HOUSE BILL NO. 22 "An Act extending the termination date of the Statewide Suicide Prevention Council; and providing for an effective date." 1:49:38 PM Co-Chair Wilson thanked Representative Tarr for quickly running through the bill earlier in the week. REPRESENTATIVE GERAN TARR, BILL SPONSOR, reviewed the bill which reauthorized the suicide prevention council through 2027, an 8-year extension. The extension came following the successful audit recommending the extension. She indicated the committee would hear from the auditor about a couple of recommendations later in the meeting. She had talked about her experience serving on the board previously. She spoke of a couple of key reasons why the membership was so important. She had mentioned in a previous meeting about the diverse membership and the statutory requirement that there be a Veteran or military representative, a person from the Alaska Federation of Natives (AFN), and a person from a faith-based organization in addition to other more expected membership representing agencies and legislators. Representative Tarr discussed the importance of the Veteran and military connection. Alaska had the highest number of Veterans per capita in the country, and suicide was a major problem with Veterans. She referenced in members' packets, "Suicide Facts and Figures" (copy on file). She pointed to the Alaskan Veteran suicide rate which was much higher than the Western Region and the national Veteran suicide rate. She reiterated the importance of having representation from military and Veteran affiliation. She reported other data that suggested someone who served in the military was twice as likely to commit suicide. Representative Tarr talked about the importance of having representation from AFN. A member from AFN had knowledge and connections to tribal organizations and the Alaska Native community. Suicide was an issue that affected rural communities harder than anywhere else in the state. She reported that the group of individuals who were dying the most from suicide were Alaska Native males between the ages of 19 to 25. The council had partnered with AFN at all of the recent meetings to provide information, training, prevention work, and healing. She spoke of a suicide at an AFN conference a few years prior. The incident made it even more clear the importance of continuing to work on the issue and how impactful it was to communities and families. Representative Tarr stressed the importance of having someone with a faith-based background on the board. Churches and schools, especially in small communities, were some of the more stable organizations. They were good organizations to partner with. Also, an important part of healing from trauma or abuse was a person's faith. Over the years the council had worked with members in the faith community to offer training for people who were leaders. Often times people went to their faith leaders for advise when they were experiencing a challenging time in their life. 1:53:57 PM Representative Tarr suggested that the state's suicide rates were rising. She referred to the suicide fact sheet again. She thought another piece of data which was important to consider in relation to the number of suicides which was the number of calls to the Care Line. The number of calls had jumped substantially. In 2012 there were 6,956 contacts for the entire year. In 2018 there were 20,976 calls. Even though the suicide rates had increased, the call line numbers were very large. She thought both data points should be taken into consideration together. There was no way of knowing whether the outcome could have been different if those individuals had not called the Care Line. The calls to the careline cemented the idea that it was essential to provide resources for people in crisis. Representative Tarr spoke about the recommendations from the audit. She wanted to talk about an additional piece she hoped members would consider. The council produced an annual report - the third report was recently released recasting the net. She highlighted a checklist found at the end of the report of things that individuals, families, and communities could do. The council always tried to incorporate things that it learned into its work. The list reflected some of the data the council knew was working. She suggested to legislators to provide information in their newsletters and talk about the council's resources at constituent meetings. She thought having a diverse group, coordinating and designing a plan and sharing it with communities, organizations, and churches would be how the state would achieve the desired change. Representative Tarr relayed that the fiscal note would be addressed in the committee and the funding was included in the base for the Department of Health and Social Services (DHSS). She noted funding for the related grant which was incorporated into the work of the council 5 years ago. She reported that the grants went through the council and out through the Department of Education and Early Development (DEED) to schools for primary prevention (very promising early intervention type of work with young people). The money was in the budget, however, the legislature needed to pass the bill extending the council. 1:57:42 PM Representative Carpenter was looking at the findings and recommendations of the audit and the prior 2012 sunset audit recommendations. He asked about the recommendation for the council to develop performance measures. He wondered how the council was measuring success with the program. He saw a chart that showed 2007 to 2016 with categories of Alaska Native, Alaska Non-Native, Alaska, and U.S. and with a rate per 100,000. Co-Chair Wilson asked Representative Carpenter to identify the page he was looking at. Representative Carpenter was looking at page 7 of the audit report, Exhibit 3. He knew it was difficult to quantify how many people did not commit suicide but wondered how the council was measuring the effectiveness of the program. Representative Tarr indicated it was difficult to measure success. It was unknown who might have been thinking about committing suicide. She brought up the number of calls to the Care Line as a way of measuring success. The Care Line reported quarterly to the suicide prevention council meetings. She encouraged people to contact the council to find out more about the work performed by the council. She could not provide an answer to the representative's question. However, the council looked to the numbers from the Care Line as an indication that the demand and need was growing for individuals looking for services to address when they were feeling in a crisis situation. She added that when looking at the grants, some of them did work that involved a training program. She used iTalk Assist as an example of a program used in high schools and taught students to speak up if they saw something. It allowed students to be a part of a support network for people. She thought looking at metrics geared towards how providing services and training could be achieved would be more quantifiable. She did not think it was possible to track the number of deaths that were prevented. Representative Carpenter relayed that there were 39 per 100,000 in 2007, and in 2016 the number was 42 per 100,000. Over the time span the numbers had not changed much. There was a marginal increase. The state was spending over $500,000 per year without apparent results. He wondered how to know the council's effectiveness. 2:02:42 PM Representative Tarr responded that most people thought the number would be much higher without the program. She noted the village of Hooper Bay and the contagion of suicide a few years back. She noted that when looking at the smaller segment of population sometimes an event, such as the one in Hooper Bay, influenced the date significantly. Representative Carpenter asked what the suicide prevention council did in the instance of the deaths in Hooper Bay. Representative Tarr responded that after the event the council got people from the community connected with resources for the postvention. The council sent resources to the community and tried to provide the support necessary for a small community to respond to such tragic events that happened in close succession. She noted that the council wanted to do more of the postvention training. In terms of the training, none of it was happening previously. More of the training had been offered in the past 5 years because money was more available currently. It was reported to the council that the training had been critical to the crisis response after the incidents. 2:05:46 PM Representative Sullivan-Leonard asked for examples of the work done through the council regarding the grants and how the grants were dispersed. She also about what was actually happening out in the communities. Representative Tarr replied that earlier the council had been working on setting up framework. The framework had been a coalition model. There was a Juneau Coalition and two coalitions in Anchorage. There were others around the state as well. Some had been more successful than others. One of the things the council noticed was that in the urban centers, in churches and schools, it had been easier for the sustainability and longevity of the coalitions. In some of Alaska's smaller communities it had been more difficult to sustain the coalitions over time. The council was trying to build and strengthen the coalitions in the communities. The coalitions often included people from the council or people who were working closely with JAMI in Juneau or NAMI in Anchorage. For example, Juneau Suicide Prevention Coalition conducted training events and held conferences getting out into communities. NAMI focused on supporting families. Representative Tarr continued that the grants awarded to schools were geared towards primary prevention programs and teaching. Much of the work recently was focused on being trauma-informed. They recently completed some training models that could be used for education professionals and was accessible online by dedication a certain number of slots for the public. The funds were used to produce the training which had longevity because it was done in a webinar format. She was hoping that individuals that worked with children, such as individuals working at childcare centers, could potentially go online to use the resource. She noted there was prevention and postvention work occurring in communities as well. 2:09:54 PM Co-Chair Wilson invited Ms. Fishel to comment. SHARON FISHEL, EDUCATION SPECIALIST II, DEPARTMENT OF EDUCATION (via teleconference), responded that the grant program saved lives including the lives of children and teachers. There was a tremendous effort in training staff. She reported that in 2012 there was a law passed, SB 137, that required all educators to receive suicide prevention training. Since then, through the department's e-Learning system there had been over 18,000 of DEED's 23,000 users that have taken 1 of 4 suicide prevention courses developed by the department in collaboration with the suicide prevention council. The depart also developed several trauma courses. Ms. Fishel continued that over the 5 years that the department had the grants, there had been 20 grants that had gone out to different school districts and some particular schools. School districts were moving to a peer- to-peer model training students how to recognize signs of suicide. They were teaching students how to encourage individuals by letting them know they were not alone. She mentioned several school districts that were utilizing the funds. She spoke highly of the program. She provided some examples of school districts and how they were making efforts to educate students about suicide prevention. She noted that a federal grant manager commented that the small grant for suicide prevention saved lives and had the largest impact of all of the millions of dollars he managed. Every 3 years districts were asked to apply for the grants. They were all required to use an evidence-based practice. She reported that over 137,000 Alaskans had been touched or were part of the program in the previous two grant cycles. 2:14:37 PM Co-Chair Wilson asked for information regarding the allocation of grants. Representative Carpenter asked if the department kept any non-attributable statistics on suicide ideation, attempted suicide, or successful interventions. He was looking for verification that the program was saving lives. Ms. Fishel reported the information would point to specific individuals and would break privacy provisions. She mentioned the youth risk behavior survey done every 2 years included questions about depression, whether a person considered suicide, and whether a person attempted suicide. The last statistics the department had were from 2017. The information was currently being administered, and she was unsure of the trend line. The survey was collected from students. However, the data the representative was asking for was not collected by DEED. Representative Carpenter thought, going forward, the department should keep non-attributable information in order facilitate a conversation about the program's success. He did not approve the measure that was currently in place. He thought measures of effectiveness were necessary in managing a program. Co-Chair Wilson asked if there was a fee attached to any of the courses being offered. Ms. Chambers responded in the negative. All the courses were free. 2:18:48 PM Vice-Chair Ortiz asked about the issue of suicide prevention and awareness. He wondered if it was possible that the state had more documented suicides because people were paying more attention to the issue. He thought it was possible that previously suicides might not have been documented prior to the new level of awareness in the state. Co-Chair Wilson thought Vice-Chair Ortiz's question was valid. However, Representative Tarr already testified on the difficulty of measuring success of the program. Representative Tarr added that DHSS could provide additional information. Sometimes suicide was not listed on a death certificate as the cause of death. She provided additional Care Line numbers. The numbers reflected a jump at each measure taken. There continued to be an increase. People were finding out about the service. She believed the care line might have more information. Representative Tilton asked for a list of grantees of the past history of the program. She wondered if most of the grantees were going out to government agencies or faith-based organizations. Co-Chair Wilson asked if a 2- year look back was a large enough timeframe. 2:22:57 PM Representative Tilton responded in the affirmative. She mentioned that in the fiscal note it stated that the Statewide Prevention Council was developing and implementing a plan, the council's most significant statutory duty. There was a new revised plan that moved away from an intervention plan to more of a prevention and promotion plan. She asked Representative Tarr to talk about the change. Representative Tarr replied that it was essentially recasting the net. It was available online, and a checklist was provided. In her work in public health, she had seen a shift from a crisis response model - the costliest point of intervention - to an earlier intervention and prevention model. The grants were awarded to a promising or evidence-based practice. People wanted to use evidence-based models to know for sure that the model was effective. She reported that evidence-based models showed that the earlier intervention and prevention was the most effective and cost-effective model. She suggested that in working with young people it helped them to develop skills for themselves in how they experienced and addressed a personal crisis as well as being a resource for others. She mentioned the vulnerable group of young men, ages 19-25 and the hope of reaching them and providing tools to them that would help them to be resilient. Representative LeBon wondered if the history of the funding for the program had been static. Representative Tarr responded that it had been static. She reported that in the earlier years there had been just one staff person. Once the grants were factored in, the funding had been pretty consistent over the prior 5 years. The funding covered the cost of staff, travel, and the grants. During her time on the council she had visited multiple sites which provided significant insight. There were travel funds and grant monies. She indicated the fiscal note estimated the cost of the position, travel, and the grants. Under Governor Walker there had been a travel freeze. For a couple of years it appeared that travel came under budget, but it was the freeze that influenced the number. 2:27:33 PM Representative LeBon pointed to the graph on page 7 that confirmed that Alaska had a real problem with suicide in the state. However, the graph did not specify the number of suicides prevented by the state's actions. He suggested that one option would be to zero out the program and see how many suicides occurred, however he did not believe it was a good strategy. Representative Josephson thought that in a failed attempt there could be great costs borne by the public in degree, far greater than the fiscal note. He asked Representative Tarr if he was correct. Representative Tarr responded affirmatively. She highlighted the handout regarding suicide facts and figures which spoke to Representative's question. She read from the handout: Suicide cost Alaska a total of $226,875,000 combined lifetime medical and work loss cost in 2010, or an average of $1,383,382 per suicide death. Representative Tarr relayed that the cost of someone dying at a young age was very costly. Beyond the dollar, she conveyed losing her brother to suicide and the personal impact to family and friends. 2:29:47 PM KRIS CURTIS, LEGISLATIVE AUDITOR, ALASKA DIVISION OF LEGISLATIVE AUDIT, read a portion of the audit dated, August 3, 2018 (copy on file): The audit found the council operated in the public's interest by actively broadening the public's awareness of suicide prevention and coordinating the efforts of other suicide prevention entities including State agencies, regional groups, coalitions, and local communities. Additionally, the council fulfilled its statutory duty by issuing the 2018-2022 Suicide Prevention Plan and working closely with stakeholders to add and refine the plan's strategies, resources, and indicators. The audit also concluded that administrative improvements were needed to ensure council meetings are adequately public noticed and the executive director is consistently evaluated on an annual basis. In accordance with AS 44.66.010(a)(7), the council is scheduled to terminate on June 30, 2019. We recommend that the legislature extend the council's termination date to June 30, 2027. Ms. Curtis directed members to turn to page 4 of the audit showing expenditures and funding sources. It showed that the council was funded entirely by general fund appropriations and that in FY 18 the council spent just under $600,000. She referred to a detailed list of council activities conducted during the audit period on pages 9 and 10. She reported there were two minor recommendations as a result of the audit beginning on page 12. Both were administrative in nature and easily addressed: The council's executive director should develop and implement procedures to ensure public notices for meetings are published timely and accurately. From July 2014 through March 2018, 5 of the 18 meetings held (28 percent) were not public noticed or not public noticed properly. Specifically, two were not published on the State's Online Public Notices system, two were published with incorrect meeting dates, and one was published one day prior to the meeting. The deficiencies were caused by a lack of written procedures to ensure notices are posted timely and contain accurate meeting dates. Ms. Curtis reviewed the second recommendation: The council chair should develop and implement written procedures to ensure performance evaluations are completed annually for the council's executive director. Between July 2014 and March 2018, two evaluations were completed for the executive director; however, two more should have been completed. Specifically, there were no evaluations for the period of November 2014 to November 2015, and November 2015 to June 2016. Per discussion with council staff and the previous council chair, it is unclear why the evaluations were not completed for the executive director. Ms. Curtis restated that the recommendations were easy to address. She indicated the responses to the audit could be found on page 23. She reported that the commissioner of DHSS and the counsel chair agreed and concurred with the report conclusions and recommendations. Representative Josephson asked if it was true that in all of the cost saving measures the administration proposed, they wanted the council untouched. Ms. Curtis did not know. Co-Chair Wilson indicated the committee would ask someone from DHSS. 2:32:46 PM Co-Chair Johnston asked about how the division audited the coordination between the suicide groups and the state agency. She thought Ms. Curtis had seen improvement. Ms. Curtis clarified Vice-Chair Johnston's question. Vice-Chair Johnston restated her query. Ms. Curtis explained that as part of the audit her division sampled, reviewed, and read the board meeting minutes, reviewed annual reports, and conducted interviews of stakeholders and council members to reach their conclusions about coordinating. The council served in an advisory position to the legislature and the governor. Legislative Audit looked at whether the council had been accomplishing its statutory mandate, which she thought they had. Another statutory duty was to develop a statewide plan which had been done in a timely fashion. Legislative Audit had been looking at the council since inception. Initially the council had a rough start. At one point the division might have recommended termination in the council's early stages. The current audit and the prior audit were very complimentary of the council in how it conducted business and coordinated throughout the state. Co-Chair Wilson asked Vice-Chair Johnston to comment on Representative Josephson's question regarding the money that was put back in the budget that was originally removed in the governor's version of the budget. Vice-Chair Johnston responded that she had better not answer the question. Representative Josephson commented that the governor wanted to keep the monies in place. Vice-Chair Johnston commented that it was interesting to listen to the governor's report because they were listing the priorities of the departments. On a scale of 1 to 5 the item had a 1, the lowest number on the scale. She commented that it was interesting that the governor wanted it funded. 2:36:14 PM Co-Chair Wilson turned to page 3 of the audit report. She wondered about item 13 under public member: 13. one public member. The council is staff ed by a program assistant and an executive director. The council's executive director also serves as the executive director for AMHB and ABADA. The co-location is formalized by a memorandum of agreement between the three entities and facilitates collaboration through shared resources. Per the agreement, AMHB and ABADA pay the personal services and travel costs for the executive director until such time as the council has the resources to contribute. Co-Chair Wilson asked if they were looking for other funds outside of general funds at the time the council was put together. Ms. Curtis responded that in the prior sunset audit the division had a recommendation of a co-location that had been put together and working well. There was nothing documented between the three entities. The person was just serving. The auditor indicated an agreement was needed. In the current audit there was an agreement in place. She assumed they meant general funds. Legislative Audit did not look at what the three entities were thinking when the agreement was made. Co-Chair Wilson asked if Ms. Curtis knew whether the mental health board had ever participated in funding any of the program since they were a benefactor. Ms. Curtis replied that she knew that the suicide council was not paying the cost of personal services. Per the agreement, the other two entities paid the personal services and travel costs. She clarified that the personal services on page 4 was not the executive director, rather, it was a staff person to the executive director. Co-Chair Wilson was trying to figure out who else would be contributing based on the way things were written. Ms. Curtis reported that the other two entities were paying for the executive director. She thought they assumed that the suicide prevention council would help contribute at some point when monies became available. Co-Chair Wilson indicated there were invited testifiers online. 2:39:09 PM BARBARA FRANKS, CHAIR, ALASKA SUICIDE PREVENTION COUNCIL, NINILCHIK (via teleconference), was a mother of a child who died by suicide. She provided a personal story as it related to the death of her family member. The suicide prevention program helped her tremendously when her son committed suicide and her husband died of cancer. She had lived in Juneau for over 30 years. While she was visiting she had found out about someone she knew who had jumped off the Douglas Bridge. She spoke of the coalition built through the council. The Juneau Suicide Prevention was there and would be at the gentleman's funeral in the following week. She spoke of the need for young people to know how to talk about suicide. She advocated not waiting for a crisis to happen to call the suicide prevention number. She spoke of the benefits of the tool of the program. She thanked the committee. 2:43:35 PM JAMES BIELA, AMERICAN FOUNDATION FOR SUICIDE PREVENTION, BETHEL (via teleconference), reported that for the previous 4 years the Alaska chapter had drastically improved on working with the Statewide Suicide Prevention Council by sharing information provided by trainings. The council had also assisted him at the elder and youth conference the previous 6 years. He had the pleasure of doing chapter presentations on suicide loss, lived experience, and surviving after a suicide. The council had also increased their participation in the International Suicide Loss Day, which was held the Saturday before Thanksgiving. He talked about the benefits of the council and being able to have access to suicide prevention. He spoke in support of HB 22. Mr. Biela was aware the nation had reported a 30 percent increase in suicides in the previous year. Alaska rates had risen by 13 percent. The state did not have any statistics for the number of lives that had been saved. He spoke of the Statewide Suicide Prevention Council assisting him in responding to suicides in the Southwest Region. Regarding fiscal goals, he worked full-time as an itinerant school social worker. In 2017 he had been trained in suicide prevention and had trained roughly 1,395 students. There had been 222 requests from people to take the course. He reported that of the 119 requests 89 kids had entertained thoughts of suicide. He highly recommended extending the Statewide Suicide Prevention Council. 2:47:06 PM Co-Chair Wilson OPENED Public Testimony. 2:47:20 PM LILY WERTZ, SELF, ANCHORAGE (via teleconference), was a lifelong resident of Anchorage. She was bipolar and had been saved through the suicide hotline. She provided some suicide statistics. She urged support for HB 22 to extend the council until 2027 and beyond. 2:48:26 PM TINA WALSH, SELF, ANCHORAGE (via teleconference), [Note: Testimony was inaudible]. 2:51:20 PM AT EASE 2:54:02 PM RECONVENED Co-Chair Wilson thanked the previous testifier for calling in. SAM TRIVETTE, JUNEAU SUICIDE PREVENTION COALITION, JUNEAU (via teleconference), had been a member of the coalition for 11 years. He thanked the sponsors for introducing HB 22 which would extent the Statewide Suicide Prevention Council for 8 years. He reported it being the third session that he had testified on behalf of the council extension in the previous decade. He was a survivor of suicide loss. He and his wife lost their son to suicide on June 28, 2007. He and his wife had utilized the resources available of the program and had been involved with the council for the prior 10 years. He had participated in a number of the statewide conferences, regional conferences, and trainings. The council had linked him to some national experts and resources to help him tackle the major public health problem. Mr. Trivette opined that the council was the glue that kept everyone together and kept people working on suicide issues. He noted positive changes happening constantly because of the work of the council. He provided a couple of examples of the work done by the council. He spoke of a recent council meeting in Juneau. A group had trained high school students about suicide prevention. Those high school students were then going into the middle schools and elementary schools talking about suicide prevention, delivering tools on a peer-to-peer basis. He noted that suicides would continue. However, with more information getting out into the public was resulting in more calls to the Care Center. All of the calls went to Fairbanks where there were folks answering calls. He continued with his testimony. He personally was aware there were no stats available with the exception of the number of calls on the Care Line. He thought the council had helped make an impact. He appreciated the committee's time. 3:02:04 PM Co-Chair Wilson CLOSED Public Testimony. Co-Chair Wilson commented that it was the job of the House Finance Committee to question where dollars were spent. She asked Ms. Brazak to review the fiscal note. 3:02:49 PM LINDA BRAZAK, ADMINISTRATIVE OPERATIONS MANAGER, DIVISION OF BEHAVIORAL HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, reviewed the fiscal note. The note represented one position; a classified, full-time, range 16 position. She mentioned travel funds used to bring board members to meetings. The services represented department-wide and statewide charge back costs. Commodities represented materials for the council and the grant. Co-Chair Wilson asked about the cost to keep the Care Line going. Ms. Brazak could provide the information in writing. Representative Tilton asked about previous reductions to travel costs affecting the council. Ms. Brazak deferred to Mr. Morrison. 3:04:42 PM ERIC MORRISON, PROJECT ASSISTANT, DIVISION OF BEHAVIORAL HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, introduced himself. Representative Tilton restated her question. Mr. Morrison replied that originally the council tried to meet on a quarterly basis across the state. Several years ago it had not been feasible with the funding the council had. Instead, the council had gone to having video conferences in the summer. The travel freeze became effective in 2015 or 2016. The council went to two quarterly meetings, then down to one quarterly meeting in communities. Going to the sites was the largest outreach in communities each year. He mentioned a number of places the council had met in and around the state. There were key partnerships started at the site visits. Teleconferences were not as effective when it came to building relationships. Co-Chair Wilson announced amendments were due for HB 22 and SB 35 by 5:00 P.M. on the following Monday. HB 22 was HEARD and HELD in committee for further consideration. Co-Chair Wilson reviewed the agenda for the following week.