Legislature(2013 - 2014)SENATE FINANCE 532
01/31/2013 09:00 AM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| Budget Overview: Alaska Mental Health Trust Authority | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 20 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
SENATE FINANCE COMMITTEE
January 31, 2013
9:01 a.m.
9:01:39 AM
CALL TO ORDER
Co-Chair Kelly called the Senate Finance Committee meeting
to order at 9:01 a.m.
MEMBERS PRESENT
Senator Pete Kelly, Co-Chair
Senator Kevin Meyer, Co-Chair
Senator Anna Fairclough, Vice-Chair
Senator Click Bishop
Senator Mike Dunleavy
Senator Lyman Hoffman
Senator Donny Olson
MEMBERS ABSENT
None
ALSO PRESENT
Jeff Jessee, Chief Executive Officer, Alaska Mental Health
Trust Authority; Mike Barton, Trustee, Alaska Mental Health
Trust Authority; Russ Webb, Member, Board of Trustees,
Alaska Mental Health Trust Authority.
SUMMARY
SB 20 APPROP: MENTAL HEALTH BUDGET
SB 20 was HEARD and HELD in committee for further
consideration.
^BUDGET OVERVIEW: ALASKA MENTAL HEALTH TRUST AUTHORITY
9:01:44 AM
JEFF JESSEE, CHIEF EXECUTIVE OFFICER, ALASKA MENTAL HEALTH
TRUST AUTHORITY (AMHTA), presented "Senate Finance
Committee FY 14 Budget" (copy on file).
MIKE BARTON, TRUSTEE, ALASKA MENTAL HEALTH TRUST AUTHORITY,
made introductions. He introduced slide 2 titled "AMHT
Beneficiaries":
· People with mental illness
· People with developmental disabilities
· People with chronic alcoholism and other substance
related dementia
· People with traumatic brain injury
Mr. Barton detailed slide 3 titled "Guiding Principles":
· To improve the lives of AMHT beneficiaries, The AMHT
is committed to:
o Education of the public and policymakers on
beneficiary needs;
o Collaboration with consumers and partner
advocates;
o Maximizing beneficiary input into programs;
o Prioritizing services for beneficiaries at risk
of institutionalization;
o Useful and timely data for evaluating program
results;
o Inclusion of early intervention and prevention
components;
o Provision of reasonably necessary beneficiary
services based on ability to pay.
Mr. Barton discussed slide 4 titled "AMHT Advisors and
Partners":
· Advisory Board on Alcoholism & Drug Abuse
· Alaska Mental Health Board
· Governor's Council on Disabilities & Special Education
· Alaska Commission on Aging
· Commissioners of Health and Social Services, Revenue,
Natural Resources and Corrections
· Alaska Brain Injury Network
· Statewide Suicide Prevention Council
9:06:05 AM
Mr. Barton highlighted slide 5: "AMHT Funding FY 14:" He
noted that the great bulk of AMHTA funding came from the
fund pay-out. The AMHTA fund payout at 4.25 percent equaled
$18,090,000. The payout was based on a four-year average
principal and reserve balances of $426 million.
Mr. Barton detailed slide 6: "AMHT Resource Portfolio." He
explained that AMHTA had approximately 1 million acres of
land resulting from a settlement. The acres were divided by
region. The Trust had full fee ownership for 55 percent of
the land. The Trust owned coal, oil and gas rights for one-
third of the land and full mineral rights for 11 percent.
The Trust Land Office (TLO) contributed a total of $138
million since 1994 when the settlement was achieved.
9:08:06 AM
Mr. Barton detailed slide 7 titled "Formula for Success":
· Committed partners + Strategic thinking = Results for
AMHT beneficiaries
o Identify a problem or community need
o Collaborate with governmental agencies, advisory
groups, nonprofits, service providers,
philanthropic organizations and private sector
o Develop strategic, sharply focused solutions
o make lasting system improvements
Mr. Barton explained slide 8 titled "Five Program Focus
Areas":
· Bring the Kids Home
o reforming Alaska's mental health care for
children and adolescents so they are diagnosed
earlier and treated as close to home as possible
· Disability Justice
o reducing the involvement and recidivism of AMHT
beneficiaries in the criminal justice system
· Affordable Appropriate Housing
o increasing a continuum of housing options for
AMHT beneficiaries
· Workforce Development
o creating an available and competent workforce for
AMHT beneficiaries and service providers
· Beneficiary Projects Initiative
o supporting grassroots, peer-to-peer programs for
AMHT beneficiaries
9:09:17 AM
Mr. Barton detailed slide 9 titled "Alcohol Initiatives":
· Recover Alaska
o initiative lead by Rasmuson Foundation, includes
The AMHT, Mat-Su Health Foundation, DHSS and
other stakeholders
o goal to help individuals, families and
communities in Alaska "recover" from impacts of
alcohol
o focus on systems, policy, statutory and practice
changes that will lead to long-term improvements
· Title 4 review
o partnership with Alcohol Beverage Control Board,
which is convening stakeholders to review and
possibly recommend changes to Alaska's alcohol
beverage control statutes in Title 4.
9:09:40 AM
Mr. Jessee highlighted slide 10 titled "Bring the Kids
Home":
· Problem
o FY 06: 743 Alaskan children with severe emotional
disturbances received out-of-state residential
psychiatric treatment services
ƒseparated from families and communities
ƒdifficult transitions back to Alaska
ƒlength of stay varied from several months to
multiple years
ƒcosts peaked at $40+
· Committed partners
o DHSS, behavioral health service providers, parent
and youth advocates, AMHT partner boards, Alaska
Native health providers, Dept. of Education,
Denali Commission and others
· Strategic thinking
o intervene earlier, more intensively, and with the
family
o use residential resources carefully
o expand implementation of effective practices
o develop in-state treatment for youth with complex
needs
o use data to guide service development
9:12:54 AM
Mr. Jessee explained slide 11: "Results for Beneficiaries."
He explained that the AMHTA dramatically decreased the
number of admissions to out-of-state Residential
Psychiatric Treatment Centers (RPTC). At the onset of the
program, 437 kids were placed in out-of-state facilities,
and the placement in 2013 was less than 100. The success
was in the reinvestment of services in Alaska. The AMHTA
also tracked recidivism. He noted that recidivism was best
seen in the Department of Corrections (DOC) budget. He
pointed out that AMHTA reduced recidivism within one year
from 20 percent to 5 percent.
9:14:00 AM
Mr. Jessee detailed slide 12 titled "Shifting Expenditures
in State":
· Out-of-state RPTC expenditures 64 percent lower than
FY 06
· In-state RPTC expenditures 54 percent higher than FY
06
· Overall RPTC expenditures 33 percent lower than FY 06
· Community mental health expenditures for youth <18 are
26 percent higher than FY 09
9:16:09 AM
Mr. Jessee described slide 13 titled "Results for
Beneficiaries":
· Developing in-state treatment options for children
with co-occurring and complex disorders
o Complex Behaviors Collaborative
o in-state RPTC unit
o resources for youth who experience FASD
Mr. Jessee added that the AMHTA was seeking to replicate
programs in Alaska that only exist in out-of-state
facilities for children with more complex issues. He
informed the committee that a partnership with Department
of Health and Social Services (DHSS) led to the discovery
of a program in Maine that provided in-patient services for
the population requiring additional care. The children were
often diagnosed with autism, Fetal Alcohol Spectrum
Disorder (FASD), severe emotional disturbances, often with
behavioral issues that made it difficult to remain in the
home or in a residential program. The program in Maine
offered help with communications and behavioral management.
Co-Chair Kelly asked about the term "complex behaviors".
Mr. Jessee responded that complex behaviors included
"acting out, running away, self-injury, combative behavior,
or other behavior that the current environment was unable
to manage." If the behaviors went unmanaged, the individual
must leave the placement. He advocated for the development
of state-of-the art, evidence based, behavior management
plans.
Mr. Jessee explained that the Alaskan children with those
problems were spending over 400 days in out-of-state
treatment facilities and returning with their issues
intact. The program in Maine, in contrast, had an average
stay of 45 to 90 days, reducing the cost for the high-end
care. He highlighted that the program connected to
community-based services, either family or a resident
provider. He noted that the program in Maine discharged
two-thirds of their clients back into the home by
developing behavior plans and bringing the family in from
the beginning of treatment. The family shadowed the staff
as behavior programs were developed and then instituted the
program in the facility for the child prior to discharge.
After discharge, the staff remained available for
consultation. He pointed out the program's recidivism rate
of less than 10 percent.
Mr. Jessee stated that AMHTA had engaged North Star, a
residential provider in Anchorage, to provide the in-
patient piece. He added that community providers would help
to match patients with providers.
Mr. Jessee explained that the AMHTA's role in the process
was to incur travel expenses for community providers and
employees of North Star. He stated that the Bring the Kids
home program was winding down, but AMHTA would continue to
coordinate with families and programs in Alaska when
children do leave the state.
9:22:34 AM
Co-Chair Kelly asked the age limits for Bring the Kids
Home. Mr. Jessee replied that the parameters were age 8
through 21.
Co-Chair Kelly asked about the process when a child "ages
out" of the program. Mr. Jessee responded that the goal was
to transition the children to "life." He lamented that some
children required transition to the adult mental health
system for ongoing support.
Senator Olson asked if the patients were ineligible for
Medicaid after a certain age. Mr. Jessee responded that
financial status was the criteria for Medicaid.
9:24:11 AM
Mr. Jessee read from slide 14 titled "Results for
Beneficiaries":
· Working with young children to prevent severe
disturbances
· Working with families to keep/return children to their
homes
o expanding early childhood services
o increasing delivery and quality of family therapy
services
o expanding trauma training
Mr. Jessee discussed Adverse Childhood Experiences (ACE)
scores. The AMHTA discovered that the more negative
experiences a child had, the greater the likelihood that
they would end up with long-term behavioral health issues.
He noted that people who commit suicide had multiple
adverse childhood experiences. He pointed out that high ACE
scores also led to increases in physical problems like
diabetes and heart disease. The information was important
to digest as it allowed the organization of prevention
efforts toward areas of potential success. The challenge
with prevention was in targeting efforts to sufficiently
deliver enough intervention to change the trajectory. If
the target population was not identified, money was often
wasted. He mentioned the challenge of sustaining the DHSS
budget over the next 20 years. He pointed out that early
intervention and partnerships with schools was important,
as most families were not self-reporting.
9:27:01 AM
Mr. Jessee detailed slide 15: "Ahead in FY 14." He noted
the incorporation of Mental Health Traits Authority
Authorized Receipts (MHTAAR). He explained that the
legislature did not appropriate AMHTA funds, but instead
authorized agencies to receive AMHTA funds that the
trustees authorized for that use. Federal funds were
handled in a similar fashion. He added that GF/MH was the
acronym for General Fund and Mental Health.
Mr. Jessee explained the Trust's proposal versus the
governor's recommendation in the FY 14 Budget. The trustees
proposed a one-to-one match on AMHTA funds versus the state
funds. He pointed out that the governor had reduced the
request for GF/MH. He stated that he would work with
Senator Olson and the subcommittee on the issue. His goal
was to maintain the one-to-one match.
9:28:46 AM
Mr. Jessee detailed slide 16 titled "Looking Towards FY
15":
· FY 15 BTKH increments, if any, will transition on-
going successful projects from MHTAAR to GF/MH for
long-term sustainability
· BTKH efforts will continue, using existing GF/MH
resources to sustain planning and to maintain and
build on success
· The AMHT believes further progress will require a
shift in focus to earlier intervention, prevention and
family-based services to decrease long-term costs for
behavioral and health while improving outcomes for
children and families.
Mr. Jessee discussed slide 17: "Disability Justice." He was
pleased with cooperation from the Department of Corrections
(DOC). Reduction of recidivism was an important issue. He
pointed out that 43 percent of the youth in the juvenile
justice system and 42 percent of incarcerated adults were
AMHTA beneficiaries. The goal of AMHTA was to lower those
rates. He expressed that the partnership with DOC was
promising. The department's focus was also to reduce
recidivism. Trust beneficiaries tended to recidivate at a
higher rate than individuals without mental health issues.
9:30:36 AM
Mr. Jessee discussed slide 18 titled "Committed Partners":
· Local governments
· Alaska Native tribal entities
· Alaska Court System
· Departments of Administration, Corrections, Health and
Social Services, Law, Public Safety
· AMHT partner boards
· Community behavioral health providers
Mr. Jessee discussed slide 19 titled "Strategic Thinking":
· Prevent and reduce inappropriate or avoidable arrest,
prosecution, incarceration and criminal recidivism of
juvenile and adult AMHT beneficiaries
· Increase criminal justice system's ability to
accommodate, support, protect and provide treatment
for victims and offenders who are AMHT beneficiaries
· Reduce use of jails and prisons to provide protective
custody of adult AMHT beneficiaries under Alaska
Statute 47.37.170 (protective custody hold)
· Improve community re-entry planning from juvenile
detention and treatment, and adult correctional
facilities back into Alaska communities.
9:32:12 AM
Mr. Jessee addressed slide 20 titled "Outcomes Driven
Results":
· Working together state, local agencies save lives,
improve public safety
o 75 percent reduction in non-criminal Title 47
protective custody holds at Yukon Kuskokwim
Correctional Center from 2010-2012
o Individuals screened, referred to appropriate
treatment
· Therapeutic Courts
o Juneau Mental Health Court opened May 2012
o Anchorage Mental Health Court combined savings
almost 2.5 times program annual operating cost
(293,000)
9:33:58 AM
Senator Hoffman believed that the mental health program in
Bethel was functioning well. He asked about the non-
criminal Title 47 protective custody holds illustrated on
slide 20. He asked if Title 47 should be amended from "non-
criminal to criminal."
Mr. Jessee responded that a modification of the protective
custody statute was possible. He pointed out that police
officers made difficult decisions when determining the
ideal holding location for criminals vs. non-criminals. He
advocated for solutions that would provide the system
better options rather than driving legislative action.
9:35:43 AM
Senator Hoffman noted that Bethel had struggled with Title
47 protective custodies. He noted that the Yukon Kuskokwim
Correctional facility was over 200 percent capacity, which
was a separate issue. He opined that the community was
skirting the issue by leaving the statute as written. He
advocated for treating an inebriated person differently, if
alcoholism was considered a disease.
Co-Chair Kelly requested that Mr. Jessee provide an answer
to Senator Hoffman's question regarding costs. He mentioned
Judge Blankenship in Fairbanks who was very concerned about
issues happening in the northern regions. He assumed that
the best solutions would come from AMHT.
9:37:11 AM
Senator Olson discussed the complexities of Title 47 and
the impact on Kotzebue with its lack of a holding area. He
wondered how the state could protect and take care of
Alaskans under the current circumstances.
Mr. Jessee responded that Nome had a new hospital. The old
hospital would be renovated as a wellness center for
treatment. The wellness center could function as a sobering
center with positive programs. He mentioned the turn-over
at the health corporation, which slowed the project's
progress.
9:38:59 AM
Senator Olson asked why a holding facility did not exist in
Kotzebue. He asked why a person held under Title 47 with
mental health issues had to travel to Nome.
Mr. Jessee agreed that the availability of services in
smaller communities was indeed important. Additional
facilities in smaller communities could prevent congestion
in the larger facilities. He highlighted that resources and
triage were the key components. The Trust was a member of
the Behavioral Health Aide Program that was currently
funding the development of the Behavioral Health Aide
manual that will be patterned after the Health Aide manual.
Behavioral health services in village settings were very
important. He added that Kotzebue employed the use of video
to assist behavioral health aides or village counselors in
their use of telemedicine. Telemedicine could avoid
transport to large communities.
9:40:35 AM
Senator Olson asked if Mr. Jessee would be available when
he visited DOC requesting resolution of the Kotzebue jail
situation. Mr. Jessee responded yes.
Co-Chair Kelly asked if Kotzebue was in the fourth judicial
district.
Senator Olson replied that Kotzebue was in the second
judicial district.
Co-Chair Kelly advocated for collaboration between the
mental health community, the political arm and the judicial
branch.
9:41:52 AM
Mr. Jessee appreciated the information.
Co-Chair Kelly pointed out the need for a capital
expenditure for the correctional facility in Kotzebue. He
asked if AMHTA engaged in a match with other entities for
proposed capital expenditures.
Mr. Jessee responded that AMHTA lacked the resources to
contribute much to capital expenditures. He highlighted
small capital grants in the range of $50 thousand to $100
thousand. The Trust provided guidance to organizations
seeking interest about capital requests. He noted that the
Rasmuson Foundation called on AMHTA regularly with queries
about capital projects. He stated that AMHTA would then
provide a relatively small match.
Mr. Jessee informed the committee that AMHTA was a partner
with the Denali Commission, the Mat-Su Health Foundation
and the Rasmuson Foundation in the predevelopment program.
When a funder was interested in a project they were
referred to the predevelopment program, which was housed at
the Foraker group. Many non-profit organizations were in
the human service business, as opposed to the building
business. The predevelopment program allowed organizations
to gain an education about capital project details.
9:45:19 AM
Mr. Jessee discussed slide 21: "Ahead in FY 14:" He pointed
out that the largest GF/MH increment was the $1,165,000
required to sustain the wellness court capacities. The
funding was essential to maintaining the gains made.
9:46:12 AM
Mr. Jessee discussed slide 23: "Affordable Appropriate
Housing." He stressed the importance of housing to AMHTA
beneficiaries. He wished to reduce the stigma that mentally
ill people were prone to violence. Mentally ill people were
significantly more likely to be victims. He explained that
a person receiving a state supplement earned approximately
$12 thousand per year. A beneficiary working a minimum wage
job earned $16 thousand per year. The cost-of-living in
Alaska, including a studio apartment, was $28 thousand. He
understood that dividends were paid by Alaska Housing
Finance Corporation (AHFC), but most of them went into the
general fund. He expressed that housing was one of the most
critical areas of focus.
9:48:22 AM
Senator Bishop requested data about Alaskan communities
with the highest rate of chronic homeless populations.
Mr. Jessee detailed slide 24 titled "Committed Partners":
· Alaska Council on the Homeless: Alaska Housing Finance
Corporation, the departments of Health and Social
Services, Corrections, Labor and Public Safety, and
the Veterans Administration.
· Housing development organizations
· Social service agencies
· Local affordable housing and homeless coalitions
· Private business owners
9:49:37 AM
Mr. Jessee discussed slide 5: "Clarifying the need." He
stated that numbers of vulnerable adults in the state were
not decreasing. Various programs such as "Housing First" in
Anchorage and Fairbanks were utilized.
Co-Chair Kelly expressed interest in the Housing First
model.
Mr. Jessee stated that one strategy was to demand that
people with chronic alcoholism stop drinking before housing
was provided. The strategy led to increased homelessness
and increased cost to society. The idea of Housing First
came as a solution to the problem. Providing housing
initially, followed by strategies, allowed for an explosion
of new information about the homeless population. He added
that the project disputed many myths regarding a person's
desire to drink and camp. The findings suggested that
homeless people did not want to live on the street and they
did not want to be alcoholics. By providing housing, the
beneficiary's health status improved and drinking
decreased.
Mr. Jessee stated that the Housing First project in
Anchorage was successful. Initially there was concern that
the beneficiaries would be out in the neighborhood streets
and in neighbor's doorways, but instead it was a challenge
to encourage beneficiaries to leave their rooms. He stated
that Fairbanks had a Housing First project and Juneau was
considering one as well.
9:54:37 AM
Mr. Jessee described slide 26 titled "Strategic Thinking":
· Adapting programs for sustainability - replicating
successful strategies through AHFC
o Special Needs Housing Grants (SNHG)
o Homeless Assistance Program (HAP)
· Collaborating on creating "no wrong door"
o coordinating services statewide through homeless
coalitions
o assessment of housing barriers
· Collaborating on creating "no wrong door"
o DHSS Divisions of Behavioral Health and Senior
and Disability Services
o Assess needs by region and beneficiary group
· Effective program models implemented
o Trust/DHSS/AHFC collaboration on HUD pilot
(reducing General Relief participants through
supported housing)
o program development: Bridge Home and more
intensive community outreach models
Mr. Jessee detailed slide 27 titled "Results for
Beneficiaries":
· Working the Plans
o Alaska Council on the Homeless Ten-Year Plan,
Anchorage Ten-Year Plan on Homelessness, other
community plans
· Replicating Housing First
o targeting the most vulnerable and costly homeless
· Anchorage and Fairbanks on-track to replicate Outside
results:
o Seattle decreased drinking by 30 percent and
reduced costs by $4 million in 12-month period.
o Anchorage tenants are becoming stable - 78
percent retention compared to 80 percent in
similar programs
· Karluk Manor phase II - expansion and design
improvements
o working with Municipality of Anchorage to
identify land to relocate
o new facility will allow more individuals to be
served and will create space and staffing
efficiencies
· New projects under consideration: Anchorage, Juneau,
Nome
9:55:30 AM
Senator Bishop asked for anecdotal information regarding
alcoholism and the benefits of family and community support
as it pertained to cost-savings for the state.
Mr. Jessee replied that families were often willing and
able to provide support, but many times the situation was
overwhelming. The challenge for AMHTA was to provide the
least support necessary allowing for the efficacy of
natural systems. He expressed frustration about people
seeking treatment and achieving sobriety, but returning to
the same situation and issues that they had prior to
seeking treatment. He wished for "sober housing" for those
leaving treatment to help them resist temptations and work
their plan.
Mr. Jessee advocated for supporting families as opposed to
placing kids into programs and facilities.
9:58:28 AM
Co-Chair Kelly initiated a discussion regarding chronic
inebriation especially in rural Alaska. He asked if AMHTA
crafted their vision to "fix the problems" or to utilize
the limited funding available. He asked if a model existed
to "fix this problem." He understood that such a prospect
would be expensive. He compared the endeavor to a legacy
project. He asked if AMHTA might have such a project or
proposal to present to the legislature.
Mr. Jessee responded that each of the "focus areas" had a
logic model and a system of developing strategies over time
to achieve the ultimate outcomes. He stated that successful
models exist. He added that models for adults and
adolescents were often different. He advocated for poling
the best minds to identify the problem and the measurable
outcome desired. Effective and cost-effective strategies
could then be developed. He noted that AMHTA did not have
the resources to implement all of the programs. The best
service did not rely on governmental funding.
10:01:53 AM
Co-Chair Kelly expressed respect for Mr. Jessee and AMHTA.
He suggested an entrepreneur without experience in the area
of mental health might be able to solve the problem. He
noted that many of the problems expressed in the
presentation were the same problems he heard in committee
hearings 18 years ago. He expressed strong support for the
proposal of an "innovative model to fix the problem with a
funding schedule." He advocated for beginning in western
and northwestern Alaska. He shared a story about the
tragedy of suicide. He opined that AMHTA was able to
address only a small portion of the very large issue. He
requested an innovative model that did not rely on the
legislature's ability or willingness to fund it.
Co-Chair Kelly wondered if the discussion of "dry or damp"
community issues was relevant. He asked if Bethel was an
open community.
Senator Hoffman stated that Bethel and Kotzebue voted to
lift the ban on alcohol, but licenses were not issued to
local businesses. Because Bethel had voted to lift the ban,
laws did not exist regarding the council's wishes to
refrain from issuing licenses. He stated that Kotzebue and
Bethel were damp for 20 years. He relayed a story about
students raised in dry communities, who asked elders why
communities were dry. The elders respond that when they
drink, they can't handle alcohol. He opined that the
bootlegging problem led to heavy drinking. Bethel and
Kotzebue struggled with the issues and an attempt was made
to allow drinking. He stated that the phenomenon was new
and the results were yet to be seen.
10:09:13 AM
Co-Chair Meyer voiced that mental health illness was a
complex issue. Alzheimer's and alcoholism were often
inherited and brain damage could happen to anyone. He added
that fetal alcohol syndrome was devastating and completely
preventable. He asked what AMHTA offered to educate women
about avoiding drugs and alcohol during the nine months of
pregnancy. He requested statistics regarding state savings
when women avoided drugs and alcohol.
10:11:20 AM
Vice-Chair Fairclough commented that Anchorage business
owners had entertained the idea of purchasing and
relocating the Housing First facility. She opined that the
issue was not only a mental health issue; it was also an
"Alaska issue." She was willing to invest in a primary
prevention approach to address the problem. She wondered
how to highlight the issue for community education. She
appreciated AMHTA as a convener, but suggested that Alaska
look at primary prevention on a multitude of issues facing
the state.
10:14:50 AM
AT EASE
10:22:24 AM
RECONVENED
RUSS WEBB, MEMBER, BOARD OF TRUSTEES, ALASKA MENTAL HEALTH
TRUST AUTHORITY, appreciated the insightful conversation.
He appreciated the approach and the questions offered in
the committee process. He agreed with Vice-Chair Fairclough
that a narrow approach would not inspire change. He
advocated for an extended and broad-based approach to
preventing children from becoming involved in alcohol and
drugs by providing them resilience and information. He
opined that treatment ought to be available to parents
because alcohol and drugs were the most frequent
contributing factor to child abuse and neglect.
Mr. Webb stated that AHMT attempted to review the long-
standing problems and utilize the available resources to
make a difference. The large problems required time and
continued resource investment. He pointed out the
flexibility of the AMHTA's funding, which allowed for
implementation of good ideas. He added that AHMT was
seeking a solution, as opposed to a short-term fix. He
committed to the legislature and the state a genuine desire
to find a solution that would improve life for all
Alaskans. He stressed that he was heartened to be present
for the committee's discussion and he promised to work with
the other trustees to solve the problem.
Mr. Webb stated that AMHTA would provide the legislature a
broad-based approach that would span an extended period of
time. He added that AMHTA would invest money over the next
10 to 12 years to create a plan that would make a
difference. He pointed out that the effects of the plan
would not happen immediately. The impacts of a good
prevention effort were illustrated in a decade's time. He
requested patience and promised to work with the
legislature to communicate the ideas and progress. He
stressed that a broad-based plan would be presented to the
legislature prior to continuing with implementation.
10:28:04 AM
Co-Chair Kelly requested that AMHTA classify the request as
a "legacy project" for the state. He hoped that AMHTA would
import people from other areas. "To do the impossible, you
must think the absurd."
Mr. Webb responded that AHMT had experience seeking ideas
outside of their consulting group.
10:29:53 AM
Mr. Jessee addressed Co-Chair Meyer's question regarding
the prevention of Fetal Alcohol Syndrome (FAS). He pointed
out the state's comprehensive prevention program for FAS.
He noted that the state had a federal earmark and a state
incentive grant that addressed the prevention effort. He
agreed with Mr. Webb that society often enforced "social
norms" regarding alcohol. He shared a story about alcohol
availability during a health center opening. He viewed the
serving of alcohol as inappropriate, since many people
sought out services of the health center for help with
alcohol addictions. He pointed out that the Alcohol
Beverage Control (ABC) board was recently relocated from
the Department of Public Safety to the Department of
Commerce, Community and Economic Development in an effort
to seek promotion rather than regulation.
10:32:44 AM
Mr. Jessee continued that AMHTA would continue to seek
resources for housing issues. He pointed out that the
governor reduced the request for funding for homeless
programs. He planned to discuss the issue during the
subcommittee process, as the capitol budget moved forward.
He opined that additional resources for housing were
necessary as opposed to reductions.
Mr. Jessee discussed slide 30 titled "Workforce
Development":
· Problem
o growing need for workforce to serve Trust
beneficiaries, especially Alaskans 65+ (fastest
growing population segment)
o high vacancy rates in many health care jobs
o high turnover, especially in rural areas
ƒmany are temporary workers from Outside
ƒlack of housing
o lack of in-state training/education for some
fields
o lack of continuing education required for
licensure and certification for some professions
Mr. Jessee detailed slide 31 titled "Health Care Job
Growth":
· 38,749 new jobs in all Alaska sectors
o 12 percent increase from 2010-2020
· Health care and social service jobs expected to grow
31 percent by 2020 or one-third of total job growth
· Ambulatory health care - practitioners, outpatient
care, home health services - will gain 5,860 jobs or
28 percent increase by 2020
· Alaskans age 65+ expected to increase 89 percent by
2020, contributing to rising demand for health care
workers
· Aging population will boost social service sector,
adding about 2,400 jobs, up 25 percent by 2020
Mr. Jessee highlighted the necessary partnerships in slide
33 titled "Alaska Health Workforce Coalition":
· Core Team
o The Trust, departments of Labor, Education,
Health and Social Services; University of Alaska,
Alaska State Hospital and Nursing Home
Association, Alaska Workforce Investment Board
and Alaska Native Tribal Health Consortium
· Coalition
o Health Commission, AFL/CIP Alaska Nurses
Association, U.S. Dept. of Labor; Providence
Health and Services, Fairbanks Memorial Hospital,
Laborers Local 341, Alaska Area Health Education
Centers, Trust Training Cooperative, Alaska Rural
Behavioral Health Training academy, Alaska
Behavioral Health Association, service providers,
non-profit agencies, faith-based organizations
and Alaska Native Health Board
10:35:42 AM
Mr. Jessee discussed slide 37 titled "Ahead in FY 14":
· Funding Alaska Health Workforce Coalition Coordinator
· Analyzing and applying results of the 2012 Vacancy
Study
· Supporting development of a Graduate Certificate in
Marriage and Family Therapy (LMFT) program at
University of Alaska
· Securing a permanent home within UA system for non-
academic training and professional development for
health careers
Mr. Jessee discussed the FY 14 budget. He noted the lack of
support in a couple of areas. He planned to address the
issues in the subcommittee process.
Mr. Jessee discussed slide 38 titled "Beneficiary Projects
Initiatives":
· Community need:
o peer-based recovery support programs and peer
workforce to provide support to others with
similar experiences
o community-based peer support and other peer-based
recovery programs to help prevent need for more
expensive, intensive levels of service, including
hospitalization and/or incarceration
o recovery support for persons with high severity
and complex social and behavioral health issues
who do not fare well in traditional services
· Partners:
o 27 beneficiary grantee organizations since 2006
o Alaska Peer Support Consortium
o Divisions of Behavioral Health, Senior &
Disability Services Vocational Rehabilitation
o Trust Training Cooperative, Center for Human
Development
o Advisory Board of Alcoholism an Drug Abuse,
Alaska Mental Health Board, Governor's Council on
Disabilities and Special Education, Alaska
Commission on Aging
10:36:54 AM
Mr. Jessee discussed slide 39 titled "Strategic Thinking":
· Funding and technical assistance to support safety,
effectiveness and sustainability of peer programs and
services throughout Alaska
· Effective collaborations across service system,
advocacy groups and coalitions
· Training and education for peer support workforce
· Integration of peer support specialists across service
delivery systems
· Mini Grants to improve beneficiaries' quality of life
· Small Project Grants for small, beneficiary-focused
projects
10:37:31 AM
Co-Chair Kelly recalled a conversation with a surgical
center in Alaska stating that more than 1200 full-dental
plate replacements had been performed in their facility
last year for pediatric patients. He added that a
complication from poor dental care was the aspiration of
bacteria, which led to asthma and heart problems.
Mr. Jessee replied that people often lacked access to
preventative dental care. He noted that preventative work
often prevented major dental work, which was very
expensive. He was aware of the problem. He added that "mini
grants" of $2500 were recently offered to people in need
and the preference among them was to use the money for
dental care.
Co-Chair Kelly stressed that he did not associate full
dental replacements with pediatric patients. He was
surprised by the information.
Mr. Jessee stated strong support for the Dental Health Aid
Program, which delivered dental care to those in rural
areas.
10:39:24 AM
Mr. Jessee detailed slide 41 titled "FY 12 Small Project
Grants":
· $250,000 budgeted annually
· 25 grants in FY 12 totaling $191,361
· Up to $10,000 each
· Innovative new projects or enhancements to existing
projects of direct benefit to beneficiaries
· Organizations in Anchorage, Chugiak, Eagle River,
Homer, Juneau, Kodiak, North Pole, Palmer, Scammon
Bay, Sitka and Tanacross
Mr. Jessee concluded his presentation with slide 44 titled
"FY 14 Joint Legislative Priorities":
· Shared with all beneficiary advisory boards
o long-term support services for people with
disabilities
o Complex Behaviors Collaborative
10:40:32 AM
Vice-Chair Fairclough appreciated the holistic approach.
She wondered if the committee might sponsor a bill to
create a task force addressing the need for primary
prevention in Alaska. She suggested that other
organizations might match funding if the state initiated
primary prevention solutions.
Co-Chair Kelly offered to talk with Co-Chair Meyer about a
committee bill. He hoped that Senator Olson and Senator
Hoffman could participate in the issue. He understood
AMHTA's need for additional funding. He hoped to look at
the issues regarding that funding in a bigger way. He
invited Mr. Jessee to join him in a meeting with Bill
Pagaran regarding suicide prevention.
10:43:48 AM
Senator Olson asked about the interaction between private
efforts and the Alaska Native beneficiaries. He wondered
how the state and federal systems interacted.
Mr. Jessee responded that a large function of AMHTA was
connecting the two systems, which could potentially
complement each other. He saw room for improvement in the
joint efforts of the two systems.
ADJOURNMENT
The meeting was adjourned at 10:45 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB20 - AMHTA 2013 Senate Finance 013113 (3).pdf |
SFIN 1/31/2013 9:00:00 AM |
SB 20 |
| SB20 Mental Health Scorecard.pdf |
SFIN 1/31/2013 9:00:00 AM |
SB 20 |