Legislature(2019 - 2020)BUTROVICH 205

03/20/2019 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
01:30:44 PM Start
01:31:03 PM Presentation: Continuation of Overview of the Department of Health and Social Services
02:05:33 PM Presentation: Office of Children's Services Citizen's Review Panel by Jp Ouellete, Chair
03:02:45 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentations: TELECONFERENCED
- Overview of the Department of Health & Social
Services by Commissioner Adam Crum (Continued
from March 13)
-- Testimony <Invitation Only> --
- Department of Health & Social Services - Office
of Children's Services Citizen's Review Panel by
JP Ouellette, Chair
-- Testimony <Invitation Only> --
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 20, 2019                                                                                         
                           1:30 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator John Coghill, Vice Chair                                                                                                
Senator Gary Stevens                                                                                                            
Senator Cathy Giessel                                                                                                           
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION: OVERVIEW OF THE DEPARTMENT OF HEALTH AND SOCIAL                                                                   
SERVICES BY COMMISSIONER DESIGNEE ADAM CRUM (CONTINUATION OF                                                                    
MARCH 13, 2019 PRESENTATION)                                                                                                    
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PRESENTATION: OFFICE OF CHILDREN'S SERVICES CITIZEN'S REVIEW                                                                    
PANEL BY JP OUELLETE, CHAIR                                                                                                     
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
ADAM CRUM, Commissioner Designee                                                                                                
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Gave an overview of the Department of Health                                                              
and Social Services.                                                                                                            
                                                                                                                                
RENEE GAYHART, Program Manager                                                                                                  
Tribal Health                                                                                                                   
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided information  on DHSS  tribal health                                                             
reclaiming.                                                                                                                     
                                                                                                                                
JP OUELLETE, Chair                                                                                                              
Alaska Citizen Review Panel (CRP)                                                                                               
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:  Presented  on  the  Alaska  Citizen  Review                                                             
Panel.                                                                                                                          
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:30:44 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:30 p.m.  Present at the                                                               
call to order  were Senators Giessel, Begich,  Stevens, and Chair                                                               
Wilson.                                                                                                                         
                                                                                                                                
^Presentation:  Continuation of  Overview  of  the Department  of                                                               
Health and Social Services                                                                                                      
  Presentation: Continuation of Overview of the Department of                                                               
 Health and Social Services by Commissioner Designee Adam Crum                                                              
                                                                                                                                
1:31:03 PM                                                                                                                    
CHAIR  WILSON  announced  that Commissioner  Designee  Adam  Crum                                                               
would  continue  his presentation  from  March  13, 2019  on  the                                                               
Overview of the Department of Health and Social Services.                                                                       
                                                                                                                                
1:31:35 PM                                                                                                                    
ADAM  CRUM,  Commissioner  Designee,  Department  of  Health  and                                                               
Social  Services   (DHSS),  Anchorage,  Alaska,  said   that  Deb                                                               
Etheridge is the  acting director of the  Senior and Disabilities                                                               
Services (SDS),  which has  175 positions.  They worked  with the                                                               
Community First  Choice 1915(k) program  to increase  the federal                                                               
match to 56  percent from 50 percent. The  enhanced federal match                                                               
provides  person-centered home  and community-based  services and                                                               
supports to  help individuals with  disabilities live  within the                                                               
community.  The 1915(c)  Individualized Support  Waiver (ISW)  is                                                               
part of  the SB  74 refinancing.  The new  waiver helps  with the                                                               
community  development disabilities  grant.  It  allows each  ISW                                                               
participant to  access up  to $17,000 of  buying power  in waiver                                                               
funds per year. They are trying  to keep individuals in homes and                                                               
communities   longer,   which   is  more   cost   effective   and                                                               
therapeutically viable for the individual.                                                                                      
                                                                                                                                
COMMISSIONER  DESIGNEE  CRUM  said   they  are  also  working  on                                                               
implementing  an Electronic  Visit Verification  (EVV) system  to                                                               
meet federal requirements related to personal care attendants.                                                                  
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM said the  mission of the  Division of                                                               
Public Health is  to protect and promote the  health of Alaskans.                                                               
The director is  Mary Carlson. They took an active  role with the                                                               
7.1  earthquake  on  November   30,  2018,  which  activated  the                                                               
emergency  response  center  at DHSS.  They  had  teleconferences                                                               
within three hours of the  earthquake occurring. They worked with                                                               
hospital  partners, providers,  and senior  living facilities  to                                                               
determine  such things  as whether  the labs  were running,  what                                                               
care was needed,  and what were transportation issues.  It was an                                                               
involved process  and he was proud  to be part of  the division's                                                               
work.  A few  weeks after  the earthquake,  their partners  got a                                                               
standing ovation for  how coordinated the care was  and the level                                                               
of information  that was disseminated.  They had  unique concerns                                                               
with a lot  of the workforce being stranded in  the Mat-Su Valley                                                               
because of the  Glenn Highway issues. DHSS and  the Department of                                                               
Commerce  worked  on  temporary  licensing so  that  nurses  from                                                               
Oregon could be part of the response.                                                                                           
                                                                                                                                
COMMISSIONER DESIGNEE CRUM  added that it was  a traumatic event,                                                               
especially  with all  the aftershocks.  They  had serious  mental                                                               
health  and behavioral  health concerns.  Crisis canines  are one                                                               
example of  the follow up  that the  department did to  make sure                                                               
individuals had access to therapeutic resources.                                                                                
                                                                                                                                
1:36:50 PM                                                                                                                    
SENATOR  BEGICH  said  that  he   had  a  conversation  with  the                                                               
commissioner of  the Department of Military  and Veterans Affairs                                                               
about  the  earthquake. He  asked  what  coordination took  place                                                               
because that department also has an emergency response.                                                                         
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM replied that the  statewide emergency                                                               
operations  center  is  based  at  JBER  (Joint  Base  Elmendorf-                                                               
Richardson). It  was the  incident command  center for  the state                                                               
throughout  the  earthquake  and  in charge  of  everything  from                                                               
infrastructure to  overall response.  DHSS' side was  making sure                                                               
health  care  infrastructure   and  vulnerable  populations  were                                                               
accounted for.  On the SDS  side, they  worked to make  sure they                                                               
were in  touch with personal  care attendants and reached  out as                                                               
quickly as  possible to  see whether anyone  was stranded  and if                                                               
there were  any issues  with items  like oxygen  and medications.                                                               
They  worked in  conjunction  with the  statewide OCC  [Operation                                                               
Control Center]  based on JBER  for any concerns such  as medevac                                                               
issues.                                                                                                                         
                                                                                                                                
SENATOR  BEGICH asked  if he  observed anything  that could  have                                                               
been done better. He said  he didn't expect an answer immediately                                                               
but  asked Commissioner  Crum to  give it  some thought  and then                                                               
provide it to  the committee. The commissioner  of the Department                                                               
of Military  and Veterans  Affair expressed  a desire  for better                                                               
coordination.                                                                                                                   
                                                                                                                                
COMMISSIONER DESIGNEE CRUM  replied that he could  provide a list                                                               
of possible systems improvements.  State commissioners and deputy                                                               
commissioners  have toured  the  statewide  operations center  to                                                               
understand what  their role  is. They are  looking at  where they                                                               
did succeed and where can they improve.                                                                                         
                                                                                                                                
1:39:11 PM                                                                                                                    
SENATOR STEVENS  noted the concerns  about vaccinations  with the                                                               
national measles  outbreak. He  asked if  the Division  of Public                                                               
Health does vaccinations for measles and other diseases.                                                                        
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM answered that the  Division of Public                                                               
Health has epidemiology  and public health nurses  and the Alaska                                                               
Vaccine Assessment  Program (AVAP), the reauthorization  of which                                                               
is  working  its  way  through the  Senate.  AVAP  increases  the                                                               
state's purchasing  power to get  vaccines at a cheaper  rate and                                                               
distribute  them to  health clinics.  They monitor  outbreaks and                                                               
issue health notices.  They share information with  the public as                                                               
the  issues arise.  Public health,  epidemiology, and  the public                                                               
information  team in  the commissioner's  office work  to address                                                               
issues.                                                                                                                         
                                                                                                                                
1:40:31 PM                                                                                                                    
SENATOR  STEVENS  asked  what they  can  do  about  irresponsible                                                               
parenting that sends  kids to school who infect  the whole school                                                               
with measles. He  mentioned he had had measles as  a child. It is                                                               
quite damaging and dangerous. He  asked what their responsibility                                                               
is for dealing with irresponsibility  in parents and do they have                                                               
a responsibility.                                                                                                               
                                                                                                                                
COMMISSIONER DESIGNEE CRUM  replied that they try  to measure and                                                               
put  together the  data.  Their chief  medical  officer has  been                                                               
attending conferences, such  as for the Association  of State and                                                               
Territorial  Health  Officials  and  members of  the  Academy  of                                                               
Pediatrics.  Medical  and  science professionals  are  discussing                                                               
these  issues  and  policy  concerns. They  are  just  trying  to                                                               
present the data and what they know about these issues.                                                                         
                                                                                                                                
SENATOR STEVENS asked  Commissioner Crum to keep them  up to date                                                               
of what is  going on and how  they can keep Alaska  from having a                                                               
major outbreak.                                                                                                                 
                                                                                                                                
COMMISSIONER DESIGNEE CRUM presented  on the department's efforts                                                               
with the ongoing opioid epidemic.  Since the disaster declaration                                                               
in 2017,  the state  of Alaska  has secured  over $35  million in                                                               
federal  grants. This  is  an on-going  process  of working  with                                                               
federal partners  to address  this issue. Next  month he  will be                                                               
attending a  national conference  on this for  health secretaries                                                               
about how to  address the epidemic. They are trying  to find best                                                               
practices. It  cannot just come  from the state level.  They need                                                               
grassroots,  local task  forces to  move forward  with this.  The                                                               
preliminary numbers show  that in 2018 they did see  a 26 percent                                                               
decrease in drug overdoses compared to  2017. In 2018 there was a                                                               
67 percent decrease in fentanyl  overdoses compared to 2017. That                                                               
is a massive achievement. It  involved DHSS education efforts and                                                               
NARCAN kits and working with  Public Safety and the Department of                                                               
Transportation.  They do  attribute reductions  across the  board                                                               
for all drug overdoses to distribute of naloxone.                                                                               
                                                                                                                                
1:43:57 PM                                                                                                                    
SENATOR GIESSEL  said she  has been in  contact with  Andy Jones,                                                               
Director  of  the  Office  of   Substance  Misuse  and  Addiction                                                               
Prevention. She  noted that the  state includes  veterinarians in                                                               
the  prescription drug  monitoring  program  (PDMP) because  they                                                               
occasionally   prescribe    opioids.   She   is    hearing   from                                                               
veterinarians about  the question of  whose name to enter  in the                                                               
database,  the animal's  or the  human with  the animal.  It gets                                                               
very complicated. She  has heard that several  states have waived                                                               
the requirement for veterinarians. She  knew this was really down                                                               
in the  weeds, but it  might be something  he could ask  about at                                                               
the  national  conference.  The  state  veterinarians  are  in  a                                                               
quandary about how to manage being part of the opioid-                                                                          
prescribing community because they hardly ever do it.                                                                           
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM  said they  will look  into that.  It                                                               
does  help bring  to  light that  this is  not  a complex  issue.                                                               
People don't  think about it  very often. The White  House refers                                                               
to this as  the crisis next door. People  think about unfortunate                                                               
individuals on the  street, but this could  be someone's neighbor                                                               
who was overprescribed and became  addicted. Another simple point                                                               
they  are trying  to  educate people  about is  what  to do  with                                                               
unused  prescription  drugs.  Drug disposal  bags  are  charcoal-                                                               
activated and  can make drugs  biodegradable. Drugs are  not safe                                                               
just to  dump in the sink  or toilet. They are  trying to educate                                                               
people on issues like that.                                                                                                     
                                                                                                                                
CHAIR  WILSON asked  if the  prescription-monitoring database  is                                                               
with Department  of Commerce, Community and  Economic Development                                                               
(DCCED).                                                                                                                        
                                                                                                                                
COMMISSIONER DESIGNEE CRUM replied that it is with Commerce.                                                                    
                                                                                                                                
CHAIR  WILSON asked  if he  could  provide to  the committee  the                                                               
impact  of the  prescription  drug monitoring  database with  the                                                               
decrease of opioids  and morphine provided to  the hospitals from                                                               
the database. He knew there was  a decrease of about five percent                                                               
of  the  injectable drugs  like  morphine  during the  first  six                                                               
months  after the  database  went  into effect  and  about an  11                                                               
percent decrease of pills prescribed.                                                                                           
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM  said the  PDMP has  6,580 registered                                                               
users. That is a four-fold increase  over the past two years. The                                                               
efficacy  is  increasing as  more  people  are enrolled  in  that                                                               
program.                                                                                                                        
                                                                                                                                
1:47:34 PM                                                                                                                    
SENATOR  BEGICH said  those are  great numbers.  When Dr.  Butler                                                               
[former DHSS  acting commissioner and chief  medical officer] was                                                               
before  them, he  said he  would aggressively  pursue the  opioid                                                               
epidemic. It looks successful from  these numbers, so he commends                                                               
the department. Some pharmacy groups  came to his office recently                                                               
and had a  graph to show the  success of an effort  to reduce the                                                               
number  of pills  prescribed per  prescription. He  asked if  the                                                               
department has  a formal  process to  engage with  prescribers to                                                               
encourage them to reduce the number of pills prescribed.                                                                        
                                                                                                                                
COMMISSIONER DESIGNEE CRUM replied that  he would get back to him                                                               
on that.                                                                                                                        
                                                                                                                                
SENATOR GIESSEL said  she could answer the  question. They passed                                                               
a bill that limited a  prescription to seven days for prescribers                                                               
(and optometrists are limited to  five days), and that could have                                                               
had an impact on the decrease in volume.                                                                                        
                                                                                                                                
SENATOR STEVENS said  the fewer deaths from one year  to the next                                                               
is remarkable. He  asked if Commissioner Crum  attributes that to                                                               
naloxone  and he  wondered how  many times  it had  been used  in                                                               
Alaska. He knows policemen and communities have it.                                                                             
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM replied that  he is not an  expert on                                                               
it, but they work with  public safety, the state drug enforcement                                                               
unit, and local  municipalities and police force  to educate them                                                               
on this  process so they can  carry that as well.  They work with                                                               
local health communities and aides  and urgent clinics. They have                                                               
worked with  the local task forces  to educate them and  pass out                                                               
kits.  They  have  educated individuals  operating  in  a  first-                                                               
response role.  He does not have  hard data, but he  will look to                                                               
see what data they have on how many times it has been deployed.                                                                 
                                                                                                                                
SENATOR STEVENS asked if naloxone is readily available.                                                                         
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM  replied that  they have  grant funds                                                               
for the kits. He will find out  how much money they have left. He                                                               
mentioned that he  had just been informed that the  kits had been                                                               
used more than 250 times.                                                                                                       
                                                                                                                                
1:51:15 PM                                                                                                                    
CHAIR WILSON said  the kits were funded with a  federal grant. He                                                               
asked what the department plan  is for the naloxone program after                                                               
the two years of grant funding ends.                                                                                            
                                                                                                                                
COMMISSIONER DESIGNEE CRUM  said anecdotally, it does  seem to be                                                               
a successful program.  They will continue to evaluate  it. At the                                                               
conference next  month, they will  learn about other  things that                                                               
can be done as they update their comprehensive, long-term plan.                                                                 
                                                                                                                                
CHAIR WILSON  said he heard  that the Office of  Substance Misuse                                                               
and Addiction Prevention has been  changed and a new position was                                                               
created in the governor's office.                                                                                               
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM said an  official order has  not been                                                               
released  yet. Because  of  the priority  of  public safety,  the                                                               
administration  is considering  something along  the lines  of an                                                               
Office of  Drug Control Policy.  That would allow  the individual                                                               
to  work interdepartmentally  and have  access to  data and  work                                                               
across departments and statewide.                                                                                               
                                                                                                                                
CHAIR WILSON said that it would be a more integrated approach.                                                                  
                                                                                                                                
COMMISSIONER DESIGNEE CRUM answered yes.                                                                                        
                                                                                                                                
COMMISSIONER DESIGNEE CRUM said  that tribal Medicaid beneficiary                                                               
claims have  been reimbursed at  a 100 percent federal  match for                                                               
services provided  by or  through a  tribal health  facility. The                                                               
State   Health  Official   Letter   requires  care   coordination                                                               
agreement, referrals, and exchange of records.                                                                                  
                                                                                                                                
1:53:55 PM                                                                                                                    
RENEE  GAYHART, Program  Manager,  Tribal  Health, Department  of                                                               
Health  and Social  Services (DHSS),  Juneau,  Alaska, said  that                                                               
tribal health  reclaiming came about  in February of 2016.  SB 74                                                               
gave them targets  to meet for FY  17 through FY 22.  They had to                                                               
work   with  tribal   health  organizations,   so  the   previous                                                               
administration scheduled two week-long  meetings with the tribes.                                                               
The  department   needed  their   help  with   care  coordination                                                               
agreements, which  have to be  between the tribal  and non-tribal                                                               
organizations. The  state is  not part  of the  care coordination                                                               
agreement.  The  tribal organizations  have  to  assist with  the                                                               
referrals and exchange of records.                                                                                              
                                                                                                                                
MS.  GAYHART said  the state  worked with  tribes to  enhance the                                                               
partnership.  The  tribes  had three  projects  they  wanted  the                                                               
department's  assistance with.  One  was  to reimburse  community                                                               
health  aides, levels  1-4 and  practitioner, and  the behavioral                                                               
health aides at an encounter  rate. There are about 450 providers                                                               
around the  state. They  came up  with a  set rate  that assisted                                                               
with   the   tribe's   revenue  generation   to   maintain   that                                                               
infrastructure  and the  staffing  patterns  of community  health                                                               
aides in  the most outlying  areas. The department  also assisted                                                               
with reimbursing  for lodging. Tribes own  500 pre-maternal homes                                                               
or hotel beds.  They now reimburse those at the  federal per diem                                                               
rate rather  than the state  rate. The  third project was  to let                                                               
tribes take  over travel  arranging. They took  over all  the air                                                               
and   ground   transport    arrangements   for   their   Medicaid                                                               
beneficiaries, which  is about  1,000 travels  a week.  That also                                                               
assists with the  reclaiming effort. That was the  first piece to                                                               
work out on partnering in  exchange for assistance with the three                                                               
elements  the  department  needs  to meet  in  the  State  Health                                                               
Official Letter.                                                                                                                
                                                                                                                                
MS. GAYHART shared the three-year snapshot of efforts:                                                                          
                                                                                                                                
     SFY17: Look at high dollar/low volume claims to meet                                                                       
     target:                                                                                                                    
        • Transportation (air and ground ambulance, travel                                                                      
          broker services)                                                                                                      
        • Hospital inpatient/outpatient, case managed complex                                                                   
          kids                                                                                                                  
        • Accurate IHS Coding in MMIS                                                                                           
                                                                                                                                
     SFY18: Continue to add care coordination agreements and                                                                    
     strategize                                                                                                                 
        • Continue with services from SFY17 plus:                                                                               
        • Pharmacy, Long-Term Care, Out of State Residential                                                                    
          Psychiatric Treatment Facilities                                                                                      
        • Tribal Providers in Non-Tribal Facilities                                                                             
        • Non-IHS Mothers with IHS Newborns                                                                                     
                                                                                                                                
     SFY19                                                                                                                      
        • Continue with services from SFY17 and SFY18 plus:                                                                     
        • Waiver Services                                                                                                       
        • Service Authorizations with date spans on travel                                                                      
          itineraries                                                                                                           
        • Optical Services                                                                                                      
                                                                                                                                
MS.  GAYHART said  they had  to  strategize about  how they  were                                                               
going to  get to those  dollars. They  looked at the  high dollar                                                               
claims  with   low  volume.  Those  are   transportation  claims,                                                               
hospital  inpatient/outpatient,  both in-state  and  out-of-state                                                               
facilities. There are many kids  around the state who need things                                                               
such  as neonatal  help, transplants,  brain  surgery, and  heart                                                               
surgery.  They  looked  at  accurate  coding  in  MMIS  [Medicaid                                                               
Management Information  System]. Race  is an optional  code. When                                                               
anyone  applies for  Medicaid, they  can  claim a  race, if  they                                                               
wish. When claims are paid when  a race is absent, they don't get                                                               
the   appropriate  match.   They   worked   with  Indian   Health                                                               
Services'(IHS)  central office  in  Baltimore to  get the  Indian                                                               
Health Services'  beneficiary list. Then they  could compare what                                                               
they had  in MMIS to  get the appropriate  race codes. For  FY 18                                                               
they  continued with  those efforts  and  moved on  to the  other                                                               
items in  the bulleted list.  They also  worked with the  feds on                                                               
something that many  other states were doing,  but Alaska wasn't.                                                               
A non-IHS  mother with a Native  baby can be claimed  as IHS from                                                               
prenatal to 60  days postpartum. That includes  all their claims,                                                               
including behavioral  health, dental,  optometry, etc. In  FY 19,                                                               
they continued with  previous efforts and added the  items in the                                                               
bulleted list.                                                                                                                  
                                                                                                                                
MS.  GAYHART  said  that  all the  reclaiming  efforts  are  just                                                               
guidance from the feds. They don't  have to get approval for what                                                               
they do, but they must have  criteria and justification as to why                                                               
they are  claiming on  certain referrals  or certain  episodes of                                                               
care  each quarter.  Whenever there  is  a service  authorization                                                               
from  someone  to  travel  from one  location  to  another,  they                                                               
include all the claims within that travel span.                                                                                 
                                                                                                                                
MS. GAYHART  showed in slide  26 that they exceeded  their target                                                               
in FY 17 and FY 18. They are  on path to meet their target for FY                                                               
19.                                                                                                                             
                                                                                                                                
CHAIR  WILSON  said that  his  office  has heard  concerns  about                                                               
tribal compacting.  He asked  if the  department has  a timeframe                                                               
for deciding about whether to continue tribal compacting.                                                                       
                                                                                                                                
COMMISSIONER  DESIGNEE  CRUM  clarified  that  Chair  Wilson  was                                                               
referring  to   child  tribal  compacting   and  said   the  next                                                               
negotiation is scheduled  for May. This is  an ongoing discussion                                                               
between the department and their partners.                                                                                      
                                                                                                                                
MS.  GAYHART  added  that  the  compacting  is  with  the  social                                                               
services  of  the  tribes  and   she  works  with  tribal  health                                                               
organizations. They go hand-in-hand  in the communities, but when                                                               
they look  at tribal health  reclaiming, it is separate  from the                                                               
social services organizations.                                                                                                  
                                                                                                                                
SENATOR BEGICH  asked if  they are  still supporting  efforts for                                                               
tribal compacting.                                                                                                              
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM  replied that  yes, they  are working                                                               
with  them  and talking  about  that  process,  as well  as  what                                                               
increased services may be available.                                                                                            
                                                                                                                                
CHAIR WILSON asked if the commissioner had any last words.                                                                      
                                                                                                                                
COMMISSIONER DESIGNEE CRUM  said that he had  explained last week                                                               
that  they had  a goal  of gaining  efficiencies--how to  provide                                                               
service  better.   They  are  increasing  efforts   for  customer                                                               
service. They are dealing with  vulnerable populations. They want                                                               
to address them  with care and speed. They will  continue to look                                                               
at how  to maximize  relationships with  community-based partners                                                               
and work with them to make  sure they are providing the most care                                                               
possible.                                                                                                                       
                                                                                                                                
2:03:12 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
                                                                                                                                
^Presentation:  Office of  Children's  Services Citizen's  Review                                                               
Panel by JP Ouellete, Chair                                                                                                     
  Presentation: Office of Children's Services Citizen's Review                                                              
                  Panel by JP Ouellete, Chair                                                                               
                                                                                                                                
                                                                                                                                
2:05:33 PM                                                                                                                    
CHAIR  WILSON  announced  the  presentation   on  the  Office  of                                                               
Children's  Services  Citizen's  Review  Panel  by  JP  Ouellete,                                                               
Chair.  He noted  this is  the third  year in  row the  panel has                                                               
briefed the committee.                                                                                                          
                                                                                                                                
2:06:01 PM                                                                                                                    
JP OUELLETE, Chair, Alaska Citizen Review Panel (CRP),                                                                          
Anchorage, Alaska, began by thanking Diwakar Vadapalli [former                                                                  
chair of the Citizen Review Panel] for legitimizing what they                                                                   
do.                                                                                                                             
                                                                                                                                
MR. OUELLETE gave the presentation outline:                                                                                     
                                                                                                                                
        • Introduction to the role and purpose of the Citizen                                                                   
          Review Panel                                                                                                          
        • Goals and recommendations from 2017-2018                                                                              
        • Goals for 2018-2019                                                                                                   
        • Improvements in CRP-OCS collaboration                                                                                 
        • Way forward                                                                                                           
                                                                                                                                
MR. OUELLETE reviewed the central purpose of the CRP:                                                                           
                                                                                                                                
        • Congress created CRPs to help child protection systems                                                              
          be more responsive to community needs. A CRP is a                                                                     
          mechanism   for    public   participation    in   child                                                             
          protection.                                                                                                           
        • It  should   facilitate    robust   and    meaningful                                                                 
          participation by citizens                                                                                             
             1. In diverse roles in child and family welfare                                                                    
             2. Representing all five regions                                                                                   
             3. With a shared interest in promoting a healthy and                                                               
               collaborative CPS system                                                                                         
                                                                                                                                
MR. OUELLETE  said they have  really tried to target  people with                                                               
diverse roles in  child and family welfare so that  the panel has                                                               
that expertise. In  the past, CRP has taken anyone  with an ax to                                                               
grind. That  is helpful in  voicing some  things that need  to be                                                               
highlighted,  but   they  want   to  create  something   that  is                                                               
empowering the child protection system to  do its best and be the                                                               
best. They are  recruiting someone from Southeast  Alaska so that                                                               
all five regions will be represented on the panel.                                                                              
                                                                                                                                
MR. OUELLETE reviewed the federal mandate and state mandate.                                                                    
                                                                                                                                
     Federal Mandate (42 U.S.C. ? 5106a.(c)):                                                                                   
             • Examine the policies, procedures, and practices                                                                  
               of state and local child protection agencies and                                                                 
               evaluate the extent to which these agencies are                                                                  
               effectively discharging their child protection                                                                   
               responsibilities                                                                                                 
             • Conduct public outreach both to assess the impact                                                                
               of current policies and procedures, and to                                                                       
               solicit    public   comment    on   the    panel's                                                               
               recommendations.                                                                                                 
                                                                                                                                
     State Mandate (AS 47.14.205):                                                                                              
             "The CRP shall examine the policies, procedures, and                                                               
             practices of  State  and  local agencies  and  where                                                               
             appropriate, specific cases, to  evaluate the extent                                                               
             to which  State and  local  child protection  system                                                               
             agencies   are    effectively   discharging    their                                                               
             protection responsibilities."                                                                                      
                                                                                                                                
MR. OUELLETE reviewed the primary functions of the CRP:                                                                         
                                                                                                                                
     Review/Evaluate (from statute):                                                                                            
        • States' CAPTA Plan                                                                                                    
        • Child protection standards                                                                                            
        • And any other criteria that the Panel considers                                                                       
          important                                                                                                             
                                                                                                                                
     Conduct public outreach (from statute):                                                                                    
        • Assess the impact of OCS policies, procedures, and                                                                    
          practices on children and families                                                                                    
        • This assessment should inform its review function                                                                     
                                                                                                                                
     Advocate for (from congressional record):                                                                                  
        • Relevant changes based on its review                                                                                  
                                                                                                                                
MR. OUELLETE  said the panel  develops its criteria as  it visits                                                               
each region  throughout the  year. They  advocate for  a healthy,                                                               
effective  child protection  system  (CPS), not  one agency  over                                                               
another.                                                                                                                        
                                                                                                                                
MR. OUELLETE reviewed what CRP does not do:                                                                                     
                                                                                                                                
        • Comment on proposed or pending legislation                                                                            
        • Get involved in individual cases, contract, or                                                                        
          situations                                                                                                            
        • Micromanage OCS operations                                                                                            
        • Program evaluation                                                                                                    
        • Lobby                                                                                                                 
                                                                                                                                
MR.  OUELLETE said  that when  they visit  regions, they  provide                                                               
feedback  specific to  that region,  but this  year they  made it                                                               
clear  that their  feedback is  not official  but rather  talking                                                               
points about collaboration.                                                                                                     
                                                                                                                                
2:11:09 PM                                                                                                                    
MR. OUELLETE presented  a visual on how the CPS  works. The needs                                                               
of children and families drive what  they do. The needs are shown                                                               
as the big wheel. They look  at three questions: What is supposed                                                               
to be done? What is  actually done? What is needed? Traditionally                                                               
the CRP  has given feedback on  the first two questions.  The CRP                                                               
is starting  to take a more  in-depth look at why  things are not                                                               
being done and  what can be done to solicit  the support so those                                                               
things can be done.                                                                                                             
                                                                                                                                
MR. OUELLETE  reviewed changes  in CRP  operation to  become more                                                               
collaborative with the Office of Children's Services:                                                                           
                                                                                                                                
    Reorientation of CRP as a public participation mechanism                                                                    
        • Discussions began early fall 2017                                                                                     
        • A tentative three-year timeline                                                                                       
        • Elements will include                                                                                                 
             o Participatory evaluation                                                                                         
             o A systems focus                                                                                                  
             o Robust recruitment and retention strategy                                                                        
             o Data-driven review and outreach                                                                                  
             o Collaborative and constructive                                                                                   
                                                                                                                                
MR. OUELLETE  said they have worked  to make their OCS  goals and                                                               
recommendations align  with the momentum  to make OCS  better and                                                               
healthier. He has results to share later in the presentation.                                                                   
                                                                                                                                
MR.  OUELLETE reviewed  the goals  for 2017-2018.  He noted  they                                                               
developed the goals in collaboration with OCS:                                                                                  
                                                                                                                                
     GOAL 1: Examine the effectiveness of the current                                                                         
     administrative review process and whether the changes made                                                                 
     in 2015 have improved the system.                                                                                          
                                                                                                                                
     GOAL 2: Examine if 'family reunification' is prioritized as                                                              
     a goal for children in out-of-home care placement, and OCS'                                                                
     efforts in pursuit of 'family reunification'.                                                                              
                                                                                                                                
     GOAL 3: Examine OCS' efforts in finding relatives for                                                                    
     placement of children in foster care.                                                                                      
                                                                                                                                
MR. OUELLETE  said the administrative review  process became more                                                               
efficient but accomplished less, so  it was about redefining what                                                               
the administrative review process  was supposed to accomplish. In                                                               
the past,  it was an  opportunity for everyone to  collaborate on                                                               
the case plan.  The administrative review was changed  to make it                                                               
faster. People  who were involved with  the administrative review                                                               
process in the  past had discomfort because there  was not enough                                                               
time to work with families in  the meeting. Now there seems to be                                                               
a better understanding  of what the administrative  review is for                                                               
and efforts  are being  made to  look at  the case  continuum and                                                               
identify  other  areas  besides   the  administrative  review  to                                                               
accomplish certain things.                                                                                                      
                                                                                                                                
MR.  OUELLETE said  the  prioritization  of family  reunification                                                               
depended on  the region. In policy  it always is a  priority, but                                                               
depending  on the  worker  investment in  community,  it was  not                                                               
always an overt  practice. CRP looked at ways  to help strengthen                                                               
some  of the  things  that  undergird that  sense  of why  family                                                               
reunification is a priority.                                                                                                    
                                                                                                                                
MR. OUELLETE  said OCS has been  doing well with Goal  3, finding                                                               
relatives  for  placement of  children  in  foster care.  OCS  is                                                               
collaborating with tribal partners  in finding placements and the                                                               
tribes have incredible databases.                                                                                               
                                                                                                                                
2:17:24 PM                                                                                                                    
SENATOR BEGICH asked  if the increase in foster  care workers had                                                               
any impact on Goal 3.                                                                                                           
                                                                                                                                
MR.  OUELLETE replied  that in  some regions  it made  an impact.                                                               
Later  in  the  presentation  he  would  talk  about  how  worker                                                               
wellness and quality of life  undergirds all these priorities and                                                               
helps  those to  happen.  Where  there has  been  an increase  in                                                               
workers,  it has  had a  dramatic improvement  in the  quality of                                                               
life of  the workers. He  hears from  the workers that  they have                                                               
more time to work the case plans with the families.                                                                             
                                                                                                                                
SENATOR BEGICH said anecdotally, he  has heard those things about                                                               
the  Mat-Su  office.  He  asked if  any  measurements  of  worker                                                               
satisfaction are made or is it just observed.                                                                                   
                                                                                                                                
MR.  OUELLETE  said  they  did   propose  that  CRP  be  part  of                                                               
satisfaction surveys.  He worked  closely with OCS  leadership on                                                               
developing a section of the  survey that focuses on wellness. The                                                               
Anchorage office  has been  very cooperative  about incorporating                                                               
the  wellness initiatives  and getting  that staff  feedback. The                                                               
staff feedback he has received  has been that feedback or surveys                                                               
doesn't matter because  no one cares what they say.  So this year                                                               
they  worked   together  to   try  to   develop  a   survey  that                                                               
acknowledges that they heard what  the workers said last year and                                                               
x, y,  and z changes are  because of the feedback  from last year                                                               
and they  look forward to  doing x, y, and  z this year  based on                                                               
staff feedback.  They are  wording surveys  in ways  to encourage                                                               
participation and reinforce that what  they say matters. They are                                                               
coming to  see the CRP as  an entity that garners  that voice for                                                               
them.                                                                                                                           
                                                                                                                                
SENATOR  BEGICH replied  that it  is to  let them  know they  are                                                               
listening. The committee  is paying attention thanks  to the work                                                               
Mr. Ouellete is doing.                                                                                                          
                                                                                                                                
2:20:15 PM                                                                                                                    
SENATOR STEVENS  said last  year the  legislature was  visited by                                                               
children  in  foster  care. They  heard  repeatedly  that  little                                                               
effort was  being done  to find  relatives. He  was glad  to hear                                                               
that it  is improving, but  it would have  had to improve  in one                                                               
year because  they heard  so many complaints  last year  from the                                                               
kids  in  foster  care.  To   him,  their  work  seemed  akin  to                                                               
accreditation  in terms  of making  recommendations. He  asked if                                                               
CRP has  any power. He  asked in the end,  what is the  impact of                                                               
CRP.                                                                                                                            
                                                                                                                                
MR. OUELLETE  replied that  Diwakar Vadapalli  fought that  for a                                                               
long time. CRP has no  power legislatively. The relationship with                                                               
OCS was frustrating  at times. The CRP has realized  that if they                                                               
looked at  OCS like  a family  in crisis,  then they  approach it                                                               
differently. Workers  work with  families in crisis.  CRP thought                                                               
what if they approached OCS like  that. They don't have the power                                                               
to  say they  have to  do what  they tell  them, so  how do  they                                                               
garner that rapport, collaboration,  and reception that they need                                                               
from OCS.  They have  taken a  different approach  to acknowledge                                                               
how difficult  the work  is. These  things need  to be  fixed. He                                                               
said he is experiencing a  completely different conversation with                                                               
OCS. Rather  than OCS bracing for  a visit from CRP,  it's been a                                                               
thank you for  coming. A month after visiting  with the Anchorage                                                               
office, the leadership had gone  down the checklist and completed                                                               
everything CRP  had recommended.  The answer  to his  question is                                                               
they have  no legislative  power, but they  can when  they garner                                                               
that collaborative relationship.                                                                                                
                                                                                                                                
SENATOR STEVENS thanked him for what he is doing.                                                                               
                                                                                                                                
2:23:17 PM                                                                                                                    
CHAIR  WILSON said  the CRP  went six  years without  a forum  or                                                               
being  recognized for  the important  work it  does. He  reported                                                               
that he  asked CRP before the  committee so all Alaskans  can see                                                               
the work they do and have  their functions recognized at a higher                                                               
level.                                                                                                                          
                                                                                                                                
SENATOR BEGICH thanked the chair  because he didn't know anything                                                               
about the  CRP until the  CRP hearings  in the committee.  At the                                                               
first  hearing  significant  issues   were  brought  up  and  the                                                               
committee  asked   for  responses  from  OCS.   They  didn't  get                                                               
responsive  answers from  OCS, and  the following  year with  the                                                               
persistence and  desire of the  panel and the department  to work                                                               
collaboratively,  they got  responsive  answers. "We  end up,  by                                                               
virtue  of  listening  to the  panel,  becoming  the  legislative                                                               
power, if you will," he said.                                                                                                   
                                                                                                                                
MR. OUELLETE thanked the chair for  helping them have a voice and                                                               
a  sense of  legitimacy with  the work  that they  do. He  shared                                                               
Goals 4 and 5 of 2017-2018.                                                                                                     
                                                                                                                                
     GOAL 4: Expand public outreach in collaboration with                                                                     
     efforts under the Tribal-State strategic plan.                                                                             
                                                                                                                                
     GOAL 5: Strengthen the panel through aggressive recruitment                                                              
     of new members, enhanced website, and tools to reach                                                                       
     diverse groups of stakeholders.                                                                                            
                                                                                                                                
MR. OUELLETE  said last year they  reached out to tribes  to make                                                               
sure communication between  tribes and state was  where it should                                                               
be.  He recounted  a  story  of how  beneficial  it  was to  have                                                               
someone from  Bethel on the panel  when they did a  site visit in                                                               
Bethel.                                                                                                                         
                                                                                                                                
CHAIR WILSON asked how someone gets involved.                                                                                   
                                                                                                                                
MR.  OUELLETE replied  that people  can go  to crpalaska.org  and                                                               
send a message to the coordinator.                                                                                              
                                                                                                                                
MR.  OUELLETE reviewed  recommendations for  2017-2018 and  noted                                                               
that   he   would  go   over   the   highlights,  but   not   all                                                               
recommendations.                                                                                                                
                                                                                                                                
   Overall, CRP recommendations fall into five categories:                                                                      
        • Quality Assurance                                                                                                     
        • Management                                                                                                            
        • Practice                                                                                                              
        • Public participation                                                                                                  
        • CRP's role and functions                                                                                              
                                                                                                                                
MR. OUELLETE reviewed Recommendation 1 for 2017-2018:                                                                           
                                                                                                                                
     Improve Administrative Review Process                                                                                    
                                                                                                                                
     Recommendation  1:   The  Panel  recommends  that   OCS  not                                                             
     transition to a judicial review  process as was proposed but                                                               
     fine-tune  the current  administrative  process  to make  it                                                               
     more comprehensive.                                                                                                        
                                                                                                                                
MR. OUELLETE  said that  over time they  have realized  there was                                                               
lack  of  information about  the  purpose  of the  administrative                                                               
review process.  Now that they  know about the process,  they are                                                               
asking  where in  the continuum  of care  to address  things that                                                               
used to be in the review process.                                                                                               
                                                                                                                                
2:29:22 PM                                                                                                                    
SENATOR STEVENS asked  what a judicial review is and  why it is a                                                               
bad thing.                                                                                                                      
                                                                                                                                
MR.  OUELLETE   said  that  instead  of   having  cases  reviewed                                                               
internally at  OCS, they  were going  to go  before a  judge. The                                                               
feedback they received  in every region was that  they would need                                                               
more  judges.  Judges already  have  a  backlog  and there  is  a                                                               
backlog of administrative review cases.                                                                                         
                                                                                                                                
MR. OUELLETE reviewed Recommendation 2 for 2017-2018:                                                                           
                                                                                                                                
     Improve Outcomes for Family Reunification:                                                                               
                                                                                                                                
     Recommendation 2: The Panel recommends that OCS take the                                                                 
     following measures:                                                                                                        
                                                                                                                                
          ACTION:  OCS   should  target  recruiting   efforts  to                                                             
          workers  with life  experience in  or near  the regions                                                               
          they will be serving.                                                                                                 
                                                                                                                                
          ACTION:  OCS should  provide  orientation and  training                                                             
          that  explains the  often  overlooked  cycle of  trauma                                                               
          children  endure when  separated  from their  families,                                                               
          and the reason family  reunification is a priority. OCS                                                               
          supervisors and trainers  should encourage a strengths-                                                               
          based approach to working with parents.                                                                               
                                                                                                                                
          ACTION:  OCS  should  support   and  train  workers  to                                                             
          practice  early  intervention   /  in-home  efforts  to                                                               
          prevent   removal.   We   suggest  drawing   from   the                                                               
          experience of  more seasoned workers  who do  this very                                                               
          well   in   their   regions   to   provide   mentorship                                                               
          opportunities.                                                                                                        
                                                                                                                                
MR.  OUELLETE said  that regions  that have  workers invested  in                                                               
their  communities  have  better family  reunification  outcomes.                                                               
Regions  with  workers  who  are transplanted  from  out  of  the                                                               
community,  out of  the  state, and  at times,  from  out of  the                                                               
country,  often  do not  possess  the  information to  work  with                                                               
families  in that  region. The  panel  felt a  child's trauma  of                                                               
being  removed  was  not  stressed enough.  When  a  case  worker                                                               
understands that,  the case worker can  prioritize exhausting all                                                               
measures before removing a child.                                                                                               
                                                                                                                                
MR. OUELLETE reviewed Recommendation 3 for 2017-2018:                                                                           
                                                                                                                                
     Strengthened Cultural Competency                                                                                         
                                                                                                                              
     Recommendation 3:  The Panel recommends that  OCS leadership                                                             
     look  in to  identifying the  cultural differences  that can                                                               
     contribute to  bias among OCS  workers and  minorities, then                                                               
     find ways to improve their cultural competency.                                                                            
                                                                                                                                
          ACTION:  This can  be  done  through more  observation,                                                             
          listening,  and engagement,  as  well  as targeted  and                                                               
          evidence-based  trainings like  "Healthy Families"  and                                                               
          "Knowing Who You Are."                                                                                                
                                                                                                                                
          ACTION:   Cultural  competency   training  from   local                                                             
          village councils  or other tribal training  partners to                                                               
          build from  a collaborative foundation between  OCS and                                                               
          the  tribes  and  give caseworkers  an  opportunity  to                                                               
          engage with tribal  representatives establishing better                                                               
          lines of communication for achieving ICWA objectives.                                                                 
                                                                                                                                
          ACTION:  Collaborate with  tribes to  ascertain if  and                                                             
          where the ICWA  specialist could leverage relationships                                                               
          with local  elders and community  leaders to  help case                                                               
          workers  develop  effective  strategies  for  community                                                               
          engagement and interaction with Tribal resources.                                                                     
                                                                                                                                
MR.  OUELLETE said  in almost  all regions  tribal partners  have                                                               
good trainings about  the families they are working  with and the                                                               
values of those  families that workers need  to understand. Sitka                                                               
has  done  a  great  job   of  collaborating  with  their  tribal                                                               
partners. At  times he  has seen silos  between state  and tribal                                                               
partners,  and families  suffer from  the lack  of collaboration.                                                               
CRP is  working on how  to broker those relationships  better and                                                               
be a facilitator of that communication.                                                                                         
                                                                                                                                
2:34:54 PM                                                                                                                    
SENATOR COGHILL arrived.                                                                                                        
                                                                                                                                
SENATOR BEGICH noted that the CRP  travel budget is funded by the                                                               
state.  He  asked if  CRP  is  affected  by the  proposed  budget                                                               
restrictions on travel.                                                                                                         
                                                                                                                                
MR. OUELLETE answered  that he is not aware that  CRP is affected                                                               
by travel restrictions.                                                                                                         
                                                                                                                                
SENATOR BEGICH  asked if the  department knew the  answer because                                                               
he wanted to know if their work would be limited.                                                                               
                                                                                                                                
CHAIR WILSON  said the department  would be before  the committee                                                               
on  Friday to  give the  response to  the presentation  and could                                                               
answer his question then.                                                                                                       
                                                                                                                                
MR. OUELLETE  said they had  begun a conversation  about allowing                                                               
more  panelists to  travel before  the proposed  budget cuts.  He                                                               
hoped travel  would not be cut  because face-to-face interactions                                                               
in the community are vital to the work they do.                                                                                 
                                                                                                                                
SENATOR BEGICH said the CRP  is seeking to have collaborative and                                                               
participatory  relationship. He  understood the  adversarial role                                                               
with the department  response, but he hoped that in  the long run                                                               
the relationship would  be more collaborative and  they would see                                                               
CRP and the department present side-by-side.                                                                                    
                                                                                                                                
CHAIR WILSON said the vice chair  of the committee had had a bill                                                               
to move  the CRP  from the  administrative branch  to legislative                                                               
oversight, but  the bill  didn't' get the  momentum to  pass last                                                               
year. He did not know if that was still a goal of CRP.                                                                          
                                                                                                                                
MR. OUELLETE said it was not  still on the goal list because they                                                               
have reprioritized. He  thanked Senator Coghill for  his help for                                                               
getting that bill  on the floor. Because it didn't  pass and they                                                               
are going to  be housed within OCS, they asked  themselves how to                                                               
make  sure their  autonomy is  clear. The  relationship with  OCS                                                               
shows  they are  receptive  to feedback.  Their  feedback is  not                                                               
swayed by being  housed within their budget. As  he had mentioned                                                               
earlier, because of the changes  CRP had made, their criticism is                                                               
better received  and followed up  on. It used  to take six  to 12                                                               
months  to  get  a  response to  recommendations.  For  his  last                                                               
meeting with  the former director  of OCS,  she said she  cut the                                                               
requirement to three  months with a focus on  replying within one                                                               
month.  He thinks  that  they  are going  to  be more  responsive                                                               
because CRP is supportive of the things that OCS needs to do.                                                                   
                                                                                                                                
2:39:57 PM                                                                                                                    
SENATOR COGHILL said that Bethel,  which has some of the toughest                                                               
cases, has  added a public  defender to  work with OCS.  He asked                                                               
about the impact.                                                                                                               
                                                                                                                                
MR. OUELLETE recapped that Senator  Coghill was talking about the                                                               
addition of  a public defender,  who represents parents.  He said                                                               
he did not  know the answer from a  CRP perspective. Vocationally                                                               
he is mediator  in CINA [Child in Need of  Aid] cases. It depends                                                               
on  the defender.  He  has seen  it be  very  effective when  the                                                               
public defender is a strong  advocate for families who say, "Hey,                                                               
the reason that  we're here at a termination trial  is because no                                                               
one has given this family a case  place for six months and now we                                                               
are at  termination. That's not  the way it's supposed  to work."                                                               
He has  also seen defenders who  are just used to  the way things                                                               
go. It is unfortunate, but it's the way it works in some areas.                                                                 
                                                                                                                                
SENATOR  COGHILL  said Bethel  is  probably  one of  most  unique                                                               
places in Alaska because OCS  deals with tribal and state groups,                                                               
IWCA [Indian Child Welfare Act]  and state laws and tribal groups                                                               
that don't always have to follow  the IWCA laws. He asked how the                                                               
OCS office in Bethel is bridging the different approaches.                                                                      
                                                                                                                                
MR. OUELLETE replied that his last  site visit was to Bethel, and                                                               
that is where  the watchdog function of the CRP  really came out.                                                               
But it is balanced with  constructive feedback. The Bethel office                                                               
is having a  hard time. CRP's recommendations  for 2018-2019 were                                                               
formed largely as a result from the visit to the Bethel office.                                                                 
                                                                                                                                
MR. OUELLETE reviewed Recommendation 4 for 2018-2018:                                                                           
                                                                                                                                
     Increased Community Engagement                                                                                           
                                                                                                                                
     Recommendation 4: CRP to facilitate the constructive                                                                     
     exchange   of   vital   information   between   stakeholders                                                               
     increasing collaboration.                                                                                                  
                                                                                                                                
          ACTION:  Encourage  local/regional  OCS  leadership  to                                                             
          help  arrange  and   facilitate  townhall  or  "talking                                                               
          circle" type  meetings during each site  visit that the                                                               
          CRP conducts in 2018-2019.                                                                                            
                                                                                                                                
MR. OUELLETE  reviewed Recommendation  5 for 2017-2018  and noted                                                               
that work  burnout and vacancies  has been  a problem for  a long                                                               
time for OCS and is still a problem:                                                                                            
                                                                                                                                
     Worker Burnout and Vacancies                                                                                             
                                                                                                                                
     Recommendation  5:  Recruiting,  supporting,  and  retaining                                                             
     workers   that  have   the   skills,  character,   community                                                               
     investment,  and resilience  to serve  the needs  of Alaskan                                                               
     families is key.                                                                                                           
                                                                                                                                
          ACTION: Tighten OCS hiring policies in the following                                                                
          ways:                                                                                                                 
             • Acquire or develop a tool that screens job                                                                       
               applicants for resiliency.                                                                                       
             • Require applicants have field-related experience                                                                 
               and/or education.                                                                                                
                                                                                                                                
MR. OUELLETE  said finding  a tool to  screen job  applicants for                                                               
resiliency may not be possible, but  it should be looked into. He                                                               
has  seen that  OCS is  tolerating vacancies  longer before  just                                                               
putting  someone  in a  position.  While  it  hurts not  to  have                                                               
someone there, it  hurts more to put someone  there who shouldn't                                                               
be there.                                                                                                                       
                                                                                                                                
MR. OUELLETE  reviewed Recommendation  6 for 2017-2018  and noted                                                               
they were getting good feedback on progress for this:                                                                           
                                                                                                                                
     Improve Centralized Intake                                                                                               
                                                                                                                                
     Recommendation 6: While regions are  adapting to what may be                                                             
     an   irreversible  change,   there  are   still  significant                                                               
     concerns about  the efficacy of the  current intake process.                                                               
     Stakeholders across the regions  shared frustration over the                                                               
     inconsistency  of  the  process   and  the  intake  worker's                                                               
     inability to  facilitate necessary actions in  a region they                                                               
     are unfamiliar with in a timely manner.                                                                                    
                                                                                                                                
          ACTION: Equip  centralized intake workers  with region-                                                             
          specific   resources   and   a   concise   standardized                                                               
          assessment  tool   for  prioritizing  calls   based  on                                                               
         already existing OCS policies and procedures.                                                                          
                                                                                                                                
2:45:19 PM                                                                                                                    
MR. OUELLETE reviewed progress on the 2017-2018 goals:                                                                          
                                                                                                                                
        • 2017 was, we hope, the pinnacle of a tumultuous period                                                                
          for  OCS  involving  much public  scrutiny,  incredibly                                                               
          high   worker  turnover,   lack  of   (though  growing)                                                               
          collaboration  and communication  between OCS  and CRP,                                                               
          and  internal frustration  with statewide  changes such                                                               
          as admin review and centralized intake.                                                                               
                                                                                                                                
        • Many of the recommendations went unaddressed and                                                                      
          appear  under new  headings for  2018-2019  as the  CRP                                                               
          reimagined its  role moving  from "watchdog"  to broker                                                               
          and  facilitator   of  effective   communication  while                                                               
          remaining critically objective.                                                                                       
                                                                                                                                
MR. OUELLETE said CRP had to reimagine its role from just giving                                                                
recommendations to giving support and building a relationship to                                                                
make it possible to meet the recommendations:                                                                                   
                                                                                                                                
     Moving into 2018-2019                                                                                                  
                                                                                                                                
        • Acknowledging the crisis OCS was facing, the CRP                                                                      
          adapted  its approach  to  site  visits looking  deeper                                                               
          into  core  contributing  factors leading  to  burnout,                                                               
          turnover,   backlogged   IAs,   and   less-than-optimal                                                               
          results for children and families.                                                                                    
        • CRP developed this year's goals to address the                                                                        
          relationship   between   worker   wellness,   community                                                               
          collaboration   and   best    efforts   toward   family                                                               
          reunification.                                                                                                        
        • CRP  began    pre-site-visit    teleconferences    to                                                                 
          collaborate  with  leadership  toward a  fruitful  site                                                               
          visit.                                                                                                                
                                                                                                                                
MR. OUELLETE  said the pre-site  visit briefings give  OCS plenty                                                               
of  time  to  review  CRP  priorities  and  think  of  thoughtful                                                               
responses  to  questions. Typically,  CRP  visits  were met  with                                                               
consternation. They are trying to  change that and have seen good                                                               
results.                                                                                                                        
                                                                                                                                
MR. OUELLETE reviewed Goal 1 for 2018-2019.                                                                                     
                                                                                                                                
     GOAL 1:  Assess Family Reunification Efforts & Best                                                                      
     Practices                                                                                                                  
        • What are practices that are working well in the                                                                       
          regions to promote family reunification  and how can we                                                               
          replicate that in other regions?                                                                                      
        • What are barriers workers and families face to moving                                                                 
          toward reunification?                                                                                                 
        • What needs to be done to eliminate those barriers?                                                                    
                                                                                                                                
He  said  Goal 1  will  probably  always  stay  a goal,  but  the                                                               
questions are changing  from "are you meeting  the objectives" to                                                               
"how are you meeting the objectives and what are the barriers."                                                                 
                                                                                                                                
MR. OUELLETE reviewed Goal 2 for 2018-2019:                                                                                     
                                                                                                                                
     GOAL 2:  Evaluate OCS Staff Wellness Efforts and Community                                                               
     Engagement                                                                                                                 
        • What efforts are in place to promote wellness, safety,                                                                
          healthy office culture, and community engagement                                                                      
          (particularly in remote regions)?                                                                                     
        • How can the CRP help promote wellness among staff?                                                                    
                                                                                                                                
MR. OUELLETE  said as he visited  each region, he was  grieved by                                                               
the  lack of  emphasis on  wellness for  workers. For  people who                                                               
have some of  the hardest and thankless jobs in  the state, there                                                               
is no  sense of  self-care, no  sense of  helping each  other, or                                                               
that awareness that they have a  hard job that is killing them if                                                               
they don't  take care of themselves.  It is a problem  that there                                                               
is no room  in the budget for wellness. He  doesn't know that CRP                                                               
can address  that, but they  can ask  about what supports  are in                                                               
the  community  for wellness.  Sometimes  the  OCS staff  doesn't                                                               
appreciate the effects of secondary  trauma on them, which can be                                                               
devastating. The  Anchorage office has started  suicide awareness                                                               
and secondary trauma  training. The union gives  trainings on how                                                               
to access benefits. CRP feels  that healthy OCS workers are going                                                               
to contribute to healthy families in Alaska.                                                                                    
                                                                                                                                
MR. OUELLETE reviewed Goals 3-5 for 2018-2019:                                                                                  
                                                                                                                                
     GOAL 3: Region-Specific/Culturally-Appropriate Training for                                                              
     OCS Staff                                                                                                                  
        • What are current requirements for staff?                                                                              
        • What offerings available through tribal partners?                                                                     
        • How can the CRP facilitate better communication and                                                                   
          collaboration with tribal partners in this area?                                                                      
                                                                                                                                
     GOAL 4:  Awareness of Tribal-State Strategic Plan                                                                        
        • At what levels do different staff engage with the                                                                     
          Plan?                                                                                                                 
        • Are the efforts coming from the Plan tangible to                                                                      
          stakeholders?                                                                                                         
                                                                                                                                
     GOAL 5:  Coordinate Panel Activities & Improve Panel                                                                     
     Participation                                                                                                              
        • Streamline regular schedule for panel activities.                                                                     
        • Focus recruitment efforts on regions outside of                                                                       
          Anchorage.                                                                                                            
                                                                                                                                
MR. OUELLETE reviewed progress on the 2018-2019 goals:                                                                          
                                                                                                                                
     Progress on 2018-2019 Goals                                                                                            
     Our change in approach has                                                                                                 
                                                                                                                                
             • Highlighted the strengths and improvements in                                                                    
               each region and given honor where due:                                                                           
                  o Recognized   to    state   leadership   where                                                               
                    regional and local leadership has played a                                                                  
                    significant role in improving outcomes for                                                                  
                    families                                                                                                    
                  o Recognized  supervisors  who model  effective                                                               
                   and supportive leadership                                                                                    
                                                                                                                                
             • Acknowledged the   challenges   faced   by   all                                                                 
               stakeholders and contributed to building unity                                                                   
               among OCS and its partners.                                                                                      
                  o Naming  and normalizing  the stress  incurred                                                               
                    by those who work directly with families in                                                                 
                    their greatest time of need                                                                                 
                  o Providing  empathetic  and positive  feedback                                                               
                    from the community to OCS workers                                                                           
                  o Communicated to  all stakeholders  the common                                                               
                    goals of OCS and community partners                                                                         
                                                                                                                                
             • Tailored  recommendations    for   success    by                                                                 
               collaborating with leadership and seeking out                                                                    
               sources of support from community partners.                                                                      
                  o Worked with stakeholders  to provide tangible                                                               
                    solutions to challenges in communication,                                                                   
                    collaboration, and cultural competency                                                                      
                  o Provided  OCS  leadership   with  ideas  from                                                               
                    staff and contact information for support                                                                   
                   available in the community                                                                                   
                                                                                                                                
             • Resulted in   a   positive   and   collaborative                                                                 
               relationship between CRP and OCS leading to                                                                      
               unprecedented   responsiveness,   and   successful                                                               
               implementation of CRP recommendations.                                                                           
                                                                                                                                
2:54:50 PM                                                                                                                    
MR. OUELLETE concluded with the following:                                                                                      
                                                                                                                                
     The CRP is an institution, with a statutory role and                                                                       
     responsibility.                                                                                                            
     It is an organization of the state.                                                                                        
     It facilitates citizen participation.                                                                                      
     It must cultivate a critical, but constructive lens.                                                                       
     It exists to help OCS.                                                                                                     
     Its success depends on its relationship with OCS.                                                                          
                                                                                                                                
MR. OUELLETE  said the  success of  the CRP  is dependent  on its                                                               
collaborative  relationship  with  OCS  and the  success  of  OCS                                                               
depends  on  collaboration  and   support  with  their  community                                                               
partners.  If  he could  advocate  for  anything today,  he  said                                                               
cutting  in areas  that  decreases access  to  those partners  or                                                               
diminishes the capacity of those  partners to be a support system                                                               
for OCS  is detrimental  to families. He  asked the  committee to                                                               
take  a hard  look  at  how any  proposed  cuts  for DHSS  impact                                                               
families.                                                                                                                       
                                                                                                                                
                                                                                                                                
SENATOR COGHILL said collaborative  work is expected, but another                                                               
set of eyes to shed light on  what is going on is also necessary.                                                               
He thanked Mr. Ouellete for  taking the responsibility seriously.                                                               
OCS  has said  it is  looking at  new ways  of training  and that                                                               
might  percolate up  this year.  He  asked whether  he had  heard                                                               
employees were anticipating this or dreading this.                                                                              
                                                                                                                                
MR. OUELLETE asked for clarification of the question.                                                                           
                                                                                                                                
SENATOR COGHILL said  there are more efforts at  training for OCS                                                               
workers on  the frontline  with the new  money and  new positions                                                               
the Legislature  funded last  year. They  are trying  to mitigate                                                               
turnover  and vacancy  rate. His  comment is  not meant  to be  a                                                               
criticism, but he wondered if  had heard any discussion about the                                                               
training.                                                                                                                       
                                                                                                                                
MR. OUELLETE  replied that  there has  been a  lot of  talk about                                                               
that.  More training  is going  to be  very welcome.  One of  the                                                               
things they  hear the most from  case workers is that  they don't                                                               
have enough training to do this.  An emphasis on training is only                                                               
going to  be helpful to case  workers. It will create  a delay in                                                               
getting workers to the field, but  his assumption is that it will                                                               
pay dividends.                                                                                                                  
                                                                                                                                
SENATOR COGHILL  said he  thought the law  that passed  last year                                                               
placed a limit on caseloads, so  they need to hire people and get                                                               
the training completed.                                                                                                         
                                                                                                                                
CHAIR WILSON said  today's presentation in some ways  served as a                                                               
preliminary  audit of  HB 151  since  issues regarding  training,                                                               
placement  times, wellness,  and collaboration  were part  of the                                                               
bill.  He has  great hopes  that progress  with OCS  continue and                                                               
that the gains will multiply.                                                                                                   
                                                                                                                                
3:00:10 PM                                                                                                                    
SENATOR  STEVENS  commented  that  being   a  case  worker  is  a                                                               
stressful job.  Last year the  committee heard case  workers were                                                               
quitting faster than they could  be hired. The most valuable part                                                               
of any  accreditation for  a college or  university is  the self-                                                               
study  before  the  auditors  arrive.  He asked  if  CRP  can  do                                                               
something similar.                                                                                                              
                                                                                                                                
MR. OUELLETE  replied that  they made a  change for  that reason.                                                               
CRP  usually starts  the presite  visit  briefings several  weeks                                                               
ahead and  request data so that  they know what they  are looking                                                               
for and also give OCS all the  questions they are going to ask so                                                               
they can  review those.  It used  to be a  concern that  by doing                                                               
that, OCS could  stage the environment, but there is  not time to                                                               
do that.  Since CRP started  doing this, they are  more receptive                                                               
when they are given a heads up.  He wanted to speak to an earlier                                                               
comment about the  effectiveness of putting more  people into the                                                               
workforce.  That has  been  helpful and  the  emphasis on  worker                                                               
wellness  will  hopefully keep  people.  They  can keep  spending                                                               
money on  putting more  people there, but  if the  conditions are                                                               
terrible, why would  they stay. While the  legislation is helping                                                               
to get more people in there, the CRP is helping people to stay.                                                                 
                                                                                                                                
3:02:17 PM                                                                                                                    
CHAIR WILSON announced that the  committee will hear the response                                                               
from OCS  on Friday and  the status  on the implementation  of HB                                                               
151.                                                                                                                            
                                                                                                                                
3:02:45 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee at 3:02 p.m.                                                                                                 

Document Name Date/Time Subjects
CRP - Senate HSS Presentation 3-20-19 [Autosaved].ppt SHSS 3/20/2019 1:30:00 PM
DHSS OCS Citizen's Review Panel
Senate HSS March 13 Dept Overview Presentation.pdf SHSS 3/20/2019 1:30:00 PM
DHSS Overview Commissioner Crum