Legislature(2017 - 2018)CAPITOL 106
10/26/2017 02:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Division of Behavioral Health, Opioid Treatment in Alaska | |
| 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
October 26, 2017
2:05 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Chair
Representative Bryce Edgmon, Vice Chair
Representative Sam Kito
Representative Geran Tarr
Representative Jennifer Johnston (via teleconference)
Representative Colleen Sullivan-Leonard
Representative Dan Saddler (alternate)
MEMBERS ABSENT
Representative David Eastman
Representative Matt Claman (alternate)
OTHER LEGISLATORS PRESENT
Representative Harriet Drummond
Representative Paul Seaton
Representative George Rauscher
COMMITTEE CALENDAR
PRESENTATION: DIVISION OF BEHAVIORAL HEALTH~ OPIOID TREATMENT IN
ALASKA
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
RANDALL BURNS, Director
Central Office
Division of Behavioral Health (DBH)
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint which focused on
opioid treatment in Alaska.
JAY BUTLER, MD, Chief Medical Officer/DPH Director
Central Office
Division of Public Health (DPH)
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the presentation
on opioid treatment.
GENNIFER MOREAU-JOHNSON, Behavioral Health Policy Advisor
Office of the Commissioner
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation on opioid
treatment.
CATHLEEN MCLAUGHLIN, Director
Partners Reentry Center
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "Justice
Reinvestment Funds, An Agency's Perspective."
LAURA BROOKS, Health Care Administrator
Division of Health & Rehabilitation Services (DHRS)
Department of Corrections (DOC)
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint via teleconference.
APRIL WILKERSON, Director
Juneau/Anchorage
Division of Administrative Services (DAS)
Department of Corrections (DOC)
Juneau, Alaska
POSITION STATEMENT: Testified during the presentation.
ACTION NARRATIVE
2:05:16 PM
CHAIR IVY SPOHNHOLZ called the House Health and Social Services
Standing Committee meeting to order at 2:05 p.m.
Representatives Spohnholz, Sullivan-Leonard, Edgmon, Tarr, and
Johnston (via teleconference) were present at the call to order.
Representatives Kito and Saddler (alternate) arrived as the
meeting was in progress.
^PRESENTATION: DIVISION OF BEHAVIORAL HEALTH, OPIOID TREATMENT
IN ALASKA
PRESENTATION: DIVISION OF BEHAVIORAL HEALTH, OPIOID TREATMENT IN
ALASKA
2:05:50 PM
CHAIR SPOHNHOLZ announced that the first order of business would
be a presentation by the Division of Behavioral Health regarding
the opioid epidemic and interactions with the Justice
Reinvestment programs.
2:07:50 PM
RANDALL BURNS, Director, Central Office, Division of Behavioral
Health, Department of Health and Social Services, shared a
PowerPoint (via teleconference) regarding the Prescription Drug
and Opioid Addiction Treatment Programs. He directed attention
to the "Substance Use Residential Treatment Program" [Included
in members' packets], stating that the right hand column, titled
"Level of Care," was based on the American Society of Addiction
Medicine criteria. He added that there was also a fact sheet
with very good background from the American Association for the
Treatment of Opioid Dependence on Medication Assisted Treatment
[Included in members' packets]. He directed attention to slide
2, "Medicaid Assisted Treatment," and spoke about the federal
grants received in the past few years, as they focused on
medication assisted treatment. He reported that SAMHSA
(Substance Abuse and Mental Health Services Administration, in
the United States Department of Health and Human Services)
targeted three priority areas to combat opioid abuse on which to
focus: the opioid prescribing practices to reduce opioid use
disorders and overdose; the expanded use and distribution of
naloxone (Narcan) to help in emergencies; and the expansion of
Medication-assisted treatment (MAT) to reduce opioid use
disorders and overdose. He reported that Alaska was focusing on
the expansion of MAT with most of its funding, adding that
Department of Health and Social Services had applied for a grant
in May 2016 which proposed to target Anchorage and Juneau,
communities with a high prevalence of individuals with opioid
use disorders, for expanded access to MAT. In September 2016,
the department was awarded $1 million for each of three years.
2:12:15 PM
MR. BURNS moved on to slide 3, "Medicaid Assisted Treatment
(con't)" and shared that in January 2017, the funding was
distributed to two grantees, the Narcotic Drug Treatment Center
in Anchorage, and the Rainforest Recovery Center in Juneau. He
added that these centers had committed to an increase in the
caseload of 250 patients over the next 2.5 years.
REPRESENTATIVE SULLIVAN-LEONARD asked about the determination
for choosing Anchorage and Juneau.
MR. BURNS replied that the decision was specifically based on
data about the prevalence of opioid abuse, and that these two
communities were the most impacted.
2:15:05 PM
MR. BURNS discussed the next grant received, slide 4, "Opioid
State Targeted Response (STR)," and explained that the focus of
this funding was to increase provider capacity in Alaska around
the MAT, and to increase the number of clients receiving
appropriate treatment, while decreasing the negative impact of
opioid use. He reported that this STR grant awarded two years,
$2 million each year, of funding to Alaska. He shared that a
four-pronged approach was being utilized to achieve the goals:
fund three agencies in high-needs communities; increase the
number of physicians, physician's assistants (PAs), and nurse
practitioners (NPs) by facilitating access to education and case
consultation; engage Alaska's reentry coalitions to facilitate
access to MAT; and purchase and distribute drug disposal bags
and naloxone in remote areas of the state.
2:17:25 PM
MR. BURNS pointed to slide 5, "Opioid State Targeted Response
(STR)," and noted the areas targeted for funding, which would
begin in October 2017: the Fairbanks Native Association in
Fairbanks for $400,000; the Interior Aids Association in
Fairbanks for $400,000; and the Cook Inlet Council on Alcoholism
and Drug Abuse in Kenai for $350,000. He noted that an
additional award for $350,000 was set aside for administration
by the Office of Substance Misuse and Addiction Prevention
(OSMAP). He said there was an additional search for a group to
target youth and young adults experiencing opioid disorders.
2:19:58 PM
MR. BURNS shared slide 6, "Prescription Drug Opioid Overdose-
Related Deaths" and said there was a collaboration between the
Division of Behavioral Health and the Office of Substance Misuse
and Addiction Prevention for implementation of Project HOPE and
the distribution of Narcan kits statewide.
2:21:25 PM
MR. BURNS spoke about slide 7, "The Strategic Partnership for
Success (PFS)," which was the final grant received by the state
and was a very comprehensive approach to opioid addiction in the
state. The goal of this initiative was to reduce and prevent
the non-medical use of prescription opioids and heroin among 18
- 25-year old's by focusing on three areas of prescription
opioids: the social availability, the retail availability, and
the perceptions of harm for risk. He reported that prevention
and early intervention coalitions in Sitka, Juneau, Kenai,
Anchorage, Matanuska-Susitna, and Fairbanks were awarded more
than $1.5 million for each of the next five years. He stated
that the initiative required these coalitions to implement
evidence based informed, local, environmental strategies which
could be sustained within the local system as well as implement
a media campaign.
2:24:14 PM
REPRESENTATIVE TARR expressed her desire to understand the
current state resources and how these were being used, to better
understand "where the gaps are." She asked for verification
that each slide presented a different set of federal grants.
She asked whether the dates mentioned referred to the federal
fiscal year.
MR. BURNS acknowledged that three federal grants had been
referenced, all based on federal fiscal years, which
specifically focused on opioid addiction and targeted
communities to help with this crisis.
REPRESENTATIVE TARR asked about the relative impact of these
dollars.
MR. BURNS expressed his agreement that it was too soon to tell.
2:28:01 PM
REPRESENTATIVE KITO directed attention to slide 5 and asked if
the individual grantees were required to provide services
outside of their communities.
MR. BURNS explained that the primary focus was on the local
community and residents, and these were not residential
treatment programs.
REPRESENTATIVE KITO offered his belief that these three grants
covered many Alaskans. He stated that he did not want to see
these programs focused only on urban centers, and that outreach
and support needed to be extended to smaller communities. He
asked if the upcoming youth grant would be required to be a
statewide program.
MR. BURNS clarified that initially all the grants were
competitively awarded, and that only three communities had
responded to the four grants available. He stated that the
solicitations were not limited.
REPRESENTATIVE KITO stated that he wanted to ensure that the
state provided coverage beyond the few urban centers, even if
this necessitated a re-write of the grant solicitations. He
expressed his concern that there would be a self-selection
process for the grants to be awarded to communities with large
populations, which would leave the smaller communities to fend
for themselves during this opioid epidemic. He suggested that
providers in the larger communities should also do outreach and
provide services beyond the community.
2:33:03 PM
REPRESENTATIVE SADDLER asked about the hub and spoke model
referenced on slide 4.
MR. BURNS explained that this was not the same as the common
regional hub and surrounding communities, but was, instead, a
reference to a Vermont model in which the hub was the office
based opioid treatment provider and counseling, and the spokes
were the office-based treatment and case management with local
services.
REPRESENTATIVE SADDLER asked if there was any correlation
between unemployment levels and addiction rates.
MR. BURNS replied that he did not have any information for this,
although it was believed that two key tenets of recovery were
housing and employment.
REPRESENTATIVE SADDLER asked about the use of vivitrol as a
medication.
MR. BURNS replied that this was used by the Department of
Corrections to individuals with a history of addiction to
heroin, and that there was a study planned for its
effectiveness. He said there was nothing that prevented an
individual from opting for vivitrol as opposed to suboxone.
2:37:18 PM
REPRESENTATIVE EDGMON asked how these grants were tying into the
6-year framework for Senate Bill 91, and if there were any
matching fund relationships with state funding. He noted that
criminal justice reform was largely based on evidenced based
practices and measurable outcomes. He asked if the various
agencies were working together and were these results
measurable. He asked what could be done to reduce recidivism in
crime.
CHAIR SPOHNHOLZ reiterated that the purpose of this meeting was
for "rolling through the work that's being done by the
Department of Health and Social Services, particularly to
address the issue of addiction and addiction treatment in the
State of Alaska." She noted that there would also be discussion
for the reinvestments into re-entry programs and treatment
programs.
2:40:21 PM
REPRESENTATIVE KITO referenced slide 12 and asked about "the
universe of need for residential treatment beds in Alaska and
then what is the plan to try and get to that bed count or is
that even known."
CHAIR SPOHNHOLZ pointed out that slide 12 had not yet been
presented.
2:41:18 PM
CHAIR SPOHNHOLZ referenced slide 2 and asked if any partners had
been identified in Matanuska-Susitna.
MR. BURNS reiterated that with the Medicaid assisted treatment
program, Anchorage and Juneau had been targeted as these
communities having the highest prevalence of need.
CHAIR SPOHNHOLZ expressed her surprise that Matanuska-Susitna
did not rise to the top for need. She asked if there had been
any skewing of the numbers with people coming to Anchorage from
Matanuska-Susitna for treatment services.
MR. BURNS reported that although this was a possibility, during
application for the State Targeted Response (STR) grant,
Matanuska-Susitna had not applied. He mused that it depended
not only on the interest but the capacity of the community to
provide service.
2:44:00 PM
REPRESENTATIVE TARR asked for an explanation to the medication
assisted treatment and the order for usage of each drug.
MR. BURNS directed attention to the handout titled "AATOD Fact
Sheet" [Included in members' packets] which explained the value
and the differences between Methadone, Vivitrol, and Suboxone.
He stated that all three provided treatment. He explained that
daily Methadone treatment was highly recommended for addiction
to heroin and those subsequent changes to the brain, which
required long term maintenance to "get themselves back on
track." He said that it was taken each day to maintain sobriety
and work on addiction. He explained that Vivitrol was
administered as a shot, once a month. He reported that Suboxone
was another alternative, dependent on the patient need and what
works best. He declared that they all worked well for an
individual to get off addiction.
2:50:39 PM
REPRESENTATIVE TARR asked if the reference to detox was for the
early phase and then MAT was referenced after this initial
recovery period.
MR. BURNS explained that the terminology was changing under the
American Society of Addiction Medicine (ASAM), and that detox
was now called "withdrawal management" and only applied for
alcohol abuse. He offered his belief that individuals with
addictions to heroin and opioids never really de-toxed, but
instead were treated and managed for stabilization and
withdrawal.
CHAIR SPOHNHOLZ offered her belief that alcohol withdrawal was
the only process that could kill you.
2:54:11 PM
REPRESENTATIVE TARR asked if Mr. Burns was describing sudden
opioid withdrawal.
MR. BURNS replied that it was best to treat the addiction and
help them to stabilize by eliminating the highs and lows.
2:55:32 PM
JAY BUTLER, MD, Chief Medical Officer/ DPH Director, Central
Office, Division of Public Health, Department of Health and
Social Services, in response to Representative Tarr, stated that
the agonist Methadone and the partial agonist, Suboxone, had a
role in the withdrawal management process; whereas, the complete
antagonist, Vivitrol, was used after the end of the withdrawal
phase as the drug could induce withdrawal. He stated that
alcohol withdrawal was more dangerous for mortality, but that
withdrawal from opioids could combine with other compromising
health conditions for a fatal outcome. He said that there were
different methods of medication delivery, including sprays,
shots, implants, and a film strip placed under the tongue. He
said that more than 100 providers in Alaska had prescribed
Vivitrol at one time or another and it had been used in
treatment for alcohol dependency.
2:59:05 PM
CHAIR SPOHNHOLZ asked for clarification that Vivitrol could not
be used if there was any opioid in the system. She asked if
this was also contraindicated for use with methadone or
suboxone.
DR. BUTLER said that if there was any agonist in the system, it
was necessary for a very careful transition, hence it was fairly
uncommon.
3:00:34 PM
GENNIFER MOREAU-JOHNSON, Behavioral Health Policy Advisor,
Office of the Commissioner, Department of Health and Social
Services, introduced slide 8, "Recidivism Reduction," and said
that this funding was intended to break the cycle of repeat
offenders. She said that the Division of Behavioral Health
received $1 million in FY17, and $2 million in FY18, and that
the division was able to leverage a strong grants and contracts
infrastructure to coordinate targeted programming support.
MS. MOREAU-JOHNSON addressed slide 9, "Funds are being used
for," and reported that the funds were being used for direct
service outcomes through the Partners Reentry Center in
Anchorage, and through existing community reentry programs and
coalitions in Anchorage, Fairbanks, Matanuska-Susitna, and
Juneau to offer case management for housing placement,
transitional support, linkage to treatment, employment
assistance, Medicaid enrollment, transportation, and emergency
assistance vouchers. She added that there was funding for rural
reentry coalitions in Nome, Ketchikan, Dillingham, and Kenai
which focused on provider capacity and community planning.
MS. MOREAU-JOHNSON directed attention to slide 10, "Funds are
being used for," and reported that recidivism reduction funding
was co-funding a two-year study with the University of Alaska
Anchorage to assess the Department of Corrections Vivitrol
intervention program. She stated that recidivism reduction
funding was funding technology platforms for therapeutic courts
and reentry programs to utilize a case management module. She
added that there was also funding through treatment recovery
grants, which were leveraged with criminal justice-specific
supports and linkages to treatment providers.
3:03:01 PM
MR. BURNS stated that $400,000 in recidivism reduction funding
was being used to support housing programs for individuals
coming out of prison.
3:03:45 PM
REPRESENTATIVE SADDLER referenced the technology platforms on
slide 10 and pointed out that Senate Bill 91 did recommend
expanded use of diversions, drug courts, and therapeutic courts.
He asked if the broad band would support the existing platforms.
MS. MOREAU-JOHNSON replied that the funding was for what was
currently in place.
CHAIR SPOHNHOLZ asked if these technology platform improvements
would allow for a seamless coordination of services.
MS. MOREAU-JOHNSON stated, "yes, that is the vision for this."
In response to Chair Spohnholz, she stated that there was still
work to be done to ensure compliance with regulations for
criminal justice and Health Insurance Portability and
Accountability Act information systems.
3:05:20 PM
REPRESENTATIVE SADDLER asked if there would be a request for
additional funding to expand to accommodate more diversion
programs, drug courts, and tele-behavioral medicine.
MS. MOREAU-JOHNSON replied, "yes."
3:05:46 PM
REPRESENTATIVE EDGMON asked if there was any information to tie
in the rising crime rates with the rising use of drugs.
MR. BURNS offered his belief that "the answer to that is no, not
at this time." He acknowledged that there was a lot of
unfortunate belief that there was a correlation, though he was
not aware of any studies which had been undertaken. He opined
that information about individuals incarcerated for substance
abuse would offer an insight into the problem.
REPRESENTATIVE EDGMON replied that this was counter to what he
was hearing and seeing. He stated that it was apparent that
more tools were necessary in the tool box to combat the
increasing statewide crime. He offered his belief that there
was a correlation between the increase in drug use and the
increase in crime.
MR. BURNS reported that the University of Alaska Justice Center
had a research arm which would be well positioned for a study.
CHAIR SPOHNHOLZ asked for clarification that this had not yet
been studied, and not that there was or was not a correlation or
causation.
MR. BURNS acknowledged that there had not yet been a study to
establish any correlation.
3:09:55 PM
REPRESENTATIVE KITO offered his belief that there were studies
outside Alaska which related to an increase in unemployment to
an increase in crime. He stated that even without studies, it
was valid to have concerns.
3:10:36 PM
REPRESENTATIVE SULLIVAN-LEONARD stated that her discussions with
public safety officials indicated a direct correlation.
CHAIR SPOHNHOLZ clarified that Mr. Burns had stated there had
not been studies.
3:11:53 PM
MR. BURNS moved on to slide 11, "Alcohol Safety Action Program,"
and reported that the Adult Substance Abuse Program (ASAP) had
received a modest amount of funding, specifically to train ASAP
staff on the use of screening tools. These tools included use
of local referral and services.
CHAIR SPOHNHOLZ asked for a more detailed description for the
function of this program.
MR. BURNS explained that the Alcohol Safety Action Program was
created for individuals with misdemeanors, primarily a
misdemeanor DUI (driving under the influence), as an option to
being placed in jail and would include regular monitoring, urine
analysis, appointments, and drug screening. He noted that there
was now risk assessment for suggestions to the levels of
treatment.
CHAIR SPOHNHOLZ asked if this included the 24/7 program.
MR. BURNS replied, "it does."
CHAIR SPOHNHOLZ asked if this program was currently on line.
MR. BURNS explained that it had been the subject of a protracted
contractual issue and was currently only being provided to those
already in the program.
3:16:48 PM
REPRESENTATIVE SULLIVAN-LEONARD asked about the Alaska Justice
Information Centers report on the effectiveness of the adult
criminal justice program and the benefits of investment on
recidivism.
MR. BURNS replied that he had not seen the study.
REPRESENTATIVE SULLIVAN-LEONARD asked about the success rate of
ASAP.
MR. BURNS replied that did not have exact numbers and opined
that the program had been "pretty successful with the
individuals who stay in the program." He allowed that some
individuals did choose to leave the program, although they were
then required to "deal with the judge and the consequences of
that decision." He offered his belief that those who stayed in
the program and were monitored had been very successful.
3:19:31 PM
MR. BURNS directed attention to slide 12, "Increased Substance
Use Disorder Treatment Services," and spoke about the $31
million funding which the legislature had added for behavioral
health services, which had ultimately been reduced to $6 million
for substance use disorder services over three years. He added
that the Central Peninsula Hospital Withdrawal Management
program had been funded for six beds, with a plan for expansion
to ten beds. He reported on funding for the Tanana Chiefs
Conference Sobering Center day program, which had expanded to a
12-bed capacity.
3:22:09 PM
REPRESENTATIVE KITO directed attention to slide 12 and asked if
there was any information or a plan to identify the universal
need in Alaska for in-patient treatment beds.
MR. BURNS said that there had not been a total statewide needs
assessment. He stated that a large part of this issue should be
driven by regionally identified needs. He reported that a
significant component of the $6 million funding was that the
communities share a needs assessment indicating the value of
this service. He expressed his agreement that each region
determine which service was best for that region. He reported
that the federal grants each had a significant evaluation
component, which the department would collect and evaluate.
REPRESENTATIVE KITO asked to clarify that there was not any
information to identify the number of beds needed in the state.
He offered a comment that it was difficult for policy makers to
make decisions without statewide data and that a regional
approach could result in overwhelming use from other regions
that had not adequately identified needs.
MR. BURNS reported that statewide there were 311 residential
treatment beds. He said that these were tracked for capacity
and wait lists. He acknowledged that the reporting was somewhat
erratic, and that it was necessary to account for beds being
held open for someone transitioning.
3:27:46 PM
REPRESENTATIVE SADDLER pointed to the challenge that the costs
were the same to maintain a stand-by equipped and staffed
facility. He spoke in support of a regional approach because of
the flexibility and efficient utility for demand. He asked if
there was any national data to determine treatment beds per
population, which could be modified to the unique situations in
Alaska.
MR. BURNS said that he was not aware of any data, and he pointed
to the difficulties posed by Alaska's geography and small
communities for using national data.
REPRESENTATIVE SADDLER reported on the treatment facility
currently under construction within his district, in Eklutna.
3:29:59 PM
REPRESENTATIVE TARR declared that she wanted to get a sense for
how much money spent so far had been from grants. She listed
the various grants and asked if there would be equal spending
over the next five years. She mused that there was $6-8 million
coming in the next few years.
MR. BURNS offered to provide a chart of what had been extended
to date and what remained to be spent for each grant.
REPRESENTATIVE TARR opined that this would allow a more
strategic approach by the legislature in its spending
distribution. She asked if the Kenai detox program included
beds available for anyone experiencing alcohol or opioids
addiction or in treatment.
MR. BURNS replied that it was an alcohol withdrawal management
treatment center. He reported that there were 17 residential
treatment programs in Alaska with 311 beds. He stated that none
of these programs treated for anything other than alcohol
withdrawal. He pointed out that opioid medication assisted
treatment did not require residential treatment, as it included
any necessary medication and counseling.
3:35:29 PM
DR. BUTLER spoke about the Office of Substance Abuse and
Addiction Prevention within the Department of Health and Social
Services. He declared that this was a wise move to
institutionalize some of the functions for coordination,
communication, and community engagement. He pointed out that
there was assistance from other agencies. He explained that the
focus was for both primary prevention and prevention of bad
outcomes. He mentioned that this would address both the supply
and demand side for drivers to substance misuse and addiction.
He spoke about Adverse Childhood Experiences (ACEs), and
unemployment, noting that "a healthy economy makes healthy
Alaskans." He brought attention to slide 7, "The Strategic
Partnership for Success," which explained prevention activity.
3:39:43 PM
REPRESENTATIVE EDGMON asked about the impact if Senate Bill 91
was repealed.
MR. BURNS opined that should the programs and services lose the
recidivism reduction funding, those communities with organized
services for those individuals leaving prison would be affected.
He noted that programs with federal or legislative funding would
be less affected.
3:41:34 PM
REPRESENTATIVE SADDLER offered his belief that Senate Bill 91
anticipated future savings because of a reduction to
incarceration and asked whether the programs would still have
the necessary resources even should Senate Bill 91 be repealed.
DR. BUTLER explained that the work through the Office of
Substance Abuse and Addiction Prevention was primarily driven
with federal grant monies and would most likely continue. He
pointed out that treatment programs within prisons would be
affected and admitted that he was unsure what other actions
would be a result from the repeal of Senate Bill 91.
3:44:04 PM
CATHLEEN MCLAUGHLIN, Director, Partners Reentry Center, stated
that the facility was an open, walk-in center, which was
available to everyone. She introduced a short video.
3:47:19 PM
MS. MCLAUGHLIN directed attention to the PowerPoint, titled
"Justice Reinvestment Funds, An Agency's Perspective." She
addressed slide 2, "Goals," and stated that the agency always
had monthly statistics with real-time data entry available. She
reported that the Center had been around for four years, and
that it had enhanced its programs in the last year with justice
reinvestment funds. She stated that the goal was to reduce
recidivism and to enhance public safety, which she deemed went
"hand in hand." She added that it was very important for the
center to provide timely "reentrant-centric" services. She
shared a story of a recently released inmate. She emphasized
that the Center would never let anyone be homeless the night
they were released from incarceration.
MS. MCLAUGHLIN moved on to Slide 3, "Here is the reality,"
reporting that 95 percent of all offenders will be released.
She offered her belief that Senate Bill 91 changed the timing of
this release, not the type of people that were being released.
3:51:16 PM
MS. MCLAUGHLIN shared slide 4, "The CliffsNotes Version,"
explaining that the Partners Reentry Center viewed life on the
street level. She reported that criminal justice reform was a
"heavy lift" and they were still learning at the street level.
She declared that there were three things vital to criminal
justice reform: collaboration, cooperation, and continuums of
care. She said that as there was a lot of competitiveness for
funding, people did not share as they should. She explained
that collaboration should allow for an immediate referral for
someone. She pointed out that they blended their funds from
various sources to allow for housing for longer periods. She
said that continuum of care was especially important for people
with medically assisted treatment. She declared that the
transfer of responsibility for each individual had to be done
seamlessly.
3:54:57 PM
MS. MCLAUGHLIN shared slide 6, "The Center." She stated that
people needed to be able to come and go freely without feeling
as if they were being watched. She reported that between 60 and
100 individuals came daily, and that people were greeted within
a minute, no one was waitlisted, and services were provided that
day.
MS. MCLAUGHLIN moved on to slide 7, "Partners Reentry Center -"
and explained that the cheapest and easiest thing to offer was
to give reentrants purpose and hope. She declared that there
were plenty of beds available in Anchorage and that the Center
also provided supportive services, such as bus passes, and help
with identification and driver licenses. She emphasized that
the Center did timely referrals to services. She said the
Center was open for groups to come and sign up reentrants for
Medicaid and food stamps.
3:58:49 PM
MS. MCLAUGHLIN explained slide 8, "Partners Reentry Center Has
Received $250,000 in Justice Reinvestment Funds for 2018." She
noted that the allocation was primarily for direct services, as
the Center believed that the quicker someone could receive
community-based services, the higher the likelihood they would
not recidivate. She reported that the money went to housing,
another case manager, a full-time data person, and additional
bus passes, transportation, clothing vouchers, and bikes.
MS. MCLAUGHLIN shared slide 10, "Statistics," and reported that
since August 2013 there had been 5,110 unique individuals
served, with 109 new clients in September. She explained MRT
(Moral Reconation Therapy) which sought to decrease recidivism
by increasing moral reasoning. She stated that the goal was to
turn a "Son of Sam" into a "Mother Theresa."
MS. MCLAUGHLIN stated that the average number of reentrants
using the services was between 329-369. She addressed slide 11,
"Being Meaningfully Engaged in Community Reduces Recidivism,"
which listed the components of the drive to reduce recidivism,
and included: pre-release planning, housing, employment and
training, behavioral modification, and social support. She
explained some of the difficulties of adjustment for reentrants.
4:04:51 PM
MS. MCLAUGHLIN directed attention to slide 12, "Partners' Opioid
and Alcohol Pilot Project," and shared a story of a heroin
overdose and the initiation of a vivitrol program. She stated
that medically assisted treatments were often necessary and
should be treated as a tool. She pointed out that vivitrol did
not have any street value and was administered as a shot. She
added that if a person left incarceration clean, then vivitrol
would help him/her stay clean.
4:07:35 PM
MS. MCLAUGHLIN referenced slide 13, "Partners' Opioid Pilot
Project Outcomes," which reported on the 254 individuals who
were offered this voluntary option to date. She noted that of
the 142 individuals who had accepted the Vivitrol program for
one month or more, 64 percent had remained in the community,
while 36 percent had recidivated. She pointed out that although
vivitrol helped with alcohol or opioids, the effect of vivitrol
was diverted if the individual was still a user. She reported
that alcohol was one of the highly abused substances for Alaska
Native reentrants. Of the 112 individuals who had declined the
Vivitrol program, 80 percent had recidivated, 16 percent had
remained in the community, and 4 percent had died of a heroin
overdose.
4:10:27 PM
MS. MCLAUGHLIN shared that the offer of direct service in a
timely fashion, community-based reentry, was a great benefit for
community safety and for the reentrants. She declared that it
was necessary to be honest about the homeless population, as
they would break in for food or shelter. She noted that
unemployment was also a problem, as there was not a purpose, and
more time to do bad things. She pointed to the difficulty for
avoiding these actions in many parts of the state. She offered
her belief that crime should not be tied to Senate Bill 91, and
that instead, there should be a review of these drivers.
4:13:55 PM
REPRESENTATIVE SULLIVAN-LEONARD asked how soon there was
interaction with the housing facilities for inmates in order to
think about release.
MS. MCLAUGHLIN shared that the model that worked best was a
regular schedule as it allowed for them to get to know
individuals. She added that there would be a regular telephone
conference with the individual and the institution as release
was upcoming. She stated that the goal was to develop
relationships sooner rather than later.
REPRESENTATIVE SULLIVAN-LEONARD asked about funding and budgets.
MS. MCLAUGHLIN replied that initially, four years prior, the
Center had been funded with a $600,000 grant divided among three
non-profits. After one year, one group left, and the contract
had been reduced to $550,000, which had been the operating
budget for the past two years. She reported that currently
there was a $550,000 contract with Department of Health and
Social Services, which was enhanced with $250,000 from Justice
Reinvestment funds. She summarized that the commitment from the
Department of Behavioral Health was now $800,000 with an
additional $150,000 for homeless assistance for housing, and a
federal SNAP grant which was projected to add another $11,000
each month.
REPRESENTATIVE SULLIVAN-LEONARD asked about work with unions or
organizations that provided training.
MS. MCLAUGHLIN replied that there were almost 700 employers who
would hire. She said that apprenticeships could be "a little
tricky," as the Center encouraged self-sufficiency as quickly as
possible. For this reason, they did not encourage schooling
until the reentrants could better understand budgets. She
declared that they did look at all activities and opportunities
to give purpose to individuals.
4:20:44 PM
REPRESENTATIVE SADDLER asked if Senate Bill 91 was heard by the
House Health and Social Services Standing Committee (HHSS).
CHAIR SPOHNHOLZ said that it had not been heard by HHSS.
REPRESENTATIVE SADDLER asked if Partners was the only official
State of Alaska reentry program, and he shared his background
knowledge of transitioning out of the military. He asked about
any reentry programs through the Department of Corrections.
MS. MCLAUGHLIN explained that there were several reentry model
programs, and that Partners worked with the reentry coordinator
at Department of Corrections. She added that there were reentry
coalitions in some hub areas, as well as reentry programs
through Cook Inlet Tribal Council and Alaska Native Justice
Center. She reported that the only reentry programs funded
through the Justice Reinvestment were the Partners Reentry
Center and the coalitions. In response to further questions
from Representative Saddler, she stated that there was not any
religious aspect to Partners, and that about 70 percent of the
clients had substance abuse issues and that 70 percent had
mental health issues.
4:23:17 PM
REPRESENTATIVE EDGMON asked about the impact to these reentry
programs if Senate Bill 91 was repealed.
MS. MCLAUGHLIN relayed that from a programmatic point of view,
the programs had made headway for community-based reentry. She
declared that the month to month credit in Senate Bill 91 was
good incentive to behave and do the right thing. She
acknowledged that there were some weaknesses in Senate Bill 91
and that the community-based programs needed to be able to take
immediate control. She stated that it was necessary to "play
small ball" as there were not going to be a "bunch of home runs
right now." She declared that it was necessary to take the
benefits offered by Senate Bill 91 and focus on the gaps, and
not to ignore that headway had been made. She pointed out that
Partners had been in existence prior to Senate Bill 91, and that
the program would, hopefully, continue, although, she opined,
there would be less interest in reentry programs if Senate Bill
91 were repealed.
REPRESENTATIVE EDGMON suggested that the reentry program efforts
would be less successful, and the momentum would be lost.
4:27:15 PM
MS. MCLAUGHLIN, in response to Representative Tarr, reported
that for individuals with more than 15 years of incarceration,
their release was different as they were more motivated, more
structured, and more disciplined and their release was more of a
social acclimation. She added that these individuals had
probably committed violent crimes. She stated that these
individuals were very easy to work with, as they wanted to prove
themselves, and they had a lot more to lose if they violated
parole. She noted that the program had its least success with
the "high flying misdemeanants," as they had not done enough
time to understand the consequences of their actions. She said
there were ways to improve this, now that recidivism rates had
been identified for this population. She emphasized that these
reentry types were totally different. In response to a further
question from Representative Tarr, she explained that Partners
used its funding for direct bed day rates with individual
contracts for housing, and that they had 16 transitional sites
in Anchorage. She said they did not use vouchers. She added
that support for a permanent placement of housing required that
the individual had "purposeful activity."
4:31:09 PM
REPRESENTATIVE KITO reported that Juneau also had a reentry
coalition, which was a regional service. He asked how to manage
individuals who were not residents of the local area and wanted
to return to their home community yet needed to have a parole
relationship.
MS. MCLAUGHLIN explained the Partners' Going Home Program, which
had been created for Alaska Natives and was based on the
restorative justice model. She said that involvement for
reentry to their home community included asking permission from
the tribal leaders and putting a safety net around them, before
sending them home. She added that Partners did pay for housing
and flights if they were allowed to return home. She pointed
out that the village, or the region, became a part of the
healing process. She said that the safety net included
accountability to the community. She declared that a key was
for someone to follow the individual, and that successful
reentry required case management and connection to services,
which could be creative. She said that she did not know the
intention of the Juneau coalition.
REPRESENTATIVE KITO asked if this program was something that
could engage with other reentry coalitions and organizations.
MS. MCLAUGHLIN said that their contract mandated for technical
assistance with the other areas of the state which desired parts
of the program that would work in those communities. She
offered her belief that every community should create its own
reentry program, and this should not be a cookie cutter model.
She pointed out that Partners was unique because "we didn't have
a road map, we figured it out as we went."
4:34:29 PM
CHAIR SPOHNHOLZ directed attention to an earlier remark in the
presentation about referrals, and asked which referrals were not
being picked up in a timely manner.
MS. MCLAUGHLIN explained that these were for mental health
treatment, substance abuse treatment, anger management
treatment, and sex offender treatment. She stated that the
challenge for timely referral acceptance was the need for an
immediate consultation with a medical person, and not placement
on a wait list.
CHAIR SPOHNHOLZ relayed that the legislature was struggling with
what would be the next steps. She wanted to ensure that the
necessary services were put in place. She asked about the
shortages of services.
MS. MCLAUGHLIN explained that the service gaps were timely
referral because of bureaucratic challenges. She pointed out
the difficulty of asking someone for whom English was a second
language to fill out a 15-page application for a prescription
refill. She opined that collaborating agencies should have
their funding tied to being collaborative with other agencies.
4:37:45 PM
REPRESENTATIVE SADDLER pointed out that as Senate Bill 91 was
not before the committee, it was not necessarily fair to ask her
to opine about its repeal or change.
4:40:23 PM
LAURA BROOKS, Health Care Administrator, Division of Health &
Rehabilitation Services, Department of Corrections, stated that
the presentation would focus on the substance abuse programs.
She estimated that between 70 - 80 percent of the criminal
justice population had serious substance use disorders. She
directed attention to slide 2, "Institutional Substance Abuse
Treatment Programs," which identified the target areas related
to Senate Bill 91, which included: increase availability of
substance abuse services and assessments; expand services
available to female offenders; expand services available to
pretrial offenders; develop medical assist treatment re-entry
(MATR) and implement overdose intervention response programs;
and improve referral process for offenders upon reentry.
4:43:48 PM
MS. BROOKS pointed to slide 3, "Institutional Substance Abuse
Treatment Programs," and stated that this outlined the programs
provided by the division. She spoke about each of the programs:
the RSAT (residential substance abuse treatment) program, the
IOPSAT (intensive outpatient substance abuse treatment) program,
the Dual Diagnosis program which was also an IOPSAT 19-week
program, and the PsychEd, a six week program typically found at
the pre-trial facilities with a transient population and a focus
on education about substance use and addictive behaviors, and
the harmful consequences of high risk, high use behaviors.
4:47:45 PM
MS. BROOKS addressed slide 4, "Institutional Substance Abuse
Treatment Programs," and reported that offenders received a
substance abuse assessment, so the true substance abuse issues
and levels of treatment could be determined. She spoke about
the new MATR (Medicaid assisted treatment upon reentry) vivitrol
program. She reported that individuals were referred to this
program and went through a screening to ensure they were healthy
enough with no contraindications for vivitrol.
4:50:46 PM
MS. BROOKS moved on to slide 5, "Institutional Substance Abuse
Treatment Programs," which included the MATR Vivitrol and
methadone treatment. She noted that vivitrol was only one
choice in a true medication assisted treatment program. She
reported that the program wanted to ensure there was "a healthy,
safe bridge" for those people already on methadone and releasing
very soon. She shared that they were working with the community
methadone clinics so that it was not necessary to detox everyone
on methadone. She listed the additional program planning for FY
18, which included: Full expansion of vivitrol in all the
facilities and detox treatment beds which allowed for women to
withdraw under medical observation. She spoke about development
of a WRAP (Wellness Recovery Action Plan) program, which was a
peer-based intervention program to help individuals design a
relapse prevention plan and have peer support for crisis. She
added that a SBIRT (screening, brief intervention, referral to
Treatment) program, an evidence based brief intervention program
which identified, treated and referred people with substance
abuse, was also being worked on.
4:57:30 PM
MS. BROOKS shared slide 6, "Community Residential Center (CRC)
Substance Abuse Treatment Programs," and spoke about the Senate
Bill 91 funding for substance abuse treatments in the community
residential centers. She noted that there was intensive out-
patient programming in three of the CRCs. She added that there
was still work toward the intensive outpatient programing in
Juneau and Bethel.
4:58:27 PM
REPRESENTATIVE KITO addressed the high pre-trial population in
correctional facilities and the release of people prior to the
completion of treatment. He asked if there were any plans to
work on a transition program for those individuals in initial
treatment to carry that out in the pre-trial release.
MS. BROOKS said the department was working on the case
management system, so these individuals could go to a treatment
program in the community which would match the curriculum in the
facility. She acknowledged that during treatment was the best
time for re-connection.
REPRESENTATIVE KITO asked if the Department of Corrections had
adequate resources to provide treatment for those wanting
treatment or were there still some unmet needs.
MS. BROOKS explained that the department was reviewing how well
it would be able to fill the programs currently being planned.
She said that as not everyone wanted treatment, it was not clear
what was the needed capacity. She shared anecdotally that there
had not been enough treatment programs; however, she expressed
her hope that with the funding from Senate Bill 91 and the
current plans for expanded services, [the department] would be
able to better meet that need.
5:02:12 PM
REPRESENTATIVE SADDLER asked if the Department of Corrections
had become the default substance abuse treatment program for the
state. He asked for a comparison of the relative expenditure
and capacity for substance abuse treatment between Department of
Corrections and Department of Health and Social Services.
MS. BROOKS reported that Department of Corrections was the
largest substance abuse treatment provider, as well as the
largest mental health provider. She pointed out that they were,
in some ways, the default provider, as they had a "captive
audience," and they were attempting to take advantage of this
opportunity. She stated that it was difficult because there was
not ready access to treatment both before and after
incarceration.
REPRESENTATIVE SADDLER asked about the funding sources for
treatment, and whether there was a cost-benefit analysis for the
use of medication assisted withdrawal recovery.
MS. BROOKS replied that the funding source for substance abuse
treatment programs were almost entirely from the Department of
Corrections budget. She added that there was a relatively small
federal grant, although there was not any funding for substance
abuse from the Alaska Mental Health Trust or other resources.
5:04:34 PM
APRIL WILKERSON, Director, Juneau/Anchorage, Division of
Administrative Services, Department of Corrections, reported
that about $70,000 was received from Department of Health and
Social Services through the alcohol tax fund, which supported
the residential substance abuse program. She relayed that the
remainder was general funds.
MS. BROOKS, in response to Representative Saddler, explained
that the primary cost to the Vivitrol program was for staff
resources, as the Vivitrol injections were free samples from the
pharmaceutical companies. She relayed that the department
wanted to ensure that these injections were beneficial for a
reduction in clinical relapse back to opioids and a reduction in
recidivism. She shared that the department was in partnership
with University of Alaska Anchorage (UAA) to do a study of the
vivitrol program with a focus on recidivism and relapse data.
She added that the cost of each injection was between $700-
$1,000.
CHAIR SPOHNHOLZ reported that Department of Corrections had only
used 72 doses of the 1200 doses donated. She acknowledged the
importance for the two-year study to evaluate the efficacy of
the program, considering the steep cost for the vivitrol.
5:07:33 PM
REPRESENTATIVE TARR asked about the barriers to employment upon
release. She asked about consideration for the policy that
allowed individuals upon release to use a homeless shelter as
their home, as the shelters did not typically have the capacity
for case management.
MS. BROOKS expressed her agreement that the homeless shelter was
not an ideal placement. She stated that there was the need for
a more robust case management system for substance abusers. She
acknowledged that case management in the shelters was very
limited, and this created a barrier for the department follow-
up.
5:09:38 PM
REPRESENTATIVE EDGMON opined that although Senate Bill 91 had
not come before the House Health and Social Services Standing
Committee, the discussion was germane to the work of the
committee and asked what would happen to the Department of
Corrections if Senate Bill 91 were repealed.
MS. BROOKS replied that the Department of Corrections had
received $1 million to expand substance abuse treatment programs
while in custody, and another $1 million to implement programs
within the CRCs. She stated that she was not aware of any
alternative funding sources that would allow continuation for
expansion or continuation of the programming in the halfway
houses.
MS. WILKERSON reported that there were many elements in Senate
Bill 91, and that rolling this back in full would create
challenges for maintaining the efforts toward recidivism
reduction and provision of the services and programs included in
the bill.
REPRESENTATIVE EDGMON declared that this was the opportunity for
fundamental reform in criminal justice and that this momentum
for reducing crime and expenses would be lost if Senate Bill 91
were repealed.
5:14:07 PM
CHAIR SPOHNHOLZ declared that she was impressed with the scope
of treatment offered and that even without dramatic improvement
in recidivism rates, this was a step in the right direction.
She asked about the two to three assessments per week referenced
on slide 4.
MS. BROOKS explained that each assessment would take hours to
interview and write a report. She stated that this would be
expanded to include more assessments, if necessary.
CHAIR SPOHNHOLZ asked if there was opportunity to expand if
necessary.
MS. BROOKS said there was the opportunity if there were enough
providers, noting that there was difficulty in some locations
with finding substance abuse programs having enough staff to
provide services in the facilities.
CHAIR SPOHNHOLZ acknowledged the need for more workers even when
the funding was available. She asked about the difficulty for
finding individuals who wanted treatment upon exit from prison.
MS. BROOKS stated that it was very difficult finding treatment
beds for even those motivated people who were ready for
treatment. She added that some criminal background could make
it even more difficult. She reported that on average, it would
take several weeks to get an individual into a treatment bed.
CHAIR SPOHNHOLZ asked if a more proactive exit plan would help.
MS. BROOKS reported that the residential treatment beds in
communities were full, although there was greater success with
outpatient treatment.
5:19:22 PM
REPRESENTATIVE SADDLER suggested that the department expect
questions regarding the efficiency and efficacy, as well as a
robust cost-analysis, of the program. He asked if she would
still have an opinion for the repeal of Senate Bill 91 if the
money was still made available.
MS. BROOKS replied that she was reluctant to offer any analysis.
She said that some of these programs were already in place, but
expansion for the programs was difficult without money. She
pointed out that Medicaid did not pay for substance abuse
treatment for individuals in custody.
CHAIR SPOHNHOLZ stated that this was "a very important fact."
5:21:37 PM
REPRESENTATIVE EDGMON said that he was not aware of the pre-
trial aspects, given the importance of Senate Bill 91 to the
Department of Corrections.
MS. BROOKS said that she could only speak about her division,
although Representative Edgmon was correct for the impact of
Senate Bill 91 to the entire department.
CHAIR SPOHNHOLZ reported that the Commissioner of Department of
Corrections had been unable to attend.
5:22:48 PM
REPRESENTATIVE TARR offered her belief that there had not been
enough anticipation for the time necessary for programs to be
funded and up and running. She asked about the timing to allow
for provider capacity and for the services to be available.
MS. BROOKS explained that the RFP (Request for Proposal) process
was "not always a quick one." She said that it was necessary to
develop RFPs for various communities, and, in some cases, it was
necessary to repeat the process as there were not responses.
She added that as some agencies did not feel they were able to
bring in a program, it was necessary to move the program. She
reported on a contract that DOC had in place with anticipation
for expansion, and, instead, the contractor ended the contract.
She pointed out that it was necessary to start over in some
cases, while maintaining the "bare bones essential treatments
going in a handful of our facilities."
REPRESENTATIVE TARR asked to which substances did lack of
treatment capacity refer.
MS. BROOKS opined that this was a unilateral issue.
CHAIR SPOHNHOLZ summarized the issues discussed.
5:31:21 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:31 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 102617 AATOD-MAT-Fact-Sheet.pdf |
HHSS 10/26/2017 2:00:00 PM |
Justice Reinvestment Programs |
| 102617 Final DBH HHSS 10.17 Opioids and Reentry.pdf |
HHSS 10/26/2017 2:00:00 PM |
Justice Reinvestment Programs |
| 102617 American_Society_of_Addiction_Medicine_Level_of_Care.pdf |
HHSS 10/26/2017 2:00:00 PM |
Justice Reinvestment Programs |
| 102617 Final SUD Residential and Outpatient 10.17.pdf |
HHSS 10/26/2017 2:00:00 PM |
Justice Reinvestment Programs |
| 102617 PRC September Stats 2017.pdf |
HHSS 10/26/2017 2:00:00 PM |
Justice Reinvestment Programs |
| 102617 PRC Justice Reinvestment Funds an Agency's Perspective.pdf |
HHSS 10/26/2017 2:00:00 PM |
Justice Reinvestment Program |
| 102617 DOC Substance Abuse SB91.pdf |
HHSS 10/26/2017 2:00:00 PM |