Legislature(2019 - 2020)BUTROVICH 205
03/20/2019 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Continuation of Overview of the Department of Health and Social Services | |
| Presentation: Office of Children's Services Citizen's Review Panel by Jp Ouellete, Chair | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
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 |