Legislature(2017 - 2018)CAPITOL 106
03/15/2018 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Healthy Start & Strong Families | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
JOINT MEETING
HOUSE EDUCATION STANDING COMMITTEE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 15, 2018
3:03 p.m.
MEMBERS PRESENT
HOUSE EDUCATION STANDING COMMITTEE
Representative Harriet Drummond, Chair
Representative Justin Parish, Vice Chair
Representative Tiffany Zulkosky
Representative Ivy Spohnholz
Representative Jennifer Johnston
Representative Chuck Kopp
Representative Geran Tarr (alternate)
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Representative Ivy Spohnholz, Chair
Representative Tiffany Zulkosky, Vice Chair
Representative Geran Tarr
Representative David Eastman
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
MEMBERS ABSENT
HOUSE EDUCATION STANDING COMMITTEE
Representative David Talerico
Representative Lora Reinbold (alternate)
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Representative Sam Kito
Representative Matt Claman (alternate)
Representative Dan Saddler (alternate)
COMMITTEE CALENDAR
PRESENTATION: HEALTHY START & STRONG FAMILIES
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
MONICA WINDOM, Director
Division for Public Assistance
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Provided a presentation on Healthy Start
and Strong Families.
BARBARA HALE, Manager
Children's Health Insurance Program (CHIP)
Division of Healthcare Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Provided a presentation on Providing health
coverage to Alaskans in need.
REBEKAH MORISSE, Section Chief
Women's, Children's & Family Health
Division of Public Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented on Public Health -Early Childhood
Health Programs.
TIM STRUNA, Section Chief
Public Health Nursing
Division of Public Health
Juneau, Alaska
POSITION STATEMENT: Presented on Public Health Nurses.
DUANE MAYES, Director
Division of Senior and Disability Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Introduced the presentation on Senior and
Disability Services.
MAUREEN HARWOOD, Chief of Developmental Programs
Senior and Disabilities Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented on Senior & Disabilities
Services.
BRITA BISHOP, Quality Assurance Section Administrator
Division of Behavioral Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented on Partners Promoting Healthy
Communities.
CHRISTY LAWTON, Director
Office of Children Services (OCS)
Juneau, Alaska
POSITION STATEMENT: Presented on Strengthening Families.
ACTION NARRATIVE
3:03:06 PM
CHAIR IVY SPOHNHOLZ called the joint meeting of the House Health
and Social Services Standing Committee and House Education
Standing Committee to order at 3:03 p.m. Representatives Parish,
Sullivan-Leonard, Zulkosky, Tarr, Johnston, Drummond, and
Spohnholz were present at the call to order. Representatives
Kopp and Eastman arrived as the meeting was in progress.
CHAIR SPOHNHOLZ reviewed the presentations the committee has
recently had and how the state departments and programs serve
children ages 0-7 and their families.
3:04:50 PM
^Presentation: Healthy Start & Strong Families
Presentation: Healthy Start & Strong Families
CHAIR SPOHNHOLZ announced that the only order of business would
be a presentation on Healthy Start and Strong Families.
3:05:48 PM
MONICA WINDOM, Director, Division for Public Assistance,
Department of Health and Social Services (DHSS), provided a
presentation on Healthy Start and Strong Families. She said
many of the programs work across state departments and with
federal agencies.
3:08:42 PM
MS. WINDOM addressed slide 4, "AECC Alaska Early Childhood
Coordinating Council." She indicated all programs were needs-
based. She explained how the Division of Public Assistance fits
under the umbrella of the AECCC.
3:11:31 PM
MS. WINDOM spoke to slide 5, "Healthy Start and Strong
Families," which read as follows [original punctuation
provided]:
• Denali KidCare
• Supplemental Nutrition Assistance Program (SNAP)
• Women, Infants and Children Program (WIC)
o Farmer's Market Nutrition Program (FMNP)
o Breastfeeding Peer Counseling Program (BFPC)
• Child Care Assistance Program (CCAP)
• Alaska Temporary Assistance Program (ATAP)
• Heating Assistance
MS. WINDOM said Denali KidCare covers about 56,000
children. She said the household income limit is 203
percent of federal poverty level for children without
insurance and 177 percent of poverty level for those with
insurance. She informed that the SNAP program serves
31,000 children under the age of eight.
REPRESENTATIVE JOHNSTON asked how the breakdown with Denali
KidCare relates to Indian Health Service.
MS. WINDOM answered the participants receive Medicaid and the
department receives a 100 percent federal match.
REPRESENTATIVE JOHNSTON asked to receive the breakdown.
MS. WINDOM added the average benefit in Alaska is $180 per
person. The WIC program serves 17,000 women, infants, and
children. The eligibility level is 185 percent of the federal
poverty level, and the program serves women who are pregnant,
breastfeeding, postpartum, and children up to age five. She
stated the WIC program fosters parent success.
REPRESENTATIVE PARISH asked how many Alaska children would
likely have died without the program.
MS. WINDOM answered she would attempt to get that figure.
CHAIR SPOHNHOLZ asked Ms. Windom to recap the percent of poverty
level for Denali KidCare eligibility.
MS. WINDOM answered that for those without insurance, the level
is 203 percent of the federal poverty level, and for those with
insurances the level is 177 percent.
REPRESENTATIVE SULLIVAN-LEONARD asked for the average income
level of the families at the poverty level.
MS. WINDOM answered 100 percent of the federal poverty level is
is about $1,600 a month, or $19,200 annual income.
3:16:53 PM
REPRESENTATIVE TARR mentioned the federal poverty level and
suggested if the state could return the income levels to 200
percent [of the federal poverty level], the program would help a
lot more kids.
REPRESENTATIVE SULLIVAN-LEONARD commented on Denali KidCare and
the Affordable Care Act (ACA). She said she would rather see
the private sector be successful.
CHAIR SPOHNHOLZ clarified that most people who use Denali
KidCare work in places that don't provide health insurance.
REPRESENTATIVE SULLIVAN-LEONARD clarified she was remarking on
the connection with the ACA.
3:19:39 PM
MS. WINDOM described the farmers market nutrition program (FMNP)
and the Breastfeeding Peer Counseling Program which makes 781
contacts per month to aid breastfeeding mothers.
MS. WINDOM said the Child Care Assistance Program in 2017 served
an average 3,500 children and 2,000 families per month. She
listed the eligibility criteria for the program. She said the
Alaska Temporary Assistance Program (ATAP) serves 6,500 children
under the age of 8. She said the amount of the benefit is based
on income and shelter expenses. The average benefit is $263 per
person.
REPRESENTATIVE JOHNSTON asked for the figures in writing.
MS. WINDOM added that in order to qualify for ATAP, the parent
has to cooperate with child support. She said the parent is
required to be self-sufficient. She addressed heating
assistance. She said around 3,100 children benefit from heating
assistance. She said the income limit is 150 percent of the
federal poverty level. She shared her personal experience with
the programs.
3:25:46 PM
MS. WINDOM moved to slide 6, "Data and other Collaborations,
which read as follows [original punctuation provided]:
• Free school lunch program
• Family Nutrition Program
• Child Care Assistance Program
o Office of Children's Services
o Alaska Child Care and Development Fund
(CCDF) Tribal Grantees
• thread
o Alaska Early Care and Learning Data Dashboard
Project
o Temporary link: bit.ly/alaskadashboard
3:28:54 PM
MS. WINDOM addressed slide 7, "Presenting the Alaska Early Care
and Learning Data Dashboard," showing a "sneak peek" of the
website for the dashboard. The website presents statewide early
learning data.
3:29:34 PM
REPRESENTATIVE ZULKOSKY asked for the number of Alaska children
who use SNAP.
MS. WINDOM answered 31,304 children under 8 use the program.
REPRESENTATIVE PARISH asked about the use of the FMNP in
Southeast Alaska.
MS. WINDOM said she would get the information.
REPRESENTATIVE JOHNSTON asked whether the division works with
the Child in Transition program in the Anchorage, Alaska, school
district.
MS. WINDOM answered, "Not that I know of."
3:30:27 PM
BARBARA HALE, Manager, Children's Health Insurance Program
(CHIP), Division of Healthcare Services, Department of Health
and Social Services (DHSS), provided a presentation on
Providing health coverage to Alaskans in need." She said CHIP,
known in Alaska as Denali KidCare, had been implemented in March
1999.
MS. HALE spoke to slide 9, "Early Periodic Screening Diagnostic
& Treatment," which read as follows [original punctuation
provided]:
For children and adolescents
• Covered by Medicaid & CHIP
• EPSDT program covers all medically necessary
services regardless of whether they are in the
State Plan:
Medical
Hearing
Developmental screening
Vision
Immunizations
Dental
Behavioral health and substance misuse
Translation
Transportation
MS. HALE read from a prepared statement, which reads as follows,
[original punctuation provided]:
• Medicaid and Denali KidCare offer comprehensive
health insurance coverage for children and teens,
ages 0 up to the age of 21 in Alaska under what
is known as the Early Periodic Screening
Diagnostic and Treatment (EPSDT) service
provision, which falls under Title XIX of the Act
or regular Medicaid
• The EPSDT service provision under Section 1905(a)
of the Act provides for coverage of all medically
necessary Medicaid services to correct or
ameliorate a child's physical or mental
condition, regardless of whether such services
are covered under a State's Medicaid State Plan,
which is often a surprising revelation.
• The bulleted list in the slide outlines some of
the services covered under EPSDT and you'll see
that the services are very comprehensive and also
cover enabling services to ensure access such as
transportation and translation, for example. In
addition, EPSDT has a requirement to inform
families with children about EPSDT services and
the regular intervals that well child visits
should occur.
• DHSS has adopted by reference in the AAC the
AAP/BF recommended periodicity schedule. To
reference the 0-8 early childhood age group,
you'll note, when you have a chance to review the
handout provided, that there are a minimum of 18
preventive health care visits recommended in the
first 8 years of life to cover history,
measurements, sensory screenings (vision and
hearing), developmental/behavioral health,
physical examination, procedures including lab
tests, oral health and anticipatory guidance. For
a link to the CMS EPSDT webpage to read more
detailed information please see the handout. On
this webpage, a link to the EPSDT Guide for
States can be found. The EPSDT handout also
provides a link to the AAP/BF periodicity
schedule.
• Annual reporting requirements on EPSDT to CMS on
child screening and participation rates are
required for all children enrolled in Medicaid by
age and delivery system. The report, known as the
EPSDT 416, is due each April and covers the prior
FFY.
• EPSDT also requires Medicaid agencies at 42 CFR
to partner with their Public Health, Maternal
Child Health agency, in AK known as WCFH Title
V, to ensure child and adolescent access to
Medicaid services and delivery of quality health
care including children with special health care
needs, which are the highest cost children to
serve in Medicaid.
MS. HALE added that EPSDT has a requirement to inform families
of the availability of services. She referenced a handout
listing Early Periodic Screening Diagnostic & Treatment Services
[included in committee packet].
3:35:40 PM
MS. HALE advanced to slide 10, "Leverage, Report, Strategize,"
which read as follows [original punctuation provided]:
• Partnerships to streamline efforts
o Public Health, Women's Children & Family Health
o Pediatric Children's Quality Measures
o Chance to leverage funds
o Enhanced rates
o For all children
• Medicaid/CHIP child participation rates
o Measuring in spirit of SB74
MS. HALE continued to read from her prepared statement, as
follows [original punctuation provided]:
• As a segue to the last slide, the CHIP, under
Title XXI of the Act also includes annual
reporting requirements on children's health care
quality, utilizing standardized measures for
children funded under both Medicaid and CHIP,
including a CAHPS patient experience of care
survey. CHIP has also incentivized children's
quality improvement. AK, OR and WV participated
in a $15 million children's quality improvement
demonstration between 2010 2015 where the focus
of our work was on children's quality measures,
improving models of care via (PCMH), which are
important to ensure continuity of care for
children, while incorporating the use of HIT. The
3 states partnered closely with our MCH agencies
to leverage resources and population health
expertise on C&YSHCNs and health provider models
of care and systems.
• There are opportunities available under the CHIP
for health services initiative proposals, which
are approved by CMS and provide enhanced funding
up to a capped limit for not only children
enrolled in ME/DKC, but also the population,
which is the focus of work in WCFH. Medicaid &
Denali KidCare are partnering to develop a
proposal for Department leadership with our WCFH
and other PH section counterparts to strengthen
the work that is priority to their PH sections,
while leveraging CHIP health services initiative
funding to improve the quality of the CQM data
reported by Medicaid/CHIP, and could assist in
the SB 74 Quality and Cost measurement work that
includes a number of the CMS standardized
measures for evaluation of the Medicaid program.
These standardized measures could also be used in
some of the SB 74 demonstration work to serve as
basis for comparison at the state, provider and
national levels. An example of one of the
commonly reported child measures by states is
Access to Primary Care and is provided in the
handouts. You will see the data reported for 2014
as compared to other states.
• Under the CHIPRA 2009, AK DHSS was awarded $18.5
million in performance bonuses for
simplifying/streamlining enrollment and
eligibility from 2009 2013, which enjoins the
partnership that the Medicaid and CHIPs have with
the DPA, which is the gatekeeper for children's
and adult enrollment in AK. Accordingly, the DHSS
monitors the data reported through the US Census
Bureau surveys through the ACS and CPS on
uninsurance and corresponding participation
rates. The data show that from 2013 2015, AK
had a child PR of 87.6% as compared to the
national average of 93.1%, so there is room for
improvement in providing access and working
collaboratively with the DPA.
• To fold this presentation back into the data
presented by Pat Sidmore yesterday, Medicaid has
added questions in our annual patient experience
of care survey to parents about whether Medicaid
enrolled providers are proactively asking parents
ACE questions related to abuse, neglect and
family dysfunction in addition to questions from
the NSCH on positive health/thriving/resilience
to assess parental response on whether their
children and adolescents are flourishing. Lastly,
as Trevor Storrs mentioned in his presentation
yesterday, many Alaskan families are living at or
below the FPG level. AK's upper income limit for
children enrolled in ME & DKC is 203%. Under the
CHIP, a targeted low-income child is defined as
living in a family earning < or equal to 200%
FPG, meaning that this income level represents
what it takes to cover the basic necessities of
food, clothing and shelter. It is important to be
mindful that AK's upper income limit for children
enrolled in Medicaid and Denali KidCare, as a
percentage of the FPG, was ranked as the 9th
lowest in the nation to qualify for children's
health insurance and this is important to
remember as health insurance is very difficult to
afford at these income levels. Often child only
coverage in the HIM or individual market is too
expensive and dependent coverage, if a parent is
fortunate to have ESI, is also not affordable
according to the research.
MS. HALE pointed to the handout on 2014 data for access to
primary care, "AK Medicaid/CHIP Child Quality Measure
Compared to Other States: Percentage Visiting a Primary
Care Provider, by Age 2014*" [included in committee
packet].
th
MS. HALE added that Alaska ranks 9 lowest in the nation to
qualify for health insurance.
3:40:57 PM
REPRESENTATIVE PARISH asked for confirmation that the percentage
of the federal poverty guideline in Alaska is 9th lowest in the
nation.
MS. HALE answered in the affirmative.
REPRESENTATIVE PARISH asked whether, if the cost of living were
accounted for, the state would be worst in the nation.
MS. HALE answered it would not, as Alaska and Hawaii have
different income standards due to cost of living.
CHAIR SPOHNHOLZ noted that the families of children who qualify
for Denali KidCare are the working poor. She shared her
personal experience with the program.
REPRESENTATIVE PARISH asked whether the legislature could reduce
the state percentage to second or third lowest in the nation and
what the fiscal impact would be.
MS. HALE answered the states have the responsibility of setting
Medicaid and children's health insurance program income
guidelines. She said that the department would have to do a
fiscal analysis in order to set a different income level.
3:44:28 PM
REBEKAH MORISSE, Section Chief, Women's, Children's & Family
Health, Division of Public Health, Department of Health and
Social Services (DHSS), presented on Public Health - Early
Childhood Health Programs.
MS. MORISSE spoke to slide 11, "Public Health - Early Childhood
Health Programs," which read as follows [original punctuation
provided]:
• Women's, Children's & Family Health (WCFH)
Programs for pregnant women and their children
• Public Health Nursing
A local presence throughout Alaska; protects and
improves the health of young Alaskans
• Chronic Disease Prevention and Health Promotion
Programs to help Alaskans live longer healthier
lives, like the Quitline
• Epidemiology
Keeps young Alaskans safe from communicable
diseases, injuries and other health hazards
MS. MORISSE progressed to slide 12, "Division of Public Health,
which read as follows [original punctuation provided]:
• Obesity Prevention
• Maternal, Infant & Early Childhood Home Visiting
• Parents as Teachers
• Early Childhood Comprehensive Systems (ECCS)
• Newborn Screening
• Immunizations
• Lead screenings
• Safe Sleep
• Targeted outreach to high-risk families
MS. MORISSE continued to slide 13, "Alaska Obesity
Prevention and Control Program," which read as follows
[original punctuation provided]:
Works with early care and education programs to help
Alaska's young children grow up to be a healthy weight
and be ready to learn
• Training and resources for Early Care & Education
(ECE) providers
• Obesity Prevention-ECE Work Group -
DPH, Obesity Prevention and Control Program
Child Care Program Office (CCPO)
Child and Adult Care Food Program (CACFP)
Women, Infants, and Children (WIC)
Head Start
Thread
Municipality of Anchorage
UAA/UAF
3:48:04 PM
REPRESENTATIVE SULLIVAN-LEONARD asked about the trend in
childhood obesity.
MS. MORISSE answered that she thinks there is a combination of
factors and the programs aim to educate providers and early
childhood educators about healthy choices.
REPRESENTATIVE JOHNSTON spoke to Indian Health Services (IHS)
and mentioned a large grant for obesity. She asked whether the
group is included in the partnership.
MS. MORISSE answered she would find out. She said there is a
lot of collaboration with Tribal Health.
REPRESENTATIVE TARR asked whether the population of children
receiving assistance through the programs is the same that is
overweight.
3:51:53 PM
MS. MORISSE answered she would find out.
CHAIR SPOHNHOLZ mentioned the nutrition programs. She spoke to
the free and reduced lunch program. She related that she did
not let her daughter eat the free lunch as they contained
reconstituted, frozen, or fried foods. There has been some
research that shows there is an overlap between poverty and
obesity due to "misinformed execution of federal nutrition
guidelines."
MS. MORISSE addressed slide 14, "Maternal, Infant & Early
Childhood Home Visiting," which read as follows [original
punctuation provided]:
• Federally-funded, voluntary program
o Provides comprehensive services to at-risk
families
o Strengthens and improves maternal and newborn
health outcomes
• Uses evidence-based practices:
o the Nurse-Family Partnership model (RNs)
o Proven return on investment: $1 saves up to $5.70
MS. MORISSE added that research on the effects of the
program noted increases in family education, employment
levels, and savings in governmental costs. She listed
eligibility requirements. She said AECCC serves as the
advisory body for the program.
3:57:10 PM
REPRESENTATIVE EASTMAN asked what goes into the calculation of
the $5.70 savings and who the savings benefit.
MS. MORISSE answered the saving is related to governmental cost.
She said she would follow up with more information on the study.
REPRESENTATIVE TARR shared her understanding that funding for
the program that has been reduced.
MS. MORISSE answered the federal funding has just been approved
for another five years. In the past, there was some state
funding for home visiting but not for this program.
REPRESENTATIVE TARR asked how many families could be served if
there were no limitations to the program.
MS. MORISSE remarked there is a relatively small amount of
federal funding due to the small state population.
REPRESENTATIVE SULLIVAN-LEONARD commented on the work done by
public health nurses and thanked them for their work in the
communities.
REPRESENTATIVE PARISH seconded Representative Sullivan-Leonard's
remarks and asked whether there is other funding the state can
pursue.
MS. MORISSE answered she did not anticipate other federal funds,
given the recent 5-year approval. She informed the division
was constantly looking for more opportunities to expand their
ability to serve the target population.
4:02:52 PM
REPRESENTATIVE JOHNSTON asked about any other partnerships such
as non-profit organizations that are not part of the federal
program.
MS. MORISSE answered there is a tribal health nurse-family
partnership serving the tribal health beneficiaries. She said
the state program and the tribal health organization have a
memorandum of understanding with each other and coordinate
referrals. She underlined they serve two different populations.
REPRESENTATIVE JOHNSTON said she wanted to highlight it is not
the only program in the state.
MS. MORISSE listed other home visiting programs such as Cook
Inlet Tribal Council's Parents as Teachers which are "in the
works."
4:05:30 PM
REPRESENTATIVE DRUMMOND asked how many children are served
through "Parents as Teachers.
MS. MORISSE said she would find the numbers and report to the
committee.
MS. MORISSE addressed slide 15, "Parents as Teachers," which
read as follows [original punctuation provided]:
• Family education & parent support home visiting
program to:
o Increase parent knowledge of early childhood
development and improve parenting
o Detect developmental problems early on in
development
o Prevent child abuse and neglect
o Increase school readiness
• Collaboration with DEED
o Currently funds 4 federally funded grantees
o Serves Anchorage, Juneau, Hoonah, Haines,
Kodiak, Kake, and others
MS. MORISSE advanced to slide 16, "Early Childhood Comprehensive
Systems (ECCS), which read as follows [original punctuation
provided]:
• ECCS goals are to:
o Enhance
o Improve outcomes in children's developmental
health and family well-being
• Focus is to increase evidence-based developmental
screening
• Communities Kodiak, Mat-Su, and Nome
• Partnership with Help Me Grow Alaska
• Federally funded
4:09:55 PM
MS. MORISSE advances to slide 17, "Screening Services," which
read as follows [original punctuation provided]:
• Newborn screening (required by State statute;
funded by federal grants and fees)
o Bloodspot Screening
for conditions that can cause serious health
complications or death if not identified and
treated early
o Hearing Screening
by one month of age; diagnosis by 3 months;
early intervention services by 6 months
• Pediatric Specialty Clinics
o Autism/Neurodevelopmental screening and
diagnosis
o Metabolic Clinic for metabolic genetic
disorders
o Services not available elsewhere
o Funding: federal and mental health general
funds
MS. MORISSE advanced to slide 18, "Maternal and child health
data collection and analysis," which read as follows [original
punctuation provided]:
• Pregnancy Risk Assessment Monitoring System
(PRAMS) & Childhood Understanding Behaviors
Survey (CUBS)
• Alaska Birth Defects Registry (ABDR)
• Maternal Child Death Review
• Alaska Surveillance of Child Abuse and Neglect
(SCAN)
o Focus on data over many years gives clearer
picture:
1 in 3 children born in Alaska reported to OCS
before age 8 years
4:14:39 PM
TIM STRUNA, Section Chief, Public Health Nursing, Division of
Public Health, Juneau, Alaska, presented on public health
nurses. He spoke to itinerant public health nurses who target
high risk families and children. He said that cuts to the
section had reduced the workforce by 20 percent. He shared an
example of a referral that had been shared by one of the nurses.
He underlined that the nurses are making high-risk encounters
across the state. He spoke to self-regulatory skills and
protective factors. He said nurses ensure that families get the
resources they need for those protective factors. He added the
group is committee to community interventions to look at and
address local issues. He said they work to bring data sources
into communities. He spoke to bring awareness of adverse
childhood experience.
4:19:11 PM
CHAIR SPOHNHOLZ asked about the term "expansion" on slide 21.
MR. STRUNA answered it should be a contraction, not an
expansion.
CHAIR SPOHNHOLZ commented that public health resources have been
significantly reduced in recent years.
MR. STRUNA said the efforts have seen some progress. He said
there was also progress in raising awareness about substance
misuse.
4:24:35 PM
DUANE MAYES, Director, Division of Senior and Disability
Services, Department of Health and Social Services (DHSS),
introduced the presentation on Senior and Disability Services.
4:26:05 PM
MAUREEN HARWOOD, Chief of Developmental Programs, Senior and
Disabilities Services, Department of Health and Social Services
(DHSS), presented on Senior & Disabilities Services. She
explained the infant learning program moved from children
services to senior and disabilities.
MS. HARWOOD spoke to slide 24, "IDEA, Part C Overview," which
read as follows [original punctuation provided]:
Congress established this program in 1986 in
recognition of "an urgent and substantial need" to:
• enhance the development of infants and toddlers
with disabilities;
• reduce educational costs by minimizing the need
for special education through early intervention;
• minimize the likelihood of institutionalization,
and maximize independent living; and,
• enhance the capacity of families to meet their
child's needs.
MS. HARWOOD explained that Part C of the law relates to
infants and toddlers. She added that in Alaska the program
had always been within the Department of Health and Social
Services (DHSS).
4:29:02 PM
MS. HARWOOD spoke to slide 25, "Minimum Components
Required by IDEA, which read as follows [original
punctuation provided]:
• Comprehensive child find and referral system
• Public awareness program focusing on early
identification of infants and toddlers with
disabilities and providing information to parents
of infants and toddlers through primary referral
sources
• Central directory of public and private EI
services, resources, and research and
demonstration projects
• Comprehensive system of personnel development,
including the training of paraprofessionals and
the training of primary referral sources
MS. HARWOOD advanced to slide 26, "34 CRF & 303.302
Comprehensive Child Find system," which read as follows
[original punctuation provided]:
Scope of Child Find:
All infants and toddlers with disabilities in the
State who are eligible for early intervention services
are identified, located, and evaluated including:
Coordination:
• Child Find System must be coordinated with all
other major effort efforts to local and identify
children by other agencies with the assistance of
the ICC.
• Child Find System is coordinated with:
o Program authorized under Part B
o Maternal, Infant, and Early Childhood Home
Visiting Program (MIECHV)
o Early Periodic Screening, Diagnosis, and
Treatment (EPSDT)
o Programs under the Developmental Disabilities
Assistance and Bill of Rights Act of 2000
o Head Start and Early Head Start
o SSI program under Title XVI of the SS Act
o Child protection and child welfare programs
under the state agency responsible for
administering the Child Abuse Prevention and
Treatment Act (CAPTA)
o Early Hearing Detection and Intervention (EHDI)
o Children's Health Insurance Program (CHIP)
o Child care programs in the state
MS. HARWOOD advanced to slide 27 showing the steps in the system
from Identification & Referral to Intake & Family Assessments to
Child Evaluation & Functional Assessment to Individualized
Family Service Plan Development which must all be completed
within 45 days though Service Delivery & Transition.
4:33:03 PM
MS. HARWOOD advanced to slide 28, "State Partnerships." She
highlighted the Governor's Council and the Alaska Infant
Learning Providers Association.
MS. HARWOOD advanced to slide 29, "Local Partnerships." She
said local programs replicate the state partnerships. She said
the graphic displays how the local programs work with local
infant learning providers (ILPs). She highlighted Parents as
Teachers and the Office of Children's Services.
MS. HARWOOD advanced to slide 30, "Child Find: Percentage of
Birth to one Population served," showing the actual data
compared to the targets.
REPRESENTATIVE DRUMMOND asked about the national number.
MS. HARWOOD clarified the black line on the graph was the state
target and the state number ended up being higher.
REPRESENTATIVE DRUMMOND asked whether the increase shown on the
graph was due to the program being new.
MS. HARWOOD said it was due to increased referrals and
awareness.
4:38:01 PM
REPRESENTATIVE DRUMMOND asked whether Alaska is higher than the
national average.
MS. HARWOOD answered in the affirmative.
REPRESENTATIVE ZULKOSKY asked about the "50 percent delay."
MS. HARWOOD answered it referred to a 50 percent delay in the
developmental area, such as speech or motor [skills], for IDEA
Part C eligibility. She indicated the factor would be
addressed more fully in the subsequent hearing.
MS. HARWOOD moved to slide 32, "Program Referral Data" showing
FY17 Activity data. The table shows 3,547 referrals, 1,855
evaluations, and 1,108 new enrollments. She emphasized that
families have to be interested in the services.
MS. HARWOOD advanced to slide entitled "Top 5 referral sources
in FY 17," which read as follows [original punctuation
provided]:
Alaska Part C received a total of 3,547 referrals in
FY 17:
• 721 Parent
• 719 Physician
• 818 Child Protective Services (CPS)
• 344 Neonatal Intensive Care Unit
• 208 Alaska Native Medical Center
MS. HARWOOD advanced to slide 34, "Referrals and total
enrollment in FY17". She stated the average age of a child's
first referral is 13 months. Referrals have increased by 20
percent since FY10 while enrollment has increased by 30 percent
since FY10
MS. HARWOOD advanced to slide 37, "What families say," showing
"some of the best" comments from families.
4:43:53 PM
BRITA BISHOP, Quality Assurance Section Administrator, Division
of Behavioral Health, Department of Health and Social Services
(DHSS), presented on Partners promoting healthy communities.
MS. BISHOP addressed "Activities for Young children and their
families" on slides 39-40, which read as follows [original
punctuation provided]:
• Prevention Coalitionspartnering with communities
to strengthen families
• Provider Networktreating young children with
serious emotional disturbances and their families
o Outpatient services mental health and
substance use
o Residential substance use services for women
and children
o Therapeutic family-based treatment homes
o Northern Alaska Shelter Care children birth to
5
o Gap: No residential psychiatric treatment
center beds for children under 12
MS. BISHOP listed some of the prevention coalitions. She
gave a point-in-time count for children out of state in
psychiatric treatment of 46 children under 12, 5 of whom
are under the age of 8. Slide 40 read as follows [original
punctuation provided]"
• Other DBH Program Supports
o Housing
o Peer Navigation and Family Support Services
o Flexible Funding "Individualized Services
Program"
• Other Cross System Work
o Complex Behaviors Collaborative
o Improving Child Welfare Outcomes
o Housing Vouchers
o Neo-natal Abstinence Syndrome
MS. BISHOP gave examples of flexible funding and its
recipients. She described the complex behaviors
collaborative.
4:52:08 PM
MS. BISHOP advanced to slide 41, "System Development for Young
Children and their families," which read as follows [original
punctuation provided]:
• Training and Technical Assistance supporting
system development to expand access and improve
treatment
o Alaska Child Trauma Center
o Cross walk to qualify young children for
Medicaid services
o Yearly training conferences
• 1115 Medicaid WaiverBehavioral Health
Demonstration Project
o Priority populations include at-risk children
and families
o Implement evidence-based screening tools to
identify behavioral health needs at all ages
o Expand in-home and mobile response services for
children and families
REPRESENTATIVE PARISH asked whether there is anything the
division needs from the legislature.
MS. BISHOP answered the division is "early in the process" for
the 1115 Medicaid Waver.
4:55:12 PM
CHRISTY LAWTON, Director, Office of Children Services (OCS),
presented on Strengthening Families. She spoke to research from
the Center for Study on Social Policy regarding support for
families. She listed five protective factors: parental
resilience, social connections, knowledge of parenting and child
development, concrete support in times of need, and social and
emotional competence.
5:00:40 PM
MS. LAWTON spoke to "Family support and preservation services"
on slides 44-46, which read as follows [original punctuation
provided]:
Family Support Services
Community-based primary prevention services designed
to:
• Increase the strength and stability of families,
particularly those with young children.
• Increase parents' competence in parenting skills
and enhance child development.
• Services include: in-home supports; ongoing
family assessment; facilitated access to
resources such as transportation; service
coordination; and parent education and support.
Family Preservation Service
Intensive services designed for families when children
are at risk of future out-of-home placement in order
to keep families together and to create a safe, stable
and supportive family environment.
• Grantees provide coordination of services to meet
the identified needs of the family, including
transportation; service plan implementation and
monitoring; assessment of family progress; and
parenting education and support.
Family Support Current Grantees
• Alaska Family Services: Wasilla, Palmer and
surrounding areas
• Cook Inlet Tribal Council: Anchorage
• RurAL CAP: Anchorage
• Frontier Community Services: Soldotna and Kenai
• Nome Community Service : Nome
• Resource Center for Parents and Children:
Fairbanks
• Sprout Family Services: Homer and surrounding
areas
head2right SFY17: 432 children & 268 families served
head2right Total Funding: $550,000. Funded by Federal Grant,
Community Based Child Abuse Prevention (CBCAP)
head2right Target Population: Alaska families who do not
have an open case with OCS
head2right Families can self-refer, or be referred by the
community.
head2right Grantees must use evidence informed approaches,
such as Parents as Teachers
Family Preservation "Circle of Support" Grantees
• Nome Community Center: Nome
• Alaska Family Services: Wasilla, Palmer and
surrounding areas
• Cook Inlet Tribal Council: Anchorage
• Women in Safe Homes: Ketchikan, Metlakatla
• Resource Center for Parents and Children
head2right Target Population: Families referred by OCS only.
head2right Grant requires warm hand off where the OCS
worker, the family and the grantee meet together
for the service intake, in order to promote
family engagement.
5:01:54 PM
MS. LAWTON pointed to the clause on slide 47, Alaska Child
Welfare Tribal Compact, which read as follows [original
punctuation provided]:
"Alaska Native Tribes know what is best for their
children, Alaska Native families and communities are
the best places for their children to thrive, and
Alaska Native children steeped in the love, values,
and culture of their Tribe have the best chance of
being healthy, engaged members of society."
Whereas clause, pg. 3, Alaska Tribal Child Welfare
Compact
MS. LAWTON progressed to slide 48, "The Compact Creates
Opportunities, which read as follows [original punctuation
provided]:
For change and innovation
• Early intervention and prevention services
through the sharing of Protective Services
Reports
• Tribes/Tribal Organizations will have the
opportunity to reach out to support and offer
services to families more upstream to reduce
further maltreatment
MS. LAWTON spoke to slide 49, "Child Abuse Prevention and
Treatment Act (CAPTA):
• States must ensure all children less than 3-years
of age who are involved in a substantiated case
of child abuse or neglect are referred to the
Infant Learning/Early Intervention program
• Infant Learning/Early Intervention Program
Provides home-based child development services to
children aged birth up to 3-years of age, who
have moderate to severe mental or physical
handicapping conditions or are at risk for
developing these conditions. For each eligible
child the infant learning program must develop an
Individualized Family Service Plan (IFSP) for
providing services.
MS. LAWTON described challenges involved in timely
referrals. She said Alaska receives some funds from Child
Abuse Prevention and Treatment Act (CAPTA) and therefore
there are requirements for reporting and policy procedures.
5:07:11 PM
REPRESENTATIVE ZULKOSKY asked about the $500 thousand and
whether it is split between grantees.
MS. LAWTON answered the amount is the total of what is split
between grantees.
REPRESENTATIVE JOHNSTON asked whether the process is improving
and whether it is digitized.
MS. LAWTON answered the system is automated once details are
entered into the Online Resource for the Children of Alaska
(ORCA) system. She indicated there can be a lag time.
REPRESENTATIVE JOHNSTON asked what the risks were should it not
be completed timely.
MS. LAWTON answered if the details are not entered timely, often
the family has moved, or the staff aren't prepared for the phone
call referral.
REPRESENTATIVE JOHNSTON suggested the process could be made
shorter.
MS. LAWTON answered it could be looked into.
5:11:15 PM
ADJOURNMENT
There being no further business before the committee, the joint
House Health and Social Service Standing Committee and House
Education Standing Committee meeting was adjourned at 5:11 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Alaska-Medicaid-CHIP Handout.pdf |
HHSS 3/15/2018 3:00:00 PM |
AECCC |
| EPSDT.leg.handout.3-15-2018.DR2.pdf |
HHSS 3/15/2018 3:00:00 PM |
AECCC |
| SDS Handout.pdf |
HHSS 3/15/2018 3:00:00 PM |
AECCC |
| DAY 2 Early Childhood DHSS Final 3-12-18.pdf |
HHSS 3/15/2018 3:00:00 PM |
AECCC |