ALASKA STATE LEGISLATURE  SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  March 22, 2019 1:32 p.m. MEMBERS PRESENT Senator David Wilson, Chair Senator John Coghill, Vice Chair Senator Gary Stevens Senator Cathy Giessel Senator Tom Begich (via teleconference) MEMBERS ABSENT  All members present COMMITTEE CALENDAR  PRESENTATION: OFFICE OF CHILDREN'S SERVICES RESPONSE TO THE CITIZEN'S REVIEW PANEL - HEARD PREVIOUS COMMITTEE ACTION  No previous action to record WITNESS REGISTER NATALIE NORBERG, Director Office of Children's Services (OCS) Department of Health and Social Services (DHSS) Juneau, Alaska POSITION STATEMENT: Gave the OCS response to the Citizen's Review Panel. ACTION NARRATIVE 1:32:29 PM CHAIR DAVID WILSON 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 Coghill, Stevens, Giessel, and Chair Wilson. ^Presentation: Office of Children's Services Response to the Citizen's Review Panel Presentation: Office of Children's Services Response to the  Citizen's Review Panel  1:32:51 PM CHAIR WILSON announced the presentation Office of Children's Services Response to the Citizen's Review Panel by Natalie Norberg, Director of the Office of Children's Services. He noted it was the third year in a row that OCS has presented a response to the Citizen Review Panel (CRP) presentation. 1:33:15 PM NATALIE NORBERG, Director, Office of Children's Services (OCS), Department of Health and Social Services (DHSS), Juneau, Alaska, thanked the CRP and especially its new chair, JP Ouellete, for its extensive commitment and volunteer time on the board. She said she appreciates their work and the new emphasis on collaboration. It is very appreciated that the CRP is trying to intentionally align its priorities with the OCS priorities. OCS doesn't have much latitude in their priorities because so much of what OCS does is compliance-driven by the federal government. They have over 36 different compliance measures that they must adhere to for a state-run child protection system. CHAIR WILSON noted that Senator Begich was online. MS. NORBERG said that one of the first things that Mr. Ouellete spoke about was the administrative review process, and she presented the following information on the process: Background: Federal Requirements tied to funding require a formal case review of all child protection cases every six months until case closure. • To comply, OCS employs six full time staff and two administrative assistants, to facilitate the federally required reviews. • These staff complete 2855 reviews per year. • Alaska is one of only 2 states who have not incorporated these functions into the court system. MS. NORBERG said the review process was put in place in 1997. The federal government instituted it to create a third level of oversight for cases. The purpose is to make sure that cases have an outside perspective to make sure certain elements are in place. They don disagree that it's very important. However, many states have implemented this process into their judicial system. Alaska is only one of two states that didn't. Many of the elements of the review are already incorporated into court hearings. So for OCS, it feels like a redundant process. They are steadfast that they want to continue to work toward having the administrative reviews incorporated into the judicial system. As part of the program improvement plan that they are negotiating with the federal government, they are working closely with the court improvement program to implement a pilot in the Fairbanks judicial court system, which has agreed to take on elements of the reviews into their hearings. It will only require an additional hearing after the case has been in the system for about a year. They will examine the pilot's effectiveness and efficiencies, but they are hopeful that this process will work out and be a better use of resources. They employ six full-time employees to do reviews. It is a high utilization of their resources. MS. NORBERG presented the following information on the CRP second goal and the OCS response: #2 Improve Outcomes for Family Reunification Background: Reunification is the priority goal for all children in foster for at least the first 9 - 12 months in care. • In 2018, of the children who exited foster care 54.5% were reunified • National rate for reunification is: 49% Summary of CRP Recommendations: Recruit and retain more local caseworkers; provide training to caseworkers regarding the importance of reunification and the trauma of separation, be more trauma informed; train and support workers to provide more early intervention and in-home efforts to prevent removal; ensure caseworkers have access to seasoned workers in their regions who are good family support and reunification. OCS Response OCS remains aligned with the priority to improve rates of reunification. Reunification is largely dependent on two systemic issues: 1. Stable workforce 2. The accessibility of appropriate community services. New Opportunities created by the 1115 Behavioral Health Waiver and Family First Prevention Services Act MS. NORBERG pointed out that OCS is doing better than the national average for reunification. CRP did identify many great strategies that they are aligned with. OCS is working to have workers embrace the notion of reunification. Sometimes caseworkers hit barriers with that. It is important not to rush reunification if the family is not ready. They do not want repeat entries. OCS does not provide direct intervention other than creating the linkages to help families access community resources. If there are no community resources, it makes their work very difficult. MS. NORBERG said OCS is very excited about the 1115 Behavioral Health Waiver: 1115 Behavioral Health Waiver • Services designed to target families at risk of entering the child welfare system • Continuum of community based, in-home family support services • Current Gap Analysis includes OCS to ensure the unique needs of families involved with child welfare are being discussed and addressed with providers. MS. NORBERG said she was fortunate to be involved in some of the initial design work. She was part of a work group that looked at target populations and the services that would be made available. She is very happy that one of the target populations for the 1115 Behavioral Health Waiver is families at risk of entering the foster care system. One of the targets for the initiative is what services are needed to help struggling families and what are the community-based supports that should be and must be made available for those families. OCS is participating in the current gap analysis. The Division of Behavioral Health is working on this statewide initiative with the assistance of the Mental Health Trust. Communities are being visited by a team from the Division of Behavioral Health and OCS who meet with providers to ask about their capacity and to help them understand what the new services will be under the new waiver. OCS is part of the process so they can have that intimate conversation with providers about the specific needs of families in the child welfare system and how are they going to be able to take advantage of these new funding opportunities and be able to provide those in-home family supports that their families so desperately need. 1:40:33 PM SENATOR STEVENS said he was responding to questions from his constituents about racial differences with family reunification. He asked if she had figures on that. MS. NORBERG said that the reunification rate for Alaska Native/American Indian children in Alaska is higher than it is for their nonwhite counterparts. It is around 55 percent while the reunification rate for non-Native children is closer to 50 percent. SENATOR STEVENS said that was very interesting. MS. NORBERG said OCS is optimistic about a large piece of legislation passed by Congress last year and presented the following information about the Family First Prevention and Services Act: • Allows states to claim reimbursement for 50% of costs for the services after they have been provided • Children and parents must meet eligibility requirements: o the child must be a "candidate" for foster care, or o be a pregnant or parenting youth in foster care • Allows the following evidence-based services to be reimbursed: o Mental health prevention and treatment services provided by a qualified clinician for not more than a 12-month period. o Substance abuse prevention and treatment services provided by a qualified clinician for not more than a 12-month period. o In-home parent skill-based programs that include parenting skills training, parent education and individual and family counseling for not more than a 12-month period. MS. NORBERG said that the Act opens up the opportunity for states to claim up to 50 percent reimbursement through the Title IV-E program, which is the open-ended entitlement that funds child welfare services through the federal government. It is a very new opportunity which for the first time will allow for the purchase of services. Never before have they been able to use this funding stream for services. It is an excellent opportunity; however, there are certain criteria. The family must have come to the attention of the child welfare system and it must have been determined that they needed intervention. The services are very prescribed. The federal government has been slow in providing the list of services. MS. NORBERG shared the preliminary list of services: Prevention Services/Mental Health: • Parent-Child Interaction Therapy • Trauma Focused-Cognitive Behavioral Therapy • Multisystemic Therapy • Functional Family Therapy Substance Abuse: • Motivational Interviewing • Multisystemic Therapy • Methadone Maintenance Therapy In-Home Parent Skill-Based: • Nurse-Family Partnership • Healthy Families America • Parents as Teachers MS. NORBERG said OCS is exploring provider capacity with the gap analysis and through other outreach efforts. Some of these programs exist in Alaska, but many don't. The exhaustive list is coming out in May. The services can only be paid for as a last resort after Medicaid. There is a lot to figure out, but they see it as an opportunity to create more targeted services for families in the child welfare system. 1:43:56 PM SENATOR COGHILL commented on the compliance requirements under Title IV-E. He asked if this is a new set of criteria or a rearranging of the criteria. MS. NORBERG replied that it is separate criteria. She suggested he was thinking of the criteria for things like foster homes to be licensed in a certain way and the family to have met certain income requirements. Those types of things do not apply to the new dollars because [families] are not entering the foster care system, so it is a little looser. CHAIR WILSON said the Family Prevention and Services Act offers many different opportunities for the state and this was the tip of the iceberg. He asked if there is also funding for extending the age range of foster youth eligible for grant funding for continuing education. MS. NORBERG said there is the opportunity for states to expand the reimbursement rate for the age of children they consider to be in the independent living category. Alaska did not choose to expand because of its smaller population, but there are other dollars for independent living services. They are not taking advantage of some of the act because with the economies of scale, it did not make sense for Alaska. There are many aspects of this act that OCS has already taken advantage of. CHAIR WILSON said he was hoping that it would be an opportunity for the university to be involved with working with foster youth and their certification programs to have a partnership with the department to expand on those funds, but apparently not. MS. NORBERG replied that OCS does have a partnership with the university. They provide extensive supports through a program to assist foster youth in their journey to getting a college education. Last year they had the highest number of high school graduates and youth enrolled and graduating from the university. They partner with the university to offer educational training vouchers. That is a program OCS takes advantage of in the state and more youth than ever are taking advantage of that program. CHAIR WILSON asked if that is funded through unrestricted general funds or federal dollars. MS. NORBERG answered that those are federal dollars. 1:48:21 PM SENATOR STEVENS asked whether Parents as Teachers on the preliminary list of allowable services was the same program eliminated in the governor's budget. MS. NORBERG answered that she not aware of that program being eliminated. SENATOR STEVENS said there is a Parents as Teachers program, but he is not sure if it is same thing. He thought that was eliminated in the proposed budget. CHAIR WILSON said the committee would get a response from the department for that question. SENATOR STEVENS said his question was what do they do with the program if that was eliminated. MS. NORBERG said Parents as Teachers is an evidence-based model and the Division of Public Health supports one program. There are other programs provided by nonprofits agencies that also support the same model. They are very interested in partnering with those entities to see if there is a way to draw down the new funding opportunity to offset the expenses of the existing programs. It is an opportunity to see if they can supplement the funding. SENATOR STEVENS said that the governor's budget eliminated Best Beginnings and other early learning programs. One is called Parents as Teachers. He said it may be two different things with the same name, but he would like an answer. CHAIR WILSON said that is more the modality of the service provided. If the agency provided this modality of service, that funding may have been cut, but it is reimbursable under this new act. They will try to get a response to committee members. MS. NORBERG presented the OCS response to the CRP's third priority, cultural competency: OCS is concerned about and committed to addressing potential racism and cultural bias among its workforce. This has been addressed in an ongoing fashion through multiple strategies, including: • Tribal State Collaboration Group Meetings • Extensive required training on the Indian Child Welfare Act for new workers • Cultural Humility curriculum is required for all new staff • Two-day Knowing Who You are Training, provided and required for the last decade designed to help caseworkers address and acknowledge the unique experiences of racial minorities. • Cultural Resources for Alaska Families: Traditional Health and Wellness Guide • Tribal partners are involved on hiring teams for MS. NORBERG said cultural competency remains an important priority for OCS because of the continued disproportionality rate of Alaska Native children in the child welfare system. Today 64 percent of their cases are comprised of children who are Alaska Native or American Indian; they are only 23 percent of the child population in Alaska, so it is quite a disparate number. They appreciate the CRP's support of this as a continued priority. They do offer staff trainings and they have tried to do creative things. They invite tribal partners to be part of their interviewing team for their critical, frontline staff positions and supervisory positions because it is important that the tribal partners feel comfortable with the people OCS hires. They have received permission from the Department of Administration to do that. 1:52:46 PM SENATOR COGHILL said OCS was dealing with three things regarding cultural competency. One is how to deal with blended families, specifically as it relates to ICWA [Indian Child Welfare Act]. Tribal groups don't always follow ICWA rules, and he saw that tribal compacting is on the next slide. They have children with both federal and state requirements, but the tribal groups have a different view of it. He asked if there is a good relationship with tribal groups who have different authorities. MS. NORBERG asked whether Senator Coghill was asking about OCS relationships with tribal government. SENATOR COGHILL clarified that they have clear, directive rules, federal and state. ICWA has directive rules. He asked if that is also true of some of the tribal groups because they don't operate under the same directives. MS. NORBERG replied that the requirements of the Indian Child Welfare Act do not apply to tribal governments who are taking over their own child welfare cases. Because they are the tribe, they don't have to adhere to the same oversight, and they can provide services and conduct their child welfare system in any way they decide. The Indian Child Welfare Act is about making sure the state allows for tribes to have that legal intervention and ability to be a legal party to the case. Because there are so many tribal jurisdictions in Alaska, it is a very complicated process for OCS staff to navigate. They do it better in some regions than others. The relationship is working well in Sitka. Sitka is one tribe out of 229. It is a lot of navigating for their staff. They can do a better job helping staff understand the nuances between tribal courts, tribal social services entities, and tribal health. There are so many different aspects. It is confusing for brand new workers, but they work hard and have implemented different strategies for staff to get to know and understand these various systems and to be aware of the very rich and important and exciting opportunities that having so many diverse tribal communities brings to families in Alaska. CHAIR WILSON said that there is a federal case regarding ICWA that might be heard by the Supreme Court. He asked if there had been any injunctions or any changes about how ICWA operates in the state. MS. NORBERG responded that there have been no injunctions at this time. SENATOR COGHILL said that the Texas Supreme Court made a ruling regarding ICWA that might make its way to the Supreme Court. There is a difference between cultural competency and legal directives. Both the review panel and OCS are traveling in an interesting world. They want to take the best out of the culture, but the legal entanglement isn't always well described. They have tried to figure out how to do that. On the other hand, the Alaska Native children should never lose their rights as a citizen of the United States. They haven't figured that out totally. Meanwhile, the best care is still at the local level. He wanted to highlight that competency is one thing, but the legal rules are a very different thing. SENATOR STEVENS asked what is meant by cultural humility. MS. NORBERG answered that it refers to the ability to be respectful of other cultures. It is being humble and having an openness to learning about and being respectful of other cultures. Because the staff works with such a diverse population, it important that they understand and respect and want to learn and understand the strength of other cultures. SENATOR STEVENS said that it seems an odd choice of words. To him, it suggests that humility of one's own culture so that it doesn't interfere with other cultures. He asked if that was part of it. MS. NORBERG replied that it could be potentially part of the message. 1:59:50 PM SENATOR BEGICH referenced the university graduation rates. He asked how many kids they were talking about. MS. NORBERG said she could get that to him. It was probably under 25. MS. NORBERG said the CRP goal of finding relatives for placement of children in foster care remains a high priority for OCS. They have done a lot of things over the last five years to improve their effectiveness in this area. They are slowly starting to see the numbers of children placed with relatives increase. In the last five years it increased ten percent. When they look at the span of a child's life in foster care, they oftentimes were placed at least once with a relative, but sometimes those placements don't last. They do try to prioritize that, but it can be challenging for family members to take on additional relatives. They try to support them. The percentage placed with relatives is a constantly varying number. They have done some interesting things. With their ORCA [Online Resource for the Children of Alaska] system, they can generate an automated letter to inform relatives that they have a relative child in the child welfare system. They must make that notification to all known relatives within 30 days of a child being removed and throughout the life of the case at various intervals. If there is going to be an adoption, they must renotify relatives if a child is not going to be adopted into a relative home. MS. NORBERG said that the first scope of work undertaken by tribal compacting cosigners was relative searches for OCS. They have worked out an amazing system with tribal partners. They do the search for OCS. They have access to their electronic database and enter names of relatives on the state's behalf and the letters get automatically generated. Because of HB 151, there were new training and policy requirements for the supervisory oversight for making sure relative searches were happening on an ongoing basis. CHAIR WILSON asked if parents whose children are removed put the names of relatives in the automated system also. MS. NORBERG replied that part of the relative search process requires someone to interview the parents and ask for all known relatives and then those individuals are asked and then it branches out like a tree. It is common for parents to be reluctant to identify relatives. Then they use what they can of electronic databases and the tribes have access to their tribal enrollment databases. They use a variety of sources, including the PFD database to figure out who the relatives are. CHAIR WILSON said that for kinship care, HB 151 has a requirement of 45 days. A few weeks ago a constituent shared a story about a worker who said, "I got 45 days to complete you." He asked if it has become a new norm to wait 45 days. MS. NORBERG said the policy is that the Office of Children's Services has 45 days to assess a request for placement. There can be a lengthy background check and home inspection to determine if a family is appropriate to take a relative child. Sometimes they get numerous requests for a specific child, which is wonderful. The timeline has not changed. They are trying to adhere to that because they had heard it was taking a long time to asses relatives. The committee is aware of the multiple demands on case workers. Identifying and exploring numerous relative placements when a child perhaps is in an appropriate placement may or may not be the top priority that day. It is certainly their expectation that every relative identified has a thorough examination done to determine if they are appropriate. When there are multiple appropriate homes, it can be a difficult decision about who is going to get that child. It can be quite complex and multilayered. 2:07:27 PM SENATOR STEVENS said that last year when they were dealing with HB 151, they were visited by foster children. He was shocked that two young ladies who visited him had been with eight to ten foster families. He asked if that is common, if the 45 days kick in with each placement, and if they keep track of the number of times a child is in a foster home. MS. NORBERG replied they are required to keep track of the number and where the children are placed. Every time a placement disrupts, it can take a long time to find a new placement. Unfortunately, grief and trauma can manifest in behaviors that are quite challenging for foster families and for all involved. Sometimes children must be moved. There are lots of variables. Oftentimes placements aren't found right away or they are temporary placements. So yes, children have to move around. It is a very, very sad part of the work. MS. NORBERG gave an update on efforts related to HB 151, Children Deserve a Loving Home Act. The bill had many new requirements for OCS, and they have been working hard to implement them. The addition of 21 new positions was one of the most important parts of the bill. The bill was signed in June 2018, and they were given authority to begin recruiting for those positions in July 2018. Many positions were not filled until October. They have worked hard over the last year to incorporate the new training requirements. They have an excellent relationship with the child welfare training academy at the university. They are constantly revamping and changing the training to meet their needs and the needs of their staff. It takes about two months from posting a recruitment to hire someone. The training is spread over four months. It is mixed up with a lot of time in the field. They hear often that classroom is training is great, but workers don't know what to do in the field. They are trying new strategies, including five traveling mentors, which was part of HB 151, who are assigned to staff and work with them in the field. They offer real-time support when trying to make decisions. The transfer of learning process is improving with the new training system, but it does take time. The question has been asked of where all the new positions are and what is their case carrying capacity. She would like the committee to know, that with their new positions, their analysis is they can be afforded a 35 percent vacancy rate. They have 231 frontline positions. Today, they have 134 positions filled. They have a vacancy rate of 51.7 percent. They can only have a 35 percent vacancy rate to implement case load standards. Today 53 percent of the staff have been on the job one year or less. Retention remains one of their highest priorities and crises at this point. They continue to not have the staff to do the job. It is better in some parts of the state. MS. NORBERG said that in 2017, they received 31 new positions; the majority went to the Wasilla office because of its large population growth. They doubled the staff there. In the year and a half that they have had the extra staff, their vacancy rate has gone down to about 40 percent. They are starting to see wonderful results with their ability to do the case work they want them to be doing--meeting with families, creating case plans, visiting children, making sure kids are safe. They are starting to see positive results because of the influx of positions from a year and a half ago, but it does take time for these positions to get trained and to start taking on caseloads. The bill requires the caseload caps to implement by June 2020. They won't be implementing those caseload caps until they have enough staff because it would not be safe for them to do that. CHAIR WILSON said he is very appreciative of the additional staff in Mat-Su. He asked about the physical space capacity for OCS to work efficiently because he remembers people working in the hallway. He knows Bethel is looking for more space. He asked about space utilization statewide if they are increasing the number of staff. MS. NORBERG replied that currently the Wasilla office has enough space. Some of the staff moved into the new child advocacy center. Some are offsite. New staff does create the need for more space, which leads to more expensive lease agreements. They are struggling to figure that out. They have enough space now, but they continue to look at office configurations in Anchorage. OCS is about to lease new space in Bethel after the building they were in basically collapsed. For now, OCS has adequate space. 2:16:43 PM SENATOR STEVENS commented that HB 151 was sold on the principle that staff were quitting faster than they could be hired and that they could get ahead of that curve by adding new positions. He asked her to repeat the information about the turnover rate. MS. NORBERG answered that the current turnover rate is 51.7 percent. They can afford to be at 35 percent but their target is less than that. Nationally, the turnover rate for the child welfare workforce is between 30 to 40 percent. They can expect that, but theirs is quite high. They need to get it to at least 35 percent to change the trend. SENATOR STEVENS clarified what the 51.7 number was for. MS. NORBERG said 51.7 is the current vacancy rate. They are basically at 50 percent. SENATOR BEGICH asked if any of the vacant positions are eliminated in the governor's budget. MS. NORBERG answered that no positions are eliminated in the governor's amended budget. MS. NORBERG presented the OCS response to the CRP priority about worker burnout and vacancies: • Dedicated staff to Recruitment and Retention • Letters of Agreement to address unique challenges • Commitment to Recruiting the Right People for the Job • Develop Managers and Supervisors • Support for Wellness Activities • First Year Onboarding • Mentorship Program • Recognition and Welcome Packages • Exit Surveys • Social media and local recruitment efforts MS. NORBERG said that CRP is committed to identify ways to support OCS staff to acknowledge the challenging work they do on a daily basis that involves not only the trauma of dealing with child abuse but also navigating the complicated governing system that is the child welfare system with so many expectations on the staff. They inform their staff about the Employee Assistance Program, but many areas are not able to take advantage of the program. Since she became director, they are committed to taking a good look at what is happening to staff during the first year and making the onboarding process a very intentional and deliberate process such that they try to eliminate as many external distractions as possible and focus on what is available to them to support them, to focus on wellness and having a plan. Many small offices cannot have a wellness committee. They are looking to support them from a regional office. MS. NORBERG said OCS is trying to centralize as many activities as possible around the recruitment and retention process. Frankly, the regional offices are often in crisis and cannot pay attention to all the details. In the state office they are committed to doing as much as they can. They are trying to work with unions on different letters of agreement to address unique challenges and create special opportunities for staff in certain areas where they need the flexibility to offer different incentives and supports. They would like to pay for time off after a staff has experienced a very traumatic event. It is not something they can currently do. There are so many things they are trying to address on a systemic level. It is very challenging. They are doing what they can without a lot of money. Nonprofits in some communities have been very generous. Beacon Hill in Anchorage is providing furniture to make the office nicer. Chaplains come in for emotional support. OCS deals with real-life crises and they need support. Canines come in for emotional support. There are pockets of creative things happening, but they have no ability to implement anything statewide. They have tried to dedicate a few staff to focus on the recruitment process because the state has taken cuts and human resources is backed up. They can't always get timely processing of the applicant pool, so they have had to take that on within the division. They are doing everything they can within the confines of the state system to impact timely recruitment and retention. It will take a lot of effort and different strategies. They are not giving up on it. It is a huge problem. They are very committed to it. 2:23:53 PM SENATOR BEGICH said that Mr. Ouellete talked about the importance of CRP traveling to different sites and asked for more travel resources. He wondered how they had been impacted by the governor's travel restrictions and how their future travel plans would be affected. MS. NORBERG replied that CRP's budget, like the budget for OCS, has not been changed from last year. They have looked into their request for more money, but they haven't' spent all the money allocated for this year. They still have $48,000 for travel. If they request more money for this fiscal year, they will assess that. All state boards and commissions have taken travel hits. SENATOR BEGICH asked if left-over money is rolled over or returned. MS. NORBERG answered that she is not sure. They get a new budget at the beginning of the fiscal year. SENATOR COGHILL thanked her for her work and willingness to take on the director role. It is one of the more sobering jobs in Alaska. Besides recruitment, they struggled with technology. The ORCA system is now up and running. Then there is bandwidth. He asked if they have the tools for the new people to do their work. They fought to get bandwidth in the Bethel area. MS. NORBERG responded that she was not aware of any bandwidth issues lately. The bandwidth there is slower, but they can do their work. They struggle with making their devices more mobile. They are behind the nation with available technology. The staff cannot send or receive anything of a confidential nature while in the field. The new commissioner is committed to figuring out the issues with mobile device management. There are many things they could do more quickly if they could manage confidential information in the field. SENATOR COGHILL said there must be off-the-shelf encryption. He asked if it were a cost issue. MS. NORBERG answered that she doesn't understand what the barriers are. Some of it is that with the standardization through the Office of Technology, whatever they use must be compatible with the rest of the state. They would love to just go out and get what they need, but they must work within the confines of the rest of state. That makes sense, but it slows down the process. SENATOR COGHILL said this is a quality of life issue for frontline workers, which includes everything from travel issues to computer issues. Having the tools they need might make them feel more respected. That has been a struggle. They are living in very frugal times, but it is not just the actual equipment. It is how to make that equipment work in the system. They should keep a fire under it. 2:29:42 PM SENATOR STEVENS commented that the turnover rate of 50 percent is a shocking figure. It is one of the toughest jobs he has ever heard of in the state of Alaska. He asked her to thank her staff for sticking with it. Half the people leave every year, but half stay. That is remarkable in a job that has a lot of burnout. He asked if there are people who stay for years and are happy doing this. They have heard the bad stories about people leaving, but he asked if she can give them an idea of how long some stay. MS. NORBERG replied that the frontline staff vary. Perhaps a quarter of the staff have been on the job longer than two to five years. Most staff who stay quickly promote and become supervisors or managers or take related jobs to help support caseworkers. Many people are extremely passionate about child welfare and want to stay around the work, but they cannot sustain the frontline for long periods of time. They don't know if it is healthy for people to stay in the frontline for very long because it is such traumatic and emotionally draining work. She tends to worry about people who are exposed to that level of trauma for that long. CHAIR WILSON said that in the Mat-Su they have amazing frontline workers. He gets upset when they leave and become promoted to supervisors because they are effective. He understands that and loves the team at the children's advocacy center. They are amazing staff. They don't always get to appreciate the hard work they do. He is appreciative of that staff that have stayed and have the passion and drive to do this hard work. MS. NORBERG said that she wanted to share an exciting new initiative called Plans of Self-Care. It is a model that looks at assisting women who may have been identified during pregnancy screens who are using or abusing substances. It is an interdisciplinary approach to assisting women before birth and after birth. They will be doing a pilot with a birthing hospital and other entities in Mat-Su to create a systemic process to support moms and their babies and the whole family if substance abuse during pregnancy has been an issue. They are trying to avoid those kids coming into the foster care system in the future. It is a promising initiative. Anything to do with prevention is exciting to her. They don't have the opportunity with their current needs to pursue prevention opportunities, but there may be others in the near future. She can't wait to share those with them next. CHAIR WILSON said the committee would look forward to hearing from her next year. 2:34:44 PM There being no further business to come before the committee, Chair Wilson adjourned the Senate Health and Social Services Standing Committee meeting at 2:34 p.m.