Legislature(2009 - 2010)CAPITOL 106
02/12/2009 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Mental Health Comprehensive Plan | |
| Alaska Mental Health Trust-bring the Kids Home | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 12, 2009
3:03 p.m.
MEMBERS PRESENT
Representative Bob Herron, Co-Chair
Representative Wes Keller, Co-Chair
Representative John Coghill
Representative Bob Lynn
Representative Paul Seaton
Representative Sharon Cissna (via teleconference)
Representative Lindsey Holmes
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
PRESENTATION: MENTAL HEALTH COMPREHENSIVE PLAN
- HEARD
PRESENTATION: ALASKA MENTAL HEALTH TRUST-BRING THE KIDS HOME
- HEARD
PREVIOUS COMMITTEE ACTION
No Previous Action to Record
WITNESS REGISTER
BILL HOGAN, Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented a Power Point and testified about
the mental health comprehensive plan.
DELISA CULPEPPER, Chief Operating Officer
Alaska Mental Health Trust Authority (AMHTA)
Department of Revenue (DOR)
Anchorage, Alaska
POSITION STATEMENT: Testified about the mental health
comprehensive plan.
JEFF JESSEE, Chief Executive Officer
Alaska Mental Health Trust Authority (AMHTA)
Department of Revenue (DOR)
Anchorage, Alaska
POSITION STATEMENT: Presented a Power Point and testified on
Bringing The Kids Home (BTKH) initiative.
KARIN SCHAFF, Adolescent Treatment Services Director
Volunteers of America Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified about the Alaska Youth and Family
Network (AYFN) and the Adolescent Residential Center for Help
(ARCH).
KAREEM NOEL, Youth Navigator
Alaska Youth and Family Network (AYFN)
Anchorage, Alaska
POSITION STATEMENT: Testified about the Youth Navigator
program.
CARLA NICHOLAI, Youth Navigator
Alaska Youth and Family Network (AYFN)
Anchorage, Alaska
POSITION STATEMENT: Testified about the Youth Navigator
program.
ACTION NARRATIVE
3:03:49 PM
CO-CHAIR BOB HERRON called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Herron, Keller, Seaton, and Holmes were present
at the call to order. Representatives Lynn, Coghill, and Cissna
(via teleconference) arrived as the meeting was in progress.
^Presentation: Mental Health Comprehensive Plan
3:04:36 PM
CO-CHAIR HERRON announced that the first order of business would
be a Power Point presentation about the Comprehensive Integrated
Mental Health Plan and the Alaska Scorecard titled "Moving
Forward." [Included in the members' packets.]
3:05:28 PM
BILL HOGAN, Commissioner, Office of the Commissioner, Department
of Health and Social Services (DHSS), spoke about the Power
Point titled "Moving Forward." He mentioned that the DHSS had
decided to post more information and regularly update data on
its website. He referred to slide 2, "Statutory Requirements,"
and stated that DHSS must "prepare, and periodically revise and
amend a plan for an integrated comprehensive mental health
program." He summarized that this included plans for
developmental disability, alcoholism, and dementia. He pointed
out that the leadership team and planning group included
representatives from DHSS, Alaska Mental Health Board, and the
Department of Corrections, as well as other federal, state, and
private behavioral health services, as listed on slide 3, "Comp
Plan Leadership Team."
DELISA CULPEPPER, Chief Operating Officer, Alaska Mental Health
Trust Authority (ANHTA), Department of Revenue (DOR), explained
slide 4, "Comprehensive Integrated Mental Health Plan:" She
noted that the program was an online tool and a source of
information about the issues.
CO-CHAIR HERRON asked if it was currently operational.
MS. CULPEPPER replied that it had been operational on the DHSS
website for the last few years. She pointed out that it was
easier to maintain an on-line updated plan with all its links
rather than a printed plan.
3:10:18 PM
MS. CULPEPPER noted that slide 5 "Populations," listed the
targeted populations, which included people with alcoholism,
mental illness, and brain injuries. She added that the
comprehensive plan included programs from prevention to
treatment.
MR. HOGAN further explained that the plan included data for the
prevalence of people suffering from alcoholism, mental illness,
etc as seen on slide 6, "What is in the Comp Plan?" He noted
that information was included on, among others, substance abuse,
suicide, and housing. He reported that there was information
defining the current system of care, and detailing the current
initiatives and emerging issues.
3:11:54 PM
REPRESENTATIVE SEATON asked if autism was included in the
comprehensive plan.
MR. HOGAN responded that although autism was not listed,
Department of Health and Social Services (DHSS) worked with the
Alaska Mental Health Trust Authority (AMHTA) to provide services
for each child.
MS. CULPEPPER confirmed that people with autism were
beneficiaries of AMHTA as it was both a developmental and a
behavioral disability.
REPRESENTATIVE SEATON asked to verify that autism was not
falling through the crack.
MS. CULPEPPER responded that autism was a beneficiary.
MR. HOGAN reported on the consideration of a Medicaid waiver for
autism which would increase the likelihood for reception of an
array of services.
3:14:51 PM
MS. CULPEPPER directed attention to slide 7, "Alaska Scorecard:"
and explained that this was a report on the performance of the
mental health program. She pointed out the key indicators and
the sources for data. She confirmed that both the Comp Plan and
the Alaska Scorecard provided direction for policy and planning.
3:16:37 PM
MS. CULPEPPER called attention to the website for the "Moving
Forward Plan."
3:17:26 PM
MR. HOGAN referred to the handout "Comprehensive Integrated
Mental Health Plan." [Included in members' packets] He
elaborated that the vision and the purpose of the plan was to
direct resource allocation and to ensure availability of a
comprehensive service system for AMHTA beneficiaries. He
directed attention to the Boards and Commissions that DHSS
worked with and he indicated the target population of the plan.
3:18:54 PM
MS. CULPEPPER referenced the "Moving Forward Plan" and mentioned
that the blue hyperlinks allowed direct access to the data. She
reported that AMHTA was proud of its results in the areas of
Health, Safety, Living with Dignity, and Economic Security.
3:20:49 PM
MR. HOGAN explained the Client Status Review Form. He reported
that it was not enough to be clean and sober, but that a person
needed to have a good job, a place to live, to stay out of the
criminal justice system, and to be a contributing member of the
community. He remarked that the true outcome of the treatment
plans was for recovery and contributing membership in society.
3:23:25 PM
MS. CULPEPPER emphasized that the success of the treatment plan
was also attributable to assessment and result measurement; all
of which lead to betterment for the recipients' lives.
3:24:48 PM
MR. HOGAN, in response to Co-Chair Keller, explained that
funding for behavioral health was shifting, that providers had
to show true outcomes, and that funding was linked to proven
results.
3:26:17 PM
CO-CHAIR KELLER opined that this was exactly what government
should be doing, taking care of those who could not help
themselves. He expressed his concern for a clear delineation
between a volitional choice and an agency declaration of
helplessness.
3:27:20 PM
MS. CULPEPPER reviewed the history of AMHTA, and noted that the
state now had responsibility to fund the base of the mental
health program and treatment.
3:30:27 PM
MR. HOGAN, in response to Representative Seaton, explained that
there was enough information to show either improvement, or the
need for additional resources.
MS. CULPEPPER added that the FY08 data would soon be available.
3:32:38 PM
MR. HOGAN, in response to Representative Herron, explained that
the plan focused on mental health trust beneficiaries, but that
providers also served people who did not have as serious
problems.
CO-CHAIR HERRON asked for a way to access people who were
unaware of this plan.
MR. HOGAN explained that the client filled out the plan with the
case manager, and that this plan was reviewed every three to six
months. He reported that it was a requirement for every
behavioral health client to use this tool. He allowed that this
was not required for community health centers and many others
outside the behavioral health system.
MS. CULPEPPER added that it was only required of people using
the public health system and it did not include the private
industry.
3:36:07 PM
MR. HOGAN described the current array of services as a pyramid
with a foundation built on community prevention, education, and
public awareness. He shared that the philosophy of the
community based system was to keep people in their own home and
to receive the right kind of service in a timely fashion.
3:37:30 PM
MS. CULPEPPER explained that there was a matrix to direct the
type of services at each level.
MR. HOGAN affirmed the DHSS priorities: substance abuse, health
and wellness, health care reform, long term care, and vulnerable
Alaskans. He explained that the Comprehensive Integrated Mental
Health Plan structured each of these areas. He confirmed that a
person could go to the website and click on the problem; this
would describe the problem, explain the need to address the
problem, and detail the efforts and outcomes to date.
3:39:38 PM
MR. HOGAN, in response to Co-Chair Herron, agreed to investigate
the number of visits to the programs on the website.
MS. CULPEPPER pointed out that the initiatives were updated
every year.
3:41:00 PM
MR. HOGAN commented on the two issues DHSS was preparing for: an
increase for Medicare payment rates, and the number of returning
veterans with traumatic brain injury and post traumatic stress
disorder.
3:43:28 PM
REPRESENTATIVE HOLMES relayed a problem that National Guard
members upon return to inactive status, after being released
from active duty, were not being covered by the Veterans Health
Administration. She asked if DHSS was aware of this.
MR. HOGAN offered his belief that many individuals would be
eligible for services through the Alaska Native Tribal Health
Consortium.
3:45:08 PM
CO-CHAIR HERRON asked if traumatic brain injury was forecast as
a future problem.
MR. HOGAN agreed that DHSS recognized it was a problem and was
determining the best system of services. He offered his belief
that the problem was much more substantial than commonly
thought.
MS. CULPEPPER noted that sport injuries, including those from
motorized sport vehicles, also contributed to traumatic brain
injuries. She directed attention back to the index and the
"Alaska Scorecard" [Included in members' packets]. She observed
that the "Alaska Scorecard" reviewed the status of beneficiaries
and would be updated every year.
MS. CULPEPPER, responding to a question by Representative
Seaton, explained that the down arrows indicated "Needs
Improvement." She referred to the "Key to [the] Scorecard,"
which listed the inputs used for making the status
determination.
3:52:15 PM
MR. HOGAN explained that the "Alaska Scorecard" was a one page
snapshot by DHSS that indicated measurement of the progress in
each area. He suggested that this initial scorecard be used as
a baseline.
MS. CULPEPPER reminded the committee that the scorecard was a
comparison of Alaska to the rest of the nation, not solely for
the performance of an individual program. She directed
attention to the hyperlinks listed on the back page which she
said connected to a wealth of information.
3:55:26 PM
^Alaska Mental Health Trust-Bring the Kids Home
3:55:41 PM
CO-CHAIR HERRON announced that the next order of business would
be a Power Point presentation by the Alaska Mental Health Trust
Authority on the Bring the Kids Home initiative.
3:56:57 PM
JEFF JESSEE, Chief Executive Officer, Alaska Mental Health Trust
Authority (AMHTA), Department of Revenue (DOR) presented a Power
Point titled "Bringing (Keeping) the Kids Home Update- February
2009" [Included in the members' packets]. He lauded the
leadership of Brita Bishop and Bill Herman with this initiative.
3:59:46 PM
MR. JESSEE directed attention to slide 2, "Exponential Growth in
Use of Out-of State Residential Psychiatric Treatment Centers
(RPTC)," and pointed out the prior exponential growth for
placement of kids in out of state RPTCs. He explained that
previously there had not been a plan to increase the in-state
capacity for these kids. He gave an example of the lack of
oversight for fiscal responsibility that the program had
engendered. He credited former Commissioner Gilbertson for
initiating the change.
4:03:24 PM
MR. JESSEE furnished slide 3, "Progress: Decrease in RPTC
Admissions," which diagramed the recent changes for in and out
of state custody. He commented that this was a result of
investment in residential programs, individual and community
based services, and a systems redesign for children's mental
health. He offered his belief that the continuum of care should
have been started with an array of services at the family home.
He indicated, should that care have proved unsuccessful, that
the next stage of care should have been residential services
within the community. He allowed that a gradual build up of
this program would have meant that only a few kids each year
would have been sent out of state. He opined that the
legislature would not have funded the early intervention
strategies. He explained that home and community based services
were the most effective and cost efficient.
MR. JESSEE noted that early community intervention treatment
reflected a decrease in the recidivism rate, as shown on slide
4, "Progress: Length of Stay and Recidivism."
4:06:36 PM
MR. JESSEE referred to slide 5, "Progress: Medicaid Expenditures
for Residential Psychiatric Treatment Centers (RPTC)," which
showcased the shift in RPTC expenditures as in-state treatment
increased.
MR. JESSEE moved to slide 6, "Progress: Projected BTKH
Reinvestment," which reflected re-investment of dollars in more
appropriate levels of service within the community and within
the state. He noted that the strategy might not cost less, but
the reinvestment in Alaskan families and services would be
better for Alaska at all levels of the system.
MR. JESSEE noted slide 7, "Ahead in FY 2010: Support for On-
going Efforts," and said that more than 40 percent of youth in
RPTC are Alaska Native. He expressed the need to work with
tribal partners for better connectedness and cultural service.
CO-CHAIR HERRON asked about the representation from other ethnic
groups.
MR. JESSEE said there was a high correlation between RPTC
patients and low socio-economic conditions.
4:11:09 PM
MR. JESSEE described slide 8, "Ahead in FY2010: Expanding In-
State Capacity," and warned that transitional aged youth was an
area that needed improvement. He pointed out that the
development of an Alaska system of care resulted in a Medicaid
match savings for FY2010.
4:13:37 PM
KARIN SCHAFF, Adolescent Treatment Services Director, Volunteers
of America Alaska, spoke about two programs involved in the
initiative. She selected slide 9, "Volunteers of America Alaska
ARCH program," and explained that ARCH was a treatment center
for youth with substance use disorders and severe emotional
disturbances. She called attention to the new state of the art
treatment facility.
4:15:11 PM
MS. SCHAFF moved to slide 10, "Volunteers of America Alaska-
ARCH program," and shared that the new facility had more beds,
and a mental health service. She explained that the focus was
for family involvement and transition back into the community.
4:16:17 PM
MS. SCHAFF spoke about slide 11, "Assertive Continuing Care
(ACC)," and mentioned that ACC was a community based program and
one of the first pilot projects in the BTKH initiative. She
said that the ACC focused on sustaining the results from other
residential programs, so that the kids would be successful. She
explained that the kids coming from these other programs were
tired of counseling and counselors, so the ACC staff would go to
them and work on the kids' goals. She also spoke about the new
program with McLaughlin Youth Center.
4:18:40 PM
MS. SCHAFF, in response to Representative Coghill, explained
that the 58 percent program completion rate was measured once
the youth left McLaughlin Youth Center. She explained that the
ACC program started while the youth were in the youth center in
order to help develop a relationship.
4:19:51 PM
MS. SCHAFF, in response to Representative Seaton, explained that
the ACC program was an evidence based practice designed for
youth with severe emotional disturbances and substance use
disorders. She conveyed that it consisted of family counseling,
case management, and group and individual counseling all
designed around the youth, as opposed to putting them into a
program.
REPRESENTATIVE LYNN asked what programs the youth go to after
they leave McLaughlin Youth Center, and what was the recidivism
rate.
4:22:08 PM
MS. SCHAFF said that the youth center served kids up to 18 years
of age, and after that, some of them go back to school for their
GED. She explained that the 58 percent completion rate was for
kids who did not reoffend and did not return to the institution
for 6 months. She explained the transience of the kids, and
that it was difficult to find them after 6 months. She
mentioned that the residential program had had kids go off to
college and then return to work as program supervisors.
4:23:42 PM
REPRESENTATIVE HOLMES asked if all the kids came through
juvenile justice.
MS. SCHAFF responded that the youth in the ACC program came from
out of state residential treatment centers, in state residential
treatment centers, intensive treatment outpatient centers, and
McLaughlin Youth Center.
4:24:37 PM
REPRESENTATIVE COGHILL asked about the levels of care at the
psychiatric treatment centers.
MR. JESSEE noted that, previously, when kids were sent out of
state to the RPTC, they were put in in-patient intensive care.
He said that not all the kids needed this level of care, but at
that time there were no in-state options for lower levels of
care. He said that some of the kids could now come back to
lower levels of care, such as group or foster homes. He stated
that when intermediate care levels are provided, it can often
preclude in-patient services.
4:27:16 PM
REPRESENTATIVE COGHILL remarked that the state had set up some
treatment centers for different levels. He asked for a
description to each of the levels of care.
4:28:05 PM
MS. SCHAFF explained that the Residential Psychiatric Treatment
Centers were considered Level 5. She noted that ARCH was
considered Level 3. She shared that many youth who had failed
in the Level 5 RPT centers were successful in Level 3 because of
their needs. She reported that the community based programs
were Level 1 and Level 2.
REPRESENTATIVE COGHILL opined that things were better than
previously. He inquired if the non-profits would often seek
placement into the highest level.
4:29:59 PM
MR. JESSEE agreed that this was a problem. He described a
private Fairbanks facility, and noted its request for a
Certificate of Need for the entire 120 bed facility to be at
Level 5. He said that an examination had determined that
regional bed needs were only necessary for 44 beds. He offered
his opinion that the Certificate of Need process was essential.
He confirmed that the private Fairbanks facility had received a
Level 5 Certificate of Need for 44 beds, but that the remainder
of its beds could be offered as Level 3 and Level 4. He noted
that the facility was currently only filling twenty-something
beds.
4:32:23 PM
REPRESENTATIVE COGHILL observed that he had concerns with both
the non-profit and for profit organizations' assignment of care,
and asked if management always gravitated to assignment for the
highest level of care.
4:33:11 PM
MR. JESSEE explained that a lot of the residential beds which
the state used were in group homes. He mentioned that these
Level 3 group homes were similar to family homes, and that these
facilities could be sold as family homes should the state's
needs diminish. He clarified that this allowed service for an
appropriate level, as there was not a need to fill unused beds.
He opined that the state rewarded the institutional providers at
the expense of the community based provider. He acknowledged a
current bill in the legislature which would allow hospitals and
nursing homes an automatic rate review and adjustment, whereas
community based providers would not be allowed this automatic
rate adjustment. He opined that this was bad public policy.
4:35:53 PM
MR. JESSEE quickly reviewed slide 12, "Mat Su Demonstration
Project," and slide 13, "Mat Su Demonstration Results." He
mentioned that care coordination, the better use of current
services, was important in maintaining youth stability within
the community. He remarked that the Mat Su project was working
with 26 families, and its success had been to transition the
kids home 87 days earlier than originally planned.
4:36:47 PM
KAREEM NOEL, Youth Navigator, Alaska Youth and Family Network
(AYFN), spoke about his background in foster homes and
residential treatment centers. He explained that his current
role as a youth navigator for the Alaska Youth and Family
Network had allowed him to see that his life had value. He
acknowledged that the support of family, friends, and AYFN had
allowed him to be successful and a positive contributor to his
community. He asked the committee to continue to fund "Bring
The Kids Home," and to increase the funding for community based
groups, such as AYFN. He emphasized that these programs allowed
youth and families to be successful and to rebuild their lives
and relationships.
4:40:01 PM
CARLA NICHOLAI, Youth Navigator, Alaska Youth and Family Network
(AYFN), spoke about her background which included abuse by her
biological family, foster care, and diagnosis of co-occurring
disorders. She declared that AYFN and other community based
services had made her success possible. She proudly detailed
her current role as a Youth Navigator, an Alaskan Native student
at University of Alaska Anchorage (UAA), and a cherished member
of her adopted family. She affirmed her dream of looking
forward to helping others. She opined that community based
services would help Alaska youth, and noted that it "was not a
hand out, but a hand up." She appealed to the committee to
continue support for community based services because her
experience showed that this brought success to Alaskan youth.
4:44:47 PM
CO-CHAIR HERRON asked each of them to relate a story or event
that made them realize how glad they were to be navigators.
MS. NICHOLAI offered her appreciation for everyone's support
here in Juneau.
MR. NOEL declared that his work with AYFN would help another kid
become a better person.
4:47:20 PM
REPRESENTATIVE HOLMES asked each how long they had been
navigators and how many navigators were there.
MS. NICHOLAI shared that she had started being a navigator a few
months ago.
MR. NOEL reported that he had been a navigator for a month.
MS. NICHOLAI said that there were two navigators in the Mat Su,
and that there were three navigators with a youth coordinator,
in Anchorage. She offered her belief that there was a parent
navigator in Fairbanks.
4:50:49 PM
REPRESENTATIVE SEATON asked how many youth they each worked
with.
MR. NOEL explained that he worked with multiple youth, and that
the group met each week.
MS. NICHOLAI reported that she worked with multiple youth and
that each week she met with a class that dealt with prevention
of the stigma for mental health diagnosis. She allowed that
this class was a safe place for the participants to talk. She
disclosed that her life goal was to help others deal with the
same issues she had.
REPRESENTATIVE SEATON asked about the variability of group size
each week.
MR. NOEL said that sometimes he would have 2-3 people, sometimes
5, and occasionally there were 10 kids.
MS. NICHOLAI reported the same variability, though usually there
were 5-6 kids each week.
MR. NOEL said that the regular attendance was increasing.
4:54:24 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:54 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Comp Plan HSS presentation.doc |
HHSS 2/12/2009 3:00:00 PM |
|
| MF-Scorecard.ppt |
HHSS 2/12/2009 3:00:00 PM |
|
| REVISED2 BB BTKH Leg Presentation Thur.ppt |
HHSS 2/12/2009 3:00:00 PM |