had  recidivated,  16 percent  had                                                               
remained in  the community, and  4 percent  had died of  a heroin                                                               
4:10:27 PM                                                                                                                    
MS.  MCLAUGHLIN shared  that the  offer  of direct  service in  a                                                               
timely fashion, community-based reentry,  was a great benefit for                                                               
community safety  and for the  reentrants.  She declared  that it                                                               
was  necessary to  be honest  about the  homeless population,  as                                                               
they  would  break in  for  food  or  shelter.   She  noted  that                                                               
unemployment was also a problem, as  there was not a purpose, and                                                               
more time  to do bad things.   She pointed to  the difficulty for                                                               
avoiding these actions  in many parts of the state.   She offered                                                               
her belief that  crime should not be tied to  Senate Bill 91, and                                                               
that instead, there should be a review of these drivers.                                                                        
4:13:55 PM                                                                                                                    
REPRESENTATIVE   SULLIVAN-LEONARD  asked   how  soon   there  was                                                               
interaction with the  housing facilities for inmates  in order to                                                               
think about release.                                                                                                            
MS.  MCLAUGHLIN shared  that the  model  that worked  best was  a                                                               
regular  schedule  as  it  allowed   for  them  to  get  to  know                                                               
individuals.  She  added that there would be  a regular telephone                                                               
conference  with the  individual and  the institution  as release                                                               
was  upcoming.    She  stated   that  the  goal  was  to  develop                                                               
relationships sooner rather than later.                                                                                         
REPRESENTATIVE SULLIVAN-LEONARD asked about funding and budgets.                                                                
MS.  MCLAUGHLIN replied  that initially,  four  years prior,  the                                                               
Center had been funded with  a $600,000 grant divided among three                                                               
non-profits.   After one year,  one group left, and  the contract                                                               
had  been  reduced to  $550,000,  which  had been  the  operating                                                               
budget  for the  past two  years.   She  reported that  currently                                                               
there  was a  $550,000  contract with  Department  of Health  and                                                               
Social Services,  which was enhanced  with $250,000  from Justice                                                               
Reinvestment funds.  She summarized  that the commitment from the                                                               
Department  of  Behavioral  Health   was  now  $800,000  with  an                                                               
additional $150,000  for homeless  assistance for housing,  and a                                                               
federal SNAP  grant which  was projected  to add  another $11,000                                                               
each month.                                                                                                                     
REPRESENTATIVE SULLIVAN-LEONARD  asked about work with  unions or                                                               
organizations that provided training.                                                                                           
MS. MCLAUGHLIN replied  that there were almost  700 employers who                                                               
would hire.   She  said that apprenticeships  could be  "a little                                                               
tricky," as the Center encouraged  self-sufficiency as quickly as                                                               
possible.   For  this reason,  they did  not encourage  schooling                                                               
until  the  reentrants  could better  understand  budgets.    She                                                               
declared that they  did look at all  activities and opportunities                                                               
to give purpose to individuals.                                                                                                 
4:20:44 PM                                                                                                                    
REPRESENTATIVE SADDLER asked  if Senate Bill 91 was  heard by the                                                               
House Health and Social Services Standing Committee (HHSS).                                                                     
CHAIR SPOHNHOLZ said that it had not been heard by HHSS.                                                                        
REPRESENTATIVE SADDLER  asked if  Partners was the  only official                                                               
State of  Alaska reentry  program, and  he shared  his background                                                               
knowledge of transitioning  out of the military.   He asked about                                                               
any reentry programs through the Department of Corrections.                                                                     
MS. MCLAUGHLIN  explained that there  were several  reentry model                                                               
programs, and  that Partners worked with  the reentry coordinator                                                               
at Department of Corrections.   She added that there were reentry                                                               
coalitions  in  some  hub  areas, as  well  as  reentry  programs                                                               
through  Cook  Inlet Tribal  Council  and  Alaska Native  Justice                                                               
Center.   She  reported  that the  only  reentry programs  funded                                                               
through  the  Justice  Reinvestment  were  the  Partners  Reentry                                                               
Center  and the  coalitions.   In response  to further  questions                                                               
from Representative  Saddler, she stated  that there was  not any                                                               
religious aspect  to Partners, and  that about 70 percent  of the                                                               
clients  had  substance abuse  issues  and  that 70  percent  had                                                               
mental health issues.                                                                                                           
4:23:17 PM                                                                                                                    
REPRESENTATIVE  EDGMON asked  about the  impact to  these reentry                                                               
programs if Senate Bill 91 was repealed.                                                                                        
MS. MCLAUGHLIN  relayed that from  a programmatic point  of view,                                                               
the programs had  made headway for community-based  reentry.  She                                                               
declared that  the month to  month credit  in Senate Bill  91 was                                                               
good  incentive  to   behave  and  do  the  right   thing.    She                                                               
acknowledged that  there were some  weaknesses in Senate  Bill 91                                                               
and that the  community-based programs needed to be  able to take                                                               
immediate control.   She  stated that it  was necessary  to "play                                                               
small ball" as there  were not going to be a  "bunch of home runs                                                               
right  now."   She declared  that it  was necessary  to take  the                                                               
benefits offered  by Senate Bill  91 and  focus on the  gaps, and                                                               
not to ignore  that headway had been made.   She pointed out that                                                               
Partners had been in existence prior  to Senate Bill 91, and that                                                               
the  program would,  hopefully, continue,  although, she  opined,                                                               
there would be  less interest in reentry programs  if Senate Bill                                                               
91 were repealed.                                                                                                               
REPRESENTATIVE EDGMON suggested that  the reentry program efforts                                                               
would be less successful, and the momentum would be lost.                                                                       
4:27:15 PM                                                                                                                    
MS.  MCLAUGHLIN, in  response  to  Representative Tarr,  reported                                                               
that for  individuals with more  than 15 years  of incarceration,                                                               
their release  was different  as they  were more  motivated, more                                                               
structured, and more disciplined and  their release was more of a                                                               
social  acclimation.    She  added  that  these  individuals  had                                                               
probably  committed  violent  crimes.    She  stated  that  these                                                               
individuals were very easy to work  with, as they wanted to prove                                                               
themselves, and  they had  a lot  more to  lose if  they violated                                                               
parole.   She noted that the  program had its least  success with                                                               
the  "high flying  misdemeanants," as  they had  not done  enough                                                               
time to understand  the consequences of their actions.   She said                                                               
there were  ways to improve  this, now that recidivism  rates had                                                               
been identified for  this population.  She  emphasized that these                                                               
reentry types were  totally different.  In response  to a further                                                               
question from  Representative Tarr,  she explained  that Partners                                                               
used  its  funding  for  direct bed  day  rates  with  individual                                                               
contracts for  housing, and that  they had 16  transitional sites                                                               
in Anchorage.   She said  they did not  use vouchers.   She added                                                               
that support for  a permanent placement of  housing required that                                                               
the individual had "purposeful activity."                                                                                       
4:31:09 PM                                                                                                                    
REPRESENTATIVE  KITO  reported that  Juneau  also  had a  reentry                                                               
coalition, which was a regional service.   He asked how to manage                                                               
individuals who were  not residents of the local  area and wanted                                                               
to return  to their home  community yet  needed to have  a parole                                                               
MS. MCLAUGHLIN explained the Partners'  Going Home Program, which                                                               
had  been  created  for  Alaska  Natives and  was  based  on  the                                                               
restorative  justice  model.    She  said  that  involvement  for                                                               
reentry to  their home community included  asking permission from                                                               
the tribal leaders  and putting a safety net  around them, before                                                               
sending them home.   She added that Partners did  pay for housing                                                               
and flights  if they were  allowed to  return home.   She pointed                                                               
out  that the  village,  or  the region,  became  a  part of  the                                                               
healing  process.    She  said   that  the  safety  net  included                                                               
accountability to  the community.   She declared  that a  key was                                                               
for  someone  to  follow  the  individual,  and  that  successful                                                               
reentry  required case  management  and  connection to  services,                                                               
which could  be creative.   She  said that she  did not  know the                                                               
intention of the Juneau coalition.                                                                                              
REPRESENTATIVE  KITO asked  if this  program  was something  that                                                               
could engage with other reentry coalitions and organizations.                                                                   
MS. MCLAUGHLIN  said that their  contract mandated  for technical                                                               
assistance with the other areas  of the state which desired parts                                                               
of  the  program that  would  work  in  those communities.    She                                                               
offered her  belief that  every community  should create  its own                                                               
reentry program,  and this should  not be a cookie  cutter model.                                                               
She pointed out that Partners  was unique because "we didn't have                                                               
a road map, we figured it out as we went."                                                                                      
4:34:29 PM                                                                                                                    
CHAIR SPOHNHOLZ  directed attention to  an earlier remark  in the                                                               
presentation about referrals, and  asked which referrals were not                                                               
being picked up in a timely manner.                                                                                             
MS.  MCLAUGHLIN  explained  that  these were  for  mental  health                                                               
treatment,   substance   abuse    treatment,   anger   management                                                               
treatment,  and sex  offender  treatment.   She  stated that  the                                                               
challenge  for timely  referral acceptance  was the  need for  an                                                               
immediate consultation  with a medical person,  and not placement                                                               
on a wait list.                                                                                                                 
CHAIR SPOHNHOLZ relayed that the  legislature was struggling with                                                               
what would  be the  next steps.   She wanted  to ensure  that the                                                               
necessary  services were  put  in  place.   She  asked about  the                                                               
shortages of services.                                                                                                          
MS.  MCLAUGHLIN  explained  that  the service  gaps  were  timely                                                               
referral  because of  bureaucratic challenges.   She  pointed out                                                               
the difficulty  of asking someone  for whom English was  a second                                                               
language to  fill out  a 15-page  application for  a prescription                                                               
refill.    She opined  that  collaborating  agencies should  have                                                               
their funding tied to being collaborative with other agencies.                                                                  
4:37:45 PM                                                                                                                    
REPRESENTATIVE SADDLER  pointed out  that as  Senate Bill  91 was                                                               
not before the committee, it was  not necessarily fair to ask her                                                               
to opine about its repeal or change.                                                                                            
4:40:23 PM                                                                                                                    
LAURA  BROOKS, Health  Care Administrator,  Division of  Health &                                                               
Rehabilitation Services,  Department of Corrections,  stated that                                                               
the  presentation would  focus on  the substance  abuse programs.                                                               
She  estimated that  between  70  - 80  percent  of the  criminal                                                               
justice  population had  serious  substance use  disorders.   She                                                               
directed  attention to  slide 2,  "Institutional Substance  Abuse                                                               
Treatment Programs,"  which identified  the target  areas related                                                               
to  Senate Bill  91, which  included:   increase availability  of                                                               
substance  abuse   services  and  assessments;   expand  services                                                               
available  to  female  offenders; expand  services  available  to                                                               
pretrial  offenders; develop  medical  assist treatment  re-entry                                                               
(MATR)  and implement  overdose  intervention response  programs;                                                               
and improve referral process for offenders upon reentry.                                                                        
4:43:48 PM                                                                                                                    
MS.  BROOKS pointed  to slide  3, "Institutional  Substance Abuse                                                               
Treatment Programs,"  and stated that this  outlined the programs                                                               
provided by the division.  She  spoke about each of the programs:                                                               
the  RSAT (residential  substance abuse  treatment) program,  the                                                               
IOPSAT (intensive outpatient  substance abuse treatment) program,                                                               
the  Dual Diagnosis  program  which was  also  an IOPSAT  19-week                                                               
program, and the  PsychEd, a six week program  typically found at                                                               
the pre-trial facilities with a  transient population and a focus                                                               
on  education about  substance use  and addictive  behaviors, and                                                               
the harmful consequences of high risk, high use behaviors.                                                                      
4:47:45 PM                                                                                                                    
MS.  BROOKS addressed  slide  4,  "Institutional Substance  Abuse                                                               
Treatment  Programs,"  and  reported that  offenders  received  a                                                               
substance abuse  assessment, so the  true substance  abuse issues                                                               
and levels  of treatment  could be determined.   She  spoke about                                                               
the new MATR (Medicaid assisted  treatment upon reentry) vivitrol                                                               
program.   She reported  that individuals  were referred  to this                                                               
program and went through a  screening to ensure they were healthy                                                               
enough with no contraindications for vivitrol.                                                                                  
4:50:46 PM                                                                                                                    
MS. BROOKS  moved on to  slide 5, "Institutional  Substance Abuse                                                               
Treatment  Programs,"  which  included   the  MATR  Vivitrol  and                                                               
methadone  treatment.   She  noted  that  vivitrol was  only  one                                                               
choice  in a  true medication  assisted treatment  program.   She                                                               
reported that the program wanted  to ensure there was "a healthy,                                                               
safe bridge" for those people  already on methadone and releasing                                                               
very soon.  She shared that  they were working with the community                                                               
methadone clinics so that it  was not necessary to detox everyone                                                               
on methadone.  She listed  the additional program planning for FY                                                               
18,  which included:    Full  expansion of  vivitrol  in all  the                                                               
facilities and  detox treatment beds  which allowed for  women to                                                               
withdraw under medical observation.   She spoke about development                                                               
of a  WRAP (Wellness Recovery  Action Plan) program, which  was a                                                               
peer-based  intervention program  to  help  individuals design  a                                                               
relapse prevention  plan and have  peer support for crisis.   She                                                               
added that  a SBIRT (screening,  brief intervention,  referral to                                                               
Treatment) program, an evidence  based brief intervention program                                                               
which  identified, treated  and  referred  people with  substance                                                               
abuse, was also being worked on.                                                                                                
4:57:30 PM                                                                                                                    
MS. BROOKS  shared slide 6,  "Community Residential  Center (CRC)                                                               
Substance Abuse  Treatment Programs," and spoke  about the Senate                                                               
Bill 91 funding  for substance abuse treatments  in the community                                                               
residential centers.   She  noted that  there was  intensive out-                                                               
patient programming in  three of the CRCs.  She  added that there                                                               
was  still work  toward  the intensive  outpatient programing  in                                                               
Juneau and Bethel.                                                                                                              
4:58:27 PM                                                                                                                    
REPRESENTATIVE KITO  addressed the  high pre-trial  population in                                                               
correctional facilities  and the release  of people prior  to the                                                               
completion of  treatment.  He  asked if  there were any  plans to                                                               
work on  a transition  program for  those individuals  in initial                                                               
treatment to carry that out in the pre-trial release.                                                                           
MS.  BROOKS  said   the  department  was  working   on  the  case                                                               
management system, so  these individuals could go  to a treatment                                                               
program in the community which  would match the curriculum in the                                                               
facility.   She acknowledged that  during treatment was  the best                                                               
time for re-connection.                                                                                                         
REPRESENTATIVE KITO  asked if the  Department of  Corrections had                                                               
adequate  resources  to  provide   treatment  for  those  wanting                                                               
treatment or were there still some unmet needs.                                                                                 
MS. BROOKS explained  that the department was  reviewing how well                                                               
it would  be able to  fill the programs currently  being planned.                                                               
She said that as not everyone  wanted treatment, it was not clear                                                               
what was the needed capacity.   She shared anecdotally that there                                                               
had not  been enough treatment  programs; however,  she expressed                                                               
her  hope that  with  the funding  from Senate  Bill  91 and  the                                                               
current plans  for expanded services,  [the department]  would be                                                               
able to better meet that need.                                                                                                  
5:02:12 PM                                                                                                                    
REPRESENTATIVE  SADDLER asked  if the  Department of  Corrections                                                               
had become the default substance  abuse treatment program for the                                                               
state.   He asked  for a comparison  of the  relative expenditure                                                               
and capacity for substance abuse  treatment between Department of                                                               
Corrections and Department of Health and Social Services.                                                                       
MS.  BROOKS  reported  that Department  of  Corrections  was  the                                                               
largest  substance  abuse  treatment  provider, as  well  as  the                                                               
largest mental health provider.   She pointed out that they were,                                                               
in  some ways,  the  default  provider, as  they  had a  "captive                                                               
audience," and  they were  attempting to  take advantage  of this                                                               
opportunity.  She stated that  it was difficult because there was                                                               
not   ready   access  to   treatment   both   before  and   after                                                               
REPRESENTATIVE  SADDLER  asked  about  the  funding  sources  for                                                               
treatment, and whether there was  a cost-benefit analysis for the                                                               
use of medication assisted withdrawal recovery.                                                                                 
MS. BROOKS  replied that the  funding source for  substance abuse                                                               
treatment programs  were almost  entirely from the  Department of                                                               
Corrections budget.  She added  that there was a relatively small                                                               
federal grant, although  there was not any  funding for substance                                                               
abuse from the Alaska Mental Health Trust or other resources.                                                                   
5:04:34 PM                                                                                                                    
APRIL   WILKERSON,   Director,  Juneau/Anchorage,   Division   of                                                               
Administrative  Services,  Department  of  Corrections,  reported                                                               
that about  $70,000 was  received from  Department of  Health and                                                               
Social  Services through  the alcohol  tax fund,  which supported                                                               
the residential  substance abuse program.   She relayed  that the                                                               
remainder was general funds.                                                                                                    
MS.  BROOKS, in  response  to  Representative Saddler,  explained                                                               
that  the primary  cost to  the  Vivitrol program  was for  staff                                                               
resources, as the Vivitrol injections  were free samples from the                                                               
pharmaceutical  companies.    She  relayed  that  the  department                                                               
wanted  to ensure  that these  injections were  beneficial for  a                                                               
reduction in clinical relapse back  to opioids and a reduction in                                                               
recidivism.   She shared that  the department was  in partnership                                                               
with University  of Alaska Anchorage (UAA)  to do a study  of the                                                               
vivitrol program  with a  focus on  recidivism and  relapse data.                                                               
She  added that  the cost  of  each injection  was between  $700-                                                               
CHAIR SPOHNHOLZ reported that Department  of Corrections had only                                                               
used 72  doses of the 1200  doses donated.  She  acknowledged the                                                               
importance for  the two-year  study to  evaluate the  efficacy of                                                               
the program, considering the steep cost for the vivitrol.                                                                       
5:07:33 PM                                                                                                                    
REPRESENTATIVE TARR  asked about the barriers  to employment upon                                                               
release.   She  asked  about consideration  for  the policy  that                                                               
allowed individuals  upon release  to use  a homeless  shelter as                                                               
their home, as  the shelters did not typically  have the capacity                                                               
for case management.                                                                                                            
MS. BROOKS expressed her agreement  that the homeless shelter was                                                               
not an ideal  placement.  She stated that there  was the need for                                                               
a more robust case management  system for substance abusers.  She                                                               
acknowledged  that  case  management  in the  shelters  was  very                                                               
limited, and  this created a  barrier for the  department follow-                                                               
5:09:38 PM                                                                                                                    
REPRESENTATIVE  EDGMON opined  that although  Senate Bill  91 had                                                               
not come  before the  House Health  and Social  Services Standing                                                               
Committee,  the  discussion  was  germane  to  the  work  of  the                                                               
committee  and  asked what  would  happen  to the  Department  of                                                               
Corrections if Senate Bill 91 were repealed.                                                                                    
MS.  BROOKS  replied  that  the  Department  of  Corrections  had                                                               
received $1 million to expand  substance abuse treatment programs                                                               
while in  custody, and another  $1 million to  implement programs                                                               
within  the CRCs.   She  stated  that she  was not  aware of  any                                                               
alternative  funding sources  that would  allow continuation  for                                                               
expansion  or  continuation of  the  programming  in the  halfway                                                               
MS. WILKERSON  reported that there  were many elements  in Senate                                                               
Bill  91,  and  that  rolling  this back  in  full  would  create                                                               
challenges   for  maintaining   the  efforts   toward  recidivism                                                               
reduction and provision of the  services and programs included in                                                               
the bill.                                                                                                                       
REPRESENTATIVE EDGMON declared that  this was the opportunity for                                                               
fundamental  reform in  criminal justice  and that  this momentum                                                               
for reducing crime  and expenses would be lost if  Senate Bill 91                                                               
were repealed.                                                                                                                  
5:14:07 PM                                                                                                                    
CHAIR SPOHNHOLZ  declared that she  was impressed with  the scope                                                               
of treatment  offered and that even  without dramatic improvement                                                               
in  recidivism rates,  this was  a step  in the  right direction.                                                               
She asked about the two  to three assessments per week referenced                                                               
on slide 4.                                                                                                                     
MS. BROOKS  explained that  each assessment  would take  hours to                                                               
interview and  write a  report.   She stated  that this  would be                                                               
expanded to include more assessments, if necessary.                                                                             
CHAIR  SPOHNHOLZ asked  if  there was  opportunity  to expand  if                                                               
MS. BROOKS  said there was  the opportunity if there  were enough                                                               
providers,  noting that  there was  difficulty in  some locations                                                               
with  finding substance  abuse programs  having  enough staff  to                                                               
provide services in the facilities.                                                                                             
CHAIR SPOHNHOLZ acknowledged the need  for more workers even when                                                               
the funding  was available.   She asked about the  difficulty for                                                               
finding individuals who wanted treatment upon exit from prison.                                                                 
MS. BROOKS  stated that it  was very difficult  finding treatment                                                               
beds  for  even  those  motivated   people  who  were  ready  for                                                               
treatment.   She added that  some criminal background  could make                                                               
it even more  difficult.  She reported that on  average, it would                                                               
take several weeks to get an individual into a treatment bed.                                                                   
CHAIR SPOHNHOLZ asked if a more proactive exit plan would help.                                                                 
MS.  BROOKS  reported  that the  residential  treatment  beds  in                                                               
communities were  full, although  there was greater  success with                                                               
outpatient treatment.                                                                                                           
5:19:22 PM                                                                                                                    
REPRESENTATIVE  SADDLER  suggested  that  the  department  expect                                                               
questions regarding  the efficiency  and efficacy,  as well  as a                                                               
robust  cost-analysis, of  the program.   He  asked if  she would                                                               
still have  an opinion for  the repeal of  Senate Bill 91  if the                                                               
money was still made available.                                                                                                 
MS. BROOKS replied that she  was reluctant to offer any analysis.                                                               
She said that  some of these programs were already  in place, but                                                               
expansion  for the  programs was  difficult without  money.   She                                                               
pointed  out  that  Medicaid  did not  pay  for  substance  abuse                                                               
treatment for individuals in custody.                                                                                           
CHAIR SPOHNHOLZ stated that this was "a very important fact."                                                                   
5:21:37 PM                                                                                                                    
REPRESENTATIVE  EDGMON said  that he  was not  aware of  the pre-                                                               
trial  aspects, given  the importance  of Senate  Bill 91  to the                                                               
Department of Corrections.                                                                                                      
MS. BROOKS  said that  she could only  speak about  her division,                                                               
although  Representative Edgmon  was  correct for  the impact  of                                                               
Senate Bill 91 to the entire department.                                                                                        
CHAIR SPOHNHOLZ  reported that the Commissioner  of Department of                                                               
Corrections had been unable to attend.                                                                                          
5:22:48 PM                                                                                                                    
REPRESENTATIVE TARR  offered her belief  that there had  not been                                                               
enough anticipation  for the  time necessary  for programs  to be                                                               
funded and up  and running.  She asked about  the timing to allow                                                               
for provider capacity and for the services to be available.                                                                     
MS. BROOKS explained that the  RFP (Request for Proposal) process                                                               
was "not always a quick one."   She said that it was necessary to                                                               
develop RFPs for various communities,  and, in some cases, it was                                                               
necessary  to repeat  the process  as there  were not  responses.                                                               
She added  that as some agencies  did not feel they  were able to                                                               
bring in  a program, it was  necessary to move the  program.  She                                                               
reported on  a contract that  DOC had in place  with anticipation                                                               
for expansion,  and, instead, the contractor  ended the contract.                                                               
She  pointed out  that it  was necessary  to start  over in  some                                                               
cases,  while maintaining  the "bare  bones essential  treatments                                                               
going in a handful of our facilities."                                                                                          
REPRESENTATIVE  TARR  asked  to  which  substances  did  lack  of                                                               
treatment capacity refer.                                                                                                       
MS. BROOKS opined that this was a unilateral issue.                                                                             
CHAIR SPOHNHOLZ summarized the issues discussed.                                                                                
5:31:21 PM                                                                                                                    
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 5:31 p.m.                                                                                                          

Document Name Date/Time Subjects
102617 AATOD-MAT-Fact-Sheet.pdf HHSS 10/26/2017 2:00:00 PM
Justice Reinvestment Programs
102617 Final DBH HHSS 10.17 Opioids and Reentry.pdf HHSS 10/26/2017 2:00:00 PM
Justice Reinvestment Programs
102617 American_Society_of_Addiction_Medicine_Level_of_Care.pdf HHSS 10/26/2017 2:00:00 PM
Justice Reinvestment Programs
102617 Final SUD Residential and Outpatient 10.17.pdf HHSS 10/26/2017 2:00:00 PM
Justice Reinvestment Programs
102617 PRC September Stats 2017.pdf HHSS 10/26/2017 2:00:00 PM
Justice Reinvestment Programs
102617 PRC Justice Reinvestment Funds an Agency's Perspective.pdf HHSS 10/26/2017 2:00:00 PM
Justice Reinvestment Program
102617 DOC Substance Abuse SB91.pdf HHSS 10/26/2017 2:00:00 PM