Legislature(2019 - 2020)CAPITOL 106
04/30/2019 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB89 | |
| Presentation: Alaska Citizen Review Panel | |
| Presentation: Office of Children's Services - Citizen Review Panel Response | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 89 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 30, 2019
3:04 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Matt Claman
Representative Harriet Drummond
Representative Geran Tarr
Representative Sharon Jackson
MEMBERS ABSENT
Representative Lance Pruitt
COMMITTEE CALENDAR
HOUSE BILL NO. 89
"An Act relating to the prescription of opioids; relating to the
practice of dentistry; relating to the practice of medicine;
relating to the practice of podiatry; relating to the practice
of osteopathy; relating to the practice of nursing; relating to
the practice of optometry; and relating to the practice of
pharmacy."
- HEARD & HELD
PRESENTATION: ALASKA CITIZEN REVIEW PANEL
- HEARD
PRESENTATION: OFFICE OF CHILDREN'S SERVICES - CITIZEN REVIEW
PANEL RESPONSE
- HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 89
SHORT TITLE: OPIOID PRESCRIPTION INFORMATION
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
03/11/19 (H) READ THE FIRST TIME - REFERRALS
03/11/19 (H) HSS, FIN
04/04/19 (H) HSS AT 3:00 PM CAPITOL 106
04/04/19 (H) Heard & Held
04/04/19 (H) MINUTE(HSS)
04/09/19 (H) HSS AT 3:00 PM CAPITOL 106
04/09/19 (H) -- MEETING CANCELED --
04/11/19 (H) HSS AT 3:00 PM CAPITOL 106
04/11/19 (H) -- MEETING CANCELED --
04/16/19 (H) HSS AT 3:00 PM CAPITOL 106
04/16/19 (H) Heard & Held
04/16/19 (H) MINUTE(HSS)
04/23/19 (H) HSS AT 3:00 PM CAPITOL 106
04/23/19 (H) Scheduled but Not Heard
04/25/19 (H) HSS AT 3:00 PM CAPITOL 106
04/25/19 (H) Scheduled but Not Heard
04/30/19 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
MIRANDA DORDAN, Intern
Representative Ivy Spohnholz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Spohnholz,
sponsor, introduced the committee substitute for HB 89, Version
S.
J.P. OUELETTE, Chair
Alaska Citizen Review Panel
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint presentation
entitled, "Alaska Citizen Review Panel," dated 4/30/19.
NATALIE NORBERG, Director
Central Office
Office of Children's Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Provided a PowerPoint presentation
entitled, "Office of Children's Services - Citizen Review Panel
Response 2018-2019," dated 4/30/19.
ACTION NARRATIVE
3:04:08 PM
CO-CHAIR ZULKOSKY called the House Health and Social Services
Standing Committee meeting to order at 3:04 p.m.
Representatives Spohnholz, Jackson, Claman, Tarr, Drummond and
Zulkosky were present at the call to order.
HB 89-OPIOID PRESCRIPTION INFORMATION
3:05:15 PM
CO-CHAIR ZULKOSKY announced the first order of business would be
HOUSE BILL NO. 89, "An Act relating to the prescription of
opioids; relating to the practice of dentistry; relating to the
practice of medicine; relating to the practice of podiatry;
relating to the practice of osteopathy; relating to the practice
of nursing; relating to the practice of optometry; and relating
to the practice of pharmacy."
3:05:31 PM
CO-CHAIR SPOHNHOLZ moved to adopt the committee substitute (CS)
for HB 89, labeled 31-LS0421\S, Fisher, 4/18/19, as the working
document [Version S].
CO-CHAIR ZULKOSKY objected for discussion purposes.
3:06:08 PM
MIRANDA DORDAN, Intern, Representative Ivy Spohnholz, Alaska
State Legislature, introduced the committee substitute for HB
89, Version S. She advised of a typographical error on the
document [included in the committee packet] entitled,
"Explanation of Changes" as follows: Section 7. AS
47.47.040(24) should read Section 7. AS 47.37.040(24). Ms.
Dordan then paraphrased from the document, which read [original
punctuation provided]:
Section 7. AS 47.47.040 (24)
On page 8, line 30: The phrase "?and maintain current
information?" was added.
From page 8, line 30 to page 9, line 1: The phrase
"?for purposes of patient education, a onepage,
printable handout in 12-point font?" was added.
On page 9, line 3-4: The phrase "?the information must
be written in plain language that can be easily
translated into other languages commonly spoken in the
state?" was added.
These changes make stipulations for the Department of
Health and Social Services to keep the opioid handout
regularly updated.
The requirement of the minimum 12-point font was added
to ensure that the opioid handout can be easily read.
The provision of plain language that can be easily
translated into other languages commonly spoken in
Alaska was added in order to ensure that the
information will be accessible to all patients, not
just those who speak and read English.
MS. DORDAN, in response to Co-Chair Zulkosky, restated the
correct section is: Section 7. AS 47.37.040 (24).
REPRESENTATIVE DRUMMOND pointed out on the Explanation of
Changes document, "From page 8, line 30 to page 9," should read:
"From page 8, line 31 to page 9." She suggested the ["printable
handout" on page 8, line 31 of the CS] could depict symbols and
graphics the Department of Health and Social Services (DHSS) may
find in the "international language of medicine."
3:10:12 PM
CO-CHAIR SPOHNHOLZ directed attention to an "info graphic
document" [slide 11, entitled, "Section 7: Visual Aid," of a
PowerPoint presentation entitled, "House Bill 89: Opioid
Addiction Risk Disclosure" provided to the committee on 4/4/19]
that was included in the committee packet and that was prepared
by DHSS in request to a bill introduced in the Thirtieth Alaska
State Legislature. She said the document uses [graphics] and
language to ensure it is easy to understand and translate; in
fact, she has been informed by practitioners who serve immigrant
populations, and parts of rural Alaska where English is not
always a patient's first language, the document must be easy to
translate and accessible to all.
REPRESENTATIVE TARR questioned whether there is a fiscal note
attached to HB 89.
CO-CHAIR SPOHNHOLZ acknowledged there is a forthcoming fiscal
note that will be attached to the bill in the amount of $14,200
to pay for the cost of regulations.
3:11:41 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, Version S was before the committee.
CO-CHAIR ZULKOSKY announced HB 89 was held over.
3:12:47 PM
The committee took an at-ease from 3:12 p.m. to 3:14 p.m.
^PRESENTATION: ALASKA CITIZEN REVIEW PANEL
PRESENTATION: ALASKA CITIZEN REVIEW PANEL
3:14:23 PM
CO-CHAIR ZULKOSKY announced the next order of business would be
a presentation by the Alaska Citizen Review Panel.
3:14:38 PM
J.P. OUELETTE, Chair, Alaska Citizen Review Panel (CRP),
informed the committee CRP is a volunteer panel. He introduced
a PowerPoint presentation entitled, "Alaska Citizen Review
Panel," paraphrasing from slide 1, "Presentation Outline," which
read:
? Introduction to the role and purpose of the Citizen
Review Panel
? Goals and recommendations from 2017-2018
? Goals for 2018-2019
? Improvements in CRP-OCS collaboration
? Way forward
MR. OUELETTE paraphrased from slide 2, "Central Purpose," which
read:
Congress created CRPs to help child protection systems
be more responsive to community needs.
? A CRP is a mechanism for public participation in
child protection.
? It should facilitate robust and meaningful
participation by citizens
1. In diverse roles in child and family welfare
2. Representing all five regions
3. With a shared interest in promoting a healthy
and collaborative CPS system
MR. OUELETTE noted CRP panelists are primarily professionals
working in the child and family welfare system and who have
experience living in the system; CRP seeks panelists from all
five regions of Alaska who have an interest in collaboration and
creating an environment that encourages cooperation.
MR. OUELETTE paraphrased from slide 3, "Functions - Mandates,"
which read:
Federal Mandate (42 U.S.C. ? 5106a.(c)): Examine the
policies, procedures, and practices of state and local
child protection agencies and evaluate the extent to
which these agencies are effectively discharging their
child protection responsibilities Conduct public
outreach both to assess the impact of current policies
and procedures, and to solicit public comment on the
panel's recommendations.
State Mandate (AS 47.14.205): "The CRP shall examine
the policies, procedures, and practices of State and
local agencies and where appropriate, specific cases,
to evaluate the extent to which State and local child
protection system agencies are effectively discharging
their protection responsibilities."
3:19:17 PM
MR. OUELETTE paraphrased from slide 4, "Primary Functions,"
which read:
Review/Evaluate (from statute):
? States' CAPTA Plan
? Child protection standards
? And any other criteria that the Panel considers
important
Conduct public outreach (from statute):
Assess the impact of OCS policies, procedures, and
practices on children and families
? This assessment should inform its review function
Advocate for (from congressional record):
? Relevant changes based on its review
MR. OUELETTE clarified CAPTA is the Child Abuse Prevention and
Treatment Act. He paraphrased from slide 5, "Functions - What
CRP Does Not Do," which read:
? Comment on proposed or pending legislation
? Get involved in individual cases, contract, or
situations
? Micromanage OCS operations
? Program evaluation
? Lobby
MR. OUELETTE stressed CRP is not an investigative body but seeks
a general consensus of ones' experience with the Office of
Children Services (OCS), Department of Health and Social
Services (DHSS), and not the circumstances of individual cases.
Although the policy of CRP is not to micromanage OCS operations,
it does conduct site visits to gather details and provide
support. He directed attention to [slide 6] and pointed out the
state's system of child protection is a combination of policy,
practice, and the needs of children and families; the federal
mandate of CRPs is to review a state's policies, determine
whether the policies are put into practice, and determine
whether the policies are serving the needs of children and
families. Speaking from his experience, he said developing
recommendations [for change] is a long process; however, CRP
will first review the needs of children and families, determine
if the practices are effective, identify barriers to practices,
and decide whether changes to policy are necessary. He opined
the focus of CRP is to garner the collaboration of affected
communities, improve [OCS] practices, and find the root causes
of systemic problems.
3:23:31 PM
MR. OUELETTE paraphrased from slide 7, "Changes in CRP
Operation," which read:
Reorientation of CRP as a public participation
mechanism Discussions began early fall 2017 A
tentative three-year timeline Elements will include
? Participatory evaluation
? A systems focus
? Robust recruitment and retention strategy
? Data-driven review and outreach
? Collaborative and constructive
MR. OUELETTE discussed the renewed interest of CRP panelists and
a better relationship between CRP and OCS since 2017. He
paraphrased from slides 8 and 9, "Goals 2017 - 2018," which
read:
? GOAL 1: Examine the effectiveness of the current
administrative review process and whether the changes
made in 2015 have improved the system.
? GOAL 2: Examine if 'family reunification' is
prioritized as a goal for children in out-of-home care
placement, and OCS' efforts in pursuit of 'family
reunification'.
? GOAL 3: Examine OCS' efforts in finding relatives
for placement of children in foster care. GOALS 2017-
2018
? GOAL 4: Expand public outreach in collaboration with
efforts under the Tribal-State strategic plan.
? GOAL 5: Strengthen the panel through aggressive
recruitment of new members, enhanced website, and
tools to reach diverse groups of stakeholders.
MR. OUELETTE, regarding Goal 1, reminded the committee in 2015 a
change was made in the administrative review process to a more
efficient process, thus CRP sought to review the change.
Regarding Goal 2, CRP found the pursuit of family reunification
differed between regions of the state. Regarding Goal 3, he
said the goal is much improved due to better relationships with
Tribal partners. Regarding Goal 4, he said there are regional
differences in community investment. Regarding Goal 5, he said
CRP is developing its website and is recruiting panelists.
3:28:04 PM
MR. OUELETTE paraphrased from slide 10, "Recommendations 2017 -
2018," which read:
Overall, CRP recommendations fall into five
categories:
? Quality Assurance
? Management
? Practice
? Public participation
? CRP's role and function
MR. OUELETTE paraphrased from slide 11, "Improve Administrative
Review Process," which read:
Recommendation 1: The Panel recommends that OCS not
transition to a judicial review process as was
proposed but fine-tune the current administrative
process to make it more comprehensive.
? ACTION: Ensure that case workers are present during
review; and maintain flexibility in scheduling so that
there is maximum participation from interested
parties.
MR. OUELETTE explained the previous administrative review
process collected a lot of information and brought parties
together, but there was not consensus as to whether it was
serving its purpose, which is "a box checking session, to make
sure that everything was on track where it was supposed to be
and feedback could be given if it wasn't." So, a judicial
administrative review process was proposed; however, every
region opposed a judicial administrative review process and CRP
concurs. In response to Representative Tarr, he further
explained a team decision making (TDM) process is meant to allow
parties to share information; however, the purpose of an
administrative review process is not to share information, and
the change was to shorten the process. He said the change was
not clearly communicated to CRP or to those participating in the
administrative review process; he pointed out the administrative
review process does need to provide communication between family
members, and participation with all parties and professionals
involved, such as biological parents, foster parents, and
guardians ad litem (GALs).
CO-CHAIR SPOHNHOLZ surmised the administrative review process is
designed to "make sure that we've ... checked all the boxes that
we're supposed to be checking, along the way, but people weren't
really clear about what the process was for ...."
MR. OUELETTE said correct. He acknowledged miscommunication
created confusion over a process that really mattered, such as
providing constructive and supportive feedback.
3:32:29 PM
MR. OUELETTE paraphrased from slide 12, [continued from slide
11, "Improve Administrative Review Process"] which read:
ACTION: Evaluate the case-continuum for opportunities
to build rapport and collaboration among all
stakeholders if this (unintended, but crucial)
objective is no longer being met during the
Administrative Review (AR)
? ACTION: Ensure case workers are provided with
constructive and supportive feedback in how to better
achieve compliance.
? ACTION: Develop and implement a training on the AR
process be developed and delivered for case workers
and families to better understand the scope and goals
for AR and what should be the anticipated outcomes
that follow from an AR.
MR. OUELETTE stated CRP also recommended OCS develop training on
the administrative review process to ensure parties understand
and participate in the process. He paraphrased from slides 13
and 14, "Improve Outcomes for Family Reunification," which read:
Recommendation 2: The Panel recommends that OCS take
the following measures:
? ACTION: OCS should target recruiting efforts to
workers with life experience in or near the regions
they will be serving.
ACTION: OCS should provide orientation and training
that explains the often overlooked cycle of trauma
children endure when separated from their families,
and the reason family reunification is a priority. OCS
supervisors and trainers should encourage a strengths-
based approach to working with parents.
? ACTION: OCS should support and train workers to
practice early intervention / in-home efforts to
prevent removal. We suggest drawing from the
experience of more seasoned workers who do this very
well in their regions to provide mentorship
opportunities
MR. OUELETTE, regarding the first action, said from his
experience removal of a child can be prevented when people are
aware of the alternatives, which happens in regions where family
connections are strong. Regarding the second action, he opined
this has always been implicit in policies and procedures, but
not in philosophy and practices, and [removal] should truly be
the last resort.
3:34:33 PM
REPRESENTATIVE JACKSON asked about the general differences
between the regions in Alaska related to family reunification.
MR. OUELETTE advised there are many complexities within each
region that create barriers to family reunification, such as the
landscape, history of trauma, leadership, and [OCS] staff who do
not have an investment in the region in which they are working.
In the most remote regions, local recruitment is difficult; CRP
is working with OCS to strengthen recruitment. Of the five
regions, the Western and Northern regions experience the most
difficult situations; the Anchorage region has a lot of
resources; there have been improvements the Southcentral region
due to provisions of House Bill 151 [passed in the Thirtieth
Alaska State Legislature]; the Southeast region benefits from
collaboration with Tribes.
REPRESENTATIVE JACKSON urged OCS to share successful models with
all regions.
MR. OUELETTE agreed.
3:40:29 PM
CO-CHAIR SPOHNHOLZ returned attention to the administrative
review process and asked for an explanation of the first action
shown on slide 12.
MR. OUELETTE explained the old administrative review process
provided more time and opportunity for parents to communicate
with GALs and caseworkers; the new process is impersonal and
short. If this vital communication is not a function of the
administrative review process, OCS must provide a new
opportunity for family participation.
CO-CHAIR SPOHNHOLZ questioned whether the objective of the
administrative review process is just to review documents.
MR. OUELETTE expressed his understanding the administrative
review process is box checking activity that is required prior
to federal review that identifies where OCS is achieving
objectives in a case; however, caseworkers complain the
administrative review "only identifies places where we're
failing."
CO-CHAIR SPOHNHOLZ related caseworkers feel OCS operations in
the recent past have lacked utility and support for overworked
caseworkers; she pointed out the aforementioned progress [in the
Southcentral region] stems from House Bill 151, by which the
state chose to lower caseloads and invest resources to support
caseworkers and staff.
3:45:20 PM
MR. OUELETTE continued to slides 15 and 16, "Strengthened
Cultural Competency," which read:
Recommendation 3: The Panel recommends that OCS
leadership look in to identifying the cultural
differences that can contribute to bias among OCS
workers and minorities, then find ways to improve
their cultural competency.
? ACTION: This can be done through more observation,
listening, and engagement, as well as targeted and
evidence-based trainings like "Healthy Families" and
"Knowing Who You Are."
? ACTION: Cultural competency training from local
village councils or other tribal training partners to
build from a collaborative foundation between OCS and
the tribes and give caseworkers an opportunity to
engage with tribal representatives establishing better
lines of communication for achieving ICWA objectives.
? ACTION: Collaborate with tribes to ascertain if and
where the ICWA specialist could leverage relationships
with local elders and community leaders to help case
workers develop effective strategies for community
engagement and interaction with Tribal resources
MR. OUELETTE noted all OCS employees receive cultural competency
training but lack training in region-specific cultural
competency. Region-specific cultural competency achieves two
objectives: knowing the landscape and people where you work,
and collaboration with Tribes. He said [the actions] were
developed in response to Tribal partners who indicated the
knowledge of elders was underutilized and not understood by
those outside of their culture.
CO-CHAIR ZULKOSKY related during one of the initial meetings of
the House Special Committee on Tribal Affairs, the committee
heard rural Alaska and the Alaska Native community are not a
monolithic culture; she appreciated CRP's acknowledgement of the
importance of cultural orientation and region-specific cultural
understanding. She cautioned those within the Alaska Native
community believe one can always grow one's knowledge and may
prefer the concept of cultural understanding to one of cultural
competency.
MR. OUELETTE said CRP understands the complexity of the 227
federally recognized Tribal entities in Alaska, and their
diversity, and he gave an example.
3:51:23 PM
MR. OUELETTE paraphrased from slide 17, "Increased Community
Engagement," which read:
Recommendation 4: CRP to facilitate the constructive
exchange of vital information between stakeholders
increasing collaboration.
? ACTION: Encourage local/regional OCS leadership to
help arrange and facilitate townhall or "talking
circle" type meetings during each site visit that the
CRP conducts in 2018-2019.
MR. OUELETTE said recommendation 4 was challenging and CRP held
one very successful talking circle in Wasilla with OCS
leadership, professionals, and panelists.
REPRESENTATIVE TARR asked Mr. Ouelette to clarify stakeholder
engagement related to recommendation 4.
MR. OUELETTE said stakeholders include other service providers
outside OCS who may or may not have cooperative relationships
with OCS. The talking circle format led to a meaningful
discussion of solutions.
REPRESENTATIVE TARR suggested expanding the group of
shareholders may bring further understanding to all parties of
those individuals who need services.
MR. OUELETTE said, "... I would agree with you. I think that
probably lies a bit beyond the scope of the CRP ...."
3:56:16 PM
REPRESENTATIVE JACKSON supported the use of the talking circle
format; she cautioned a lack of communication brings
misunderstanding, and strongly urged for enhanced communication
within communities.
MR. OUELETTE agreed and gave an example in Sitka. He
paraphrased from slides 18 and 19, "Worker Burnout and
Vacancies," which read:
Recommendation 5: Recruiting, supporting, and
retaining workers that have the skills, character,
community investment, and resilience to serve the
needs of Alaskan families is key.
? ACTION: Tighten OCS hiring policies in the following
ways: Acquire or develop a tool that screens job
applicants for resiliency. Require applicants have
field-related experience and/or education.
? ACTION: OCS should provide wellness support for
staff including on-site counseling, education and
training in secondary traumatic stress at least
annually, and mandatory self-care including supportive
check-ins with supervisors, breaks, and
walks/exercise.
MR. OUELETTE acknowledged recommendation 5 is "a tall order."
Although, at one time there was a philosophy to hire persons who
were not helpful, OCS is now holding vacancies when it is not
satisfied with the applicants for a position. In regard to the
second action, he said CRP addresses this issue in its 2018-2019
priorities.
4:01:32 PM
MR. OUELETTE paraphrased from slide 20, "Improve Centralized
Intake," which read:
Recommendation 6: While regions are adapting to what
may be an irreversible change, there are still
significant concerns about the efficacy of the current
intake process. Stakeholders across the regions shared
frustration over the inconsistency of the process and
the intake worker's inability to facilitate necessary
actions in a region they are unfamiliar with in a
timely manner.
? ACTION: Equip centralized intake workers with
region-specific resources and a concise standardized
assessment tool for prioritizing calls based on
already existing OCS policies and procedures.
MR. OUELETTE said the transition to centralized intake intended
to make OCS management more feasible for the state; however,
there were many complaints due to slow responses to inquiries
and the lack of consistency with services. Currently, most
problems have been addressed and most people are satisfied with
the centralized intake process. He paraphrased from slide 21,
"Progress on 2017 - 2018 Goals," which read:
? 2017 was, we hope, the pinnacle of a tumultuous
period for OCS involving much public scrutiny,
incredibly high worker turnover, lack of (though
growing) collaboration and communication between OCS
and CRP, and internal frustration with statewide
changes such as admin review and centralized intake.
? Many of the recommendations went unaddressed and
appear under new headings for 2018-2019 as the CRP
reimagined its role moving from "watchdog" to broker
and facilitator of effective communication while
remaining critically objective.
MR. OUELETTE acknowledged OCS is receptive to criticism from
CRP. He paraphrased from slide 22, "Moving into 2018 - 2019,"
which read:
Acknowledging the crisis OCS was facing, the CRP
adapted our approach to site visits looking deeper
into core contributing factors leading to burnout,
turnover, backlogged IA's, and less-than-optimal
results for children and families.
? We developed this year's goals to address the
relationship between worker wellness, community
collaboration and best efforts toward family
reunification.
? We began pre-site-visit teleconferences to
collaborate with leadership toward a fruitful site
visit.
MR. OUELETTE opined worker wellness, and community
collaboration, contribute to better outcomes of helping
families, but are often overlooked. In fact, he characterized
OCS [caseworkers] as similar to a traumatized family because
they endure secondary trauma and work under difficult
circumstances, and caseworkers need a mechanism for support. He
further explained pre-site-visits help caseworkers prepare for a
site-visit; previously, CRP visits were "almost like a surprise
visit" and were not effective. Although there were concerns,
pre-site-visits ensure effective communication and
collaboration.
4:05:43 PM
MR. OUELETTE paraphrased from slides 23 and 24, "Goals for 2018
- 2019," which read:
? GOAL 1: Assess Family Reunification Efforts & Best
Practices What are practices that are working well
in the regions to promote family reunification and how
can we replicate that in other regions? What are
barriers workers and families face to moving toward
reunification? What needs to be done to eliminate
those barriers?
? GOAL 2: Evaluate OCS Staff Wellness Efforts and
Community Engagement What efforts are in place to
promote wellness, safety, healthy office culture, and
community engagement (particularly in remote regions)?
How can the CRP help promote wellness among staff?
? GOAL 3: Region-Specific/Culturally-Appropriate
Training for OCS Staff What are current requirements
for staff? What offerings available through tribal
partners? How can the CRP facilitate better
communication and collaboration with tribal partners
in this area?
? GOAL 4: Awareness of Tribal-State Strategic Plan
At what levels do different staff engage with the
Plan? Are the efforts coming from the Plan tangible
to stakeholders?
? GOAL 5: Coordinate Panel Activities & Improve Panel
Participation Streamline regular schedule for panel
activities. Focus recruitment efforts on regions
outside of Anchorage.
MR. OUELETTE explained goal 1 is a change in CRP's line of
questioning from a focus on policies and procedures; this change
has resulted in more response and cooperation from OCS
caseworkers and community partners. He gave one example of how
CPR addressed goal 2 at the office in Anchorage. Regarding to
goal 3, he noted CRP's efforts to share resources with other
entities in the Western region. Regarding goal 4, he said there
is limited engagement with the strategic plan; however, CRP
continues to support Tribal-state collaboration. Regarding goal
5, he noted CRP is represented by a panelist from every region
but Southeast.
4:10:02 PM
MR. OUELETTE paraphrased from slides 25 to 27, "Progress on 2018
- 2019 Goals," which read:
Our change in approach has Highlighted the strengths
and improvements in each region and given honor where
due:
? Recognized to state leadership where regional and
local leadership has played a significant role in
improving outcomes for families
Recognized supervisors who model effective and
supportive leadership
? Our change in approach has Acknowledged the
challenges faced by all stakeholders and contributed
to building unity among OCS and its partners.
? Naming and normalizing the stress incurred by those
who work directly with families in their greatest time
of need
? Providing empathetic and positive feedback from the
community to OCS workers
? Communicated to all stakeholders the common goals of
OCS and community partners
? Our change in approach has Tailored
recommendations for success by collaborating with
leadership and seeking out sources of support from
community partners.
? Worked with stakeholders to provide tangible
solutions to challenges in communication,
collaboration, and cultural competency
? Provided OCS leadership with ideas from staff and
contact information for support available in the
community Resulted in a positive and collaborative
relationship between CRP and OCS leading to
unprecedented responsiveness, and successful
implementation of CRP recommendations.
MR. OUELETTE expressed pride in CRP's recognition of those in
leadership who have played a role in improving outcomes for
families, and he provided examples. He stressed renewed
responsiveness from OCS to CRP recommendations is important in
order to address issues now.
MR. OUELETTE paraphrased from slide 28, "CRP- A Statutory
Institution," which read:
The CRP is an institution, with a statutory role and
responsibility. It is an organization of the state. It
facilitates citizen participation. It must cultivate a
critical, but constructive lens. It exists to help
OCS. Its success depends on its relationship with OCS.
MR. OUELETTE added the success of OCS depends on its
relationship with its community and Tribal partners. He
concluded, urging the committee to take every opportunity to
advocate for continued funding for OCS partners and successful
health and social service programs.
4:14:07 PM
REPRESENTATIVE TARR, Co-Chair Spohnholz, Representative
Drummond, Representative Claman, and Co-Chair Zulkosky expressed
support for the changes made by CRP.
4:16:48 PM
The committee took an at-ease from 4:16 p.m. to 4:20 p.m.
^PRESENTATION: OFFICE OF CHILDREN'S SERVICES - CITIZEN REVIEW
PANEL RESPONSE
PRESENTATION: OFFICE OF CHILDREN'S SERVICES - CITIZEN REVIEW
PANEL RESPONSE
4:20:17 PM
CO-CHAIR ZULKOSKY announced the final order of business would be
a presentation by the Office of Children's Services (OCS), DHSS.
4:20:25 PM
NATALIE NORBERG, Director, Central Office, OCS, DHSS, provided a
PowerPoint presentation entitled, "Office of Children's Services
- Citizen Review Panel Response 2018-2019." Ms. Norberg
expressed her appreciation for the emphasis on collaboration
achieved by CRP in the past year and the work of its volunteer
panelists. Further, she said CRP has aligned its goals and
priorities more closely with those of OCS, which is helpful.
She informed the committee OCS's administrative review process
is a federal requirement of its funding through [title IV-E and
IV-B of the Social Security Act and the Adoption and Safe
Families Act of 1997]. The purpose of the administrative review
is to provide third-party oversight of cases; in Alaska and one
other state, the administrative review is not incorporated into
the state's judicial process. The administrative review ensures
that certain criteria are met in a timely manner, such as the
development of a case plan. Although the review process is very
important, it is very time consuming for staff and previously
did not achieve its stated goal. Ms. Norberg said OCS believes
if it could focus caseworker time to individually meet with
families, Tribal partners when applicable, and GALs, caseworkers
could accomplish needed work related to case planning (slide 1).
She described the administrative reviews as mini court sessions;
however, many of the requirements of the reviews could happen
within a court setting, which would be more efficient. Ms.
Norberg said OCS seeks to incorporate administrative reviews
into the Alaska judicial system, a change that is supported by
judges, GALs, defense attorneys, and Tribal partners. As part
of the OCS Federal Program Improvement Plan, a judicial review
pilot program will be implemented in Fairbanks to demonstrate
its efficiency and efficacy (slide 2).
CO-CHAIR SPOHNHOLZ asked about the history of Alaska's decision
to create its current administrative review process.
MS. NORBERG suggested there was concern that a judicial review
process would be a burden for the court system; however, she
pointed out Alaska needs the court system to be more involved in
child welfare cases in response to "pressure we are getting from
the federal government right now ... to have more involvement of
the courts in our system." Further, early court involvement may
alert families to the seriousness of a situation at the
beginning of a case, which may result in an earlier permanent
resolution of a case.
4:26:15 PM
CO-CHAIR SPOHNHOLZ remarked:
I'm a little surprised to hear you say that you think
that we should have more and earlier court involvement
in cases when some of the most exciting work that's
being done in child welfare right now is being done
in, in more of a collaborative way. ... I'm thinking
about the work that's being done with the safe baby
[Family Infant Toddler (FIT) therapeutic] court in,
out in the Mat-Su valley, and maybe that's an example
where the involvement of the court is a positive
thing, but they're actually trying to move away from a
traditional court model ....
MS. NORBERG advised [FIT court] is the model OCS seeks to
promote within the court system: having a more collaborative
approach with families and also bringing the seriousness of a
situation to everyone's attention and impart a sense of urgency.
She opined court oversight would hold child welfare workers, and
all parties, accountable and would provide clarification of
legal issues. The Fairbanks pilot program will draw from
lessons learned at FIT court in Mat-Su, "the Kenai model," and
"the safe court process in Ketchikan."
CO-CHAIR SPOHNHOLZ expressed support for FIT Court.
REPRESENTATIVE TARR expressed her concerns about court
proceedings, that are not well-understood by parents of children
in custody, and occasions when parents are represented by the
Office of Public Advocacy (OPA), which is understaffed.
MS. NORBERG pointed out the pilot program will develop tools to
help families understand the court system, such as an
orientation video, and opportunities to ask questions prior to a
legal proceeding. She explained the pilot program is based on a
model that has been adopted by other states; she stressed OCS
seeks to advance the pilot program because it currently employs
six fulltime staff to perform an administrative function that
could be achieved in a more efficient way.
4:32:25 PM
MS. NORBERG continued, noting one of CRP's recommendations is to
prioritize family reunification. She said training caseworkers
in how to write case plans that promote reunification is
important; in fact, nationally, Alaska's rate of reunification
ranks above the U.S. average and OCS staff continue to receive
annual training (slide 3). In addition, a stable workforce and
accessibility to services are two key factors that will improve
family reunification rates (slide 4).
CO-CHAIR ZULKOSKY returned attention to slide 3 and clarified
Alaska's 2018 rate of reunification was 54.5 percent of children
exiting foster care.
MS. NORBERG said correct. She then directed attention to slide
5 and stated the [section 1115 of the Social Security Act
Behavioral Health Demonstration Waiver (1115 waiver)] targets
families who are at risk of entering the child welfare system.
In fact, the waiver will provide a new continuum of community
based, in-home services that Medicaid has not paid for in Alaska
before; the services will benefit OCS families who will now
receive services nearby or in their homes. Further, OCS has
participated in the "statewide gap analysis" to inform providers
and recipients.
4:36:36 PM
MS. NORBERG turned attention to the [Family First Prevention and
Services Act that was included in the Bipartisan Budget Act of
2018]. She restated title IV-E is the primary federal funding
source for child welfare services. The Family First Prevention
and Services Act (Family First) allows the funding to pay for
direct services for children and families who are not yet in the
foster care system. This new opportunity means OCS will need to
develop a prevention plan using data from the gap analysis and
from stakeholders; also, OCS will become a third-payer, for
services not otherwise paid through grants or Medicaid, and will
seek 50 percent reimbursement for allowable services (slides 6
and 7).
REPRESENTATIVE TARR cautioned Alaska does not have the workforce
to provide [allowable services listed on slide 7].
MS. NORBERG agreed there is a "workforce issue." However, the
state may be reimbursed by 1115 waiver and Family First funding
for services provided by lower level technicians and peer
support, such as elders and natural helpers, thereby creating
access to a wider workforce.
4:40:44 PM
REPRESENTATIVE DRUMMOND returned attention to slide 6 and asked
who is reimbursing [Alaska and other states] for 50 percent of
costs claimed.
MS. NORBERG explained OCS will pay upfront costs to providers
and will track the outcomes from the services; at billing,
Medicaid will be billed first if applicable, and if not, OCS
will be reimbursed by the federal government for 50 percent of
its costs. Ms. Norberg, returning attention to the preliminary
list of allowable services [slide 7], said the services must be
evidence-based and proven effective, and not all of the services
are available in Alaska at this time.
CO-CHAIR SPOHNHOLZ spoke in support of the Parents as Teachers
program.
4:44:35 PM
MS. NORBERG continued to the CRP recommendation that OCS staff
receive more regional cultural competency opportunities. She
observed the state struggles with a high disproportion of Alaska
Native children in the child welfare system, and said OCS is
committed to sensitivity to the needs of Alaska Natives and to
the children and families it serves. The division seeks to
avoid cultural biases and thus in the last five to ten years has
invested in how to increase sensitivity by offering extensive
training on the Indian Child Welfare Act (ICWA); furthermore, a
Cultural Humility curriculum is required of all staff to prepare
them for ICWA training. Also, OCS is one of the only agencies
in the state that received permanent permission to allow Alaska
Native Tribal partners on its caseworker and management position
hiring teams (slide 8).
CO-CHAIR ZULKOSKY asked for a description of the extensive
training shown on slide 8.
MS. NORBERG said she would provide information on the length of
the training; historically, OCS has held two standalone
trainings on ICWA, in addition to that which is received by new
staff. The Introduction to ICWA has been incorporated into the
first three weeks of classroom training received by caseworkers
and includes a general overview of the law; she said she would
provide further information on the second phase and the total
hours of training. The Cultural Humility curriculum is an
online training; Knowing Who You Are Training is a two-day
standalone training that helps staff discuss racial and ethnic
identity and encourages courageous conversations in the work
environment. Further, OCS has five regional ICWA specialists
and a statewide ICWA coordinator who are available to help staff
navigate specific Tribal relations and ICWA issues.
4:49:41 PM
CO-CHAIR ZULKOSKY referred to the Alaska Humanities Forum
Creating Cultural Competence (C3) education mentorship program
for new teachers, in which new teachers are partnered with a
member of the local community where they will be teaching. The
program has been shown to increase the retention of new teachers
in communities and she suggested there may be other mentorship
opportunities. Co-Chair Zulkosky related her district is
challenged by a low rate of recruitment and retention of OCS
staff and recommended, in addition to improvements in training,
mentorship of [new OCS staff] with local community or Tribal
leaders.
MS. NORBERG indicated her interest in Co-Chair Zulkosky's
recommendation. She returned to the CRP recommendation to
identify relatives for placement of children in foster care and
said, since 2014, OCS as seen an increase of approximately 10
percent in the overall number of children placed with relatives,
which may not represent a permanent placement. She said OCS
seeks to sustain relative placement by changing the upfront
payment process for relative placements to ensure stipends are
issued to immediately offset the cost of care during the
licensing process. In addition, licensed foster parents receive
a higher rate of reimbursement than that received through
Temporary Assistance for Needy Families (TANF). Other efforts
in this regard include automated relative notifications online,
identification of relatives through Tribal partners, and new
training for supervisors (slide 9).
4:53:20 PM
MS. NORBERG turned attention to OCS workforce issues and efforts
to improve worker retention. She said the fifty-two new
positions that were authorized during the last two fiscal years
have begun to stabilize the OCS workforce. Many of the first
new positions were assigned to the Mat-Su office and have
reduced the previous caseloads of 40 cases per caseworker.
Other positions were dispersed statewide; she cautioned about
the significant amount of time required to recruit and train
staff for a position, especially with the six weeks of training
required by House Bill 151. Also, OCS is more cautious about
cases that are assigned to new caseworkers when possible (slide
10). Also due to House Bill 151, OCS has instituted a
mentorship program which assigns a field mentor to staff in
training who will answer questions, provide support, and help
staff transition from training to casework. Further, staff exit
surveys have indicated OCS fails to provide sufficient
supervision, thus OCS is developing more training in support of
supervisors and managers through a new coaching program. During
the next three years, OCS will focus attention on its managers
and new staff; within six to nine months, all of its new
positions will be filled and trained, and she expressed hope OCS
will begin to reduce its current statewide turnover rate of
approximately 50 percent, and regional rates as high as 80-100
percent. She stressed the majority of cases in Alaska are
Alaska Native cases - which are under the jurisdiction of ICWA -
and thus are more time consuming and require a higher level of
service, case management, and support. She concluded, noting OCS
seeks to support wellness activities for staff and is working
with the administration and the union to develop flexible
scheduling, opportunities for additional leave, and longevity
and incentive pay for caseworkers (slide 11).
4:59:16 PM
REPRESENTATIVE JACKSON returned attention to slide 1 and asked
what percentage of the almost 3,000 administrative reviews
result in the removal of children from their family.
MS. NORBERG clarified administrative reviews are required every
six months for children who are already in foster care;
administrative reviews are an additional requirement, which is
why OCS seeks to incorporate administrative reviews into a
judicial review process.
5:00:40 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:00 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| OCS CRP Response 4-30-19.pdf |
HHSS 4/30/2019 3:00:00 PM |
Citizen's Review Panel |
| CRP - House HSS Presentation 4-30-19.pdf |
HHSS 4/30/2019 3:00:00 PM |
Citizen's Review Panel |
| H0089 Version S 04.29.2019.pdf |
HHSS 4/30/2019 3:00:00 PM |
HB 89 |
| HB0089 Explanation of Changes ver S 04.29.2019.pdf |
HHSS 4/30/2019 3:00:00 PM |
HB 89 |