Legislature(2017 - 2018)CAPITOL 106

04/17/2018 03:00 PM HEALTH & SOCIAL SERVICES

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Heard & Held
-- Testimony <Invited/Public> --
Moved SB 208 Out of Committee
-- Testimony <Invited/Public> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
           SB 198-UAA LONG-ACTING CONTRACEPTION STUDY                                                                       
3:04:25 PM                                                                                                                    
CHAIR SPOHNHOLZ announced that the  first order of business would                                                               
be  SENATE BILL  NO. 198,  "An  Act relating  to a  study of  the                                                               
effectiveness  and  cost   of  providing  long-acting  reversible                                                               
contraception to women with substance abuse disorders."                                                                         
3:05:12 PM                                                                                                                    
SENATOR  PETE  KELLY,  Alaska   State  Legislature,  shared  some                                                               
background  of his  reasons  for bringing  the  bill forward  and                                                               
paraphrased the Sponsor Statement  [included in members' packets]                                                               
[original punctuation provided], which read as follows:                                                                         
     The rising rate of maternal  opioid use has resulted in                                                                    
     a  drastic  increase  in children  born  with  Neonatal                                                                    
     Abstinence Syndrome (NAS). In  Alaska, the incidence of                                                                    
     children  born with  NAS has  increased over  500% from                                                                    
     2004  to 2015.  1  In addition  to  the ongoing  opioid                                                                    
     crisis, Alaska  continues to report one  of the highest                                                                    
     rates  of fetal  alcohol spectrum  disorders (FASD)  in                                                                    
     the  nation. The  true rate  of  FASD in  the state  is                                                                    
     likely to  be significantly higher according  to recent                                                                    
     national prevalence studies.                                                                                               
     Through  SB  198,  the  UAA   Center  for  Alcohol  and                                                                    
     Addiction  Studies will  evaluate  the feasibility  and                                                                    
     effectiveness  of  providing   Long  Acting  Reversible                                                                    
     Contraception  (LARC)  to  women involved  in  services                                                                    
     such as Alaska  Regional Hospital's Neonatal Abstinence                                                                    
     Evaluation  Support   Treatment  (NEST)   program.  The                                                                    
     population  of   women  served  by  the   NEST  program                                                                    
     represent one of the highest  risk groups in Alaska for                                                                    
     unintended   pregnancy    and   prenatal   drug/alcohol                                                                    
     exposure.  The public  health consequences  of NAS  and                                                                    
     FASD addressed  by this program highlight  the critical                                                                    
     importance    of    providing    effective    long-term                                                                    
     contraception options to  women struggling with alcohol                                                                    
     and drug addiction challenges.                                                                                             
     SB 198  is an  important step  in eradicating  FASD and                                                                    
     NAS in  Alaska. This  study will provide  critical data                                                                    
     on LARC as  an effective tool in reducing  the rates of                                                                    
     FASD  and NAS.  Furthermore,  the anticipated  outcomes                                                                    
     can inform future  state spending related to  LARC as a                                                                    
     public  health strategy  and its  utility for  reducing                                                                    
     pressure on  state programs and  budgets. Approximately                                                                    
     50%  of  infants   with  Neonatal  Abstinence  Syndrome                                                                    
     treated  at  Alaska  Regional Hospital's  NEST  program                                                                    
     were immediately placed into the  care of the Office of                                                                    
     Children's  Services. 1  In Alaska,  the Department  of                                                                    
     Health and  Social Services  has estimated  the average                                                                    
     cost of treating  an infant with NAS  is $88,869, which                                                                    
     is predominantly  paid by  Medicaid.2 According  to the                                                                    
     Alaska Department  of Health and Social  Services, each                                                                    
     child born with  FASD in Alaska will cost  the State of                                                                    
     Alaska between  $860,000 and $4.2 million  dollars from                                                                    
     birth to age 18.                                                                                                           
     SB 198 is a foundational  step towards turning the tide                                                                    
     on these staggering statistics.                                                                                            
3:13:17 PM                                                                                                                    
HEATHER CARPENTER, Staff, Senator Pete Kelly, Alaska State                                                                      
Legislature, paraphrased from the Sectional Analysis, [Included                                                                 
in members' packets] which read:                                                                                                
     Section 1:                                                                                                             
     (A)Directs  the University  of Alaska  Anchorage Center                                                                    
     for Alcohol  and Addiction Studies  to conduct  a study                                                                    
     to evaluate the  effectiveness of providing long-acting                                                                    
     reversible   contraception   (LARC)   to   women   with                                                                    
     substance  abuse disorders  who  are at  high risk  for                                                                    
     unintended  pregnancies  that  may result  in  prenatal                                                                    
     drug or alcohol exposure.                                                                                                  
     The  study   shall  be   done  in   collaboration  with                                                                    
     hospitals  and  health  care providers  in  Alaska  who                                                                    
     treat women with substance abuse disorders and:                                                                            
     (1)  Establish  an  advisory  council  to  assist  with                                                                    
     designing and implementing the study,                                                                                      
     (2)  Evaluate best  practices  for  treating women  and                                                                    
     children  when  there  is  a   high  risk  of  neonatal                                                                    
     abstinence  syndrome (NAS)  or  fetal alcohol  spectrum                                                                    
     disorders (FASD),                                                                                                          
     (3)   Facilitate  a   network  for   sharing  of   best                                                                    
     (4) Identify  women and children to  participate in the                                                                    
     study on a voluntary basis,                                                                                                
     (5)  Provide LARC  to participants  who are  at a  high                                                                    
     risk  for unintended  pregnancies  that  may result  in                                                                    
     prenatal drug or alcohol exposure,                                                                                         
     (6) Evaluate  the cost  and effectiveness  of providing                                                                    
     LARC to reduce the occurrence of NAS and FASD,                                                                             
     (7) Develop a  cohort of women and children  who can be                                                                    
     evaluated in later studies regarding NAS and FASD,                                                                         
     (8)  Provide a  data  driven framework  to establish  a                                                                    
     comprehensive  strategy for  using LARC  to reduce  NAS                                                                    
     and FASD in Alaska.                                                                                                        
     (B)  Directs the  University  to  complete two  interim                                                                    
     reports by June 30 of 2019  and 2020 and a final report                                                                    
     by June 30, 2021.                                                                                                          
     (C)  Provides definitions  for "fetal  alcohol spectrum                                                                    
     disorder," "long-acting  reversible contraception," and                                                                    
     "neonatal abstinence syndrome."                                                                                            
     Section 2:                                                                                                             
     Repeals  Section 1  on June  30, 2021,  which coincides                                                                    
     with the date of the final report on the project                                                                           
3:17:06 PM                                                                                                                    
SENATOR KELLY, in response  to Representative Zulkosky, explained                                                               
that  the NEST  program  was the  Neonatal Abstinence  Evaluation                                                               
Support & Treatment  program to treat women  with substance abuse                                                               
problems at Alaska  Regional Hospital.  He said that  this was an                                                               
example of  the kind of program  that would be partnered  with in                                                               
the proposed research program under SB 198.                                                                                     
REPRESENTATIVE ZULKOSKY  reflected on the research  regarding the                                                               
efficacy of  long-acting reversible contraception and  asked what                                                               
medical  question remained  that was  necessary to  cover in  the                                                               
proposed bill.                                                                                                                  
SENATOR KELLY  offered his belief  that the depth  of information                                                               
derived from  the pregnancy test  dispensers revealed  a question                                                               
as to what was effective and for what populations.                                                                              
3:19:39 PM                                                                                                                    
MS. CARPENTER  explained that this  was applied  health research,                                                               
that  the long-acting  reversible contraception  (LARC) would  be                                                               
provided and  data would  be gathered.   She  stated that  it was                                                               
important to have  a smaller test group.  She  explained that the                                                               
NEST program  was doing  a good  job providing  intense services,                                                               
pointing  out that  it cost  $88,869 for  treatment of  an infant                                                               
with  NAS (Neonatal  Abstinence Syndrome).   She  noted that  the                                                               
fiscal note would help fund provision of the LARC.                                                                              
REPRESENTATIVE ZULKOSKY stated that  the Department of Health and                                                               
Social Services had  reported more than 3400  Medicaid claims for                                                               
coverage  of LARCs  and asked  what  were the  barriers that  Ms.                                                               
Carpenter referred.                                                                                                             
3:23:08 PM                                                                                                                    
MS. CARPENTER  offered her  belief that,  although 80  percent of                                                               
women stopped  drinking when they  found out they  were pregnant,                                                               
the LARC study would impact  "this very vulnerable population who                                                               
have alcohol  and addiction."   She shared that there  were about                                                               
120  new   cases  of  FASD  (fetal   alcohol  spectrum  disorder)                                                               
diagnosed and  that the NEST  program was  serving a lot  of this                                                               
high-risk population.  She reported  that, for women with an FASD                                                               
or NAS baby, there was a  high likelihood for having another baby                                                               
with  FASD or  NAS.   This would  offer a  woman an  option right                                                               
after birth to have LARC or some other contraception.                                                                           
SENATOR KELLY offered  that this population may  never attempt to                                                               
get those  contraceptive services,  which may separate  them from                                                               
the general Medicaid population.                                                                                                
3:24:01 PM                                                                                                                    
REPRESENTATIVE KITO noted that he did  not see a request from the                                                               
University research department for this study.                                                                                  
SENATOR  KELLY replied,  "yes."   In  response to  Representative                                                               
Kito, he said that it may not  be in the material, his office had                                                               
been asked to move forward with this.                                                                                           
3:24:22 PM                                                                                                                    
REPRESENTATIVE KITO asked where that  was stated in the material,                                                               
as there did not appear to be a formal request.                                                                                 
SENATOR KELLY said that he would obtain a request.                                                                              
3:24:28 PM                                                                                                                    
REPRESENTATIVE  KITO  shared that  none  of  the members  of  the                                                               
legislature were  research scientists and that,  as this proposed                                                               
study appeared  to be a  political policy direction not  based on                                                               
any scientific  knowledge, this caused  him "grave concern."   He                                                               
declared that when the legislature  requested money to generate a                                                               
data  set, that  data set  was  not objective.  He referenced  an                                                               
earlier statement that 20 percent  of women did not quit drinking                                                               
[when pregnant]  and that  this study  would target  those women.                                                               
He asked  whether this 20 percent  of women were all  in the NEST                                                               
3:25:53 PM                                                                                                                    
SENATOR KELLY  expressed his  agreement that,  as the  members of                                                               
the legislature were  not scientists, the UAA  Center for Alcohol                                                               
and Addiction Studies  had requested to conduct the  program.  He                                                               
added  that  the  idea  for  the  study was  to  get  to  a  more                                                               
representative smaller population.  He  stated that this was just                                                               
a research program,  not a program for  statewide distribution of                                                               
3:26:21 PM                                                                                                                    
REPRESENTATIVE  KITO   offered  his  belief  that   the  original                                                               
statement had  been for  this data  to be  used to  inform future                                                               
policy.  He expressed his concern  that, as this question was not                                                               
scientifically posed,  the information  would not  be universally                                                               
SENATOR KELLY  reiterated that  this was the  reason to  have the                                                               
Center for Alcohol and Addiction Studies run the program.                                                                       
3:27:01 PM                                                                                                                    
REPRESENTATIVE JOHNSTON suggested that this  study was for how we                                                               
can best  provide a birth  control service that would  be helpful                                                               
to the  community and how  to eradicate FAS.   She mused  that it                                                               
was  more of  a  pilot process  for how  to  create an  effective                                                               
program for the State of Alaska.                                                                                                
SENATOR  KELLY  added  that  it   was  also  for  "studying  this                                                               
particular population."                                                                                                         
3:28:04 PM                                                                                                                    
REPRESENTATIVE  TARR expressed  her concern  that this  set up  a                                                               
situation that separated  a woman from her  addiction by focusing                                                               
on control of  her ability to reproduce.  She  offered her belief                                                               
that,  although  this  may  be  a  temporary  way  to  relieve  a                                                               
situation for  as long as she  has the LARC and  would not become                                                               
pregnant,  the  underlying  problem   was  the  addiction.    She                                                               
declared that  it was  necessary to  "view the  woman as  a whole                                                               
person, pregnant  or not pregnant,  with addiction or  not having                                                               
addiction."  She asked how the  other needs would be met "through                                                               
participation in this potential  research program."  She declared                                                               
that  it  was   necessary  for  a  woman   to  get  comprehensive                                                               
information to  choose the  method that  was right  for her.   It                                                               
should not  be an  assumption entering this  study that  the LARC                                                               
was the  best method.   She pointed  out that there  were adverse                                                               
health and  cultural issues  to be  addressed, and  she suggested                                                               
that, if a  woman did choose to participate and  had some adverse                                                               
effects, there  should be the  ability for follow up  health care                                                               
and counseling.                                                                                                                 
SENATOR KELLY expressed his agreement  that the addiction and the                                                               
reproduction should not be separated.                                                                                           
3:31:30 PM                                                                                                                    
MS.  CARPENTER  directed  attention  to the  fiscal  note,  which                                                               
included payment for  a case manager position to  ensure that all                                                               
the women would receive assistance  and critical services such as                                                               
addiction  treatment and  access  to housing.    She offered  her                                                               
belief that  it was  a benefit  to do the  research this  way, as                                                               
there was a high bar to work through the university.                                                                            
3:32:44 PM                                                                                                                    
REPRESENTATIVE  ZULKOSKY  asked  about  the  fiscal  note,  which                                                               
indicated that,  although the funding  would cover  the personnel                                                               
costs  for the  investigators and  the case  management, and  the                                                               
associated medical  costs for providing the  contraceptive, there                                                               
was  no indication  for  the cost  of removal  if  there were  an                                                               
adverse reaction to the LARC.                                                                                                   
MS.  CARPENTER explained  that this  was one  of the  pieces that                                                               
would  be  addressed  by  the University  while  setting  up  the                                                               
3:34:05 PM                                                                                                                    
CHAIR SPOHNHOLZ opened invited testimony on SB 198.                                                                             
3:34:17 PM                                                                                                                    
AMANDA SLAUNWHITE,  Associate Professor,  Center for  Alcohol and                                                               
Addiction  Studies,  College  of  Health,  University  of  Alaska                                                               
Anchorage,  stated  her  support  for the  proposed  bill.    She                                                               
declared that "this critical project  will partner the university                                                               
with a  network of  hospitals and health  care providers  lead by                                                               
the NEST program at Alaska  Regional to evaluate increased access                                                               
to  substance  abuse  treatment and  effective  contraception  to                                                               
women in need, including mothers  with opioid use disorder."  She                                                               
said  that  women  with substance  abuse  disorders  reported  an                                                               
unintended  pregnancy  rate  of   nearly  90  percent,  and  that                                                               
significant  barriers  existed  for  access  to  substance  abuse                                                               
treatment and  effective long lasting  reversible contraceptives.                                                               
She  added that  most mothers  addicted to  opioids when  leaving                                                               
hospitals  would not  have access  to  substance abuse  treatment                                                               
services  or effective  family planning  services.   She reported                                                               
that, as almost  70 percent of mothers with one  child exposed to                                                               
drugs  or  alcohol  in  utero  will have  another,  it  was  very                                                               
important  to figure  out a  way  to solve  these challenges  for                                                               
unintended pregnancies  and access to substance  abuse treatment.                                                               
She   stated  that   the  ethical   oversight   offered  by   the                                                               
institutional review  board would  protect all the  human subject                                                               
research  at  UAA  to  ensure that  the  research  fulfilled  the                                                               
federal regulations  and requirements and operated  in an ethical                                                               
and non-coercive  manner.  She  added that the staff  were highly                                                               
experienced in  conducting applied health research  projects with                                                               
vulnerable populations.   She offered an example  of the Vivitrol                                                               
evaluation  project  being  completed  in  conjunction  with  the                                                               
Department of Corrections.  She  noted that UAA offered assurance                                                               
to the Department  of Health and Social Services  that they would                                                               
meet all the requirements outlined  in federal regulations, which                                                               
ensured that  projects conducted  by researchers met  the highest                                                               
ethical  standards,  including  that   risk  was  minimized,  the                                                               
protocols were  not coercive, and informed  consent was obtained.                                                               
She  declared that  participation was  always voluntary  and that                                                               
participants  could withdraw  at  anytime for  any  reason.   She                                                               
declared  that the  program fully  anticipated that  the proposed                                                               
bill  would result  in improved  health outcomes  to mothers  and                                                               
infants,  and significantly  reduce  the cost  and social  impact                                                               
associated  with  unintended  pregnancy  and  prenatal  drug  and                                                               
alcohol exposure.                                                                                                               
3:38:41 PM                                                                                                                    
REPRESENTATIVE KITO asked about her doctorate.                                                                                  
DR. SLAUNWHITE  said that her  PhD was in Health  Geography, with                                                               
background as a research scientist.                                                                                             
3:39:10 PM                                                                                                                    
REPRESENTATIVE  KITO   asked  who   would  provide   the  medical                                                               
oversight for the participants.                                                                                                 
DR. SLAUNWHITE said  that an advisory board would  be guiding the                                                               
development of the protocols for the research.                                                                                  
3:39:32 PM                                                                                                                    
REPRESENTATIVE KITO pointed out  that these were invasive medical                                                               
procedures on people and reiterated  his question for the medical                                                               
responsibility to the patients.                                                                                                 
DR.  SLAUNWHITE explained  that  they would  work in  partnership                                                               
with the NEST program at Alaska Regional Hospital.                                                                              
3:40:10 PM                                                                                                                    
REPRESENTATIVE  KITO  asked  for verification  that  the  medical                                                               
director  and the  doctors would  be providing  medical oversight                                                               
for these participants.                                                                                                         
DR.  SLAUNWHITE   expressed  her   agreement,  noting   that  the                                                               
participants would be patients of Alaska Regional Hospital.                                                                     
3:40:27 PM                                                                                                                    
REPRESENTATIVE  KITO asked  about  any  relationships with  other                                                               
hospitals for this study.                                                                                                       
DR.  SLAUNWHITE opined  that the  advisory  group would  approach                                                               
interested hospitals  about participation.   She shared  that she                                                               
had on-going relationships with numerous other hospitals.                                                                       
3:41:11 PM                                                                                                                    
REPRESENTATIVE KITO  asked for a  request to this study  since he                                                               
did not see it in members' packets.                                                                                             
DR.  SLAUNWHITE  explained that  they  had  been working  to  get                                                               
funding in  place to conduct  the work.   She listed some  of the                                                               
applications  submitted but  pointed to  the urgency  for getting                                                               
the work underway due to the  opioid epidemic.  She stated that a                                                               
large  portion  of  the  study would  focus  on  women  currently                                                               
struggling with  opioid use  disorder and  would collect  data on                                                               
the mothers  and children to  track them through  adolescence and                                                               
3:42:34 PM                                                                                                                    
REPRESENTATIVE KITO  offered his agreement that  prevention of an                                                               
unwanted pregnancy  during alcohol  or drug  use would  result in                                                               
better outcomes  for the  child and asked  what was  the question                                                               
seeking  a resolution.    He  mused that  the  only  need was  to                                                               
provide  for the  appropriate contraception  to individuals  with                                                               
alcohol or drug  problems and that it was not  necessary to study                                                               
whether a contraceptive would decrease incidences of FAS or NAS.                                                                
DR. SLAUNWHITE replied  that it was necessary to find  the way to                                                               
do  that.   She shared  that, as  many women  were detached  from                                                               
health  care providers  and would  not seek  pre-natal care,  the                                                               
question  was  how  to  reach  these  women  to  offer  addiction                                                               
treatment and family planning resources.                                                                                        
3:44:44 PM                                                                                                                    
REPRESENTATIVE   KITO  suggested   that,   as  family   planning,                                                               
counseling, and  contraceptive use  would be beneficial,  why was                                                               
there a focus on the LARCs.                                                                                                     
DR. SLAUNWHITE  explained that past  research had  indicated that                                                               
women with substance  abuse issues did not have  a high adherence                                                               
to  traditional forms  of birth  control.   She added  that LARCs                                                               
were often chosen because of the ease.                                                                                          
3:45:50 PM                                                                                                                    
REPRESENTATIVE  KITO offered  his belief  that this  should be  a                                                               
decision between the patient and  a medical professional, and not                                                               
directed by a study.                                                                                                            
DR. SLAUNWHITE  pointed out  that the women  had full  choice for                                                               
birth control including LARC.                                                                                                   
3:46:10 PM                                                                                                                    
REPRESENTATIVE  KITO asked  if the  proposed  bill included  more                                                               
than a LARC, as that was not stated  in the bill, and if so, then                                                               
the proposed bill needed to be corrected.                                                                                       
CHAIR SPOHNHOLZ  suggested that there  were more  questions about                                                               
the protocol and  the entry point for women  participating in the                                                               
3:46:37 PM                                                                                                                    
REPRESENTATIVE JOHNSTON  asked if  the advisory council  would be                                                               
part  of the  initial  development  of the  study,  how it  would                                                               
interact  with the  academic  committee, and  what  would be  its                                                               
DR. SLAUNWHITE replied  that the advisory council  would be fully                                                               
integrated into  the academic research component  of the project.                                                               
She said  that she would  fully expect that the  advisory council                                                               
would provide input  and guidance on all aspects  of the research                                                               
project.   She  opined  that  the council  would  be  made up  of                                                               
stakeholders   from  throughout   the   state  including   family                                                               
planning, women's health services,  pediatricians, and the Office                                                               
of Children's Services.                                                                                                         
3:48:04 PM                                                                                                                    
REPRESENTATIVE TARR posed that Dr.  Slaunwhite had offered a much                                                               
broader description of the project  than what was included in the                                                               
proposed bill.  She questioned  whether the National Institute of                                                               
Health  would support  the proposed  bill.   She opined  that the                                                               
research question  should be for the  most effective intervention                                                               
for women  at high  risk for substance  use disorders  that could                                                               
result  in  pregnancies  with  the offspring  having  FAS.    She                                                               
declared that  the research  project should  not be  entered with                                                               
any kind  of inherent bias  as it would  negate the value  of the                                                               
study.  She offered her belief  that this also made the choices a                                                               
bit coercive  as the study  was geared  toward the use  of LARCs.                                                               
She reiterated that the proposed  bill and the study as described                                                               
by Dr. Slaunwhite were different.                                                                                               
DR. SLAUNWHITE  said that the  bill did describe  the development                                                               
of a cohort related to the broadening that had been referenced.                                                                 
REPRESENTATIVE  TARR  said  that research  from  Alaska  Regional                                                               
Hospital, the  largest urban center  in the state, should  not be                                                               
applied  statewide   as  it  was  not   relevant,  especially  to                                                               
questions  for  access.    She  noted  that  there  was  not  any                                                               
indication  where  the  other  collaborations   would  be.    She                                                               
declared  that $500,000  was not  enough money  to do  this study                                                               
properly  because  one  adverse  reaction with  one  woman  which                                                               
required hospitalization  could "eat  up thousands  and thousands                                                               
of dollars  in short order."   She added  that there was  not any                                                               
follow up care addressed in the proposed bill.                                                                                  
DR. SLAUNWHITE  said that Alaska  Regional Hospital was  the only                                                               
unit in Alaska that was  specifically designed to treat neo-natal                                                               
abstinence  syndrome.   She  said  that data  had  shown that  82                                                               
percent of infants  born with in-utero opioid  exposure were from                                                               
the Anchorage  area.  She  declared that  it was desired  to have                                                               
collaborators from  throughout the state to  have the rural-urban                                                               
3:52:34 PM                                                                                                                    
REPRESENTATIVE ZULKOSKY asked for  elaboration about the research                                                               
question, offering her  belief that it "treads  really closely to                                                               
some  historic issues  around  forced  sterilization for  certain                                                               
subsets of the population."                                                                                                     
DR. SLAUNWHITE reported that women  would have the choice for the                                                               
type  of  birth  control,  if  any, that  they  would  prefer  to                                                               
receive.   She explained that  the focus  was on LARC  because of                                                               
the  scientific  foundation that  LARC  were  very effective  for                                                               
women  with  substance  abuse  disorders  in  reducing  rates  of                                                               
unintended pregnancy.  She added  that women who receive the LARC                                                               
would be the  intervention group, and women who  decide to either                                                               
not  receive any  birth control  or receive  a different  form of                                                               
birth control would be the comparison group.                                                                                    
3:55:20 PM                                                                                                                    
REPRESENTATIVE  ZULKOSKY  asked  if the  research  dollars  would                                                               
cover women using  a type of birth control other  than LARC.  She                                                               
asked  how the  research  would address  access to  contraceptive                                                               
counseling training for health care  providers, and whether there                                                               
were  experts in  family  planning  and contraceptive  counseling                                                               
included in the design and  implementation plans for the proposed                                                               
DR.  SLAUNWHITE  replied that  they  would  like to  have  family                                                               
planning experts  "heavily involved in this  project" and engaged                                                               
in the  conversations for the  research protocol.   She suggested                                                               
that coverage for  the removal and medical care  could be covered                                                               
by Medicaid.   She offered an example for a  similar situation to                                                               
the  aforementioned  vivitrol  program.     She  added  that  the                                                               
substance abuse  treatment services and case  management would be                                                               
provided  to  women  in  the  NEST  program  at  Alaska  Regional                                                               
Hospital,  as the  health insurance  status  of the  participants                                                               
could be  determined.  She  stated that a broader  discussion for                                                               
the  options  to  women  without  health  insurance  would  be  a                                                               
conversation  with  the  advisory  group in  order  to  determine                                                               
participation in the study.                                                                                                     
3:57:58 PM                                                                                                                    
REPRESENTATIVE ZULKOSKY  questioned the necessity of  the expense                                                               
for a  $0.5 million study when  it was already known  that Alaska                                                               
women  eligible for  Medicaid  had  access to  LARCs  if they  so                                                               
desired.   She  suggested that  the money  be used  to provide  a                                                               
process or  comprehensive care, instead  of "looking at  the need                                                               
for efficacy in a particular group of women."                                                                                   
DR. SLAUNWHITE  said that it was  known that this group  of women                                                               
was not  accessing these  services and that  it was  necessary to                                                               
learn more for how to reach  these women and how to provide care,                                                               
treatment,  and services  after  delivery of  a  drug or  alcohol                                                               
exposed infant.                                                                                                                 
3:59:41 PM                                                                                                                    
CHAIR  SPOHNHOLZ reflected  on the  question of  contraception to                                                               
address  Fetal Alcohol  Syndrome (FAS)  and neo-natal  abstinence                                                               
syndrome  (NAS)  and  asked  if  the study  was  about  the  care                                                               
coordination as much as about delivery of contraception.                                                                        
DR.  SLAUNWHITE acknowledged  that,  although it  was known  that                                                               
contraception,  especially  LARCs,  was successful,  it  was  the                                                               
coordination for delivery  and the services that was  the core of                                                               
the intervention.   She said that these were  not currently being                                                               
provided in maternity services.                                                                                                 
4:00:40 PM                                                                                                                    
CHAIR SPOHNHOLZ asked if this was  "a care delivery model that is                                                               
being framed as a study."                                                                                                       
DR. SLAUNWHITE expressed  her agreement and said  that the Alaska                                                               
Regional Hospital  NEST program was  selected as the  first pilot                                                               
site because  it was  a unique program  using an  evidence based,                                                               
anti-stigma,  family-oriented approach  toward  the  birth of  an                                                               
infant  exposed to  opiates and  other drugs.   She  declared the                                                               
desire to  build on  this existing  model as it  was known  to be                                                               
effective for reducing the need  for medication during withdrawal                                                               
and  for increasing  mother-baby bonding.   She  said that  these                                                               
services  would  get  the mother  into  addiction  treatment  and                                                               
provide family planning resources.                                                                                              
4:02:07 PM                                                                                                                    
CHAIR SPOHNHOLZ asked  if there were partnerships  with any other                                                               
DR.  SLAUNWHITE   replied  that   there  were   partnerships  and                                                               
collaborations with  researchers and medical staff  at many other                                                               
institutions  throughout Alaska.   She  noted that  conversations                                                               
with  facilities  in  Fairbanks  for their  program  changes  had                                                               
indicated  this  as  "a  really great  second  site,  if  they're                                                               
interested  because  they  are  starting   to  use  some  of  the                                                               
approaches used by the NEST unit."                                                                                              
4:03:01 PM                                                                                                                    
CHAIR  SPOHNHOLZ   asked  how  the  program   would  specifically                                                               
identify the patients  and the type of care available  as part of                                                               
this process.                                                                                                                   
DR. SLAUNWHITE  explained that the  protocols would  be developed                                                               
with  the   advisory  council,  as   this  discussion   was  just                                                               
beginning.  She  said that a woman who had  disclosed a substance                                                               
exposed pregnancy  could potentially be approached  by medical or                                                               
research staff  for participation in  the study and she  would be                                                               
briefed on  her rights as  a participant.   She would be  given a                                                               
lengthy  consent form  and  then a  care  coordinator and  social                                                               
worker would be provided to collect information.                                                                                
4:05:03 PM                                                                                                                    
CHAIR SPOHNHOLZ asked  if contraceptive care was paid  for by the                                                               
study from the point of consent to participate.                                                                                 
DR.  SLAUNWHITE replied  that  there would  be  an evaluation  to                                                               
determine whether the participant  had health insurance coverage.                                                               
If not, there  was an amount in  the budget to cover  the cost of                                                               
birth control.                                                                                                                  
4:06:00 PM                                                                                                                    
CHAIR  SPOHNHOLZ  asked  if   contraception  would  be  provided,                                                               
regardless of the type or her ability to pay.                                                                                   
DR. SLAUNWHITE replied that was her understanding.                                                                              
4:06:20 PM                                                                                                                    
CHAIR SPOHNHOLZ  asked whether, if  a woman  opted for a  type of                                                               
contraception other  than LARC,  that care would  be paid  by the                                                               
DR.  SLAUNWHITE offered  her belief  that this  would be  a small                                                               
number of participants as her  research indicated that many women                                                               
had health insurance coverage.                                                                                                  
4:07:10 PM                                                                                                                    
CHAIR  SPOHNHOLZ  expressed her  concern  that  there was  not  a                                                               
coercive  motivation  to  use  one  form  of  contraception  over                                                               
another  form, especially  for a  woman who  did not  have health                                                               
DR. SLAUNWHITE  said that  a woman  would be  free to  choose and                                                               
that any  form of birth  control included  in the study  would be                                                               
offered, as determined by the  advisory group.  She expressed her                                                               
understanding for  the ethical concerns  for "even  an appearance                                                               
of coercion."                                                                                                                   
4:08:43 PM                                                                                                                    
CHAIR  SPOHNHOLZ  reflected  on the  Institutional  Review  Board                                                               
(IRB) process  and asked for  more detail  about the review  of a                                                               
human subject research project.                                                                                                 
DR.   SLAUNWHITE  explained   that  it   would  include   a  full                                                               
application  to  the board  for  the  way participants  would  be                                                               
recruited,  who was  eligible to  participate in  the study,  all                                                               
sites  where the  research would  be  conducted, all  instruments                                                               
used to gather  data, any medical records, and any  other data or                                                               
processes used to gather the data.   She said that the University                                                               
of Alaska  Anchorage (UAA)  IRB would review  the packet.   After                                                               
the  review, there  would be  a meeting  with faculty,  community                                                               
members,  and  the chair  of  the  IRB  with an  opportunity  for                                                               
questions about  the protocol.   She  shared her  experience that                                                               
this  was a  very rigorous  process that  could last  for several                                                               
months, with revisions of protocol  and surveys after advice from                                                               
the group.                                                                                                                      
4:11:20 PM                                                                                                                    
CHAIR SPOHNHOLZ asked who served on the IRB.                                                                                    
DR.  SLAUNWHITE replied  that there  were two  community members,                                                               
often representative  from specific  groups, as well  as research                                                               
professors for feedback on protocols and instruments.                                                                           
4:11:53 PM                                                                                                                    
CHAIR SPOHNHOLZ asked  if any necessary follow up  care for women                                                               
without health insurance would be covered by the study.                                                                         
DR. SLAUNWHITE offered  her belief that there would  be follow up                                                               
care  while at  Alaska Regional  Hospital, and  that part  of the                                                               
service  "would  be  to  obtain some  form  of  health  insurance                                                               
especially because  as part  of this project  we want  to provide                                                               
case  management  and  a  direct  pathway  into  substance  abuse                                                               
treatment  for these  women."   She  noted that,  as these  women                                                               
would  be going  into  treatment, there  would  be an  associated                                                               
cost, payment of  which would be determined  through the advisory                                                               
board and  the protocol development.   She reported that,  with a                                                               
link  to addiction  treatment, there  would be  a requirement  to                                                               
have health insurance, most likely to be Medicaid.                                                                              
4:13:40 PM                                                                                                                    
CHAIR  SPOHNHOLZ asked  who the  principal  investigator was  for                                                               
this research project.                                                                                                          
DR. SLAUNWHITE said that she was the principal investigator.                                                                    
4:13:50 PM                                                                                                                    
REPRESENTATIVE KITO  asked if there  were any medical  doctors on                                                               
the IRB.                                                                                                                        
DR. SLAUNWHITE replied  that the chair of the IRB  was a clinical                                                               
psychologist, and although there were  not any medical doctors on                                                               
the IRB, there were temporary IRB  members added, as needed.  She                                                               
expressed  her hope  that, through  the  advisory council,  there                                                               
would be  a group  of experts  including pediatricians,  OB GYNs,                                                               
and  representatives  from  family planning  and  women's  health                                                               
4:15:21 PM                                                                                                                    
REPRESENTATIVE TARR  expressed her concern for  coercion, opining                                                               
that the process "sounds horrible."   She shared that, as a woman                                                               
with  a   substance  disorder,  most  likely   with  a  difficult                                                               
pregnancy, and having health impacts  after delivery unrelated to                                                               
substance  use disorder,  she would  not  be fully  "of my  right                                                               
mind"  because of  the throes  of addiction.   She  would need  a                                                               
significant  period  of  time for  detoxification  to  have  full                                                               
capacity for  decision making.   If she  was a  vulnerable women,                                                               
she had probably not had  positive experiences with government or                                                               
police  and  now,  post-delivery,  there would  be  someone  with                                                               
lengthy paperwork telling  her to read and to  sign something she                                                               
may not comprehend.  She declared  that in this scenario, a woman                                                               
would  not have  real choice,  and  that this  was a  problematic                                                               
process.   She directed attention  to page 2,  lines 14 -  19, of                                                               
the proposed bill,  and pointed out that there was  no mention of                                                               
care coordination or  the correct interventions for  the woman to                                                               
access health care, addiction treatment,  and birth control.  She                                                               
declared  that what  Dr. Slaunwhite  had described  and what  the                                                               
proposed bill said  were not the same.  She  reiterated that this                                                               
was not  a situation whereby a  woman had full choice  over these                                                               
4:18:39 PM                                                                                                                    
DR.  SLAUNWHITE replied  that  if a  woman  was incapacitated  or                                                               
going   through   significant   detoxification  and   unable   to                                                               
comprehend or  fully understand  the project,  they would  not be                                                               
accepted  for  participation.   She  declared  that  people  with                                                               
addiction issues  consented to be  involved in  research projects                                                               
all the  time.  She  said that  they could fully  understand what                                                               
was being asked  and what were the risks  and benefits associated                                                               
with the  project.  She  pointed out that  they did not  have any                                                               
interest  in participation  by someone  who  did not  want to  be                                                               
involved.   She reiterated that  it was fully voluntary,  and the                                                               
person was  free to  withdraw from  the study at  any time.   She                                                               
relayed  that  they  would  do  everything  to  ensure  that  the                                                               
information  and the  consent forms  were communicated  at a  low                                                               
reading level, to  ensure understanding and that  there would not                                                               
be  any coercion  for anything.   She  acknowledged that  she may                                                               
have  communicated the  research  somewhat  differently that  the                                                               
proposed  bill, although  the proposed  bill  did articulate  the                                                               
research  questions that  she had  described  for evaluating  the                                                               
costs for providing  LARC and its effectiveness  for reducing the                                                               
occurrence of FAS  and NAS, as well as the  cohort development to                                                               
facilitate  the long-term  study  of the  development of  infants                                                               
born with substance exposure.                                                                                                   
4:22:05 PM                                                                                                                    
REPRESENTATIVE  TARR  declared  that   the  idea  of  choice  was                                                               
impacted  by   physical  condition.    She   suggested  that  the                                                               
individual  have an  advocate whose  purpose was  to monitor  the                                                               
needs  of   a  vulnerable  individual  with   no  motivation  for                                                               
participation in the  program.  She offered her  belief that this                                                               
should be more accurately described  in the language of the bill.                                                               
She  opined that  there  was a  difference  between the  Vivitrol                                                               
intervention  and  the  control  of   a  woman's  right  to  make                                                               
reproductive choices.   She  reminded that  there was  a terrible                                                               
history for segmenting different women  and trying to control the                                                               
ability  to  reproduce.    She reiterated  that  she  had  strong                                                               
concerns as this was a significant medical intervention.                                                                        
4:24:16 PM                                                                                                                    
REPRESENTATIVE ZULKOSKY,  pointing to  an earlier  statement that                                                               
participation  in the  study would  be fully  voluntary and  that                                                               
participants could  withdraw at  any time  for any  reason, asked                                                               
whether it was  a penalty to not have removal  or follow up costs                                                               
for care be covered  by the study.  She noted  that, as the study                                                               
in its  current form did not  cover these costs, this  could be a                                                               
coercive  way  for  participation.    She  declared  a  need  for                                                               
"greater wrap  around services for  care coordination  or greater                                                               
resources for  substance abuse treatment, not  necessarily access                                                               
to birth  control."  She  suggested that  there was a  segment of                                                               
women,  and possibly  children,  viewed  as a  cost  risk to  the                                                               
state,  and  instead,  the  state  should  be  dealing  with  the                                                               
holistic needs of an individual.                                                                                                
DR.  SLAUNWHITE  expressed  her  understanding  and  offered  her                                                               
belief  that  approval  for  the   project  would  necessitate  a                                                               
protocol to  ensure that  women would  be able  to have  the LARC                                                               
device removed,  should they  wish, with no  penalty.   She added                                                               
that  there should  also  be a  protocol to  give  women a  clear                                                               
choice for  the type of  birth control available, and  that there                                                               
would not be any penalty for discontinued use.                                                                                  
4:27:37 PM                                                                                                                    
JEFFREY  JESSEE, Dean,  College of  Health, University  of Alaska                                                               
Anchorage, shared that  he had previously been CEO  of the Alaska                                                               
Mental Health Trust Authority for 22  years.  He noted that, as a                                                               
lot of  the material had  already been covered, it  was important                                                               
to keep a  few points in mind.   He said that  all hospitals were                                                               
required by  law to report  to the Office of  Children's Services                                                               
(OCS)  any positive  drug  screen on  any mother  or  child.   He                                                               
pointed  out how  traumatic it  was to  both the  mother and  the                                                               
child,  as often  the  child was  removed from  the  mother.   He                                                               
stated that  much of this  applied research  was for how  to take                                                               
the next step and do better than  this process.  He said that, as                                                               
currently  there was  not comprehensive  counseling and  referral                                                               
services, many of  these mothers ended up back  in the community,                                                               
still  addicted,  with data  indicating  a  high probability  for                                                               
having another affected  child.  He reiterated that  this was not                                                               
a study  of the effectiveness  of birth  control, if it  was used                                                               
reliably,  and he  stated that  the LARC  was one  form of  birth                                                               
control  which was  easiest for  women  who wanted  to remain  on                                                               
birth control with  no interference from an  addiction or chaotic                                                               
personal life.  He acknowledged  that, although the best solution                                                               
would be  for the women  to become sober  and have housing  and a                                                               
better  life experience,  there was  not the  technology to  help                                                               
everyone  who was  addicted  to get  sober.   He  said that  some                                                               
addictions  were so  pervasive and  ingrained in  an individual's                                                               
life that  it was not  known how to get  them sober.   He pointed                                                               
out  that one  reason for  the Housing  First concept  for people                                                               
with chronic  alcoholism was to  provide effective  treatment and                                                               
support, instead  of being prisoners of  their addiction, waiting                                                               
for the  next terrible thing  to happen.   He declared  that this                                                               
proposal  was  the  next  step  for  these  women  who  had  been                                                               
repeatedly traumatized  and would  be referred  to the  Office of                                                               
Children's Services at  the end of their pregnancy.   He declared                                                               
that  the points  by  the committee  were  excellent, that  there                                                               
should not be a coercive element  to the program and that the IRB                                                               
would work  with researchers to  ensure this was considered.   He                                                               
added that,  for full data  of the research, not  everyone should                                                               
choose LARC,  which would allow for  a control group to  test for                                                               
the  most effective  strategy to  help these  women gain  control                                                               
over at  least part  of their  future.  He  declared that  it was                                                               
absolutely essential  to have "the  highest quality  medical care                                                               
that  we  can possibly  give  them."    He noted,  however,  that                                                               
hospitals  were limited  in the  ability to  follow through  with                                                               
effective  case management  to access  critical services  such as                                                               
treatment  and safe  housing.    He added  that  many women  were                                                               
concerned with accepting services from  a hospital which had just                                                               
referred them to  the OCS.  He opined that  this applied research                                                               
project would  offer more objective  assistance to  these mothers                                                               
than  total reliance  on the  hospitals for  these services.   He                                                               
reiterated that the purpose of  the University [of Alaska] was to                                                               
assist legislators  in "getting  the best  bang for  your dollars                                                               
and  the best  outcome for  the public  policy outcomes  that you                                                               
want to see."  He declared that  it was necessary to "look at how                                                               
to best approach these women; how  to best present an option; how                                                               
to best  help them follow through  with at least housing,  if not                                                               
treatment; and  help them  to move  forward in  their lives  in a                                                               
more positive way...  "  He declared that there  was a commitment                                                               
to  respect the  rights  of the  women, and,  as  the women  were                                                               
offered a  full range of  options, this would provide  answers to                                                               
the  many questions  asked by  the  legislature for  how to  move                                                               
forward and  reduce the incidences  for these  affected children.                                                               
He added that healthy living  would lead toward a more fulfilling                                                               
life for these women.                                                                                                           
4:38:04 PM                                                                                                                    
REPRESENTATIVE ZULKOSKY  lauded the great mental  health work and                                                               
advocacy performed  by Mr.  Jessee.   She acknowledged  that they                                                               
had  shared goals  for  the reduction  of  pre-natal exposure  to                                                               
drugs and alcohol  for Alaska children, as well  as resolution to                                                               
the  conundrum around  the provision  of care  and services  to a                                                               
population of women  that may not otherwise seek this  care.  She                                                               
directed attention  to the proposed bill  which explicitly stated                                                               
that  the intention  of  the  study was  to  provide long  acting                                                               
reversible  contraception to  participants who  were at  risk for                                                               
unintended  pregnancies  that may  result  in  pre-natal drug  or                                                               
alcohol exposure.  She added  that another intent of the proposed                                                               
bill  was to  provide  a  data driven  framework  to establish  a                                                               
comprehensive   strategy  for   using   long  active   reversible                                                               
contraception to  reduce fetal alcohol spectrum  disorders (FASD)                                                               
and  neo-natal   abstinence  syndrome  (NAS)  in   Alaska.    She                                                               
expressed her  concern for  social justice  and racial  equity as                                                               
there had not been any  discussion for the issues of demographics                                                               
for  women in  Alaska who  may fall  into this  population.   She                                                               
declared  that  she  did  not  see  any  difference  from  forced                                                               
sterilization on women who could not advocate for themselves.                                                                   
MR. JESSEE  reported that forced  sterilization was "a  very dark                                                               
part of  our past in  this country"  which had been  conducted as                                                               
the perceived solution for  many reasons, including developmental                                                               
disabilities and  mental illness.  He  added that this was  not a                                                               
system of  support but  a means of  control, specifically  of the                                                               
reproductive  rights.   He reported  that there  were even  court                                                               
orders supporting these practices.   He stated that this proposed                                                               
bill was  not about  these practices but  was about  working with                                                               
women who  were currently  not able  to get sober  and were  at a                                                               
much  higher  risk  for  unintended pregnancy.    He  shared  his                                                               
surprise that 50  percent of all pregnancies  were unintended and                                                               
noted  that the  percentage  of unintended  pregnancies was  much                                                               
higher, over  80 percent, for this  group of addicted women.   He                                                               
declared that it  was not helping these women to  bring them to a                                                               
hospital, deliver the babies, refer  them to OCS, provide minimal                                                               
support,  and  then  send  them  back into  the  community.    He                                                               
acknowledged  that these  women could  not be  forced to  use any                                                               
birth control,  to seek  treatment, or to  stay in  safe housing.                                                               
He referenced the Housing First  model and reported that this was                                                               
a  valuable service  which  gave addicted  people  a belief  that                                                               
something positive was  happening and they had  some control over                                                               
their  life.   He  reported  that many  people  at Housing  First                                                               
reduced their  drinking, while  "some even  get sober,"  and that                                                               
most all have improvements to  their health condition.  He stated                                                               
that  the opportunity  to control  reproductive  health with  the                                                               
choice  of  birth  control  was  the  exact  opposite  of  forced                                                               
sterilization.   He declared  that the proposed  bill would  be a                                                               
benefit to  the individuals and  the community and would  offer a                                                               
better understanding for how to  work with these women to achieve                                                               
the desired outcomes.                                                                                                           
4:45:41 PM                                                                                                                    
REPRESENTATIVE  ZULKOSKY   opined  that   it  was   important  to                                                               
acknowledge the  history for full choice  of reproductive rights,                                                               
regardless of  an individual's station  in life.  She  shared her                                                               
struggle of  coming from a rural  area as an Alaska  Native woman                                                               
with  the   background  for  challenges  to   the  Alaska  Native                                                               
community.   She  stated that  there were  many similarities  for                                                               
ostracizing a subsect of the  community for the advancement of an                                                               
institution and declared that it was "deeply disturbing."                                                                       
DEAN JESSEE  expressed his agreement  for the  trauma experienced                                                               
by the women and their children  and declared that not enough was                                                               
being done  to avoid further  trauma.  He  said there was  not "a                                                               
magic wand" to  help these women become sober,  pointing out that                                                               
they did not  have control over their addiction or  the trauma it                                                               
included.  He  emphasized that it was necessary to  take the next                                                               
step in  order "to value these  women and believe that  there's a                                                               
better future for them."                                                                                                        
4:50:18 PM                                                                                                                    
ART   DELAUNE,   Legislative   Chair,   Governor's   Council   on                                                               
Disabilities  and  Special  Education, stated  that  the  Council                                                               
supported the proposed  bill and agreed with the  concept for the                                                               
option to  LARC for women who  are known to have  substance abuse                                                               
disorders.  He  shared a personal anecdote for his  two sons with                                                               
FASD  and with  his  background  as a  parent  navigator for  the                                                               
Fairbanks  FASD diagnostic  team.   He stated  that FASD  was 100                                                               
percent preventable  and that women  needed access  to resources,                                                               
information, support,  and care or  treatment.  He said  that the                                                               
research from  the proposed  bill had  the potential  to identify                                                               
barriers and examine the long-term cost and savings to Alaska.                                                                  
4:54:09 PM                                                                                                                    
REPRESENTATIVE TARR  added that it  was necessary for  a holistic                                                               
MR. DELAUNE expressed his agreement.                                                                                            
CHAIR SPOHNHOLZ  shared the  difficulties for  understanding FASD                                                               
and its effects.                                                                                                                
4:56:38 PM                                                                                                                    
TREVOR  STORRS,  Executive  Director,  Alaska  Children's  Trust,                                                               
shared that  ongoing research had shown  that social determinants                                                               
could  be  a  predictor  to  the   level  of  risk  for  a  child                                                               
experiencing  child  abuse and  neglect.    By identifying  these                                                               
social determinants  that influence  this level  of risk,  it was                                                               
possible to move  further "upstream" to prevent  this child abuse                                                               
and neglect.   He stated  that the  proposed bill was  an example                                                               
for achievement  of this goal.   He  pointed out that  Alaska had                                                               
been  able to  identify  key social  determinants which  included                                                               
unplanned and  unwanted pregnancies.   He shared that  49 percent                                                               
of pregnancies  were unintended, and  that, for women age  19 and                                                               
younger, more than 4 out  of 5 pregnancies were unintended, while                                                               
under  the age  of 15,  98 percent  of the  pregnancies were  not                                                               
planned.   He reported  that unplanned  or closely  spaced births                                                               
were associated with adverse maternal  and child health outcomes,                                                               
which  included depression,  smoking,  alcohol consumption,  poor                                                               
mental  health,  increased  risk   of  physical  violence  during                                                               
pregnancy, reduction  of the likelihood  for breast  feeding, and                                                               
lower mother-child  relationship quality.  For  the children, the                                                               
result included  greater infant mortality, likelihood  to be less                                                               
physically  and  mentally healthy,  less  likely  for success  in                                                               
school,  and  more  likely  to   live  in  poverty,  need  public                                                               
assistance,  and  have  delinquent  and criminal  behavior.    He                                                               
reported that 90 percent of  women stopped drinking once aware of                                                               
their pregnancy, which  meant that the highest  risk for exposure                                                               
of the  fetus to alcohol  was between conception  and realization                                                               
of  pregnancy.   He pointed  out  that all  of these  adversities                                                               
resulted in  greater economic  and social  impacts on  the state,                                                               
and  to  reduce  unplanned  and   unwanted  pregnancies,  it  was                                                               
necessary  to   ensure  better  access  to   the  most  effective                                                               
contraceptive  methods.   He referenced  an article  which stated                                                               
that  experts  suggested  that  programs  which  improved  family                                                               
planning  would be  the  best strategy  for  prevention of  child                                                               
maltreatment and would reduce FAS and pre-natal drug exposure.                                                                  
5:00:34 PM                                                                                                                    
CHAIR SPOHNHOLZ announced that SB 198 would be held over.                                                                       

Document Name Date/Time Subjects
SB 208 Fiscal Note 4.13.18.pdf HHSS 4/17/2018 3:00:00 PM
SB 208
SB 208 Sponsor Statement 2.27.18.pdf HHSS 4/17/2018 3:00:00 PM
SB 208
SB 208 Support Doc 1 2016 AFN Resolution 16-45.pdf HHSS 4/17/2018 3:00:00 PM
SB 208
SB 208 Support Doc 3 AST Annual Drug Report 2016.pdf HHSS 4/17/2018 3:00:00 PM
SB 208
SB 208 Support Doc 4 Economic Costs of Alchohol Abuse in AK MHTA.pdf HHSS 4/17/2018 3:00:00 PM
SB 208
SB 208 Support Doc 5 Protective_Factors_for_Youth_Substance_Abuse_and_Delinquency.pdf HHSS 4/17/2018 3:00:00 PM
SB 208
SB 208 Supprot Doc 2 AS 47.37.010.pdf HHSS 4/17/2018 3:00:00 PM
SB 208
SB 198 Sectional Analysis.pdf HHSS 4/17/2018 3:00:00 PM
HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Fiscal Note UA-AC 4.13.18.pdf HHSS 4/17/2018 3:00:00 PM
SB 198
SB 198 Sponsor Statement.pdf HHSS 4/17/2018 3:00:00 PM
HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Supporting Documents - ACT Letter of Support 4.13.18.pdf HHSS 4/17/2018 3:00:00 PM
SB 198
SB 198 Supporting Documents - Alaska Dispatch Article May 2016 4.13.18.pdf HHSS 4/17/2018 3:00:00 PM
SB 198
SB 198 Supporting Documents - GCDSE Support Letter & White Paper 4.13.18.pdf HHSS 4/17/2018 3:00:00 PM
SB 198
SB 198 Supporting Documents - JSAT Article 4.13.18.pdf HHSS 4/17/2018 3:00:00 PM
SB 198
SB 198 Supporting Documents - NEJM Study May 2012 4.13.18.pdf HHSS 4/17/2018 3:00:00 PM
SB 198
SB 198 PPVNH_SB 198_LARC study_testimony.pdf HHSS 4/17/2018 3:00:00 PM
HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 SisterSong LARCStatementofPrinciples.pdf HHSS 4/17/2018 3:00:00 PM
HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Guttmacher Policy Review.pdf HHSS 4/17/2018 3:00:00 PM
HHSS 4/19/2018 3:00:00 PM
SB 198