Legislature(2023 - 2024)BUTROVICH 205
03/26/2024 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB231 | |
| SCR9 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 231 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SCR 9 | TELECONFERENCED | |
SB 231-MINORS & RESIDENT PSYCH TREATMENT CENTERS
3:32:31 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 231
"An Act relating to residential psychiatric treatment centers;
and providing for an effective date."
3:32:46 PM
SENATOR MATT CLAMAN, District H, Alaska State Legislature,
Juneau, Alaska, sponsor of SB 231 provided the following
introduction of the bill:
Thank you for hearing Senate Bill 231 today. In 2022,
the United States Department of Justice investigated
Alaska's behavioral health care system for youth. The
DOJ investigation found an overreliance on
institutionalization to treat minors with behavioral
health disabilities in Alaska.
3:33:13 PM
SENATOR CLAMAN continued:
In response to these findings, the Department of
Health embarked on the Behavioral Health Roadmap
Project for Alaska Youth in fall 2023. My office
recognizes and appreciates the steps that the
Department, behavioral health care providers, and
other stakeholders across the State put into regional
meetings and their drafted report. I hope that
together, meaningful progress can be made to care for
Alaskan youth in the most appropriate setting along a
continuum of care.
There remains an urgent need for transparency and
parent-guardian involvement at the facilities that
serve Alaskan youth with in-patient, intensive
behavioral healthcare needs. SB 231 enhances and
protects the rights of youth psychiatric patients who
receive residential care in Alaska.
3:33:58 PM
SENATOR CLAMAN continued:
SB 231 has three main objectives: first to ensure that
youth patients have access to at least one-hour of
communication with their parent or legal guardian each
week; second to ensure that the Department of Health
conducts twice-per-year, unannounced inspections of
facilities providing residential treatment to youth
psychiatric patients in which 50 percent of all youth
patients are interviewed about their experiences; and
third to ensure that every time seclusion or restraint
is used on a youth patient, it's reported within 24
hours to the Department of Health and to the patient's
parent or guardian.
There are aspects of SB 231 that we look to work with
the Committee to improve. Since this bill was drafted,
we've learned that some facilities in Alaska that
provide residential-based psychiatric treatment to
youth are not licensed as residential psychiatric
treatment centers. I hope that future version of this
bill will include all youth receiving residential-
based psychiatric treatment in Alaska, including those
served at facilities licensed as psychiatric and
specialized hospitals.
3:35:01 PM
SENATOR CLAMAN continued:
We've also heard concerns from youth behavioral
healthcare providers about the confidentiality
requirement for communication between youth patients
and their parent or guardian. We look forward to
working with Committee members to make sure this
requirement accounts for the safety and well-being of
youth patients and staff.
3:35:34 PM
CLAIRE LUBKE, Staff, Senator Matt Claman, Alaska State
Legislature, Juneau, Alaska, offered the following sectional
analysis for SB 231:
Senate Bill 231
Sectional Analysis Version A
Section 1 AS 47.30.840 Right to privacy and personal
possessions; other rights. Adds new subsection (c) to
ensure a minor undergoing evaluation or inpatient
treatment at a residential psychiatric treatment
center has the right, unless otherwise prohibited by
law or court order, to have confidential video
communication at least once each week for at least one
hour with the minor's parent or legal guardian,
facilitated by the residential psychiatric treatment
center.
Section 2 AS 47.32.110 Right of access and inspection.
Amends subsection (c) to authorize the officer or
employee of a department with licensing authority to
enter for any purposes described in a new subsection
(d).
Section 3 AS 47.32.110 Right of access and inspection.
Adds new subsection (d) to require a designated agent
or employee of the Department of Health to conduct, at
least twice a year, an unannounced inspection of each
residential psychiatric treatment center and these
inspections will require at least 50% of the patients
to be interviewed.
Section 4 AS 47.32.200 Notice required of entities.
Adds new subsection (g) to require a residential
psychiatric treatment center to send written
notification of each use of seclusion or restraint on
a person, including the use of a chemical, mechanical,
or physical restraint, to the Department of Health and
the person's parent or guardian within one business
day after the use of seclusion or restraint.
3:37:45 PM
SENATOR TOBIN said she is asking her questions to ensure that SB
231 incorporates Indigenous communities and addresses certain
concerns. She referenced SB 231, page one, line eight, regarding
the term "minor's parent or legal guardian," and expressed
concern about the definition of "legal guardian." She explained
that in previous work with the Alaska Reads Act, the definition
of legal guardian sometimes excluded grandparents, stepparents,
or relatives like aunts or uncles, which are common caregivers
in rural communities. She emphasized the importance of making
sure the definition is inclusive to reflect the family dynamics
in these communities.
3:38:47 PM
SENATOR CLAMAN acknowledged that the issue raised had already
been identified as an area needing refinement. He explained that
the concern is recognizing that, in some cases, parents may be
contributing factors to a minor's psychiatric issues, and it may
not always be appropriate for them to be the primary point of
contact. He supported finding language that allows for other
close family members, such as grandparents, to be identified,
especially when the parent may not be suitable for regular
communication. He clarified that the intent is not to strictly
limit the term "legal guardian" to the legal statute but to
provide flexibility for situations where a court may not be
involved, particularly in private cases. The goal is to ensure
that minors have regular communication with someone who is safe
and trusted, outside the facility, even if a formal legal
guardian is not established.
3:40:47 PM
SENATOR TOBIN referenced SB 231, Section 3, and raised concerns
about young people in the Office of Children's Services (OCS)
care. She asked if the definition on line 5, which refers to a
"designated agent or employee of the Department of Health,"
would include an Indian Child Welfare Act (ICWA) worker or
someone from a tribal entity. She emphasized the importance of
ensuring that ICWA workers or tribal representatives are
involved in the process, particularly in unannounced inspections
of facilities, to support the young person and be part of their
life dynamic.
3:41:32 PM
SENATOR CLAMAN said he welcomed further examination of the
topic. He clarified that the focus of SB 231, Section 3, as
drafted, is on facilities licensed by the state, with the intent
that the licensing entity would conduct regular inspections. He
noted that this differs from the type of oversight someone might
seek regarding an individual patient's well-being.
3:42:04 PM
SENATOR TOBIN thanked him for his clarity and said would wait to
ask further questions.
3:42:12 PM
SENATOR GIESSEL suggested adding language to SB 231 that would
allow, when appropriate, an individual from the Indian Child
Welfare Act (ICWA) or a teacher from the child's school district
who is a close confidant to be involved. She emphasized that
this inclusion could better support the child.
3:42:38 PM
SENATOR CLAMAN expressed support for developing language to
include individuals such as an ICWA worker or a teacher in SB
231. He noted that this suggestion ties into the earlier
discussion about page one, line eight, regarding who can be in
regular contact with the youth. He emphasized that if a teacher
has been a key figure in a youth's life for years, it would be
important to allow that communication, rather than restricting
it simply because the teacher isn't listed as an official
contact. He highlighted the need to prioritize the relationships
that are most meaningful to the youth.
3:43:27 PM
SENATOR TOBIN asked for clarification regarding the definition
of "confidential" under SB 231, Section 1, specifically in
relation to confidential video communication. She inquired
whether the facility would be prohibited from recording the
communication, whether the facility could monitor it, and what
authority they would have over the communication. She expressed
concern that a child in crisis might not feel comfortable
disclosing their situation if they know the communication is
being monitored or if they cannot establish a secure, encrypted
conversation with a trusted adult.
3:44:05 PM
SENATOR CLAMAN acknowledged that an earlier suggestion was to
add telephone communication, in addition to video, because in
some parts of Alaska, video communication may not be reliable,
and the goal is to ensure communication happens through
practical means. He recognized the importance of confidentiality
from the patient's standpoint, so the youth feels secure that no
one is listening. However, he pointed out that for patient
protection, especially if a youth expresses suicidal thoughts
during a conversation, the facility would need to be aware. He
highlighted the challenge of balancing confidentiality with the
need to share critical information for treatment and safety. He
admitted that finding this balance is complex, particularly in
intensive psychiatric settings, but it is essential to address
both needs effectively.
3:45:36 PM
SENATOR TOBIN replied it is a complex issue.
3:45:47 PM
CHAIR WILSON raised concerns about SB 231, Section 1, which
mandates that residential facilities "shall facilitate"
communication. He pointed out that there are times when a child
in a facility may be experiencing an episode or acute crisis and
might not be in a state to communicate, even if parents are
demanding it. He acknowledged the clause allowing for court-
ordered restrictions, but pointed out that in some cases,
forcing communication may not be therapeutic for the child.
3:47:30 PM
CHAIR WILSON shared his experience working in residential
psychiatric and childcare facilities, where crises can occur
randomly or consistently, making it difficult to meet the
"shall" requirement, especially if staff are busy managing other
emergencies. He suggested considering more flexible language or
creating a window for communication that accommodates the
operational challenges of the facility, ensuring communication
is handled at an appropriate and therapeutic time for both the
parent and the child.
3:48:14 PM
SENATOR CLAMAN acknowledged that the concerns raised are valid
and need to be explored. He expressed support for finding a
better way to address these issues in the legislation. He
suggested adding regulatory language that would allow for more
detailed exceptions to be handled by the Department of Health.
This approach would avoid the need for legislators to account
for every possible exception to the seven-day communication
rule. Instead, the Department of Health could provide
flexibility and oversight, determining when it is reasonable to
extend the communication timeline under specific circumstances.
3:49:21 PM
CHAIR WILSON agreed, noting that the goal is to find a way to
allow flexibility. He acknowledged that it's impossible to
account for every possible situation, so including flexible
language in SB 231 would help address varying circumstances as
they arise.
3:49:31 PM
SENATOR CLAMAN stated he is very supportive of that.
3:49:36 PM
SENATOR TOBIN referred to SB 231, Section 4, and raised
questions about the definitions of "seclusion" and "restraint."
She specifically asked for clarification on the definition of
"physical restraint" and whether it includes situations where an
individual is holding a child to prevent self-harm or harm to
others. She noted that such restraint might be brief or
prolonged, depending on the situation, and asked for more
clarity or a reference to a definition that explains the use of
physical restraint in this context.
3:50:20 PM
SENATOR CLAMAN responded by stating that the general intent of
Section 4 is to ensure that any use of restraint is reported,
rather than going unmentioned. He emphasized that the goal is to
be more inclusive rather than exclusive about what constitutes
restraint. He agreed to look further into the definitions to
provide more clarity on the issue.
3:50:53 PM
CHAIR WILSON stated his understanding that physical restraint
refers to any time a child is physically restrained, whether to
prevent harm to themselves or others, or when someone lays hands
on the child to inhibit their mobility. He emphasized that such
actions must be reported and follow the required procedures. He
noted that the department could clarify his understanding.
3:51:20 PM
SENATOR TOBIN followed up by asking whether there is
documentation of any physical harm, such as bruising, that
occurs as a result of restraint. She expressed concern about
ensuring that if a child sustains physical markings from
restraint, it is properly evaluated during inspections or
interviews. She emphasized the importance of competent follow-up
by the Department of Health to address any inappropriate use of
restraint and ensure that such issues are brought to the
department's attention for action.
3:52:28 PM
TRACY DOMPELING, Director, Division of Behavioral Health,
Department of Health, Juneau, Alaska, introduced herself.
3:52:35 PM
CHAIR WILSON asked that Senator Tobin repeat the question.
3:52:37 PM
SENATOR TOBIN sought clarification on SB 231, Section 4, asking
whether the definition of "restraint," which includes physical
restraint, would cover situations where an individual holds or
restrains a child. She inquired if there is a specific timeframe
associated with the length of the restraint that would trigger
the requirement for notification under current practice.
Additionally, she asked if there is any documentation, such as
photographic evidence, that records the incident, the reasons
for restraining the child, the consequences of the restraint,
and how the situation is evaluated to mitigate harm to the young
person.
3:53:29 PM
MS. DOMPELING explained that according to the Center for
Medicare and Medicaid Services (CMS) definition, restraint is
any instance where someone puts hands on a child, with no
specific timeframe required. She confirmed that after such an
event, nurses are required to perform an assessment to check for
injuries, in line with current practices.
3:53:54 PM
SENATOR TOBIN asked if SB 231, Section 4, is codifying current
practices under the Center for Medicare and Medicaid Services
(CMS) and whether parents are notified after an incident of
restraint. She inquired if there is follow-up from the
department to understand why restraint was used and whether
there is a process for reviewing multiple instances of restraint
to identify potential patterns of behavior or issues with
specific staff members, such as a nurse causing more
altercations. She requested an explanation of how this process
works in practice.
3:54:33 PM
MS. DOMPELING acknowledged that she might not be the best person
to provide a detailed walkthrough of the process and suggested
deferring the question to others who might better address the
specifics. She shared her experience in social services and
residential programs, noting that most programs she is familiar
with have processes in place to examine what led to incidents
and who was involved. She mentioned her background in juvenile
justice, where similar reviews of restraint incidents occurred,
but recommended asking the others for further detail.
3:55:21 PM
JAMIE LANG, Medicaid Program Specialist, Division of Behavioral
Health, Department of Health, Anchorage, Alaska, explained that
when there are orders for seclusions or restraints, a specific
form must be completed, which is required by the State of Alaska
for all Psychiatric Residential Treatment Facilities (PRTs)
enrolled in Alaska Medicaid. The parents or guardians are
notified of the incident, and most facilities either call or
email a copy of the form to the parents. The Division also
receives a copy. Additionally, nurses assess the child, and a
physician or another licensed practitioner is required to review
the emergency safety interventions used.
3:56:28 PM
CHAIR WILSON asked if that is in regulation.
3:55:17 PM
MS. LANG explained that the Code of Federal Regulations (CFR)
has been adopted into Alaska's regulations. This includes
specific regulations for Psychiatric Residential Treatment
Facilities (PRTFs), referred to as Residential Psychiatric
Treatment Centers (RPTCs) in Alaska. The state has incorporated
the Centers for Medicare and Medicaid Services (CMS)
requirements for seclusion and restraint, ensuring that all
PRTFs must adhere to those standards.
3:57:06 PM
CHAIR WILSON asked if it would be possible to provide the
relevant documents or references to his office.
3:57:17 PM
MS. LANG replied yes.
3:57:20 PM
SENATOR TOBIN expressed interest in seeing the regulations and
asked about the timeframe mentioned in SB 231, page two, line
16, which stipulates notification "no later than one business
day." She asked if this timeframe is already codified in
regulation or if it would introduce a new change to regulatory
practice.
3:57:46 PM
MS. LANG confirmed that the one-business-day timeframe is
already included in the provider manual, which requires reports
to be submitted within that time. She added that in cases of a
death or more serious incidents, the division must be notified
immediately.
3:58:09 PM
CHAIR WILSON asked how many residential psychiatric treatment
centers (RPTCs) are currently licensed and operating in the
state that would fall under SB 231.
3:58:22 PM
MS. LANG replied less than 30. She said she would provide the
exact number to the committee.
3:58:40 PM
CHAIR TOBIN referred to SB 231, Section 3, regarding inspection
and noted that there are existing statutes detailing inspection
requirements. She asked whether these inspection practices are
already codified in regulation and whether they include reviews
of the use of restraint to identify patterns or behaviors.
3:59:13 PM
MS. LANG deferred the question to residential licensing.
3:59:29 PM
ANA KARINA THOMPSON, Licensing Specialist, Residential
Licensing, Department of Health, Anchorage, Alaska, explained
that residential licensing conducts biennial inspections, during
which they review if restraints have been used. She added that
licensed homes are expected to submit an incident report every
time a restraint occurs. If such reports are not submitted, they
are reviewed during the biennial inspections.
4:00:26 PM
CHAIR WILSON announced invited testimony on SB 231.
4:00:45 PM
MATEO JAIME, Youth Board Member, Facing Foster Care in Alaska,
Anchorage, Alaska, emphasized the importance of SB 231 for youth
in the foster care system and stressed that inspections should
be the bare minimum to hold facilities accountable. He shared
his personal experience, stating that during his time in a
facility, there were no inspections, leaving youth without
adequate assistance or services. Therapy appointments were often
focused on transferring him to other psychiatric facilities,
contributing to what he described as a "revolving door" that
destabilizes at-risk youth.
4:01:45 PM
MR. JAIME also recounted witnessing many instances of restraint,
describing them as "legal child abuse," where staff physically
harmed youth in painful holds. He shared that he was once placed
in a quiet room for two hours, without access to a restroom. The
room only had a small window, a mat, and no lights. This
situation went unreported. He stated it is imperative for
facilities to document and investigate incidents involving
restraints. He highlighted that restraints were often
disproportionate to the youth's behavior, explaining that
something as simple as not listening could result in "booty
juice," where staff forcibly removed youth's pants and
chemically sedated them without consent.
4:03:32 PM
MR. JAIME stressed the importance of confidential video
communication, recalling that staff would immediately hang up
calls if they heard something they did not like, resulting in
the loss of phone privileges. He concluded by reiterating that
more regulation and documentation are necessary to ensure
facilities are held accountable and to prevent abuse.
4:04:27 PM
AUTUMN SMITH-AMY, Owner, Northwest Regional Relative and Kinship
Providers, Anchorage, Alaska, gave a brief work and personal
history. She stated that children are often placed in
psychiatric units in Alaska due to behavioral challenges or the
lack of quality, culturally appropriate foster homes. She
emphasized that these children deserve extra protection and
oversight. She highlighted that blanket standing orders for
medications, seclusion, and restraint do not meet the due
diligence standard of providing the least restrictive
environment, which child protection agencies are mandated to
ensure. She referenced public outcry regarding the treatment of
children in care, specifically noting that children removed from
homes for neglect or abuse are promised a safer environment, not
one where they face further trauma or neglect.
4:01:52 PM
MS. SMITH-AMY pointed out that SB 231 addresses these issues by
providing children in psychiatric units access to legal counsel,
knowledge of their rights, opportunities to speak with oversight
agencies, and random inspections of their placements. She
asserted that these are necessary protections to ensure the
safety of children in state care. She stated her expertise lies
in children under the custody of OCS that are placed in
psychiatric inpatient care. She opined that for their well-being
these children should have oversight at least every 15 days, as
opposed to the current 30-day standard. She also supported
Senator Tobin comments, emphasizing that private facilities have
no requirements to allow tribes to monitor the conditions of the
sites or their children. She advocated for language that would
allow ICWA workers or designated tribal representatives to visit
children in psychiatric inpatient care no less than every 30
days, noting that 68 percent of children in state custody are
Alaska Native or American Indian which is disproportionate to
their population. She stressed that tribal entities must have
access to ensure children's safety and cultural needs are being
met, calling the disproportionate numbers an example of systemic
racism.
4:07:28 PM
CHAIR WILSON opened public testimony on SB 231.
4:07:52 PM
ANNE DENNIS CHOI, President, Alaska Child and Family, Anchorage,
Alaska, testified in support of SB 231 with concerns. She stated
that Alaska Child and Family is a licensed and Joint Commission-
accredited organization. She expressed her support for the
intent and spirit of the bill to ensure the safety and well-
being of Alaskan children. However, she provided feedback on how
SB 231 may be operationalized in residential treatment
facilities, along with suggestions for improvement. She
emphasized the need for a clearer definition of "confidential
communication" to ensure consistent interpretation by all
stakeholders, including auditors. She expressed concern that
"confidential" might imply "unsupervised," which could be
problematic for children on suicide watch or with a history of
unsafe behaviors, especially online. She urged the committee to
balance safety with family access.
4:09:22 PM
MS. CHOI said regarding the requirement for at least one hour of
communication with families each week, she suggested more
flexibility, allowing for shorter, cumulative sessions based on
the child's and family's preferences. She also recommended
allowing phone communication, as not all families have access to
telehealth. She pointed out that the Alaska Child and Family
facility already undergoes annual, unannounced state
inspections, where the rights of children, including access to
family communication, are reviewed. She suggested that SB 231
focus on unlicensed facilities or those that are non-compliant,
as licensed facilities like Alaska Child and Family already
follow such regulations. Additionally, she noted that 100
percent of youth in their care are invited to interviews during
state inspections, which exceeds the requirement of SB 231
interviewing 50 percent. She recommended maintaining the annual
inspection frequency instead of increasing it to every six
months, citing administrative burdens and workforce shortages.
4:11:26 PM
MS. CHOI expressed full support for the requirement that
facilities notify the Department in writing about the use of
seclusion and restraint. Though her facility does not use these
practices, she emphasized their importance. She concluded by
mentioning that she has submitted written testimony with more
detailed feedback.
4:12:23 PM
CHAIR WILSON closed public testimony on SB 231.
4:12:30 PM
CHAIR WILSON asked if there are any non-licensed facilities in
the state that are holding children.
4:12:48 PM
MS. LANG asked that the question be repeated.
4:12:52 PM
CHAIR WILSON asked if there are currently non-licensed
facilities operating as psychiatric treatment centers in the
State of Alaska.
4:12:59 PM
MS. LANG responded that, to her knowledge, any facility that
seeks enrollment in Alaska Medicaid must be licensed,
accredited, and have a psychiatrist or medical doctor on staff,
along with an interdisciplinary team. Therefore, there are no
non-licensed facilities holding children in the state.
4:13:27 PM
CHAIR WILSON acknowledged the licensure requirements but
expressed concern about the possibility of rogue, unlicensed
facilities operating in Alaska, such as a childcare facility in
someone's garage. He referenced the testifier's mention of non-
licensed facilities and asked if the state is aware of any such
facilities advertising themselves as residential psychiatric
treatment centers.
4:13:56 PM
MS. LANG stated that she is not aware of any unlicensed
facilities operating as residential psychiatric treatment
centers, but suggested that residential licensing might have
more information on the matter.
4:14:06 PM
CHAIR WILSON asked if youth at the Alaska Psychiatric Institute
(API) would be included under SB 231 and whether API is
considered one of the licensed facilities covered by SB 231.
4:14:20 PM
MS. LANG stated her belief that SB 231 applies to residential
treatment facilities, not acute psychiatric hospitals like the
API, but mentioned that the distinction may not be entirely
clear.
4:14:36 PM
CHAIR WILSON said the department could get back to the committee
if they did not know.
4:14:47 PM
MS. DOMPELING stated that Ms. Lang's response was correct.
4:14:58 PM
SENATOR TOBIN followed up by asking whether the legislation
would apply to the approximately 100 youth currently placed in
out-of-state residential treatment facilities. She noted that
these are Alaskan residents who have been sent out of state due
to the lack of facilities in Alaska and asked if they would be
covered under SB 231.
4:15:21 PM
MS. DOMPELING replied no, the specific statute referenced in SB
231 is the in-state psychiatric residential treatment
facilities, so it would not apply to youth placed in out-of-
state facilities.
4:15:59 PM
CHAIR WILSON held SB 231 in committee.