Legislature(2005 - 2006)CAPITOL 106
02/01/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
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| Overview: Division of Behavioral Health | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 1, 2005
3:02 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Tom Anderson
Representative Vic Kohring
Representative Lesil McGuire
Representative Paul Seaton
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
OVERVIEW: DIVISION OF BEHAVIORAL HEALTH, DEPARTMENT OF HEALTH
AND SOCIAL SERVICES
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
BILL HOGAN, Director
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented an Overview of the Division of
Behavioral Health.
PATRICIA SENNER, Family Nurse Practitioner
Covenant House Alaska
Anchorage, Alaska
POSITION STATEMENT: Described the problems with caring for youth
with mental and substance abuse issues, and suggested being a
part of the new Bring the Kids Home initiative.
KARA NYQUIST, Attorney
Covenant House Alaska
Representative, Alaska Association of Homes for Children (AAHC)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of the Bring the Kids
Home initiative and made suggestions.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education, and
Social Services Standing Committee meeting to order at 3:02:03
PM. Representatives Seaton, Wilson, and Kohring were present at
the call to order. Representatives Cissna, Gardner, Anderson,
and McGuire arrived as the meeting was in progress.
^OVERVIEW: DIVISION OF BEHAVIORAL HEALTH
CHAIR WILSON announced that the only order of business would be
an overview of the Division of Behavioral Health.
3:03:31 PM
BILL HOGAN, Director, Division of Behavioral Health, Department
of Health and Social Services (DHSS), presented an overview of
the division. Mr. Hogan pointed out that the Division of
Behavioral Health has been working with federal, regional, and
community partners to transform the way health care and
substance abuse services are provided in Alaska. He reminded
the committee that on July 1, 2003, DHSS formed the new Division
of Behavioral Health by integrating the Division of Mental
Health, the Division of Alcohol and Drug Abuse; the Office of
Fetal Alcohol Syndrome; and various staff of the Divisions of
Public Health and Medicaid.
3:04:19 PM
MR. HOGAN noted that the division has responsibility for
developing, implementing, and managing a "welcoming, accessible,
continuous, comprehensive, and integrated behavioral health
services system based on sound policies, effective practices,
and partnerships." He said that the division wants to do a
better job for people with both a mental health and a substance
abuse disorder.
3:05:20 PM
MR. HOGAN stated that the division supports an array of
services, including prevention, treatment, rehabilitation, and
aftercare. The structure of the division includes a steering
committee made up of various entities and two task forces: an
external one which includes other agencies and an internal one
made up of senior management.
MR. HOGAN discussed the new focus on providing help for
individuals with co-occurring disorders. Between 50 and 75
percent of clients have both mental health and substance abuse
disorders, and he said the goal is to create an integrated
system. He said the state has separate statutes for mental
health and substance abuse. Currently the system is financed
through grants and fee-for-service Medicaid, and Mr. Hogan
thinks there is a better way to fund it. He said that Alaska is
one of seven states that received a co-occurring disorder grant
from the federal Substance Abuse and Mental Health Services
Administration.
3:11:02 PM
MR. HOGAN informed the committee that the division is working
with the University of Alaska and the Alaska Mental Health Trust
to determine what kind of work force the state will need for the
new integrated system. The division is providing technical
assistance in the communities of Tok, Wrangell, Kodiak,
Unalaska, Palmer/Wasilla, and Nenana. Mr. Hogan said the
division wants to move toward an efficient service-delivery
system that focuses on what the communities, individuals, and
families need by promoting shared services.
3:13:10 PM
MR. HOGAN spoke of the new web-based Alaska Automated
Information Management System. Health care providers use it to
obtain medical records and as a billing system. The system has
allowed the division to analyze the "outcomes" of individuals
being served by its mental health and substance abuse programs
"between intake and discharge." He summarized the analysis as
follows: Based on 4,000 clients, 60 percent reported an increase
in productive activities; 70 percent reported a reduction in
physical health problems; 70 percent reported a reduction in not
having the ability to pay for basic needs, such as food and
clothing; and 21 percent reported a reduction in homelessness.
3:19:17 PM
MR. HOGAN introduced the Bring the Kids Home initiative. He
said there are "a number of kids in out-of-state residential
psychiatric treatment placements, and we want to not only bring
those kids home to Alaska to stay with their own families and be
in their own communities, but we also want to keep kids from
going out of state."
3:20:58 PM
MR. HOGAN said the division is proposing four substance abuse
prevention initiatives: 1) Reach Out Now, a community and
school-based program which works with 11- and 12-year olds, 2)
Leadership Initiative, designed to fight underage drinking, 3)
Local Options Campaign, which will work with villages in efforts
to go dry or damp, and 4) Multimedia Education Campaign, which
will be state wide.
3:23:03 PM
MR. HOGAN reported that the division is actively involved in
disaster response to take care of the emotional needs of victims
of natural and man-made disasters. He also highlighted the
division's vision of partnering with state, federal, faith-
based, and volunteer organizations to promote healthy
communities.
3:24:36 PM
REPRESENTATIVE GARDNER asked about Mr. Hogan's comment on
disaster response.
MR. HOGAN responded that it is important to be available for
people after disasters because an increase in drug and alcohol
abuse often follows.
3:27:01 PM
REPRESENTATIVE CISSNA expressed her support for the Bring the
Kids Home initiative. She asked about a new facility for youth
and wondered if the home is the best place for children, not
"large warehousing of kids."
3:28:15 PM
MR. HOGAN said the intent is to build the full continuum of
care. Families are important, so even in large facilities he
feels that there is a need to have a home-like environment.
3:29:24 PM
CHAIR WILSON asked Mr. Hogan to explain the program in the six
communities he mentioned.
MR. HOGAN said the division chose a diverse array of communities
where a contractor conducts meetings and helps each community
explore the process of integrating services for people with co-
occurring disorders. Wrangell has already merged mental health
with substance abuse care and has thereby increased its service
capacity by 200 percent. Mr. Hogan said such administrative
efficiency will allow money to be redirected to serve more
people.
3:31:46 PM
REPRESENTATIVE GARDNER asked what the legislature can do to
promote the division's work, "aside from the funding."
MR. HOGAN said he did not want to start at the statutory level;
the division will start with standards, build up through
regulations, and then assess the need for statutes.
3:32:54 PM
REPRESENTATIVE SEATON asked if the newly reorganized human
resources program in the Department of Administration is helping
the division's efficiency level.
3:33:30 PM
MR. HOGAN said the division does not generally provide direct
services, instead it directs 300 grants to 135 grantees, which
are mostly private, non-profit groups, and so the organizational
change in the state's human resources program has had no impact.
REPRESENTATIVE SEATON asked if those groups could partner with
the state's human resources program.
MR. HOGAN responded that he thinks private non-profits have two
missions: business efficiency and providing services. He is
familiar with the reorganization of the human resources program
but would have to explore Representative Seaton's suggestion.
3:35:43 PM
CHAIR WILSON said that the work force for health care will see a
huge need in the near future, and in Alaska "we don't have the
people to do it." She requested that Mr. Hogan expound on the
discussion of what the University of Alaska is doing.
MR. HOGAN said there are various endeavors, but it will take
several years before an impact is seen. Health care will have
many needs at the entry level, as well as people with masters
and PhD degrees. In conjunction with the university, the state
envisions starting a program in psychology. He expressed his
hope that these trained psychologists will be directed to work
in community settings and not enter private practice.
3:37:39 PM
MR. HOGAN stated that the intent is to expand bachelors and
master's degree programs in social work. There is preliminary
planning for a training academy for rural behavioral health. He
said there is a need for orientation for workers moving to
Alaska from elsewhere, but he also thinks there is good
potential "to grow our own" behavioral health experts.
3:39:02 PM
CHAIR WILSON asked about incentives for workers to stay in
Alaska.
MR. HOGAN responded that the division has talked about stipends,
scholarships, and loan forgiveness programs, but the current
proposal does not include such incentives.
CHAIR WILSON expressed her belief that the need for these
workers is "phenomenal." She said that by 2010 the state will
need 4,000 more nurses. "We definitely need the training," she
said.
3:40:21 PM
MR. HOGAN told the committee that he has an analysis of those
predicted shortages.
REPRESENTATIVE CISSNA said she has been working with the
Anchorage School District to develop career ladders in secondary
schools. She added her understanding that by the fourth grade,
students have already de-selected careers. She suggested
statewide curricula that allows students to look at health
careers as "viable things that will keep them in their community
and give them good, sustainable jobs."
3:42:09 PM
MR. HOGAN said Representative Cissna was correct; people who
already have headed toward the health care field aren't enough.
3:42:45 PM
REPRESENTATIVE SEATON questioned how the state could get people
trained for community service and not have them move to private
practice.
3:43:42 PM
MR. HOGAN believed the state has to create an incentive not a
mandate, and he is not sure how it can be done, especially since
the money is better in private practice.
3:44:59 PM
REPRESENTATIVE MCGUIRE expressed that the incentives within the
Public Health Service program are good models. She brought up
the topic of traumatic brain injury (TBI), a physical injury
that leads to mental disorders, and asked how TBI services fall
into the new integrated health model.
3:46:01 PM
MR. HOGAN responded that the division received a grant from the
Health Resources Services Administration for TBI. The money is
helping to create a TBI advisory board. He thinks TBI service
should not be completely separate. Since July 2004, all
grantees track all individuals regarding TBI, fetal alcohol,
substance abuse, and mental health problem.
3:48:41 PM
REPRESENTATIVE MCGUIRE said the state has a high rate of TBI,
and she feels that there needs to be more focus on it.
3:49:35 PM
REPRESENTATIVE ANDERSON reported that he was visited by
advocates from the Alaska Medical Association asking him to
sponsor legislation to enhance the ability of foreign physicians
to work in Alaska because of shortages in the state.
3:50:13 PM
MR. HOGAN agreed there is a shortage of psychiatric doctors,
especially child psychiatrists, but one caveat is that
psychiatry is practiced in a cultural context which might hamper
the proficiency of foreign specialists.
3:51:25 PM
REPRESENTATIVE CISSNA expressed how different everyone's needs
are and that there are various specialists that can zero in on
particular problems, so she asked how the division can meet
diverse needs while integrating services.
3:52:39 PM
MR. HOGAN said he envisioned a continuum of services, with some
basic services at the village level and a broader array of
services in Anchorage where there would be more specialists. He
added that the division's next big step is integrating primary
care with behavioral care.
3:53:50 PM
PATRICIA SENNER, Family Nurse Practitioner, Covenant House
Alaska, told the committee that her responsibility is to
evaluate the roughly 500 youth a year that come through the
Covenant House crisis center residential program for physical
and mental health problems. She stated that she was acutely
aware of the mental health needs of Alaska's youth. The key
risk factor for these youth is [substance abuse] by parents;
approximately 80 to 90 percent of them have been either
physically or sexually abused, and most have been prenatally
exposed to alcohol or drugs. Most of these youths have had
interactions with the mental health system, and a few of them
suffer from mild mental retardation and schizophrenia, and many
suffer from depression, attention deficit and hyperactivity
disorder, poor anger management, post traumatic stress disorder,
and sleep disorders. She said that there needs to be a paradigm
shift for youth services because many of them have a disability
that can't be cured, and she gave an example of people with
fetal alcohol spectrum disorder (FASD) who have "poor executive
functioning, they have extreme difficulties planning and
connecting causes with effect, they live in the here-and-now and
have difficulties planning for the future. They have very poor
impulse control." Adolescence is particularly difficult for
FASD patients, and they often end up in residential programs
because of lack of sound judgment. Research has shown that 80
percent of youth with FASD end up in supervised settings.
3:57:42 PM
MS. SENNER said that the current approach of sending youths to
residential mental health facilities is expensive and
ineffective. She said the Covenant House regularly gets youth
recently discharged from an out-of-state residential facility
without long term discharge plans and only a couple weeks worth
of medication. It often takes months to obtain their records,
she reported.
MS. SENNER stressed that "we need to give thought to how we are
going to provide care to these youths with a lifetime
developmental disability." She stated that their mental health
issues can be handled on an out-patient basis, but "what is
desperately needed is better [indecipherable} for dealing with
their poor decision impulsivity which in many cases is caused by
brain damage."
3:59:04 PM
MS. SENNER said that providers have put an emphasis in getting
these kids out of bad home environments. Often the foster or
adoptive parents can't handle the problems and then the kids end
up in facilities. She stated the Covenant House wants to be
part of the Bring the Kids Home initiative.
4:00:18 PM
KARA NYQUIST, Attorney, Covenant House Alaska; Representative,
Alaska Association of Homes for Children (AAHC), Anchorage. She
said AAHC is made up of non-profit, community-based residential
programs for homeless and runaway youth. She added that AAHC
has been meeting for about 18 years, and the last three years
they have focused on bringing children home, so they are happy
with the new initiative.
4:01:38 PM
MS. NYQUIST noted that the division's Bring the Kids Home plan
places an emphasis on "gate keeping," which she supports. She
said that many of the youth are in inappropriate levels of care
outside of the state, and they could have been helped locally
with better success. She pointed out that last year the state
spent about $40 million to serve a few hundred kids in out-of-
state care. Looking at programs in AAHS, a similar budget
served over 10,000 kids. Twenty-five percent of their budget
comes from the state through grants, and the rest comes from
fundraising, corporate donations, and federal and private
grants.
MS. NYQUIST said institutional care is not the answer for many
of these youths, and "we do not think there is a large need for
more than one institution in the state." She stated that
community-based programs can serve these kids. She added that
there needs to be a lifespan plan for them. When they don't
have a plan for aftercare they end up in the court system, and
she also noted that Alaska ranks 50th in the nation for teen
violent suicide deaths.
4:05:29 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:05 p.m.
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