Legislature(2025 - 2026)BUTROVICH 205
05/14/2025 01:30 PM Senate JUDICIARY
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| Audio | Topic |
|---|---|
| Start | |
| HB35 | |
| HB36 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 190 | TELECONFERENCED | |
| += | HB 35 | TELECONFERENCED | |
| *+ | HB 36 | TELECONFERENCED | |
HB 36-FOSTER CHILDREN PSYCHIATRIC TREATMENT
[SCS HB 36(HSS) was before the Senate.]
2:20:17 PM
CHAIR CLAMAN reconvened the meeting and announced the
consideration of HOUSE BILL NO. 36 "An Act relating to the
placement of foster children in psychiatric hospitals; relating
to the care of children in state custody placed in residential
facilities outside the state; and amending Rule 12.1(b), Alaska
Child in Need of Aid Rules of Procedure."
CHAIR CLAMAN said this is the first hearing of HB 36 in the
Senate Judiciary Committee. The intention is to consider a
Senate committee substitute (SCS), version W, as the working
document.
2:20:30 PM
CHAIR CLAMAN solicited a motion.
2:20:34 PM
SENATOR KIEHL moved to adopt the Senate committee substitute
(SCS) for HB 36, work order 34-LS0358\W, as the working
document.
2:20:51 PM
CHAIR CLAMAN objected for purposes of discussion. He invited his
staff to present the summary of changes.
2:20:58 PM
BREANNA KAKARUK, Staff, Senator Matt Claman, Alaska State
Legislature, Juneau, Alaska, presented the explanation of
changes for HB 36 from version [L] to version W.
[Original punctuation provided.]
House Bill 36
Explanation of Changes
Version L to Version W
Version W defines treatment foster homes and allows
regulations for treatment foster homes licenses. These
changes are seen in Sections 1-2, 5-7, and 9-13.
Version W changes language in section 4 about
"admissions" and "admit" to "seek services for" and
"placement".
Section 4 amends the standards for placement in a
hospital in (a)(1) and (a)(2).
Version W deletes Section 2(a)(3) of Version L.
Version W updates requirements and language for the
Department of Family and Community Service's annual
report to the legislature on employee recruitment and
retention.
Version W includes a title change and conforming
changes.
2:22:10 PM
CHAIR CLAMAN removed his objection and SCS HB 36, version W, was
adopted as the working document.
2:22:24 PM
CHAIR CLAMAN invited Ms. Vogeley from the Department of Family
and Community Services (DFCS) to discuss the changes in HB 36
related to treatment foster homes.
2:22:51 PM
CHRISSY VOGELEY, Senior Policy Advisor, Department of Family and
Community Services, Juneau, Alaska, delivered a presentation,
"Treatment Foster Home License." She explained the impetus for
the change to HB 36. She said that Executive Order 121, issued
in 2022, reorganized the Department of Health and Social
Services into the Department of Health (DOH) and the Department
of Family and Community Services (DFCS). She stated that the
reorganization allowed each department to focus on their
respective responsibilities and better assess the needs of the
state. The DFCS has operated as an independent department for
nearly three years. She said it has implemented new processes,
analyzed needs, and identified gaps in services. One gap DFCS
seeks to address is the lack of appropriately licensed settings
for services needed by the state's youth.
2:24:00 PM
MS. VOGELEY moved to slide 2 and offered a narration of the
following points:
[Original punctuation provided.]
What is Treatment Foster Care?
• States have a defined treatment/therapeutic foster care
program that includes:
• Enhanced/intensive case management services
• Caregivers who are active in the treatment team
• Clinical services provided by community or agency
providers
• Alaska is the only state that does not have a defined
treatment foster care program
• Most states create licenses via regulation not statute
• Behavioral Health Roadmap identified expansion of treatment
foster care as an action item for the state
2:24:05 PM
MS. VOGELEY explained that the traditional foster care system is
designed for children who have been removed from their families
due to abuse or neglect and require temporary care in a safe and
stable environment. She stated that this differs from treatment
foster care, which is the focus of the proposal.
MS. VOGELEY stated that treatment foster care is an exciting
idea that addresses gaps and provides more services to children.
Treatment foster care is designed for family-based placement for
children with serious behavioral, emotional, or medical needs.
The program aims to serve these children in the community, with
intensive support from agencies specializing in such services.
MS. VOGELEY stated that treatment foster care programs are
specialized and include enhanced or intensive case management
services. The caregivers, who are also foster parents, are
highly trained and participate as members of the treatment team.
Community or agency providers deliver clinical services to the
children.
2:25:16 PM
MS. VOGELEY emphasized that Alaska is the only state without a
defined treatment foster care program. Treatment foster care is
not established in statute or regulation, in part, due to how
DFCS was statutorily structured. She explained that under
existing licensing statute AS 47.32, DFCS lists the types of
licenses it offers. Most other states do that differently; they
authorize departments to establish licenses through regulation.
She said that, due to the structure of its statutes and the
effort required to change them, DFCS has relied on traditional
foster home licensing rather than addressing the need for
treatment foster home licensing.
MS. VOGELEY stated that in recent years, both the Department of
Health and DFCS conducted a behavioral health roadmap. The
departments engaged with communities across the state to
identify their needs. She said that expansion of treatment
foster care was identified as an action item. She said that
while the roadmap did not specifically call for creation of a
new license, DFCS believes establishing a treatment foster care
license is a necessary first step to expand the service.
2:26:41 PM
MS. VOGELEY moved to slide 3 and provided the following
narration:
[Original punctuation provided.]
What do we have?
AS 47.32.990 (5) "foster home" means a place where the
adult head of household provides 24-hour care on a
continuing basis to one or more children who are apart
from their parents;
• Foster home license is the only family-like setting in
statute.
• Utilized to create settings for children to receive
health care services
• Therapeutic Treatment Home
• Family Habilitation Homes
• Regardless of service delivery, all foster homes have
the same regulatory requirements
• Foster parent qualifications, training, physical
environment
• Kids can currently stay in a therapeutic treatment
home for longer than treatment is necessary
2:26:45 PM
MS. VOGELEY referred to the statutory definition of foster home
on slide 3. She said the definition is vague and allows for any
child, essentially, to be placed in a foster home regardless of
custodial status. Foster homes are the only family-like setting
listed in statute. As a result, it has been used to create
health care settings for children, such as therapeutic treatment
homes and family habilitation homes.
MS. VOGELEY stated that therapeutic treatment homes utilize a
foster care license and are certified by Medicaid to provide
therapeutic treatment home services to children with serious
behavioral and emotional needs. She explained that family
habilitation homes also utilize a foster home license and are
certified by Medicaid to provide services to children with
complex medical needs or intellectual and developmental
disabilities.
MS. VOGELEY emphasized that all foster homes are subject to the
same regulatory requirements, regardless of the type of services
provided or whether the caregiver is a relative. She stated that
all foster parents must meet the same qualifications, training
requirements, and physical environment standards.
MS. VOGELEY stated that DFCS does not have homes that address
both behavioral and complex medical needs, describing the system
as siloed. It is a challenge to find placements for children
with complex needs. She further explained that because
therapeutic treatment homes are licensed as foster homes,
children may remain in those homes indefinitely after completing
treatment services until reunification or another permanency
option is available. She stated that this means less beds for
kids that need those services.
2:28:52 PM
MS. VOGELEY moved to slide 4 and offered a narration of the
following points:
[Original punctuation provided.]
Why Do We Need a Treatment Foster Home License?
• Alaska has a disconnected way of ensuring treatment
foster care is provided effectively
• OCS oversees traditional foster care license
• DBH oversees therapeutic treatment home service
certification
• SDS oversees family habilitation home service
certification
• Child Placement Agencies manage these homes
• Acuity in children is increasing we can ensure
better service provision to children with complex
needs
• Traditional foster care is not health care
2:28:55 PM
MS. VOGELEY explained that DFCS proposed the treatment foster
home license to address fragmentation within the system. She
stated that multiple agencies are involved in service delivery,
including the:
• Office of Children's Services (OCS), which oversees
traditional foster care licensing,
• Division of Behavioral Health, which oversees therapeutic
treatment home certification, and
• Division of Senior and Disabilities Services, (DOH), which
oversees family habilitation home certification.
MS. VOGELEY said that child placement agencies, which are
community providers, manage all these homes and provide
services. However, there is no single framework connecting these
components. She expressed her belief that the proposed treatment
foster home license would ensure better care coordination across
agencies and improve service delivery for children with complex
needs. She noted that the severity and complexity of children's
needs are increasing and emphasized that the state really needs
to do something to ensure better service to these children.
2:30:07 PM
MS. VOGELEY emphasized that traditional foster care is not the
same thing as health care. She explained the healthcare
provision as it relates to foster care, stating that traditional
foster care provides a safe and stable family environment for
children temporarily separated from their families. She
explained that the healthcare component involves enrolling
foster parents in Medicaid and training them to provide services
to children. She said legislative approval of the proposed
treatment foster care would demonstrate that the state
distinguishes between traditional and treatment foster care. She
noted that other states and experts make that distinction in
terms of the healthcare provision.
2:31:19 PM
MS. VOGELEY moved to slide 5, Payment Structure:
[Original punctuation provided.]
Payment Structure
Children in state custody Children in parental
custody
Room and board funded Room and board funded
through Title IV-E, by parents
if eligible
Services funded by Medicaid Services funded by Medicaid,
private insurance (if
services are covered), or
self-funded by parents
Codifying a treatment foster home license would have zero
fiscal impact on the state since the payment structure
already exists.
2:31:20 PM
MS. VOGELEY explained the proposed payment structure for
treatment foster homes. She stated:
• If a child is in state custody and requires services, room and
board would be funded through Title IV-E, consistent with
traditional foster care, while Medicaid would fund services.
• If a child is in parental custody and requires services, the
parents would fund room and board. Medicaid would fund
services if the child were enrolled. If the child is covered
by private insurance and the policy includes the services, the
private insurance would pay, or the cost would be self-funded
by the parents.
MS. VOGELEY expressed her belief that codifying the program
would have zero fiscal impact because the payment structure and
the infrastructure within DFCS are already in place.
2:32:08 PM
MS. VOGELEY moved to slide 6, Anticipated Effect of Treatment
Foster Home License:
[Original punctuation provided.]
Anticipated effect of Treatment Foster Home license
• Separating the settings to distinguish between
traditional and treatment foster care will lead to
more services being provided to children in Alaska
• Remove the disconnect and ensure service
coordination among agencies
• Align licensure standards with Medicaid requirements
• Increase in the number of treatment foster homes due
to streamlining processes
• Increase in positive outcomes for children
2:32:11 PM
MS. VOGELEY stated that the goal of creating a treatment foster
home license is to separate it from traditional foster care. The
department believes the separation will lead to more services
for children in Alaska. She explained that removing the
disconnect between agencies would ensure better service
provision to children with complex needs.
MS. VOGELEY expressed her belief that aligning licensure
standards with Medicaid requirements will streamline the process
and increase the number of treatment foster homes. The DFCS
would ensure that children who need treatment services are in
settings designed to support positive outcomes. She stated that
the objective is to ensure that children receive the services
they need and achieve successful outcomes.
2:33:09 PM
SENATOR MYERS asked whether the proposal could have been
implemented through regulation rather than legislation if the
Department of Health and Social Services had not been
reorganized into the Department of Health (DOH) and the
Department of Family and Community Services (DFCS).
MS. VOGELEY responded that, regardless of the reorganization,
establishing a treatment foster home license is necessary to
clearly distinguish it from traditional foster care. She
explained that traditional foster care provides a temporary,
safe, and stable environment for children in custody, whereas
treatment foster care would serve as a separate family-like
setting that provides healthcare services.
MS. VOGELEY stated that while there may be an avenue to
implement such a license through regulation, the distinction is
significant enough to warrant creation of a statutory license.
2:34:21 PM
SENATOR TOBIN stated that the Senate Health and Social Services
Committee would have been a great place to propose this
particular license type and discuss related healthcare dynamics.
She asked for examples of the types of healthcare services
provided under the proposed treatment foster care model. She
asked the DFCS senior policy advisor to describe the training
required for foster parents, the additional supports DFCS
intends to provide, and any associated resource or funding
requirements, including Medicaid.
2:35:04 PM
MS. VOGELEY replied that agencies in the state already provide
similar services, commonly referred to as therapeutic foster
care. These programs include counseling and family therapy, and
foster parents receive training, including trauma-informed care.
She stated that while these services are already provided, each
agency has its own program structure and requirements, and each
operates differently. There are 15 such agencies, and their
practices vary. She stated that the proposed license would
establish a regulatory framework to create consistency across
agencies. She expressed her belief that DFCS would see positive
outcomes with the proposed change. She emphasized that while the
agencies already provide strong services, the intent is to
standardize practices to support improved outcomes.
2:36:25 PM
SENATOR TOBIN expressed her understanding that the state would
oversee the proposed license type and direct how programs
operate. She asked whether this oversight would extend to
municipalities or other entities.
MS. VOGELEY replied, yes, the state would provide oversight. She
clarified that private agencies, not municipalities, operate the
programs.
SENATOR TOBIN asked what extra support the department would
provide if new requirements were set.
MS. VOGELEY deferred to the Department of Health (DOH) for
questions related to Medicaid certification, stating she could
follow up with DOH and coordinate Medicaid certification
responses.
MS. VOGELEY addressed the question of extra support. DFCS has
already given agencies the authority to conduct foster home
studies. Agencies select which homes to bring in and support.
She explained that licensing packets are submitted to the Office
of Children's Services (OCS), which then issues the licenses.
MS. VOGELEY stated that the department does not provide
significant extra support; rather, agencies are given
flexibility to operate their programs and ensure services are
provided to the children who are in their programs. She
explained that the DFCS would streamline the licensure and
Medicaid certification processes, making it easier for agencies
to develop homes and deliver services.
MS. VOGELEY asked if that answered the senator's question.
SENATOR TOBIN indicated that the response did not fully address
her question.
2:38:17 PM
SENATOR KIEHL referenced materials that were before the
committee, including court case documents, hospital admission
standards, and a presentation on "a different type of foster
home that may not be foster care." He wondered when the
committee would address those topics or if there had been a
substantive change made to HB 36.
2:38:47 PM
CHAIR CLAMAN responded by explaining that during the development
of HB 36 and discussions with the governor's office, treatment
foster homes were identified as a recommended component. He
stated that treatment foster homes would help address fiscal
challenges and provide less restrictive service options,
allowing individuals to avoid extended hospital stays or
hospitalization altogether. There was a very small fiscal note.
CHAIR CLAMAN stated that the behavioral health roadmap for youth
recommendations included the provision for treatment foster
homes. He explained that while the language and structure are
new, the provision is consistent with the overall subject matter
of HB 36.
2:39:51 PM
SENATOR KIEHL stated that while the explanation was helpful, it
was difficult to track the various types of foster homes: the
licensed foster homes, therapeutic foster homes, family
habilitation foster homes, and treatment foster homes. He asked
for clarification on the new treatment foster home category,
including the level of service the provider must offer and
whether they function as an alternative to hospitalization or as
a step below hospital-level care.
MS. VOGELEY explained that these types of homes have existed for
some time and have been funded through various ways. The
[Medicaid Section] 1115 waiver led to the therapeutic treatment
home services provision.
2:41:21 PM
At ease.
2:41:41 PM
CHAIR CLAMAN reconvened the meeting.
2:41:42 PM
MS. VOGELEY continued her response, stating that the therapeutic
treatment home service provision was intended as a step-down
placement from residential psychiatric treatment centers. The
idea was that children could transition from a higher level of
care into a treatment foster home or move to a more intensive
setting. All the while, continuing to receive wraparound support
from a treatment team to ensure the child receives appropriate
services in the least restrictive setting.
MS. VOGELEY stated that treatment foster homes are operated by
foster parents who receive specialized training through an
agency to provide services to children with serious behavioral,
emotional, or medical needs. She explained that individuals
serving in this role must also enroll in Medicaid as direct
service providers in order to deliver services and receive
reimbursement. She said the role of a treatment foster care
provider could be filled by individuals who choose to become
trained foster parents and service providers.
2:43:02 PM
SENATOR KIEHL stated that he was reticent to do Health and
Social Services committee work in the Judiciary Committee. He
asked about the length and intensity of training required for
treatment foster care providers. He expressed concern that
subacute mental health care would require more than minimal
training and asked her to elaborate on that.
MS. VOGELEY replied that there are currently no statutory or
regulatory standards specifying training requirements for
treatment foster parents. She explained that training varies by
agency, though many use evidence-based models, such as Pressley
Ridge which provides the training. Training may range from 30 to
60 hours and is tailored to the needs of the child. She stated
that establishing a treatment foster home license would allow
the department to set minimum training standards through
regulation that agencies would be required to meet or exceed.
2:44:24 PM
SENATOR KIEHL asked who would provide subacute mental health
care services and whether an outpatient provider would deliver
those services in conjunction with the treatment foster home.
MS. VOGELEY responded that subacute mental health facilities are
distinct from treatment foster homes. She explained that in
treatment foster homes, foster parents are trained to provide
certain services. Agencies that offer other services would
support foster parents. Such support would include clinicians,
who provide counseling and support. Most programs include 24-
hour crisis care support, which DFCS would require as well. She
explained that agencies can provide immediate assistance through
internal staff or through contracted providers to deliver
services such as counseling and other intensive supports.
2:45:42 PM
SENATOR KIEHL asked about access to treatment foster care
services and whether availability would be limited to hub
communities or include telehealth providers.
MS. VOGELEY responded that telehealth could be incorporated into
the model. She stated that agencies are primarily located in hub
communities, but that DFCS would like to expand them. She noted
the potential for kinship treatment foster homes, including
training relatives in rural communities to provide services.
MS. VOGELEY stated that, unlike many states that limit services
to children in custody, DFCS intends to make treatment foster
care available to all children, regardless of custodial status.
She explained that Alaska needs to expand access to mental
health services for children with complex needs. It does not
matter whose custody they are in if they need the services.
2:47:02 PM
SENATOR MYERS asked whether the proposal would allow a parent or
parents to obtain a license to provide treatment services to
their own child.
MS. VOGELEY replied that is not necessarily how it would work.
She explained that parents usually approach an agency when a
child has significant needs. The agency would conduct an intake
evaluation to determine whether services can be provided in the
home or if the child should be placed in a treatment foster
home. She stated that treatment foster care providers would
typically not be the child's biological or adoptive parents, but
would include other individuals, such as relatives, depending on
the structure of the program.
2:48:05 PM
SENATOR TOBIN asked how the proposed legislation would intersect
with the Indian Child Welfare Act (ICWA) and referenced a
comment made by the senior policy advisor. She referred to a
scenario mentioned by the advisor involving a parent requesting
placement of a child who identified as a different gender and
had severe behavioral issues. She said the comment raised a
personal red flag and asked whether HB 36 would allow parents to
make such decisions.
MS. VOGELEY expressed her belief that DFCS would need to
establish a regulatory framework, potentially informed by
Medicaid certification, to determine when it could accept a
child for these services. She expressed uncertainty about
whether that would use a DMS-5 [Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition] to identify what
would be considered a disorder for mental and emotional health.
She stated that she might need to follow up on how to set that
up.
SENATOR TOBIN requested further explanation about ICWA.
MS. VOGELEY responded that ICWA would still apply, and that DFCS
would like to see more ICWA treatment foster homes. She
emphasized the importance of cultural connections. She said the
intention of treatment foster care is as a service rather than a
long-term, permanent placement. She noted that cultural
competency training could be incorporated into the regulatory
framework. She stated that DFCS hopes and anticipates having
treatment foster homes aligned with ICWA.
2:50:05 PM
SENATOR TOBIN asked about the number of foster care families in
Alaska, whether there is sufficient capacity, and how the
proposed license type might affect that dynamic.
MS. VOGELEY sought clarification, asking whether the question
pertained to all foster homes in general or only to the proposed
type.
SENATOR TOBIN replied, all.
MS. VOGELEY responded that there are about 1,000 licensed foster
homes statewide, with about 29 providing therapeutic treatment
or family habilitation services. She stated that separating
treatment foster care from general foster home licensing could
allow for regulatory adjustments that better meet the needs of
Alaskans and potentially increase the number of general foster
homes. There is a clear need for more treatment foster homes,
and she noted that agencies expressed a strong demand for
expanding this type of service.
2:51:23 PM
SENATOR KIEHL said what remains unclear is the nature of
treatment foster homes. He said they appear to function as a
step below mental health hospitalization and wondered whether
such placements involve a mental health provider. He said they
provide a residential home setting but are not intended as a
long-term placement. He noted that OCS could order a placement
or a parent could initiate one. He wondered whether a court
could also order a child placed there.
MS. VOGELEY responded that courts could potentially have the
authority to place a child in such a setting if the child were
involved with the Division of Juvenile Justice. However, this
has not occurred in recent years. She explained that treatment
foster homes are family-based settings where foster parents are
trained to provide behavioral and mental health services and are
enrolled in Medicaid as direct service providers. She expressed
her belief that foster parents are enrolled as behavioral health
associates or similar roles due to the training they receive.
MS. VOGELEY stated that treatment foster homes are a step-down
or less restrictive alternative to residential psychiatric
treatment centers or psychiatric hospitals. She said the
upcoming invited testimony could elaborate on what these homes
look like, which might help clarify what they will look like in
the future. She said that similar models already exist and that
the purpose of the proposed legislation is to codify and provide
greater oversight of these homes to ensure better outcomes for
the children receiving services.
SENATOR KIEHL stated that he looked forward to the upcoming
testimony.
2:53:40 PM
CHAIR CLAMAN expressed his belief that, in child-in-need-of-aid
cases, DFCS or the involved parties typically propose
placements. The court approves rather than initiates placements
independently. He noted that the fiscal note decreased from
$18,000 to $0. He asked how the changes in Senate committee
substitute (SCS), version W, fiscally affected the department.
MS. VOGELEY replied that version W includes language allowing a
hearing to be vacated if all parties agree on the course of
treatment. This aligns with the existing OCS team's decision-
making process in which stakeholders determine appropriate
services for a child. She stated that this provision would
reduce or eliminate additional costs, resulting in a zero fiscal
note.
2:55:39 PM
CHAIR CLAMAN announced invited testimony on HB 36.
CHAIR CLAMAN invited Ms. Malchick to identify herself for the
record and speak to the SCS, version W.
2:55:57 PM
BARBARA MALCHICK, Member, Board of Directors, Facing Foster Care
in Alaska (FFCA), Anchorage, Alaska, testified by invitation in
support of HB 36, version W, with remarks as paraphrased:
Mostly, my comments are going to be directed to
Section 4 of the bill, which is the short-term
psychiatric hospitalization on pages 6 and 7 of
version W that I'm looking at.
A little bit about me. I've been involved with FFCA
since it began over 20 years ago, and I've been on its
board of directors since it became a nonprofit in
2012. Prior to that, I was a guardian ad litem
supervising attorney with the Office of Public
Advocacy (OPA) beginning in 1984. I retired from OPA
and stopped practicing law in 2010, and then worked
part-time for the court system, developing training
criteria for all the parties involved in child-in-
need-of-aid custody cases.
In my past role as a guardian ad litem (GAL) and
attorney, and my current role as an FFCA board member,
I have represented and come into contact with hundreds
and most probably thousands of children and youth in
the foster care system, many of whom have spent time
in emergency psychiatric hospital settings. Sadly,
those stories have not changed all that much in the
past 40 years. Youth have been told that they were
only admitted to the hospital because there was no
other place they could go, like a foster home, or they
were not told at all why they were admitted.
I'm thinking that a lot of you in the committee
hearing today have talked with FFCA youth during their
retreats in Juneau, and they've talked about their
experiences in these hospitalizations.
2:58:00 PM
MS. MALCHICK continued testifying by invitation on HB 36,
version W, with remarks as paraphrased:
Speaking [as] a former GAL, we never got notified when
youth were placed in the hospital until long after the
fact. There were no court hearings. There was no
attorney appointed for the youth. Youth languished in
these places for 30 days or even longer, many times.
The youth suffered, being stigmatized, being
traumatized from being in the hospital for a long
time, where they may be overmedicated. It is pretty
chaotic. Their school studies suffered.
We believe that HB 36 is long overdue. It's a very
important bill and a very necessary bill.
About a year ago, the Alaska Supreme Court issued a
decision in the "Quinhagak" case, where they addressed
the situation of children in hospitals for psychiatric
reasons and held that they have a constitutional right
to a hearing as soon as reasonably possible after
being placed in a hospital for mental health reasons.
2:59:12 PM
MS. MALCHICK continued testifying by invitation on HB 36,
version W, with remarks as paraphrased:
There is currently no statute that addresses this
situation. There is a statute, AS 47.10.087, which
actually was set forth on page 5 of this bill, and
that talks about situations where OCS is required to
get prior court authorization in order to place the
youth in a long-term residential psychiatric hospital.
But there's never been a statute that addresses the
situation of a child who is in crisis, an emergency
situation where they need to go to the hospital, and
there is no time to get prior court authorization to
do that.
FFCA supports the bill for a number of reasons. In
subsection (a) of the bill, it recognizes that OCS has
the authority to make emergency placements for youth
without prior court authorization. There is a
necessary standard there to make sure it is an actual
emergency: the child is in crisis, you have a mental
health issue that they may harm themselves or somebody
else, and also there is no less restrictive setting
for the youth.
3:00:25 PM
MS. MALCHICK continued testifying by invitation on HB 36,
version W, with remarks as paraphrased:
Subsection (b) provides that notice must be given
immediately, within 24 hours, to all the parties
involved in the child-in-need-of-aid case, the child,
the guardian ad litem, the parents, the tribes, if
there is a tribe, any party, and anybody who has been
accepted as a legal party to the case would get
notification.
I think the really important part of subsection (b) is
that OCS needs to start looking as soon as possible,
promptly, for less restrictive settings. So, we do not
get in a situation where the child is ready to be
released, but OCS has not taken the opportunity to
look for other placements.
Another section of the bill, which is way later on
page 13, would amend the child-in-need-of-aid court
rule that would require the appointment of an attorney
for a youth involved in this situation, which we
support.
3:01:41 PM
MS. MALCHICK continued testifying by invitation on HB 36,
version W, with remarks as paraphrased:
Subsection (c) of the bill, I guess, is the key
provision, which talks about the time for a hearing.
Although FFCA would have preferred a shorter time
frame for the hearing, we are okay with the 7 days
after the hospitalization. At that point, we should be
able to weed out the youth who do not belong there,
who did not belong there initially, or who are
stabilized enough to be released at that point.
It is also an important time to get the parties all
together to get the ball rolling on finding a less
restrictive setting. As the previous testifier
mentioned, there are team meetings where everyone gets
together and tries to figure out the best next
placement. If that results in agreement with
everybody, including the child, after talking with
their attorney, then the court hearing can be vacated.
I guess that is about all that I had to address. I am
happy to answer any questions. We appreciate all the
hard work that Senator Claman and Representative Gray
have done, and I think it's been kind of a
collaborative effort to come up with the bill the way
it looks right now.
3:03:25 PM
COREY GOHEEN, Chapter Chair, Family Focused Treatment
Association (FFTA), Ketchikan, Alaska, testified by invitation
in support of HB 36. She provided a brief overview of her
background, stating that she has served for the past 14 years in
the therapeutic foster care field and has 13 years of experience
as a licenser. She said her team reviewed the proposed changes
to HB 36 and believes the bill would remove certain licensing
barriers. She emphasized the importance of differentiating
between traditional OCS foster care homes and treatment foster
care homes.
MS. GOHEEN discussed training expectations that differ from
traditional foster homes, including best practices and ongoing
monitoring. She explained that monitoring allows the therapeutic
clinical team to make recommendations to families to better
support youth in their homes. She said training includes plan
development, the Pressley Ridge curriculum, medication
management, and medical training for medically fragile youth,
describing the training as specialized.
MS. GOHEEN stated that the Pressley Ridge curriculum requires
approximately 40 hours to complete. She said accreditors require
additional annual measures. She expressed her understanding
that, as a result of [Section] 1115 [of the Social Security
Act,] agencies are required to be accredited. She explained that
different accreditation bodies establish standards that require
a higher level of care than traditional foster care. She said
the expectation is that services are delivered as a team,
including 24-hour crisis support and coordination of services
across home, school, and other settings to support youth with
complex needs.
MS. GOHEEN expressed her belief that HB 36 would remove barriers
and streamline the licensing process.
3:08:38 PM
CHAIR CLAMAN opened public testimony on HB 36.
3:09:00 PM
LEON JAIMES, representing self, Anchorage, Alaska, testified in
support of HB 36. He stated that he recently served as a juror
in a homicide case and said the experience highlighted systemic
gaps in social support systems. He explained that the
individuals involved in the case, including the victim, the
defendant, and many of the witnesses reflected missed
opportunities for intervention during childhood.
MR. JAIMES stated that the impacts of the case were significant
for the victim's family, friends, and community, and noted that
the defendant would face long-term incarceration at state
expense. He expressed the view that the outcome was avoidable.
MR. JAIMES stated that a family member at sentencing urged the
state to address systemic failures that did not meet the
defendant's needs during childhood. He said it seemed to him
that psychiatric care appeared to have been used inappropriately
as an intervention.
MR. JAIMES stated that HB 36 represents a step toward addressing
those systemic issues and encouraged the committee to advance
the bill.
3:10:42 PM
CHAIR CLAMAN closed public testimony on HB 36.
CHAIR CLAMAN invited the bill sponsor to provide comments on HB
36.
3:10:54 PM
REPRESENTATIVE ANDREW GRAY, District 20, Alaska State
Legislature, Juneau, Alaska, sponsor of HB 36, stated that
foster children are extraordinarily vulnerable to being
hospitalized in short-term psychiatric facilities and often
remain there longer than other children. They are held there too
long in a way that other children are not. He explained that
this is mainly because history has shown that OCS does not
advocate as a parent would for their own child. These short-term
psychiatric facilities often end up serving as a placement.
REPRESENTATIVE GRAY said he shares Senator Tobin's concerns
about the potential for unintended consequences of creating a
new license. He noted that new licensure language was added that
day and that he is still reviewing it.
REPRESENTATIVE GRAY addressed Senator Kiehl's concerns regarding
provider type. It is important to discuss what often happens
with foster kids when they end up at a short-term psychiatric
facility. He explained that foster children placed in short-term
psychiatric facilities often have experienced trauma that led to
their removal from home and that the removal itself is
traumatic. He said behavioral issues are common and that
children may act out in their placements. He stated that in some
cases, when a child is out of control, foster parents have
limited options. He said a child may threaten suicide, prompting
transport to an emergency department. He explained that a
doctor, acting out of an abundance of caution, may diagnose
suicidal ideation and recommend a hold, resulting in placement
in an acute psychiatric facility. That foster parent is not
going to be taking the child back. The child ends up there and
is held for long periods.
3:13:06 PM
REPRESENTATIVE GRAY continued making comments on HB 36:
REPRESENTATIVE GRAY said he has worked on the bill for a long
time. He explained that in discussions with the commissioner and
the Department of Family and Community Services, he identified a
gap in Alaska's system between therapeutic foster homes and
psychiatric facilities. He said therapeutic foster homes
function as a step above traditional foster homes and often
serve youth with more severe behavioral issues. He stated that
even in therapeutic foster homes, behaviors can become
unmanageable, including property damage and injuries to other
children in the home. He said in those situations it is not safe
for the therapeutic foster parent to continue the placement, and
the child often ends up in a psychiatric facility.
REPRESENTATIVE GRAY said some states have developed models that
provide an intermediate option. He expressed his belief that
this is the intent of the new licensure language. He stated that
many of these children are traumatized rather than mentally ill
and do not necessarily require antipsychotic medication. He
agreed with Senator Tobin that the legislature must carefully
consider the potential consequences of creating a new license.
He said the motivation for the license is the lack of an option
between a therapeutic foster home and a psychiatric facility. He
emphasized that finding that middle ground is important and
relevant to the bill.
3:15:10 PM
CHAIR CLAMAN held HB 36 in committee.