Legislature(2007 - 2008)CAPITOL 106
02/15/2008 01:30 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
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| Start | |
| Presentation: Bring the Kids Home Update | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
JOINT MEETING
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 15, 2008
1:37 p.m.
MEMBERS PRESENT
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
Representative Peggy Wilson, Chair
Representative Berta Gardner
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES
Senator Bettye Davis, Chair
Senator Joe Thomas, Vice Chair
Senator John Cowdery (via teleconference)
Senator Kim Elton
MEMBERS ABSENT
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
Representative Bob Roses, Vice Chair
Representative Anna Fairclough
Representative Wes Keller
Representative Paul Seaton
Representative Sharon Cissna
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES
Senator Fred Dyson
COMMITTEE CALENDAR
PRESENTATION: BRING THE KIDS HOME UPDATE
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
JEFF JESSEE, Chief Executive Officer
Alaska Mental Health Trust Authority (AMHTA)
Department of Revenue (DOR)
Anchorage, Alaska
POSITION STATEMENT: Presented the Bring the Kids Home Update.
BILL HERMAN, Senior Program Officer
Alaska Mental Health Trust Authority (AMHTA)
Department of Revenue (DOR)
Anchorage, Alaska
POSITION STATEMENT: Participated in the presentation of the
Bring the Kids Home Update.
BRITA BISHOP, Health Program Manager
Office of the Commissioner
Department of Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Participated in the presentation of the
Bring the Kids Home Update.
KAREN SCHAFF, Director
Adolescent Treatment Services
Volunteers of America Alaska
Anchorage, Alaska
POSITION STATEMENT: Participated in the presentation of the
Bring the Kids Home Update.
DEE FOSTER, M. S.; Director
Family Services
Anchorage Community Mental Health Services, Inc.
Anchorage, Alaska
POSITION STATEMENT: Participated in the presentation of the
Bring the Kids Homes Update.
WALTER MAJOROS, Executive Director
Juneau Youth Services, Inc.
Juneau, Alaska
POSITION STATEMENT: Participated in the presentation of the
Bring the Kids Home Update.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the joint meeting of the House and
Senate Health, Education and Social Services Standing Committees
to order at 1:37:23 PM. Representative Wilson was present at
the call to order. Representative Gardner arrived as the
meeting was in progress. Senators Davis, Elton, Cowdery (via
teleconference), and Thomas were present at the call to order.
^Presentation: Bring the Kids Home Update
1:38:33 PM
Chair Wilson announced that the only order of business would be
a presentation on the Bring the Kids Home Update.
1:39:16 PM
JEFF JESSEE, Chief Executive Officer, Alaska Mental Health Trust
Authority (AMHTA), Department of Revenue, introduced the panel.
He stated that he was proud to present one of the most
successful collaborative efforts between the AMHTA, the DHSS,
tribal health organizations, providers, and families. There was
a broad base of involvement which led to the positive results
from this partnership.
1:40:32 PM
BILL HERMAN, Senior Program Officer, Alaska Mental Health Trust
Authority, Department of Revenue (DOR), informed the committees
that there has been an increased use of out-of state residential
psychiatric treatment centers in the last ten years. This trend
was due to funding through Medicaid that directs funding streams
to higher levels of care, rather than to out-patient and early
intervention care. In fact, kids have been moving into higher
levels of disease and care. The goal of the Bring the Kids Home
Initiative is to reverse that trend and provide treatment for
kids closer to, or in, their homes which will hasten recovery.
An added benefit of providing treatment locally is to bring the
money spent on care, estimated at $40 million, back to Alaska.
Mr. Herman illustrated that, since 1998, in-state treatment has
remained level while out-of state referrals have increased to
749 kids.
1:43:11 PM
MR. JESSEE explained that the initiative was originated during
the Murkowski administration when the AMHTA trustees were asked
how to address the exponential growth in the use of out-of state
residential psychiatric treatment centers. The AMHTA then began
to work with the DHSS and developed strategies to invest in the
local infrastructure that was needed to provide treatment in
Alaska. Mr. Jessee pointed out that the state has leveraged the
AMHTA to invest millions of dollars in the development of this
infrastructure.
1:45:38 PM
BRITA BISHOP, Health Program Manager, Office of the
Commissioner, Department of Social Services (DHSS), stated that,
during FY 06 out-of state expenditures for residential care
decreased from about $40 million to about $36 million. The
number of kids who are placed outside has been decreasing, also.
The drop in expenditures corresponds with the drop in the
utilization of more expensive out-of state residential
psychiatric treatment center (RPTC) care and the increase of in-
state RPTC care. Projected utilization to FY 2013 is that the
number of children treated out-of state will be reduced to 500
children. Ms. Bishop stated that the goal is to end the
imitative at this time.
1:47:28 PM
MR. JESSEE referred to a chart showing the relative allocation
of community investment, in-state RPTC expenditures, and out-of
state RPTC expenditures. The chart showed a steady increase in
community investment and declining in-state and out-of state
RPTC care beginning in FY 05 and projected through FY 13. He
stressed that savings must be reinvested in the infrastructure
in Alaska to continue this trend. Mr. Jessee emphasized that
sustaining the increments of money needed to support the program
is a concern to legislators; however, one must understand that,
at the same time, the state is reducing total expenses by
reducing out-of state care. It is critical to understand that
the reinvestment strategy is effective in saving money. Mr.
Jessee further explained that, had the state initially built a
continuum of care for kids and families, it would have been
necessary for an enormous up-front investment in home based and
community based services and facilities. He opined that a
request for funding to build these facilities would not have
been funded; therefore, it is necessary for Alaska to invest in
RPTCs, in the short term, to bring, and keep, kids home.
However, DHSS and AMHTA do not want to continue to focus on
residential services because they are not the most successful,
they are disruptive to families, and they are expensive. He
concluded that future investments in home based and community
based care will keep kids out of residential care.
1:52:59 PM
MS. BISHOP presented tracking and progress information that was
determined by admissions and the number of clients served.
Also, other indicators from grants and service agreement funding
pools reflect how money is utilized and its impacts. The
Department of Behavioral Health (DBH) is also maintaining
indicators of client satisfaction and functional improvement.
The goal of tracking this information is to ensure that there is
improvement in outcomes and that there is not a decline in the
quality of service.
1:54:47 PM
MR. JESSEE pointed out that keeping a record of indicators is a
core part of the strategy of this program. A highly
sophisticated way to chart success and indicators will ensure
that investors can see results, and that, when necessary,
changes and improvements are made. He recalled the lesson of
the Alaska Youth Initiative. This program was not properly
managed or documented, and its funding was revoked. Mr. Jessee
turned to FY 09 projects and explained that the purpose of the
AMHTA funding is to accelerate the capacity of communities to
expand facilities and to stabilize the investments. He reminded
the committee of a troubled program in Valdez that was
successfully revived by AMHTA money. In fact, through this
initiative, trust money will support institutions, and the
legislature can support community services. Mr. Jessee
presented six primary strategies of the program's five year
plan. The strategy to build a skilled behavioral health work
force is particularly challenging. He then presented an
activities and estimated budget that called for general fund
mental health funding in excess of $20 million over five years.
He reiterated that the state must serve its citizens and that
the reinvestment strategy will continue to be successful with a
sufficient commitment from the legislature.
2:02:18 PM
MR. JESSEE continued to explain that the five year plan also
includes workforce and capital development. He noted that the
Denali Commission has contributed over $6 million in capital
funding for infrastructure projects, some of which will be
supported by federal funds after completion.
2:03:40 PM
REPRESENTATIVE GARDNER asked whether the RPTC in Eklutna is for
adult or kid residential care.
2:03:51 PM
MR. JESSEE said adolescent care.
2:03:58 PM
SENATOR THOMAS asked where the anticipated overall expense is
shown in the presentation.
2:04:31 PM
MR. JESSEE directed the committee's attention to the report
found in the committee packet that shows the projected total
costs of the initiative by fiscal year.
2:05:06 PM
SENATOR THOMAS surmised that the presenters are anticipating
costs in FY 13 to be less than the costs projected for FY 06.
2:05:19 PM
MR. JESSEE agreed, and added that inflation and rate adjustments
will impact the projections. He opined that this initiative
will not save money, but is designed to change where investments
are made.
2:06:39 PM
SENATOR THOMAS stated his agreement with the goal of spending
more of the mental health budget in-state and building the
economy.
2:06:57 PM
REPRESENTATIVE GARDNER asked whether the plan is also designed
to change outcomes.
2:07:06 PM
MR. JESSEE said yes.
2:07:16 PM
CHAIR WILSON stated that the plan is designed to save kids.
2:07:27 PM
KAREN SCHAFF, Director, Adolescent Treatment Services,
Volunteers of America Alaska, informed the committee that her
organization is involved in the Assertive Continuing Care
program, which is an evidence based practice designed to serve
kids who are coming out of RPTCs and other residential, or out-
patient programs. Beginning in 2006, 121 youths have been
served. The volunteers continue contacts with kids in their
homes, schools, or in the community, and reinforce coping
skills. She presented positive data as a result of continuing
care. Presently, volunteers are serving all of the youths
discharged from the McLaughlin Youth Center.
2:10:32 PM
CHAIR WILSON asked how many visits are made in a month.
2:10:43 PM
MS. SCHAFF said that volunteers see kids approximately four
times in the month prior to discharge, including group meetings.
She then explained that the ARCH program is a residential
expansion and replacement project located outside of Anchorage.
The present facility is in need of replacement and, with support
from the state and foundations, her organization is building a
new, 24 bed facility for youths with substance use disorders,
severe emotional disturbances, and co-occurring disorders.
2:12:34 PM
CHAIR WILSON asked whether this facility is similar to a halfway
house.
2:12:53 PM
MS. SCHAFF answered that this is a residential treatment center.
2:13:01 PM
CHAIR WILSON asked about the conditions of release for
residents.
2:13:20 PM
MS. SCHAFF informed the committee that, prior to release, there
is family therapy and support is established in home
communities. She opined that 80 percent of the residents are
from rural areas and are sent home on transitional passes to
prepare for their return to school and home life.
2:13:59 PM
MS. SCHAFF continued to say that the new facility will be
completed in June, 2008.
2:14:15 PM
MR. JESSEE pointed out that the state's contribution to this new
facility is $1.2 million towards a total cost of more than $6
million. He predicted that there will be a request for capital
funds in FY 2010.
2:15:21 PM
DEE FOSTER, M. S., Director, Family Services, Anchorage
Community Mental Health Services, Inc., stated that her
organization serves about 700 kids per year. Eighty percent of
those served suffer from child abuse and neglect, rather than
neurological disorders. The site has developed a child trauma
center and can access national expert information. During a 30
month time period, Anchorage Community Mental Health Services
served 107 clients and 65 percent successfully completed
treatment. Ms. Foster listed factors that indicate successful
treatment.
2:17:54 PM
REPRESENTATIVE GARDNER asked for how long a period clients are
monitored for success.
2:18:11 PM
MS. FOSTER stated that the follow-up procedure is now being
developed. Kids and families are in treatment from six to
twelve months with an emphasis on changing families and the
youth's environment.
REPRESENTATIVE GARDNER surmised that the 65 percent who
successfully completed treatment are those who finished their
recommended plan.
2:19:23 PM
MS. FOSTER concurred.
2:19:36 PM
CHAIR WILSON asked about the remainder.
MS. FOSTER explained that a percentage of families refuse to
participate. In answer to a question, she said that, of the 107
clients in the sample, 6 percent were returned to out-of state
care.
2:20:05 PM
SENATOR ELTON asked whether clients are wards of the state and
whether decisions about placement are made by family members.
2:20:36 PM
MS. FOSTER estimated that about 50 percent of her clients are
wards of the state.
2:20:49 PM
SENATOR ELTON observed that decisions are made by families or
surrogates.
2:20:58 PM
MS. FOSTER clarified that, even for children in state custody,
decisions are made jointly with their families.
2:21:13 PM
CHAIR WILSON described a situation with a family.
2:21:32 PM
MS. FOSTER further explained that measures are taken by mental
health services to also help family members.
2:21:58 PM
SENATOR THOMAS expressed his appreciation for the cost
comparisons [in the report in the committee packet] between
community and out-of state residential care.
2:22:38 PM
MS. FOSTER added that the costs to the Bring the Kids Home
program are combined with Medicaid costs; the actual cost to the
program for each child is $80 per month.
2:22:56 PM
SENATOR THOMAS noted that adding the cost of the new facilities
would indicate a lower expense for residential care per child.
2:23:25 PM
MS. FOSTER informed the committee that, as a child therapist,
she was shocked to see a child with attachment disorder sent
away from his family and community to an out-of state facility.
She said that this is not the appropriate treatment.
2:23:58 PM
REPRESENTATIVE GARDNER related her experience as a volunteer,
where she saw a six year old sent out-of state for eight years.
2:24:31 PM
MS. FOSTER opined that this treatment is inhumane.
2:24:34 PM
WALTER MAJOROS, Executive Director, Juneau Youth Services, Inc.,
introduced the Montana Creek Residential Program and the Black
Bear Transitional Living Apartments located in Juneau. The
Montana Creek residential program opened in August, 2007, and is
a 15 bed facility, including a gymnasium, and is designed for
kids with co-occurring disorders of mental health and chemical
dependency. The facility is co-ed and for youth aged 12 to 15.
Mr. Majoros stated that the facility was built with multiple
capital funding partners and without state funding for capital
expenses. The program is a partnership with the SouthEast
Alaska Regional Health Consortium (SEARHC) and is unique in that
regard; in fact, there is 100 percent reimbursement from
Medicaid for Native kids, which saves the state about $64,000
per child per year.
2:29:10 PM
SENATOR ELTON stated that successful treatment programs work
because of the quality of the service providers.
2:29:53 PM
MR. MAJOROS then described the Black Bear Transition Living
Apartments. This is not a residential treatment center, but a
13 bed apartment building, with a resident case manager, for
youth aged 18 to 21 years. Residents are youths coming from
residential programs, the foster care system, and the juvenile
justice system, or are runaways or homeless. Like Montana
Creek, this project was funded by a partnership and is meeting a
critical need. He advised that the Bringing the Kids Home
program does not support clients in the community when they
become young adults. His agency maintains the apartment with a
federal grant; however, its savings are gone. Mr. Majoros
opined that, to continue to serve kids in Alaska, the state must
invest in community based services.
2:33:12 PM
REPRESENTATIVE GARDNER asked for the capacity of both
facilities.
2:33:33 PM
MR. MAJOROS responded that Juneau Youth Services has a waitlist
of 100 kids who are waiting for services. Utilization of the
residential programs averages 98 percent to 100 percent.
2:34:12 PM
CHAIR WILSON asked whether there is support from the City and
Borough of Juneau.
2:34:28 PM
MR. MAJOROS said that there are small grants available and he is
hopeful for a larger contribution from the municipality in the
future.
2:34:38 PM
MR. JESSEE recalled that funding for one of Juneau Youth
Services early childhood programs was rejected by the Health and
Social Services Finance Subcommittee.
2:34:54 PM
CHAIR WILSON asked whether the home life of children is getting
better or worse.
2:35:45 PM
MR. MAJOROS expressed his belief that, because Juneau Youth
Services offers a full array of services, it is able to keep
families engaged.
2:36:14 PM
CHAIR WILSON re-stated her question.
2:36:33 PM
MR. MAJOROS opined that life is harder for kids and families
these days. In his experience, there are more severe problems;
for example, there were four or five youth suicides in Juneau
within the last year.
2:37:14 PM
MS. FOSTER expressed her feeling that there is more stress on
families than 20 years ago.
2:37:45 PM
ADJOURNMENT
There being no further business before the committees, the joint
meeting between the House Health, Education and Social Services
Standing Committee and the Senate Health, Education and Social
Services Standing Committee was adjourned at 2:37 p.m.
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