Legislature(2001 - 2002)
02/04/2002 01:31 PM Senate HES
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SCR 21-TREATMENT FOR DISTURBED CHILDREN
MR. JERRY BURNETT, staff to Senator Lyda Green, explained that
SCR 21 was introduced because there are over 300 severely
emotionally disturbed Alaskan children currently receiving
treatment in residential facilities in other states. He stated,
Families are separated, sometimes for years.
Flexibility to provide an appropriate mix of treatment
between residential and community based care is lost
when children must be sent out-of-state for treatment.
Millions of state dollars and hundreds of jobs are
being exported from Alaska. Alaska currently lacks the
necessary facilities to provide the full continuum of
community based and residential care in Alaska for the
treatment of severely emotionally disturbed children.
The largest gap in this continuum is the lack of
residential treatment beds that can provide the
necessary level of care. SCR 21 asks the Department of
Health and Social Services to work with the Alaska
Mental Health Board, the Alaska Mental Health Trust
Authority, and other interested parties to strengthen
this continuum of services and to establish a priority
for the development of sufficient in-state residential
care to serve emotionally disturbed children who would
otherwise be placed in out-of-state facilities.
CHAIRWOMAN GREEN noted that legislators have received many
comments over the years from concerned family members who spend
time trying to figure out how to manage long distance
relationships with their children in residential treatment
facilities. The committee hopes to address that by encouraging
continued care in Alaska.
MR. RUSS WEBB, Deputy Commissioner of the Department of Health
and Social Services (DHSS), said that DHSS, health care
providers, and child advocates agree it is preferable to serve
children in-state as opposed to out-of-state whenever possible,
for a variety of reasons. Over the last few years, a growing
number of children have come into DHSS custody and a growing
number of children are going out-of-state to receive care. DHSS
appreciates the legislature's encouragement to address this
issue. DHSS has been and will continue to focus on it and work
with the Alaska Mental Health Board, health providers and family
advocates. DHSS is entering into a broad-based initiative to
look at the full continuum of care, not just residential care
needs. The Division of Medical Assistance will soon have a
contract in place to do a review of the children in out-of-state
care to determine why they are there and what it will take to
return them to Alaska. DHSS agrees this is an important matter to
address and wants legislators to know it is already working hard
on it.
MR. RICHARD RAINERY, Executive Director of the Alaska Mental
Health Board, informed committee members that the goals stated in
SCR 21 are goals the Board has had at the top of its priority
list. The Board has a process in place to address these issues
that brings in stakeholders from across the state. While the
Board believes there is inadequate in-state residential capacity
for children, as it looks at the ideal system of care in the
state, it wants to also focus on the additional pieces of the
continuum of care. It believes that community based care is the
best option for most children and, with adequate services, could
avert a lot of residential placements.
CHAIRWOMAN GREEN said that bringing those children back to Alaska
will make any transition easier and she hopes that SCR 21 does
nothing to negate the continuum of care approach as that is a
well-established model.
MR. RAINERY agreed that returning those children to Alaska is the
first step.
SENATOR LEMAN asked whether any information is available
describing how many children are severely emotionally disturbed
for a particular reason, such as fetal alcohol syndrome (FAS).
He said he believes many of the problems in Alaska are caused by
bad behavior of parents.
MR. RAINERY said he receives quarterly reports from DHSS that
contain the diagnoses of children placed out-of-state.
SENATOR LEMAN asked for a one-page summary of those numbers.
CHAIRWOMAN GREEN took public testimony.
MS. KATHY CRONEN, North Star Behavioral Health Care System CEO,
said out-of-state placement creates significant problems for
children and the state because:
· It provides less than optimal clinical care because of a
lack of involvement by families and support systems;
· It creates difficulties with discharge planning for ongoing
care, which diminishes chances for long term success;
· Alaskan jobs are lost to treatment centers outside of the
state - bringing those children back to Alaska will bring a
minimum of 450 new jobs;
· Youth stay at North Star longer than necessary while
awaiting long term placement, which is much more costly -
the cost of acute care hospitalization for mental health
patients ranges from $560 per day to $1500 per day.
MS. CRONEN said the solution is to build more residential
treatment beds in the state. North Star has land on which to
build a treatment center in the Mat-Su Borough, creating both in-
state treatment and new jobs for Alaskans. It is critical to
bring Alaskan children home and expand the continuum of care.
1:45 p.m.
MS. CAREY EDNEY, Director of Clinic Services at North Star
Hospital, informed members she oversees discharge planning and
placement of all patients. She has a lot of experience in
inpatient services over the years, and is concerned that
inpatient utilization has increased over the last two years. She
stated support for SCR 21 and to provide a wide range of services
for children to hopefully reduce the number of repeated
admissions for inpatient and residential stays. She estimates
about 15 to 20 percent of the youth at her clinic are ready for
and could be placed at a residential treatment facility if one
was available in the state.
MR. JAMES MURPHY, owner/director of the Good Samaritan Counseling
Centers, stated strong support for SCR 21. Because Alaska has no
residential treatment facilities, many patients end up in acute
care facilities when they would receive better treatment in
residential treatment. Sending children and teenagers out-of-
state disrupts family life and treatment.
MR. DAVE SPERBECK, a forensic psychologist, mental health
director for the Department of Corrections and chair of the
Psychologists' Licensing Board, told the committee he has
considerable experience dealing with very disturbed children who
grow up to become disturbed adults that require high levels of
institutional and sometimes incarceration care. He stated that
Senator Leman's comments about the extent to which children are
conditioned to require intensive psychiatric treatment are
accurate. Children rarely are born requiring inpatient
psychiatric treatment and often are abused or neglected by
families who require treatment with the child. It is impossible
to make a family healthy when members are separated by distance.
It is crucial to bring these children back to Alaska because they
will reunite with their families. He stated full support for
more in-patient residential treatment services in Alaska.
1:54 p.m.
MR. DOV RAPPAPORT, a medical doctor, stated support for SCR 21.
He suggested creating a formal body made up of providers to
provide an adequate continuum of care and benefit Alaskans and so
that providers can share information.
MR. WILFRED CASSELL, previous head of the childrens' and
adolescents' psychiatric ward at the Alaska Psychiatric Institute
and current president of medical staff at North Star Hospital,
said it is obvious that to uproot a person from a rural community
to Anchorage for psychiatric treatment is a traumatic experience
but Anchorage staff is able to handle it well because of good
communication with rural caregivers. That problem is exacerbated
when rural patients are transferred out-of-state because of the
cultural gap. He likened it to moving the Aleuts during World War
II. He said that many patients have ongoing medical
complications. A break in the continuity of medical providers can
be detrimental. Regarding the issue of discharge and follow-up,
it is much easier for physicians in Alaska to communicate with
the mental health providers in the community. He told members
that North Star is experimenting with telemedicine and other new
techniques to improve services.
MR. TONY LOMBARDO, Director of Advocacy for Convenant House
Alaska, said he is testifying on behalf of the Alaska Association
of Homes for Children (AAHC). The AAHC strongly advocates for
community based services in which the family can participate in
the treatment of their children and support the call to develop
sufficient instate residential care facilities to meet the needs
of Alaska's children. He stated appreciation for acknowledgement
in SCR 21 that residential treatment beds are a critical
component in a continuum of care for severely emotionally
disturbed children. He strongly advocates for an instate
residential facility to lower the recidivism rate for children.
CHAIRWOMAN GREEN noted that a constituent recommended an
amendment that makes the following changes.
Page 1, line 15 would read: "involvement of a child's family,
members of the child's support system and involved community
providers"
Page 1, line 16 would read: "and leading to better outcomes and
long-term success and improved client satisfaction; and
Page 2, line 3 would read: achieved when a child is discharged
from an in-state residential treatment facility, focusing on
transition and a variety of local, community-based services
in the child's home of origin; and
Page 2, line 9 would read: interested parties to strengthen the
full continuum of residential and community-based care to
work in a coordinated, cooperative, collaborative and
partnering manner towards integration of services.
CHAIRWOMAN GREEN explained the purpose of the amendment is not to
undo or undermine anything that is already in place. That new
language would be added to reinforce to community members that
they will continue to be involved.
SENATOR LEMAN moved to adopt Amendment 1. There being no
objection, the motion carried.
SENATOR LEMAN said the sponsor statement refers to over 300
severely emotionally disturbed children while information from
the Division of Family and Youth Services refers to 423 children.
He asked for clarification.
DEPUTY COMMISSIONER WEBB explained that 423 is an unduplicated
count of children who received care in out-of-state facilities
during FY 01 that were funded by Medicaid. The 300 is an
approximate number who may be receiving care at any given point
in time. He noted the number of children who are in-state
custody and in out-of-state care at any given point in time is
about 50.
SENATOR WARD asked if Medicaid pays for travel.
DEPUTY COMMISSIONER WEBB said it does.
SENATOR WARD asked if the travel costs were included in the base
figure.
CHAIRWOMAN GREEN thought it was included in the total amount.
SENATOR WARD asked if someone must escort the patient.
DEPUTY COMMISSIONER WEBB said yes.
SENATOR DAVIS asked what DHSS's timeline is to bring some of
these children back to Alaska.
2:08 p.m.
DEPUTY COMMISSIONER WEBB said that private facilities are already
under development and the Division of Medical Assistance has
already entered into a contract to look at the needs and the full
continuum of care. He said the Division will have to look at
what impediments exist as to the development to the kinds of
resources we need in the state, such as capital costs or
regulatory issues.
CHAIRWOMAN GREEN asked if DHSS is looking at constructing a
facility.
DEPUTY COMMISSIONER WEBB said DHSS does not plan to build any
facilities; it buys care from private non-profit and for-profit
agencies.
SENATOR DAVIS asked for ongoing reports from DHSS on this
project.
SENATOR WARD asked if the 300 children who are in out-of-state
facilities are in similar types of facilities.
DEPUTY COMMISSIONER WEBB said the commonality of those facilities
is the level or type of care being provided.
CHAIRWOMAN GREEN said it is her intention to move this
legislation out of committee today.
SENATOR LEMAN moved CSSCR 21(TRA) from committee with individual
recommendations. There being no objection, the motion carried.
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