ALASKA STATE LEGISLATURE  SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  March 22, 2017 1:32 p.m. MEMBERS PRESENT Senator Natasha von Imhof, Vice Chair Senator Cathy Giessel Senator Peter Micciche Senator Tom Begich MEMBERS ABSENT  Senator David Wilson, Chair COMMITTEE CALENDAR  DEPARTMENTAL OVERVIEW: OFFICE OF CHILDREN'S SERVICES - HEARD AND HELD PREVIOUS COMMITTEE ACTION  No previous action to record WITNESS REGISTER CHRISTY LAWTON, Director Office of Children's Services Alaska Department of Health and Social Services Juneau, Alaska POSITION STATEMENT: Provided a departmental overview of the Office of Children's Services. ACTION NARRATIVE 1:32:28 PM VICE-CHAIR NATASHA VON IMHOF called the Senate Health and Social Services Standing Committee meeting to order at 1:32 p.m. Present at the call to order were Senators Giessel and Vice- Chair von Imhof. ^DEPARTMENTAL OVERVIEW: OFFICE OF CHILDREN'S SERVICES DEPARTMENTAL OVERVIEW: OFFICE OF CHILDREN'S SERVICES    1:32:54 PM VICE-CHAIR VON IMHOF announced that the committee will hear a departmental overview by Ms. Christy Lawton, Division Director for the Alaska Department of Health and Social Services (DHSS), Office of Children's Services. 1:33:27 PM CHRISTY LAWTON, Division Director, Office of Children's Services (OCS), Alaska Department of Health and Social Services, Juneau, Alaska, summarized her presentation agenda as follows: · Overview of key data. · Address OCS work-force challenges. · Highlight new initiatives. · Address upcoming child and family services review. · Address the Citizen Review Panel (CRP) report. She addressed child maltreatment data from 2007 to 2016. She noted that a 54 percent increase occurred for out-of-home children from 2011 to 2016, [2011: 2,730 vs. 2016: 4,132]. She revealed that four out of Alaska's five-geographic regions have seen significant growth, the only part of the state that has not seen the growth is the western region. She added that the state's overall population has experienced a less than one- percent growth from 2011 to 2016. SENATOR GIESSEL asked Ms. Lawton to verify that Alaska's western region did not see significant growth. MS. LAWTON answered yes. 1:35:16 PM She addressed children's foster care and maltreatment data in Alaska as follows: Alaska is one of 35 states across the country or 71 percent of states who have reported an increase in the number of children in foster care over the last 3 years. Nationally, family stress related to the recession and to the opioid epidemic around parental- substance abuse are the top two reasons that states are articulating for that growth, so Alaska is not alone. Alaska has one of the highest per capita rates of child maltreatment in the country. Alaska's children, sadly, are 56 percent more likely to be abused than the national average. Alaska's rate of child abuse is 14.5 while the national rate is 9.2 per every 1,000 children. In 2016, 1-in-10 Alaska children was reported to OCS. Alaska also has historically one of the highest rates of repeat maltreatment. Repeat maltreatment is really measured when we receive a report of maltreatment, we go out and assess and investigate that. If we substantiate, meaning we indicate that the abuse did occur and then we have a subsequent report where we also substantiate within 12 months, that's considered repeat maltreatment and that is not a good thing for children; so unfortunately, that is a very high rate in Alaska. We have been making some significant efforts which is also part of our increase in growth because we made some policy changes to say, "We need to get out to see more families so we don't keep seeing them come back again and again. 1:37:03 PM MS. LAWTON referenced a graph that showed key data points for the past five years as follows: 1. Total protective services reports: 17,418 reports in 2016; 2. Removals: 1,356 in 2016; 3. Unduplicated children in out-of-home care: 3,905 in 2016; 4. Discharge: 1,038 in 2016. She detailed that the graph shows the total number of protective services reports which are the reports that the public makes to OCS, 70 percent come from reports who are mandated by law to report to OCS: law enforcement, education, and the medical community. She revealed that neglect is far and above the type of maltreatment that OCS sees, followed by mental injury and physical abuse. She said of the 17,000 reports received in 2016, 9,500 reports were for an initial assessment that resulted in an investigation. She disclosed that the 7,900 remaining reports that were not screened for an investigation were recorded into OCS's database and no family contact was made. 1:37:12 PM SENATOR BEGICH joined the committee meeting. MS. LAWTON provided an overview of OCS's workforce as follows: · Primarily young and inexperienced, a lot right out of school; · Primarily women; · Lacking diversity, very few Alaskan native staff when 55 percent of the children are Alaskan native; · May or may not have social work education; · Average length of training: two weeks; · Starts in investigations, tend to be the most inexperienced; · Average length of stay: 18 months, studies show that caseworkers need 2 years to learn their job. She summarized that OCS's staff turnover ultimately impacts outcomes for children and families by not providing the proper support. 1:41:59 PM VICE-CHAIR VON IMHOF asked if training for two weeks is long enough. She inquired what the caseload was for an individual that starts in investigations. MS. LAWTON explained that normal classroom training is two weeks, some workers get three if they are in a rural office where an individual has to be more of a "generalist." She noted that OCS has "onboarding" plans when employees come onboard that outlines what a person needs to understand in terms of the agency, communities, services, and meeting work partners. She detailed that investigators typically do not receive more than 12 cases per month. She admitted that investigators typically get more than 12 cases per month, which results in OCS not being able to initiate and access child safety on a timely basis. 1:44:17 PM VICE-CHAIR VON IMHOF asked what kind of support is provided for a new, young person. She asked if support is provided on a regular basis to help a young person emotionally as well as looking at strategy in how to help with all of the different situations. MS. LAWTON replied that a new worker receives support from their supervisor as well as colleagues in their unit. She revealed that supervisors average seven to eight workers per unit. She noted that ideally a supervisor should have no more than five workers. She disclosed that new workers "shadow" other caseworkers as well. SENATOR BEGICH addressed workers' average length of stay and asked if exit interviews have been conducted to identify reasons for the high turnover rate. MS. LAWTON explained that exit surveys are offered, but not required. She stated that the main reasons most often for exiting are: workload, inability to do meaningful work with kids and families, and not connecting with supervisors. 1:47:38 PM VICE-CHAIR VON IMHOF asked Ms. Lawton when visiting with caseworkers what is she finding. MS. LAWTON explained caseworkers often feel overwhelmed and limited due to administrative tasks and the inability to do home visits for one-on-one encounters. VICE-CHAIR VON IMHOF asked if Ms. Lawton travels to different sites around Alaska to do some home visits and see what is going on. MS. LAWTON answered that she has not in the last couple of years. She specified that she visits field offices to communicate with staff. SENATOR BEGICH stated that Ms. Lawton has underscored what he had seen regarding the continued frustration with retaining staff, workload, and not being able to do what a person was hired to do. He asked Ms. Lawton if she had a list of recommendations to specifically address turnover and workload. 1:50:43 PM MS. LAWTON replied that the state and Legislature has to take a comprehensive look at tackling child maltreatment in Alaska regarding prevention and determining the optimum workforce level to get caseloads down. SENATOR BEGICH concurred that a comprehensive review makes a lot of sense. 1:53:38 PM MS. LAWTON provided turnover rates for caseworkers as follows: · FY2012: 37 percent, · FY2013: 25 percent, · FY2014: 35 percent, · FY2015: 39 percent, · FY2016: 38 percent. MS LAWTON reiterated the reasons for the caseworkers' turnover rates. She added that the pay for caseworkers is not in line with the type of work they are asked to do. 1:55:27 PM She addressed OCS's successes and opportunities as follows: · DHSS 5-year strategic plan to transform child welfare in Alaska. Commissioner Davidson initiated the plan. Focus is placed on Alaska natives due to disproportionate representation and outcomes. · Reduced rate of repeat maltreatment. · Streamlined practices (National Electronic Interstate Child Exchange/Centralized Intake) to help get children placed with out-of-state relatives. · Medicaid reform, 1115 Waiver that will benefit families. Access expansion to telehealth services will have a positive impact on rural areas. · Safe Baby Courts starting in Palmer in July 2017 to help struggling first-time moms. · Federal Child and Family Services Review (CFSR) in May 2017. 2:02:41 PM She explained that the federal government requires a comprehensive assessment of what OCS is doing well and wrong. She referenced the first phase of the CFSR as follows: · Provides the state an opportunity to gather and analyze qualitative and quantitative data and information in order to assess and evaluate the current child-welfare programs and practices. · Provides data and analysis specific to the safety, permanency and wellbeing, as well as the seven-systemic factors, and outlines OCS's child welfare system strengths and weaknesses. · Informs the Children's Bureau of key areas that the state has identified as areas needing improvement. The assessment also helps inform phase two of the review process, which is the on-site evaluation. 2:04:20 PM MS. LAWTON explained that the CFSR is Alaska's third review since 2002. She detailed the onsite review process as follows: · Alaska is scheduled for the onsite review May 22-26. · Three sites have been identified: Anchorage, Fairbanks and Ketchikan. · A random sample of 25 in-home cases and 40 out-of-home cases will be reviewed in Alaska. · During the onsite review, teams of state and federal reviewers will examine case records and conduct case related interviews to collect information on the outcomes and systemic factors. · A key component of the CFS is the statewide stakeholder interviews. · The combination of information from the Statewide Assessment, the onsite CFSR and the stakeholder interviews will be used to determine if the state is in substantial conformity with the federal requirements, or if a performance improvement plan is needed. She summarized that a comprehensive report will be presented in August 2017. 2:06:55 PM VICE-CHAIR VON IMHOF noted that three sites were selected for the CSFR. She asked how many sites OCS has in Alaska. MS. LAWTON answered that OCS has 24 sites. VICE-CHAIR VON IMHOF asked if the CFSR sites are rotated. MS. LAWTON answered yes. She noted that Anchorage will always have to be a site as the largest urban area. She specified that Bethel and Juneau were sites in 2008. She disclosed that many of the state's small sites do not have enough sample sizes to qualify. VICE-CHAIR VON IMHOF pointed out that the previous CSFR occurred in 2008. She asked how often the CSRF occurs. MS. LAWTON answered that the CSFR is supposed to occur every five years. 2:08:21 PM MS. LAWTON addressed the Citizen Review Panel's (CRP) recommendations for OCS as follows: 1. Assign CRP a significant role in implementing priority areas of the "Transforming Child Welfare Outcome for Alaska Native Children: Strategic Plan 2016-2020." 2. Tribal-State Collaboration Group should consider a dialogue with leaders of Alaska native for-profit corporations to garner their support and any resources they may be able to leverage to enhance child protection services. 3. The CRP should be evaluated by an external entity to assess its effectiveness with attention to: internal structure and the CRP-OCS statutory relationship to ensure roles and responsibilities are clear. 4. OCS should consider building on CRP's survey effort by: viewing training in more detail, including special sections or topics of interest, identifying other survey efforts OCS conducts and consider leverage resources from external entities. 5. OCS should work with the CRP to strengthen the CRP's ability for public participation, rely on it to improve public awareness of the nature and content of OCS work. 2:13:38 PM SENATOR BEGICH suggested that maybe it was time for a Reimbursable Services Agreement (RSA) between the university and the division. He recommended that Dr. Vadapalli, CRP chair, write the regulations. VICE-CHAIR VON IMHOF asked how long Dr. Vadapalli has been a CRP member. SENATOR BEGICH answered that Dr. Vadapalli has chaired CRP for four years and served on the panel for five years. He opined that the university is a function of state government and has the power to RSA over to OCS. SENATOR GIESSEL opined that because Dr. Vadapalli is faculty, he is required to spend 20 percent of his time in community service. She noted that Dr. Vadapalli is stepping down and suggested that he may be interested in community service to assist with writing regulations. VICE-CHAIR VON IMHOF remarked that Dr. Vadapalli has amassed unique knowledge that probably should be captured. 2:18:45 PM SENATOR BEGICH asked Ms. Lawton if consideration has ever been given for a retired social worker to apply and volunteer to be on the CRP for providing expertise that could mitigate the tension from the "got you" elements that naturally emerge in panels like CRP. MS. LAWTON replied that she has not considered retired social workers. She stated that she would be supportive of Senator Begich's suggestion. SENATOR BEGICH concurred with Ms. Lawton that a more comprehensive review would help in finding out what is needed. He stated that he would like to help in any way. He opined that there must be a way to craft the review to help OCS without being just another mandate or burden put on the division. MS. LAWTON replied that she appreciated Senator Begich's offer to help. She explained that a comprehensive approach is being addressed. 2:22:03 PM SENATOR MICCICHE joined the committee meeting. VICE-CHAIR VON IMHOF addressed OCS's workforce statistics on new employees and admitted that Ms. Lawton's comments gave her pause because the newly-hired caseworkers are at the heart of OCS. She noted that Ms. Lawton mentioned annual staff surveys. She asked who sees the surveys and if committee members could see the comments as well. MS. LAWTON explained that the annual staff surveys are posted on OCS's website. She noted that last year's staff survey was addressed by CRP. She offered that the last five years of the staff surveys can be provided to committee members. VICE-CHAIR VON IMHOF disclosed that she reviewed OCS's organizational chart and noted that there are five layers of management between the division director down to the social- service associates. She opined that OCS's management layers seem to be a bit higher than other departments. She asked why OCS is set up the way it is and how does communication work. MS. LAWTON explained that the organizational chart that Vice- Chair von Imhof is referencing looks at OCS on the state-office level without including all of the five regions with field staff. 2:25:26 PM VICE-CHAIR VON IMHOF noted that the intent is to ask each agency to look at ways to operate efficiently due to the state's current fiscal environment. She remarked that resources should be placed into the people who are having direct contact with families. She said she wants to make sure that the mid- management layers are either helping or hindering OCS. She hoped that Ms. Lawton was spending time looking at how the division can be made better. SENATOR MICCICHE asked how the correlation works between the increase since 2012 in children in foster care versus the reduction in removals between 2015 and 2016. MS. LAWTON replied that the focus was on the "front end" due to an increase in removals. She shared that recent data has shown for the first time in several years that kids exiting is exceeding kids coming in. 2:29:20 PM SENATOR MICCICHE opined that the parents OCS interacts with fall into three categories: parents that are not ready to be parents, parents that are just simply unprepared to be parents because of the way they were raised, and folks that are unfit to perhaps ever be parents. He asked Ms. Lawton to provide the proportions of the parental categories he identified. He explained that the reason for asking his question centers on OCS's priority for reunification of people that have the potential to be fit parents. MS. LAWTON replied that she does not put parents into the same categories as Senator Micciche does. She explained that some people become parents by accident. She admitted that OCS does not have a sense of which parents are accidental all of the time. She said what OCS sees are parents that are struggling with significant substance abuse, mental health, and domestic violence. She added that OCS sees parents that are second or third generation that have been served by OCS where they are not prepared and have not been provided with good examples. She asserted that OCS sees that most parents truly love their kids and want to do what is best for them. She said there is a tiny percentage of parents, two to three percent, that really should never have been parents or have their children back due to the severity of what they have done. She admitted that all parents have the ability to improve and have their situation remedied such that they can safely be a parent. She opined that OCS does not expect "parents of the year," but the threshold is for individuals to be safe parents so that a child can grow up and not have additional adverse-childhood experiences. 2:32:00 PM SENATOR MICCICHE stated that he hoped reunification for parents with potential to be successful is absolutely always a priority. He addressed OCS's annual-staff-turnover rates as being significantly higher than the mean average of 33 percent. He asked if there was a regional difference in staff turnover rates. MS. LAWTON replied that there are variables; for example, Ketchikan has been stable due to a stable supervisor whereas Wasilla is experiencing a higher turnover rate due to having the highest caseload per worker in the state. She disclosed that Alaskans out of Juneau, Anchorage and Fairbanks typically do not apply for positions in western Alaska, and most workers going to western Alaska are from out of state where they have no intention of staying for a long time. 2:35:25 PM SENATOR MICCICHE addressed the two-week training period for new workers and asked how well the supervisors are prepared for supporting new caseworkers. MS. LAWTON admitted that supervisors are mostly not prepared. She pointed out that good caseworkers get promoted, but good caseworkers do not always make good supervisors. She disclosed that supervisors receive training through the University of Alaska-Anchorage, but admitted that the training is not as extensive as caseworker training. She disclosed that a coaching program has been initiated for supervisors in the last year and a half. She detailed that the coaching program is showing positive results in providing guidance to supervisors to teach workers to think for themselves. She added that training also addresses secondary trauma regarding the emotional aspects that happen and how to provide support for staff members. She admitted that the secondary-trauma component is not nearly as robust and intensive as she would like it to be. 2:38:50 PM SENATOR GIESSEL noted that part of Senator Micciche's district used be her district and her regional office was also above an OCS field office. She disclosed that she had met with OCS representatives while at her regional office and shared that her visit was gratifying where she emphasized the team concept versus the "us and you" scenario. SENATOR GIESSEL addressed OCS's workforce-turnover rate and compared the situation to her years of experience in critical care where inexperienced nurses were exposed to long hours, high stress and emotional situations where people died. She noted that the typical span-of-life for a critical-care nurse was two years. She said OCS's frontline folks are critical-care staff. She stated that she does not deny that OCS has areas that could be improved, but suggested that perhaps there is a distraction with the wrong target. She offered that rather than saying OCS needs improvement, she suggested that the focus should be on how families could be stronger; in other words, prevention. She admitted that rather than two-parent families, fractured families are becoming more common. She pointed out that the fractured families are commonly in crisis. She noted that she would be interested in finding out from OCS how many families are single-parent families. She added that families are also becoming more separated from grandparents where the grandmother teaches the new mother how to be a mother. She set forth that all of the scenarios that she posed have escalated. She added that communities have become more fractured where other families and communities no longer step in because people have become more transitory. She summarized that she sincerely appreciates what OCS does and opined that OCS is sometimes criticized when actually the focus should be on ourselves and how much "we" as a society can improve and support families. She thanked Ms. Lawton for her work at OCS. VICE-CHAIR VON IMHOF noted that Ms. Lawton mentioned Wasilla as one of OCS's tougher areas. She asked if Ms. Lawton had an emergency plan for Wasilla. 2:42:25 PM MS. LAWTON replied that in the past when an office like Wasilla would get in particular crisis the caseloads throughout the state were looked at and workloads were rebalanced by allocating positions from one region to another. She admitted that there was no good answer in dealing with OCS's current situation because there was no good place to pull from without causing negative consequences on the communities where people would be pulled from. She admitted that high caseloads were everywhere. She conceded that her only available tool is excessive overtime which people are already putting in which further burns workers out. She noted that OCS has been using a "travel team" concept over the past three years where five to six non-permanent people are typically former OCS employees that are deployed in places that have the highest urgency. She added that former employees are brought back to work in non-permanent positions to help for a period of time as well. VICE-CHAIR VON IMHOF replied that Ms. Lawton obviously has put some thought into emergency situations where several tools are at her disposal. She noted that Ms. Lawton mentioned that successful caseworkers are promoted when they show promise. She suggested that Ms. Lawton might consider a private sector "all hands on deck" tactic where previously elevated workers take one or two cases. 2:46:00 PM SENATOR MICCICHE asked how effective the external partnerships have been and could the partnerships be expanded. MS. LAWTON replied that OCS has extensive relationships with the tribal non-profits. She admitted that the tribal non-profits get very few dollars that are tied to Indian child welfare cases and their capacity is limited like OCS. She stated that OCS is always looking for opportunities to partner where government can play less of a role in a community or a tribe can play a larger part. 2:49:59 PM SENATOR MICCICHE analogized that it is a lot less expensive to maintain steering rather than eventually having to get a vessel off of the rocks. He suggested that all of the social ills are connected to not breaking the cycle from alcoholism and substance abuse, to suicide where the state is number one in the country. He said a person feels helpless in not being able to assist earlier in the process as opposed to what OCS has to intervene in when things get serious later on. VICE-CHAIR VON IMHOF remarked that Senator Micciche's previous comment is a discussion that many have on an ongoing basis. She asserted that a thriving economy is important were jobs are available. She emphasized that coordination in needed between nonprofits and all sorts of agencies to create synergy where data and services are traded to see if a system can be developed that works together rather than in silos. 2:51:46 PM There being no further business to come before the committee, Vice-Chair von Imhof adjourned the Senate Health and Social Services Committee at 2:51 p.m.