Legislature(1993 - 1994)
09/21/1993 09:00 AM House TAA
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE TASK FORCE ON ALCOHOL
AND ALCOHOL ABUSE
Nome, Alaska
September 21, 1993
9:00 a.m.
MEMBERS PRESENT
Representative Brian Porter, Chairman
Representative Eldon Mulder
Representative Jim Nordlund
Representative Richard Foster
MEMBERS ABSENT
Representative Joe Sitton
COMMITTEE CALENDAR
Public testimony on alcohol abuse.
WITNESS REGISTER
LOREN JONES, Director
Division of Alcoholism and Drug Abuse
Department of Health and Social Services
P.O. Box 110607
Juneau, AK 99801
465-2071
VIRGINIA TURNER
Alcohol Use Prevention Coordinator
Department of Corrections
P.O. Box 2145
Bethel, AK 99559
543-5389
CRISTY WILLER TILDEN
Program Director
Bristol Bay Area Health Corp.
P.O. Box 130
Bristol Bay, AK 99576
842-5266
LOUIE JONES
Police Officer
Dillingham Police Department
P.O. Box 130
Dillingham, AK 99576
842-5266
REGGIE JOULE
P.O. Box 51
Kotzebue, AK 99752
442-3601
DIANA FREEMAN
Norton Sound Health Corp.
P.O. Box 966
Nome, AK 99762
443-3344
ARDYCE TURNER
Substance Abuse Education andPrevention Department
YKHC
P.O. Box 1153
Bethel, AK 99559
543-4061
ELIZABETH SUNNYBOY
YKHC
P.O. Box 1568
Bethel, AK 99559
543-3854
SOPHIE NOTHSTINE
KAWERAK
P.O. Box 948
Nome, AK 99762
443-5150
DUFFY HALLADAY, Manager
Turning Point Detox Center
P.O. Box 1890
Nome, AK 99762
443-5577
ACTION NARRATIVE
TAPE ONE, SIDE A
Number 000
The meeting was called to order by Chairman Porter at 9:50
a.m. Chairman Porter gave his opening remarks.
CHAIRMAN PORTER: First of all, thank you very much to
Representative Foster for coming and getting us and
providing the logistical support for the first of the task
force's meetings here in Nome. This Alcohol Task Force is
comprised of myself, Representative Brian Porter. And the
other task force members are Representative Richard Foster
here from Nome, Representative Eldon Mulder from Anchorage,
Representative Joe Sitton, who is not able to be with us
today from Fairbanks, and Representative Jim Nordlund is
here.
I would also like to initially call the task force members'
attention to the task force book that we have prepared by
the staff of my office. The staff of my office happens to
be the one person sitting right behind us, Eric Musser, and
I would like to thank him very much for compiling a very
comprehensive book to get us a very firm foundation of
examining the problem of substance abuse and alcohol abuse
within the state.
I would like to, if you haven't already, call the members'
attention to the Ombudsman's Investigative Report which
calls to our attention the need for evaluation programs --
the Department of Corrections' substance abuse program,
which during this year's session we have heard an awful lot
of testimony about the requirements of the Department of
Corrections and indications that apparently most of the
inmates therein are there as a result of substance abuse
problems. Within the framework of that, we (inaudible)
information especially from the testimony that was received
by the sentencing commission. The Alaska Judicial Council
report is also very interesting.
That basis really was the inspiration for House Speaker
Barnes to appoint this task force, to look at the overall
state policy, statutes and law that are aimed at dealing
with the state's alcohol abuse problems. We have, as I've
discussed with most of you, we have no fixed agenda. We're
not going in with any presumptions about the extent of the
problem or what is really necessary to correct it, with the
exception I think of two assumptions and one conclusion that
are somewhat fundamental.
One of the assumptions is that Alaska has had and still has
a myriad of problems caused by alcohol abuse and more
problems that are exacerbated by alcohol, the abuse of
alcohol and other substances. While these problems
continue, as with the case with state programs, resources to
address these problems are diminishing. Consequently, it
would appear mandatory that this task force look for
programs that will provide measurable results that can
identify potential as well as existing problems and
individuals and deter potential alcohol abusers and redirect
those primary abusers. I guess it's also fair to observe
that the problem that we are attempting to deal with is one
that has plagued this state and our nation, for that matter,
for decades and that there is no one quick and single
answer.
Existing responses to the symptoms or the problems,
whichever they turn out to be, can be found in the
philosophies of the field of education, health service,
public safety, social programs and many others. What we
would like to do is hear from as many of these disciplines
as possible and learn their perspectives of the problems and
their solutions and to get perspectives from as many members
of the public as possible. (Inaudible) this information we
would like to see if there are any obvious directions for
the state to take in terms of coordination, innovation, or
for that matter, elimination of programs. At the very
least, we would like to see this task force develop a list
of items of apparent promise and to deal with these
individually during 1994.
I would like to note our recognition of the work presently
being done by the Alaska Natives Commission, the joint
federal/state board looking at all issues affecting Alaska
Natives and look to receive their input as it would relate
to the same topics that we're addressing.
With that in mind, we will begin taking testimony. That is
as I hope is appropriate, and we appreciate his presence,
the Director of the State Division of Alcohol and Substance
Abuse, Mr. Loren Jones. Welcome Mr. Jones and please turn
yourself on and talk to us.
LOREN JONES: Okay, thank you Representative Porter. For
the record, my name is Loren Jones. I am the Director of
the Division of Alcoholism and Drug Abuse for the Department
of Health and Social Services. We welcome this task force,
uh the division, uh is always attempting to determine from
local programs and from local providers and the public what
kinds of services we should provide and what the local
programs need and want to address those pressing issues
locally. I was scheduled for an hour of testimony. I don't
think I'll take that long, but I would like to just sort of
give you a little bit of background on the division, how
we're organized, what some of our purposes are, to describe
some of the efforts we have done to address some of the
issues raised in the Ombudsman's report, as well as to
address issues we feel are facing the field of alcohol and
drug abuse and inhalant abuse, and then to take a minute to
describe some of the resources available, some of the
programs available in the communities, that I believe are on
the teleconference or potentially on the teleconference
today, so that you have an idea as you listen to the people
from the various communities what kinds of services are
available there and where we feel they may be lacking
services and what kinds of issues are there.
I also have brought with me as much information as I could
sort of glom onto to hopefully answer any questions that you
might have either after my testimony or during the day if
the opportunity presents itself.
The division is a division within the Department of Health
and Social Services. We became a division in 1990 by
executive order. Prior to that we were an Office of
Alcoholism and Drug Abuse. We have an advisory board that
is made up of 12 citizens appointed by the Governor. There
are currently 11 members on that advisory board. The
statutory authority for our division is found in AS 47.37,
which lays out the duties, responsibilities of the division,
lays out the philosophy of the state regarding alcoholism
and intoxicated persons. Within that chapter is also the
involuntary commitment act for those persons who do not seek
treatment on their own and for whom individuals responsible
for them feel that they need to be committed, give guidance
to the court as the courts reach that decision as to whether
to involuntary commit.
Our board has a status under AS 44.29. That again lays out
the duties of that board which are basically to advise the
department and the commissioner on issues relating to
alcohol abuse, drug abuse and inhalant abuse. This task
force is set up as an alcohol and alcohol abuse task force.
My division also has responsibilities for drug abuse issues
and inhalant issues.
At the federal level we are now being required, as a result
of federal block grant funding, to be somewhat responsible
for tobacco, even though within our department of Health and
Social Services tobacco is structurally under the Division
of Public Health. Along with CDC's recommendation, the
Center for Disease Control, and other federal officials, we
are now being required to do some things in terms of
violence prevention as well as its related to use of
substance abuse in schools, weapons in schools, the advent
of gangs, those kinds of things, youth violence. We're
slowly being required at the federal level to deal with that
as part of our overall prevention efforts. The other task
forces (inaudible) in terms of alcohol and alcohol abuse.
My division's responsibilities are quite broad. We are
basically organized into three sections. We have an office
in Juneau that is basically the policy section, the
management information section and our administrative
section where we do all the grants management. We have two
offices in Anchorage. One our Anchorage field office which
has seven staff members that is responsible for the quality
assurance program and responsible for providing the
technical assistance and grant support to all the various
local programs that are funded out of our division. AS
37.37 also requires us to establish standards for quality
treatment programs and to apply those standards to both
public and private treatment agencies. So we do an on-site
to give a certificate of approval to every program that says
they provide alcohol or drug abuse treatment.
CHAIRMAN PORTER: What title is that now?
LOREN JONES: AS 37.37.130 I believe. So we do review the
programs at Providence, Charter, private psychologists,
private programs like that as well as state grant funded
programs.
Our third office in Anchorage is the Anchorage Alcohol
Safety Action Program and it's located in the Court
building. They have two responsibilities: one is to
provide direct services to the Anchorage court system for
misdemeanant offenders referred by the court system. The
Alcohol Safety Action Program started out to be programs
that dealt with drunk drivers. Currently the Anchorage
court system in particular and many courts around the state
are now sending other alcohol related misdemeanant
offenders. Our Anchorage case load is about 50% drunk
driving offenders and 50% other misdemeanant offenders.
Step down felonies that deal with alcohol related violence,
domestic violence cases, assault, burglaries, those kind of
misdemeanor cases that are in fact alcohol related are
referred to the ASAP office. That has made our case load
there increase in the last six or seven years by almost 200%
with no increase in staff. Also these (inaudible) ASAP
programs around the state to various nonprofit agencies,
they do the same function.
The second function of the Anchorage ASAP office is to
provide technical assistance, quality assurance and
oversight of the other grantee programs that do the Alcohol
Safety Action Program. The task of the ASAP is to assure
there is continuity and that we offer the same services to
each court system. We have a standardized assessment
process, standardized protocol for handling the cases,
referring them on for other treatment or education and also
getting back to the court if they are noncompliant with
either their treatment or their education. That is the only
direct service that the division operates. All services
provided in the State of Alaska for the direct prevention,
intervention or treatment of alcoholism, alcohol abuse, drug
abuse and inhalant abuse are done through local nonprofit
grantees or municipal government.
The grant in aid authority that we operate under is AS
47.30.475-500. It lays out the conditions for granting
funds to local programs. It lays out the match requirement,
which is 10%, and they also lay out the requirement for
local plans, local needs assessment that are required of the
local programs. We're only allowed to grant to nonprofits
or municipal arms of government. We may not provide any
funds to profit corporations, and by federal law we cannot
provide any funds to inpatient treatment. The inpatient
that is available in Alaska as within the private sector and
it is funded through either private health insurance or
first party pay.
We recently in FY 92, toward the end the legislature, passed
HB 545 which permitted Medicaid to begin paying for
substance abuse treatment. To date, regulations have not
received approval to implement that program and so no
program has yet to receive any Medicaid funding. It is now
authorized and we are trying to get the regulations through.
That would provide Medicaid funding for some residential
care and mostly outpatient treatment care for those
individuals who are on Medicaid. However, the way in which
the Medicaid program operates, under the program refinancing
scheme, we will be required to pay the match to Medicaid,
which means that we reduce the grants to the local program
in the amount we think they will achieve when they start
billing Medicaid. So that there is some gain we are
basically replacing general fund dollars with 50% federal
and 50% general fund instead of 100% general fund; but under
that scheme of trying to refinance, we're not able to
increase the amount of services available. We're basically
staying flat.
Our budget, and I know it's in the book that Eric had put
together, a budget summary for you from about 1984 forward,
and as you'll notice we reached a relative high in FY 92 and
in FY 93 we took a decrease of about $1.2 - 1.3 million, and
for FY 94 we took an additional decrease of $500,000. Some
of that was in state money and some of that was in federal
funds. The legislature has also changed the nature of our
funding, as has the federal government. We receive a
federal block grant from the Center for Substance Abuse
Treatment. The Center for Substance Abuse Treatment is
within the Substance Abuse and Mental Health Services
Administration in the Department of Health and Human
Services within the federal government.
Prior to FY 93 the block grant was combined with mental
health. In FY 93, under the reauthorization of block grant
was split between mental health on one side, as a separate
block grant, and alcohol and drug abuse service as a
separate block grant. When we did that, we had a reduction
in funds come to us because they took a higher percentage of
that money for the mental health block grant that had
previously been done. At the same time, the legislature
over the last three or four years has continued to increase
the amount of general fund dollars that come from the mental
health trust into our budget and decrease the amount of
general fund. In the largest grant component in my BRU, I
have about $900,000 of general funds out of $17 million. $2
million is federal, the rest is from the mental health
trust. What this has done is to...
One of the criticisms of the Ombudsman's report was that our
mission statement didn't necessarily give us a direction to
go that we could show that we had some impact and we didn't
do very much of a needs based assessment and we didn't put
our money where there's the best chance of having a good
return come from. One of the federal statutes and federal
block grant requirements, ...we have to spend 20% of our
federal block grant on prevention. We have to spend 35% of
our block grant on alcohol abuse programs. We must spend
35% of our block grant on drug abuse programs, and
increasing to 20% now on women's only services. If you add
that up it comes to 105%. We're also allowed to take 5% for
administrative costs, which we do. We can double count in
the fact that people who do receive alcohol services may be
getting prevention services, women may be getting drug abuse
services, and those kinds of services give the ability to
double count. But it does place some restrictions on how we
can spend the money, irrespective of what our plan might
say, irrespective of what we might desire. We might want to
spend 90% of our money on alcohol, but we are precluded from
doing so.
In addition, under the mental health proposed settlement and
under the court ruling, the beneficiary of the mental health
trust is the chronic alcoholic with psychosis. There is a
definition of law. There is no clinical definition of a
chronic alcoholic with... therefore, the mental health
board, acting as trustee, believes the legislature has erred
in assigning 86 to 90% of my budget to the mental health
trust because they feel that less than 25% of the clients we
serve are in fact chronic alcoholics with psychosis.
Therefore, we tried desperately not to fund prevention
efforts from the mental health trust dollars and try to use
general fund dollars.
Specifically, drugs are not mentioned in the mental health
trust settlement so we try to use general fund and federal
dollars for drug abuse funds as well. That is increasingly
hard to do when you have a decreasing general fund dollar
and an increase in mental health trust dollars to honor the
basic law from the court that says the beneficiary of the
trust is a chronic alcoholic with psychosis. So we've sort
of been placed in a box that makes it difficult to put the
funding where individuals feel it is best needed, to make
sure that the programs, as they serve the client, who
doesn't care if they are a beneficiary of the mental health
trust, doesn't care if they are in a box at the federal
funding level, but do care that they get the appropriate
service that they want to solve their issue they have with
alcohol and drug abuse or inhalants.
That is a problem that we faced that we don't know a ready
solution to. The administration's position is that the
legislature has established that policy that alcohol
services will be funded from the trust, that by their
appropriation of those funds they have expanded the
beneficiary. The mental health board feels that is not the
case, that the legislature needs to pass a statute that says
their standing as the beneficiaries of the trust which under
the court ruling they are allowed to do.
So then, trying to plan down to the level of services under
some of the recommendations of the Ombudsman, we do run into
some of those financial considerations that pose a problem
for us. In addition to the fact that inflation eats into
the treatment and prevention dollars of the local programs,
the fact that we reduced their programs the last two years
in a row, you can add to that whatever inflationary factor.
We went back and looked at our budget from 1984 forward to
1994 and we started out in 1984 and we just added a simple
3% inflationary factor so that you get a basic... if we had
gotten a 3% increase every year... what our funding level
would be, we are well below that level with FY 94, so that
the impact of inflation, the impact on increased health care
costs, the impact on fixed costs for residential costs where
you have fuel oil dollars that go up and electricity costs
that go up and you have staff costs that go up and you have
increasing social security costs that go up and an
increasing costs of doing business and a decreasing amount
of funds coming into local programs, has really put a lot of
programs on the brink. Just not being able to provide the
level of service they currently provide and certainly not
the comprehensive level of service they think they need to
adequately serve their particular areas.
Under 47.37 the legislature has laid out what they feel is a
comprehensive program and this comprehensive program must
include an emergency care, it must include residential
treatment, it must include outpatient care and it must
include after care and follow-up. We attempt to provide
that level of care and at least Level 3 communities and
Level 4 communities. Level 1 and Level 2 communities we
have a reduced level of that care. Within health planning
Level 1 communities would be small villages, Level 2
communities would be health communities, I believe that Nome
falls under a Level 3 community, a population over 2500 to
3000, so we do have a level of care that sort of determines
what we are willing to support in a local community. Within
those realms then the local communities have some ability to
change services to make those services more appropriate for
the local community and I'll explain a little of that in a
minute.
We have many issues that face our division and face the
alcohol and drug abuse and inhalant field in the next few
years. The issue of the increasing realization of the
dually diagnosed population, those who are mentally ill and
are also substance abusers, there are liberal debate raging
at various places, not as heavy in Alaska as it is in other
places, over what the extent of that population is and
what's the appropriate way to address and treat that
population.
There are definitely a significant number of individuals who
are mentally ill that abuse alcohol and drugs. They do that
as part of their mental illness, they do that as a method to
medicate themselves, they do that as a method to try to
solve some of the mental health problems; they may also be
physically addicted to alcohol or drugs and also be
diagnosed as suffering from alcoholism or drug addiction.
In addition, there are significant number of persons who are
alcoholic or drug addicts who are not mentally ill, who do
not have a diagnosable mental illness, and they may exhibit
at times the same diagnostic characteristics. But periods
of absence and a quality recovery program and those symptoms
tend to go away.
It's a difficult process in some communities so separate
those two and that is an issue that we are constantly
dealing with, both at the federal level and within Alaska.
Emergency care is a problem in that we try to provide some
level of detox or emergency care within most of the hub
communities, but that is expensive and not always available.
And there are differences of opinion as to how you should
provide that.
Anchorage is a prime example, where several years ago they
used a public inebriate reception center, tried to hold
people there. It was relatively inexpensive. There's a lot
of individuals who didn't want to go on for detox, which is
more expensive level of care. They dropped that and now
have expanded the size of their detox, trying to sort out
how to deal with the homeless population, trying to deal
with the street people.
In a community like Nome... they have a five bed detox in
this community that refers people into a residential
treatment program. In Bethel there is no detox program.
They have... its been a difficult process for the community
of Bethel to decide whether they want one, how they would
operate it, how it wouldn't be (inaudible) just a revolving
door institution for people who were ill, who needed to go
on to further treatment, but simply use this to be safe in
the wintertime and to get a little bit of their health back
and then who refuse to go on to further treatment. That is
a relative expensive level of care.
There are many communities that would like to use the
involuntary commitment act that is part of AS 47.37. They
have asked that we as a division look at revising that
portion of the statute. With all of our other priorities we
have not had a lot of time to look at that. Several years
ago, then Senator Uehling had a bill in that would have
changed that. It ran into some significant problems with
some communities over the way it was worded. It ran into
some problems with confidentiality issues and what could be
shared in a court hearing from clinical treatment records
and what could be not and some of those issues just didn't
get resolved before the Senator was no longer in office.
Some communities use it very well, other communities do not.
Two or three of the major problems with it is that it does
not guarantee treatment. If you were mentally ill and you
were committed under the mental health commitment statute
you have a right to treatment. If you can't be treated in
the local community, than you can be committed to API. That
is their final back-up if they can't use the local hospital,
if they can't use the hospital in Fairbanks, then their
backup is API.
Under the alcohol commitment statute there is no right to
treatment. If the court commits the individual and there is
no treatment available in that community, then they have to
try to find another bed someplace else, and if that's not
possible, then the individual does not get admitted even
though the court has involuntary committed them to a
treatment program. We're not funded to guarantee that
there's beds available. We're not funded to pay for the
transportation.
As an example, you could have an individual in Wrangell that
has an outpatient program. You get the individual care
committed, there's no beds in Juneau, there's no beds in
Ketchikan, there is a bed in Fairbanks. How you pay for the
transportation to get that individual from Wrangell to
Fairbanks, that's not part of our current budget stream,
it's not something that we have felt the statute gives us
the responsibility for. Sometimes they'll get that donated,
sometimes the person can pay part way, sometimes the program
pays, sometimes the program will pay half the cost, the one
way ticket. After the person's been through treatment, then
the person's responsible for the return flight.
So those are a couple of the issues facing them. Also,
because it's not within the same (inaudible) as the mental
health, if the local program does the commitment, they have
to get their own attorney. Under the mental health statute,
it's the state that is committing this person to the
community mental health center and the state Attorney
General's Office represents the state's interest in
committing this individual.
That is not the case under the involuntary commitment for
alcoholics. It may be an issue that this committee may want
to look at more closely or ask some questions of those who
do use the commitment act.
I believe that John Dapcivich from the City and Borough of
Juneau has done a look at the involuntary commitment act and
looked at public inebriate services and I think he sent that
report up to Representative Porter's office. If he didn't,
I'd be sure to get another copy. He looked at those issues
as they were done in Sitka, Petersburg, Ketchikan, Anchorage
and Fairbanks. I came to Anchorage and just had a meeting
and I'll get you a copy of that. I thought that he had said
that he had sent that up.
In addition, I think you'll hear during the course of this
testimony, even though this is on alcohol and alcohol abuse,
I think you'll hear increasing requests for services to
young children for inhalant abuse. It is a growing problem
in recognition and I think in actuality, in rural Alaska
especially, but some in the urban community, we have been
attempting to deal with that existing services with existing
programs and I don't think that we are being very
successful.
We have the Norton Sound Health Corporation here in Nome
apply to us, to the federal government for a inhalant
treatment program at White Mountain. We have some
indication that there might be a chance that might be
funded. We should know hopefully be the end of this month,
the first part of October. If that happens, it will be one
of only the second inhalant abuse treatment programs that
have been funded by the federal government. One is in South
Dakota, a program called Our Home or Our House and so the
Nome area would have the second one in the nation that was
funded specifically for inhalant abuse.
We still have the recurring issues of drug abuse, ups and
downs, some increasing cocaine issues facing treatment
providers. That seems to be an increasing drug of choice as
people come into treatment. It is still overwhelmingly
alcohol, but we are seeing more of that. Even though some
of the public safety issues and some of the major arrest
issues and stuff are down somewhat. We are continuing to
see an increase in people that are coming into treatment for
cocaine use.
We have attempted in the six or eight months since the
Ombudsman's report came out and since we went through
legislative hearings in the budget process to answer some of
the questions, and Representative Porter certainly raised it
this morning in terms of finding out which programs work,
what the emphasis of the programs are, how effective they
are.
We have done this in three ways. First of all, the House
Finance Subcommittee had originally proposed some intent in
the budget that would have required all of the programs to
do outcome research and to determine the efficacy of their
individual programs. That intent never made into the final
budget process, but we did put a special condition in all of
our treatment grants that asked them if they had done
follow-up studies, if they have checked on clients after
treatment, if they have done any of that research, that they
are to submit a report to us by the first of December so
that we can compile that information and present it to the
legislature in some summary form. Also, so that we can look
at are they using a common definition of outcomes, are they
using the same approach, is there something here that we
might be able to learn from and could institute that across
all of our programs? We hope that we will get a good report
from that.
Secondly, we hired a college intern this summer who has been
working in our Anchorage ASAP office. She has been taking a
sample of cases that were referred to the ASAP office in
1989 and then using the public safety's computer system, the
Alaska Justice Information System, she has been going
through and seeing if any of these individuals have repeated
the offense for which they were sent to ASAP; i.e., have
they done another drunk driving offense, have they committed
any other offenses over the years 90, 91 and 92? That data
analysis should be completed by the first part of October.
We then applied to the Department of Public Safety, through
the Highway Safety Planning Agency, for money for a
professor at the University of Alaska to analyze that data.
Just as I was leaving yesterday, I found out that that will
probably be funded, but we won't know for another week. And
if that is funded, then hopefully by the time the
legislature comes in we will have that report available from
the University in terms of how well at least the Anchorage
ASAP office is doing.
CHAIRMAN PORTER: Who's is that Professor?
LOREN JONES: Sharon O'Raji
CHAIRMAN PORTER: What University?
LOREN JONES: Sociology Department, University of Alaska
Anchorage.
And third, we were able to convince both the Commissioner
and the Office of Management and Budget to use a portion of
capital funds that were earmarked for Mental Health Trust
facilities for beneficiaries, to use some of that money to
put together a more standardized follow-up project for both
rural and urban out-patient and residential programs. We
have set aside $250,000, we have received authority from
General Services and Supply to sole source this contract
with a program called New Standards Incorporated out of
Minnesota. They used to go by the name CATOR, which is a
Comprehensive Alcohol Treatment Outcome Research Project.
It is a firm that has gained a significant reputation in the
field and among other states starting out first in the
private sector and now working more in the public sector in
attempting to do some standardized treatment follow-up that
allows you to compare both between programs and compare
programs of like in other states, in other places. They
have maintained a fairly large, expansive data base of
services. We are in the process of negotiating that
contract now. Hopefully the data collection will start in
December. The final, final results will be 2-1/2 years from
that time. The reason for this is that follow-up studies
are extensive, expensive and need a lot of time.
We are going to collect data for a year. That means that
when a person enters the treatment programs that we select,
they will be given the standard assessment that that program
does, as well as a standard assessment from CATOR. If
they're in a residential program, they will be given the
same instrument at discharge from the residential program.
If they are in an outpatient program they will pick a time
certain, usually a month or two months after they begin
treatment, and they will do this discharge summary. Then
all that information is collected at the local program level
and sent to CATOR. They put those all into their computer
data base and begin the analysis of, What is the profile of
the client as they come in the door? What is their
employment status, their health status, their legal status,
their diagnostic categories, educational level, marital and
family status, use of social services agencies, all of those
things that are harmed within a person's life by their
substance abuse. They will then contact that person at six
months and 12 months from the time of discharge to determine
what their status is on all those same variables so we can
see how they've improved, which clients improved the best
within what kinds of treatment and also what information
will be available back at the programs. Some preliminary
data will be able to come out at nine months and 12 months
because we will at least have intake information and we will
know what our client population looks like, different from
our management information system. To do that level of
follow-up to give you the scientific validity, that you did
the appropriate sampling, that you got enough clients so
that you're statistically correct, that if this is not an
anomaly, takes a significant amount of time and effort.
We are going to try, I think, to collect the initial
information on roughly 1,400 clients. CATOR is hoping that
700 to 800 will still be able to be found and followed up 12
months after their discharge from treatment. We do expect
some attrition. People will refuse, they'll change their
mind, they won't want to talk on the telephone, there will
be all kinds of other issues that will be raised for people
who drop out, but we're hoping that effort will come about.
We will have that contract and the scope of the work
available when the legislature... so we will be able to walk
that through the budget committee and the other legislative
committees if they're interested.
In addition, we have put together a group of individuals
called our Strategic Planning Team that represent the
providers in the field, that represent the Departments of
Corrections, the Department of Education, within our
department the Division of Public Health, the Division of
Family and Youth Services and the Division of Mental Health
into a strategic planning team that has been looking at
three things: one, at our mission statement, what we're
about, why we exist, where we should go from here, and to
basically try to put together a strategic plan for our
division that will both push and pull us into the future and
not keep us mired as much in the past as I think some of our
plans have been rightly criticized for being. The first
draft of that plan will be presented to our advisory board
in Fairbanks on Thursday. On Friday and Saturday they will
be holding public hearings in Fairbanks on that plan. We
are reviewing it within themselves, making comments back to
us. We will then take the month of October to finalize
writing it. The last two days in October, I think the 28th
and 29th of October, we will bring our strategic planning
team back together to take one more look at that product and
then by statute that product will then go back to the
commissioner's office and then to the Governor. I believe
it's AS 47.37.040(10), requires us to develop a plan for the
Governor, and so this plan will be presented to the Governor
and hopefully he will accept that plan and then we will be
on our way to basing our fees for the next budget cycle, the
next grant cycle. Hopefully that will address some of the
issues addressed in the Ombudsman's report.
CHAIRMAN PORTER: Let me interject here if I may and I hope
(inaudible) vote that my voice is not getting all the way
to Bethel. I hope it is now. I'm a little closer to the
mike. If not, let me know and I'll put it in the back of my
head. I recognize that obviously for final approval that
that draft plan for your division would have to go the
Governor's office. I would appreciate it if you could find
out for us whether or not this task force could be made
aware of what that plan contains prior to that with whatever
restrictions the Governor's office might want to put on it,
to the extent that we could perhaps have input from the
information that we're gaining to suggest inclusions for
dilution's or amendments to that plan before it gets etched
in stone and has to go through another lengthy process.
LOREN JONES: I have assumed that at the October 4th
meeting, which was after our board had met that, 1) there
may be some testimony from those who attended that meeting,
at least the front section I believe I was going to try to
get to the task force. What we had the most difficult time
crunch on is when you get down to the nitty gritty of
defining the goals and trying to put those in the
appropriate outcome measures. It's harder to get agreement
and that is the weakest part of the draft to date and that
is the part we will work on through October and the end of
October at the strategic meeting, (inaudible) and then
philosophy on some of the research and the background behind
that, I'm planning to provide the task force on October 4th,
after our board had looked at it and made their comments and
so we will provide that.
And then as soon as that plan has been approved by the
strategic planning committee, if the Commissioner desires, I
will make sure you have it as early in November as I can
before your December 1st hearing to make sure you do have
that available.
Just a couple other things and I guess I will stop for some
questions and allow other people to testify. I have an
opportunity through several other hearings to say other
things.
One of the issues that you talked about in terms of
coordination and cooperation between other programs... This
division, with it's divisional status, certainly does
attempt to coordinate as best we can with other divisions
within our own department. Sometimes that's easier and
sometimes it's harder. We do have some projects jointly
with the Division of Mental Health. One of those projects
is the dually diagnosed projects... (end of tape)
TAPE ONE, SIDE B
Number 000
...by the Division of Alcoholism and Drug Abuse. It
provides for rural human service workers in the villages,
people that can provide, like a community health aide does,
providing primary health care in the village and like the
(inaudible) providing primary public safety that the human
services worker would be able to provide substance abuse
services, mental health services, referral, after care,
education, prevention work within each of the villages. The
Niel Corporation in Kotzebue and the Dillingham/Bristol Bay
Area Health Corporation are two grantees under that program
that may be on this teleconference and that is a joint
funded program that provides for additional services in the
villages. One of the lacking of some of the services as I
described those will be that lack of services into the
communities.
In addition, the Department of Corrections we have work with
in terms of providing counselors within each of the jails.
The Norton Sound Health Corporation here has a contract, has
a contract, with the Department of Corrections to provide a
counselor at Anvil Mountain. Those grants used to come from
us. Corrections gave us the money several years ago. The
Department of Corrections opted to want to run that more in
house of their department rather than our division. We have
been in the process of reversing that and we were going to
RSA them money. The legislature deleted that money in the
FY 94 budget so the entire inmate substance abuse program
within the Department of Corrections is solely funded with
the Department of Corrections funds.
We have encouraged them and they have continued to use local
providers rather than hiring alcohol counselors on state
salaries. We feel the local programs provide ample
expertise and abilities to provide those services in the
jail and to (inaudible) substance abuse costs to the
Department of Corrections. However, the Department of
Corrections is still using us to fund community treatment
beds for inmates who are getting out on furlough or getting
out on parole that need a residential level of care once
they have left the institution, and so we do have a
relationship with them and then we grant that money out to
local providers and communities that the Department of
Corrections desires, and that money then flows out to the
local treatment programs to provide bed space and treatment
capacities for persons leaving the Department of
Corrections.
Within the Department of Education, they have a federal
program called the Drug Free Schools in which the federal
government gives the State of Alaska a certain money. That
money is then sent out to the local school districts on a
per capita basis with formula basis based on their average
daily census within the schools. As part of that there is a
requirement that they have an advisory board that advises
the Department of Education on the plan and some of their
distribution. I am a member of that, as well as a member
from the Governor's office.
In addition, the Governor has awarded discretionary funds
under the drug free schools act, and I think some other
bureau of justice system that the governor's of each state
has the ability to give where they want to provide whatever
services. Governor Hickel, Governor Cowper before him,
opted to give that money to the Department of Education and
that is put out in prevention grants to local school
districts, to some local providers.
They are all prevention efforts. They subsidize DARE
programs, the Drug Abuse Resistance Education programs that
are operated by local police officers, and we fund some of
those directly.
So we do in many cases opt to work with other divisions and
other departments in order to better coordinate services for
the client.
I understand in the book you were given a map that people on
teleconference won't be able to see, but basically lays out
our regions. Also on the map that gives you an idea what
our funding percentages are based on that population.
One group of people I'm leaving out are the Indian Health
Service which does provide a considerable amount of money
directly to local programs, mostly 638 contractors, although
they do have some funds that they call bi-Indian money. But
most of them are 638 funds as federal public law that allows
for Indian self determination and the Indian Health Services
funds from (inaudible) corporations for primary medical
care. Substance abuse prevention, I think some FAS funds,
health care community health aids, a lot of that is under
the 638.
If I might, I could just sort of go down the regions that
may be on the teleconference and if I can a little bit from
memory give you an idea of the (inaudible) of the bill. If
you start of the top, Region 6 is basically the North Slope
Borough. The major grantee is the North Slope Borough
Health Department. They receive funds for both outpatient
and outreach efforts in Barrow and the other communities.
They are funded for a six bed detox program and a 16 bed
residential program in Barrow. We are probably a minor
contributor in terms of funds. I believe we contribute
roughly $500,000; I think the Borough probably puts in
another $1.5 million in order to fund that program at the
level at which they do fund it.
Region 5 -- as you go down the left side, is in the Manilik
region. The Manilik Association receives funding through
the budget request region, the Manilik BRU. They do not
receive funding out of our grant budget. They provide for
village outreach, a level of outpatient care. They have a
detox program and a 12 bed residential program. They also
do some of the prevention work in the schools. Also, as
part of Region 5, is the Norton Sound Health Corporation
Region that's headquartered here in Nome. The Norton Sound
Health Corporation also is funded from a Budget Request
Unit. It is not funded out of our budget. I believe they
primarily use our money for their residential program,
Northern Lights Recovery Center. Indian Health Service
money pays for their prevention effort, some of their
outreach effort. I know that there's one representative
here in the room that has testified. She could probably
better describe that program better than I can. I'm
probably not doing justice to it.
Region 7 -- which is the YK Health Corporation, the Bethel
Region. They are funded in two ways. They get some money
from our grant, the majority of money from our grant
program. They also have their rural services, they are
village counselors, there are nine, are funded through the
budget request unit for YK (Yukon-Kuskokwim). The City of
Bethel used to operate the treatment program there and the
YK Health Corporation did the rural services. About two
years ago the City of Bethel opted to no longer perform
those services and so YK Health Corporation has taken over.
The money has just never moved into their BRU, but I suspect
that this year we will be coming in with a request to do
that.
Region 2 covers the Dillingham area. The Bristol Bay Area
Health Corporation is the provider there. They provide
mostly outpatient services. They provide alcohol safety
action programs. We pay for services in the villages,
village counselors. The Indian Health Service supports
that, as does the rural human services project. They just
recently opened up sort of a transitional residential place
for those who have been, say in Anchorage or Fairbanks for
treatment. On their way back to their village they may stay
in Dillingham for two or three days to sort of adjust back,
to talk to the local people, make contact with the provider
there, before they go back to their local community. It's
also a transition for those who are leaving their local
community, maybe going to treatment elsewhere, to come in
from a outlying village into Dillingham, spend three or four
days talking with the staff there, and then moving on. I do
believe when I talked to the program director there
yesterday that she was going to try to, during the day, to
testify and I'm sure that Dillingham will do that.
Region 9 is mostly the interior. It's the Tanana
Chiefs/Doyon Region. I don't know if you are
teleconferenced to either Galena, McGrath or Aniak, but
within that river system, sort of the mid-interior, we do
have a project in Galena, we do have a project at McGrath to
serve all those villages there and then Aniak serves the
villages of the Kuskokwim Natives Association which is
called the Yukon/Kuskokwim Health Corporation District, but
they do have a separate program for the seven or eight
villages along the Kuskokwim River out of Aniak. As you can
see by the map, it describes basically the population and
the percent of dollars. These are a low population area.
They get a considerable number of resources.
Region 6 has one percent of the state's population and they
get three percent of our grant funds and Indian Health
Service money. When you combine all the money provided out
there they get three percent.
Region 5 has three percent of the population, nine percent
of the funding.
Region 7 has four percent of the population, seven percent
of the funding.
Region 2 has three percent of the population and four
percent of the funding.
We feel that this distribution is justified in many ways.
It is very difficult to provide services out here. It is
very costly to provide services. When you're in the Nome
area and you try to serve St. Lawrence Island and you have
to fly people out and fly clients in, prevention efforts
out, salaries are higher, travel costs are higher. There
are real significant issues with that.
I guess with that as an overview, I'll give you an idea of
whom might be testifying. I can either answer questions now
or as the day proceeds, whatever you desire. Thank you very
much Mr. Chairman.
CHAIRMAN PORTER: Thank you Loren, very much, for that very
comprehensive overview of where we are and what's going on.
I would recognize over the teleconference network that we
have, I believe, Kotzebue, Bethel, we have people here in
Nome of course, and Dillingham. I think I'll ask the
committee now if there are any specific questions of Loren
and if we can get a few of those taken care of. Loren, you
will be here with us during the day?
LOREN JONES: Yes, sir, I'll be here all day.
CHAIRMAN PORTER: So we don't have to exhaust him right now
and could get some quick ones taken care of and then we'll
go out and rotate through the teleconference and here in
Nome people who would like to talk to the task force.
Representative Mulder.
REPRESENTATIVE MULDER: Thank you Mr. Chairman. Loren,
starting at the beginning point, the assumption for every
BRU, or every division -- if only I had more money, we could
do a better job. I recognize that in one hand it's kind of
the senseless question to ask you if you had more money
could you do a better job because a good bureaucrat is
always going to say you bet. Being very critical Loren, at
what level funding does it begin to drop off. You know,
there is a point where you just can't overcome a problem or
you are looking at it from a different direction or a wrong
direction. The question is really a general one. Does more
money mean a better program in your sense?
LOREN JONES: I believe the answer is yes, for several
reasons. One is that we do a very good job given the
resources we have available. I think that any outcome
research we would do or anybody else would do would show
that the programs are working for a majority of the
individuals who come through treatment. We are as
comparable with any comparable programs anywhere in the
nation. I think where we could improve -- and I can't
answer the question, When is enough, enough? -- in terms of
when does the treatment foul up. There are a lot of issues
that make treatment less successful than it could be and
thus cost money. When you take an individual from a rural
community and bring them into Nome, provide quality
treatment, they leave here full of hope, they are feeling
good about themselves, they've got a better self concept.
Physically they are healthier, and they go back to that
village, and they're back in the same housing situation with
other people who may or may not be in recovery, who may
still be actively drinking, they are still in the same
economic conditions as they were before. Some people who,
because of the treatment and because of the aftercare
provided, stay in recovery and some don't. Some relapse and
need to be brought back. In a more urban setting a lot of
the individuals that are treated in the public sector are
homeless, marginally housed. Treatment doesn't change that.
Some funds for housing might, some funds to build housing
that's not available in the Anchorage area or a Juneau area
where these individuals, maybe more half-way houses for
these individuals that are some place to go after primary
treatment that are less expensive. Job training, vocational
training, long term care for some of the hard core public
inebriate, those are expensive for a small portion of the
population. I'm not sure where the economic benefit stops
in terms of getting better results out of the treatment
program.
But, we are sending people back into the rural areas from
treatment programs in the communities that have no support
for them. There is no aftercare worker out there. There is
no VPSO out there. There is a community health aide
possible. It's very difficult for that person. Programs do
it by telephone. They try to contact the person by phone,
but that's difficult to do. Placing people out in those
villages, maintaining them, training them, providing them
their clinical support, is expensive and we're not funded at
a level sufficient enough to do that.
So, yes, more resources would make the treatment system
better because we could do some of the things beyond
treatment, beyond the physical period of sixty or ninety
days in a treatment program, beyond the actual outpatient
counseling that might be able to give that person the
stability they might need to maintain themselves.
CHAIRMAN PORTER: Representative Nordlund.
REPRESENTATIVE NORDLUND: Just to follow-up on Eldon's
question, too. I had another question. I guess we don't
really know, frankly, how well these programs are working
because there is some outcome research done, but the
criticism in the Ombudsman's was that it's not very adequate
and I think Loren's willing to admit that there is a better
job that can be done. So, until we have that component, we
are not going to be sure that the politics of the treatment
is.
Then I have a question. We have the research that's been
done, or the contract that's been let to CATOR to develop
their outcomes research, and at the same time you have the
strategic plan to determine the future of the division. I
guess my question is, How is the CATOR working, the
standards by which CATOR is judging the outcomes going to be
determined if you haven't done your plan yet? In other
words, what is the ultimate objective you are trying to
achieve, even in terms of social costs versus simply the
amount of personal (inaudible)?
LOREN JONES: Two-fold. One, is the outcome research is
very clinically oriented to the individual. There is a body
of literature and a body of research that is very extensive
in the Lower Forty-Eight, very extensive by the federal
government, that describes those things that drive people
into treatment for things that happen to people while they
are using substances: loss of employment, loss of skills,
marriage break-ups, over use of emergency rooms at
hospitals, loss of jobs, loss of family, dropping out of
school, not finishing your education, having failed personal
health. There are all kinds of issues that revolve around
an individual who is alcoholic and/or a drug addict who
uses. Youth, in terms of their completion of school,
staying out of trouble, drunk driving for adults and kids,
criminal behavior, all kinds of things that we relate to
alcohol.
Individually, you can measure how a person's experiences in
those various areas and you can determine a year after
treatment if those areas have improved. If their health has
improved, they are using ER's less. That's what CATOR is to
do. There is a standard body of knowledge out there and
they pretty well standardized this so that we can look at
comparable programs in the Lower Forty-Eight that they have
the data base on. We can find programs that serve the same
kinds of clients, the same age groups, the same racial
breakdown, the same sex breakdown, the same level of
debility or nondebility if you are talking about out-patient
clients. So we can compare how we're doing irrespective of
what the strategic plan is.
I can tell you that in the strategic plan one of the issues
is to develop a more on-going maintenance of that kind of
follow-up effort so that we don't have to wait two and
one-half years to get a result so that hopefully by the time
CATOR is done we will have taken that information,
instituted that on a routine basis, so that each year we
will have continuing information. So a strategic plan is to
push us ahead. We agree that there is not formalized
outcome research done in this state. We have not done a
(inaudible), a telephone study in 82' or '83. We have not
made a very good effort at that partly because we have been
under a lot of pressure, we feel rightly so, to expand some
services.
When we have asked for increments to fund that, generally
services have been funded and not research, and we have
opted not to take money from the grantees in order to do
that research and that's a choice we made and the Ombudsman
called us on it. At the same time, there is a body of
evidence that certain kinds of programs are more effective,
that programs that have these kinds of services, that
provide treatment for a certain length of time, cover those
subjects, provide the aftercare, make the referral to
self-help groups, are the kinds of programs that are
evaluated. We do have a process to determine that those are
kinds of programs that are being operated. So we have an
intuitive feel, we have a process feel and the programs
understand.
The people here in Nome know whether they have been
successful or not because the people they treat live here,
the people they treat are in their villages. They see those
people and they make the adjustments in their program as are
required. So, we think that we do know what is needed to
operate a quality program, that we have put in place
programs that meet those standards, that give us every
indication that they are being successful in what they are
doing. We just do not have the organized, scientific
research that will satisfy a (inaudible) maybe even satisfy
myself and certainly not have satisfied the Ombudsman. But,
we think we've got enough of that in place to be able to
come together with our funds.
REPRESENTATIVE NORDLUND: Loren, I've got a question
regarding the strategic plan and just how in the long-term
this is going to work. What assurance do we have, the
legislature and the citizens, that once a certain length of
time is often accepted, including the strategic plan, that
it's going to continue to be that way, that there is some
longevity to it. We could have changes in the
administration, a change in philosophy and turn the division
upside down. Is there something we can put in statute once
this is developed, or what sort of assurance do we have that
there is some longevity to it?
LOREN JONES: I'm not sure if there is a statutory answer.
The answer is, is there longevity to it to the extent that
the local programs are being funded to the extend that we
did hold some public hearings and we could combine? I would
hope that they would be able to force any changes of
administration to look at that plan and to try to accept it,
but I have no guarantees. I've watched the Division of
Family and Youth Services develop their strategic plan, and
then a change of administration and that plan got shelved.
There is a statutory requirement that there is a plan.
There is a statutory requirement that it be approved by the
Governor. When this administration came in, they accepted
the plan that was in place and I would expect that if we've
done a quality job and there is a lot of buy-off, that the
next administration would look at that. They might not want
to implement all of it. They may want to push it ahead.
In terms of are there guarantees for the legislature? No.
That's why the legislature has one, the Ombudsman's Office,
and two, legislative committees like this. That's your
control over us that we're doing our job correctly. If you
read the Ombudsman's report, we felt, and I felt when I was
interviewed, and I still feel, that we have tried to honor
the requirements of the statute. The statute gives nineteen
shalls that we shall do and we have a staff of 28. We have
a lot of programs out here that try to provide quality
services and we try to provide them with as much support as
we can.
The statute gives us the ability to define what is in a
comprehensive program, from emergency care to residential
care to outpatient care to aftercare and follow-up, and we
felt that we were trying to honor that. It gives us the
philosophy. It tells us what our mission is. It tells us
who our clients are: alcoholics, intoxicated persons, drug
abusers and inhalant abusers, and yet the Ombudsman felt
that that wasn't sufficient, that we have not maybe lived up
to that and that we had not gone beyond that statute. So,
even having it in statute does not necessarily keep a
program from either not meeting a certain set of standards
that somebody else places or maybe even not meeting the
standards that were set for itself.
REPRESENTATIVE NORDLUND: I guess one of the comments in the
Ombudsman's report, one of the main things was that there is
no mission statement and I think I can sympathize with that.
Over time and with changes in administration, the division
could gravitate, you know, or respond to political whims,
more so than if it had more of a state ironclad mission.
Not that a mission like that couldn't change over time, but
maybe you look at maybe some sort of statutory requirement
that there would be in (inaudible) of the strategic plan.
LOREN JONES: We will get the first part of the report,
which is the mission statement. The team worked very hard
to develop that and I think it does answer what the
Ombudsman would like us to answer, and in fact will give us
some real direction.
CHAIRMAN PORTER: Thank you Representative Nordlund. This
is Representative Porter. I'm going to go to plan C here and
try and get my voice to Bethel and use the button instead of
the switch. If that still doesn't work, I'll trade mics I
guess. Loren, if I might follow-up really on what
Representative Nordlund was mentioning. In reading the
Ombudsman's report, it appeared to me that part of the
ability of the Ombudsman had to criticize was that there had
very recently been criteria developed nationally, or at
least recognized nationally, begin to be recognized
nationally, of new methods of evaluation and new emphasis in
that area. With that in mind, and I'm sure you are now
looking at those methods to incorporate into your plan, if
it is the Title 47 that sets up standards for program, it
may well be that there is a need for statutory change and I
know that I would echo what Representative Nordlund just
said that we would be very interested in any recommendations
that your division, or all of the other people telling you
what to do, bring to you in regards to an inability that you
may have that could be rectified by statute or specificity
in what you should be doing that could be rectified by
statute. In that regard, also, I may have some experience
in program evaluation requirements within this state.
I know that one of the things, if you haven't already, that
a really comprehensive evaluation system is going to run
into is the problems of gathering data from other agencies,
other departments, as a result of confidentiality problems.
When those hit, I say when, not if, we would also be very
willing to look at what might be required to overcome those
obstacles.
LOREN JONES: Thank you very much. We will get you some
recommendations. It may well be, in terms of evaluation,
mandated. I believe that it is part of the statute, whether
it is specific or not, I don't know. We will take a look at
that and maybe be able to make some recommendations at the
October 4th meeting. In terms of what the Ombudsman said
about other states, one in particular they talked about,
South Dakota, had opted to use local funds to do that. They
are contracting to CATOR, the same agency that we are now
contacting with. The state of Ohio has just recently
contracted with CATOR also. So, some of the programs that
some of those states were mentioned in the Ombudsman's
report are using new standards.
CHAIRMAN PORTER: I think that the Kelso report ten years
ago, and now CATOR, will be able to, at quite an expense,
ferret out information using confidentiality, or having the
ability to overcome confidentiality programs with the
research exceptions and those kinds of things. What you
need to do, as you mentioned, is set up the ability to
provide ongoing reception of this information so that you
can continue this work with Kelso and CATOR go away. These
are the kinds of requirements that are going to be bring
these problems to bear. And as I say, when they get there,
let us know.
REPRESENTATIVE NORDLUND: This is on the funding question.
I need to just get some clarification here and maybe a
chance for you to address the Ombudsman's point. Your
funding right now is oh 85 to 90 percent out of the mental
health trust income account.
LOREN JONES: That's right.
REPRESENTATIVE NORDLUND: And according to that, the
beneficiary groups of that are current alcoholics with
psychosis.
LOREN JONES: That's correct.
REPRESENTATIVE NORDLUND: Now let's say that you're trying
to serve, what, 85 to 90 percent of your budget serves
chronic alcoholics with psychosis?
LOREN JONES: No. We have an agreement to disagree with the
mental health board in that we try to be as clear as we can
that we don't fund drug only programs, such as methadone
programs, drug free outpatient, uh, programs whose purpose
is primary drug of choice is other than alcohol from the
trust. We use federal funds and general funds to do that.
We do not fund prevention programs directly from the trust.
There is a prevention component to a lot of programs. The
Norton Sound Health Corporation has a prevention effort
funded by the Indian Health Service, but some of their local
alcohol effort comes from the state through their BRU, which
is also mental health trust, probably funds a little bit of
community prevention, a speaker's bureau, whatever. But, we
try not to fund directly. We do, however, fund women's
services. We do fund some youth services. We do fund other
programs that are not directly related to a chronic
alcoholic with psychosis. The mental health board has
accepted women's only services because if you provide
services to a woman of child bearing age or a woman who is
pregnant, and you can prevent a child from being born that
is FAS, then you have prevented a new beneficiary to the
mental health trust; a developmentally disabled child. So,
they have agreed that services targeted toward women of
child bearing age and services to pregnant women is a
legitimate use of the trust. We've sort of reached that
compromise over time.
But it is a difficult process to look at the definition, and
now what is Chapter 66, which will become effective if and
when the mental health trust ever gets settled. There is a
pretty strict definition in that statute of what is a
chronic alcoholic with psychosis and a teenager in
treatment; a person with inhalant abuse, a young pregnant
woman, even a young male, probably is not going to fit that
definition very well.
REPRESENTATIVE NORDLUND: How does that amount that this
thing is arrived at, which is a huge share of your budget,
that seems unreasonable. It seems to me that an alternate
way... I mean, we all understand how the mental health trust
income accounting is somewhat of a shell game. It would
seem to me to be more forthright, straightforward, to just
determine the amount of your budget that actually do serve
those clients and ascribe that percentage that's coming from
the trust.
LOREN JONES: The rationale for the legislative action
happened just before I took over. If you look at the budget
summary that's in your book, you will see where the mental
health trust funding started out at very low levels, two or
three million the first year, and about three years later it
was up to thirteen or fourteen million. The legislature did
it at a time when there was increasing pressure to decrease
the general fund expenditures and the mental health was
beyond the cap set for general fund expenditures. There was
an audit by the Office of Management and Budget that came
out just shortly after, about six months, eight months,
after I got this job, that basically felt that most of our
services should be under the trust. They felt that the
definition was unduly narrow from the court and even felt
that our Alcohol Safety Action Program, which deals with a
lot of these individual who are not alcoholic or abusers who
at one time got caught drunk driving, could be funded from
the trust. So there was that audit among the Office of
Management and Budget that the legislature may have used.
But the significant increase... this year they didn't
decrease our mental health trust, but the legislature
decreased our general fund. That raised the percentage
without increasing the dollars. So, I'm not sure what the
rationale of the legislature was at the time because I was
not in this position then. But, they've maintained that
because it's a way to maintain the budget without breaking
the general fund cap when they deal with general fund
dollars.
CHAIRMAN PORTER: Okay. Loren, thank you very much and we
appreciate your being able to be with us so that if other
questions come up during the day you can jump back in. I'll
now uh, Representative Foster?
REPRESENTATIVE FOSTER: I just wanted to know if you would
be available when the people here from Nome, if they've got
any questions later when they testify, if they can address
them?
LOREN JONES: Yes. I'll be here all day.
REPRESENTATIVE FOSTER: Okay.
CHAIRMAN PORTER: I have arbitrarily decided to go
alphabetically. I'm going to start with the first person in
the first city in the alphabet that I have, and that's
Bethel, and ask if Virginia Turner is in Bethel and can
testify?
VIRGINIA TURNER: Yes, I am.
CHAIRMAN PORTER: Welcome Virginia. Please give us your
full name for the record and we'd be anxious to hear from
you.
VIRGINIA TURNER: My name is Virginia Turner. I've been an
Alaska resident for eighteen years and a Bethel resident for
the past year. In the past ten years I've worked for the
Department of Corrections in an alcohol use prevention
program for pregnant and post-partum women and their infants
for the prevention of FAS/FAE children. In these two work
settings I've become familiar with some of the issues that
arise surrounding cultural differences in physical settings.
In corrections, the issue was probationary supervision and
follow-up for the Alaskan released from prison and returning
to a village. In the alcohol prevention program, the issue
from the women's stand-point was similar -- appropriate
follow-up and support services in the village after
treatment. Oftentimes treatment was deferred because these
clients felt the residential programs available to them were
not sufficiently cognizant of their needs for strong active
support and follow-up upon their return to their homes in
the village. I wanted to go on record with these concerns
for village based probation and alcohol use prevention
programs and follow-up so legislators will be sort of in
tune with the needs of rural villages. In both the
correctional setting and alcohol prevention, in the
Department of Corrections, inmates who are Native, an
extremely high majority of them have been incarcerated due
to alcohol related crimes and so alcohol is at the base of
even this probationary follow through, and I just wanted to
say whatever efforts the government can make, this is just
an extra voice saying please support village based programs.
Thank you.
CHAIRMAN PORTER: Virginia, thank you. Are there any
questions? Seeing none, Virginia, thank you very much. We
have written down your comments. I'd next like to go to
Dillingham, the next one in the alphabet and ask if Ms.
Cristy Willer Tilden is ready to testify?
CRISTY WILLER TILDEN: Yes. This is Cristy Willer Tilden in
Dillingham. I am the program director of the Bristol Bay
Area Health Corporation drug and alcohol program, also
running as Loren pointed out earlier a new transitional care
unit called Jake's Place. I didn't know exactly how to
frame remarks today, but I figured that one dramatic line
that would appeal was cost effectiveness. So, I was just
jotting some notes here about what, from our experience here
in Bristol Bay, would be some of the more cost effective and
generally effective ways to go with the continuation of our
drug and alcohol services. For instance, as Loren also
mentioned, we lose patients and lose money when people
returning from treatment don't have follow-up and aftercare,
which is a primary reason for going to transitional care in
the first place. People returning to villages who go back
into the same environment that they left, who don't have any
time to hone skills, who don't have any support networks in
villages, can and often do bounce right back to treatment.
It seems important and reasonable to assume that having more
supports in the villages makes sense and makes fiscal sense
as well.
For that reason, we and our mental health program are
fielding more family services workers through some funding
we got from the Division of Mental Health and Developmental
Disabilities, but in total we have only about fourteen such
workers in a region the size of Ohio with 32 villages. That
doesn't cut it and it doesn't cut it for the people we have
in villages who are doing the best they can with limited
resources, many of them half-time and many of them without
other supports outside of health aides and occasionally
VPSO's to work on what everybody recognizes is our largest
health and social problem. Sorely, its widely recognized
that prevention and early intervention are methods that, in
the long run, are extremely cost effective in terms of
impacting the larger problems of alcoholism and drug abuse.
Currently, we have funding, we're about a third funded
through the Division of Alcoholism, a third through IHS, and
a third through local revenues to the health corporation's
hospital unit.
We have one youth coordinator position, again for all of
Bristol Bay. It's, and I'm in an enviable spot for anybody
to be in to try to provide both treatment and prevention
services for all of the young people in this very large
region which, although the population is low perhaps
relatively to urban areas, is spread out and we have a lot
of young people here, who if we could directly effect their
developing lives, to a better extent, might well not ever
wind up in our treatment or your treatment programs. One
person covering all those villages is not enough.
Another way to impact our situation is to train more local
people in those jobs. As I say, one way to do that is to
work through our rural human services program that's been, I
think, effective. It's a new program but we've enjoyed and I
think are helping to build it along with the other four
regions that are involved in it. But to the extent that we
could continue to work with training, hire local people in
our programs, we would cut into turnover costs, travel
costs, bringing people in from outside and in addition build
the local programs and the local population.
You mentioned the Title 47 laws impacting the statutory
changes in that. How many of, and I know this is right, but
so many of our resources are sucked into the problem of
dealing with public inebriates, but to change those laws so
that we could all respond more effectively and less
intensively would help us to deliver more appropriate
services, I believe. That was really what I had on my list.
In sum, the least effective way to deal with these problems
is to ignore them, of course, and to hope that they'll go
away. If you assume that at this point we're not sure
exactly what works then we can't fund anything. We, I
think, are reasonably sure that we know what works. We are
very happy to know that we'll be involved in more outcome
studies and are initiating some of our own follow-up and
assessment studies throughout the region to make that more
concrete. We are pleased with the work of the division. We
want to continue being a part of that and looking forward to
your support. I'll be here for questions too.
CHAIRMAN PORTER: Cristy, thank you very much. If I might
ask, as Mr. Jones mentioned, and it would appear to me and
certainly I would agree that it's areas like Dillingham and
Nome and even smaller areas that really know whether a
program has worked or not; to that end, especially
considering your needs in the villages, are there any
villages that have shown what you would say is a success in
either early intervention or aftercare programs that could
be used in others?
CRISTY WILLER TILDEN: Yes. I think issues run in cycles
too. To some extent there are several villages in this
region that over time have, some with our direct assistance
and some more on their own, have developed programs under
the general Arabic of community development that have been
replicated in other villages. In fact, we're working on an
idea of having some sister villages where we can build
communication with between those that have and those that
haven't got strong programs. One in particular I was
thinking of has made it their business to send large numbers
of village residents to statewide conferences, such as rural
providers conference, to build a kind of home base of people
who have thereby received a similar vocabulary and
experience in healing from the larger group of people in
this state who are involved in the sobriety movement. They
and some other villages are getting... (end of tape)
TAPE TWO, SIDE A
Number 000
...(inaudible) different ways in which to respond. But,
unless this answers your question that there are several
villages who have different responses. I have with me one
of our counselors, Louie Jones, and he might have another
response to that question if you would like to hear it.
CHAIRMAN PORTER: Certainly.
LOUIE JONES: Yes. High everybody. I am from the
Dillingham Police Department and when they have hired a
counselor in my village, our office in Nome, I believe
solely on the Title 47's for that village and the time that
counsel was hired there, there is quite a number of
decreases, and whether they are effective in that part or
not I don't know, but there was definitely a decrease in the
number of Title 47's from that area.
CHAIRMAN PORTER: I appreciate that. If you have it in
hand, I'd like to get it. If not, if you could send it to
us the name of those villages and perhaps a contact person
that we could get some additional information from.
LOUIE JONES: Yes. I'll try and do that, but I would like
to work with Dillingham's police department on that because
at that time I was working for the Dillingham Police
Department under their public inebriate program and now I'm
working for Jake's Place. I'd also like to give a little
testimony here on the plans there are on probationary that
include that they either work with us during that time or if
they are a success and we could discharge them. We here in
Dillingham are in the process of working with the courts,
with other different agencies here in Dillingham, and we are
talking about what our problems are and they in turn are
telling us what's going on and now we are trying to work
together.
Another group we are working with also is the Location
Rehabilitation Program that (inaudible) in finding out what
is going on and also that they may be able to go to say like
vocational training. I just wanted to mention that had...
what is successful that they found out through their program
that the court deferral were more success than the self-
referral. Why, I don't know.
And also on the issue about, ah, I heard some people trying
to set up a program for cocaine, inhalants and alcohol and
other programs. I think it's coming to that time where we
need to look at climatic conditions. I am talking about on
a personal level that I was into cocaine, marijuana,
alcohol, inhalants, hallucinate drugs, but I found out
through the counselor that they are able to find out the
causes and conditions of those that when you start doing the
counselor to help the client that's in their village and not
send them somewhere else. This is a need for some people,
but for those of people (inaudible) sit down in those areas
and (inaudible).
CHAIRMAN PORTER: Okay. Louie, thank you very much. If
there are no questions, and I see none, I'd like to move if
we could to Kotzebue and see if Reggie Joule is ready to
testify?
REGGIE JOULE: Can you year me?
CHAIRMAN PORTER: Yes, we can.
REGGIE JOULE: Good morning. This is Reggie Joule in
Kotzebue. Currently I am the chairman of the Advisory and
Drug Abuse for the State of Alaska. I'd like to present my
testimony wearing that hat. I guess prior to addressing
some of the issues a couple of items I'd like to bring up...
I guess a question was posed to Loren about the level of
funding. In regards to the substance abuse, it's been a
known fact for a while that alcohol, other drug and other
inhalant abuse is Alaska's number one health problem.
Unfortunately, the funds haven't really followed that. In
fact, we kind of got a decrease over the last year. I think
it is kind of a knee jerk reaction to the Ombudsman's report
and I'd just like to point out that, you know, with regards
to dollars that flow to AIDA and this being Alaska's
so-called number one health problem, I guess if I were to
use an analogy, it would be to take a look at the kinds of
dollars that flow to DOT, the Department of Transportation,
for preventive road maintenance, that kind of stuff, and
when there are pot holes that are really, really bad, you
know, they move basically right in there to fix them to
protect the life and safety of all the motorists, which is
very, very understandable. And also, another analogy is
that inflation-proofing the permanent fund, you know, that's
just money and we're talking about real lives and real
people in a life, health, safety issue with regards to
alcohol and drugs.
I'd like to talk a little bit about our current structure
because right now we have... the advisory is made up of
twelve members, two members who are licensed to practice
medicine in this state, one of whom is certified in
psychiatry. That particular seat, I believe, is still empty
so we have currently eleven active members. One member who
was admitted to practice law in the state of Alaska, eight
members from the public at large who've expressed an
interest in the problem of alcohol and other drug abuse, and
one member who is a representative of the liquor industry,
and these are all appointed by the Governor, as they should
be.
Our duties, and I'd like to point these out because there is
some legislation and there is something that your task force
can make recommendation on to the legislature, but the
duties of the board are to act in an advisory capacity to
the Commissioner of Health and Social Services in the
following manners:
1) special problems effecting mental health with
alcoholism or drug abuse may present,
2) educational research and public informational
activities conducted by the Department of Health and Social
Services and others in respect to the problems presented by
alcoholism or drug abuse,
3) social problems that effect rehabilitation of
alcoholics and drug abusers,
4) legal processes that affect the rehabilitation and
treatment of alcoholics and drug abusers,
5) development of programs of prevention, treatment and
rehabilitation for alcoholics and drug abusers,
6) review applications and subsequent recommendations
to the Commissioner of Health and Social Services for use of
funds for grants for local alcoholism and drug abuse
projects and programs, and finally
7) evaluation of effectiveness of alcoholism and drug
abuse programs in this state.
I give you that background because some of you may be
familiar with Senate Bill 65, which deals with the mental
health lands trust issue that's being held up in court.
When we read that document, Chapter 66, there is some
proposals in there that directly affect the Division of
Alcoholism and Drug Abuse, and specifically, the advisory
board. There would be a new waivers to go through and this
is something that the legislature could single out of Senate
Bill 65 and do this through the legislative process, is to
go ahead and make some changes, changes I believe that are
needed, and shouldn't be made to wait until the courts come
up with a decision on the mental health lands trust.
One of the priorities of the member, the change of the board
would increase from twelve members to fifteen members. One
member would be licensed to practice medicine in this state.
One member practice law in this state; four members who are
chronic alcoholics with psychosis who are recovering. We
would like to suggest there is, that those numbers, is that
maybe we strike the word psychosis and leave it open to four
members who are chronic alcoholics who are recovering.
Then it goes on to three members who are substance abuse
treatment professionals who represent public and private
providers of substance abuse prevention and treatment
services, and five members who have shown an interest in the
problems of alcoholism, mental and drug abuse, who have
knowledge of social problems associated with these
substances.
In there it also means that if you've been adding the
numbers, you come up with fourteen. It also means the
director of the Division of Alcohol and Drug Abuse would be
an ex-officio member of this board and would we would like
to propose there is that we strike ex-officio and just make
that individual, Loren in this case, a full member of that
board.
Staffing, at one point when SB 65 was initially proposed, I
think this was in the last legislative session, not this
last year but the year prior, some funding had been set
aside in anticipation that this was going to be going
through for staffing, and we not talking about staffing,
what I'm talking about is staffing for the board.
Currently, the advisory board has no staff, and so a lot of
the things we are supposed to get to, we make an attempt but
the division, Loren and his staff, they have their hands
full as you can well imagine from his testimony this
morning. So they have a full plate to deal with and the
fact of the matter is, you know, the Mental Health Board,
the Council on Domestic Violence, some of the other people
and parties that were named in the mental health trust, not
only do they have their own boards or councils, but they are
stacked as well with their executive directors, you know,
people who are there to take some slack off the executive
directors who's day-to-day work, research, and those kinds
of things, as well as secretarial help, and we have none of
that and so that would be a big help. And as I mentioned
before, funding had been appropriated and then it was
deleted so that funding is not there. So basically what
we're talking about is a staff for the board of three
people, an executive director, an analyst and then some
secretarial help.
The other thing that needs to happen, as you are well aware
from Loren's testimony, is that not only are we charged with
addressing the issues of alcoholism and drug abuse, but also
inhalant abuse, and nowhere in this Chapter 66, SB 65 is
inhalant abuse addressed, but yet from prior statutes that
is part of our responsibility and so that language needs to
be included if these changes are to be made.
And I guess just a note to that to kind of reinforce what
Loren had been saying a little bit earlier, and that is that
while the division has been given the responsibility to deal
with inhalant abuse, as well as alcoholism and other drugs,
no money has come forth from the legislature to address that
issue and I guess the expectation has been to do that with
the existing dollars and from Loren's description of the
programs and types of services you could see that would be
kind of hard to do, especially if inhalant abusers are not
mentioned in the mental health lands trust as a beneficiary.
Also while you're changing it, I'd like to recommend to this
committee, to this task force with regards to... is that
currently we are in an advisory board capacity. What we
would like to propose is that we drop advisory and so that
this board is in fact just more than one that gives advise
and that the duties that are here would not necessarily
focus us in on the commissioner as we are now, but that we
would deal in policy issues and address some of the issues
that you have concerns over and that, quite frankly, the
Ombudsman has some concerns over and to also deal with
budgetary and working on the budgets that the division has
to work through.
The new duties of this board, as proposed, would be to act
in an advisory capacity to the legislator, the Governor, and
state agencies in the following matters:
a) special problems affecting mental health and
alcoholism or drug abuse may present,
b) educational research and public informational
activities in respect to the problems presented by
alcoholism or drug abuse,
c) social problems that affect rehabilitation and
alcoholics and drug abusers,
d) legal processes that affect the treatment and
rehabilitation of alcoholics and drug abusers,
e) development of programs of prevention, treatment and
rehabilitation for alcoholics and drug abusers,
f) evaluation of effectiveness of alcoholism and drug
abuse programs in the state.
Divide the mental health trust authority for its review and
consideration recommendations concerning the integrated
comprehensive mental health program for people who are
described in AS 47.40.056(b)(3), I'm not sure that's the
right jargon to describe that, and concerning the use of
money in the mental health trust income account in a manner
consistent with regulations adopted under AS 47.30.031.
The board is the state planning and coordinating body for
purposes of federal and state laws relating to alcohol and
drug and other substance abuse prevention and treatment
services and, finally, the board shall prepare and maintain
a comprehensive plan of service for the prevention and
treatment of alcohol, drug and other substance abuses. So,
as you can see that the current language that if in fact the
statutes are amended as we should have to address inhalant
abuse that inhalant abuse needs to be added to the parts
that say alcohol and drug abuse.
That about raps up my testimony, and if there are any
questions, I'd be happy to try and answer them. Thank you
for your time. I really appreciate it and I'm glad that you
are doing this issue with this focus at this time.
CHAIRMAN PORTER: Mr. Joule, thank you. I see no questions
right now, but I would add that as was mentioned we will
certainly be looking at any proposed legislation that might
have a specific or general effect on this area and would be
happy to look at the proposal you just read to us. Within
that, I had hoped to ask this question of Mr. Jones, either
here or at a subsequent committee meeting but, since you are
the chairman of that advisory group, while there is
obviously a different approach as is required by criminal
law to alcohol abuse and drug abuse, I have read that and
seem reasonably convinced at this stage of my learning that
substance abuse appears to be substance abuse, whether it's
alcohol, drugs, inhalants, or whatever they come up with
next year, and I'm wondering if your advisory committee,
from the standpoint of the individual and collective social
and health adverse effects from substance abuse, might want
to look at it in that manner.
REGGIE JOULE: As long as I guess those areas that we are
mandated, you know, if we're going to call it substance
abuse, then there needs to be a glossary somewhere that
defines substance abuse because substance abuse also, I
think, could include something like cigarettes, which are in
another division within the same department; and so, if we
were talking about substance abuse, I think we need to, just
so that anybody whose turf that their in knows what we're
talking about when we talk about substances and that it's
more clear what's being covered there.
CHAIRMAN PORTER: Well, I certainly would agree. Having
quit smoking a few years ago myself I know the trauma is
just as much there, I would guess, as an alcoholic, but what
I think perhaps would be a reasonable start at a definition
would be substances that would alter conscious awareness,
which I guess if I recall as a teenager, cigarettes did for
a while, but they quickly went. In any event, I appreciate
your testimony and if I may I would like to move back to
Nome and ask if Diana Freeman is still with us and can
testify? Diana, you can push the button down so that
everybody can hear you.
DIANA FREEMAN: My name is Diana Freeman. I have been
working in treatment for five years. I work at the Northern
Lights Recovery Center, which is part of the Norton Sound
Health Corporation, and I have lived in Nome, Alaska, nine
years I believe. I do hear the concern about inhalant abuse
and we, as a program, have tried to meet that unmet need by
writing grants and seeking other funding.
Another part that I agree with, the lady from Dillingham
talked about village based services, and we also feel the
need for that also and have been working through alternative
funding through the Robert Wood Johnson Grant Foundation to
receive a scope of programs through them that would identify
a village person to respond and to counsel and kind of be a
first responder. Another unmet need that I see is
transitional living program, which we have pursued funding
for three or four years, five years. We would like to see
more halfway houses, especially one here in Nome.
If we bring people in from the villages and they get
stabilized and they get real solid in treatment, and they go
back out to that same village and enter that same
environment, and they don't have a job, their recovery rate
is low. So, I think that would help us in a way and we are
continually trying to strive to do that by doing alternative
funding. We also do initiate follow-up work. We did an
extensive follow-up of our program for three years, 1989,
90, 91, and found out a lot of information from doing that.
We do believe our program and it is like Loren says. I've
been in treatment five years so I see the people that come
back. I know them, I see them out in the community. I see
that they are getting sober and I do believe that we do have
a strong sobriety movement.
Also, what has helped us here in the Nome area is the
putting in of the detox center. When I first started
working with Northern Lights Recovery Center, we did not
have such an entity in Nome. Now we work together quite
closely and it is a good team effort to try to get these
people into treatment. One of the villages that we do have
that has taken the initiative upon themselves is Savoonga.
They have created a suicide crisis response team and I did
hear about two cases. One, they responded to a young woman
with suicide iviation and they stayed with her continually
through the night. The other one was a young man using
inhalants and they put him in a closed quarters and stayed
in there with him until he came off the gasoline. These
people are not paid. They do it as a part of wanting to
help their own community and I could give you information on
who to contact there later.
Also with the Northern Lights Recovery Center we do have a
prevention unit and some of the more innovative things that
they do are in the fall of the year and the spring of the
year, they put on two large workshops where they bring in
people from the villages to create awareness and we've had
different workshops on FAS, FAE, inhalants. This fall we're
having anacoral conference. It's the Alaska Native Children
of Alcoholics conference that's going to be coming up so
they do things like that to initially create the awareness.
Another thing that I had identified specifically from the
needs assessment that has been something that I have been
wanting to do for a long time, but we do need assistance
with funding, is to create a support group by the mechanism
that we are all listening to this conversation. That is to
have a support group that all the villages could link up to
on a bridge that could be a teleconference that could be
something that is consistent for these people in the way of
support and so we are looking at trying to get some type of
funding for that also. I think that's initially what I had
to say.
CHAIRMAN PORTER: Thank you very much, Diana. Is the group
in Savoonga, how long have they been in existence?
DIANA FREEMAN: I would say probably about six months.
CHAIRMAN PORTER: Are they in any way receiving any training
or anything in terms of peer counseling?
DIANA FREEMAN: I think they receive training through the,
uh, we have a crisis response team through Norton Sound of
professionals that go out when suicide or some kinds of
devastating thing effects the village. These same people
work closely with them. They also worked closely with R.E.
Oder, the new director of mental health. She did herself go
out there and give them several training sessions. I think
this team arised from the, uh, there were several suicides
in this village and from that they decided to deal with the
problem themselves, which I think is really good and they
need more of that.
CHAIRMAN PORTER: Thank you. Representative Nordlund.
REPRESENTATIVE NORDLUND: Diana or Diane?
DIANA FREEMAN: Diana.
REPRESENTATIVE NORDLUND: I saw you nodding your head in the
back when Loren was saying that it is easy to tell in
smaller communities, especially in the villages, whether or
not programs are effective. I was wondering if you could
comment on how you determine if your treatment programs are
working or not. Is it pretty much anecdotal or has there
been some follow-up?
DIANA FREEMAN: Okay. We did, since I've been in this
position that I've been in, which is about two years now, I
did an in- depth study which asked them the kinds of things
Loren went over, like basically what has changed in your
life? Have you been employed? Have you been in trouble
with the law? Have you violated your probation? Are you
having trouble with issues that they had in treatment like,
grief is the big thing, overcoming grief, and oppression,
for here in this region is a very large obstacle in their
treatment. Through this, you know, I was amazed at the
response and I was amazed at some of the feedback that they
gave me. From what I could gather from those that
responded, 76 percent of our people were still sober. Also,
there has been, since I have been here doing this five
years.
In the beginning there was a minimal amount of people at
sobriety functions and also at support meetings. Now we
have to have bigger meeting places and we can have sobriety
dances two or three times a month or once every week and
people do come and enjoy themselves in an alcohol free
environment. So the people that come tell you that yes,
they have changed. So I see these people, most of them on a
daily basis.
REPRESENTATIVE NORDLUND: Ms. Freeman. So, it's an ongoing
situation you noted. Is it something like being checked on
a year later, two years later, three years later, or is it
more informal than that?
DIANA FREEMAN: I would say most of the people that receive
treatment from this region, I would see them more than once
in the last three years and most of these people come
together and serve on committees and get involved. You
know, we are talking about people that have changed their
lives so they are wanting to care, especially for that other
person. So, they make themselves available and I see them
everywhere from the grocery store to taking classes with
them at the local college. It is a diverse kind of a thing.
CHAIRMAN PORTER: Diana, if you have any documentation on
that study you did that indicated that 76 percent of your
people are still sober, I'd sure like the committee to
receive that if you can.
DIANA FREEMAN: That's no problem. I have a copy and I'll go
get one.
CHAIRMAN PORTER: Okay, thank you very much Diana. Before I
go through the list again, I would like to recognize that we
have several staff people from the offices of Representative
MacLean, Senator Jacko and Senator Leman that are on the
teleconference network listening in and taking information
back to their respective legislators. Okay, if I could go
back then to Bethel and ask if Ardyce Turner is still there?
ARDYCE TURNER: Yes, I am.
CHAIRMAN PORTER: Welcome Ardyce. We'd be happy to hear
from you now.
ARDYCE TURNER: Okay. My name is Ardyce Turner of the
Substance Abuse Education and Prevention Department. I
started last year. I transferred from the Substance Abuse
Services, which is with the teenagers of the villages. I am
a recovering alcoholic myself. It's been like four years
myself. I graduated from PATC in the outpatient program, so
I would like to let Diana know there are people in Bethel
who have maintained their sobriety each day and move on into
bigger and better things to help other people. But as far
as when I'm with these out in the villages, I've heard other
people saying village based workers, when I worked for the
alcohol department there were 10 village alcohol education
counselors. Now there are nine. There's one Hooper Bay
office that funding was cut. The things at villages are,
there are at least two or three or even four villages
besides their own, and they really need a lot of help out
there. It's theirs to fulfill for them, and as far as
coming out of PATC, the clients that go back out to the
villages need a lot of support. And what I would like to
see more of is more comprehensive support for them out in
the villages because our main concern here with Substance
Abuse Education and Prevention Department is maintaining
sobriety or at least increasing the high rate of alcoholism,
inhalant abuse and other drugs, as mentioned earlier. But I
really support any funding towards that, towards the
villages because they are really in much need.
As far as training also, there needs to be village alcohol
board members, like in the past they used to come in and
train. I think I heard someone mention training. They did
come in and train, so there were people that did go back
into their villages and contact the resource people in the
village and they were one of them. Like in the past, they
did receive training and they would go back to the villages,
having more help so they can help their local people once
they return back to the villages. So, I would just like to
please, please ask for more funding towards the village
based workers. Thank you very much.
CHAIRMAN PORTER: Ardys, thank you. If I could ask you a
question, or any of the other people there in Bethel, we
haven't had any real discussion or testimony regarding the
differences in some villages that opted to be dry and others
that aren't. Do you see that as a significant difference in
the problems that exist in villages, or does it have any
effect or not?
ARDYCE TURNER: Yes, it does.
CHAIRMAN PORTER: I'm going to assume that you mean by that,
that if a village is dry that it has fewer problems than
those that aren't?
ARDYCE TURNER: Yes, that is so. Like in some villages, the
ones that are dry, some of them have requested for support
by talking to a support group or a substance abuse, such as
alcohol, inhalant abuse, chewing tobacco. We just started
this year with chewing tobacco, which I am very glad that
they requested for that. There are different people out
there who do try in their community to keep prevention as
one of their main priorities.
CHAIRMAN PORTER: Thank you. Representative Mulder?
REPRESENTATIVE MULDER: Yes. I think that is really a
pertinent question. As you know we have been laboring
throughout this state for a number of years. The whole
question is to go damp or dry and we really credit the
village leaders for placing it such a priority. But, I
think it would be interesting from the committee's
standpoint and from mine personally if one or other people
would bring the community or the corporation, the Native
corporations who have been pushing for it, if there is any
statistical information to show what effect it's had so far.
Maybe it's recency where it hasn't had time to take hold.
But I think it's appropriate information because it's a
radical departure, a radical change from the standard
operating procedure in the way we've been treating
alcoholism or drug abuse in our communities, and if that's
the kind of change that is bringing on the desired effect,
well then maybe those are some avenues we should be looking
at.
CHAIRMAN PORTER: We're sure going to see Director Jones,
frantically writing things to do.
LOREN JONES: Yes. There was a study several years ago. We
will try to dig it out of our shelves on this. It's not one
that has gone through a lot of scrutiny in terms of
villages. But, if you do talk to the police officers, you
talk to the village public safety officers, there is a
significant difference. I know in communities that are
damp, there is a significant decrease in police calls, a
decrease in some of the violence in the communities, that at
least have been reported. To my knowledge nobody has
officially, in any of the villages, either local people,
department of state troopers, ever taken a real serious look
at it. There was one done several years ago and we will dig
out that study and let you know.
REPRESENTATIVE NORDLUND?: If I could continue, Mr.
Chairman? Loren, have you worked conjunctively with our
university to look at doing some studies along these lines.
It seems like you have a wealth of information, or a
resource there you might be able to tap into. Being an old
grad student, you're always looking for a good project to
explore or cut your teeth on. This certainly seems like an
avenue that's on the cutting edge of, not only Alaska and
our rural communities, but also throughout the United
States. This one would seem to be a natural.
LOREN JONES: There is within the University of Alaska,
Anchorage, a center for alcohol and addiction studies that
years ago did a considerable amount of research. That has
been cut back over the recent years with university
reductions as well. They primarily look for us for funding
and we have not had the funding. They are currently doing a
research project on AIDS and on AIDS prevention that is
funded by the National Institute of Drug Abuse in Anchorage.
But, they are not active out in the community, nor is
either the psychology or the sociology department to
institute (inaudible) generally be available. The
university affiliated program within the University of
Alaska, Anchorage, is active but it is active in the area of
the developmentally disabled and also some of the mental
health community. It is an avenue we would like to be able
to work with the university as well.
CHAIRMAN PORTER: I think Sophie Nothstine just left the
room so we'll have to skip over her real quickly and ask if
Elizabeth Sunnyboy is still available to testify from
Bethel?
ELIZABETH SUNNYBOY: Yes. This is Elizabeth Sunnyboy. I've
been with the last seven years with PATC for five years and
in the substance abuse field many moons. In listening this
morning, as usual when we talk about alcohol problems and
substance abuse problems, it is draining. We hear that over
and over. What has made a difference, when I transferred
over to community development program, what has made a
difference in going to communities is that we have done a
team approach, we have addressed problems and stayed with
the community for a week, you know, in providing services.
When they request services we provide those services and
stay with the community like for a week and that has made a
difference in many communities. And what started off, like
when we work with the village alcohol education counselors,
in the beginning it was very stressful, very challenging.
Many of our alcohol education counselors felt defeated
because there seemed to be no support, nobody; even the
court referred people refused to VAC's offices and what
happened to that group of people, they decided to get
creative with their ideas and to start making changes to
attract more people. What they did in the beginning was
they talked with their elders. They spent time with their
elders, talked with their elders.
I've been hired to work with our people that have alcohol
and drug problems but nobody's coming, and the elders
suggested that's the problem, you're (inaudible) on your
door, its alcohol or drug education counselor. With the
help of the elders and the village people, they got
suggestions of how to make a difference in their community
and with that they changed the name of the door, the name of
their titles which made it more attractive. Many people
responded to them better. And so just a name change made a
difference with a lot of alcohol education counselors. I
mean with that avenue they were able to give more education
prevention types of activities, alternative activities that
include alcohol free dances and they got more responses from
the community people because peoples are involved in their
activities.
In our department of community holistic development program
we have four positions, community youth advocates. They are
village based workers and they work mainly with students and
young people in their communities to provide alternative
activities in their communities that are alcohol and drug
free. These group of people, because (inaudible) errors in
the beginning, they are instructed right from the beginning
to utilize their elders, to utilize the people in their
community... (end of side A)
TAPE TWO, SIDE B
Number 000
...to use community aide advocates that are working in these
villages have support, even from a home full of people, have
their support in place because they work with people, they
work with the young people, giving input affecting living
together. So, its causing all to, beginning with the
village based workers, we are able to work with the
community aides allowing the kids to be more effective in
their communities.
I understand also that mental health has started village
based workers and they are in the process of getting
screening, and so the earlier concern that Ardyse Turner and
the other people that have spoken, if the support that these
people need (inaudible) the training monies for the village
based alcohol education counselors has been completely cut
out and they don't have any training money whatsoever. They
have a handicap there because they need the additional
training to be more effective in serving their people. And
so the training moneys there was completely cut off and
that's the biggest concern that they have with the village
alcohol education counselors funded under PATC and the
community aides advocates funded under YKHC community
holistic development program.
So that's the concern that we have is the training moneys
that were cut off. We are fortunate that the community aide
advocates have no training moneys due to a declining and
limited budget, we have to... One of my community aide
advocates from Hooper Bay community was cut because we don't
have the budgets to keep her on. That's again, putting the,
taking away from the community a service that is needed.
Earlier, people were talking about activities and different
villages that are making a difference in their community.
As you all know, there's been a big history of suicide in
one of our communities in the Yukon area. The community
today is doing different activities within that community.
At first we used to go in on a crises approach, especially
with the long history of suicides in that village community.
Crisis counselors came one day and left and finally that
community decided to have their own support group and to
support people way after a crisis has happened, to work with
family, to follow up on the family that had a loss, to work
with that family. That group is called the Snow Flakes
Support Group. It's really active, it does many activities
with the community. They provide workshops, they provide
Eskimo dancing, honoring the young people for their first
dances. They provide basketball tournaments. So, they're
very active in that community.
They've had setbacks on several occasions where even after
the suicides have gone down in that community, again they
have had a couple of suicides later on, but the difference
here is that the support is still there in that community
and that's what's making a difference in some communities,
so it goes back to empowering the people themselves.
When we do go into communities that request us, most of our
activities in community holistic development program is upon
village requests for services and we honor that request and
we do travel to that community and specifically ask, what
are your needs, what do you want? We honor that request.
We just don't go in because some community is having
problems. We honor that request from a community to travel
to a community and in this way it's like we're honoring a
community and working with what their needs are. That tells
me the difference also.
Cost effective suggestions I would make is for like
treatment programs. One of the things that I feel that
strongly needs to happen is not to send one person from a
community because again we're talking about lack of support
in the community because of no education or prevention
activities or maybe that community hasn't gotten active. So
one suggestion I would make is for treatment programs to get
more than one person within a community to go into
treatment, you know, as a group, so that group of people,
when they go back, they will support themselves. Or involve
family members in that treatment because with no family
involvement it's like you are just treating one part of the
whole thing, just one part of that thing, and it doesn't
usually work. There is no balance. It creates unbalance so
that chaos again and when the person goes back they are
right back in the chaos. So if treatment program is going
to be effective, they need to involve families, they need to
involve cultural activities that are relevant to the people
they're serving. Vocational skills, parenting skills.
Another person talked about addressing the grief and
recovery process. Only after you stop drinking is when you
start becoming aware of unresolved griefs, and because those
aren't addressed, the person will go back to drinking
because that's too much to handle. People need to know and
address unresolved grief. Work through those as a group,
not on an individual basis. Those are some of the things we
try to address.
I also have a question on this confidentiality. We have
problems with that left and right. In schools, in villages,
in treatment programs, a lot of times I question, you know,
confidentiality on whose terms? In one community that we
went to and did a community workshop, three or four of the
parents in that community were in tears because of
confidentiality. The teachers or the school counselors
wouldn't tell the parents what kinds of problems their child
was having in school or even at home so that maybe if they
were involved they would correct it together. At that
meeting all the counselors talked about was no, we couldn't
contact you because of confidentiality rules.
If we're going to help families and if we're going to send
the children back to the families, I think we need to reword
or change, or whatever we need to do, especially on that
confidentiality issue, because when they are an alcoholic or
into drugs everybody knows that. Maybe you're the one that
denies you're the one that has the problem. So
confidentiality needs to be studied, worked (inaudible)
recovery activity, people need to work together and address
the problem and find solutions together.
Communities have resources that they can resolve the
problem. All we need to do is work with them and have them
find their resources, their strengths, their ability to find
solutions to their problem and they have that. So in that
sense we try to work with communities knowing that these
communities have their resources, they have their strengths,
they have their skills and they have knowledge to correct
their problems and all we need to do is to be there to
support them and to put this into action.
So these are the things I wanted to bring out. And here in
YK Bethel we also have a talk show that we hold every month.
There are different agencies that hold talk shows and we do
hook up to Nome station and we do education prevention,
sharing through the neighbors. We do different types of
preventative education. We talk about grief and recovery or
different topics that people will listen to, ask questions
about. That also makes a difference in Bethel because KYUK
radio station will also have monthly input of our activities
and our jobs, what we do with providing services with
communities. In the community holistic development program
we work with agencies, we work with villages, we work with
private councils, we also work in the schools and these are
with patients. These are the types of activities we are
doing at YKHC.
One of the things that I will bring up which has created
some confusion, and I feel is a contradicting message, is
that the cuts that are happening to the social service
programs, alcohol programs, human service programs. You
know, the contradicting message that I get is that the
Governor is cutting these services that are needed in our
communities and his wife is talking and seems supportive of
these programs and that seems contradicting to me that he
would cut and cut and cut these programs, but his wife is
talking and seems to be supporting these kinds of programs.
I look at that as contradicting. You know, it's confusing,
and so I just wanted to bring that out and you can put it on
record if you want to.
That has been one of my concerns, because like somebody else
brought out, the Governor is really supporting economic
growth, but if we don't have people in recover or support
for people promoting recovery, its like its defeating what
we are trying to do. We need that support. Thank you very
much.
CHAIRMAN PORTER: Well, Elizabeth, thank you very much. I
think it's very helpful to the committee to be able to hear
from people like yourself. If perhaps this isn't a totally
unsolvable problem and we have people motivated like you
that are out there working on it. I would like to ask you
one question if I may. In your experience, do you think
that there is a direct relationship between the village
suicide problem and substance abuse?
ELIZABETH TURNER: Yes, there is. Also, there are also
other factors involved in suicide. There's language, the
breakdown of language, the communication, there's
traditional values that are not taught any more. Whether
our elders are speaking Yupiik, Indian people mostly speak
English, and so the communication is cut off. Our
traditional activities are not often practiced in
communities. Maybe there's also denomination effects, you
know, different church denominations that got a lot to do
with the breakdown of communication, or even the breakdown
in families. In my own family line, relations are Russian
Orthodox. I have relations that are Catholic, I have
relations that are married and these are all direct
relations that are divided in religion. You know, and so
there's different denominations that have their own rules
and own functions, and so again, that creates conflict
within family units.
Yes, alcohol and drugs will have suicide, but there's other
things also that because of the pain or the hurt that lead
people to drinking or to using drugs.
CHAIRMAN PORTER: Okay Elizabeth, thank you very much. Now
the very patient Sophie Nothstine.
SOPHIE NOTHSTINE: Thank you. I am Sophie Nothstine and I
am from Prince of Whales and I have been very reluctant to
talk on this microphone. In order to give a class, I want
to say that I'm going to have to get back to Alcoholics
Anonymous and also it's so important to me because I have
been sober 18 years and going on 19. If you take, um, I was
partially raised in Nome and the biggest places I've gotten
drunk was in Nome. (Inaudible). Humility and I guess the
futility. (Inaudible).
The only other thing I wanted to say is that the anarchy of
the villages, (Inaudible) and that's the villages I went to
recently, they have suicide in their village and they wanted
to get some help for their village. They want to learn how
to do things for their own village. But what I'm getting at
is what everybody has mentioned already is the village
people are going to help there. The loss of culture, the
loss education by the elders, is a very important factor as
the loss of language and the loss of dances. I have advised
my Prince of Wales in dances a (Inaudible).
In order to get back to that, a person that is in the system
needs education, spirituality. The best way to get a
feel... the treatment centers are very important. I've
gotten well by Alcoholics Anonymous and I am talking about
the village people that go to treatment that go in and out.
The people that are in the village are getting back to the
people. (Inaudible). Some of them are (inaudible). The
whole village at a time is not well. They have alcohol and
drug problems and some of my relatives are not well. Some
of the village elders of mine sent the school system, and
the village has the right when they are growing up. I am
65. My elders quit teaching. They have turned it over to
the agencies to teach me and it needs to stop. It needs to
get back to the Native system and I don't know how to put
that into words.
Alcohol, I see some of the villages that are drunk, the
whole town, from children to adults, and I have heard about
the FAE and FAS and what I was hoping is that a FAE adult or
child is very difficult for the treatment such as the
(inaudible) FAE person cannot themselves be able to
function. They have to have somebody to help them and this
is difficult. (Inaudible) I was thinking that the politics
in order to help a person effectively in the agency,
sometimes the agency gets lost in order to appear as they
are okay in the system they use that, uh, they are working
with that client.
I guess that what I'm saying is that it is hard to work with
a person in treatment centers. We need village based things
because the systems approach that does not recognize the way
of traditional approaches. All the things that I heard is
(inaudible) third world country that is minorities, that is
poor countries. I didn't realize that the Native persons
that are minorities, that is poor. Mostly in my village
when I was growing up my father was a big hunter and I was
sent there as a very rich child and when I came to Nome I
was considered a very poor child.
I guess getting back to court system I said earlier is that
I believe in the court referral as the agency most qualified
to work with parents. (inaudible) to work with. You don't
have much to work with as a person who is sick. The
children, I like the idea of having the half-way houses here
for the parents that are not ready to go back to the village
because most of the village is still wet and some of the
villagers are still drinking and staying in the bars and I
don't believe...
I have a doctor and I just met her last week and she said
(inaudible) and if you have clients that you are dealing
with even though you aren't drinking alcohol you are still
wet. To be alcohol free for a person who is dealing with a
client it is important at his level of understanding to work
the steps. By the way, the Native ways are twelve steps of
AA but they're not written and sometimes traditional
(inaudible). I think we need to educate some of our Native
leaders to learn to be alcohol free. (Inaudible) It is a
lot better. They really ought to have a FAE or FAS child
teaching a mother that is FAE, who is still drinking and
drugging, (inaudible).
And this is all hard news since white man has settled or
Russians or so and it's still very (inaudible). There's
rules and regulations we are dealing with under the white
system approach and I think we need to have more Native
culture's approach too. Also, helping with the VPSO, health
aides, and our councils in the villages, I feel it is very
important to mostly attach some of the other village people.
I (inaudible) a person who is a board member might feel
(inaudible) in order to deal with the problem of not being
able to talk to someone or whatever it is that cultural
transitioning seems to be the biggest factor for me to get
drunk in the village. Another thing to be overcome is
resentment and anger toward people, places and things.
Native way is to forgive, but Native people need to learn to
speak up and say what they want.
CHAIRMAN PORTER: Sophie, thank you very much. Your
testimony is right from the heart and has behind it a lot of
experience and observations. One of the questions that has
always plagued me as regards the alcohol problem in Alaska
Native culture, and I would ask you, do you think alcohol
abuse is the problem or is a symptom of the problem that
Alaska Natives have, as you described in cultural
difficulties and transitional values, traditional values,
problems and self-esteem?
SOPHIE NOTHSTINE: I think the answer to your question is
Native person like me have very low self-esteem and self-
worth. Until a person is shown that they're okay. My first
family is like people in Anchorage and in order to deal with
them as one family I had to have somebody else to help out
that is not of my immediate family. I think that alcohol
should be attacked first and later on the culture, depending
on where the person is coming from, what they are dealing
with. They should deal with what is causing them to drink
and use drugs or what is causing them to commit suicide.
I think that alcohol is the first factor of the people.
Children of alcoholics, the ones who have parents as
alcoholic. Alcoholics are the people who have never learned
how to live. They have to be shown how to hunt, dance, how
to face life after this, learn how to talk, raise their
children, little kids, one years old or two years old. You
have a 65 year old like me, there is a child that is still
temper tantrum and some parents (inaudible) you really can't
deal with it, it just comes out. You have to learn how to
put a stop to it. Alcoholic is a person who has never
learned how to deal with those things, so it's very
difficult to learn how to deal with that person on step one.
That's why they have drinking alcohol only once, the rest is
learning how to live.
CHAIRMAN PORTER: From one 55 year-old to another, thank you
very much.
REPRESENTATIVE MULDER: Thank you, Mr. Chairman. Just a few
things here. Representative Foster and I are co-chairs of
Military and Veterans Affairs. The offices of the National
Guard. As you know, the Guard in Alaska takes on many roles
throughout the state, performing different missions in the
urban areas as the rural areas. One of the things that
really struck me about the Guard in rural Alaska is that it
provides a very strong role model for the kids growing up in
the villages. It seems they have a positive outlook. It
gives them something to aspire to and towards. The kids and
their values and self-worth, something that is very
important for all of us, especially kids growing up, and I
would welcome the Chairman and Eric for subsequent meetings,
to call someone from the Guard. They have a number of
programs they are pursuing and looking at that I think are
worthwhile for this committee to pursue and to look at and
perhaps including recommendations for consideration and to
give testimony about their programs because they work hand
and glove with what Sophie was outlining.
CHAIRMAN PORTER: Very good suggestion. Perhaps the October
meeting in Fairbanks would be a good place to hear from
them?
REPRESENTATIVE MULDER: I think that would be fine. I know
they would love to talk about it because they are very
excited about the things they are doing in the villages.
They've had an uphill climb as well and they are beginning
to see success through their efforts. They've got some
ideas on how to expand those efforts into the schools and
into the instructional units. That's real important because
kids, when you get down to education, is the best way of
preventative medicine and will save us a lot of cost in the
long run.
CHAIRMAN PORTER: Very good. I'll ask Eric to touch base
with you and get the right names to invite to the Fairbanks
meeting. Sophie, thank you again. That seems to be the end
of the list of people who I had indicated that wanted to
testify. I now ask if there is anyone else in Bethel that
wishes to testify? Hearing none, how about Dillingham? And
Kotzebue?
UNIDENTIFIED: No sir.
CHAIRMAN PORTER: Okay. Thank you very much, all of you for
your participation, it has been good. Is there anyone else
here in Nome that would like to address us? There is.
Please come forward, sir.
DUFFY HALLADAY: My name is Duffy Halladay. I'm the chief
manager at Turning Point Detox Center. I'll try and be
brief. This has been a long meeting. I have just two
points I want to get across. Both of these are pertinent
information. At the Turning Point Detox about 10 percent of
our clients come from the emergency room and maybe 10
percent are Title 47 who are on hold and perhaps, I'd say
perhaps 80 percent are self admits, and in fact, some who
are on hold, brought in by the police.
There are 16 villages that come into Nome, and after a few
times from the police they will come in on their own. It's
like they do want to sober up. We show alcohol videos and
take people to the AA meetings on a nightly basis.
(inaudible) AA meetings are supposed to be separate, but in
the villages people most of the time do not have AA meetings
in the smaller villages to go to and I think that would be a
real positive step.
We have an AA register and we can give it to people and the
clients are going back to their own villages. They stay
with us for five days and they are willing to go to AA
meetings that are in the village. Like I say, they are
willing to follow, but they're not willing to start an AA
meeting and it would be nice if all the small villages would
have a group. I don't know what the answer to that is. It
might be something the task force could look into, trying to
get that going.
Just recently, we've been open for four years in January,
and in the last eight weeks the court system has started to
give us court referrals, 72 hour holds, and we have had
perhaps five in the last eight weeks. It's working very
well. We're getting a whole different group of clientele
with jobs, family, cars and basically they're having their
drivers license held hostage. It's the choice of going up
to Anvill Mountain for 72 hours or to a detox center and so
they're going to detox. We're glad to have them too.
One point I'd like the task force to consider is funding
that's continually been cut, as you well know, and we're
just taking on the additional responsibilities and
(inaudible). But we might have to consider that the court
system is going to give us additional responsibility,
hopefully there would not be a cut in funding in order to
offset the 72 hour hold.
I've been in Nome all this time and I'm not familiar with
Mr. Jones, but I just never work (inaudible) he definitely
understands things from the trenches, he understands where
the problems are, so in the future hearings you can take
testimony from everybody, but if you just scratch your head
and figure out what to you, we can certainly speak for our
detox center because we do understand the issues. We are
hitting the nail on the head quite often and that's all I
have to say.
CHAIRMAN PORTER: Thank you. As one of the people who used
to bring in the orangutans I can sympathize with you and the
transaction. Representative Mulder?
REPRESENTATIVE MULDER: Thank you, Mr. Chairman. Duffy,
quick question on the percentage. You said that 80 percent
were self- admit. Of those 80 percent, how many of those
would you consider to be chronic repeaters; you know, those
people who are coming in and self-admitting themselves
repeatedly?
DUFFY HALLADAY: These are people who are trying to get
well. I wouldn't say that is a problem according to
percentage, but the first words out of the board of
directors is that they did not want to be a revolving door,
whereas when the bar closed down they would come and sleep
and then get up in the morning and leave. We don't send
people away, but we are asking them to commit themselves for
five days. That's pretty big if they want to go drink
tomorrow. It's like they are going to go to AA meetings and
such and so they are going to weed themselves out if they
are just looking for a bed.
REPRESENTATIVE MULDER: Would you say that half of that 80
percent are repeaters more than twice. In other words, been
in there three or more times.
DUFFY HALLADAY: Certainly. We do have some that I know
their birthdays. They are in there quite often, but staying
sober for five days, and there are usually two counselors
per shift, and they get along with one or the other, they
would open and talk to somebody. When we first started bed
utilization and the referrals, about 75 percent we could
actually refer on to Northern Lights or the other treatment
centers. Where they went from there, whether they walked
away or they complete it or not, or you would have 75
percent who would just go out the door and 25 percent of
those who would actually try some treatment.
CHAIRMAN PORTER: Duffy, if you wanted to try to evaluate
your system and you referred people on to Northern Lights,
can Northern Lights tell you what your people did, or is
that confidential?
DUFFY HALLADAY: Yes, they do. We have a reciprocating
agreement. The clients sign confidentiality and understand
that we do the follow-ups and such, and so that is not a
problem.
CHAIRMAN PORTER: I think you are one of the few communities
that (inaudible) the problem. Make sure I understand, when
you say that you're getting, from whom are you getting the
referrals, rather than the 72 hour hold, the court or...?
DUFFY HALLADAY: The bulk of them are the police department
who will take people in Title 47, 12 hour hold.
CHAIRMAN PORTER: But the 72 hour hold. That has to process
through a court?
DUFFY HALLADAY: Yes. We just recently started that and the
judges were giving the choice, either you are going out to
Anvill Mountain Correctional Center or you are going to the
detox center.
CHAIRMAN PORTER: But this is the Title 47 as opposed to a
sentence like DWI or something like that?
DUFFY HALLADAY: It is a DWI, and we have to report back to
the court, did they spend 72 hours they spent with us, how
many substance abuse videos did they watch, and did they go
the AA meetings? We don't fiscally restrain them if they
want to walk out before the 72 hours is up. Basically, we
just report back to the court and the court decides to give
the license back, or whatever. It's working very well so
far. In fact, I believe Bethel, no Kotzebue's, detox center
felt it was working well with our detox center so.
CHAIRMAN PORTER: Let me suggest that if I understand you
correctly that it's a court referral as an alternative to 72
hours in jail for DWI that you talk with DOC because they
should be helping you out with the cost of your program.
REPRESENTATIVE MULDER?: I'm sorry, Mr. Chairman, but I urge
you (inaudible). We were all involved in the alternative
sentencing for DWI's. Is this a relative new program,
Duffy? Is it an outgrowth of that legislation, and
basically are you acting as a so-called halfway house? Or
are you providing an alternative location for sentencing
instead of a correctional institution?
DUFFY HALLADAY: Correct. I was told at the last staff
meeting there's a repeat offender who was there fourteen
days. What my concern is that down in the states they're
getting really tough on them, and Alaska as well may change
the laws. My brother who's working on the Oklahoma for six
months, and he gets to go home on weekends to see his wife
and four children. My point is that Alaska may in the
future, at least on DWI's, and it will affect our program,
and you need to consider that for your funding.
CHAIRMAN PORTER: Duffy, thank you. Diana, please help us.
DIANA FREEMAN: I was involved in a meeting with Judge
Kenley, Magistrate Jayder and Susie Kanler and we came up
with a vehicle to provide services for DWI offender in lieu
of... Most often they would insist they do 72 hours and
attend five AA meetings. Well,.... (end of tape)
TAPE THREE, SIDE A
Number 000
...by law that they would do. So not only are they housed
there, they're watching videos and they are working on a
treatment plan and so that (inaudible) that comes from.
CHAIRMAN PORTER: But that plan is as opposed to having to
go down to the mountain for a few days?
DIANA FREEMAN: That's correct.
CHAIRMAN PORTER: That's great that someone's doing that.
Representative Nordlund?
REPRESENTATIVE NORDLUND: What does it cost you to keep
these folks in for 72 hours? Part of the idea of the bill
Representative Mulder sponsored was to, for a low cost
sentencing alternative to DWI offenders with the idea that
it would cost the state less money, as well as provide more
treatment. One, what is it costing you to hold these people
and treat them? And two, are you developing any new
treatment methods that might be more appropriate to treat
the DWI?
DUFFY HALLADAY: Basically we funded through the state
Division of Alcoholism and they are treated as our regular
clients. We have a sliding fee scale and wherever they fit
in there, and if they don't have a penny in their pockets,
we will still let them in. We don't turn people away. It's
new for us and we are still working things out. The court
has said (inaudible) if the person said up and the answer
was no, they got a bench warrant and I suppose they are
going to Anvil Mountain. You had the choice and you didn't
show up. We just report back to the court and they take it
from there.
CHAIRMAN PORTER: Diana?
DIANA FREEMAN: We have two bills by Corrections that we
initiated negotiations in January, me and the former
director of the program, and now we have in place since July
two pay beds: one is for furloughs and one is for
probationary people. Throughout I had noted that we would
get a lot of furloughs and those people don't pay their
bills. So we initiated a price of 49 dollars a day. That's
what we get to house them.
CHAIRMAN PORTER, REPRESENTATIVES NORDLUND, MULDER:
Discussion.
REPRESENTATIVE MULDER: I might also remind this committee
though that part of the bill provided that people pay for it
themselves when they are financially available, if they're
not, the court is able to go in and tap their permanent fund
dividend, and if that has been tapped then they come back to
the state. By and large, that 49 dollars, as opposed to
what it is at Anvil Mountain, 49 (inaudible).
CHAIRMAN PORTER: I see no one else here. I ask one more
time if there is anyone else on the teleconference network
that wishes to testify? I see none. Let me say then that
we will conclude the teleconference and the committee
hearing. I appreciate very much the committee members, the
task force members, and all those people who testified. I
think we have had a very good beginning and gotten some good
regional information from this district of our state and
will continue to gather that as we move around and put it
all together when we get to Juneau and see if we can't come
up with something. Again, thank you very much and that will
be it.
Meeting adjourned at 1:04 p.m.
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