Legislature(2019 - 2020)CAPITOL 106

02/13/2020 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:04:07 PM Start
03:04:50 PM Presentation: 2019 Novel Coronavirus
03:40:13 PM Presentation: Alaska Children's Justice Act Task Force
05:07:02 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentations: TELECONFERENCED
- Coronavirus: Alaska's Response & Preparedness
by Dr. Anne Zink, Chief Medical Officer, DHSS
- Alaska Children's Justice Act Task Force by
Dr. Mike Hopper, Pam Karalunas, & Gayle Garrigues
-- Testimony <Invitation Only> --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                       February 13, 2020                                                                                        
                           3:04 p.m.                                                                                            
                                                                                                                                
                             DRAFT                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Tiffany Zulkosky, Chair                                                                                          
Representative Ivy Spohnholz, Vice Chair                                                                                        
Representative Matt Claman                                                                                                      
Representative Harriet Drummond                                                                                                 
Representative Geran Tarr                                                                                                       
Representative Sharon Jackson                                                                                                   
Representative Lance Pruitt                                                                                                     
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION: 2019 NOVEL CORONAVIRUS                                                                                            
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PRESENTATION: ALASKA CHILDREN'S JUSTICE ACT TASK FORCE                                                                          
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
ANNE ZINK, MD, Chief Medical Officer/ DPH Director                                                                              
Central Office                                                                                                                  
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented a PowerPoint during the overview                                                               
and update of the 2019 Novel Coronavirus.                                                                                       
                                                                                                                                
PAM KARALUNAS                                                                                                                   
Alaska Children's Alliance                                                                                                      
Karalunas Consulting                                                                                                            
Chugiak, Alaska                                                                                                                 
POSITION  STATEMENT:    Presented  a  PowerPoint  on  the  Alaska                                                             
Children's Justice Act Task Force.                                                                                              
                                                                                                                                
MIKE HOPPER, PhD                                                                                                                
Private Practice Psychologist                                                                                                   
Fairbanks, Alaska                                                                                                               
POSITION   STATEMENT:       Testified   during   the   PowerPoint                                                             
presentation by the Alaska Children's Justice Act Task Force.                                                                   
                                                                                                                                
GAYLE GARRIGUES, Retired Attorney                                                                                               
Fairbanks, Alaska                                                                                                               
POSITION   STATEMENT:       Testified   during   the   PowerPoint                                                             
presentation by the Alaska Children's Justice Act Task Force.                                                                   
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
                                                                                                                                
3:04:07 PM                                                                                                                    
                                                                                                                                
CHAIR  TIFFANY  ZULKOSKY  called  the  House  Health  and  Social                                                             
Services  Standing  Committee  meeting  to  order  at  3:04  p.m.                                                               
Representatives Zulkosky,  Spohnholz, Jackson, Tarr,  Claman, and                                                               
Drummond  were present  at  the call  to  order.   Representative                                                               
Pruitt arrived as the meeting was in progress.                                                                                  
                                                                                                                                
^Presentation: 2019 Novel Coronavirus                                                                                         
              Presentation: 2019 Novel Coronavirus                                                                          
                                                                                                                              
3:04:50 PM                                                                                                                    
                                                                                                                                
CHAIR ZULKOSKY announced  that the first order  of business would                                                               
be a presentation on the Novel Coronavirus.                                                                                     
                                                                                                                                
3:05:21 PM                                                                                                                    
                                                                                                                                
ANNE  ZINK,  MD, Chief  Medical  Officer/  DPH Director,  Central                                                               
Office,  Division  of Public  Health,  Department  of Health  and                                                               
Social  Services,  Presented  a  PowerPoint  titled  "2019  Novel                                                               
Coronavirus Overview and Update."   She pointed out that the name                                                               
of the virus  had been recently changed by the  WHO (World Health                                                               
Organization)  to COVID-19.    Dr. Zink  stated  that there  were                                                               
numerous   corona   viruses   and   she   paraphrased   slide   1                                                               
"Coronaviruses (general), which read:                                                                                           
                                                                                                                                
     An  enveloped RNA  virus that  may circulate  in animal                                                                    
     host or human host                                                                                                         
     ? There are 7 coronaviruses that infect people                                                                             
     ? People  around the world  commonly get  infected with                                                                    
     these four human coronaviruses:                                                                                            
     ? 229E, NL63, OC43, and HKU1.                                                                                              
     ? These account for 10-30% of common colds every year                                                                      
     ?  Spread by  contact  with infected  secretions or  by                                                                    
     aerosol droplets                                                                                                           
                                                                                                                                
DR. ZINK moved on to paraphrase Slide 2, "Coronaviruses                                                                         
(general), which read:                                                                                                          
                                                                                                                                
     Survivability outside the body:                                                                                            
     ? 1-2 hours on nonporous surfaces (e.g. hard surfaces)                                                                     
     ? 8-12 hours on porous surfaces (e.g. soft goods)                                                                          
                                                                                                                                
DR. ZINK introduced slide 3 "New Coronaviruses, which read:                                                                     
                                                                                                                                
     ?  Sometimes  coronaviruses  that  infect  animals  can                                                                    
     evolve  and jump  from an  animal reservoir  to humans,                                                                    
     causing  illness  and then  are  identified  as a  "new                                                                    
     human coronavirus."                                                                                                        
     ?  We know  of three  recent  times coronaviruses  have                                                                    
     moved from an animal to a human host                                                                                       
     ? SARS (Severe Acute Respiratory Syndrome)                                                                                 
     ? MERS (Middle Eastern Respiratory Syndrome)                                                                               
     ? The name of this  virus is COVID-19. Previously 2019-                                                                    
     nCoV.                                                                                                                      
                                                                                                                                
3:07:51 PM                                                                                                                    
                                                                                                                                
DR. ZINK moved on to slide 4, "2019 nCoV,and paraphrased the                                                                    
slide, which read:                                                                                                              
                                                                                                                                
     ?  First  reported  by   Chinese  health  officials  on                                                                    
     December 31, 2019                                                                                                          
     ? Likely  very recently moved from  an animal reservoir                                                                    
     to humans                                                                                                                  
     ? Asymptomatic shedding is still unclear                                                                                   
        Incubation is  between 2-14  days (mean  is about  5                                                                    
     days)                                                                                                                      
     ? As  of 1/13/20 there  are 60,360 cases  worldwide and                                                                    
     1,370 deaths (WHO)                                                                                                         
     ?  As of  1/13/20 -  15 confirmed  cases in  the United                                                                    
     States in 7 states                                                                                                         
     ? No  deaths in the  United States, but one  US citizen                                                                    
     died Wuhan City, China                                                                                                     
                                                                                                                                
CHAIR  ZULKOSKY asked  to  clarify  that the  date  on the  slide                                                               
should reflect February 13, 2020.                                                                                               
                                                                                                                                
DR. ZINK expressed her agreement.                                                                                               
                                                                                                                                
3:08:58 PM                                                                                                                    
                                                                                                                                
DR. ZINK  presented slide  5, "Graph  of nCoV  cases to  date,a                                                                 
graph  depicting  the number  of  reported  cases worldwide,  the                                                               
upswing of numbers of reported cases  in China, and the number of                                                               
recovery cases.   She reported that this spike in  the upswing of                                                               
reported  cases  in China  had  occurred  since yesterday.    She                                                               
opined  that  this  was  likely because  China  had  changed  its                                                               
definition of the virus through the  use of different tests.  She                                                               
pointed out  that this  exponential growth of  the virus  was not                                                               
being seen in the United States as it was in China.                                                                             
                                                                                                                                
DR. ZINK indicated slide 6, "Case Fatality,which read:                                                                          
                                                                                                                                
     ? SARS had a case fatality rate (CFR) of ~10%                                                                              
     ?  MERS has  a  ~35% mortality  rate  and continues  to                                                                    
     circulate in  animal reservoirs with  sporadic zoonotic                                                                    
     spillover                                                                                                                  
     ? Influenza H7N9 (bird flu) had about a 40% fatality                                                                       
     ? Influenza averages 0.1% mortality                                                                                        
     ? H1N1 has a case fatality of ~0.03% fatality                                                                              
     ? Ebola has roughly 60% fatality rate                                                                                      
     ? 2019-nCoV is  estimated to have about  a 2% mortality                                                                    
     rate                                                                                                                       
                                                                                                                                
DR. ZINK shared slide 7, "Transmission, which read:                                                                             
                                                                                                                                
     ? Early on, suspected animal-to-person spread                                                                              
     ? Now, also known to be person-to-person spread                                                                            
     ? Respiratory  droplets when an infected  person coughs                                                                    
     or sneezes                                                                                                                 
     ? Close contact (about 6 feet)                                                                                             
     ? Unclear if transmitted  through touching a surface or                                                                    
     object                                                                                                                     
     ? It  is unclear how  easily or sustainably  this virus                                                                    
     is spreading between people                                                                                                
     ? 2019-nCoV  has an R  naught of about 2.5  (this means                                                                    
     each infected  person will transmit the  virus to about                                                                    
     2.5 other people)                                                                                                          
     ? Measles: >12                                                                                                             
     ? SARS: ~3                                                                                                                 
     ? 1918 flu: ~2                                                                                                             
     ? 2009 H1H1: ~1.5                                                                                                          
     ? Seasonal Flu: ~1.2                                                                                                       
                                                                                                                                
3:12:32 PM                                                                                                                    
                                                                                                                                
DR. ZINK directed  attention to slide 8, "2019 nCoV  in the U.S."                                                               
a map of  the United States which depicted those  states in which                                                               
the virus had  been positively identified.  She  noted that Texas                                                               
had also just been added to those  states.  She moved on to slide                                                               
9, "Signs and Symptoms,which read:                                                                                              
                                                                                                                                
     ? May look similar to the common cold or flu                                                                               
          For confirmed 2019-nCoV infections, reported                                                                          
      illnesses have ranged from people with little to no                                                                       
     symptoms to people being severely ill and dying                                                                            
     ? Fever                                                                                                                    
     ? Cough                                                                                                                    
     ? Shortness of breath                                                                                                      
     ? Myalgia / fatigue                                                                                                        
      ? Appears to disproportionally affect the elderly or                                                                      
     those with underlying medical conditions                                                                                   
                                                                                                                                
DR.  ZINK spoke  about slide  10, "Comparing  to the  flu,which                                                                 
compared  estimates of  the  45 million  flu  cases, 810,000  flu                                                               
hospitalizations,  and about  61,000  flu deaths.   She  reported                                                               
that about 40  percent of the U.S. population had  received a flu                                                               
vaccine, and it  was estimated that those  vaccines prevented 6.2                                                               
million  flu   illnesses,  91,000  hospitalizations,   and  5,700                                                               
deaths.  She  explained that, as the symptoms  were similar, this                                                               
would put these  in context, adding that there was  not a vaccine                                                               
for this  novel coronavirus.   She  pointed out  that a  flu shot                                                               
could  help  the hospitals  from  being  overrun by  people  with                                                               
similar symptoms who needed hospitalization.                                                                                    
                                                                                                                                
3:14:05 PM                                                                                                                    
                                                                                                                                
DR.   ZINK  directed   attention  to   slide  11,   "Testing  and                                                               
Treatment,which read:                                                                                                           
                                                                                                                                
     ? CDC has developed  a real time Reverse Transcription-                                                                    
     Polymerase  Chain  Reaction  (rRT-PCR)  test  that  can                                                                    
     diagnose  2019-nCoV in  respiratory  and serum  samples                                                                    
     from clinical specimens.                                                                                                   
     ? On  January 24, 2020,  CDC publicly posted  the assay                                                                    
     protocol  for this  test. Currently,  testing for  this                                                                    
     virus must take place at CDC.                                                                                              
     ? Currently testing can only be  done at the CDC but on                                                                    
     1/5/2020 the CDC announced they  will start to roll out                                                                    
     testing to individual states                                                                                               
     ? Alaska  Labs has been  in communication with  the CDC                                                                    
     to gear up  for testing. At the  earliest, Alaska could                                                                    
     start testing by March.                                                                                                    
     ?  There   is  no  known  treatment   except  for  good                                                                    
     supportive care.                                                                                                           
     ?  A vaccine  or treatment  is likely  not going  to be                                                                    
     available in the near future.                                                                                              
                                                                                                                                
DR. ZINK  introduced slide 12, "CDC  Evaluation Flowchart,which                                                                 
detailed  the  steps for  clinicians  and  hospitals to  identify                                                               
whether  both exposure  and illness  were present,  and then  the                                                               
steps to  isolate, assess clinical status,  inform, instruct, and                                                               
advise the  patient.   She reported that  currently there  was no                                                               
need  to test  people  in Alaska  unless they  met  one of  these                                                               
criteria.                                                                                                                       
                                                                                                                                
DR. ZINK  shared slide 13,  "PUI (Persons  Under Investigation),"                                                               
which offered  criteria for determination whether  someone needed                                                               
testing.                                                                                                                        
                                                                                                                                
3:15:58 PM                                                                                                                    
                                                                                                                                
DR. ZINK spoke about slide 14, "Notes on travel,which read:                                                                     
                                                                                                                                
     ?  Jan  1, 2020  Huanan  Seafood  Wholesale Market  was                                                                    
     closed                                                                                                                     
         Jan  23,   2020  Wuhan   City  shuts   down  public                                                                    
     transportation                                                                                                             
     ?  Jan  31,  2020  Presidential  Proclamation  suspends                                                                    
     entry into  the United States to  foreign nationals who                                                                    
     visited Mainland  China in the  past 14  days. Exempted                                                                    
     persons  include  immediate   family  members  of  U.S.                                                                    
     citizens,  legal permanent  residents and  crew members                                                                    
     of air travel                                                                                                              
                                                                                                                                
DR.  ZINK  reported that  the  current  federal quarantine  order                                                               
issued  for the  passengers returning  from China  was the  first                                                               
since  the  1960s and  she  presented  slide 15,  "Isolation  vs.                                                               
Quarantine,which read:                                                                                                          
                                                                                                                                
     ? Isolation  and quarantine help protect  the public by                                                                    
     preventing exposure  to people who  have or may  have a                                                                    
     contagious disease.                                                                                                        
     ?  Isolation separates  sick people  with a  contagious                                                                    
     disease from people who are not sick.                                                                                      
     ? Quarantine  separates and  restricts the  movement of                                                                    
     people who were exposed to  a contagious disease to see                                                                    
     if they become sick.                                                                                                       
     ?  In   addition  to  serving  as   medical  functions,                                                                    
     isolation  and  quarantine   also  are  "police  power"                                                                    
     functions, derived from the right  of the state to take                                                                    
     action  affecting   individuals  for  the   benefit  of                                                                    
     society.                                                                                                                   
                                                                                                                                
DR. ZINK  added that, in the  State of Alaska, the  Department of                                                               
Health  and  Social  Services  had the  legal  ability  to  issue                                                               
quarantine,  which   was  occasionally  used,   particularly  for                                                               
individuals with  tuberculosis who posed  a risk to others.   She                                                               
noted that the state had not done a mass quarantine.                                                                            
                                                                                                                                
3:17:36 PM                                                                                                                    
                                                                                                                                
DR. ZINK shared slide 16, "Prevention,which read:                                                                               
                                                                                                                                
     There  is currently  no  vaccine  to prevent  2019-nCoV                                                                    
     infection.  The best  way to  prevent  infection is  to                                                                    
     avoid being exposed to this virus.                                                                                         
                                                                                                                                
     CDC  always recommends  everyday preventive  actions to                                                                    
     help  prevent   the  spread  of   respiratory  viruses,                                                                    
     including:                                                                                                                 
     ?  Avoid  touching  your eyes,  nose,  and  mouth  with                                                                    
     unwashed hands.                                                                                                            
     ? Avoid close contact with people who are sick.                                                                            
     ? Stay home when you are sick.                                                                                             
     ? Cover your cough or  sneeze with a tissue, then throw                                                                    
     the tissue in the trash.                                                                                                   
     ? Clean  and disinfect  frequently touched  objects and                                                                    
     surfaces using  a regular  household cleaning  spray or                                                                    
     wipe.                                                                                                                      
     ?  Wash your  hands often  with soap  and water  for at                                                                    
     least  20  seconds,  especially   after  going  to  the                                                                    
     bathroom; before  eating; and after blowing  your nose,                                                                    
     coughing, or sneezing.                                                                                                     
     ? If soap  and water are not readily  available, use an                                                                    
     alcohol-based   hand  sanitizer   with  at   least  60%                                                                    
     alcohol.  Always  wash hands  with  soap  and water  if                                                                    
     hands are visibly dirty.                                                                                                   
                                                                                                                                
DR. ZINK  pointed to  slide 17, "An  Outbreak,which    compared a                                                               
graph for  a pandemic  with a  rapid outbreak  for the  number of                                                               
cases  with a  transition for  a  reduction to  the overall  peak                                                               
number  of cases  and  the  health effects.    She declared  that                                                               
"these  viruses  don't   have  passports,  we  live   in  a  very                                                               
international world, and we need to be prepared and ready."                                                                     
                                                                                                                                
DR.  ZINK  moved  on  to slide  18,  "Disaster  Preparedness,a                                                                  
workflow chart that listed disaster  management plans to respond,                                                               
recover, plan and prepare, then mitigate.   She added that it was                                                               
then necessary  to prepare for  the next disaster  using previous                                                               
guidelines from SARS,  MERS, and Ebola, slide  19, "Preparing for                                                               
the next steps, which read:                                                                                                     
                                                                                                                                
     ? Preparedness  is something that  we do,  practice and                                                                    
     prepare for                                                                                                                
     ?  Build on  existing  structures  and lessons  learned                                                                    
     from the 1918 flu, H1N1, SARS, MERS, and Ebola                                                                             
     ? Have  recently updated  Pandemic Influenza  Plan that                                                                    
     can be used as guidelines                                                                                                  
     ? Exercised  planning for a contagious  pandemic in the                                                                    
     "Ragin' Contagion" exercise from April 8-13, 2019                                                                          
     ?   Have  active   Emergency  Medical   Countermeasures                                                                    
     Management Plan                                                                                                            
     ? DHSS EOC (Emergency  Operations Center) stood up Jan.                                                                    
     24, 2020                                                                                                                   
     ?  Working  closely  with  other  departments,  tribal,                                                                    
     federal and  local partnerships to  run through  all of                                                                    
     the "what ifs"                                                                                                             
                                                                                                                                
3:19:44 PM                                                                                                                    
                                                                                                                                
DR.  ZINK  talked about  the  flight  which landed  in  Anchorage                                                               
bringing U.S.  citizens home from  China, noting that the  14 day                                                               
quarantine window  had closed on  Tuesday, [February  11], ending                                                               
the concern  and risk for  anyone working with the  flight, slide                                                               
20, "A special case,which read:                                                                                                 
                                                                                                                                
     ? Asked to  assist in the repatriation of up  to 240 US                                                                    
     citizens and their families on January 28th, 2020                                                                          
     ? Worked closely with federal,  local, tribal and state                                                                    
     partners to  ensure Alaskans were not  at any increased                                                                    
     risk                                                                                                                       
     ? Passenger  have all cleared  their 14  day quarantine                                                                    
     period with no cases                                                                                                       
     ? Alaska  is more prepared  from having the  courage to                                                                    
     carry out this mission                                                                                                     
                                                                                                                                
DR.  ZINK reported  that, because  of that  repatriation mission,                                                               
Alaska was  further ahead in  planning and preparation  than most                                                               
other states.  She pointed out  that it was necessary to keep the                                                               
cargo ships  and cargo  flights moving, as  almost 90  percent of                                                               
medical equipment came  from China, slide 21,  "Looking forward                                                                 
Cruise Ships and Cargo,which read:                                                                                              
                                                                                                                                
     ?  Anchorage  airport  is  one  of  the  busiest  cargo                                                                    
     airports in the world                                                                                                      
     ? Crew members of  aircraft have FAA requirements which                                                                    
     are slightly different than  the general screening into                                                                    
     the US                                                                                                                     
     ?  Cruise   lines  are  limiting  passengers   who  are                                                                    
     boarding with pre-boarding screening                                                                                       
                                                                                                                                
DR.  ZINK   addressed  slide  22,  "Strengths   and  Weaknesses,                                                                
declaring  that it  was necessary  to keep  people informed  with                                                               
accurate   information  as   we  were   actually  fighting   four                                                               
epidemics:  the novel coronavirus,  as well as epidemics of fear,                                                               
stigma,  and misinformation.   She  paraphrased the  slide, which                                                               
read:                                                                                                                           
                                                                                                                                
     ?  Strong, centralized  public health  system including                                                                    
     labs, epidemiology, emergency operations center                                                                            
     ? Strong state, federal, Tribal, local partnerships                                                                        
       Limited health care capacity and large distances                                                                         
     ? Housing and quarantine challenges                                                                                        
     ? Supply chain challenges                                                                                                  
     ? Rapid spread of fear, stigma and misinformation                                                                          
                                                                                                                                
3:22:02 PM                                                                                                                    
                                                                                                                                
DR.  ZINK concluded  with slide  23, What  is being  done,which                                                                 
read:                                                                                                                           
                                                                                                                                
     ? Health provider webinars                                                                                                 
     ? Emergency operations meetings                                                                                            
     ? Daily national calls  with federal partners including                                                                    
     CDC and others                                                                                                             
     ? Public messaging and media                                                                                               
     ? Interdepartmental preparedness planning including:                                                                       
     ? DMVA, DEED, DOT, DOC, DPS and others                                                                                     
                                                                                                                                
DR. ZINK,  in response to  Representative Claman,  explained that                                                               
the  diagram  on   slide  17  depicted  a   "general  diagram  of                                                               
epidemics" to get  an estimate of where things were,  and not the                                                               
coronavirus specifically.                                                                                                       
                                                                                                                                
3:22:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR reflected  on  the opportunity  to test  the                                                               
system when  the plane landed  in Anchorage with  the repatriated                                                               
U.S.  citizens,  and  asked  what had  been  learned  that  would                                                               
strengthen any future response.                                                                                                 
                                                                                                                                
DR. ZINK explained that the  heightened tension with the national                                                               
and  international media  was  a good  reminder  for how  quickly                                                               
things can  "get spun up."   She  shared that, upon  landing, the                                                               
plane had announced  a medical emergency which created  "a lot of                                                               
scrambling and  a lot of concern,"  and turned out to  be a minor                                                               
injury happening 9  hours earlier.  She added  that, although the                                                               
pilots and crew  never got off the  plane in China and  were in a                                                               
separate airspace  from the passengers,  they left the  plane and                                                               
went  into  Anchorage,   causing  a  lot  of   concern  from  the                                                               
misinformation.                                                                                                                 
                                                                                                                                
3:25:28 PM                                                                                                                    
                                                                                                                                
CHAIR  ZULKOSKY stated  that  the committee  would  take a  brief                                                               
recess.                                                                                                                         
                                                                                                                                
3:25:43 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:25 p.m. to 3:38 p.m.                                                                       
                                                                                                                                
3:38:19 PM                                                                                                                    
                                                                                                                                
^Presentation: Alaska Children's Justice Act Task Force                                                                       
     Presentation: Alaska Children's Justice Act Task Force                                                                 
                                                                                                                                
CHAIR  ZULKOSKY  brought the  House  Health  and Social  Services                                                               
Standing Committee  back to  order and  announced that  the final                                                               
order  of business  would  be a  PowerPoint  presentation by  the                                                               
Alaska Children's Justice Act Task Force.                                                                                       
                                                                                                                                
3:40:13 PM                                                                                                                    
                                                                                                                                
PAM KARALUNAS, Alaska  Children's Alliance, Karalunas Consulting,                                                               
shared  that much  of the  data and  research presented  had been                                                               
prepared   by  Dr.   Jared  Parrish.     She   shared  slide   2,                                                               
 Introduction to  the Alaska CJATF,and    paraphrased  the slide,                                                               
which read:                                                                                                                     
                                                                                                                                
        • Federally mandated and funded                                                                                         
        • Mission: Identify areas where improvement is needed in                                                              
          the   statewide   response   to   child   maltreatment,                                                               
          particularly child sexual abuse, make recommendations                                                                 
          and take action to improve the system.                                                                              
        • Statewide, multidisciplinary membership                                                                               
        • Legislation to improve protection & justice for                                                                       
          children (starvation, serious physical abuse, privacy)                                                                
        • Focus on education: child abuse in Alaska, mandatory                                                                  
          reporting, & best practices for the multidisciplinary                                                                 
          response to child abuse                                                                                               
                                                                                                                                
MS. KARALUNAS addressed slide 3,  "Overview of our presentation,                                                                
and reported that  Alaska had specific research  on Alaska, which                                                               
was not common among the states.                                                                                                
                                                                                                                                
3:42:18 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
3:43:50 PM                                                                                                                    
                                                                                                                                
MS. KARALUNAS returned to slide 3, which read:                                                                                  
                                                                                                                                
     Newest research on child abuse and neglect in Alaska                                                                       
     Including impact on state                                                                                                  
        Opportunities for earlier intervention: Mandated                                                                        
     reporting                                                                                                                  
     Commercial sexual exploitation of children in Alaska                                                                       
     Specific requests for legislative changes                                                                                  
                                                                                                                                
MS. KARALUNAS introduced slide  4, "Adverse Childhood Experiences                                                               
(ACEs),  a  collaborative  study   between  Centers  for  Disease                                                               
Control  and Kaiser  Permanente of  17,000 people,  mostly white,                                                               
mostly upper middle  income with some college  education, and not                                                               
considered to  be high risk.   The graph on slide  4 depicted the                                                               
percentage  of significant  connections  between early  childhood                                                               
adversities  and  health problems  in  adults.   These  childhood                                                               
adversities  were divided  into 10  categories:   physical abuse,                                                               
sexual  abuse,  emotional   abuse,  physical  neglect,  emotional                                                               
neglect,  mental illness,  incarcerated relative,  mother treated                                                               
violently,  substance  abuse in  the  home,  and divorce.    Each                                                               
category  was  determined   to  be  one  point,   no  matter  the                                                               
frequency.  She addressed slide  5, "Findings,  which stated that                                                               
ACEs  were very  common,  especially among  people with  physical                                                               
health  problems, and  listed the  findings by  percentage.   She                                                               
reported  that, although  everyone had  an 87  percent chance  of                                                               
having at least one ACE, there  was a 50 percent chance of having                                                               
3 or more ACEs.                                                                                                                 
                                                                                                                                
3:47:42 PM                                                                                                                    
                                                                                                                                
MS. KARALUNAS stated  that the higher the score,  the more likely                                                               
it  was  for  an  individual  to  have  health  risks,  slide  6,                                                               
"Increased ACE  score =  increased likelihood:"   She  added that                                                               
recent  research had  found more  of a  correlation between  high                                                               
ACEs score  and heart  disease than  with those  more traditional                                                               
causes including  hypertension and  high cholesterol.   She added                                                               
that a high ACEs score also  increased the risk for strokes, lung                                                               
disease, osteoporosis  related factors,  or early death,  as well                                                               
as  an   increased  risk  for  smoking,   alcoholism,  drug  use,                                                               
depression, suicide attempts,  multiple sexual partners, intimate                                                               
partner violence,  or rape.   She declared,  the higher  the ACEs                                                               
score, the more likely to be a victim.                                                                                          
                                                                                                                                
MS. KARALUNAS moved  on to slide 8, Alaska  ACEs snapshot,which                                                                 
listed the percentages of reported  problems as analyzed from the                                                               
Alaska  Behavioral   Risk  Factor   Surveillance  System.     She                                                               
emphasized that, in Alaska, those with  four or more ACEs were 49                                                               
percent more likely to be  unemployed, 274 percent more likely to                                                               
be  unable to  work, 92  percent more  likely to  earn less  than                                                               
$20,000 annually,  and significantly  more likely to  report poor                                                               
physical and  mental health.   She shared  slides 9 and  10, "And                                                               
it's not  just one bad  thing..." an Alaska specific  graph which                                                               
indicated  the  co-occurrence  of  adverse  childhood  experience                                                               
exposures.                                                                                                                      
                                                                                                                                
3:50:15 PM                                                                                                                    
                                                                                                                                
MS. KARALUNAS  shared slide 11, "Maltreatment  burden in Alaska,                                                                
declaring  that  the health  care  impact  was  very high.    She                                                               
reported  that annually  10 percent  of children  in Alaska  were                                                               
reported to the  Office of Children's Services (OCS)  and that 34                                                               
percent of adults  in Alaska had some ACE experience  as a child.                                                               
She  declared   that  cumulatively  37  percent   of  the  Alaska                                                               
population had some childhood trauma.   She directed attention to                                                               
slide  12,  "Trauma impacts  can  start  prior to  birth,which                                                                  
included prenatal  exposures and  experiences which  impact brain                                                               
development  in utero  and  genetics.   She  added that  children                                                               
exposed  to  pre-natal  trauma  were   much  a  higher  risk  for                                                               
hospitalization from  asthma.  She  discussed slide 13,  "What is                                                               
epigenetics? and  reported that  childhood trauma  impacts genes,                                                               
which  helps  to explain  intergenerational  trauma.   She  noted                                                               
that,  as genes  could  be turned  on and  off,  people could  be                                                               
helped after trauma.                                                                                                            
                                                                                                                                
3:54:47 PM                                                                                                                    
                                                                                                                                
MS.  KARALUNAS discussed  the  Alaska  Pregnancy Risk  Assessment                                                               
Monitoring  System  (PRAMS),  which  allowed for  mothers  to  be                                                               
interviewed in the  hospital with a follow up  process, slide 14,                                                               
"New emerging  data resources."   She stated that  currently more                                                               
than  33,000  children born  between  2009  and 2011  were  being                                                               
followed in  Alaska for medical  issues, law  enforcement issues,                                                               
and child protection reports, among  others.  She indicated slide                                                               
15,  "Pre-birth  household  dysfunction to  predict  ACE  Score,                                                                
reporting that  dysfunction during the  12 months prior  to birth                                                               
and pregnancy generated higher ACE scores.                                                                                      
                                                                                                                                
MS.  KARALUNAS moved  on to  slide 16,  "PRAMS questions  used to                                                               
measure pre-birth  household dysfunction  ACEs,and    stated that                                                               
the risk of contact with  OCS increased with the increased number                                                               
of  pre-birth household  dysfunctions.   She reported  that there                                                               
was a stepwise  association and an accumulation of  ACEs with the                                                               
more  stresses that  occurred  prenatally,  slide 17,  "Pre-Birth                                                               
Household  Dysfunction  and  ACE   Score."    She  reported  that                                                               
adjustments for maternal  race, education, or age  did not change                                                               
these  outcomes.   She  introduced  slide  18, "Impacts  continue                                                               
after birth,   which compared the  synaptic density at  birth, at                                                               
six  years, and  at fourteen  years.   She pointed  out that  the                                                               
synapsis showed  a regression at  14 years old, hence  a decrease                                                               
in the function of the brain, and a high level of vulnerability.                                                                
                                                                                                                                
3:59:46 PM                                                                                                                    
                                                                                                                                
MS. KARALUNAS  shared slide 19,  "Development influenced  by both                                                               
negative   and  positive   factors,and       stated  that   brain                                                               
development  was  also influenced  by  positive  factors such  as                                                               
meaningful  relationships.    She discussed  slide  20,  "Adverse                                                               
Childhood  Experiences   (ACE),   stating  that  the   more  ACEs                                                               
documented,  the  higher  risk  of developing  later  health  and                                                               
social problems.                                                                                                                
                                                                                                                                
MS.  KARALUNAS  pointed  to slide  21,  "Risk  (incidence)  among                                                               
children,and   reported that there  was a cumulative incidence of                                                               
contact with OCS among children born  in Alaska.  She stated that                                                               
the study had tracked these  children for nine years and measured                                                               
the cumulative  incidences.   Moving on  to slide  22, "ALCANLink                                                               
Study,  she  relayed that of  the children born between  2009 and                                                               
2011,  before  their  ninth  birthday,  one  in  three  had  been                                                               
reported to OCS, one in four had  been screened in to OCS, one in                                                               
eight had  their OCS case  substantiated, and one in  sixteen had                                                               
been removed from their home by OCS and placed in foster care.                                                                  
                                                                                                                                
4:02:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR reported that, in  2019, there were more than                                                               
23,000 OCS  protective service reports  filed in Alaska,  and, of                                                               
these, more than 11,000 were screened in for investigation.                                                                     
                                                                                                                                
REPRESENTATIVE JACKSON said  that these numbers brought  a lot of                                                               
questions.                                                                                                                      
                                                                                                                                
MS.  KARALUNAS  replied  that  Alaskans were  often  hurt.    She                                                               
explained slide 23, "Types of maltreatment, which read:                                                                         
                                                                                                                                
     Screened in by OCS in 2019:                                                                                                
     Neglect: most common type  59.4%                                                                                           
     Most common cause of child deaths                                                                                          
     Most commonly linked to parental substance abuse                                                                           
     Mental injury  22.5%                                                                                                       
     Example: Exposure to DV                                                                                                    
     Physical abuse  11.4%                                                                                                      
     Sexual abuse  6.6%                                                                                                         
                                                                                                                                
4:07:17 PM                                                                                                                    
                                                                                                                                
CHAIR ZULKOSKY asked for the definition of "screened in."                                                                       
                                                                                                                                
MS. KARALUNAS explained  that OCS would review a  report and then                                                               
determine through  their records whether there  should be further                                                               
investigation by an OCS worker.                                                                                                 
                                                                                                                                
4:08:00 PM                                                                                                                    
                                                                                                                                
MIKE  HOPPER,  PhD,  Private  Practice  Psychologist,  introduced                                                               
slide 24 "Different life trajectories:  Two roads to travel,and                                                                 
said  that, although  there were  two paths,  the path  that lead                                                               
toward trauma and chaos was often  hidden.  These were people who                                                               
had  survived multiple  ACEs, did  not want  anyone to  know, and                                                               
wanted to  forget about from where  they came.  He  noted that he                                                               
did  not know  how  he could  have survived  and  kept going  and                                                               
expressed his  own amazement  that the rate  of suicide  was low.                                                               
He  shared  a  personal  anecdote,  reading  from  a  book  about                                                               
immigrants, and  suggested to replace  the images with  those for                                                               
children  who experience  ACEs.   He stated  that people  who had                                                               
suffered  ACEs felt  like strangers  who  did not  belong in  our                                                               
society, as  they had  grown up "on  very, very  unsafe grounds."                                                               
He pointed out that, as  these individuals tried to be invisible,                                                               
it was difficult  to pick them out of general  society until they                                                               
entered  jail  or  a  psychiatric  hospital.    He  reminded  the                                                               
committee that 40 percent of Alaskans had suffered from ACEs.                                                                   
                                                                                                                                
4:13:49 PM                                                                                                                    
                                                                                                                                
MS. KARALUNAS  continued with  slide 24,  and explained  that the                                                               
neural  pathways   for  flight,  fight,  or   freeze  can  become                                                               
hardwired.   She  declared  that there  was  also resiliency  and                                                               
rewiring.     She  moved  on   to  discuss  slides  25   and  26,                                                               
"Disproportionality:    Why?and        reported    that    Alaska                                                               
Native/American  Indian children  were significantly  represented                                                               
in child maltreatment  reports and deaths.  She  stated that they                                                               
were  three  times more  likely  to  be  reported  to OCS.    She                                                               
reported that  48 percent of the  children seen at CACs  in FY 19                                                               
were Alaska  Native or American  Indian, although they  were only                                                               
14 percent of  the population.  She emphasized  that new research                                                               
had shown this  was not a part  of the culture.   She stated that                                                               
it  was necessary  to  adjust for  the  background of  historical                                                               
trauma, racism, and  the genetic factor, and it  was evident that                                                               
the  risk was  related  to the  social  ills, including  poverty,                                                               
intimate  partner  violence,  substance abuse,  and  poor  mental                                                               
health.   She declared that Alaska  did not have a  higher amount                                                               
of child  abuse in  the Alaska Native  population because  it was                                                               
part  of the  culture,  instead  it was  part  of  what had  been                                                               
happening  for generations.   She  emphasized  that the  question                                                               
should  not be  "what's wrong  with  you?", but  should be  "what                                                               
happened to you?"                                                                                                               
                                                                                                                                
4:17:44 PM                                                                                                                    
                                                                                                                                
MS.  KARALUNAS shared  slide 27,  "What  Does Child  Maltreatment                                                               
Cost   Alaska?"  and   slide   29,  "Alaska   estimates:"     She                                                               
acknowledged the difficulties for  balancing budgets, but pointed                                                               
out  the  cost  annually  for child  maltreatment,  between  $631                                                               
million and $10.7 billion.  She  reported that the costs just for                                                               
the  substantiated  OCS reports  was  $82  million for  childhood                                                               
health care,  child welfare,  and special  education.   She noted                                                               
that almost  41 percent of  adult Medicaid enrollment  was linked                                                               
to ACEs.   She suggested  that decreasing ACEs and  improving the                                                               
response  to  child maltreatment  could  save  Alaska almost  $92                                                               
million annually.   She  moved on  to slide  30, "Also  below the                                                               
surface:   CSEC,   and   spoke  about   the  commercial,   sexual                                                               
exploitation of children.                                                                                                       
                                                                                                                                
4:19:34 PM                                                                                                                    
                                                                                                                                
GAYLE  GARRIGUES, Retired  Attorney, stated  that the  commercial                                                               
sexual exploitation of children had  probably been going on for a                                                               
millennium even as law enforcement  was just becoming aware of it                                                               
slide  31, "Commercial  Sexual  Exploitation  of Children  (CSEC)                                                               
is:" which read:                                                                                                                
                                                                                                                                
     Sexual  activity  involving  a child  in  exchange  for                                                                    
     something of  value, or promise  thereof, to  the child                                                                    
     or another person or persons                                                                                               
     Treating a child as a commercial and sexual object                                                                         
     A form of violence against children                                                                                        
     Words matter: not "child prostitution"                                                                                   
                                                                                                                                
MS.  GARRIGUES  declared that,  as  words  conjured images,  they                                                               
matter, and  she paraphrased slide  32, "Sex  Trafficking,which                                                                 
read:                                                                                                                           
                                                                                                                                
     CSEC victims are victims of  sex trafficking when there                                                                    
     is  a  third  party  exploiter  who  profits  from  the                                                                  
     exploitation                                                                                                             
                                                                                                                                
     Sex  trafficking  in  which a  commercial  sex  act  is                                                                    
     induced by force, fraud, or coercion,                                                                                    
                                                                                                                                
     or in which  the person induced to perform  such an act                                                                  
     has  not attained  18  years  of age  (or  under 20  in                                                                  
     Alaska)                                                                                                                  
                                                                                                                                
4:23:21 PM                                                                                                                    
                                                                                                                                
DR. HOPPER  reported on slide  33, "Intersections of  Abuse,  and                                                               
stated that  child exploitation already occurred  within a secret                                                               
environment,  as it  was behind  closed doors,  and was  a "very,                                                               
very hidden part  of our society."  He offered  a comparison with                                                               
the  difficulty  and  courage  of  women  to  speak  out  against                                                               
powerful men in the MeToo movement,  and how difficult it was for                                                               
young girls  to also speak  out.  He  added that young  boys were                                                               
also sexually  abused at a  rate not  that far from  young girls.                                                               
He shared  an anecdote of  the intersection of  child prostitutes                                                               
and  child sexual  exploitation, pointing  out that  most of  the                                                               
sexual exploitation was  committed by people who did  not have to                                                               
pay for it.                                                                                                                     
                                                                                                                                
4:27:02 PM                                                                                                                    
                                                                                                                                
MS. GARRIGUES shifted to slide 34, "Pathways to Entry:" which                                                                   
read:                                                                                                                           
                                                                                                                                
     Parents selling/trading children for sex                                                                                   
     Violence and force                                                                                                         
     Kidnapping                                                                                                                 
     Seduction                                                                                                                  
     Fear, coercion, blackmail                                                                                                  
         False advertising for "modeling," "acting," or                                                                         
     "dancing" opportunities                                                                                                    
     Peer recruitment                                                                                                           
      Internet enticement through social media, gaming, or                                                                      
     profile-sharing sites                                                                                                      
     Survival                                                                                                                   
                                                                                                                                
MS. GARRIGUES shared anecdotes for each of these pathways.                                                                      
                                                                                                                                
4:31:12 PM                                                                                                                    
                                                                                                                                
MS. GARRIGUES spoke about slide 35, "What you need to know:"                                                                    
which read:                                                                                                                     
                                                                                                                                
       Within 48 hours of becoming homeless, one in three                                                                       
     children will be approached by a trafficker                                                                                
     In Alaska, common age of recruitment is 14-16 years                                                                        
     Average lifespan once recruited is 7 years                                                                                 
                                                                                                                                
MS. GARRIGUES moved on to paraphrase slide 36, "Alaskan Risk                                                                    
Factors,which read:                                                                                                             
                                                                                                                                
     Population with high amounts of historical trauma and                                                                      
     trauma exposure                                                                                                            
     Transient male-dominated industries                                                                                        
      Transient male-dominated industries placed in rural                                                                       
         areas next to communities with high amounts of                                                                         
     historical trauma Rural and Urban                                                                                          
      Celebrated history of prostitution                                                                                        
                                                                                                                                
MS. GARRIGUES directed attention to the glamour of the                                                                          
celebrated history of prostitution, offering an example of the                                                                  
Fairbanks "Golden Days" and the streets named for madams.                                                                       
                                                                                                                                
MS. GARRIGUES discussed slide 37, "Current Status of CSEC in                                                                    
Alaska,which read:                                                                                                              
                                                                                                                                
     Loyola University/Covenant House Study 2016                                                                                
     65 youth surveyed locally (641 Nationally)                                                                                 
     1 in 5 Identified as trafficking victims Nationally                                                                        
      1 in 4 Identified as trafficking (labor/sex) victims                                                                      
     locally                                                                                                                    
     1 in 4 females as sex trafficking locally                                                                                  
         200 victims served in last two years between 5                                                                         
     Anchorage providers                                                                                                        
     10 current minor child cases FBI                                                                                           
          Law enforcement report an increase of online                                                                          
     recruitment                                                                                                                
    More   cases    of   traffickers    creating   explicit                                                                     
     images/videos of minors                                                                                                    
                                                                                                                                
MS. GARRIGUES shared  that it was necessary to learn  the ways to                                                               
investigate cases  and what  to look  for.   She pointed  to some                                                               
protocols  for  examinations  of  sex  traffic  victims  as  this                                                               
entailed  different questions  and questioning  techniques.   She                                                               
pointed out  that the images  from these cases lasted  forever on                                                               
the internet.                                                                                                                   
                                                                                                                                
4:37:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  asked about  the bills  currently introduced                                                               
by the governor.                                                                                                                
                                                                                                                                
MS. GARRIGUES said that she would speak about that.                                                                             
                                                                                                                                
MS. KARALUNAS  shared that  the author of  the studies  by Loyola                                                               
University referenced on slide 37  had indicated that the stories                                                               
from children in Alaska were the most horrific.                                                                                 
                                                                                                                                
4:38:23 PM                                                                                                                    
                                                                                                                                
DR.  HOPPER reported  on slide  39, "How  do we  create the  best                                                               
future  for  our  children's  lives?"   a  graph  reflecting  the                                                               
trajectory of  health development from  the early ages,  6 months                                                               
to  5   years  of  age.     He  noted  that  with   the  lack  of                                                               
opportunities, including  health service and  education, children                                                               
were found to not do as well.                                                                                                   
                                                                                                                                
DR. HOPPER moved on to slide 40, "What can we do?" which read:                                                                  
                                                                                                                                
     Reasons for hope:                                                                                                          
     Healing is possible                                                                                                        
     Our brains can always learn                                                                                                
     We can all help build resilience in children                                                                               
     We can all help protect children                                                                                           
                                                                                                                                
DR.  HOPPER expressed  his disagreement  with  any suggestion  to                                                               
survivors  that  their  brains  are damaged,  as  the  brain  was                                                               
"unbelievably resilient."  He reported  that these kids protected                                                               
their  own  brains under  the  worst  possible conditions,  while                                                               
trying to  forget because there  was nothing they could  do about                                                               
abuse and neglect.   He noted that, however, "down  the line it's                                                               
a  threat  that  remains  ever  present,  that's  what  called  a                                                               
traumatic memory."   He  referred to  these memories  as "warning                                                               
lights."   He  added that  most  people did  not recognize  these                                                               
warnings  "of their  own past  calling to  them, warning  them of                                                               
what can happen."  Instead, many  people would begin to act as if                                                               
this  was all  happening  again.   He expressed  his  awe of  the                                                               
survivors.                                                                                                                      
                                                                                                                                
4:44:25 PM                                                                                                                    
                                                                                                                                
MS. GARRIGUES added  that her work with sexual  assault and abuse                                                               
victims had shown them to be  "some of the bravest people because                                                               
they had to come into the  courtroom and talk cogently about some                                                               
of the worst  experiences in their lives."  She  shared slide 42,                                                               
 Earlier  recognition &  intervention: Mandatory  Reporting,  and                                                               
slide  43,  "Mandatory  reporting  gaps,   stating  a  desire  to                                                               
"tinker with  the mandatory reporting statute."   She paraphrased                                                               
from slide 43, which read:                                                                                                      
                                                                                                                                
     EMS & paramedics (trainings)                                                                                               
    Clergy    (multiple   cases    involving   clergy    as                                                                     
     perpetrators & protectors of perpetrators)                                                                                 
     Animal control & veterinarians (research links between                                                                     
     animal cruelty & child abuse)                                                                                              
         Guardians Ad Litem (GALs) (CASA volunteers are                                                                         
     required already)                                                                                                          
      Judges (recent case      reporting not required, no                                                                       
     immediate notification)                                                                                                    
                                                                                                                                
4:47:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRUITT   asked  whether  clergy   were  currently                                                               
mandatory reporters for child sexual abuse.                                                                                     
                                                                                                                                
MS.  GARRIGUES replied  that, in  Alaska,  clergy were  mandatory                                                               
reporters for  elder abuse  but not  for child  abuse.   She said                                                               
that the  requirement for mandatory  reporters varied  from state                                                               
to state.                                                                                                                       
                                                                                                                                
REPRESENTATIVE  PRUITT shared  the  story of  a  confession to  a                                                               
clergy that was  subsequently reported, resulting in  a suit from                                                               
the confessor.                                                                                                                  
                                                                                                                                
MS. GARRIGUES  acknowledged a case  in Alaska when a  clergy also                                                               
worked as a mental health therapist  and reported an abuse.  This                                                               
had resulted in litigation  regarding confessional privilege, but                                                               
the law had  determined there was not any privilege  for a mental                                                               
health counselor.  She noted  that the rules of evidence provided                                                               
an exception  for mandatory  reporting for  clergy.   She offered                                                               
her  belief  that  a clergy  exception  for  mandatory  reporting                                                               
protected the perpetrator, not the child.                                                                                       
                                                                                                                                
REPRESENTATIVE PRUITT clarified that  the incident he relayed had                                                               
occurred outside Alaska.                                                                                                        
                                                                                                                                
4:51:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  shared background on a  prospective bill she                                                               
was drafting for mandatory reporters, which included clergy.                                                                    
                                                                                                                                
MS. GARRIGUES relayed that in  Alaska there were privileges found                                                               
for information that  may be used in court.   She added that each                                                               
member  of the  Alaska Children's  Justice Act  Task Force  was a                                                               
subject  matter  expert  if   further  specific  information  was                                                               
requested.                                                                                                                      
                                                                                                                                
REPRESENTATIVE TARR shared that  animal control and veterinarians                                                               
had been  considered as  aggravators with  violent crimes  in her                                                               
prospective bill.                                                                                                               
                                                                                                                                
MS.  GARRIGUES replied  that aggravators  happened after  someone                                                               
had  gone to  court, whereas  she  was working  toward early  and                                                               
effective intervention, prior to going to court.                                                                                
                                                                                                                                
MS. KARALUNAS  stated that  there was  clear research  making the                                                               
connection between abused animals and abused children in a home.                                                                
                                                                                                                                
DR.  HOPPER pointed  out that,  as dogs  would bark  when abused,                                                               
there  were  often  animal control  people  investigating  before                                                               
there were social workers investigating.                                                                                        
                                                                                                                                
4:55:34 PM                                                                                                                    
                                                                                                                                
MS.   KARALUNAS   addressed   slide  44,   "Early   &   effective                                                               
intervention," which read:                                                                                                      
                                                                                                                                
     Child Advocacy Centers                                                                                                     
     Multidisciplinary response                                                                                                 
     Child focused                                                                                                              
     Forensic interview                                                                                                         
     Medical exam                                                                                                               
     Mental health services                                                                                                     
     Support & advocacy                                                                                                         
     Information sharing                                                                                                        
      Nearly 33,000 children & their families served since                                                                      
     1996                                                                                                                       
                                                                                                                                
MS.  KARALUNAS  moved  on to  paraphrase  slide  45,  "Protective                                                               
Factors: Focus on adults, which read:                                                                                           
                                                                                                                                
     Supportive, nurturing, stable family                                                                                       
     Supportive social networks                                                                                                 
     Caring adults outside family                                                                                               
     Household rules, monitoring of child                                                                                       
     Parental employment                                                                                                        
     Adequate housing                                                                                                           
     Access to health care, other services                                                                                      
     Community safety                                                                                                           
     Community involvement                                                                                                      
     Cultural connectedness                                                                                                     
                                                                                                                                
MS. KARALUNAS addressed slide 46,   hat can you do?" which read:                                                                
                                                                                                                                
     Realize this affects ALL of us in Alaska                                                                                   
     Make your decisions using a trauma-informed lens                                                                           
          "It's not what's wrong with you, it's  what                                                                           
     happened to you"                                                                                                           
      Support community-based & system-wide approaches to                                                                       
     strengthen children and families                                                                                           
                                                                                                                                
4:56:51 PM                                                                                                                    
                                                                                                                                
MS.  GARRIGUES  explained  slide  50, "SB  165/HB  225:  "An  Act                                                               
relating to sex trafficking..." which  had been introduced by the                                                               
governor  and  were  related to  sex  trafficking,  bringing  the                                                               
prosecution  up   to  date.     She  declared  support   for  the                                                               
legislation,  especially support  for  the  prosecution that  the                                                               
patrons had to  register as sex offenders.   She emphasized that,                                                               
although there was  support for the recommendation  that a victim                                                               
of  sex   trafficking  may  seek   to  vacate   any  prostitution                                                               
convictions, this needed  to go further as  these sex trafficking                                                               
victims  often  committed  other  crimes, all  a  result  of  the                                                               
trafficking and  not because of their  own free will.   She urged                                                               
that the  statute be amended  to add more convictions  that could                                                               
be vacated.  She suggested  that for more successful prosecutions                                                               
of   trafficking  it   would  be   necessary   for  safe   harbor                                                               
protections, such  as housing  and support,  to help  the victims                                                               
and "go  after the  real bad  guys."   She stated  that mandatory                                                               
training  was necessary  for law  enforcement  officers, so  they                                                               
know what  questions to ask,  for prosecutors, and for  judges to                                                               
better understand.  She referenced  the proposed bills SB 168 and                                                               
HB 228  which had  come forward primarily  because of  a decision                                                               
made by the  Supreme Court that required a way  for people on the                                                               
sex offender  registry to be removed.   These bills would  set up                                                               
the process for this, clear  criteria for the courts to consider,                                                               
with a clear and convincing  standard of proof, and would provide                                                               
for victim notification and for the  victim to provide input.  It                                                               
also added other  registerable crimes.  She  declared support for                                                               
the proposed bills.                                                                                                             
                                                                                                                                
5:01:04 PM                                                                                                                    
                                                                                                                                
MS.  KARALUNAS  concluded with  slide  53,  "How  will you  be  a                                                               
champion for Alaskan children & families?"                                                                                      
                                                                                                                                
5:01:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ expressed  appreciation  for the  long-                                                               
time work  addressing child  abuse and neglect  in Alaska  by the                                                               
task  force.   She  suggested  that  there were  many  additional                                                               
preventative measures to reduce the  impact for child abuse, such                                                               
as  additional  positive  supports  for children's  lives.    She                                                               
referenced  a  federal  program,  the  "Family  First  Prevention                                                               
Services Act,"  which suggested in-home parenting  support, nurse                                                               
home  visiting programs,  and substance  abuse and  mental health                                                               
services.    She  reported  on the  investment  in  after  school                                                               
prevention programs  with supportive  adults.  She  declared that                                                               
offering  even more  positive programs  would  "save money,  save                                                               
lives, and have healthier people over time."                                                                                    
                                                                                                                                
5:04:08 PM                                                                                                                    
                                                                                                                                
DR. HOPPER  asked the committee  for a dedicated fund  for foster                                                               
kids  to have  access  with transportation  to organized  sports,                                                               
noting that this "would change thousands of lives."                                                                             
                                                                                                                                
REPRESENTATIVE JACKSON  shared that  there was "a  massive amount                                                               
of money that is coming but  the federal government is being very                                                               
mindful in  how they're going to  focus it."  She  suggested that                                                               
investment back into foster kids would break the cycle.                                                                         
                                                                                                                                
DR. HOPPER  expressed his agreement  that there were  foster kids                                                               
who had been identified as "being in the cycle."                                                                                
                                                                                                                                
5:05:20 PM                                                                                                                    
                                                                                                                                
CHAIR ZULKOSKY offered her belief that  this was a topic of broad                                                               
concern and listed  some follow up items, which  included: how to                                                               
address historic  trauma, issues of child  welfare, and mandatory                                                               
reporting.                                                                                                                      
                                                                                                                                
5:07:02 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 5:07 p.m.                                                                                                          

Document Name Date/Time Subjects
Coronavirus Update - Dr. Zink.pdf HHSS 2/13/2020 3:00:00 PM
Coronavirus Update by Dr. Anne Zink
Dispelling Myths about Child Sexual Abuse among Indigenous People.pdf HHSS 2/13/2020 3:00:00 PM
Children's Justice Act Task Force - Dispelling Myths about Child Abuse
Children's Justice Act Task Force Presentation.1.pptx HHSS 2/13/2020 3:00:00 PM
Alaska Children's Justice Act Task Force Presentation