Legislature(2015 - 2016)CAPITOL 106

11/03/2015 10:00 AM HEALTH & SOCIAL SERVICES

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Audio Topic
10:04:04 AM Start
10:05:18 AM Presentation: Proposals for Increasing Wellness and Prevention to Reduce the Number of People Accessing Medicaid or Other Health Care Services, Initiatives for State Government, Social Programs and General Practice.
05:30:01 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Recessed to 4:00 p.m. Today --
+ Presentations by Committee Members & Other TELECONFERENCED
Invited Guests:
Proposals for increasing wellness and prevention
to reduce the number of people needing to access
Medicaid or other health care services
- Initiatives for state government, social
programs, and general practice
-- Testimony <Invitation Only> --
Presenters:
Rep. Talerico; Nelly Ayala; Rep. Tarr;
Rep. Seaton
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                        November 3, 2015                                                                                        
                           10:04 a.m.                                                                                           
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Paul Seaton, Chair                                                                                               
Representative Liz Vazquez, Vice Chair                                                                                          
Representative Neal Foster                                                                                                      
Representative David Talerico                                                                                                   
Representative Geran Tarr                                                                                                       
Representative Adam Wool                                                                                                        
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Louise Stutes                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION: PROPOSALS  FOR INCREASING  WELLNESS AND  PREVENT TO                                                               
REDUCE THE  NUMBER OF PEOPLE  ACCESSING MEDICAID OR  OTHER HEALTH                                                               
CARE SERVICES, INITIATIVES FOR  STATE GOVERNMENT, SOCIAL PROGRAMS                                                               
AND GENERAL PRACTICE.                                                                                                           
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JEFF GOODELL, Building Manager                                                                                                  
Maintenance                                                                                                                     
Legislative Administrative Services                                                                                             
Legislative Affairs Agency                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Discussed the current seismic retro-fit                                                                  
construction project, maintenance department, and safety issues                                                                 
within the Capitol building.                                                                                                    
                                                                                                                                
NELLY AYALA, RN, MSN                                                                                                            
Division of Public Health, Program Manager                                                                                      
Department of Health & Social Services                                                                                          
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented  Chronic Disease Prevention Health                                                             
Promotion, Diabetes Prevention and Control.                                                                                     
                                                                                                                                
PATRICK SIDMORE, Planner                                                                                                        
Alaska Mental Health Board                                                                                                      
Advisory Board on Alcoholism and Drug Abuse                                                                                     
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Discussed  links  to  health and  economic                                                             
outcomes.                                                                                                                       
                                                                                                                                
JAY BUTLER, Chief Medical Officer/Director                                                                                      
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Clarified the source of  the three research                                                             
papers.                                                                                                                         
                                                                                                                                
MARK ERICKSON, M.D.                                                                                                             
Alaska Psychiatric Institute (API)                                                                                              
Anchorage, Alaska                                                                                                               
POSITION   STATEMENT:     Testified  regarding   vitamin  D   and                                                             
depression.                                                                                                                     
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
10:04:04 AM                                                                                                                   
                                                                                                                                
CHAIR PAUL  SEATON called  the House  Health and  Social Services                                                             
Standing   Committee    meeting   to   order   at    10:04   a.m.                                                               
Representatives Foster, Vazquez, Talerico,  Tarr, and Seaton were                                                               
present at  the call  to order.   Representative Wool  arrived as                                                               
the meeting was in progress.                                                                                                    
                                                                                                                                
^PRESENTATION: PROPOSALS  FOR INCREASING WELLNESS  AND PREVENTION                                                               
TO  REDUCE  THE NUMBER  OF  PEOPLE  ACCESSING MEDICAID  OR  OTHER                                                               
HEALTH CARE  SERVICES, INITIATIVES  FOR STATE  GOVERNMENT, SOCIAL                                                               
PROGRAMS AND GENERAL PRACTICE.                                                                                                  
PRESENTATION:  PROPOSALS FOR  INCREASING WELLNESS  AND PREVENTION                                                           
TO  REDUCE  THE NUMBER  OF  PEOPLE  ACCESSING MEDICAID  OR  OTHER                                                           
HEALTH CARE  SERVICES, INITIATIVES  FOR STATE  GOVERNMENT, SOCIAL                                                           
PROGRAMS AND GENERAL PRACTICE.                                                                                              
                                                                                                                              
10:05:18 AM                                                                                                                   
                                                                                                                                
CHAIR SEATON  reminded the committee  that today it  would review                                                               
different proposals  and opportunities  to help people  stay well                                                               
and;  therefore,  avoid  placing  a burden  on  the  health  care                                                               
system.                                                                                                                         
                                                                                                                                
10:05:52 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE TALERICO described himself  as a "rubber meets the                                                               
road"  type   of  fellow   and  that   health  safety   and  safe                                                               
environments  have always  been a  concern.   He explained  it is                                                               
likely  that  3   out  of  100  workers  will   file  a  worker's                                                               
compensation claim in  the United States, and there  may be 11-13                                                               
fatalities today  in the  United States'  workplace.   He advised                                                               
the United States has lived  with those statistics for quite some                                                               
time  and  the  goal  of   safety  professionals  throughout  the                                                               
country,  and  hopefully  all  private  business  and  government                                                               
organizations, is to  bring the number to zero.   He offered that                                                               
a person  witnessing a  fatality at  the workplace  can sometimes                                                               
take  years to  recover  and  its traumatic  effects  can take  a                                                               
person to  a numb  stage.   He offered  that safety  officers are                                                               
concerned with  an avalanche of "those  things" happening because                                                               
the focus suddenly  goes away from the actual job  and the safety                                                               
portions of it.                                                                                                                 
                                                                                                                                
10:08:46 AM                                                                                                                   
                                                                                                                                
JEFF   GOODELL,   Building  Manager,   Maintenance,   Legislative                                                               
Administrative  Services,  Legislative  Affairs  Agency,  advised                                                               
that   the  maintenance   department   purchased  updated   safer                                                               
equipment,  such as  a  saw-safe  table saw  that  will shut  off                                                               
should a  human part, wet wood,  or a piece of  metal contact the                                                               
blade.   He explained that  additional safety measures  have been                                                               
taken,  such as:  air filter  boxes  installed in  the shop;  and                                                               
safety gear is required and should  an individual work on a piece                                                               
of equipment  without safety equipment, the  individual is banned                                                               
from that  piece of equipment  for a period  of time just  to get                                                               
the message across  as eyes, ears, and lungs  are very important.                                                               
As far as the building in  general for all of its tenants, within                                                               
the  seismic retro-fit  all of  the Asbestos  Containing Material                                                               
(ACM) is  being removed that "we  are in contact with  within the                                                               
project delineation."   He pointed out that  the Capitol Building                                                               
was  built during  the late  1920s -  early 1930s,  and pipe  was                                                               
insulated  with  asbestos  wrap.   He  advised  he  has  received                                                               
authority in  areas outside of  the project but that  are exposed                                                               
to  eye sight,  and  people's  access, to  have  ACM removed  for                                                               
everything  within his  reach.   Although  it  is expensive,  the                                                               
United States  is targeting buildings  for ACM removal,  and even                                                               
though he  does not have  that luxury,  everything he can  get to                                                               
has been removed by the  abatement contractor, he explained.  Mr.                                                               
Goodell noted  that "we" are  doing our  best to improve  the air                                                               
quality in  the building, and within  that goal a number  of heat                                                               
recovery and  ventilation (HRVs)  units will be  implemented next                                                               
year.  He noted there is a  three-year process for Phase 2 of the                                                               
retro-fit, and  commented that  he will  doing everything  he can                                                               
physically  and  economically  to  improve  the  quality  of  the                                                               
building.                                                                                                                       
                                                                                                                                
10:13:44 AM                                                                                                                   
                                                                                                                                
CHAIR SEATON asked for more  detail regarding safety exercises or                                                               
meetings.                                                                                                                       
                                                                                                                                
MR.  GOODELL responded  that daily  and weekly  they discuss  any                                                               
issue  personnel is  interested  in.   Previously bulletins  were                                                               
used, but many  of the purchased bulletins  predominantly did not                                                               
pertain to this particular environment  and they are in search of                                                               
a "more  practical, more maintenance  based" weekly  bulletin, he                                                               
advised.    He related  that  he  is "constantly"  reminding  his                                                               
maintenance  and  custodial staff  about  safety,  and should  an                                                               
individual notice something to bring it forward.                                                                                
                                                                                                                                
10:15:25 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE FOSTER  recalled previous  safety meetings  he had                                                               
been involved with  and described them as important  in that they                                                               
can save  a life, limb, [or  injury].  He asked  whether there is                                                               
anything  the committee  or  state can  do to  "get  back to  the                                                               
basics," and  suggested a possible safety  education campaign for                                                               
public awareness.                                                                                                               
                                                                                                                                
10:16:31 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE TALERICO  offered that it is  encouraging that Mr.                                                               
Goodell presented  today as  one of his  main focuses  are safety                                                               
activities,  and that  safety is  considered on  a routine  basis                                                               
under  his  leadership.    He  pointed  out  that  Mr.  Goodell's                                                               
subordinates are well  aware of his commitment to  safety in that                                                               
it provides a better environment  for the worker.  Representative                                                               
Talerico commented  that everyone  in a management  or leadership                                                               
role, whether  government or private,  should take a  safety role                                                               
and lead  as there are  tremendous educational  opportunities and                                                               
suggested googling safety.  He said, "safety first."                                                                            
                                                                                                                                
10:18:42 AM                                                                                                                   
                                                                                                                                
CHAIR   SEATON  offered   appreciation   that   the  subject   of                                                               
maintenance  safety  is  discussed   and  noted  that  the  state                                                               
workforce includes  secretaries and office personnel.   He opined                                                               
that feedback  has not  been obtained  from the  commissioners of                                                               
other  departments as  to how  they address  ongoing or  possible                                                               
safety  problems  of every  shift  as  there  have been  lots  of                                                               
workman's compensation  claims within  the office personnel.   He                                                               
suggested  a  letter  to each  commissioner  from  the  committee                                                               
inquiring as  to what  they are  doing with  each class  of their                                                               
personnel to  promote safety and,  thereby, not  requiring health                                                               
care.   He  asked  Representative Talerico  for more  information                                                               
regarding his previous safety meetings and employment.                                                                          
                                                                                                                                
10:21:08 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE  TALERICO answered  that  many private  industries                                                               
[hold safety meetings],  spurred by reducing the  costs of health                                                               
care  and insurance,  and  noted that  workers  often support  an                                                               
entire family.  He explained  that many workplaces have adopted a                                                               
"safety share;"  a daily event  for work crews or  individuals to                                                               
ascertain  that an  awareness is  brought forth  to be  alert and                                                               
safe  in  a work  environment.    He  related that  safety  share                                                               
requires  participation and  everyone involved  is encouraged  to                                                               
routinely share a  safety moment, such as sharing  something of a                                                               
very serious nature  that may not be obvious to  some people.  He                                                               
remarked  that he  advises  his  staff that  one  of the  largest                                                               
workplace injuries is  referred to as "slips,  trips, and falls,"                                                               
and sometimes  the daily reminder  can not only avoid  the injury                                                               
but  the costs  associated  with  the injury.    He offered  that                                                               
recently it  was actually  safer to work  in the  mining industry                                                               
than working in a big box store,  which may have a lot to do with                                                               
focus.  The Occupational Safety  and Health Administration (OSHA)                                                               
has very  distinct, rigid safety rules  to abide by and  over the                                                               
years  many  people  covered  by   the  Mine  Safety  and  Health                                                               
Administration (MSHA) have determined the  best way to do this is                                                               
to   get   very   aggressive    with   their   safety   programs.                                                               
Consequently,  he  explained, workers  are  safer  and they  save                                                               
money, yet beyond  that there is a quality of  life issue for the                                                               
injured worker.   He agreed that the committee  should learn from                                                               
all  of  the departments  where  they  are  on safety  for  their                                                               
employees.                                                                                                                      
                                                                                                                                
10:25:03 AM                                                                                                                   
                                                                                                                                
CHAIR SEATON commented that the  House Health and Social Services                                                               
Standing   Committee  is   looking   at  initiatives,   projects,                                                               
proposals, and  procedures to  ascertain that  the state  has not                                                               
only a healthy workforce, but  healthy citizens.  He related that                                                               
a number  of legislators went  to the  North Slope and  stayed at                                                               
the ConocoPhillips Alaska facilities for  lunch and noted that at                                                               
every stairwell  is a "3  points of contact" sign  requiring that                                                               
all workers use  the handrail.  Many times  staff and legislators                                                               
do not  use the  handrail and  may trip  and, he  said, hopefully                                                               
there will be other ideas to  share with the legislators of their                                                               
responsibilities with their staff.                                                                                              
                                                                                                                                
10:26:34M                                                                                                                     
                                                                                                                                
REPRESENTATIVE FOSTER admitted to being  the latest victim in the                                                               
area of texting and falling down the stairs.                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO  related that  the "3 points  of contact"                                                               
is a  standard in most  industrial sites, and under  MSHA rulings                                                               
during an inspection  of a company if MSHA  witnesses someone not                                                               
utilizing  "3  points  of  contact" when  using  a  staircase  or                                                               
getting  on  or  off  pieces  of equipment  it  is  an  automatic                                                               
citation and fine because it keeps people safe.                                                                                 
                                                                                                                                
CHAIR  SEATON  expressed  appreciation  on  focusing  on  safety,                                                               
together with nutrition and staying off drugs.                                                                                  
                                                                                                                                
10:27:36 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE VAZQUEZ  mentioned areas in office  work that need                                                               
adjusting in  the focus for  safety, such  as the correct  way to                                                               
pick  up items,  avoiding  eye strain,  stretch  to avoid  muscle                                                               
strain, and carpel tunnel syndrome.                                                                                             
                                                                                                                                
REPRESENTATIVE  TALERICO expressed  appreciation  to Mr.  Goodell                                                               
for  staying "on  top of  this" and  expressed confidence  in his                                                               
leadership.                                                                                                                     
                                                                                                                                
                                                                                                                                
10:28:57 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE WOOL asked whether  anyone has lost any appendages                                                               
on the table saw here.                                                                                                          
                                                                                                                                
MR.  GOODELL responded  no, not  on his  watch or  the few  years                                                               
prior to his employment.                                                                                                        
                                                                                                                                
CHAIR  SEATON stated  that the  committee will  solicit from  the                                                               
different  departments   how  they  are  attempting   to  control                                                               
[injuries] and their procedures for health in their workplace.                                                                  
                                                                                                                                
10:29:44 AM                                                                                                                   
                                                                                                                                
CHAIR SEATON  announced the next  order of business would  be the                                                               
presentation of Diabetes Prevention and Control.                                                                                
                                                                                                                                
10:30:27 AM                                                                                                                   
                                                                                                                                
NELLY  AYALA,  RN,  MSN,  Division   of  Public  Health,  Program                                                               
Manager, Department of Health &  Social Services, offered a power                                                               
point presentation  to explain what  the Diabetes  Prevention and                                                               
Control Program  is doing to  help people stay well  and increase                                                               
diabetes awareness  in Alaska.   She turned to slide  2: "Chronic                                                               
Disease Prevention & Health Promotion,"  and said the slide shows                                                               
a whole person  with many chronic diseases, and that  each of the                                                               
chronic  diseases  risk factors  are  addressed  by projects  and                                                               
programs  within  the  Chronic   Disease  Prevention  and  Health                                                               
Promotion.                                                                                                                      
                                                                                                                                
MS. AYALA turned  to slide 3: "What is Diabetes."   She said that                                                               
diabetes  is a  problem in  the  body that  causes blood  glucose                                                               
(sugar) to  raise higher  than normal.   She advised  that within                                                               
this presentation,  the discussion  is Type 2  diabetes as  it is                                                               
the  most common  form of  diabetes  in the  country and  Alaska.                                                               
With regard to Type 1,  the estimates are that approximately 5-10                                                               
percent  of children  are affected,  she  advised.   Type 2  risk                                                               
factors include: weight;  inactivity; fat distribution especially                                                               
around  the mid-center,  belly  or abdomen;  family  history -  a                                                               
sibling or  parent with Type 2  diabetes; age - as  a person ages                                                               
Type 2 is more commonly seen  and quality of life is important in                                                               
aging; race - Alaska Native,  African Americans, Hispanics, Asian                                                               
Pacific  Islanders;  pre-diabetes   diagnosis  -  estimated  that                                                               
within five-years  diabetes will occur unless  lifestyle behavior                                                               
is  changed; Gestational  diabetes -  diabetes while  pregnant or                                                               
having a  baby nine pounds or  heavier puts the woman  at greater                                                               
risk  of  type  2  diabetes;   and  Polycystic  Ovarian  Syndrome                                                               
increases risk for diabetes.                                                                                                    
                                                                                                                                
10:33:38 AM                                                                                                                   
                                                                                                                                
MS.  AYALA   turned  to  slide   4:  "Diabetes   and  Prediabetes                                                               
Prevalence in  Alaska (BRFSS 2013),"  and explained the  chart as                                                               
data  from the  Behavioral Risk  Factor Surveillance  System 2013                                                               
(BRFSS), which is  the nation's premier system  of health related                                                               
telephone surveys collecting [indisc.]  data about United States'                                                               
residents regarding  their health risk behaviors,  chronic health                                                               
conditions, and use of all  preventive services.  She advised the                                                               
chart  represents the  percentage of  Alaskans age  18 and  older                                                               
diagnosed  with pre-diabetes  and diabetes.   She  explained that                                                               
pre-diabetes is  a condition  in which  individuals have  a blood                                                               
glucose level higher than normal  but not high enough to classify                                                               
as  diabetes.   She  said  the  people  listed in  the  numerator                                                               
answered the question  yes, as to whether they were  ever told by                                                               
a  health  care  professional  they had  diabetes  or  were  pre-                                                               
diabetic,  border-line  diabetic  or diabetic  during  pregnancy.                                                               
The  denominator represents  all  adults age  18  and older  that                                                               
responded  to the  diabetes and  prediabetes question,  excluding                                                               
all unsure  answers.   She pointed out  that the  chart indicates                                                               
6.5  percent  out  of  100  Alaskan women  are  estimated  to  be                                                               
diabetic, while  10.5 out of  100 Alaskan women are  estimated to                                                               
be pre-diabetic.   Individuals age  65 and older are  at greatest                                                               
risk for  pre-diabetes and diabetes;  45-64 age group  are second                                                               
largest; and the 34-44 age group is slowly rising, she advised.                                                                 
                                                                                                                                
10:36:47 AM                                                                                                                   
                                                                                                                                
MS. AYALA turned  to slide 5:   "Age-Adjusted Diabetes Prevalence                                                               
in  Adults, Alaska  (BRFSS)" and  said the  graph indicates  that                                                               
from 1991-2013 there is a  slow increase with time depending upon                                                               
issues.   Slide 6:  "Cost of  Diabetes."   She explained  that in                                                               
2010,  the annual  cost of  care for  the U.S.  Medicaid diabetes                                                               
group is  approximately $14,229;  and for those  without diabetes                                                               
in the same age group on  Medicaid was approximately $4,568.  She                                                               
pointed to 2012, and said for  the Medicaid diabetes group in the                                                               
United States, the estimated cost  was $13,741; and those without                                                               
diabetes  was  $5,853.    Table 2:  "Incurred  cost  of  Medicaid                                                               
beneficiaries 20 years  and older in AK"  represents numbers from                                                               
the  2014  Evergreen Report.    She  pointed  out that  the  2012                                                               
diabetes Medicaid  beneficiaries included 5,938  people, incurred                                                               
cost per diabetic beneficiary was  $26,468, and the total cost of                                                               
diabetic  beneficiary   was  $157,167,553.     [The   chart  also                                                               
indicates the costs for 2013 and 2014.]                                                                                         
                                                                                                                                
10:38:55 AM                                                                                                                   
                                                                                                                                
MS.  AYALA turned  to slide  7: "The  Key is  Prevention."   Risk                                                               
factors for Type 2 diabetes  include: inactivity, obesity and now                                                               
smoking has been  shown as a causal  relationship, she explained.                                                               
Educating  people  on  the major  complications  of  diabetes  is                                                               
important because this year the  CDC estimates that one out three                                                               
people  do not  know they  have  pre-diabetes, and  one out  four                                                               
people do not know they have diabetes, she said.                                                                                
                                                                                                                                
MS.  AYALA  turned   to  slide  8:  "Among   Alaska  Adults  with                                                               
Diabetes."  She  offered that it is known that  19 percent smoke,                                                               
30 percent  are inactive, and 59  percent are obese.   She opined                                                               
she is unclear  as to how many of the  individuals knew they were                                                               
diabetic.   Ms. Ayala turned  to slide  9: "What is  the Diabetes                                                               
Prevention  and Control  Program?"    She said  it  is a  program                                                               
housed  by  the Chronic  Disease  Prevention  & Health  Promotion                                                               
Division, and  works hand-in-hand with Obesity,  Tobacco, Cancer,                                                               
and  Cardiovascular Disease  Prevention  and  Stroke Programs  to                                                               
prevent these diseases.   She explained that  the program focuses                                                               
mainly on  Type 2 diabetes  for adults  in Alaska, and  access to                                                               
resources for those affected by Type 2 diabetes.                                                                                
                                                                                                                                
10:41:03 AM                                                                                                                   
                                                                                                                                
MS. AYALA  turned to slide 10:   "Barriers."  She  explained that                                                               
Alaskan barriers  include: access  to health care  and continuity                                                               
of care, such as the  military and seasonal workers; referrals to                                                               
community resources as  education, information, and communication                                                               
must be  increased; and community  level case  management because                                                               
there  is a  lack,  community resources  often  don't know  about                                                               
other  resources available  within that  city or  town and  it is                                                               
difficult in "spreading the  word" about diabetes self-management                                                               
classes and residents  often do not know  resources are available                                                               
within  their community.    She pointed  out  that barriers  also                                                               
include  financial,  such as:  insurance  coverage  in that  some                                                               
resources are not covered; staffing  in programs as staff burnout                                                               
with complaints  of too  many tasks for  one person,  low morale;                                                               
costs  of  implementation,   evaluation,  and  follow-through  in                                                               
programs  to  ascertain that  people  are  receiving the  highest                                                               
quality  care  in sustainable  programs;  and  cost of  effective                                                               
health  communication plans  and  reaching Rural  Alaska and  not                                                               
focusing solely on the urban areas.   She pointed to a barrier of                                                               
knowledge  on impact  of chronic  disease on  the overall  health                                                               
that includes: a  person suffering more than  one chronic disease                                                               
and  a person  over  65  years of  age  is  considered a  complex                                                               
patient;  and  that the  direct  relationship  in Alaska  between                                                               
tuberculosis and diabetes, obesity  and diabetes, and smoking and                                                               
diabetes is being reviewed.   A final barrier could be: education                                                               
on  the chronic  disease and  self-managing a  disease as  people                                                               
need to  feel empowered, need  to know they can  actually control                                                               
their diabetes or chronic disease,  knowing about prevention, and                                                               
that changing life  style behaviors can delay  the progression of                                                               
disease up to 11 years.                                                                                                         
                                                                                                                                
10:44:37 AM                                                                                                                   
                                                                                                                                
MS.  AYALA turned  to slide  11:   "Community-Based  Approaches."                                                               
She said  the current focus  is on community-based  approaches in                                                               
more   people  being   screened  via   partnerships  with   local                                                               
organizations for  diabetes especially, she reiterated,  when one                                                               
out of  three people do not  know they have pre-diabetes  and one                                                               
out of four do  not know they have Type 2  diabetes.  She advised                                                               
that screening  partnerships include: Alaska Health  Fairs, Inc.,                                                               
to provide free  HbA1c tests; Diabetes Lipid  Clinic provide free                                                               
HbA1c  tests; Providence  Outreach  Center to  inform the  public                                                               
about  Alaska  Health Fairs;  YMCA  to  inform the  public  about                                                               
Alaska Health Fairs  and provide paper screening  tests for those                                                               
who do not want to do  a blood test; Alaska Commercial to provide                                                               
the public with  paper screening tests in  their store; Anchorage                                                               
Neighborhood   Health  Centers   to  include   information  about                                                               
screening  in  their  website and  Facebook  page;  and  American                                                               
Diabetes   Association  to   get  more   paper  screening   tests                                                               
throughout  Alaska   and  generate  more  health   fairs  at  new                                                               
locations.                                                                                                                      
                                                                                                                                
MS.  AYALA turned  to slide  12:   "Community-Based  Approaches,"                                                               
includes  working with  local organizations  to  spread the  word                                                               
about  diabetes because  if it  is not  discussed people  tend to                                                               
forget  about it  because  they  think "it  could  not happen  to                                                               
them."   She offered that community-based  organizations approach                                                               
spreading the word, increase awareness  about diabetes, and those                                                               
organizations include: the  American Diabetes Association; Alaska                                                               
Commercial Stores;  Alaska Public  Media; ANTHC  Special Diabetes                                                               
Program  for  Indians;  YMCA; Faith-based  organizations;  Alaska                                                               
Primary  Care  Associates;  Providence  Hospital  involves  tele-                                                               
medicine,  tele-health,  and  creating programs  to  reach  other                                                               
areas such as, Sitka Hospital, SEARHC, and Kodiak.                                                                              
                                                                                                                                
10:47:30 AM                                                                                                                   
                                                                                                                                
MS. AYALA  turned to slide  13:  "Programmatic Approaches."   She                                                               
said  that a  focus  is the  self-management  program to  empower                                                               
patients, such as  those with a chronic disease, or  a care taker                                                               
of a  person with  a chronic  disease, or  requesting information                                                               
regarding diabetes or  a chronic condition.  She  explained it is                                                               
a six-week  program, meets  once a  week in  a group  setting (10                                                               
people  or more,)  is evidence-based  and is  recommended by  the                                                               
2015  ADA clinical  guidelines.   The  goal, she  offered, is  to                                                               
teach  individuals the  goals necessary  to adopt  healthy habits                                                               
and promote  the idea of life  style changes and behaviors.   She                                                               
explained that  the self-management  programs are offered  in two                                                               
way:  Chronic  Disease   Self-Management  Program  (CDSMP);  and,                                                               
Diabetes Self-Management Program (DSME).                                                                                        
                                                                                                                                
10:48:43 AM                                                                                                                   
                                                                                                                                
MS. AYALA  turned to slide  14:  "Programmatic Approaches."   She                                                               
offered  that they  are also  working with  patients affected  by                                                               
pre-diabetes,  or  at-risk  of   diabetes  through  the  National                                                               
Diabetes  Prevention  Program.    This  program,  she  explained,                                                               
begins  with  16-weeks  of  weekly  meetings,  then  small  group                                                               
meetings monthly up to one year,  with access to a CDC nationally                                                               
recognized online  program to support  the monthly  support group                                                               
meetings.  She  said the online program is free  of charge due to                                                               
a  partnership with  Nutrition Quest,  and the  on-site locations                                                               
include:  Anchorage, Juneau,  Fairbanks, and  in the  near future                                                               
Seward.                                                                                                                         
                                                                                                                                
MS.  AYALA  turned  to  slide  15:   "Benefits  of  DSME."    The                                                               
evidence-based   benefits   of   the   diabetes   self-management                                                               
education   (DSME)   are   important   as   it   reduces   health                                                               
complications including:  heart disease, stroke,  kidney disease,                                                               
nerve damage,  pregnancy complications  and eye diseases;  it can                                                               
sustain successful long-term  self-management with ongoing follow                                                               
up and  support; and lower  hospitalization rates by  34 percent.                                                               
She pointed  out that DSME  is included in the  American Diabetes                                                               
Association Standards  of Medical  Care in Diabetes  and Clinical                                                               
Practice  Recommendations,  and  is  noted  as  a  best  practice                                                               
program.                                                                                                                        
                                                                                                                                
10:51:05 AM                                                                                                                   
                                                                                                                                
MS. AYALA turned  to slide 16:  "Economic Savings  of DSME."  She                                                               
proposed  that one  way to  decrease the  economic burden  on the                                                               
health  care  system  is  by  taking  the  time  to  implement  a                                                               
successful  DSME program.   She  pointed out  that the  Evergreen                                                               
Report  estimates   that  for   each  Alaska   Diabetic  Medicaid                                                               
beneficiary the cost  is $26,300, yet if  every Medicaid enrolled                                                               
diabetic in Alaska  took at least one DSME class,  there would be                                                               
an  estimated Medicaid  cost savings  of $6.9  - $36  million per                                                               
year.   She offered that  this amount equals  a net of  $4 return                                                               
investment for every $1 spent.                                                                                                  
                                                                                                                                
10:52:00 AM                                                                                                                   
                                                                                                                                
MS. AYALA  turned to  slide 17:   "Pre-Diabetes."   She explained                                                               
that the online  system is because of  pre-diabetes "hot pockets"                                                               
that are  mainly in  urban areas, such  as Anchorage,  Kenai, and                                                               
the Matanuska-Susitna  area, and  it is  important there  is free                                                               
and  accessible  [information]  available.     People  are  being                                                               
advised,  through various  health  fairs  with their  partnership                                                               
with  Alaska Health  First, that  [DSME programs]  are available,                                                               
evidence-based, and high quality, she  offered.  When signing up,                                                               
a one-year  free subscription is  included and, she  noted, there                                                               
are long-term effects by changing life styles and habits.                                                                       
                                                                                                                                
MS. AYALA turned  to slide 18: "Summary  Slide."  Self-management                                                               
programs  help empower  people and  provide them  with the  tools                                                               
necessary  to take  care of  their health  and, she  pointed out,                                                               
that  the   total  annual  cost  of   Alaskan  diabetic  Medicaid                                                               
beneficiaries  is $165.7  million.   She  stressed that  diabetes                                                               
prevention is needed and the CDC  estimates that by 2050, one out                                                               
of three  people in the  United States  will have diabetes.   She                                                               
related that these people enjoy  the services and the opportunity                                                               
to learn from the programs.                                                                                                     
                                                                                                                                
10:54:23 AM                                                                                                                   
                                                                                                                                
MS. AYALA turned  to slide 19:  "Resources."   She explained that                                                               
the  slide includes  some of  the  diabetes resources  available,                                                               
such     as     "Nelly.Ayala@Alaska.gov;     diabetes@alaska.gov;                                                               
Http://list.state.ak.us.                                                                                                        
                                                                                                                                
10:55:09 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE TARR  referred to  Ms. Ayala's statement  that the                                                               
greatest increases of [pre-diabetes]  are found in urban centers,                                                               
and asked her to discuss the issue from a statewide perspective.                                                                
                                                                                                                                
MS. AYALA responded that the rate  focuses on 6.5 percent per 100                                                               
people, and the  more densely populated area would  have the most                                                               
people.                                                                                                                         
                                                                                                                                
10:57:42 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE TARR pointed to the  community outreach slides and                                                               
noted that quite a number of  organizations may be located in the                                                               
urban center.  She inquired as  to whether they were working with                                                               
the tribal  health organizations, or  working within some  of the                                                               
harder  to   reach  areas  of   the  state  in   community  based                                                               
prevention.                                                                                                                     
                                                                                                                                
MS.  AYALA  replied   that  they  are  working   on  a  long-term                                                               
partnership  with the  Alaska Native  Health  Consortium and  are                                                               
working.   She said discussions  have included how  funding would                                                               
be  effective  for  this  special  diabetes  program  for  Alaska                                                               
Natives,  and how  the  state can  assist, she  said.   She  then                                                               
explained that  on December 1,  2015, the Alaska  Native Diabetes                                                               
Conference  takes  place  in  Anchorage  and  all  tribal  health                                                               
representatives will  attend, and they will  listen to understand                                                               
the  stakeholders'  needs   in  developing  sustainable  programs                                                               
before implementing  or recommending  a program.   She  said that                                                               
Diabetes  Prevention   and  Control  has  discussed   creating  a                                                               
partnership with  Alaska Health  Fairs and  its wellness  base in                                                               
order  to implement  a wellness  program and  use less  resources                                                               
that   could  be   directed  elsewhere.     She   explained  that                                                               
discussions  have also  taken place  as to  receiving recognition                                                               
for the  gold standard Diabetes  Prevention Program  (DPP), which                                                               
was the  first program by the  Indian Health Board to  be created                                                               
for diabetes prevention  and control.  She remarked,  in order to                                                               
move in  that direction, the  staff must  offer input as  to what                                                               
type  of support  would be  needed as  it would  require creating                                                               
more reports  to become  CDC recognized.   She offered  that they                                                               
have been  brainstorming issues in  preparation for  the December                                                               
meeting, and that  there must be a dialogue  from tribal villages                                                               
and their community leaders.                                                                                                    
                                                                                                                                
11:00:57 AM                                                                                                                   
                                                                                                                                
CHAIR SEATON pointed to slide 3,  noting that the factors are not                                                               
addressable  as to  age, family  history, race,  or pre-diabetes,                                                               
which leaves  weight, inactivity, obesity, and  smoking, although                                                               
mechanisms  or  prevention  programs  could  address  gestational                                                               
diabetes.  He  asked whether they had reviewed  what is different                                                               
in Alaska and why the rate is  higher than the rest of the United                                                               
States.                                                                                                                         
                                                                                                                                
MS.  AYALA responded  that  Alaska does  not  necessarily have  a                                                               
higher  rate of  weight and  inactivity as  Alaska fits  with the                                                               
rest of the United States.   She related that obesity is a global                                                               
epidemic.                                                                                                                       
                                                                                                                                
CHAIR  SEATON questioned  whether  Alaska has  a  higher rate  of                                                               
diabetes.                                                                                                                       
                                                                                                                                
MS. AYALA  replied no, in  2013, the  rate of diabetes  in Alaska                                                               
was 7.1  percent, and  approximately 7  percent for  the national                                                               
average.                                                                                                                        
                                                                                                                                
11:03:07 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE  TARR   asked  members  to  bring   the  committee                                                               
materials to the next meeting.                                                                                                  
                                                                                                                                
11:04:10 AM                                                                                                                   
                                                                                                                                
CHAIR SEATON recessed to a call of the chair.                                                                                   
                                                                                                                                
4:03:28 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON reconvened  the House  Health  and Social  Services                                                               
Standing Committee at 4:03 p.m.   Representatives Talerico, Wool,                                                               
Tarr,  and  Seaton  were  present  at the  call  back  to  order.                                                               
Representatives Vasquez and Foster arrived  as the meeting was in                                                               
progress.                                                                                                                       
                                                                                                                                
4:04:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR referred  to  the  earlier presentation  and                                                               
asked the committee  to keep the same risk factors  in mind, such                                                               
as tobacco  use, alcohol use, diet,  and obesity.  She  turned to                                                               
the   PowerPoint   presentation   entitled   "Adverse   Childhood                                                               
Experiences [ACEs],"  slide 1:  "What is ACEs?"   She  said there                                                               
was a  1998 landmark study  that reviewed middle class  adults to                                                               
quantify  health outcomes  in relationship  to  traumas they  may                                                               
have experienced  as a child.   She explained that the  study was                                                               
performed  in partnership  with  the Center  for Disease  Control                                                               
(CDC) and  the Kaiser Permanente  Health Appraisal Clinic  in San                                                               
Diego, with  over 17,000  participants.   The study  developed an                                                               
ACEs  0-10  score for  individuals  in  order to  predict  health                                                               
outcomes which  in turn assists  in understanding how  to achieve                                                               
prevention savings, she remarked.                                                                                               
                                                                                                                                
REPRESENTATIVE  TARR turned  to  slide  2:   "What  is your  ACEs                                                               
Score?"   She read the  10 questions  to the committee  for their                                                               
response.        [The    ACEs    quiz    can    be    found    at                                                               
www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-                                                                
ace-quiz-and-learn-what-it-does-and-doesn't-mean.]      Following                                                               
the questions, she  noted that each member may want  to use their                                                               
ACEs score in context to the implications of high ACEs scores.                                                                  
                                                                                                                                
4:11:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  turned  to  slide  3:    "ACEs  studies  in                                                               
Alaska."   She said that  two findings include:  childhood trauma                                                               
is more common than previously  realized; and that the impacts of                                                               
this  trauma affects  individuals over  a lifetime  and societies                                                               
over  generations.   She described  a  current exciting  genetics                                                               
study  called  "Epi genetics"  that  reviews  how experiences  or                                                               
environmental influences change  the way a gene  is expressed and                                                               
that intergenerational  trauma changes can occur  at the cellular                                                               
level and impact the next generation.                                                                                           
                                                                                                                                
REPRESENTATIVE  TARR  referred  to  [page 3,  figure  3]  of  the                                                               
handout entitled  "Adverse Childhood Experiences  Overcoming ACEs                                                               
in  Alaska," and  advised  the  pyramid and  circle  [on page  5,                                                               
figure  4,  "Adverse  Childhood Experience  Cycle]  are  used  to                                                               
assist people  in understanding the  whole life experience.   She                                                               
referred to the  pyramid example and said  that adverse childhood                                                               
experiences lead to social,  emotional, and cognitive impairment,                                                               
which  leads to  the  adoption of  health  risk behaviors,  which                                                               
leads to disease, disability and  social problems, which leads to                                                               
early death.   She referred to  the circle and explained  that it                                                               
walks through how  someone with early childhood  traumas might be                                                               
changed throughout their entire lifetime.                                                                                       
                                                                                                                                
4:13:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR turned to slide  4:  "ACEs Scores in Alaska."                                                               
She advised  it offers the  most recent percentage  research, and                                                               
that there  is concern regarding  individuals with a score  of 4+                                                               
and how those  scores can be reduced to  improve health outcomes.                                                               
She referred  to the  pinwheel in  the handout  entitled "Adverse                                                               
Childhood Experiences Overcoming ACEs  in Alaska," page 6, figure                                                               
5, of  potential negative  outcomes.   She questioned  that among                                                               
the variety  of undesirable health  outcomes, what  percentage of                                                               
these  can be  linked back  to ACEs.   She  explained that  in an                                                               
attempt to reduce  costs, the pinwheel depicts that  if the state                                                               
could reduce the frequency of  these particular adverse childhood                                                               
experiences then the  frequency of poor health  outcomes would be                                                               
reduced, thereby reducing costs.                                                                                                
                                                                                                                                
REPRESENTATIVE  TARR  referred  to  slide 5:    "Select  Negative                                                               
Health Outcomes," and said, for  example the Medicaid piece shows                                                               
that 40.6 percentage of  individuals currently receiving Medicaid                                                               
services  can be  attributed back  to high  ACEs scores,  current                                                               
smokers  32 percent,  heavy drinking  20.5  percent, and  overall                                                               
poor  physical health  33.2 percent.    She described  this as  a                                                               
significant number  of individuals who could  potentially benefit                                                               
by performing prevention efforts.                                                                                               
                                                                                                                                
4:16:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  turned to slide  6:  "Costs  Associated with                                                               
ACEs," and referred  to the pinwheel and said that  32 percent of                                                               
the  current  smokers  can  be   attributed  back  to  ACEs,  and                                                               
approximately $576  million a  year is  spent on  smoking related                                                               
illnesses which  could translate up  to $186 million  in savings.                                                               
She offered that in reducing  substance abuse by 20 percent there                                                               
would be [Patrick  Sidmore's figure] $250 million  in savings and                                                               
that reducing  Medicaid cost by  40.6 percent would be  a savings                                                               
of $350 million.   She explained that when  translating this into                                                               
the  cost, the  total in  annual  savings by  preventing ACEs  is                                                               
approximately  [$786] million.   She  related there  is a  double                                                               
benefit in saving money and also improving health outcomes.                                                                     
                                                                                                                                
REPRESENTATIVE  TARR  turned  to  slide 7:    "Opportunities  for                                                               
Prevention."   She  offered that  those include:  trauma informed                                                               
health  care,  and  that trauma  informed  curriculum  speaks  to                                                               
providing educators with tools to  understand the life challenges                                                               
some of their  students are facing and  improve their educational                                                               
outcomes.   She offered  that a  prevention opportunity  could be                                                               
the  movie  "Paper   Tigers"  that  is  being   shown  by  Alaska                                                               
Children's' Trust  and community partners.   Her concern  is that                                                               
with regard to  ACEs, the state may currently be  doing the wrong                                                               
intervention and in  doing so further isolate  these students and                                                               
cause a  bigger challenge  for them  to succeed  in school.   She                                                               
said that Trauma  Informed Curriculum speaks to the  idea that if                                                               
educators can be provided with  tools to understand some of these                                                               
life challenges their  students are facing, it  would inform them                                                               
as to how  to administer curriculum in the  classroom and improve                                                               
student's educational outcomes.                                                                                                 
                                                                                                                                
4:19:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR said that other  states offer pilot programs,                                                               
and  that  Vermont  passed  legislation to  look  into  ACEs  and                                                               
determine additional opportunities  to educate community members,                                                               
and  provide resources  for individuals  working especially  with                                                               
children.  She remarked that  Montana passed legislation in 2013,                                                               
and that  other initiatives are  happening in other states.   She                                                               
referred to  the handout entitled "Adverse  Childhood Experiences                                                               
Overcoming ACEs in Alaska," [page 7,  table 2] and pointed to the                                                               
areas  marked in  red  where Alaska  ranks at  the  top of  those                                                               
categories.     In  discussing  recidivism   and  anti-recidivism                                                               
efforts, she  said, think of the  life of a child  growing up and                                                               
that  the  repetitive  instances  of  the  trauma  must  be  more                                                               
damaging.   Substance abuse in  the home, domestic  violence, and                                                               
sexual  assault  impacts  other behaviors,  she  related.    When                                                               
looking at how to prevent diabetes  and its risk factors, such as                                                               
tobacco  use, alcohol  use, and  obesity,  are things  associated                                                               
with  having bad  outcomes.    There is  much  to  gain if  these                                                               
adverse childhood experiences  can be prevented in  that it could                                                               
prevent a whole series of costly health problems, she opined.                                                                   
                                                                                                                                
4:22:56 PM                                                                                                                    
                                                                                                                                
PATRICK SIDMORE,  Planner, Alaska  Mental Health  Board, Advisory                                                               
Board  on Alcoholism  and Drug  Abuse, Department  of Health  and                                                               
Social Services, advised  there are links to  health and economic                                                               
health outcomes regarding cancer,  heart disease, asthma, smoking                                                               
and drinking.   He said, for example injecting  drugs, 78 percent                                                               
of  the people  were linked  back to  ACEs.   In other  words, he                                                               
explained,  if all  ACEs  was eliminated,  78  percent of  people                                                               
injecting drugs would be eliminated.   He said that powerful data                                                               
has been  replicated over and  over in other countries  and there                                                               
are scores and  scores of studies now.  He  advised they now have                                                               
survey  information on  8,000 Alaskans  taken in  2013 and  2014,                                                               
which  will give  them information  about their  ACEs scores  and                                                               
communities.  He provided a  recently completed document entitled                                                               
"The Economic  Costs of Adverse Childhood  Experiences in Alaska"                                                               
to  the committee,  and  advised that  six  items were  reviewed:                                                               
Medicaid, smoking,  binge drinking,  arthritis, and obesity.   He                                                               
explained  that they  picked two  states  (Arkansas and  Vermont)                                                               
that performed well  in ACEs, and overlaid their  ACEs score onto                                                               
Alaska's results and found that  in Medicaid the state could save                                                               
$32  million  a  year  and smoking  would  be  approximately  $30                                                               
million less.   The six items added  up to a savings  of over $90                                                               
million  and  it  does  not  include the  savings  of  the  other                                                               
approximately  20-30 measures  linked to  ACES, he  offered.   He                                                               
said [ACEs]  is catching on  in communities throughout  the state                                                               
as a way to impact the  health of their communities and hopefully                                                               
have  lower  cost  interventions  early  for  young  families  to                                                               
prevent this trouble  down the road.  He added  that the CDC says                                                               
that  every child  found with  the substantiated  report of  harm                                                               
costs the  state $50,000 in  childhood alone.  The  savings start                                                               
right away, but the long term  is "really where the money is," he                                                               
said.                                                                                                                           
                                                                                                                                
4:26:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR pointed  to the  handout "Adverse  Childhood                                                               
Experiences Overcoming ACE's  in Alaska," page 3,  figure 1, "ACE                                                               
Score  and Suicide  Attempt Prevalence,"  and stressed  that ACEs                                                               
may be an area to  explore when discussing suicide prevention and                                                               
missing pieces.  She advised that  men ages 18-24 are the highest                                                               
rates of suicide,  and if they had  adverse childhood experiences                                                               
it would have  been a building problem in their  life before they                                                               
choose  to  finally  take  their life.    The  adverse  childhood                                                               
experiences  program  offers  the  potential  for  better  health                                                               
outcomes, she explained.   She said she  is hopeful opportunities                                                               
will  be taken  to address  ACEs as  a legislative  body, whether                                                               
that means providing  funding for a pilot  program or legislators                                                               
doing  things  in  their communities  as  the  opportunities  are                                                               
endless at this time.                                                                                                           
                                                                                                                                
4:28:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FOSTER  referred to grant programs  and noted that                                                               
previously  money  was  appropriated  for a  program  called  the                                                               
Qungasvik, which  is out of  the Alakanuk  and Emmonak area.   He                                                               
reminded the committee that the whole  area of Hooper Bay and the                                                               
whole Lower Yukon has seen a  rash of suicides, a high per capita                                                               
number, and  the unique reason  the Qungasvik program  worked was                                                               
because  it was  culturally  relevant and  there were  activities                                                               
based in  the local  culture.   He said that  the results  of the                                                               
program showed that numbers were improving.                                                                                     
                                                                                                                                
4:30:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL expressed  that these  kinds of  studies are                                                               
illuminating in  that they can  assess a person's  upbringing and                                                               
environment to determine a number  and then correlate that number                                                               
with  certain unhealthy  activities.   Obviously,  he noted,  the                                                               
goal is to eliminate unhealthy  instances in a child's upbringing                                                               
so  their score  is lower,  and also  to intervene  later on  and                                                               
educate them.   He  asked whether there  are programs  to educate                                                               
people  about  their high  ACEs  number,  as  well as  trying  to                                                               
eliminate the behavior early on.                                                                                                
                                                                                                                                
REPRESENTATIVE  TARR answered  yes, such  as the  trauma informed                                                               
curriculum and also  building resiliencies.  She  noted there has                                                               
been a  bit of  controversy over  that concept,  but the  idea is                                                               
that if the instances cannot  be prevented from happening, how to                                                               
help an individual be stronger in  light of that and be resilient                                                               
throughout  their  lifetime  and  avoid  some  of  the  unhealthy                                                               
outcomes.  She  noted that an individual with an  ACEs score of 1                                                               
has a 20 percent increased risk  of heart disease; the score of 2                                                               
is  twice  as  likely  to experience  humanoid  disease,  and  70                                                               
percent more likely to have heart disease;  a score of 4 has a 3-                                                               
4 times  higher risk  of depression,  is 5  times more  likely to                                                               
become an alcoholic, is 8  times more likely to experience sexual                                                               
assault, and up to 10 times  more likely to attempt suicide.  She                                                               
noted that it is likely that  multiple things are going on in the                                                               
home, such  as alcohol or  drug abuse and  a parent goes  to jail                                                               
which could cause  neglect.  She asked Mr. Sidmore  to comment on                                                               
the recent study and neglect issues.                                                                                            
                                                                                                                                
4:32:54 PM                                                                                                                    
                                                                                                                                
MR.  SIDMORE advised  that during  the  first year  of the  study                                                               
using the  behavioral risk  factor surveillance  system discussed                                                               
earlier  regarding diabetes.    He explained  that  they did  not                                                               
include neglect,  but did include  neglect in the second  year of                                                               
the  study.   Neglect, he  explained, is  the most  common reason                                                               
children are  taken out of their  homes at OCS, and  in reviewing                                                               
the data today  noted that neglect is highly  correlated with the                                                               
other adverse  childhood experiences.   He said they  continue to                                                               
learn  from  this and  will  put  it  out to  professionals,  and                                                               
related that therapists around the  state are using this more and                                                               
more  and explaining  ACEs  score with  clients.   Therapist  are                                                               
changing from  "what is going on  with you" to "what  happened to                                                               
you" and  it is powerful and  helpful to individuals to  heal, he                                                               
stated.                                                                                                                         
                                                                                                                                
4:34:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   VAZQUEZ  referred   to   the  handout   "Adverse                                                               
Childhood Experiences Overcoming ACEs  in Alaska," and noted that                                                               
the Advisory Board  on Alcoholism and Drug Abuse,  and the Alaska                                                               
Mental Health Board were involved.   She pointed out that page 6,                                                               
reads  that 60.1  percent  of  individuals experiencing  frequent                                                               
mental distress have ACE scores, and asked the score.                                                                           
                                                                                                                                
MR.  SIDMORE  explained  that those  numbers  are  a  calculation                                                               
commonly   used   in    epidemiology   called   the   "Population                                                               
Attributable Fraction."   He further  explained that it  is based                                                               
upon  a  score  of  one-eight  ACEs.     He  described  it  as  a                                                               
calculation that within the population  with zero ACEs there is a                                                               
certain   percentage  of   people  that   will  have   "whatever"                                                               
condition.  The  60.1 percent would go away if  all ACEs would go                                                               
away, he said.                                                                                                                  
                                                                                                                                
REPRESENTATIVE  VAZQUEZ surmised  it is  the range  from zero  to                                                               
whatever.  She suggested that  the Alaska Mental Health Authority                                                               
could be  source of  funding as  they are  supposed to  be taking                                                               
care  of the  mental  health area,  or at  least  assist in  that                                                               
process.                                                                                                                        
                                                                                                                                
REPRESENTATIVE TARR  advised that  she learned from  Jeff Jessee,                                                               
Alaska Mental  Health Authority,  that they like  pilot programs.                                                               
She  opined  that  through  the  wisdom of  the  members  of  the                                                               
legislature that  possibly ideas could be  addressed and approach                                                               
them  to  determine whether  they  would  be  a good  partner  in                                                               
obtaining additional research.                                                                                                  
                                                                                                                                
4:36:29 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  surmised  that  a  portion  of  the  legislature's                                                               
problem in looking forward is  "really long-term solutions," when                                                               
discussing eliminating  things in  childhood to  prevent problems                                                               
in adolescence and  adulthood.  He opined that  in moving forward                                                               
his hope  is reviewing interventions and  changing the mechanisms                                                               
of interventions  because this is  such a long-term  process that                                                               
if there  are no changing  interventions accomplishing  things in                                                               
the nearer  term it is  going to be hard  to wait around  for 18,                                                               
19,  40  years to  say  "what  was the  effect."    He said  that                                                               
removing stressors from life, and  ACEs identifies a multitude of                                                               
them, is helpful in the health  of individuals.  He said he hopes                                                               
next  year  the  committee  will discuss  some  of  the  directed                                                               
changes  in  interventions and  changes  in  the way  things  are                                                               
currently dealt  with.   He agreed  with Mr.  Sidmore's statement                                                               
that instead  of telling an  individual there is  something wrong                                                               
them,  rather  to  say  this  is what  happened  to  you  so  the                                                               
individual  can  take control  and  make  intentional changes  in                                                               
their life.                                                                                                                     
                                                                                                                                
4:38:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL  noted that  some  things  can have  a  dual                                                               
function, such as recidivism  and alternate sentencing practices,                                                               
in that  by reducing prison  populations it would save  the state                                                               
money immediately, and also have  the effect of preserving a home                                                               
situation.                                                                                                                      
                                                                                                                                
REPRESENTATIVE TARR surmised  it is difficult to  quantify how to                                                               
undertake  long-term  change and  also  live  within a  world  of                                                               
budget pressure.   She  offered that  she recently  learned about                                                               
the  Heckman Equation  and  will obtain  more  information.   She                                                               
said,  it essentially  shows opportunities  for  how to  actually                                                               
quantify the  evolution over a  long period  of time, and  how to                                                               
see some of those changes.   An area most promising, she advised,                                                               
is the  trauma informed curriculum  and what happens  in schools,                                                               
and that  there could be  an immediate improvement  in graduation                                                               
results, academic  performance, as  well as  a reduced  number of                                                               
suspensions  and  behavioral  outbursts  that are  costly  for  a                                                               
school district to  address.  She noted the CDC  website has more                                                               
information on outcomes.                                                                                                        
                                                                                                                                
CHAIR SEATON passed the gavel to Vice Chair Vazquez.                                                                            
                                                                                                                                
4:41:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ asked  Chair Seaton  to proceed  with his                                                               
presentation.                                                                                                                   
                                                                                                                                
4:41:12 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON referred to the  booklet that mainly targets surgery                                                               
entitled "Reducing Negative  Health Outcomes Through Prevention,"                                                               
and a  handout on  Vitamin D, published  by the  Emery University                                                               
Hospital  validating the  use  of  Vitamin D.    He reminded  the                                                               
committee  that Dr.  L. Ray  Matthews, Director  of the  Surgical                                                               
Intensive  Care Unit  at Grady  Memorial Hospital  testified last                                                               
year  and presented  information to  the committee.   There  were                                                               
questions regarding the  components of vitamin D,  Omega 3, fatty                                                               
acids, and  whether vitamin D was  doing its job.   He noted that                                                               
the vitamin  D initiative at  Emery University  Hospital verifies                                                               
that vitamin  D, at least as  one of the components,  is making a                                                               
difference on those health care  outcomes that the protocol works                                                               
on.   The  goal is  how  to better  understand the  immunological                                                               
basis of  causes of depression  and other mental  health concerns                                                               
and  how that  could  provide a  primary  health care  prevention                                                               
window  into  reducing  Alaska's  behavioral health  needs.    He                                                               
explained  that there  is a  growing  body literature  indicating                                                               
that inflammation and inflammatory markers, such as the pro-                                                                    
inflammatory   cytokines,   have   a  strong   association   with                                                               
depression.    In cases  of  major  depression, the  inflammatory                                                               
response  system   is  often  activated  and   higher  levels  of                                                               
inflammation appear to  increase the risk for  the development of                                                               
new depression  cases and pointed  to "cytokines  and depression"                                                               
and how  the immune system  causes depression.   Articles include                                                               
"Immunology  of major  depression,"  "Meta-analysis of  cytokines                                                               
and  major  depression,"  "Association  of  high  sensitivity  C-                                                               
reactive protein with de novo major depression."                                                                                
                                                                                                                                
4:44:19 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  related that  it  is  interesting when  discussing                                                               
cytokines,  as  those  are  chemicals   the  body  produces  that                                                               
influences how the  genes work and vitamin D is  one of the major                                                               
controllers  of  cytokines   in  the  body.     He  listed  known                                                               
environmental  factors that  can elevate  the risk  of depression                                                               
including: stress,  poor diet, and  vitamin D deficiency.   Chair                                                               
Seaton pointed to  an article that depression  is an inflammatory                                                               
disease,  and other  studies found  that the  association between                                                               
vitamin D  supplementation and  reduced inflammatory  markers are                                                               
associated with  depression, as well  as the  association between                                                               
vitamin  D deficiency  and suicide.    A couple  of the  articles                                                               
state that depression  is an inflammatory disease  but where does                                                               
the inflammation come from, and they  get into the details of how                                                               
exactly  that   works.    He  said   that  previous  double-blind                                                               
randomized  controlled  trials  out  of India  show  that  bodily                                                               
inflammation  such  as  gingivitis  was  drastically  reduced  by                                                               
vitamin D supplementation.                                                                                                      
                                                                                                                                
4:46:02 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  referred to an article  entitled "Suicidal Patients                                                               
are  Deficient  in  Vitamin  D," that  is  associated  with  pro-                                                               
inflammatory  status  in the  blood.    He  offered that  [it  is                                                               
important]  to  look at  the  immunological  basis of  depression                                                               
because  it is  known  that these  things are  a  basic cause  of                                                               
depression, then  treating that  immunological basis.   Vitamin D                                                               
supplementation  is also  associated with  an increased  sense of                                                               
well-being as  the article "Randomized comparison  of the effects                                                               
of vitamin D3 adequate intake  versus 100 mcg. (4000  IU) per day                                                               
on  biochemical   responses  and  the  wellbeing   of  patients,"                                                               
indicates they  found that vitamin  D levels  at 4000 IU  per day                                                               
resulted  in a  definite wellbeing  increase as  well as  limited                                                               
respiratory tract infections, he explained.                                                                                     
                                                                                                                                
4:47:23 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  noted that  last  year  an  expert panel  for  the                                                               
Department  of Defense  found sufficient  scientific evidence  to                                                               
support an  increase in the  daily recommended intake of  Omega 3                                                               
for military  members.  In  fact, he  noted, the panel  said that                                                               
given  the  strong  evidence  for  the  reduction  of  depressive                                                               
symptoms and suicide  prevention found "it would  be unethical to                                                               
not attempt  elevating Omega 3 status  among military personnel."                                                               
He  pointed  out that  diverse  federal  agencies are  conducting                                                               
expert panels  regarding nutritional status  and how Omega  3 and                                                               
vitamin D can  influence behavioral health.   Chair Seaton opined                                                               
that the committee  needs to review ways to  [help] people change                                                               
the  way  they  operate  their  lives, and  that  it  is  a  very                                                               
difficult position  as found with  obesity and smoking.   He said                                                               
that  if  there  are  things  that can  be  done  to  change  the                                                               
immunological status of people and get  to some of these bases of                                                               
mental  health,  it   offers  a  new  outlook   instead  of  just                                                               
psychiatry.  The  problem regarding Alaska mental  health is that                                                               
there are a reduced number  of providers, and those providers are                                                               
in very short supply across  the entire United States which makes                                                               
trying  to  recruit   to  Alaska  difficult.     Looking  at  the                                                               
immunological  basis  could  be  very important  for  Alaska,  he                                                               
noted.                                                                                                                          
                                                                                                                                
4:49:58 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  said physicians and  primary care  providers report                                                               
spending a lot  of time on behavioral health and  they are really                                                               
not trained  to do that;  however, there are some  initiatives to                                                               
get training for primary providers.   Unfortunately, he remarked,                                                               
that is  a difficult job  and if it  is more related  to treating                                                               
the immunological  basis the  committee cannot  ignore that.   He                                                               
reiterated that  he is  presenting findings  to the  committee on                                                               
cytokines, and  the immunological basis of  depression and mental                                                               
health, as  it appears the issue  has been somewhat ignored.   He                                                               
related that the  Journal of Circumpolar Health  had an excellent                                                             
article on  how the  Native hospital  and providers  in Anchorage                                                               
have  been doing  to  [help] the  primary  health care  providers                                                               
identify  mental  health issues  and  depression  issues so  that                                                               
treatment is followed  up within 12 weeks.   He acknowledged that                                                               
it doesn't  always happen,  the percentages  are in  the reports,                                                               
but it  is something that needs  to be done; however,  one of the                                                               
statements is that 40-60 percent of people receiving anti-                                                                      
depressants go off of them because they don't like the side-                                                                    
effects.    When  reviewing  the "Vitamin  D  and  Depression:  A                                                               
Systematic Review  and Meta-Analysis  Comparing Studies  with and                                                               
without Biological Flaws" article  by Simon Spedding, it reviewed                                                               
vitamin D usage  without biological flaws and  found that vitamin                                                               
D supplementation  had basically  the same  size effect  as anti-                                                               
depressant  drugs.   A  consideration  should  be looking  at  an                                                               
alternative that  has the same  size effect  but do not  have the                                                               
same  kind of  depressive  side  effects.   He  pointed out  that                                                               
nutrition  is   one  of   the  biggest   things  the   state  can                                                               
effectively,  cheaply, and  quickly change  within the  status of                                                               
Alaskans and noted the changes  in technology in that drying fish                                                               
and meat used to  be all sun dried.  He  explained that vitamin D                                                               
is  made with  animal oil,  exposing it  to ultra-violet  B rays,                                                               
thereby changing it to vitamin  D and strengthening the amount of                                                               
vitamin D in  the tissues.  The process has  gone to freezers and                                                               
smoke houses  with plywood  roofs and tarps  with the  FDA saying                                                               
everything has  to be covered  and screened.   He opined  that he                                                               
does  not know  how  it  has changed  the  nutritional status  of                                                               
people across  Alaska.  There is  a project underway now  that he                                                               
opined might be very enlightening for us all, he noted.                                                                         
                                                                                                                                
4:54:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FOSTER opined that vitamin  D appears to have many                                                               
significant  benefits   and  further  opined  that   the  medical                                                               
profession probably agrees.   He questioned how to  get people to                                                               
take their vitamin  D, and suggested that when  doctors ask their                                                               
patients  whether they  had their  flu shot  to also  ask whether                                                               
they are taking  their vitamin D supplements.  He  noted that the                                                               
evidence is clear, and further  questioned how to get everyone to                                                               
take their vitamin D.                                                                                                           
                                                                                                                                
CHAIR  SEATON responded  that  education  and people  graphically                                                               
being  shown the  results  of the  ongoing  studies and  offering                                                               
people  experience.    He noted  that  various  legislators  have                                                               
reported taking vitamin D supplements  and that they've noticed a                                                               
change in  their daily lives  and attitude,  and also ask  how to                                                               
educate  and  offer  experience to  their  constituents.    Chair                                                               
Seaton used  an example  of how he  offered experience  to people                                                               
during his involvement in a health  fair in Homer.  At that time,                                                               
they took a survey and offered  that if the person would fill out                                                               
a survey  three-months from that  date and return it,  they would                                                               
be  given a  three-month supply  of 5,000  IU vitamin  D.   After                                                               
reviewing  101  returned  surveys,  (10  percent  of  all  people                                                               
attending the  health fair) he  noted that the  following results                                                               
were  surprising: people  got more  exercise; 40  percent of  the                                                               
people surveyed took over-the-counter  pain relievers less often;                                                               
22  percent  of  the  people   consuming  alcohol  reported  they                                                               
consumed  less alcohol,  which lends  support to  the issue  that                                                               
people are  self-medicating when feeling  bad; 52 percent  of the                                                               
people reported  a difference  in their  emotional state  as they                                                               
felt much better than during  previous winters; and 98 percent of                                                               
the people  said they intend  to continue taking their  vitamin D                                                               
supplements.  He  offered that there would be a  health fair next                                                               
week in Homer with starter kits for  people.  He said he tries to                                                               
inform  people that  since  they  often do  not  get sunshine  in                                                               
Alaska for seven  months out the year, they should  get vitamin D                                                               
another  other way  - whether  it is  eating sun  dried fish,  or                                                               
taking  supplements.   He said,  "I think  when you  look at  the                                                               
booklet that  we had  on surgery, which  are an  immediate thing,                                                               
and which ... when the  journal patient's safety in surgery comes                                                               
out  and says  ...  you  know, we've  reached  the  point of  its                                                               
ethical  challenge  to  not  test for  and  treat  people  before                                                               
surgery with  ... elevate their  vitamin D  levels.  I  think the                                                               
medical community  is realizing that  the risk to  their patients                                                               
is high if they don't have them with an optimal immune system."                                                                 
                                                                                                                                
5:00:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  advised  that Dr.  Jay  Butler  provided                                                               
three research papers included within the committee packet.                                                                     
                                                                                                                                
5:00:35 PM                                                                                                                    
                                                                                                                                
JAY BUTLER,  Chief Medical  Officer/Director, Division  of Public                                                               
Health, Department of  Health and Social Services,  stated he was                                                               
unsure  of  the  three  research  papers  Representative  Vasquez                                                               
referred and asked whether someone else might be involved.                                                                      
                                                                                                                                
REPRESENTATIVE  VAZQUEZ   specified  that  the  first   paper  is                                                               
entitled,  "Vitamin D  Supplementation  to  reduce depression  in                                                               
Adults:  Meta-Analysis of  randomized control  trials," published                                                               
by the Nutrition Journal.   The second paper is entitled "Vitamin                                                             
D Supplementation  for Depressive  Symptoms: A  Systematic Review                                                               
and  Meta-analysis of  Randomized Control  Trials," published  by                                                               
National Institutes of Health Public  Access.  The third paper is                                                             
entitled  "Vitamin  D and  Depression:  A  Systematic Review  and                                                               
Meta-Analysis  Comparing  Studies  with  and  without  Biological                                                               
Flaws," by Simon Spedding.                                                                                                      
                                                                                                                                
DR. BUTLER opined that the papers came from Dr. Mark Erickson.                                                                  
                                                                                                                                
5:02:22 PM                                                                                                                    
                                                                                                                                
MARK   ERICKSON,  M.D.,   Alaska  Psychiatric   Institute  (API),                                                               
informed  the  committee that  he  submitted  the three  research                                                               
papers,  and  that Chair  Seaton  is  right  on target  with  his                                                               
emphasis on  depression.  He  offered that a recent  study showed                                                               
that  in  2010 depression  became  the  second leading  cause  of                                                               
global  disability that  is an  enormous problem.   He  explained                                                               
that from  2008-2013 he  was the  medical director  of Behavioral                                                               
Services, Southcentral  Foundation, and  in 2009 became  aware of                                                               
the  research regarding  the relationship  between low  vitamin D                                                               
and  depression.   At  the time,  the  relationship was  somewhat                                                               
equivocal  but it  looked promising.    In 2013  the first  meta-                                                               
analysis  basically confirmed  that low  vitamin D  is associated                                                               
with  depression, but  at the  time he  was medical  director the                                                               
research   on  whether   raising  vitamin   D  level   by  taking                                                               
supplements improved  mood was even  more equivocal.   He pointed                                                               
out that this issue was  discussed during staff meetings and that                                                               
many staff,  including himself, would routinely  obtain vitamin D                                                               
levels  on patients  and if  the vitamin  D level  was low  would                                                               
supplement.                                                                                                                     
                                                                                                                                
DR.  ERICKSON  offered that  over  the  weekend  he went  to  the                                                               
National Library of Medicine and  looked for meta-analysis of the                                                               
relationship between  supplementing vitamin  D and  recovery from                                                               
depression, he advised, and to  his surprise there have been four                                                               
published  articles within  the last  year.   He  noted that  two                                                               
studies  did [find  an association]  but were  in subsets  and he                                                               
emphasized  that all  four analysis  pointed  out how  relatively                                                               
poor the quality of the research  had been, and that the evidence                                                               
suggesting a  favorable relationship were performed  better.  The                                                               
studies carefully measured  the vitamin D level and  it was found                                                               
to be lower  than normal.  He said that  the study population was                                                               
verified to have  clinical depression and they  offered a vitamin                                                               
D supplement that  was substantial enough to raise  the vitamin D                                                               
level to  a normal  range.   In these  cases they  showed exactly                                                               
what would be  expected of a decent study,  but unfortunately the                                                               
data  is not  as impressive  as  he would  like.   That said,  he                                                               
commented, there  has been  a tenfold increase  in the  number of                                                               
publications on vitamin D over the  last decade and he has little                                                               
doubt  that there  are  studies  going on  now  that will  likely                                                               
verify in a  randomized controlled way that  increasing vitamin D                                                               
levels in  depressed people with  low vitamin D will  be helpful.                                                               
Unfortunately,  the data  is still  a little  bit equivocal,  but                                                               
certainly  strongly  suggests  that   if  studies  are  performed                                                               
properly there  will be good  data, and offer  an idea as  to how                                                               
much vitamin D to supplement, he related.                                                                                       
                                                                                                                                
5:07:03 PM                                                                                                                    
                                                                                                                                
DR. ERICKSON  noted there is  a concern about  primary prevention                                                               
and  opined that  the literature  for the  primary prevention  of                                                               
adverse  childhood  experiences  is stronger  than  is  generally                                                               
appreciated  and  said  there  has been  an  enormous  amount  of                                                               
research about the  basic biology of parental care  over the last                                                               
15-20  years.   He  mentioned  a study  by  Dr. Lane  Strathearn,                                                               
published  in  2009  in pediatrics  ["Adult  attachment  predicts                                                               
maternal brain  and oxytocin response  to infant cues"],  in that                                                               
Dr. Strathearn  was aware  that when a  mother breast  feeds, not                                                               
only is  the baby fed  but within the  mother's brain there  is a                                                               
release of oxytocin (a bonding  hormone), prolactin (also related                                                               
to maternal care),  and dopamine.  He described it  as an "elixir                                                               
of bonding"  so every  time a mother  nurses these  chemicals are                                                               
released in  her brain  increasing the  likelihood that  she will                                                               
bond with her baby.  Dr.  Strathearn made the prediction that the                                                               
longer the ratio  of breast feeding would be  associated with the                                                               
reduced rate of  child abuse and neglect.  He  pointed to a study                                                               
cohort of  Dr. Strathearn's in  Australia, of over  6,000 mothers                                                               
who had  been followed  for 15 years  along with  their children.                                                               
Dr. Erickson  said that they  had verified maltreatment  in these                                                               
cases  and found  that mothers  who breast  fed longer  than four                                                               
months  were almost  five  times less  likely  to maltreat  their                                                               
children.   Dr. Strathearn controlled for  18 different potential                                                               
confounding variables,  including whether  the mother  wanted the                                                               
baby, and whether she was using  drugs, and he still found over a                                                               
2.5  (indisc.) reduction  in  rates of  child  maltreatment.   He                                                               
offered that this  raises the question about what  is known about                                                               
increasing the duration of breast feeding.                                                                                      
                                                                                                                                
5:09:09 PM                                                                                                                    
                                                                                                                                
DR.  ERICKSON  said that  the  gold  standard, a  United  Nations                                                               
Initiative,  called the  "Baby Friendly  Hospital Initiative"  is                                                               
robust and has been around for  15-20 years.  In 2011, the United                                                               
Kingdom decided that 100 percent  of all their hospitals would be                                                               
baby friendly.   Yet, he pointed out, the United  States has only                                                               
two  percent of  its hospitals  baby  friendly, but  there is  an                                                               
initiative having to do with  the quality birth experience of the                                                               
mother which  often double, triples,  or quadruples the  rate and                                                               
duration of  breast feeding.  He  noted this is just  one example                                                               
of  how  a fairly  simple  process  can dramatically  reduce  and                                                               
prevent  child abuse  and neglect,  and that  other possibilities                                                               
include  the learning  of hormonal  changes occurring  in men  as                                                               
they become fathers as there are  ways in which to leverage this.                                                               
He stressed that  there are probably a number of  ways to prevent                                                               
child abuse  from ever  happening if close  attention is  paid to                                                               
the emerging biology of parental care.                                                                                          
                                                                                                                                
5:10:40 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  requested Dr. Erickson  to forward  his information                                                               
in  an  email as  the  committee  has  been trying  to  determine                                                               
effective  health  interventions.    He  asked  whether  the  two                                                               
percent figure for hospitals means  that there is zero percent in                                                               
Alaska or 100 percent of Alaska,  and further asked what can this                                                               
committee  can  do to  help  with  those  issues.   He  said  the                                                               
committee  needs  the  background data,  studies,  and  proposals                                                               
coming forward  from the department  where the committee  can add                                                               
its weight and assistance in the efforts.                                                                                       
                                                                                                                                
5:12:15 PM                                                                                                                    
                                                                                                                                
DR.  ERICKSON related  his understanding  that Providence  Alaska                                                               
Medical Center is the only  baby friendly hospital in Alaska, and                                                               
that he will forward the requested pertinent publications.                                                                      
                                                                                                                                
CHAIR SEATON  said they  would see about  getting 100  percent of                                                               
the hospitals  [to be  baby friendly].   He  said that  the meta-                                                               
analysis studies take a systematic  review, and turned especially                                                               
to  the meta-analysis  "Vitamin  D and  Depression: A  Systematic                                                               
Review  and  Meta-Analysis  Comparing Studies  with  and  without                                                               
Biological Flaw"  by Simon Spedding  that do not  have biological                                                               
flaws.    In other  words,  he  related,  they are  given  enough                                                               
vitamin D to raise the low  [vitamin D level] and determined that                                                               
"the  effect  size  was comparable  to  that  of  anti-depressant                                                               
medication."                                                                                                                    
                                                                                                                                
5:14:50 PM                                                                                                                    
                                                                                                                                
DR.  ERICKSON  interjected that  he  entirely  agrees with  Chair                                                               
Seaton's comments  as it seems  the Simon Spedding study  is most                                                               
reasonable.   He said  that, basically,  in order  to get  to the                                                               
point where vitamin D is part  of a standard algorithm in medical                                                               
care,  a  number  of  higher  quality  studies  to  verify  Simon                                                               
Spedding's study,  must be  performed.   He reiterated  there are                                                               
several  other  ways  to  go about  preventing  child  abuse  and                                                               
neglect  by paying  close attention  to the  biology of  parental                                                               
care.                                                                                                                           
                                                                                                                                
REPRESENTATIVE VAZQUEZ returned the gavel to Chair Seaton.                                                                      
                                                                                                                                
5:15:59 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON pointed  out that  smoking  is an  issue that  came                                                               
across  on many  of  the topics  heard  today, whether  diabetes,                                                               
ACEs, or adverse effects at surgery.   He expressed hope that the                                                               
committee can  get the message  across to students by  taking the                                                               
initiative and  possibly advertising  in their  district's middle                                                               
school  and high  school publications  twice a  year that  it may                                                               
limit their potentials  for dating to only other  smokers, and it                                                               
might make  a difference  in their attitudes.   He  suggested the                                                               
advertisement could  read "Kissing  a smoker tastes  like licking                                                               
an ash  tray," and  speculated that this  would have  more effect                                                               
than the committee  trying to start a big  initiative to convince                                                               
people not to smoke.                                                                                                            
                                                                                                                                
5:18:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL pointed  out  that vaping  is becoming  more                                                               
prevalent  with  the  upcoming  middle  school  and  high  school                                                               
students.                                                                                                                       
                                                                                                                                
CHAIR SEATON replied there are things  that are not good, but the                                                               
committee knows what is really bad.                                                                                             
                                                                                                                                
5:19:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR offered  that she likes the  idea of outreach                                                               
to youth  and asked what  Chair Seaton envisions  the committee's                                                               
next step to be.                                                                                                                
                                                                                                                                
CHAIR SEATON answered that  the previous presentations identified                                                               
smoking as  a crucial issue  for health, and that  each committee                                                               
member could form a message that  works in their communities.  He                                                               
suggested that  the members speak  with students in  their areas,                                                               
formulate an initiative, and report  back to the committee on the                                                               
initiative and what  feedback was received.  He  said smoking and                                                               
clean  conversation with  students  by committee  members in  the                                                               
middle school and high school may be effective.                                                                                 
                                                                                                                                
5:22:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ referred  to Representative  Tarr's study                                                               
of "Adverse  Childhood Experiences,  Overcoming ACEs  in Alaska,"                                                               
and  asked whether  this  information had  been  received by  the                                                               
various school district's nurses and counselors.                                                                                
                                                                                                                                
REPRESENTATIVE TARR  responded that  the information is  new, and                                                               
noted  that   the  school  nurses  recently   held  their  annual                                                               
conference and a  panel was on Erin's Law  and discussing adverse                                                               
childhood  experiences.     She   described  [the   outreach]  as                                                               
beginning and  opined that it  will take  more time as  they work                                                               
through  with  the different  professionals.    She reminded  the                                                               
committee that there is a lot  of pressure on them right now with                                                               
testing and  different things.   She opined that they  are taking                                                               
little steps to incorporate this  information, but are making the                                                               
information   known  known   together   with  opportunities   for                                                               
additional training.  She acknowledged  that she could not say it                                                               
has been implemented  in every school or that  every educators is                                                               
currently aware of it.                                                                                                          
                                                                                                                                
5:23:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked about school counselors.                                                                           
                                                                                                                                
REPRESENTATIVE  TARR replied  that the  same is  true for  school                                                               
counselors with  some awareness.   A  challenge with  health care                                                               
providers is that certain information  was part of the curriculum                                                               
when  they  went through  their  schooling,  which is  why  these                                                               
profession require  Continuing Education Credit  because research                                                               
is ongoing with new things are  coming out, she said.  Sometimes,                                                               
she pointed  out with  state's practitioners, there  is a  gap in                                                               
what was considered the relevant  body of information at the time                                                               
they were in school and what  a student might learn today.  There                                                               
is  the issue  of trying  to  catch some  people up  to what  the                                                               
newest  information is,  which is  where  they are  at with  this                                                               
particular information penetrating all  of the professionals that                                                               
might find it useful in their daily work, she explained.                                                                        
                                                                                                                                
CHAIR SEATON noted  that Homer adopted this  most pervasively and                                                               
that  there  is  Mobilizing  for   Action  through  Planning  and                                                               
Partnerships  (MAPP)  that is  a  whole  community-wide focus  on                                                               
improving health.   He  said it focused  specifically on  ACEs as                                                               
one of  the mechanisms  in addressing things  such as  low socio-                                                               
economic status, and  that it will be hard to  change some of the                                                               
things considered in ACEs, such as smoking.                                                                                     
                                                                                                                                
5:25:50 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON asked  whether the  committee was  in agreement  to                                                               
developing an initiative  in their areas, and coming  back to the                                                               
committee  with the  progress  made, after  the  interim.   Chair                                                               
Seaton noted that  there was general agreement,  and offered that                                                               
should a  member prefer not to  participate they do not  have to.                                                               
He stated  that should a member  prefer not to put  their name on                                                               
the initiative, to  send a copy to the committee  [aide] and they                                                               
will use  the House Health  & Social Services  Standing Committee                                                               
as the  sponsor of  the ad.   Also, he  pointed out,  having this                                                               
agreement makes it a legislative  priority and should people need                                                               
$20-$30 to  put an advertisement  in the student body  paper they                                                               
can use their office account.                                                                                                   
                                                                                                                                
5:27:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  offered support for Chair  Seaton's ideas of                                                               
doing  something  and  mentioned talking  with  health  teachers,                                                               
middle  school principals  in her  area  and stated  that if  the                                                               
members  work collaboratively  they could  cover Anchorage.   She                                                               
asked whether  there could  be a working  group meeting  prior to                                                               
session to share ideas.                                                                                                         
                                                                                                                                
CHAIR SEATON clarified  that he does not believe  a working group                                                               
is necessary,  and advised  staying away  from sex.   He  said he                                                               
would  like a  copy  of  what the  members  are  doing, and  that                                                               
committee  approval is  not  required.   He  reiterated that  the                                                               
committee  agreed the  members will  work  on initiatives  within                                                               
their communities to share among the members.                                                                                   
                                                                                                                                
REPRESENTATIVE TARR commented that if  other members come up with                                                               
a great  idea then possibly she  could take the idea  and go with                                                               
it.                                                                                                                             
                                                                                                                                
CHAIR SEATON said he would like to see the committee moving                                                                     
forward with an action that is shown to be a large problem in                                                                   
Alaska's health care.                                                                                                           
                                                                                                                                
5:30:01 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 5:30 p.m.                                                                                                          

Document Name Date/Time Subjects
HHSS presentation DPH Diabetes 110315.pdf HHSS 11/3/2015 10:00:00 AM
Wellness and Prevention
Rep Tarr Presentation Outline on Preventing Adverse Childhood Experiences_HHSS11.3.15.pdf HHSS 11/3/2015 10:00:00 AM
Wellness and Prevention
RepTarr_04 16 2015 ACES article diagrams for Erins Law distribution.pdf HHSS 11/3/2015 10:00:00 AM
Wellness and Prevention
RepTarr_ACEsReportAlaska.pdf HHSS 11/3/2015 10:00:00 AM
Wellness and Prevention
DHSS ACEs support doc H-HSS 11.3.15.pdf HHSS 11/3/2015 10:00:00 AM
DHSS support doc_InvestingInPrevention2015.pdf HHSS 11/3/2015 10:00:00 AM
Wellness and Prevention
Rep Tarr_Presentation_Adverse Childhood Experiences_11-03-15.pdf HHSS 11/3/2015 10:00:00 AM
Wellness and Prevention
RepSeaton proposal overview_Immunological basis-Nutrition and Behavioral Health_11-03-2015_.pdf HHSS 11/3/2015 10:00:00 AM
Wellness and Prevention
RepSeaton_Background_Summary of research_ Immunological causes of Depression_H-HSS_11-3-15.pdf HHSS 11/3/2015 10:00:00 AM
Wellness and Prevention
Background_Dr. Erickson & Rep Seaton_Vitamin D & Depression- A systematic review and meta-analysis_Spedding.pdf HHSS 11/3/2015 10:00:00 AM