Legislature(2013 - 2014)SENATE FINANCE 532

01/30/2014 09:00 AM Senate FINANCE


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09:06:00 AM Start
09:06:35 AM SB121
09:06:35 AM Fy 15 Governor's Budget Overview: Alaska Mental Health Trust Authority
10:38:19 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 121 APPROP: MENTAL HEALTH BUDGET TELECONFERENCED
FY 2015 Budget Overview and Presentation
Jeff Jessee, CEO, Alaska Mental Health Trust
Authority
                 SENATE FINANCE COMMITTEE                                                                                       
                     January 30, 2014                                                                                           
                         9:06 a.m.                                                                                              
                                                                                                                                
                                                                                                                                
9:06:00 AM                                                                                                                    
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair Kelly called the Senate Finance Committee meeting                                                                      
to order at 9:06 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 Donny Olson                                                                                                             
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Lyman Hoffman                                                                                                           
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Jeff Jessee,  Chief Executive Officer, Alaska  Mental Health                                                                    
Trust Authority;  Russ Webb,  Trustee, Alaska  Mental Health                                                                    
Trust Authority. Mike Barton,  Trustee, Alaska Mental Health                                                                    
Trust Authority.                                                                                                                
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
SB 121    APPROP: MENTAL HEALTH BUDGET                                                                                          
                                                                                                                                
          SB 121 was HEARD and HELD in committee for                                                                            
          further consideration.                                                                                                
                                                                                                                                
SENATE BILL NO. 121                                                                                                           
                                                                                                                                
     "An Act making appropriations for the operating and                                                                        
     capital    expenses   of    the   state's    integrated                                                                    
     comprehensive mental health program."                                                                                      
                                                                                                                                
9:06:35 AM                                                                                                                    
                                                                                                                                
^FY 15 GOVERNOR'S BUDGET OVERVIEW: ALASKA MENTAL HEALTH                                                                       
TRUST AUTHORITY                                                                                                               
                                                                                                                                
9:06:35 AM                                                                                                                    
                                                                                                                                
Co-Chair Kelly discussed the day's schedule.                                                                                    
                                                                                                                                
MIKE BARTON, TRUSTEE, ALASKA  MENTAL HEALTH TRUST AUTHORITY,                                                                    
introduced  the  PowerPoint   presentation:  "Alaska  Mental                                                                    
Health Trust  Authority presentation  to the  Senate Finance                                                                    
Committee."                                                                                                                     
                                                                                                                                
9:08:15 AM                                                                                                                    
                                                                                                                                
Mr. Barton began with slide 2: "Trustees."                                                                                      
                                                                                                                                
   · Mike Barton, chair                                                                                                         
   · Laraine Derr, vice chair                                                                                                   
   · Paula Easley, secretary                                                                                                    
   · William Doolittle, MD                                                                                                      
   · Mary Jane Michael                                                                                                          
   · Larry Norene                                                                                                               
   · Russ Webb                                                                                                                  
                                                                                                                                
Mr. Barton continued with slide 3: "Trust Beneficiaries."                                                                       
                                                                                                                                
     Alaskans with:                                                                                                             
        · Mental Illness; 34,479                                                                                                
        · Developmental Disabilities; 12,784                                                                                    
        · Chronic   Alcoholism/substance   abuse   disorder;                                                                    
          21,000                                                                                                                
        · Alzheimer's disease and related dementia; 5,000                                                                       
        · Traumatic Brain Injury; 11,900                                                                                        
                                                                                                                                
Mr. Barton detailed slide 4: "Guiding Principles."                                                                              
                                                                                                                                
     Improve the lives of beneficiaries                                                                                         
        · Education of the public and policymakers on                                                                           
          beneficiary needs                                                                                                     
        · Collaboration with advocates                                                                                          
        · Maximize beneficiary input into programs                                                                              
        · Prioritize services for beneficiaries at risk of                                                                      
          institutionalization                                                                                                  
        · Useful and timely data for evaluation                                                                                 
        · Include intervention and prevention components                                                                        
        · Provision of reasonably necessary beneficiary                                                                         
          services based on ability to pay                                                                                      
                                                                                                                                
Mr. Barton continued with slide 5: "Advisors and Partners."                                                                     
                                                                                                                                
   · Advisory Board on Alcoholism and Drug Abuse                                                                                
   · Alaska Mental Health Board                                                                                                 
   · Governor's Council on Disabilities and Special                                                                             
     Education                                                                                                                  
   · Alaska commission on Aging                                                                                                 
   · Commissioners of:                                                                                                          
        o Health and Social Services                                                                                            
        o Revenue                                                                                                               
        o Natural Resources                                                                                                     
        o Corrections                                                                                                           
   · Alaska Brain Injury Network                                                                                                
   · Statewide Suicide Prevention Council                                                                                       
   · Alaska Court System                                                                                                        
                                                                                                                                
9:10:21 AM                                                                                                                    
                                                                                                                                
Mr. Barton  moved on  to slide  6: "Trust  Cash Assets  - FY                                                                    
13." The graph depicted the Trust's assets in FY 13.                                                                            
                                                                                                                                
Mr. Barton  explained slide  7: "Trust  Resource Portfolio."                                                                    
The graphs showed  the non-cash assets managed  by the Trust                                                                    
and Land Office  in the Department of  Natural Resources. He                                                                    
mentioned  that cash  assets were  managed by  the Permanent                                                                    
Fund Division  of the Department  of Revenue. The  Trust had                                                                    
full-fee  ownership  on  55  percent of  the  lands  in  the                                                                    
settlement.  The   resources  must   be  developed   on  the                                                                    
remaining  land  for  beneficiaries   to  see  the  intended                                                                    
benefits.                                                                                                                       
                                                                                                                                
9:11:57 AM                                                                                                                    
                                                                                                                                
Mr. Barton discussed  slide 8: "FY 15  Available Income." He                                                                    
stated that the Trust fund  payout was based on 4.25 percent                                                                    
of  the net  asset values  at approximately  $19 million.  A                                                                    
lapse  of the  prior  year's distributions  and land  office                                                                    
income  with  interest  combined  with  the  payout  equaled                                                                    
approximately $26 million.                                                                                                      
                                                                                                                                
Co-Chair  Kelly  asked about  a  statutory  formula for  the                                                                    
payout.                                                                                                                         
                                                                                                                                
Mr. Barton pointed out slide 9: "Trust Focus Areas."                                                                            
                                                                                                                                
     Promoting change in systems to better serve Trust                                                                          
     beneficiaries in a cost effective manner                                                                                   
        · Bring the Kids Home                                                                                                   
        · Disability Justice                                                                                                    
        · Housing (new emphasis on long-term supports and                                                                       
          services)                                                                                                             
        · Beneficiary Projects (new emphasis on employment)                                                                     
        · Workforce Development                                                                                                 
        · Alcohol and Substance Abuse (new)                                                                                     
                                                                                                                                
9:14:49 AM                                                                                                                    
                                                                                                                                
JEFF JESSEE,  CHIEF EXECUTIVE OFFICER, ALASKA  MENTAL HEALTH                                                                    
TRUST AUTHORITY, discussed slide  10: "Bring the Kids Homes…                                                                    
Investing Wisely." He stated  that an evidence-based process                                                                    
with a  focus on  outcomes allowed  for optimal  results. He                                                                    
explained that  Alaska had 430  kids housed  out-of-state in                                                                    
residential psychiatric  treatment facilities  at a  cost of                                                                    
more than $40 million.                                                                                                          
                                                                                                                                
Mr.   Jessee  informed   the  committee   that  out-of-state                                                                    
institutions   were   expensive   and  the   expenses   were                                                                    
increasing.  He  stated  that the  Murkowski  administration                                                                    
initially approached  the Trust to address  the problem many                                                                    
years ago. A reinvestment of  funds allowed progress with an                                                                    
increase of  support services for families  and communities.                                                                    
The  Trust  provided  capital, allowing  the  initiative  to                                                                    
thrive throughout different  administrations. He pointed out                                                                    
that each governor had their  own individual priorities that                                                                    
could sometimes lose emphasis  with new administrations. The                                                                    
Trust could span those changes.  The Trust spent $16 million                                                                    
to continue the initiative.                                                                                                     
                                                                                                                                
9:17:58 AM                                                                                                                    
                                                                                                                                
Mr. Jessee continued to discuss  slide 10. He explained that                                                                    
the Trust visited a model program  in Maine to learn about a                                                                    
facility that  had successfully navigated  some of  the more                                                                    
difficult  behavioral  health  issues. He  stated  that  one                                                                    
solution  was to  work closely  with families  and community                                                                    
providers on  communication and behavior. If  the kids could                                                                    
communicate  effectively  and  manage  their  behavior  they                                                                    
could  remain   with  their   families  or   in  lower-level                                                                    
programs.                                                                                                                       
                                                                                                                                
9:19:53 AM                                                                                                                    
                                                                                                                                
Mr.  Jessee brought  up the  Alaskan  Youth Initiative  that                                                                    
solved  a  similar problem  in  the  past. The  program  was                                                                    
dismantled  after  the  problem was  solved.  Following  the                                                                    
completion of the Bring the  Kids Home initiative, the Trust                                                                    
promised to  prevent a  relapse. The  program had  less than                                                                    
100 recipients at the time of the hearing.                                                                                      
                                                                                                                                
Mr. Jessee stated  that the Trust wished to  avoid a similar                                                                    
mistake  in  the final  year  of  the  Bring the  Kids  Home                                                                    
initiative. He stated that the  Trust's data framework would                                                                    
actively monitor  the costs  of children  sent out-of-state.                                                                    
Data  "trip  wires"  would   provide  early  warning  before                                                                    
another crisis could occur.                                                                                                     
                                                                                                                                
9:21:18 AM                                                                                                                    
                                                                                                                                
Mr. Jessee discussed slide 11: "Investing Wisely."                                                                              
                                                                                                                                
     Investing Wisely                                                                                                           
     Complex Behavioral Collaborative                                                                                           
        · Prevent inappropriate and costly institutional                                                                        
          placements (API, correctional facilities, and                                                                         
          out-of-state placements).                                                                                             
        · Build capacity and expertise within the state to                                                                      
          serve individuals with complex behavioral needs                                                                       
          who have multiple dialing conditions.                                                                                 
                                                                                                                                
Mr.  Jessee shared  a story  about dementia.  He noted  that                                                                    
proper  staff  training  could   prevent  a  wide  range  of                                                                    
problems in an institution like  the Pioneer Home. The Trust                                                                    
helped the  Pioneer Homes appropriately address  dementia as                                                                    
one example of the Complex Behavioral Collaborative (CBC).                                                                      
                                                                                                                                
Mr.  Jessee  credited  Rita  Sullivan   on  her  efforts  in                                                                    
assembling a list of expert  consultants in various areas of                                                                    
disability  and  behavioral  programming. The  experts  were                                                                    
linked with  facilities or families that  would benefit most                                                                    
from their  expertise. The  effort allowed  beneficiaries to                                                                    
remain in their homes or  facilities as opposed to ascending                                                                    
the  intensity-of-service scale.  The facilities  benefit as                                                                    
the skill  level of the  service providers grows.  He stated                                                                    
that the  Trust increased their  contribution in FY  13. The                                                                    
program  was fully  funded with  general fund  mental health                                                                    
funding  in FY  14, with  all increments  classified as  One                                                                    
Time Increments (OTI).                                                                                                          
                                                                                                                                
9:25:33 AM                                                                                                                    
                                                                                                                                
Mr.  Jessee shared  slide 12:  "Outcomes of  CBC." He  noted                                                                    
that expenses  for 14  participants were  approximately $600                                                                    
thousand before their  entry into the CBC  and $400 thousand                                                                    
afterward. He  acknowledged that the CBC  was not successful                                                                    
with  every single  person. He  stated that  one beneficiary                                                                    
with severe emotional problems cost  a large amount of money                                                                    
($140 thousand per year) to  treat in the Lower 48. Another,                                                                    
an  adolescent  was  treated  in   a  Lower  48  psychiatric                                                                    
treatment facility  that cost $90  per year. He  pointed out                                                                    
that the  $200 thousand savings would  continue through each                                                                    
upcoming annual cycle. He believed  that the investment made                                                                    
sense,   from  a   fiscal  policy   standpoint.  He   quoted                                                                    
Representative  Mike  Newman "we  can't  cut  our way  to  a                                                                    
sustainable budget;  somehow, we  have to cut  our front-end                                                                    
costs  over the  long  term." The  Trust  believed that  CBC                                                                    
accomplished the goal.                                                                                                          
                                                                                                                                
9:27:58 AM                                                                                                                    
                                                                                                                                
Mr. Jessee detailed  slide 13: "Disability Justice…Investing                                                                    
Wisely?" The graph was presented  to the legislature by ISER                                                                    
to  project prison  population figures  in  Alaska. The  red                                                                    
dotted line depicted a potential  scenario including the use                                                                    
of  strategies to  reduce  recidivism.  The slide  concluded                                                                    
that Alaska would not benefit  from those strategies as they                                                                    
had yet  to be implemented.  He recalled  recent discussions                                                                    
about the need for a new prison.                                                                                                
                                                                                                                                
9:29:15 AM                                                                                                                    
                                                                                                                                
Mr.  Jessee discussed  slide  14: "Clinical  Characteristics                                                                    
Trust Beneficiaries  in the  Department of  Corrections." He                                                                    
stated  that 42  percent  of inmates  in  the Department  of                                                                    
Corrections  were  trust  beneficiaries,  while  38  percent                                                                    
qualified  because of  their chronic  alcohol use.  He added                                                                    
that 26 percent of inmates  would qualify for benefits based                                                                    
on diagnosed mental illness.                                                                                                    
                                                                                                                                
Mr. Jessee  slide 15: "A  Legacy for Alaska;  addressing the                                                                    
impacts  of  alcohol."  He recalled  last  year's  committee                                                                    
conversation  and the  challenge  issued  by Co-Chair  Kelly                                                                    
regarding Alaska's difficult social legacy with alcohol.                                                                        
                                                                                                                                
Mr. Jessee  slide 16:  "Annual cost  of alcohol  in Alaska."                                                                    
The interest  in the legacy was  due to the $670  million in                                                                    
lost productivity within private  sector industry. The state                                                                    
felt the  impact of  the $200  million for  criminal justice                                                                    
and protective services and $237 million for health care.                                                                       
                                                                                                                                
Mr. Jessee continued with slide  17: "Impacts of Alcohol and                                                                    
Substance Abuse in Alaska."                                                                                                     
                                                                                                                                
   · 18,296 alcohol-related arrests                                                                                             
   · 7,996 victims of alcohol and drug associated crimes                                                                        
   · 45,500 days of hospital care associated to alcohol and                                                                     
     drug related injury                                                                                                        
   · 2,239 nursing home and long-term care days attributed                                                                      
     to alcohol and drugs                                                                                                       
   · 26.9 per 10,000 live births annually or approximately                                                                      
     700 babies per year are FAS/D                                                                                              
   · 27 percent (66,260) Alaskans experienced at least one                                                                      
     alcohol or drug involved sexual assault or forcible                                                                        
     rape in their lifetime                                                                                                     
   · 45 percent of suicides were proven or suspected                                                                            
     intoxication                                                                                                               
                                                                                                                                
9:32:05 AM                                                                                                                    
                                                                                                                                
RUSS  WEBB,   TRUSTEE,  THE   ALASKA  MENTAL   HEALTH  TRUST                                                                    
AUTHORITY, spoke to  the issues of alcohol  abuse in Alaska.                                                                    
He  discussed slide  18: "Focus  on impacts  of alcohol  and                                                                    
substance abuse."                                                                                                               
                                                                                                                                
     Interventions will be outcome focused and will:                                                                            
         · emphasize prevention and early intervention                                                                          
         · decrease the negative impacts of alcohol on                                                                          
           Alaskan families                                                                                                     
         · reduce the long-term financial burden on state                                                                       
           and local budgets                                                                                                    
                                                                                                                                
9:33:18 AM                                                                                                                    
                                                                                                                                
Mr.  Webb continued  with  slide 19:  "Focus  on Impacts  of                                                                    
Alcohol and Substance Abuse."                                                                                                   
                                                                                                                                
     Solutions must be comprehensive                                                                                            
                                                                                                                                
     Prevention and early intervention with children and                                                                        
     families                                                                                                                   
        · Education                                                                                                             
        · Early child mental health system                                                                                      
        · Primary Care                                                                                                          
     Harm reduction                                                                                                             
        · Housing programs and community-based supports                                                                         
     Cross systems collaborations                                                                                               
        · Reduce silos and maximize cross system/sector                                                                         
          collaboration                                                                                                         
     Access to treatment                                                                                                        
        · Increased and improved access                                                                                         
        · Same day access and other business efficiencies                                                                       
        · Patient Centered Medical Home                                                                                         
     Enhanced tribal partnerships                                                                                               
     Environmental strategies                                                                                                   
        · Title 4                                                                                                               
                                                                                                                                
9:36:02 AM                                                                                                                    
                                                                                                                                
Mr. Webb  shared a story about  his wife who was  a district                                                                    
court  judge.  He  stated  that  his  wife  ordered  alcohol                                                                    
rehabilitation for people who were  then placed on a waiting                                                                    
list for longer than six  months. He stated that most people                                                                    
on  those lists  racked-up  other offenses  during the  time                                                                    
that they were waiting  for rehabilitation services; costing                                                                    
the state  more money.  He discussed the  impact of  the lag                                                                    
time on the criminal justice  system. He advocated for same-                                                                    
day access, patient-centered medical  care and other methods                                                                    
that  encouraged a  holistic  approach  through the  medical                                                                    
system.                                                                                                                         
                                                                                                                                
9:38:27 AM                                                                                                                    
                                                                                                                                
Mr. Webb discussed slide 20: "Legacy Investments."                                                                              
                                                                                                                                
     Maximizing Impact                                                                                                          
       · Trust focus on Alcohol and Substance Abuse                                                                             
        · Recover Alaska                                                                                                        
        · Mat-Su Health Foundation substance abuse and                                                                          
          trauma emphasis                                                                                                       
        · Alaska Resiliency Partnership                                                                                         
        · Empowering Hope                                                                                                       
                                                                                                                                
Mr. Webb discussed slide 21: "Trust Focus: Alcohol and                                                                          
Substance Abuse Prevention and Treatment."                                                                                      
                                                                                                                                
   · Trustees committed to addressing alcohol and substance                                                                     
     abuse                                                                                                                      
  · Trustees committed $400.0 in FY 14 and $1,000.0 FY 15                                                                       
   · Emphasis addressing the whole continuum of care from                                                                       
     prevention to recovery                                                                                                     
                                                                                                                                
9:40:28 AM                                                                                                                    
                                                                                                                                
Mr. Webb discussed slide 22: "Recover Alaska."                                                                                  
                                                                                                                                
   · Joint Leadership (Rasmuson Foundation, Mat-Su Health                                                                       
     Foundation                                                                                                                 
   · Partnerships                                                                                                               
   · Strategies                                                                                                                 
        o Communications/Media Partnership                                                                                      
        o Polling                                                                                                               
        o Advocacy                                                                                                              
        o one Stop Shop                                                                                                         
        o Positive Social Norms                                                                                                 
                                                                                                                                
Mr. Webb noted slide 23: "Mat-Su Health Foundation:                                                                             
substance abuse and trauma emphasis."                                                                                           
                                                                                                                                
     Community Health Assessment                                                                                                
        · Household survey, workplace survey, local health                                                                      
         policy assessment, 23 community meetings                                                                               
                                                                                                                                
     Alcohol and substance abuse was identified as the top                                                                      
     issue in Mat-Su                                                                                                            
                                                                                                                                
     Top two goals identified through a community process:                                                                      
        · Having a community where all children are safe                                                                        
          and well-cared for                                                                                                    
        · Where people do not use drugs and are sober or                                                                        
          drank responsibly                                                                                                     
                                                                                                                                
9:42:28 AM                                                                                                                    
                                                                                                                                
Mr.   Webb   discussed    slide   24:   "Adverse   Childhood                                                                    
Experiences."                                                                                                                   
                                                                                                                                
     Adverse Child Experiences (ACEs) is one of the largest                                                                     
     investigations conducted by Kaiser Permanente and the                                                                      
     Center for Disease Control and Prevention (CDC) to                                                                         
     assess impact of childhood maltreatment and later-life                                                                     
     health and well-being.                                                                                                     
                                                                                                                                
     Child traumatic experiences utilized to determine ACE                                                                      
     score:                                                                                                                     
        · child abuse and neglect                                                                                               
        · exposure to domestic violence household member                                                                        
          abusing alcohol/drugs                                                                                                 
        · depressed, mentally ill or suicidal family member                                                                     
        · family member incarcerated                                                                                            
        · divorce/separation                                                                                                    
                                                                                                                                
9:44:25 AM                                                                                                                    
                                                                                                                                
Mr.   Webb   discussed    slide   25:   "Adverse   Childhood                                                                    
Experiences."                                                                                                                   
                                                                                                                                
     Adult alcoholism and substance abuse increases                                                                             
     exponentially with the higher number of adverse                                                                            
     experiences                                                                                                                
                                                                                                                                
     Alaska Resiliency Partnership                                                                                              
        · The Trust                                                                                                             
        · Alaska Children's Trust                                                                                               
        · Mat-Su Health Foundation                                                                                              
        · Rasmuson Foundation                                                                                                   
        · Alaska Mental Health Board                                                                                            
        · Advisory Board on Alcoholism and Substance Abuse                                                                      
        · Department of Health and Social Services                                                                              
        · University of Alaska Anchorage                                                                                        
        · Alaska Native Tribal Health Consortium                                                                                
        · First Alaskans Institute                                                                                              
                                                                                                                                
Mr. Webb discussed slide 26: "The Empowering Hope Group."                                                                       
                                                                                                                                
     Executive level think-tank focusing on Alaska's                                                                            
     critical health and social challenges                                                                                      
                                                                                                                                
9:45:17 AM                                                                                                                    
                                                                                                                                
Co-Chair  Kelly introduced  the  Empowering Hope  Leadership                                                                    
Team.  He  founded the  group  following  the 2013  overview                                                                    
provided  by the  Trust last  session.  He recalled  feeling                                                                    
surprised that  Alaska was facing similar  problems to those                                                                    
he witnessed  18 years ago.  He pointed out  that Vice-chair                                                                    
Fairclough  was  also  a  member   of  the  Empowering  Hope                                                                    
Leadership Team. He acknowledged  that his initial intention                                                                    
was to  save Alaska  from all of  the problems  that plagued                                                                    
the state.  After an initial  review, the focus  was reduced                                                                    
to addressing fetal alcohol spectrum disorder (FASD).                                                                           
                                                                                                                                
Co-Chair Kelly explained  that the group chose  to leave the                                                                    
experienced Trust in charge of  serving the victims of FASD.                                                                    
The  Empowering   Hope  Leadership  Team's  focus   was  the                                                                    
eradication of FASD.  He stated that the  group utilized the                                                                    
phrase  "leg brace"  as an  analogy  to Jonas  Salk and  the                                                                    
discovery of the polio vaccine.  While other doctors applied                                                                    
the leg braces  needed to help those  already afflicted with                                                                    
polio, Salk chose to eradicate the disease.                                                                                     
                                                                                                                                
9:50:30 AM                                                                                                                    
                                                                                                                                
Co-Chair   Kelly   explained   that  the   Empowering   Hope                                                                    
Leadership  Team was  a "think  tank" to  develop consensus.                                                                    
The  members   were  Mark   Hamilton,  Reggie   Joule,  Norm                                                                    
Phillips, Niesje Steinkruger, Val  Davidson and Jeff Jessee.                                                                    
He  referred  to  slide   27:  "Empowering  Hope;  Strategic                                                                    
Priorities."                                                                                                                    
                                                                                                                                
    1. Eradicate the occurrence of Fetal Alcohol Spectrum                                                                       
      Disorder in Alaska.                                                                                                       
         a. Alaska has the highest documented FAS birth                                                                         
           prevalence in the United States.                                                                                     
         b. Each child born with FAS/D will cost the state                                                                      
           of Alaska between $860 thousand to $4.2 million                                                                      
           over the course of his/her lifetime                                                                                  
    2. Empower   "Natural    Responders"   in    communities                                                                    
      throughout Alaska                                                                                                         
         a. "Natural Responders" within a community are                                                                         
           primary  support  providers to  fellow  community                                                                    
           members  in crisis.  "Natural Responders"  may or                                                                    
           may not  be in leadership positions  within their                                                                    
           communities                                                                                                          
    3. Mitigate infrastructure barriers to ensure healthy,                                                                      
      thriving communities                                                                                                      
         a. Address rural Alaska's access to care challenges                                                                    
                                                                                                                                
Co-Chair  Kelly   noted  that   the  problem  of   FASD  was                                                                    
particularly  acute  in  rural Alaska.  The  communities  in                                                                    
rural  Alaska were  so small  and  separate with  a lack  of                                                                    
infrastructure. He  hoped that members of  rural communities                                                                    
would help  to educate  and empower  women to  stop drinking                                                                    
alcohol  during  pregnancy. He  understood  the  need for  a                                                                    
large-scale  public relations  campaign to  enable a  better                                                                    
understanding of FASD.                                                                                                          
                                                                                                                                
9:54:59 AM                                                                                                                    
                                                                                                                                
Co-Chair  Kelly continued  to  discuss  the Empowering  Hope                                                                    
Leadership  Team.   Identification  of   the  infrastructure                                                                    
barriers  was a  key aspect  of the  solution. He  noted the                                                                    
process  of including  private enterprise  in the  solution.                                                                    
The effort must outlast the  organization of the think tank.                                                                    
He stated  that the intention  was not  to gain status  as a                                                                    
non-profit   organization.  He   spoke  about   a  potential                                                                    
collaboration with  the Alaska Wellness Coalition.  He hoped                                                                    
to provide a model for other states in the nation.                                                                              
                                                                                                                                
Co-Chair Kelly  thanked Jeff  Jessee for  his help  and many                                                                    
efforts.                                                                                                                        
                                                                                                                                
9:57:52 AM                                                                                                                    
                                                                                                                                
Vice-Chair  Fairclough echoed  the  statements  made by  Co-                                                                    
Chair Kelly. She explained that  the words "Empowering Hope"                                                                    
were  meant to  inspire.  She believed  that  if any  mother                                                                    
understood  the damage  that they  were causing  their child                                                                    
for the rest of their lives,  they would not make the choice                                                                    
to  drink  alcohol during  pregnancy.  The  group wished  to                                                                    
empower  women to  make a  different decision  while helping                                                                    
them to  understand that one  drink of alcohol  does matter.                                                                    
The group  found that the  medical community  directed women                                                                    
differently in regards to alcohol.  She noted that there was                                                                    
not  a consistent  message about  alcohol's harmful  effects                                                                    
during  pregnancy.   She  wished   to  gather   the  medical                                                                    
community  to deliver  a consistent  message about  drinking                                                                    
alcohol  during  pregnancy.  She strongly  believed  that  a                                                                    
mother would never do damage intentionally.                                                                                     
                                                                                                                                
Co-Chair Kelly pointed out that  people who suffer from FASD                                                                    
were more likely to produce  babies with FASD. He added that                                                                    
women  with  children  afflicted with  FASD  often  produced                                                                    
additional  children with  FASD.  He  stated that  affecting                                                                    
community members  with the hyper realization  regarding the                                                                    
risks of  alcohol in pregnancy  could help those  faced with                                                                    
addiction.                                                                                                                      
                                                                                                                                
10:01:00 AM                                                                                                                   
                                                                                                                                
Vice-Chair Fairclough recalled a  presentation where a woman                                                                    
was asked why  she continued to birth babies  with FASD, and                                                                    
her reply  was that the  state kept taking her  babies away.                                                                    
She  stated  that  decisions made  by  government  officials                                                                    
often had unforeseen reactions.                                                                                                 
                                                                                                                                
Co-Chair  Kelly  stated  that  the  group  was  planning  to                                                                    
introduce two  separate resolutions. He anticipated  that he                                                                    
would have the support of the administration.                                                                                   
                                                                                                                                
10:03:36 AM                                                                                                                   
                                                                                                                                
Mr.  Jessee highlighted  the  opportunity  to set  objective                                                                    
benchmarks.  He suggested  that  one benchmark  might be  to                                                                    
reduce  recidivism  into  the criminal  justice  system.  He                                                                    
stated  that the  Trust learned  to identify  a quantifiable                                                                    
target whether  financial or otherwise  to focus  their data                                                                    
around. He asked if a rallying point existed.                                                                                   
                                                                                                                                
Vice-chair   Fairclough   stated  that   identification   of                                                                    
children with  FASD would  allow the  group to  help prevent                                                                    
future pregnancies  for the  woman afflicted  with untreated                                                                    
alcoholism.   She  discussed   teenage   pregnancies  as   a                                                                    
potential health indicator. She  stated that the group would                                                                    
look to the Trust to help guide investment decisions.                                                                           
                                                                                                                                
10:05:29 AM                                                                                                                   
                                                                                                                                
Mr.  Jessee suggested  identifying a  quantifiable goal  and                                                                    
determining  individual   strategies  later.   He  suggested                                                                    
searching  for larger  indicators  that the  state could  be                                                                    
rallied around.                                                                                                                 
                                                                                                                                
Co-Chair Kelly pointed out that  there was very little known                                                                    
about state expenses in response  to alcoholism. He recalled                                                                    
a document  generated by Legislative Research  Services. The                                                                    
data  suggested  that  the Alaska's  alcohol  problems  were                                                                    
prevalent and pervasive.                                                                                                        
                                                                                                                                
10:07:24 AM                                                                                                                   
                                                                                                                                
Senator  Dunleavy   suggested  the   document:  "Legislative                                                                    
Research  Report;  Public  Funding for  Programs  in  Alaska                                                                    
Targeting Alcohol  and Substance  Abuse by Source  and State                                                                    
Fiscal Year, FY  2003 -2012 (copy on file)."   He noted that                                                                    
state  funding  for  alcohol  related  issues  in  2003  was                                                                    
$1,146,600, while  federal funding was $2,605,046.  He noted                                                                    
that 2012 saw a twelve-fold increase in spending.                                                                               
                                                                                                                                
Co-Chair  Kelly replied  that the  twelve-fold increase  was                                                                    
for identifiable expenses alone.  He stated that Legislative                                                                    
Research Services had alluded  to even greater spending upon                                                                    
further investigation.                                                                                                          
                                                                                                                                
Senator Dunleavy  clarified that  the total  alcohol related                                                                    
state spending over a nine-year period was $362,897,000.                                                                        
                                                                                                                                
10:08:59 AM                                                                                                                   
                                                                                                                                
Senator Olson  applauded the efforts  of Co-Chair  Kelly and                                                                    
Vice-chair Fairclough.  He admitted that he,  as a physician                                                                    
could accomplish  immediate results by applying  a leg brace                                                                    
for  a  patient. He  agreed  that  the  problem of  FAS  was                                                                    
monumental and he wished that he had a similar vision.                                                                          
                                                                                                                                
Co-Chair Kelly shared a story about Senator Olson                                                                               
                                                                                                                                
10:11:33 AM                                                                                                                   
                                                                                                                                
Senator  Bishop acknowledged  that  the  subject matter  was                                                                    
difficult for  him. He  asked about slide  17 and  the 7,996                                                                    
victims of  alcohol and drug associated  crimes. He wondered                                                                    
about the potential for unreported numbers.                                                                                     
                                                                                                                                
Mr. Jessee  replied that  the university  performed research                                                                    
regarding unreported  rates of domestic violence  and sexual                                                                    
assault  associated  with   the  governor's  Choose  Respect                                                                    
campaign. He  stated that the  study found large  numbers of                                                                    
unreported domestic  violence and sexual assault  in Alaska.                                                                    
Many of the instances involved alcohol.                                                                                         
                                                                                                                                
10:13:35 AM                                                                                                                   
                                                                                                                                
Senator Dunleavy  asked about the  program in  place without                                                                    
research  data.   He  asked  about  program   inventory  and                                                                    
wondered  about  an  attached  research  model  or  a  data-                                                                    
gathering  mechanism  attached  to determine  the  program's                                                                    
impact.  He  asked about  benchmarks  and  the potential  to                                                                    
abandon an unsuccessful program.                                                                                                
                                                                                                                                
10:14:51 AM                                                                                                                   
                                                                                                                                
Mr.  Jessee   stated  that  the   Trust  was   undergoing  a                                                                    
behavioral health system assessment.                                                                                            
                                                                                                                                
Mr. Webb added  that good data drove  the Trust's decisions.                                                                    
He pointed  out the lack  of good information  regarding the                                                                    
capacity  of  the mental  health  system  in the  state.  He                                                                    
stated that  the Trust  planned to  establish a  baseline to                                                                    
help make these difficult  decisions. He stated that perfect                                                                    
information  was  difficult  to  obtain.  He  had  anecdotal                                                                    
information  about  a gap  in  services  because of  waiting                                                                    
lists  for  addiction  treatment. Hard  data  regarding  the                                                                    
needs was  difficult to come  by. He added that  people with                                                                    
coexisting mental  illnesses often ended up  in the criminal                                                                    
justice  system.  He stated  that  the  hard data  would  be                                                                    
provided  to  the committee  and  the  legislature once  the                                                                    
difficult process of retrieving  it was completed. He stated                                                                    
that  the  Trust and  the  commissioner  were interested  in                                                                    
moving toward an evidence-based system.                                                                                         
                                                                                                                                
10:18:13 AM                                                                                                                   
                                                                                                                                
Mr. Jessee furthered that the  Division of Behavioral Health                                                                    
had  made strides  in achieving  outcome  measures from  the                                                                    
programs. He  had been  working with  the department  for an                                                                    
acuity  adjustment factor  to encourage  the system  to move                                                                    
toward the  target population. He advocated  for clear goals                                                                    
from  the  legislature. He  sat  with  the Criminal  Justice                                                                    
Working Group,  which was assembled with  various department                                                                    
members discussing  the problem of recidivism.  He suggested                                                                    
the Department of Health and  Social Services, Department of                                                                    
Labor and  Workforce Development and Alaska  Housing Finance                                                                    
Corporation (AHFC).                                                                                                             
                                                                                                                                
10:21:25 AM                                                                                                                   
                                                                                                                                
Mr.  Webb added  that a  good  target was  crucial. He  used                                                                    
sobriety  from alcohol  treatment as  an example.  He stated                                                                    
that the programs  did not have the capacity  to track their                                                                    
clients. He  recalled testimony  stating that  treatment did                                                                    
not work. The  expectation was for treatment  to fix alcohol                                                                    
problems. He compared problems with  alcohol to other health                                                                    
issues   such   as   hypertension.   Both   alcoholism   and                                                                    
hypertension  required diligence  on  behalf  of the  person                                                                    
suffering  from  the  health problem.  He  opined  that  the                                                                    
sobriety target should be set differently.                                                                                      
                                                                                                                                
Mr. Webb  mentioned judicial council studies  from the early                                                                    
1990s stating  that 78 percent  of misdemeanants  were under                                                                    
the influence of  alcohol when they committed  the crime. He                                                                    
stated  that 90  percent of  serious felons  were under  the                                                                    
influence  of alcohol  when they  committed  the crime.  The                                                                    
offences  were   not  categorized  as   alcohol-related.  He                                                                    
advocated  for setting  the  target  at reducing  recidivism                                                                    
among people with alcohol problems.  Another target would be                                                                    
reducing the  number of rapes and  robberies committed under                                                                    
the influence  of alcohol. He suggested  the targets because                                                                    
they drove expenditures in the state budget.                                                                                    
                                                                                                                                
10:26:14 AM                                                                                                                   
                                                                                                                                
Mr. Jessee  urged the use  of careful targets.  He mentioned                                                                    
discussions  with the  governor's office  regarding domestic                                                                    
violence issues.  He explained that decreasing  the reported                                                                    
rate of domestic violence would  seem like a valid goal, but                                                                    
a  better target  would  be to  increase  the reported  rate                                                                    
because a  situation would not warrant  intervention without                                                                    
a  report. He  suggested  that  aggressive law  enforcement,                                                                    
prosecution  and  incarceration   might  have  the  opposite                                                                    
effects.  The reported  rate might  be  driven down  because                                                                    
victims were reluctant to report domestic violence.                                                                             
                                                                                                                                
Mr. Jessee  suggested strategies that encouraged  victims to                                                                    
report  the crime  because  they feel  that  a report  would                                                                    
bring a positive outcome. The  reported rate would be higher                                                                    
initially.  He stressed  that the  goal setting  process was                                                                    
crucial to any initiative.                                                                                                      
                                                                                                                                
Mr. Webb added that while  the reported rate might increase,                                                                    
the  repeat offenders  should be  the target  for the  short                                                                    
term.                                                                                                                           
                                                                                                                                
Co-Chair Meyer  stated that  he was  also involved  with the                                                                    
treatment of FAS. His focus  was on the education system. He                                                                    
stated that a  progressive bill was heard a  couple of years                                                                    
ago, involving  the court system.  He was encouraged  by Co-                                                                    
Chair Kelly's  efforts to prevent  FASD. He stated  that the                                                                    
state experienced  recent successes with  tobacco cessation.                                                                    
He mentioned  the tobacco cessation settlement  that allowed                                                                    
for a steady media campaign.                                                                                                    
                                                                                                                                
Co-Chair   Meyer   discussed   society's   difficulty   with                                                                    
discussing mental illness. He  noted that sympathy was given                                                                    
to those with physical  illness, while mental illnesses were                                                                    
looked  at  differently.  He encouraged  open  conversations                                                                    
about mental  illness. He  advocated for  further discussion                                                                    
during  the  budgeting process.  He  wondered  if the  state                                                                    
would  be  making  a  similar   or  preventable  mistake  if                                                                    
marijuana was legalized. He wondered  if the state should be                                                                    
more progressive  with greater intervention. He  wondered if                                                                    
the  state would  pay a  future  price for  the decision  of                                                                    
legalizing marijuana.                                                                                                           
                                                                                                                                
10:32:19 AM                                                                                                                   
                                                                                                                                
Mr.  Barton stated  that  the Trust  had  not discussed  the                                                                    
issue  of legalizing  marijuana.  He  assured the  committee                                                                    
that  the conversation  would occur  between members  of the                                                                    
Trust in the near future.                                                                                                       
                                                                                                                                
Co-Chair  Meyer  suggested  that the  Trust  announce  their                                                                    
position before  the issue was  before the people  in August                                                                    
2014.  He  believed  that   the  topic  deserved  thoughtful                                                                    
discussion.                                                                                                                     
                                                                                                                                
10:33:48 AM                                                                                                                   
                                                                                                                                
Co-Chair Kelly requested  help from Mr. Jessee  and Mr. Webb                                                                    
to  develop  the  necessary  benchmarks.  He  advocated  for                                                                    
inclusion of  the commissioner of  Department of  Health and                                                                    
Social Services.                                                                                                                
                                                                                                                                
Mr.  Jessee  stated  that many  addictive  behaviors  had  a                                                                    
variety  of  consequences.  He  stated  that  policy  makers                                                                    
determined  the   legality  of   those  behaviors   and  the                                                                    
consequences for a violation of  state law. He believed that                                                                    
a  description of  the impacts  of  certain substances  were                                                                    
easier for Trust members to  decipher. The issue of legality                                                                    
was for  the policy  makers to  determine. He  stressed that                                                                    
his movement  did not have  prohibitionist intent.  The goal                                                                    
was  to  manage  the  negative consequences  of  overuse  or                                                                    
inappropriate use  of substances  or behaviors. He  shared a                                                                    
story about  himself related to alcoholism  recovery and the                                                                    
criticism faced by those in  the limelight. He believed that                                                                    
the anonymous  piece of  Alcoholics Anonymous  prevented the                                                                    
necessary  social progress.  He  compared the  issue to  the                                                                    
AIDS where society  was encouraged to treat  AIDS victims as                                                                    
normal  members. He  believed  that the  moral dimension  of                                                                    
alcoholism retarded potential problem solving.                                                                                  
                                                                                                                                
10:37:27 AM                                                                                                                   
                                                                                                                                
Mr. Webb added that the Trust supported employment for its                                                                      
beneficiaries.                                                                                                                  
                                                                                                                                
Co-Chair Kelly appreciated the efforts of the Trust.                                                                            
                                                                                                                                
SB 121 was HEARD and HELD in committee for further                                                                              
consideration.                                                                                                                  
                                                                                                                                
10:38:19 AM                                                                                                                   
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
The meeting was adjourned at 10:38 a.m.                                                                                         

Document Name Date/Time Subjects
013014 Jan 30 presentation to Senate Finance FINAL.pdf SFIN 1/30/2014 9:00:00 AM
Mental Health Budget
013014 EconomicCostofAlcoholandDrugAbuse2012.pdf SFIN 1/30/2014 9:00:00 AM
Alaska Mental Health Trust