03/19/2018 01:30 PM HEALTH & SOCIAL SERVICES
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ALASKA STATE LEGISLATURE SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE March 19, 2018 1:31 p.m. MEMBERS PRESENT Senator David Wilson, Chair Senator Natasha von Imhof, Vice Chair Senator Cathy Giessel Senator Tom Begich MEMBERS ABSENT Senator Peter Micciche COMMITTEE CALENDAR COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 151(FIN) "An Act relating to the duties of the Department of Health and Social Services; relating to training and workload standards for employees of the Department of Health and Social Services and providing immunity from damages related to those standards; relating to foster care home licensing; relating to civil and criminal history background checks for foster care licensing and payments; relating to placement of a child in need of aid; relating to the rights and responsibilities of foster parents; requiring the Department of Health and Social Services to provide information to a child or person released from the department's custody; and providing for an effective date." - HEARD & HELD CONFIRMATION HEARING(S): State Medical Board Catherine Hyndman - Dillingham Sai-Ling Liu - Nome - CONFIRMATIONS ADVANCED PREVIOUS COMMITTEE ACTION BILL: HB 151 SHORT TITLE: DHSS;CINA; FOSTER CARE; CHILD PROTECTION SPONSOR(s): REPRESENTATIVE(s) GARA 03/01/17 (H) READ THE FIRST TIME - REFERRALS 03/01/17 (H) HSS, FIN 03/16/17 (H) HSS AT 3:00 PM CAPITOL 106 03/16/17 (H) Heard & Held 03/16/17 (H) MINUTE(HSS) 03/21/17 (H) HSS AT 3:00 PM CAPITOL 106 03/21/17 (H) Heard & Held 03/21/17 (H) MINUTE(HSS) 03/23/17 (H) HSS AT 3:00 PM CAPITOL 106 03/23/17 (H) Moved CSHB 151(HSS) Out of Committee 03/23/17 (H) MINUTE(HSS) 03/24/17 (H) HSS RPT CS(HSS) NT 3DP 1DNP 1NR 2AM 03/24/17 (H) DP: TARR, EDGMON, SPOHNHOLZ 03/24/17 (H) DNP: EASTMAN 03/24/17 (H) NR: KITO 03/24/17 (H) AM: JOHNSTON, SULLIVAN-LEONARD 03/28/17 (H) HSS AT 3:00 PM CAPITOL 106 03/28/17 (H) <Bill Hearing Canceled> 04/12/17 (H) FIN AT 1:30 PM HOUSE FINANCE 519 04/12/17 (H) Heard & Held 04/12/17 (H) MINUTE(FIN) 04/13/17 (H) FIN AT 1:30 PM HOUSE FINANCE 519 04/13/17 (H) Heard & Held 04/13/17 (H) MINUTE(FIN) 05/15/17 (H) FIN AT 1:30 PM HOUSE FINANCE 519 05/15/17 (H) Moved CSHB 151(FIN) Out of Committee 05/15/17 (H) MINUTE(FIN) 05/16/17 (H) FIN RPT CS(FIN) NT 4DP 1NR 4AM 05/16/17 (H) DP: ORTIZ, GARA, SEATON, FOSTER 05/16/17 (H) NR: GUTTENBERG 05/16/17 (H) AM: TILTON, THOMPSON, KAWASAKI, WILSON 05/17/17 (H) TRANSMITTED TO (S) 05/17/17 (H) VERSION: CSHB 151(FIN) 01/18/18 (S) READ THE FIRST TIME - REFERRALS
01/18/18 (S) HSS, FIN 03/19/18 (S) HSS AT 1:30 PM BUTROVICH 205 WITNESS REGISTER REPRESENTATIVE LES GARA Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Sponsor of HB 151. AMANDA METIVIER, Statewide Coordinator Facing Foster Care in Alaska (FFCA) Anchorage, Alaska POSITION STATEMENT: Supported HB 151. CHRISTY LAWTON, Director Office of Children's Services Department of Health and Social Services (DHSS) Juneau, Alaska POSITION STATEMENT: Supported HB 151. TAMMY SANDOVAL, Director Alaska Child Welfare Academy University of Alaska Anchorage Anchorage, Alaska POSITION STATEMENT: Supported HB 151. ELIZABETH RIPLEY, Chief Executive Officer Mat-Su Health Foundation Wasilla, Alaska POSITION STATEMENT: Supported HB 151. BARBARA MALCHUK, Representing Self Anchorage, Alaska POSITION STATEMENT: Supported HB 151. SAI-LING LIU, M.D., Appointee State Medical Board Nome, Alaska POSITION STATEMENT: Testified as appointee to the State Medical Board. CATHERINE HYNDMAN, M.D., Appointee State Medical Board Dillingham, Alaska POSITION STATEMENT: Testified as appointee to the State Medical Board. ACTION NARRATIVE 1:31:25 PM CHAIR DAVID WILSON called the Senate Health and Social Services Standing Committee meeting to order at 1:31 p.m. Present at the call to order were Senators Giessel, von Imhof, Begich, and Chair Wilson. HB 151-DHSS;CINA; FOSTER CARE; CHILD PROTECTION 1:31:45 PM CHAIR WILSON announced the consideration of HB 151. [CSHB 151(FIN) was before the committee.] 1:32:00 PM REPRESENTATIVE LES GARA, Alaska State Legislature, sponsor of HB 151 said the bill is a major reform in the way the state does child protection. This bill will result in healthier children, healthier families, more stability, more retention of caseworkers, and fewer wasted resources from losing caseworkers that could otherwise be going to children and families. The founder of UPS was the founder of the Casey Family Programs, the largest nonprofit foster care in the nation. Their motto is that child protection should be about customer service, not crisis management. In most states it is about crisis management. When a system is operated on the premise of crisis management, children and families are harmed and families are torn apart. He said this is where we are today: By age 21 • 29 percent of Alaskan foster youth have been incarcerated • 53 percent have been homeless (after leaving care) • 37 percent have children of their own • 40 percent are utilizing public assistance • 34 percent are employed He said these statistics are similar to other states. The system in Alaska is like the system in many states where the reforms have not been adopted. Alaska's bigger problem is that the maltreatment rate is 70 percent higher than the national average. According to the Child Welfare League of America, Alaska consistently has one of the top five rates of child abuse in the U.S. This results in more youth being physically or emotionally damaged in their own homes. With the kind of caseloads in the system, Alaska loses almost half of its caseworkers within the first year. He said this can all be fixed. REPRESENTATIVE GARA said the nation has the highest number of foster youth ever. It is time to adopt comprehensive and recommended reforms like New Jersey did. That state had one of the most in-crisis foster care systems in the country. After a 2005 lawsuit, the court ordered the state to adopt caseload limits and training standards. Today over 80 percent of children in foster care in New Jersey experience two or fewer placements within the first year, not 20 or 30 like people heard from the youth [from Facing Foster Care in Alaska] who came through the Capitol recently. The number of youth in foster care in New Jersey is down almost 50 percent from when these reforms were adopted. He said almost nothing is more important in the foster care system than placement with relatives. In New Jersey relative placements have gone up ever since the reforms were adopted. 1:36:43 PM REPRESENTATIVE GARA said when a child is in care, a child is being damaged, a child is living in a temporary home or a number of temporary homes. Being in care is a series of damaging placements, especially for the youth who end up in 5, 10, 15 or 20 different homes. The average time a child is in care in New Jersey is ten months. The average time in care nationally is 12 to 24 months. Reunification with the original family is up substantially in New Jersey. There are fewer placement changes in New Jersey and for those youth who cannot be reunified with their original families, adoptions are occurring faster and more frequently. The biggest indicators that lead to childhood success and opportunity are working in New Jersey. In Alaska, 50 percent of cases called into OCS (Office of Children's Services) are not screened in. They are essentially rejected. Of the remaining half, about half are placed in foster care. Over 70 percent of OCS calls come from mandatory reporters, not meddling neighbors. In Alaska, there has been a 43 percent increase in reports of harm since 2014, a 51 percent increase in children in out-of- home care since 2012, and only a 14 percent increase in front- line caseworkers from FY 11-FY 19, including the 31 added last year. REPRESENTATIVE GARA quoted Casey Family Programs: A well-trained, highly skilled, well-resourced and appropriately deployed workforce is foundational to a child welfare agency's ability to achieve best outcomes for the vulnerable children, youth and families it serves. He said Alaska has unmanageable caseloads. REPRESENTATIVE GARA listed the ways an excessive caseload harms children. • Can't work with families to arrange frequent visitation, which increases reunification • High caseloads lead to more turnover 49 percent for new workers at OCS • More turnover leads to damaging placement changes • Inadequate time to investigate cases and work with families and youth He highlighted that a youth recently reported having lived in over 50 homes. He said it is his belief that when there is not enough time to investigate a case, you will err on the side of child safety. That means you err on the side of taking a child away from a family. That is not the kind of system Alaska should have and it costs money. According to surveys, excessive workloads are the number one factor affecting someone's decision to leave OCS. The higher the caseload, the higher the turnover, and the higher the turnover, the worse the results. A study from Wisconsin shows that timely placement into a permanent home happens 75 percent of the time when there is one caseworker. With two caseworkers, permanency drops to 17 percent. Children who have many caseworkers do not go into a permanent, loving home. They will languish and as they languish they will be harmed. With more turnover and more placements, ACEs (Adverse Childhood Experiences) scores go up. 1:42:35 PM REPRESENTATIVE GARA said the federal Children's Bureau uses a study from Texas to estimate the cost per lost caseworker is about $54,000 after recruiting, hiring, and training a new caseworker. This is money that should instead be spent on making healthier families and healthier children. In 2013 a New York report found counties in which workers had higher caseloads also had higher rates of repeated maltreatment. Maltreatment is abuse and neglect. A 2006 study by the National Council on Crime and Delinquency found "the correlation between turnover rate and maltreatment recurrence at every time point was strong and statistically significant." REPRESENTATIVE GARA said HB 151 is a cost-effective way to create healthier outcomes for children and families, more stable families, and more family reunification. It is cost effective because the less time a child spends in foster care, the less staff is needed at an agency, the less paid for the daily foster care rate, which is $30 a day in Anchorage and up to $100 a day for high-needs children. It also produces healthier children. Financially, you are not paying for jail or homelessness. You are getting people who work instead of costing the state money. 1:45:18 PM REPRESENTATIVE GARA said HB 151 would set manageable caseloads. . • For new caseworkers, 6 families in the first three months and 12 families in the first six months He noted an Ombudsman report about a caseworker in the MatSu Valley who had about 50 cases. • A statewide average caseload limit of not more than 13 families per worker • These levels are consistent with national recommendations, taking Alaska travel times into account He noted that OCS believes 12 families should be the statewide standard for caseloads on average, but at 13 the cost went down $1 million. Even with the 31 staff that were added last year, the caseloads are not close to these limits. In 12 offices the caseload is much higher than what caseworkers can handle. He said the evidence shows that children do better when they are placed with healthy family members. Part of the bill focuses on that. Foster youth will say this is often missed, but the caseworker with a high caseload does not have time to do a family search. He knows of one caseworker who did not know it was part of the job to do a family search. The bill says that a supervisor must sign off that a thorough family search was done. HB 151 says that caseworkers need to be trained, which makes sense. Before last year's budget amendment, OCS did three weeks of training. That was inadequate. This bill says there should be six weeks of training, which is not six weeks in a row. The bill also adopts a best practice of assigning mentors. The training is being provided at the University of Alaska Child Welfare Academy. 1:50:25 PM REPRESENTATIVE GARA said the goal is to keep families together and cut red tape. Roughly 11 other states have adopted the prudent parent standard. It lets foster care parents make decisions that a prudent parent would, such as allowing children to play sports and go on vacation. Foster care parents won't be as likely to quit out of frustration when they have to call for permission. The bill reduces removals from homes. As long as there is a safe family member in the house--it does not need to be parent--the child can remain in the house. The bill maintains connections and support, including with former foster families. The old model said no contact with former foster families. Another provision in the bill is that decisions on foster care home license applications must be made within 45 days and allows youth 14 and older to participate in their case plan. He said it is not all bad news. He pointed out the National Conference of State Legislatures magazine article that focused on what states do when foster kids are on own to make sure they have an opportunity in life. These measures are being implemented in Alaska. Foster care is extended to age 21 if a child needs it. More is being done to get youths into college and more are graduating than ever before at the University of Alaska Anchorage. The other good news, he said, is that for the first time in a long time more Alaskan kids went out of foster care than went in. He cannot guarantee that that trend will continue every month, but the predictors from New Jersey and other studies suggest that that is going to happen. Youth will exit from foster care faster into permanent homes and not left to languish in a system that is often harming them. 1:55:21 PM SENATOR GIESSEL asked Representative Gara his thoughts on OCS' tribal compacts. REPRESENTATIVE GARA said he is not the expert, but he believes that the benefit for every tribal organization is that those communities know better than social workers from Anchorage who the best family placement is. The kind of casework they can do will depend on how well trained and how well financed the tribal entity is. The obvious benefit is they will find more kindship homes and possibly more adoptive homes. SENATOR BEGICH asked Representative Gara what it meant that in 2017 removals were down and discharges were up. REPRESENTATIVE GARA said that means Alaska is doing a better job getting children into permanent homes. SENATOR VON IMHOF said she learned that a case doesn't mean one child. It can mean a wide variety of numbers. REPRESENTATIVE GARA said in the child welfare world, cases are families. That could be three children. 1:58:52 PM REPRESENTATIVE GARA paraphrased the sectional for CSHB 151(FIN), version L, as follows: Section 1 is the bill title. Section 2 talks about more contact with prior caregivers, prior foster homes. Sections 3-5 are conforming amendments. Section 6 is an amendment that says even if someone has a barrier crime more than ten years old, someone can be considered as a placement if it is in the child's best interest. Sections 7 and 10 require that supervisors certify that a family or family friend search has occurred. Section 8 adopts the prudent parent standard. Section 9 allows someone 14 or older to be part of the development of the case plan and permanency goals. Section 10 is a way to keep siblings in contact with each other. Sections 11 and 12 are repeats of the supervisor's duty to certify that a thorough family search has been done. Section 13 states no removal from a home if there is a safe adult family member in the home. Section 14 is about sibling contact. Section 15 is the guts of the bill. This is the training standards and workload standards. With those standards, turnover will be reduced, childhood health will increase, ACEs scores will be reduced, and the state will have more positive outcomes with less cost over the long term. Section 16. All foster care is considered out-of-home placement but some out-of-home placements, with relatives, for example, are not considered foster care. Those relatives not entitled to the daily reimbursement rate. Sometimes they cannot afford to take care of a child for a longer period of time. OCS will assist in those relatives becoming licensed foster care families. Section 17. Many times foster care leave youth without a birth certificate, social security card, health insurance information, etc. OCS shall help a child leaving care have those things. Section 18 requires a variance for foster homes within 45 days. Sections 19-22 are the timelines for the sections to come into effect over a three-year period. 2:02:49 PM AMANDA METIVIER, Statewide Coordinator, Facing Foster Care in Alaska (FFCA), supported HB 151. She said she spent three years in foster care in Anchorage and aged out of the system. She has been a licensed foster parent for ten years. She has two young people in her home, along with her baby. She helped start Facing Foster Care when she was 19 to give young people in the system a voice. She said last week FFCA brought 28 current and former foster youth to the Capitol to advocate and lobby. She wanted to highlight a few things in the bill that are really important to foster youth. Current law says OCS is supposed to try to find a relative or family friend up front to prevent a child from going into stranger foster care. HB 151 adds that a supervisor would certify that a relative search did happen. One of the priorities of tribal compacting is relative search. She addressed the 45-day response for licensing. She said someone interested in becoming a foster parent may never hear back on an application because people are overwhelmed. HB 151 forces a response within 45 days, which will prevent the loss of quality foster families or relatives. A child coming into the protection system can stay at home if someone safe is added to the home, such as an aunt. If a child can safely maintain in their home, they can stay in their schools and be in their own neighborhoods with their friends. 2:06:14 PM MS. METIVIER said contact with siblings is very important. Last week during the Lunch and Learn program at the Capitol, the topic of siblings was very emotional. The state is supposed to make an effort to keep siblings together. If they aren't, a supervisor has to sign off that efforts were made. HB 151 would require that if siblings are separated, they have contact information. They have a lot of youth who complain that they never get to talk to their brothers and sisters. When someone experiences abuse and neglect with siblings, the bond is even stronger. Many older siblings become parentified and being separated from their younger siblings is like having a child removed. She said the reasonable and prudent parent standard has been adopted federally but would be helpful in state statute because then Alaska courts would follow it. It would be in regulation and licensing. Their youth call it normalcy. As a licensed foster parent, she knows the rules are strict sometimes and foster parents are held liable. When she was in foster care she was not allowed to jump on a trampoline. Letting foster parents allow children to engage in normal activities takes the burden off caseworkers to respond to all the requests because foster parents are empowered to make those decisions. That may lead to them becoming a permanent loving family because they can better bond with that child. It's not just about fun things, it's also about disciplinary actions. 2:09:21 PM MS. METIVIER said many studies show that young people who are engaged in their case plan are more likely and more quickly to move toward permanency. Efforts are being made to get more youth into court hearings, so judges hear their voices and not just the caseworker and guardian ad litem. She said the bill also states that foster youth should not leave care without their documents. That should be happening now but does not always happen. She noted that she left foster care without a birth certificate. She said the training and workload standards in the bill are the most comprehensive thing Alaska has considered. For the past 15 years, young people have made many recommendations for foster care. Many of the problems and challenges are related to workload and staff time and caseworkers being able to do meaningful social work and do home visits. If a caseworker has 30 cases and is responsible for 50-70 children, it is not possible to visit those children every 30 days and know if children are safe and their needs are being met. MS. METIVIER said many of us believe that the state is the parent to children in the system. The expectation should be that it does do a better job. HB 151 will achieve that. 2:13:10 PM CHRISTY LAWTON, Director, Office of Children's Services, Department of Health and Social Services (DHSS), supported HB 151. She said she started her career in child welfare in 1996. She completed her undergraduate internship in the Fairbanks office of the then-called Division of Family and Youth Services. That was when she developed a passion for child welfare. She had led a relatively privileged and sheltered life without a real concept of the hardships many Alaskan face and the impact that can have on their children. It was a rude awakening to see children who suffered and parents who hated themselves for being the cause. But she saw the resiliency of children and the great love parents have for their children, despite their many challenges. She said some of her biggest worries were the aggressive dogs in the vast dog lots of Interior Alaska and occasionally the emotionally explosive parent. Even after obtaining a Master of Social Work in Anchorage, she only had a handful of cases where she remembers real anxiety and fear working with a few particularly ill and dangerous parents. Back then, she handwrote her case notes in her car and did her best to meet the myriad of requirements. She worked 10-12 hours a day and most weekends to put a small dent in the effort required for her cases. She kept many children safe and saw many happy endings, but there were too many situations where she felt she could have, should have done better. MS. LAWTON said she was soon promoted to supervisor. She thought she could help new workers avoid the pitfalls of child protection. She mentored and supervised them. But with every bright light that came into her unit, it wouldn't be long before the light began to diminish as they become overwhelmed with the burden of responsibility and the frustration of not being able to do the job they were hired to do. Caseloads were high back then also and requirements began to increase with the electronic case management system. Caseworkers not only had to handwrite their notes in the field, but they had to return to the office and enter the data in the computer. That's still the way it is today. MS. LAWTON related her thoughts after she became a manager: Now, now I'll be able to really make the changes to help the caseworkers and families. I worked with some of the most dedicated and brightest leaders and we worked tirelessly to improve worker retention and improve outcomes for the families we served and to try to build the credibility of the profession of child welfare in the eyes of the community. By then I had the benefit of some greater insight and was acutely aware of the systemic challenges we faced and every other child welfare agency in the country faced. As I continued my career, I had increased opportunity at every step to make improvements. And along the way. I'm proud of the accomplishments I and so many people have made, but with those accomplishments came the continued reality of the workforce problem. Despite countless new ideas, technical assistance from countless national experts and dedicated energy, we simply couldn't fix the turnover of caseworkers and the impact it had on those we served. She said the challenges workers face today are on a whole different level than 20 years when she was a caseworker. They face increasing credible threats to their personal safety in the office and in the field. Crime and the never-ending drug epidemic on top of the previous high rates of alcohol abuse, domestic violence, and sexual assault make the work harder than ever, and more dangerous. She has been director for almost eight years and the child welfare system has had as many highs as lows. It is a roller coaster every single day. The one thing that never changes is the inability to give their employees the one thing they really want most, which is the time and caseload size to enable them to see countless more kids and families reunified or never separated to begin with. Alaska has a choice. She said you can decide to invest in the workforce by supporting HB 151 and fix the primary problem or you can let things continue as they are. 2:18:46 PM MS. LAWTON said investing will help ensure safe children and strong families with many opportunities for budget reductions in the future when the system is able to give families what they need. Choosing not to support this legislation may put Alaska at risk to be the next state subject to a class action lawsuit. The number of states with consent decrees in place is growing and those consent decrees go on and on. New Jersey is one of those states. That kind of investment and focus didn't come voluntarily. Alaska could do something different. Workforce retention in child welfare has been a chronic problem for over five decades. Alaska could and should be proactive, so it can develop its own solutions for the challenges the system faces and not have it be a byproduct of a lawsuit settlement. SENATOR VON IMHOF said it was extraordinarily powerful and effective to have the kids [from Facing Foster Care in Alaska] in the Capitol last week. She thanked Ms. Lawton for her work and said she can only imagine what she has seen and experienced. The previous speaker said some the provisions in this bill came directly from foster youth. Two ideas came from the youth in her office when asked what could have helped them stay with their parents. One said requiring a urinalysis for her parents. The second said when counseling was required, he was able to stop the conflict with his father but after counseling ended, the conflict increased and he left the house. She asked Ms. Lawton for her thoughts on those ideas. 2:21:33 PM MS. LAWTON said urinalysis testing is an area where the pendulum goes back and forth. It is expensive and research says if someone is verified to be working a program, that sort of excessive testing isn't needed. OCS has tried to tailor urinalysis testing to match what is happening with the parent. If a parent is in a residential or intensive out-patient program, urinalysis testing is provided by those programs. If a parent is doing their own program, then there usually is regular urinalysis testing. If every parent with a substance abuse issue was tested (which is 80 percent of the families they have) the cost would be prohibitive. She said for counseling, every case is different. They worry that workers can be automatic when setting up referrals for counseling and sometimes providers will continue counseling for a long time without reevaluating whether it is needed. This too is expensive so it is a case-by-case determination. OCS takes its lead from the therapeutic person providing the services. Many of their staff do not have the expertise to dictate when it is appropriate to end therapeutic services. SENATOR BEGICH called the testimony outstanding. He asked if most of the caseworkers still don't have laptops. MS. LAWTON confirmed that the majority of caseworkers do not have laptops. It has not been feasible with their budget. Some workers in some officers can check out laptops. Over the next three or four years as computers are replaced, workers will have docking tablets. 2:25:07 PM CHAIR WILSON said in his professional career, he has worked with OCS almost 11 years advocating for youth and working on reunifications. One part of the bill is to strengthen systems within OCS and another part addresses the foster care situation. He asked what the average application time for placement is and how private organizations are able to certify foster homes. MS. LAWTON responded that the average time to process a foster care application varies significantly around the state. Their goal is 45 days, but they are struggling to meet that goal. Getting fingerprints in smaller communities is a challenge. Applications often need a lot of information clarified. Getting past court records can lead to delays. She noted that a few years ago OCS received more funding to increase the number of licensing staff. In a place like Anchorage, where there are not have enough foster homes in a time of increasing demand, someone would get a call for a placement right away, unless they had a specialty license or were asking for a specific type of child. CHAIR WILSON asked Ms. Lawton to provide information on whether OCS recruits for foster homes and how private organizations do their certification of foster homes. He also asked for information about whether training has changed for the new workers added last year and how many are still employed. He likes to look at problems as either a single occurrence or a systemic issue. Before he makes an investment, he wants to make sure that there is a plan in place that addresses the research, the data, and the historical situation. When he goes to administration with an issue, he is constantly reminded that he is there to legislate and appropriate, not administrate. He sees this bill as an administrative function. He is supportive of the whole concept, but feels these things are more of an administrative function than a legislative function. He has talked to the department about having a plan in place like the Department of Public Safety has in terms of recruitment and retention efforts before dollars and folks are invested. He wants DHSS to have an investment plan of how these positions, once hired, will be different in terms of training. He asked if PCNs [Position Control Numbers] would need to be modified before some of these items can be implemented. He said he wants to make sure the department is ready before it adds 30 additional positions. He also asked what has happened with the previous 30 workers. MS. LAWTON said she would be happy to provide the information. She clarified that the fiscal note is 21 additional positions. 2:31:50 PM At ease. 2:31:54 PM CHAIR WILSON reconvened the meeting and continued public testimony. TAMMY SANDOVAL, Director, Alaska Child Welfare Academy, University of Alaska Anchorage, supported HB 151. She said the academy does the training for OCS staff. She is also Director Lawton's predecessor at OCS. In her 34 years of experience with child welfare, she has never witnessed any magic or silver bullets. It takes the kind of reform Representative Gara is proposing in HB 151. It takes enough qualified staff working with community partners to work with children, youth, and families that are more complex than she's ever seen. The changes that were made last year are a good start. They added two more weeks of training for new workers and OCS added mentors to transfer learning from the classroom to practice. Workers have expressed gratitude for these improvements, but it is not enough. They can pay now or pay later when youth move to homelessness, juvenile justice, and/or corrections. "Let's do it right from the beginning," she said. To decrease the negative rates of family dysfunction will take this kind of legislation. 2:35:04 PM ELIZABETH RIPLEY, Chief Executive Officer, Mat-Su Health Foundation, supported HB 151. She said that in 2013 the foundation conducted a Mat-Su community health needs assessment. Mat-Su residents identified their number one health objective as insuring all children are safe and well cared for. The foundation created a focus area dedicated to building family resilience and preventing child maltreatment, which led to staffing and funding a place-based, collective impact project called Raising Our Children with Kindness, R.O.C.K. Mat-Su. Since that time maltreatment reports in the Mat-Su OCS office has increased from 2,840 in 2014 to 3,528 in 2015. The Palmer court Child in Need of Aid cases have increased from 216 in 2014 to 271 in 2016, largely due to the opioid epidemic. The Mat-Su OCS had 653 children in out-of-home care over 30 days in 2016. The Mat-Su Health Foundation and R.O.C.K. Mat-Su staff have become familiar with the caseload ratios, training deficits, and challenging conditions of the Mat-Su OCS office. They hear lots of complaining from parties across sectors across the state, but very little constructive assistance to set OCS and their staff up for success. HB 151 takes a crucial step in that direction. It seeks to improve both caseload levels and worker retention through new training and workforce standards. The bill also provides for mentors to help caseworkers become more effective and make the transition from training to a full caseload. These evidence-based standards will improve outcomes and allow caseworkers to perform their duties as intended. The Mat-Su Health Foundation recognizes that the Alaska child welfare system needs reform. HB 151 takes the step to make real positive changes to support youth and families and the caseworkers who serve them. 2:38:13 PM BARBARA MALCHUK, Representing Self, supported HB 151. She spent over 25 years as a guardian ad litem representing foster youth and children around the state. She retired in 2010 and continued as a CASA [court appointed special advocate] volunteer. She is now working with a group of eight siblings. She is on the Board of Directors for Facing Foster Care in Alaska and traveled to Juneau with them last week. She developed a training curriculum for the court system for lawyers, judges, child advocates, tribal representatives, and social workers who handle Child in Need of Aid cases. Her experience has given her a good feel about how the child protection system works or does not work. She supports the entire bill, but she wanted to focus on children and youth keeping family connections. The sibling relationship is even more important for children who have experienced abuse and neglect. Often times the older children are caregivers for the younger children. She said during the Lunch and Learn program last week at the Capitol, nearly all the foster youth there had been separated from their siblings and most of them have lost contact altogether. She's seen numerous youth tell their stories about foster care. They always seem to hold it together until they get to the part about losing contact with siblings and then the tears start to flow. Under the current law siblings are supposed to be together if possible and OCS policy requires ongoing contact between siblings. But the reality is that it is not happening. HB 151 has mechanisms to enforce ongoing contact. It gives OCS the authority and responsibility to give contact information and encourages caregivers to give siblings opportunities to remain in touch. 2:41:56 PM MS. MALCHUCK said relative placement is important for many reasons. When children are with relatives they are more likely to be in contact with other family members. It allows them to maintain their cultural identity. It leaves foster homes available to children without relatives to stay with. She hears from many youth about the years in foster care and numerous placements and many find out relatives were never contacted. All too often the family search doesn't happen. HB 151 offers some improvements to make relative placement a reality. Also, many relatives cannot afford to take care of children and need assistance through a foster care license. HB 151 requires OCS to assist with that. HB 151 gives advocates in court a mechanism to enforce good policy. 2:44:25 PM CHAIR WILSON held HB 151 in committee. ^CONFIRMATION HEARING(S): State Medical Board CONFIRMATION HEARING(S) State Medical Board 2:44:37 PM CHAIR WILSON reconvened the meeting and announced the consideration of the Governor's appointees to the State Medical Board. SAI-LING LIU, M.D., Appointee, State Medical Board, said she is a family practice certified physician for Norton Sound Health Corporation in Nome, Alaska. She has been a board member since 2013. This will be her second term. SENATOR GIESSEL asked why she is interested in continuing. DR. LIU said there is a lot of turnover in the board and continuity is important. At the request of several board members she will continue for another term if confirmed. It is a dedicated group of physicians safeguarding public safety for medical care. There is an increasing number of licensing applications for Alaska because of telemedicine. It is an important board. She is honored to be on it. SENATOR GIESSEL said it is a huge time commitment, but continuity on the board important. She thanked her for stepping up again. 2:48:02 PM CATHERINE HYNDMAN, M.D., Appointee, State Medical Board, said in 2000 she became employed by the Bristol Bay Area Health Corporation. She is the clinical director. She brings viewpoints of those in the bush region, particularly with regard to the odd combinations one must have in the bush without the ability to immediately access tertiary care. She can speak to the care patients have gotten in the bush. CHAIR WILSON asked what the most challenging aspects are to providing medical care to rural communities. DR. HYNDMAN said care is often quite a distance away and oftentimes the coordination of care becomes a challenge in terms of determining what means of transportation is needed and how that can be arranged. Her hospital is a level 4 trauma center. They cannot do much more than stabilize, but they need well- trained physicians in the bush who can deal with emergency care. They face a lot of problems that also exist in the cities, such as the difficulties with alcohol and drug abuse. Alcohol is the cause of most of the trauma that they see. Getting and keeping physicians is difficult because of the privations of living in the bush, such as getting a gallon of milk when the weather is bad and the public transportation issue. They are blessed to have strong health aides. She suspects all the bush regions of the state are blessed with strong health aides, but she started at ground zero in learning how to deal with health aides when she started. That can be a challenge for physicians new to the bush. 2:52:22 PM SENATOR GIESSEL noted that Dr. Hyndman was first appointed in December. She asked if she had attended a board meeting. DR. HYNDMAN said her first meeting will be in May. SENATOR GIESSEL said she may be able to write regulations for new clinicians to assist physicians. There is a bill going through the legislature that will allow the delegation to unlicensed assistant personnel as well as certified medical assistants. She will be learning a lot about the regulatory process. 2:53:24 PM CHAIR WILSON opened and closed public testimony. 2:53:56 PM SENATOR VON IMHOF moved that the appointments of Catherine Hyndman and Sai-Ling Liu to the State Medical Board be forwarded to a joint session for consideration. She reminded members that this does not reflect an intent by any of the members to vote for or against the confirmation of the individual during any further sessions. There being no objection, the names were forwarded. 2:54:23 PM At ease. 2:54:31 PM There being no further business to come before the committee, Chair Wilson adjourned the Senate Health and Social Services Standing Committee at 2:54 p.m.