Legislature(2019 - 2020)CAPITOL 106

04/30/2019 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:04:08 PM Start
03:05:15 PM HB89
03:14:23 PM Presentation: Alaska Citizen Review Panel
04:20:17 PM Presentation: Office of Children's Services - Citizen Review Panel Response
05:00:40 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 89 OPIOID PRESCRIPTION INFORMATION TELECONFERENCED
Heard & Held
+ Presentation: Citizen's Review Panel & Office of TELECONFERENCED
Children's Services Response
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         April 30, 2019                                                                                         
                           3:04 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Co-Chair                                                                                          
Representative Tiffany Zulkosky, Co-Chair                                                                                       
Representative Matt Claman                                                                                                      
Representative Harriet Drummond                                                                                                 
Representative Geran Tarr                                                                                                       
Representative Sharon Jackson                                                                                                   
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Lance Pruitt                                                                                                     
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 89                                                                                                               
"An Act relating to the  prescription of opioids; relating to the                                                               
practice  of dentistry;  relating  to the  practice of  medicine;                                                               
relating to  the practice of  podiatry; relating to  the practice                                                               
of osteopathy; relating  to the practice of  nursing; relating to                                                               
the  practice  of optometry;  and  relating  to the  practice  of                                                               
pharmacy."                                                                                                                      
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PRESENTATION: ALASKA CITIZEN REVIEW PANEL                                                                                       
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PRESENTATION: OFFICE OF CHILDREN'S SERVICES - CITIZEN REVIEW                                                                    
PANEL RESPONSE                                                                                                                  
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB  89                                                                                                                  
SHORT TITLE: OPIOID PRESCRIPTION INFORMATION                                                                                    
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ                                                                                         
                                                                                                                                
03/11/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/11/19       (H)       HSS, FIN                                                                                               
04/04/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/04/19       (H)       Heard & Held                                                                                           
04/04/19       (H)       MINUTE(HSS)                                                                                            
04/09/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/09/19       (H)       -- MEETING CANCELED --                                                                                 
04/11/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/11/19       (H)       -- MEETING CANCELED --                                                                                 
04/16/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/16/19       (H)       Heard & Held                                                                                           
04/16/19       (H)       MINUTE(HSS)                                                                                            
04/23/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/23/19       (H)       Scheduled but Not Heard                                                                                
04/25/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/25/19       (H)       Scheduled but Not Heard                                                                                
04/30/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
MIRANDA DORDAN, Intern                                                                                                          
Representative Ivy Spohnholz                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  On behalf of Representative Spohnholz,                                                                 
sponsor, introduced the committee substitute for HB 89, Version                                                               
S.                                                                                                                              
                                                                                                                                
J.P. OUELETTE, Chair                                                                                                            
Alaska Citizen Review Panel                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented a PowerPoint presentation                                                                      
entitled, "Alaska Citizen Review Panel," dated 4/30/19.                                                                         
                                                                                                                                
NATALIE NORBERG, Director                                                                                                       
Central Office                                                                                                                  
Office of Children's Services                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided a PowerPoint presentation                                                                       
entitled, "Office of Children's Services - Citizen Review Panel                                                                 
Response 2018-2019," dated 4/30/19.                                                                                             
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:04:08 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY called the House Health and Social Services                                                                 
Standing   Committee    meeting   to    order   at    3:04   p.m.                                                               
Representatives  Spohnholz, Jackson,  Claman, Tarr,  Drummond and                                                               
Zulkosky were present at the call to order.                                                                                     
                                                                                                                                
             HB 89-OPIOID PRESCRIPTION INFORMATION                                                                          
                                                                                                                                
3:05:15 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY announced the first  order of business would be                                                               
HOUSE  BILL NO.  89,  "An  Act relating  to  the prescription  of                                                               
opioids; relating to  the practice of dentistry;  relating to the                                                               
practice  of  medicine; relating  to  the  practice of  podiatry;                                                               
relating to the practice of  osteopathy; relating to the practice                                                               
of nursing; relating  to the practice of  optometry; and relating                                                               
to the practice of pharmacy."                                                                                                   
                                                                                                                                
3:05:31 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  moved to adopt the  committee substitute (CS)                                                               
for HB 89,  labeled 31-LS0421\S, Fisher, 4/18/19,  as the working                                                               
document [Version S].                                                                                                           
                                                                                                                                
CO-CHAIR ZULKOSKY objected for discussion purposes.                                                                             
                                                                                                                                
3:06:08 PM                                                                                                                    
                                                                                                                                
MIRANDA  DORDAN,  Intern,  Representative Ivy  Spohnholz,  Alaska                                                               
State  Legislature, introduced  the committee  substitute for  HB                                                               
89,  Version S.   She  advised of  a typographical  error on  the                                                               
document   [included   in   the   committee   packet]   entitled,                                                               
"Explanation   of   Changes"  as   follows:      Section  7.   AS                                                               
47.47.040(24)  should  read Section  7.  AS  47.37.040(24).   Ms.                                                               
Dordan then  paraphrased from the document,  which read [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     Section 7. AS 47.47.040 (24)                                                                                               
                                                                                                                                
     On page 8, line 30: The phrase "?and maintain current                                                                      
     information?" was added.                                                                                                   
                                                                                                                                
       From page 8, line 30 to page 9, line 1: The phrase                                                                       
        "?for purposes of patient education, a onepage,                                                                         
     printable handout in 12-point font?" was added.                                                                            
                                                                                                                                
     On page 9, line 3-4: The phrase "?the information must                                                                     
        be written in plain language that can be easily                                                                         
     translated into other languages  commonly spoken in the                                                                    
     state?" was added.                                                                                                         
                                                                                                                                
     These changes  make stipulations for the  Department of                                                                    
     Health and  Social Services to keep  the opioid handout                                                                    
     regularly updated.                                                                                                         
                                                                                                                                
     The requirement of the minimum  12-point font was added                                                                    
     to ensure that the opioid handout can be easily read.                                                                      
                                                                                                                                
     The  provision of  plain language  that  can be  easily                                                                    
     translated  into  other  languages commonly  spoken  in                                                                    
     Alaska  was   added  in  order   to  ensure   that  the                                                                    
     information  will be  accessible to  all patients,  not                                                                    
     just those who speak and read English.                                                                                     
                                                                                                                                
MS.  DORDAN,  in  response to  Co-Chair  Zulkosky,  restated  the                                                               
correct section is:  Section 7. AS 47.37.040 (24).                                                                              
                                                                                                                                
REPRESENTATIVE  DRUMMOND  pointed  out   on  the  Explanation  of                                                               
Changes document, "From page 8, line  30 to page 9," should read:                                                               
"From page 8, line 31 to  page 9."  She suggested the ["printable                                                               
handout" on page  8, line 31 of the CS]  could depict symbols and                                                               
graphics the Department of Health  and Social Services (DHSS) may                                                               
find in the "international language of medicine."                                                                               
                                                                                                                                
3:10:12 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  directed  attention   to  an  "info  graphic                                                               
document"  [slide 11,  entitled, "Section  7: Visual  Aid," of  a                                                               
PowerPoint   presentation  entitled,   "House  Bill   89:  Opioid                                                               
Addiction Risk  Disclosure" provided to the  committee on 4/4/19]                                                               
that was included  in the committee packet and  that was prepared                                                               
by DHSS in  request to a bill introduced in  the Thirtieth Alaska                                                               
State Legislature.   She  said the  document uses  [graphics] and                                                               
language to  ensure it  is easy to  understand and  translate; in                                                               
fact, she has been informed  by practitioners who serve immigrant                                                               
populations,  and parts  of  rural Alaska  where  English is  not                                                               
always a patient's  first language, the document must  be easy to                                                               
translate and accessible to all.                                                                                                
                                                                                                                                
REPRESENTATIVE  TARR questioned  whether there  is a  fiscal note                                                               
attached to HB 89.                                                                                                              
                                                                                                                                
CO-CHAIR  SPOHNHOLZ acknowledged  there is  a forthcoming  fiscal                                                               
note that will  be attached to the bill in  the amount of $14,200                                                               
to pay for the cost of regulations.                                                                                             
                                                                                                                                
3:11:41 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY removed her objection.   There being no further                                                               
objection, Version S was before the committee.                                                                                  
                                                                                                                                
CO-CHAIR ZULKOSKY announced HB 89 was held over.                                                                                
                                                                                                                                
3:12:47 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:12 p.m. to 3:14 p.m.                                                                       
                                                                                                                                
^Presentation: Alaska Citizen Review Panel                                                                                    
           Presentation: Alaska Citizen Review Panel                                                                        
                                                                                                                                
3:14:23 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY announced  the next order of  business would be                                                               
a presentation by the Alaska Citizen Review Panel.                                                                              
                                                                                                                                
3:14:38 PM                                                                                                                    
                                                                                                                                
J.P.  OUELETTE,   Chair,  Alaska  Citizen  Review   Panel  (CRP),                                                               
informed the committee  CRP is a volunteer panel.   He introduced                                                               
a  PowerPoint  presentation   entitled,  "Alaska  Citizen  Review                                                               
Panel," paraphrasing from slide  1, "Presentation Outline," which                                                               
read:                                                                                                                           
                                                                                                                                
     ? Introduction to the role and purpose of the Citizen                                                                      
     Review Panel                                                                                                               
     ? Goals and recommendations from 2017-2018                                                                                 
     ? Goals for 2018-2019                                                                                                      
     ? Improvements in CRP-OCS collaboration                                                                                    
     ? Way forward                                                                                                              
                                                                                                                                
MR. OUELETTE  paraphrased from slide 2,  "Central Purpose," which                                                               
read:                                                                                                                           
                                                                                                                                
     Congress created CRPs to help child protection systems                                                                     
     be more responsive to community needs.                                                                                     
       ? A CRP is a mechanism for public participation in                                                                       
     child protection.                                                                                                          
          ? It should facilitate robust and meaningful                                                                          
     participation by citizens                                                                                                  
          1. In diverse roles in child and family welfare                                                                       
          2. Representing all five regions                                                                                      
          3. With  a shared interest in  promoting a healthy                                                                    
     and collaborative CPS system                                                                                               
                                                                                                                                
MR.  OUELETTE noted  CRP  panelists  are primarily  professionals                                                               
working  in the  child and  family  welfare system  and who  have                                                               
experience living  in the  system; CRP  seeks panelists  from all                                                               
five regions of Alaska who  have an interest in collaboration and                                                               
creating an environment that encourages cooperation.                                                                            
                                                                                                                                
MR. OUELETTE  paraphrased from slide  3, "Functions  - Mandates,"                                                               
which read:                                                                                                                     
                                                                                                                                
     Federal Mandate (42 U.S.C. ?  5106a.(c)):   Examine the                                                                    
     policies, procedures, and practices  of state and local                                                                    
     child protection  agencies and  evaluate the  extent to                                                                    
     which these agencies  are effectively discharging their                                                                    
     child  protection  responsibilities     Conduct  public                                                                    
     outreach both to assess the  impact of current policies                                                                    
     and procedures,  and to solicit  public comment  on the                                                                    
     panel's recommendations.                                                                                                   
     State Mandate  (AS 47.14.205):  "The CRP  shall examine                                                                    
     the policies,  procedures, and  practices of  State and                                                                    
     local agencies  and where appropriate,  specific cases,                                                                    
     to evaluate the  extent to which State  and local child                                                                    
     protection system agencies  are effectively discharging                                                                    
     their protection responsibilities."                                                                                        
                                                                                                                                
3:19:17 PM                                                                                                                    
                                                                                                                                
MR.  OUELETTE  paraphrased  from slide  4,  "Primary  Functions,"                                                               
which read:                                                                                                                     
                                                                                                                                
     Review/Evaluate (from statute):                                                                                            
     ? States' CAPTA Plan                                                                                                       
     ? Child protection standards                                                                                               
     ?  And  any other  criteria  that  the Panel  considers                                                                    
     important                                                                                                                  
     Conduct public outreach (from statute):                                                                                    
       Assess  the impact  of OCS policies,  procedures, and                                                                    
     practices on children and families                                                                                         
     ?  This assessment  should inform  its review  function                                                                    
     Advocate for (from congressional record):                                                                                  
     ? Relevant changes based on its review                                                                                     
                                                                                                                                
MR. OUELETTE  clarified CAPTA is  the Child Abuse  Prevention and                                                               
Treatment Act.   He paraphrased  from slide 5, "Functions  - What                                                               
CRP Does Not Do," which read:                                                                                                   
                                                                                                                                
     ? Comment on proposed or pending legislation                                                                               
        ? Get involved in individual cases, contract, or                                                                        
     situations                                                                                                                 
     ? Micromanage OCS operations                                                                                               
     ? Program evaluation                                                                                                       
     ? Lobby                                                                                                                    
                                                                                                                                
MR. OUELETTE stressed CRP is  not an investigative body but seeks                                                               
a  general  consensus of  ones'  experience  with the  Office  of                                                               
Children  Services   (OCS),  Department  of  Health   and  Social                                                               
Services (DHSS),  and not the circumstances  of individual cases.                                                               
Although the policy of CRP  is not to micromanage OCS operations,                                                               
it  does  conduct  site  visits to  gather  details  and  provide                                                               
support.  He directed attention to  [slide 6] and pointed out the                                                               
state's system  of child protection  is a combination  of policy,                                                               
practice, and  the needs  of children  and families;  the federal                                                               
mandate  of  CRPs is  to  review  a state's  policies,  determine                                                               
whether  the  policies  are  put  into  practice,  and  determine                                                               
whether  the  policies are  serving  the  needs of  children  and                                                               
families.    Speaking from  his  experience,  he said  developing                                                               
recommendations  [for change]  is  a long  process; however,  CRP                                                               
will first review  the needs of children  and families, determine                                                               
if the  practices are effective, identify  barriers to practices,                                                               
and decide  whether changes to  policy are necessary.   He opined                                                               
the  focus of  CRP is  to  garner the  collaboration of  affected                                                               
communities, improve  [OCS] practices,  and find the  root causes                                                               
of systemic problems.                                                                                                           
                                                                                                                                
3:23:31 PM                                                                                                                    
                                                                                                                                
MR.  OUELETTE   paraphrased  from   slide  7,  "Changes   in  CRP                                                               
Operation," which read:                                                                                                         
                                                                                                                                
         Reorientation of CRP as a public participation                                                                         
        mechanism  Discussions began early fall 2017  A                                                                         
     tentative three-year timeline  Elements will include                                                                       
     ? Participatory evaluation                                                                                                 
     ? A systems focus                                                                                                          
     ? Robust recruitment and retention strategy                                                                                
     ? Data-driven review and outreach                                                                                          
     ? Collaborative and constructive                                                                                           
                                                                                                                                
MR. OUELETTE discussed the renewed  interest of CRP panelists and                                                               
a  better  relationship between  CRP  and  OCS  since 2017.    He                                                               
paraphrased  from slides  8 and  9,  "Goals 2017  - 2018,"  which                                                               
read:                                                                                                                           
                                                                                                                                
     ?  GOAL 1:  Examine  the effectiveness  of the  current                                                                    
     administrative review  process and whether  the changes                                                                    
     made in 2015 have improved the system.                                                                                     
     ?  GOAL   2:  Examine  if  'family   reunification'  is                                                                    
     prioritized as a goal for  children in out-of-home care                                                                    
     placement,  and  OCS'  efforts in  pursuit  of  'family                                                                    
     reunification'.                                                                                                            
     ?  GOAL 3:  Examine OCS'  efforts in  finding relatives                                                                    
     for placement  of children in foster  care. GOALS 2017-                                                                    
     2018                                                                                                                       
     ? GOAL 4: Expand  public outreach in collaboration with                                                                    
     efforts under the Tribal-State strategic plan.                                                                             
     ?  GOAL  5:  Strengthen the  panel  through  aggressive                                                                    
     recruitment  of  new  members,  enhanced  website,  and                                                                    
     tools to reach diverse groups of stakeholders.                                                                             
                                                                                                                                
MR. OUELETTE, regarding Goal 1,  reminded the committee in 2015 a                                                               
change was  made in the  administrative review process to  a more                                                               
efficient  process,  thus  CRP   sought  to  review  the  change.                                                               
Regarding Goal 2,  CRP found the pursuit  of family reunification                                                               
differed  between regions  of the  state.   Regarding Goal  3, he                                                               
said the goal  is much improved due to  better relationships with                                                               
Tribal partners.   Regarding Goal  4, he said there  are regional                                                               
differences in community  investment.  Regarding Goal  5, he said                                                               
CRP is developing its website and is recruiting panelists.                                                                      
                                                                                                                                
3:28:04 PM                                                                                                                    
                                                                                                                                
MR. OUELETTE  paraphrased from slide 10,  "Recommendations 2017 -                                                               
2018," which read:                                                                                                              
                                                                                                                                
     Overall,   CRP    recommendations   fall    into   five                                                                    
     categories:                                                                                                                
     ? Quality Assurance                                                                                                        
     ? Management                                                                                                               
     ? Practice                                                                                                                 
     ? Public participation                                                                                                     
     ? CRP's role and function                                                                                                  
                                                                                                                                
MR. OUELETTE  paraphrased from slide 11,  "Improve Administrative                                                               
Review Process," which read:                                                                                                    
                                                                                                                                
     Recommendation  1: The  Panel recommends  that OCS  not                                                                    
     transition  to   a  judicial  review  process   as  was                                                                    
     proposed  but  fine-tune   the  current  administrative                                                                    
     process to make it more comprehensive.                                                                                     
     ? ACTION:  Ensure that case workers  are present during                                                                    
     review; and maintain flexibility  in scheduling so that                                                                    
     there   is   maximum  participation   from   interested                                                                    
     parties.                                                                                                                   
                                                                                                                                
MR.  OUELETTE   explained  the  previous   administrative  review                                                               
process  collected  a  lot of  information  and  brought  parties                                                               
together,  but there  was  not  consensus as  to  whether it  was                                                               
serving its  purpose, which is  "a box checking session,  to make                                                               
sure that  everything was on  track where  it was supposed  to be                                                               
and  feedback could  be  given if  it wasn't."    So, a  judicial                                                               
administrative  review  process   was  proposed;  however,  every                                                               
region opposed  a judicial administrative review  process and CRP                                                               
concurs.    In  response  to   Representative  Tarr,  he  further                                                               
explained a team decision making  (TDM) process is meant to allow                                                               
parties  to  share  information;   however,  the  purpose  of  an                                                               
administrative review  process is  not to share  information, and                                                               
the change  was to shorten the  process.  He said  the change was                                                               
not clearly communicated to CRP  or to those participating in the                                                               
administrative review process; he  pointed out the administrative                                                               
review process does need to  provide communication between family                                                               
members,  and participation  with all  parties and  professionals                                                               
involved,  such  as  biological   parents,  foster  parents,  and                                                               
guardians ad litem (GALs).                                                                                                      
                                                                                                                                
CO-CHAIR SPOHNHOLZ surmised the  administrative review process is                                                               
designed to "make sure that we've  ... checked all the boxes that                                                               
we're supposed to be checking,  along the way, but people weren't                                                               
really clear about what the process was for ...."                                                                               
                                                                                                                                
MR.  OUELETTE said  correct.    He acknowledged  miscommunication                                                               
created confusion  over a process  that really mattered,  such as                                                               
providing constructive and supportive feedback.                                                                                 
                                                                                                                                
3:32:29 PM                                                                                                                    
                                                                                                                                
MR.  OUELETTE paraphrased  from slide  12, [continued  from slide                                                               
11, "Improve Administrative Review Process"] which read:                                                                        
                                                                                                                                
     ACTION: Evaluate  the case-continuum  for opportunities                                                                    
     to   build   rapport   and  collaboration   among   all                                                                    
     stakeholders   if   this  (unintended,   but   crucial)                                                                    
     objective   is  no   longer   being   met  during   the                                                                    
     Administrative Review (AR)                                                                                                 
     ?  ACTION:  Ensure  case   workers  are  provided  with                                                                    
     constructive and  supportive feedback in how  to better                                                                    
     achieve compliance.                                                                                                        
     ? ACTION:  Develop and implement  a training on  the AR                                                                    
     process  be developed  and delivered  for case  workers                                                                    
     and families  to better understand the  scope and goals                                                                    
     for  AR and  what  should be  the anticipated  outcomes                                                                    
     that follow from an AR.                                                                                                    
                                                                                                                                
MR. OUELETTE stated CRP also  recommended OCS develop training on                                                               
the administrative  review process  to ensure  parties understand                                                               
and participate  in the process.   He paraphrased from  slides 13                                                               
and 14, "Improve Outcomes for Family Reunification," which read:                                                                
                                                                                                                                
     Recommendation 2:  The Panel  recommends that  OCS take                                                                    
     the following measures:                                                                                                    
     ?  ACTION:  OCS  should target  recruiting  efforts  to                                                                    
     workers  with life  experience in  or near  the regions                                                                    
     they will be serving.                                                                                                      
       ACTION:  OCS should provide orientation  and training                                                                    
     that  explains the  often  overlooked  cycle of  trauma                                                                    
     children  endure when  separated  from their  families,                                                                    
     and the reason family  reunification is a priority. OCS                                                                    
     supervisors and trainers  should encourage a strengths-                                                                    
     based approach to working with parents.                                                                                    
     ?  ACTION:  OCS should  support  and  train workers  to                                                                    
     practice  early  intervention   /  in-home  efforts  to                                                                    
     prevent   removal.   We   suggest  drawing   from   the                                                                    
     experience of  more seasoned workers  who do  this very                                                                    
     well   in   their   regions   to   provide   mentorship                                                                    
     opportunities                                                                                                              
                                                                                                                                
MR.  OUELETTE,   regarding  the  first  action,   said  from  his                                                               
experience removal  of a child  can be prevented when  people are                                                               
aware of the alternatives, which  happens in regions where family                                                               
connections are strong.   Regarding the second  action, he opined                                                               
this has  always been  implicit in  policies and  procedures, but                                                               
not in  philosophy and practices,  and [removal] should  truly be                                                               
the last resort.                                                                                                                
                                                                                                                                
3:34:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JACKSON  asked   about  the  general  differences                                                               
between the regions in Alaska related to family reunification.                                                                  
                                                                                                                                
MR.  OUELETTE advised  there are  many  complexities within  each                                                               
region that create barriers to  family reunification, such as the                                                               
landscape, history of trauma, leadership,  and [OCS] staff who do                                                               
not have an  investment in the region in which  they are working.                                                               
In the most  remote regions, local recruitment  is difficult; CRP                                                               
is  working with  OCS to  strengthen  recruitment.   Of the  five                                                               
regions,  the Western  and Northern  regions experience  the most                                                               
difficult  situations;   the  Anchorage  region  has   a  lot  of                                                               
resources; there  have been improvements the  Southcentral region                                                               
due  to provisions  of House  Bill 151  [passed in  the Thirtieth                                                               
Alaska  State Legislature];  the Southeast  region benefits  from                                                               
collaboration with Tribes.                                                                                                      
                                                                                                                                
REPRESENTATIVE JACKSON urged OCS  to share successful models with                                                               
all regions.                                                                                                                    
                                                                                                                                
MR. OUELETTE agreed.                                                                                                            
                                                                                                                                
3:40:29 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  returned  attention  to  the  administrative                                                               
review process and  asked for an explanation of  the first action                                                               
shown on slide 12.                                                                                                              
                                                                                                                                
MR.  OUELETTE explained  the  old  administrative review  process                                                               
provided  more time  and opportunity  for parents  to communicate                                                               
with  GALs and  caseworkers; the  new process  is impersonal  and                                                               
short.   If this  vital communication  is not  a function  of the                                                               
administrative   review  process,   OCS   must   provide  a   new                                                               
opportunity for family participation.                                                                                           
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  questioned  whether  the  objective  of  the                                                               
administrative review process is just to review documents.                                                                      
                                                                                                                                
MR.  OUELETTE  expressed  his  understanding  the  administrative                                                               
review process  is box checking  activity that is  required prior                                                               
to  federal  review  that  identifies   where  OCS  is  achieving                                                               
objectives  in   a  case;   however,  caseworkers   complain  the                                                               
administrative  review   "only  identifies  places   where  we're                                                               
failing."                                                                                                                       
                                                                                                                                
CO-CHAIR  SPOHNHOLZ related  caseworkers feel  OCS operations  in                                                               
the recent  past have lacked  utility and support  for overworked                                                               
caseworkers; she pointed out the  aforementioned progress [in the                                                               
Southcentral  region] stems  from House  Bill 151,  by which  the                                                               
state chose  to lower caseloads  and invest resources  to support                                                               
caseworkers and staff.                                                                                                          
                                                                                                                                
3:45:20 PM                                                                                                                    
                                                                                                                                
MR.  OUELETTE  continued  to  slides  15  and  16,  "Strengthened                                                               
Cultural Competency," which read:                                                                                               
                                                                                                                                
     Recommendation  3:   The  Panel  recommends   that  OCS                                                                    
     leadership   look  in   to  identifying   the  cultural                                                                    
     differences  that  can  contribute to  bias  among  OCS                                                                    
     workers  and  minorities,  then find  ways  to  improve                                                                    
     their cultural competency.                                                                                                 
     ? ACTION:  This can  be done through  more observation,                                                                    
     listening,  and engagement,  as  well  as targeted  and                                                                    
     evidence-based  trainings like  "Healthy Families"  and                                                                    
     "Knowing Who You Are."                                                                                                     
     ?  ACTION:  Cultural  competency  training  from  local                                                                    
     village councils  or other tribal training  partners to                                                                    
     build from  a collaborative foundation between  OCS and                                                                    
     the  tribes  and  give caseworkers  an  opportunity  to                                                                    
     engage with tribal  representatives establishing better                                                                    
     lines of  communication for achieving  ICWA objectives.                                                                    
     ? ACTION:  Collaborate with tribes to  ascertain if and                                                                    
     where the ICWA  specialist could leverage relationships                                                                    
     with local  elders and community  leaders to  help case                                                                    
     workers  develop  effective  strategies  for  community                                                                    
     engagement and interaction with Tribal resources                                                                           
                                                                                                                                
MR. OUELETTE noted all OCS  employees receive cultural competency                                                               
training   but   lack   training  in   region-specific   cultural                                                               
competency.    Region-specific  cultural competency  achieves two                                                               
objectives:   knowing the  landscape and  people where  you work,                                                               
and  collaboration  with Tribes.    He  said [the  actions]  were                                                               
developed  in  response  to Tribal  partners  who  indicated  the                                                               
knowledge  of  elders was  underutilized  and  not understood  by                                                               
those outside of their culture.                                                                                                 
                                                                                                                                
CO-CHAIR ZULKOSKY related  during one of the  initial meetings of                                                               
the  House Special  Committee on  Tribal  Affairs, the  committee                                                               
heard  rural Alaska  and the  Alaska Native  community are  not a                                                               
monolithic culture; she appreciated  CRP's acknowledgement of the                                                               
importance of  cultural orientation and  region-specific cultural                                                               
understanding.   She  cautioned  those within  the Alaska  Native                                                               
community believe  one can  always grow  one's knowledge  and may                                                               
prefer the concept  of cultural understanding to  one of cultural                                                               
competency.                                                                                                                     
                                                                                                                                
MR.  OUELETTE said  CRP  understands the  complexity  of the  227                                                               
federally  recognized  Tribal  entities   in  Alaska,  and  their                                                               
diversity, and he gave an example.                                                                                              
                                                                                                                                
3:51:23 PM                                                                                                                    
                                                                                                                                
MR.  OUELETTE paraphrased  from  slide  17, "Increased  Community                                                               
Engagement," which read:                                                                                                        
                                                                                                                                
     Recommendation  4: CRP  to facilitate  the constructive                                                                    
     exchange  of  vital  information  between  stakeholders                                                                    
     increasing collaboration.                                                                                                  
     ?  ACTION: Encourage  local/regional OCS  leadership to                                                                    
     help  arrange  and   facilitate  townhall  or  "talking                                                                    
     circle" type  meetings during each site  visit that the                                                                    
     CRP conducts in 2018-2019.                                                                                                 
                                                                                                                                
MR. OUELETTE said  recommendation 4 was challenging  and CRP held                                                               
one  very   successful  talking   circle  in  Wasilla   with  OCS                                                               
leadership, professionals, and panelists.                                                                                       
                                                                                                                                
REPRESENTATIVE  TARR asked  Mr. Ouelette  to clarify  stakeholder                                                               
engagement related to recommendation 4.                                                                                         
                                                                                                                                
MR. OUELETTE  said stakeholders  include other  service providers                                                               
outside OCS  who may  or may  not have  cooperative relationships                                                               
with  OCS.    The  talking  circle format  led  to  a  meaningful                                                               
discussion of solutions.                                                                                                        
                                                                                                                                
REPRESENTATIVE   TARR   suggested    expanding   the   group   of                                                               
shareholders may  bring further  understanding to all  parties of                                                               
those individuals who need services.                                                                                            
                                                                                                                                
MR. OUELETTE  said, "... I  would agree with  you.  I  think that                                                               
probably lies a bit beyond the scope of the CRP ...."                                                                           
                                                                                                                                
3:56:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON  supported the  use of the  talking circle                                                               
format;   she   cautioned   a  lack   of   communication   brings                                                               
misunderstanding, and  strongly urged for  enhanced communication                                                               
within communities.                                                                                                             
                                                                                                                                
MR.  OUELETTE  agreed   and  gave  an  example  in   Sitka.    He                                                               
paraphrased  from   slides  18   and  19,  "Worker   Burnout  and                                                               
Vacancies," which read:                                                                                                         
                                                                                                                                
     Recommendation    5:   Recruiting,    supporting,   and                                                                    
     retaining  workers  that  have the  skills,  character,                                                                    
     community  investment,  and  resilience  to  serve  the                                                                    
     needs of Alaskan families is key.                                                                                          
     ? ACTION: Tighten OCS hiring  policies in the following                                                                    
     ways:    Acquire  or develop  a tool  that screens  job                                                                    
     applicants  for resiliency.    Require  applicants have                                                                    
     field-related experience and/or education.                                                                                 
     ?  ACTION:  OCS  should provide  wellness  support  for                                                                    
     staff  including  on-site   counseling,  education  and                                                                    
     training  in   secondary  traumatic  stress   at  least                                                                    
     annually, and mandatory  self-care including supportive                                                                    
     check-ins     with     supervisors,     breaks,     and                                                                    
     walks/exercise.                                                                                                            
                                                                                                                                
MR.  OUELETTE acknowledged  recommendation 5  is "a  tall order."                                                               
Although, at one time there was  a philosophy to hire persons who                                                               
were not  helpful, OCS is  now holding  vacancies when it  is not                                                               
satisfied with the  applicants for a position.  In  regard to the                                                               
second action, he said CRP  addresses this issue in its 2018-2019                                                               
priorities.                                                                                                                     
                                                                                                                                
4:01:32 PM                                                                                                                    
                                                                                                                                
MR.  OUELETTE paraphrased  from  slide  20, "Improve  Centralized                                                               
Intake," which read:                                                                                                            
                                                                                                                                
     Recommendation 6:  While regions  are adapting  to what                                                                    
     may  be   an  irreversible  change,  there   are  still                                                                    
     significant concerns about the  efficacy of the current                                                                    
     intake process. Stakeholders  across the regions shared                                                                    
     frustration over  the inconsistency of the  process and                                                                    
     the intake  worker's inability to  facilitate necessary                                                                    
     actions  in a  region  they are  unfamiliar  with in  a                                                                    
     timely manner.                                                                                                             
     ?  ACTION:   Equip  centralized  intake   workers  with                                                                    
     region-specific  resources and  a concise  standardized                                                                    
     assessment  tool   for  prioritizing  calls   based  on                                                                    
     already existing OCS policies and procedures.                                                                              
                                                                                                                                
MR. OUELETTE  said the transition to  centralized intake intended                                                               
to  make OCS  management more  feasible for  the state;  however,                                                               
there were  many complaints  due to  slow responses  to inquiries                                                               
and  the lack  of  consistency with  services.   Currently,  most                                                               
problems have been  addressed and most people  are satisfied with                                                               
the centralized  intake process.   He paraphrased from  slide 21,                                                               
"Progress on 2017 - 2018 Goals," which read:                                                                                    
                                                                                                                                
     ?  2017 was,  we  hope, the  pinnacle  of a  tumultuous                                                                    
     period   for  OCS   involving  much   public  scrutiny,                                                                    
     incredibly  high  worker   turnover,  lack  of  (though                                                                    
     growing)  collaboration and  communication between  OCS                                                                    
     and  CRP,  and   internal  frustration  with  statewide                                                                    
     changes such as admin review and centralized intake.                                                                       
     ?  Many of  the  recommendations  went unaddressed  and                                                                    
     appear  under new  headings for  2018-2019  as the  CRP                                                                    
     reimagined its  role moving  from "watchdog"  to broker                                                                    
     and  facilitator   of  effective   communication  while                                                                    
     remaining critically objective.                                                                                            
                                                                                                                                
MR.  OUELETTE acknowledged  OCS  is receptive  to criticism  from                                                               
CRP.   He paraphrased from slide  22, "Moving into 2018  - 2019,"                                                               
which read:                                                                                                                     
                                                                                                                                
     Acknowledging  the  crisis  OCS  was  facing,  the  CRP                                                                    
     adapted  our approach  to  site  visits looking  deeper                                                                    
     into  core  contributing  factors leading  to  burnout,                                                                    
     turnover,   backlogged   IA's,  and   less-than-optimal                                                                    
     results for children and families.                                                                                         
     ?  We  developed  this  year's  goals  to  address  the                                                                    
     relationship   between   worker   wellness,   community                                                                    
     collaboration   and   best    efforts   toward   family                                                                    
     reunification.                                                                                                             
     ?   We   began    pre-site-visit   teleconferences   to                                                                    
     collaborate  with  leadership  toward a  fruitful  site                                                                    
     visit.                                                                                                                     
                                                                                                                                
MR.    OUELETTE   opined    worker   wellness,    and   community                                                               
collaboration,   contribute  to   better   outcomes  of   helping                                                               
families, but  are often overlooked.   In fact,  he characterized                                                               
OCS  [caseworkers] as  similar to  a  traumatized family  because                                                               
they   endure  secondary   trauma   and   work  under   difficult                                                               
circumstances, and caseworkers need a  mechanism for support.  He                                                               
further explained pre-site-visits help  caseworkers prepare for a                                                               
site-visit; previously,  CRP visits were "almost  like a surprise                                                               
visit" and  were not  effective.   Although there  were concerns,                                                               
pre-site-visits     ensure     effective    communication     and                                                               
collaboration.                                                                                                                  
                                                                                                                                
4:05:43 PM                                                                                                                    
                                                                                                                                
MR. OUELETTE paraphrased  from slides 23 and 24,  "Goals for 2018                                                               
- 2019," which read:                                                                                                            
                                                                                                                                
     ? GOAL  1: Assess  Family Reunification Efforts  & Best                                                                    
     Practices    What are practices  that are  working well                                                                    
     in the regions to  promote family reunification and how                                                                    
     can  we replicate  that in  other regions?    What  are                                                                    
     barriers  workers and  families face  to moving  toward                                                                    
     reunification?    What  needs to  be done  to eliminate                                                                    
     those barriers?                                                                                                            
     ?  GOAL  2: Evaluate  OCS  Staff  Wellness Efforts  and                                                                    
     Community  Engagement    What efforts  are in  place to                                                                    
     promote wellness,  safety, healthy office  culture, and                                                                    
     community engagement (particularly  in remote regions)?                                                                    
       How can the CRP help promote wellness among staff?                                                                       
     ?   GOAL    3:   Region-Specific/Culturally-Appropriate                                                                    
     Training for OCS Staff    What are current requirements                                                                    
     for staff?    What  offerings available  through tribal                                                                    
     partners?      How  can   the  CRP   facilitate  better                                                                    
     communication  and collaboration  with tribal  partners                                                                    
     in this area?                                                                                                              
     ? GOAL  4: Awareness  of Tribal-State Strategic  Plan                                                                      
     At  what  levels do  different  staff  engage with  the                                                                    
     Plan?   Are  the efforts coming from  the Plan tangible                                                                    
     to stakeholders?                                                                                                           
     ? GOAL  5: Coordinate Panel Activities  & Improve Panel                                                                    
     Participation    Streamline regular schedule  for panel                                                                    
     activities.     Focus  recruitment efforts  on  regions                                                                    
     outside of Anchorage.                                                                                                      
                                                                                                                                
MR.  OUELETTE explained  goal  1 is  a change  in  CRP's line  of                                                               
questioning from a focus on  policies and procedures; this change                                                               
has  resulted   in  more  response   and  cooperation   from  OCS                                                               
caseworkers and community  partners.  He gave one  example of how                                                               
CPR addressed  goal 2 at the  office in Anchorage.   Regarding to                                                               
goal  3, he  noted CRP's  efforts to  share resources  with other                                                               
entities in the Western region.   Regarding goal 4, he said there                                                               
is  limited  engagement with  the  strategic  plan; however,  CRP                                                               
continues to support Tribal-state  collaboration.  Regarding goal                                                               
5, he  noted CRP is represented  by a panelist from  every region                                                               
but Southeast.                                                                                                                  
                                                                                                                                
4:10:02 PM                                                                                                                    
                                                                                                                                
MR. OUELETTE paraphrased from slides  25 to 27, "Progress on 2018                                                               
- 2019 Goals," which read:                                                                                                      
     Our change in approach  has   Highlighted the strengths                                                                    
     and improvements  in each region and  given honor where                                                                    
     due:                                                                                                                       
     ?  Recognized to  state leadership  where regional  and                                                                    
     local  leadership  has  played a  significant  role  in                                                                    
     improving outcomes for families                                                                                            
        Recognized  supervisors   who  model  effective  and                                                                    
     supportive leadership                                                                                                      
                                                                                                                                
     ?  Our  change  in  approach  has     Acknowledged  the                                                                    
     challenges  faced by  all stakeholders  and contributed                                                                    
     to building unity among OCS and its partners.                                                                              
     ? Naming  and normalizing the stress  incurred by those                                                                    
     who work directly with families  in their greatest time                                                                    
     of need                                                                                                                    
     ? Providing  empathetic and positive feedback  from the                                                                    
     community to OCS workers                                                                                                   
     ? Communicated to all stakeholders  the common goals of                                                                    
     OCS and community partners                                                                                                 
                                                                                                                                
     ?   Our    change   in   approach   has        Tailored                                                                    
     recommendations  for  success   by  collaborating  with                                                                    
     leadership  and seeking  out  sources  of support  from                                                                    
     community partners.                                                                                                        
     ?   Worked  with   stakeholders  to   provide  tangible                                                                    
     solutions     to    challenges     in    communication,                                                                    
     collaboration, and cultural competency                                                                                     
     ?  Provided OCS  leadership with  ideas from  staff and                                                                    
     contact  information  for   support  available  in  the                                                                    
     community    Resulted in  a positive  and collaborative                                                                    
     relationship   between   CRP   and   OCS   leading   to                                                                    
     unprecedented     responsiveness,    and     successful                                                                    
     implementation of CRP recommendations.                                                                                     
                                                                                                                                
MR. OUELETTE  expressed pride  in CRP's  recognition of  those in                                                               
leadership  who have  played  a role  in  improving outcomes  for                                                               
families,  and  he  provided  examples.     He  stressed  renewed                                                               
responsiveness from  OCS to CRP  recommendations is  important in                                                               
order to address issues now.                                                                                                    
                                                                                                                                
MR.  OUELETTE  paraphrased  from  slide  28,  "CRP-  A  Statutory                                                               
Institution," which read:                                                                                                       
                                                                                                                                
     The CRP  is an institution,  with a statutory  role and                                                                    
     responsibility. It is an organization  of the state. It                                                                    
     facilitates citizen participation.  It must cultivate a                                                                    
     critical,  but constructive  lens.  It  exists to  help                                                                    
     OCS. Its success depends on its relationship with OCS.                                                                     
                                                                                                                                
MR.  OUELETTE   added  the   success  of   OCS  depends   on  its                                                               
relationship  with  its  community   and  Tribal  partners.    He                                                               
concluded,  urging the  committee  to take  every opportunity  to                                                               
advocate for  continued funding for  OCS partners  and successful                                                               
health and social service programs.                                                                                             
                                                                                                                                
4:14:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE    TARR,   Co-Chair    Spohnholz,   Representative                                                               
Drummond, Representative Claman,  and Co-Chair Zulkosky expressed                                                               
support for the changes made by CRP.                                                                                            
                                                                                                                                
4:16:48 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 4:16 p.m. to 4:20 p.m.                                                                       
                                                                                                                                
^Presentation:  Office of  Children's Services  - Citizen  Review                                                             
Panel Response                                                                                                                
  Presentation: Office of Children's Services - Citizen Review                                                              
                         Panel Response                                                                                     
                                                                                                                              
4:20:17 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY announced the final  order of business would be                                                               
a presentation by the Office of Children's Services (OCS), DHSS.                                                                
                                                                                                                                
4:20:25 PM                                                                                                                    
                                                                                                                                
NATALIE NORBERG, Director, Central  Office, OCS, DHSS, provided a                                                               
PowerPoint presentation entitled,  "Office of Children's Services                                                               
-  Citizen  Review  Panel  Response   2018-2019."    Ms.  Norberg                                                               
expressed  her appreciation  for  the  emphasis on  collaboration                                                               
achieved by  CRP in the past  year and the work  of its volunteer                                                               
panelists.   Further,  she said  CRP  has aligned  its goals  and                                                               
priorities  more closely  with those  of OCS,  which is  helpful.                                                               
She informed  the committee  OCS's administrative  review process                                                               
is a federal  requirement of its funding through  [title IV-E and                                                               
IV-B  of  the Social  Security  Act  and  the Adoption  and  Safe                                                               
Families Act of 1997].   The purpose of the administrative review                                                               
is to provide  third-party oversight of cases; in  Alaska and one                                                               
other state,  the administrative review is  not incorporated into                                                               
the state's judicial process.   The administrative review ensures                                                               
that certain  criteria are met  in a  timely manner, such  as the                                                               
development of a case plan.   Although the review process is very                                                               
important, it  is very  time consuming  for staff  and previously                                                               
did not achieve  its stated goal.  Ms. Norberg  said OCS believes                                                               
if  it could  focus  caseworker time  to  individually meet  with                                                               
families, Tribal partners when  applicable, and GALs, caseworkers                                                               
could accomplish needed work related  to case planning (slide 1).                                                               
She described the administrative  reviews as mini court sessions;                                                               
however, many  of the  requirements of  the reviews  could happen                                                               
within  a court  setting, which  would  be more  efficient.   Ms.                                                               
Norberg  said OCS  seeks  to  incorporate administrative  reviews                                                               
into the  Alaska judicial system,  a change that is  supported by                                                               
judges, GALs,  defense attorneys, and  Tribal partners.   As part                                                               
of the  OCS Federal Program  Improvement Plan, a  judicial review                                                               
pilot  program will  be implemented  in Fairbanks  to demonstrate                                                               
its efficiency and efficacy (slide 2).                                                                                          
                                                                                                                                
CO-CHAIR SPOHNHOLZ  asked about the history  of Alaska's decision                                                               
to create its current administrative review process.                                                                            
                                                                                                                                
MS. NORBERG  suggested there was  concern that a  judicial review                                                               
process  would be  a burden  for the  court system;  however, she                                                               
pointed out Alaska needs the court  system to be more involved in                                                               
child welfare cases in response  to "pressure we are getting from                                                               
the federal government right now  ... to have more involvement of                                                               
the courts in our system."   Further, early court involvement may                                                               
alert  families  to  the  seriousness   of  a  situation  at  the                                                               
beginning of  a case,  which may result  in an  earlier permanent                                                               
resolution of a case.                                                                                                           
                                                                                                                                
4:26:15 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ remarked:                                                                                                    
                                                                                                                                
     I'm a little  surprised to hear you say  that you think                                                                    
     that we should have  more and earlier court involvement                                                                    
     in cases  when some  of the  most exciting  work that's                                                                    
     being done  in child  welfare right  now is  being done                                                                    
     in, in more of a collaborative  way.  ...  I'm thinking                                                                    
     about the  work that's  being done  with the  safe baby                                                                    
     [Family  Infant Toddler  (FIT)  therapeutic] court  in,                                                                    
     out in the  Mat-Su valley, and maybe  that's an example                                                                    
     where  the  involvement  of the  court  is  a  positive                                                                    
     thing, but they're actually trying  to move away from a                                                                    
     traditional court model ....                                                                                               
                                                                                                                                
MS.  NORBERG  advised [FIT  court]  is  the  model OCS  seeks  to                                                               
promote within  the court  system:   having a  more collaborative                                                               
approach with  families and  also bringing  the seriousness  of a                                                               
situation to everyone's attention and  impart a sense of urgency.                                                               
She opined court oversight would  hold child welfare workers, and                                                               
all  parties,  accountable  and would  provide  clarification  of                                                               
legal  issues.    The  Fairbanks pilot  program  will  draw  from                                                               
lessons learned  at FIT court  in Mat-Su, "the Kenai  model," and                                                               
"the safe court process in Ketchikan."                                                                                          
                                                                                                                                
CO-CHAIR SPOHNHOLZ expressed support for FIT Court.                                                                             
                                                                                                                                
REPRESENTATIVE   TARR   expressed   her  concerns   about   court                                                               
proceedings, that are not well-understood  by parents of children                                                               
in custody,  and occasions  when parents  are represented  by the                                                               
Office of Public Advocacy (OPA), which is understaffed.                                                                         
                                                                                                                                
MS. NORBERG pointed  out the pilot program will  develop tools to                                                               
help   families  understand   the  court   system,  such   as  an                                                               
orientation video, and opportunities to  ask questions prior to a                                                               
legal proceeding.  She explained the  pilot program is based on a                                                               
model that  has been  adopted by other  states; she  stressed OCS                                                               
seeks to advance  the pilot program because  it currently employs                                                               
six  fulltime staff  to perform  an administrative  function that                                                               
could be achieved in a more efficient way.                                                                                      
                                                                                                                                
4:32:25 PM                                                                                                                    
                                                                                                                                
MS. NORBERG continued, noting one  of CRP's recommendations is to                                                               
prioritize family  reunification.  She said  training caseworkers                                                               
in  how  to  write  case  plans  that  promote  reunification  is                                                               
important; in  fact, nationally,  Alaska's rate  of reunification                                                               
ranks above  the U.S. average  and OCS staff continue  to receive                                                               
annual training (slide  3).  In addition, a  stable workforce and                                                               
accessibility to services  are two key factors  that will improve                                                               
family reunification rates (slide 4).                                                                                           
                                                                                                                                
CO-CHAIR  ZULKOSKY returned  attention to  slide 3  and clarified                                                               
Alaska's 2018 rate of reunification  was 54.5 percent of children                                                               
exiting foster care.                                                                                                            
                                                                                                                                
MS. NORBERG said  correct.  She then directed  attention to slide                                                               
5  and  stated the  [section  1115  of  the Social  Security  Act                                                               
Behavioral  Health Demonstration  Waiver  (1115 waiver)]  targets                                                               
families who  are at risk  of entering the child  welfare system.                                                               
In fact,  the waiver  will provide a  new continuum  of community                                                               
based, in-home services that Medicaid  has not paid for in Alaska                                                               
before;  the services  will  benefit OCS  families  who will  now                                                               
receive  services nearby  or in  their homes.   Further,  OCS has                                                               
participated in the "statewide gap  analysis" to inform providers                                                               
and recipients.                                                                                                                 
                                                                                                                                
4:36:36 PM                                                                                                                    
                                                                                                                                
MS. NORBERG turned attention to  the [Family First Prevention and                                                               
Services Act  that was included  in the Bipartisan Budget  Act of                                                               
2018].   She restated title  IV-E is the primary  federal funding                                                               
source for child  welfare services.  The  Family First Prevention                                                               
and Services  Act (Family  First) allows the  funding to  pay for                                                               
direct services for children and families  who are not yet in the                                                               
foster care system.  This new  opportunity means OCS will need to                                                               
develop a  prevention plan using  data from the gap  analysis and                                                               
from  stakeholders;  also, OCS  will  become  a third-payer,  for                                                               
services not otherwise paid through  grants or Medicaid, and will                                                               
seek 50  percent reimbursement for  allowable services  (slides 6                                                               
and 7).                                                                                                                         
                                                                                                                                
REPRESENTATIVE TARR cautioned Alaska  does not have the workforce                                                               
to provide [allowable services listed on slide 7].                                                                              
                                                                                                                                
MS. NORBERG  agreed there is  a "workforce issue."   However, the                                                               
state may be  reimbursed by 1115 waiver and  Family First funding                                                               
for  services  provided  by  lower  level  technicians  and  peer                                                               
support,  such as  elders and  natural helpers,  thereby creating                                                               
access to a wider workforce.                                                                                                    
                                                                                                                                
4:40:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DRUMMOND  returned attention to slide  6 and asked                                                               
who is  reimbursing [Alaska and  other states] for 50  percent of                                                               
costs claimed.                                                                                                                  
                                                                                                                                
MS. NORBERG  explained OCS  will pay  upfront costs  to providers                                                               
and  will  track the  outcomes  from  the services;  at  billing,                                                               
Medicaid  will be  billed first  if applicable,  and if  not, OCS                                                               
will be  reimbursed by the  federal government for 50  percent of                                                               
its costs.   Ms. Norberg, returning attention  to the preliminary                                                               
list of allowable  services [slide 7], said the  services must be                                                               
evidence-based and proven effective, and  not all of the services                                                               
are available in Alaska at this time.                                                                                           
                                                                                                                                
CO-CHAIR SPOHNHOLZ  spoke in support  of the Parents  as Teachers                                                               
program.                                                                                                                        
                                                                                                                                
4:44:35 PM                                                                                                                    
                                                                                                                                
MS. NORBERG  continued to the  CRP recommendation that  OCS staff                                                               
receive  more regional  cultural competency  opportunities.   She                                                               
observed the state struggles with  a high disproportion of Alaska                                                               
Native  children in  the child  welfare system,  and said  OCS is                                                               
committed to  sensitivity to the  needs of Alaska Natives  and to                                                               
the  children and  families it  serves.   The  division seeks  to                                                               
avoid cultural biases and thus in  the last five to ten years has                                                               
invested  in how  to increase  sensitivity by  offering extensive                                                               
training on the  Indian Child Welfare Act  (ICWA); furthermore, a                                                               
Cultural Humility curriculum is required  of all staff to prepare                                                               
them for  ICWA training.  Also,  OCS is one of  the only agencies                                                               
in the state  that received permanent permission  to allow Alaska                                                               
Native Tribal partners on its  caseworker and management position                                                               
hiring teams (slide 8).                                                                                                         
                                                                                                                                
CO-CHAIR  ZULKOSKY  asked  for a  description  of  the  extensive                                                               
training shown on slide 8.                                                                                                      
                                                                                                                                
MS. NORBERG said  she would provide information on  the length of                                                               
the  training;   historically,  OCS   has  held   two  standalone                                                               
trainings on ICWA,  in addition to that which is  received by new                                                               
staff.  The  Introduction to ICWA has been  incorporated into the                                                               
first three  weeks of classroom training  received by caseworkers                                                               
and includes  a general overview of  the law; she said  she would                                                               
provide further  information on  the second  phase and  the total                                                               
hours  of  training.   The  Cultural  Humility curriculum  is  an                                                               
online  training;  Knowing Who  You  Are  Training is  a  two-day                                                               
standalone training  that helps  staff discuss racial  and ethnic                                                               
identity  and encourages  courageous  conversations  in the  work                                                               
environment.   Further,  OCS has  five regional  ICWA specialists                                                               
and a statewide ICWA coordinator  who are available to help staff                                                               
navigate specific Tribal relations and ICWA issues.                                                                             
                                                                                                                                
4:49:41 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY  referred  to   the  Alaska  Humanities  Forum                                                               
Creating  Cultural Competence  (C3) education  mentorship program                                                               
for  new teachers,  in which  new teachers  are partnered  with a                                                               
member of the  local community where they will be  teaching.  The                                                               
program has been shown to  increase the retention of new teachers                                                               
in communities  and she suggested  there may be  other mentorship                                                               
opportunities.    Co-Chair  Zulkosky   related  her  district  is                                                               
challenged  by a  low rate  of recruitment  and retention  of OCS                                                               
staff and  recommended, in addition to  improvements in training,                                                               
mentorship  of [new  OCS staff]  with local  community or  Tribal                                                               
leaders.                                                                                                                        
                                                                                                                                
MS.  NORBERG  indicated  her   interest  in  Co-Chair  Zulkosky's                                                               
recommendation.    She  returned  to the  CRP  recommendation  to                                                               
identify relatives for  placement of children in  foster care and                                                               
said, since  2014, OCS  as seen an  increase of  approximately 10                                                               
percent in the overall number  of children placed with relatives,                                                               
which  may not  represent a  permanent placement.   She  said OCS                                                               
seeks  to  sustain relative  placement  by  changing the  upfront                                                               
payment process  for relative placements  to ensure  stipends are                                                               
issued  to  immediately  offset  the  cost  of  care  during  the                                                               
licensing process.  In addition,  licensed foster parents receive                                                               
a  higher  rate  of  reimbursement  than  that  received  through                                                               
Temporary Assistance  for Needy  Families (TANF).   Other efforts                                                               
in this  regard include automated relative  notifications online,                                                               
identification  of relatives  through  Tribal  partners, and  new                                                               
training for supervisors (slide 9).                                                                                             
                                                                                                                                
4:53:20 PM                                                                                                                    
                                                                                                                                
MS. NORBERG turned attention to  OCS workforce issues and efforts                                                               
to  improve  worker  retention.    She  said  the  fifty-two  new                                                               
positions that were  authorized during the last  two fiscal years                                                               
have begun  to stabilize the  OCS workforce.   Many of  the first                                                               
new  positions  were  assigned  to the  Mat-Su  office  and  have                                                               
reduced  the  previous  caseloads  of 40  cases  per  caseworker.                                                               
Other  positions were  dispersed statewide;  she cautioned  about                                                               
the  significant amount  of time  required to  recruit and  train                                                               
staff for a  position, especially with the six  weeks of training                                                               
required by  House Bill 151.   Also,  OCS is more  cautious about                                                               
cases that are  assigned to new caseworkers  when possible (slide                                                               
10).    Also  due  to  House  Bill  151,  OCS  has  instituted  a                                                               
mentorship  program which  assigns  a field  mentor  to staff  in                                                               
training  who will  answer questions,  provide support,  and help                                                               
staff transition from training to  casework.  Further, staff exit                                                               
surveys   have  indicated   OCS  fails   to  provide   sufficient                                                               
supervision, thus OCS  is developing more training  in support of                                                               
supervisors and managers through a  new coaching program.  During                                                               
the next  three years, OCS  will focus attention on  its managers                                                               
and  new  staff; within  six  to  nine  months,  all of  its  new                                                               
positions will be filled and  trained, and she expressed hope OCS                                                               
will  begin to  reduce  its current  statewide  turnover rate  of                                                               
approximately 50  percent, and regional  rates as high  as 80-100                                                               
percent.   She  stressed  the  majority of  cases  in Alaska  are                                                               
Alaska Native cases - which are  under the jurisdiction of ICWA -                                                               
and thus  are more time consuming  and require a higher  level of                                                               
service, case management, and support.  She concluded, noting OCS                                                               
seeks to  support wellness  activities for  staff and  is working                                                               
with  the  administration  and  the  union  to  develop  flexible                                                               
scheduling,  opportunities for  additional  leave, and  longevity                                                               
and incentive pay for caseworkers (slide 11).                                                                                   
                                                                                                                                
4:59:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON  returned attention  to slide 1  and asked                                                               
what  percentage  of  the  almost  3,000  administrative  reviews                                                               
result in the removal of children from their family.                                                                            
                                                                                                                                
MS. NORBERG  clarified administrative reviews are  required every                                                               
six  months  for  children  who   are  already  in  foster  care;                                                               
administrative reviews  are an  additional requirement,  which is                                                               
why  OCS  seeks  to  incorporate administrative  reviews  into  a                                                               
judicial review process.                                                                                                        
                                                                                                                                
5:00:40 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 5:00 p.m.                                                                                                          

Document Name Date/Time Subjects
OCS CRP Response 4-30-19.pdf HHSS 4/30/2019 3:00:00 PM
Citizen's Review Panel
CRP - House HSS Presentation 4-30-19.pdf HHSS 4/30/2019 3:00:00 PM
Citizen's Review Panel
H0089 Version S 04.29.2019.pdf HHSS 4/30/2019 3:00:00 PM
HB 89
HB0089 Explanation of Changes ver S 04.29.2019.pdf HHSS 4/30/2019 3:00:00 PM
HB 89