Legislature(2015 - 2016)CAPITOL 106
01/29/2015 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: the Statewide Suicide Prevention Council | |
| Presentation: Becoming a Trauma Informed System, Division of Juvenile Justice | |
| Presentation: 24/7 Sobriety Monitoring Program | |
| Overview: Division of Behavioral Health | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 39 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 29, 2015
3:03 p.m.
MEMBERS PRESENT
Representative Paul Seaton, Chair
Representative Liz Vazquez, Vice Chair
Representative Neal Foster
Representative Louise Stutes
Representative David Talerico
Representative Geran Tarr
Representative Adam Wool
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
PRESENTATION: THE STATEWIDE SUICIDE PREVENTION COUNCIL
- HEARD
PRESENTATION: BECOMING A TRAUMA INFORMED SYSTEM~ DIVISION OF
JUVENILE JUSTICE
- HEARD
PRESENTATION: 24/7 SOBRIETY MONITORING PROGRAM
- HEARD
OVERVIEW: DIVISION OF BEHAVIORAL HEALTH
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
KATE BURKHART, Executive Director
Statewide Suicide Prevention Council
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint entitled "The
Statewide Suicide Prevention Council."
KAREN FORREST, Director
Division of Juvenile Justice
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Introduced the trauma-informed care
program.
SHANNON CROSS-AZBILL, Clinical Director
Division of Juvenile Justice
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Introduced a PowerPoint entitled "Becoming
a Trauma Informed System."
BERNARD GATEWOOD, Superintendent
Fairbanks Youth Facility
Youth Facilities
Division of Juvenile Justice
Department of Health and Social Services
Fairbanks, Alaska
POSITION STATEMENT: Testified during the discussion on trauma-
informed care systems.
TONY PIPER, Coordinator
Alcohol Safety Action Program (ASAP)
Division of Behavioral Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of the 24/7
sobriety monitoring program.
ALBERT WALL, Director
Central Office
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion on the
24/7 sobriety monitoring program and presented a PowerPoint
overview of the Division of Behavioral Health.
ACTION NARRATIVE
3:03:21 PM
CHAIR PAUL SEATON called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Seaton, Tarr, Wool, Vazquez, and Foster were
present at the call to order. Representatives Talerico and
Stutes arrived as the meeting was in progress.
^PRESENTATION: THE STATEWIDE SUICIDE PREVENTION COUNCIL
PRESENTATION: THE STATEWIDE SUICIDE PREVENTION COUNCIL
3:03:52 PM
CHAIR SEATON announced that the first order of business would be
a presentation by the Suicide Prevention Council.
3:04:56 PM
KATE BURKHART, Executive Director, Statewide Suicide Prevention
Council, Division of Behavioral Health, Department of Health and
Social Services, reported that the council was established by
the Alaska State Legislature in 2001, slide 1, in response to a
large spate of deaths by suicide. She noted that the council
had 13 volunteer members appointed by the governor and 4 ex-
officio members appointed by the Legislature. She said that the
council offered guidance and advice related to suicide to the
executive and legislative branches, as well as communities. She
listed the responsibilities of the council to include:
improving health and wellness by reducing suicide, broadening
awareness of suicide and the role of risk and protective
factors, enhancing suicide prevention services and programs,
developing healthy communities through comprehensive,
collaborative, community and faith-based approaches, developing
and implementing a statewide suicide prevention plan, and
strengthening and building new partnerships between public and
private entities to advance suicide prevention efforts. As this
was a massive responsibility, in 2010 and 2011, the council
reevaluated its approach to the work, and focused on greater
collaboration and coordination of effort with communities for a
more effective suicide prevention program.
3:08:56 PM
MS. BURKHART directed attention to slide 2, "coordinate,"
stating that coordination was "a huge part of what the suicide
prevention council does." She shared that the plan, now in its
third year, was not a typical state health program plan, but was
based on an intensive, participatory process from 150 - 200
Alaskans, including clergy, Village Public Safety Officers
(VPSOs), suicide attempters, young people, business owners, and
the clinicians providing services. This process created a plan
and strategy that was fully endorsed by those who were served,
hence it became self-implementing. The council ensured that
communities were connected with each other and with the
necessary resources to effectively implement the strategies in
the plan. She shared the Wall of Hope, which offered resilience
to young people for navigating difficult situations and a place
to seek help during a crisis. She reported that the council
worked with school districts to organize and report on these
events.
3:11:09 PM
MS. BURKHART shared slide 3, "collaborate," and offered examples
which included a long standing media campaign with the Iron Dog
race. She shared the background for the campaign. She pointed
out that the word suicide was not usually used in these
campaigns, but instead there were references such as: reasons to
live, working together, or life is a team effort. She noted
that the downtown Anchorage Rotary Club had identified suicide
prevention as a priority for the organization, and had developed
a training regimen for gatekeeper suicide prevention available
to all statewide Rotary Clubs. She acknowledged the importance
of this for the foundation of the state suicide prevention plan
that every Alaskan take responsibility for preventing suicide by
identifying when someone was in crisis and helping get them
connected to help. She spoke about a peer suicide prevention
program for high school students, "You are not alone."
3:14:19 PM
MS. BURKHART moved on to slide 4, "communicate," and explained
that the council had developed a suicide prevention portal which
allowed information to be presented at the community level, and
minimized the costs of hosting websites. She reported that the
statewide website was stopsuicidealaska.org. She mentioned that
the council also partnered with the state crisis intervention
line, Careline, which was located in Fairbanks and staffed by
Alaskans trained to talk with people in crisis. Careline also
provided follow up to people who had called and needed
additional connection. She pointed out that Careline received
state funding and was an integral part of the suicide prevention
efforts. Its partnerships with Alaska Native Tribal Health
Consortium, Department of Health and Social Services, community
coalitions, and the council allowed for advertising and
outreach, with its resources reserved for services.
3:16:10 PM
MS. BURKHART addressed slide 5, "warning signs," and listed some
of the signs, which included: threatening to hurt or kill
themselves; looking for ways of suicide; talking or writing
about death, dying, or suicide; acting recklessly; dramatic mood
changes; and, expressing feelings of purposelessness or
hopelessness. She shared a report that stated firearms and
suffocation were the two predominant means of suicide.
3:18:56 PM
MS. BURKHART remarked that the state suicide prevention plan was
a plan of action, instead of aspiration, slide 6, "casting the
net upstream."
3:19:42 PM
MS. BURKHART directed attention to slide 7, "goals," and listed
the goals to include: Alaskans accept responsibility for
preventing suicide; respond effectively and appropriately to
people at risk of suicide; communicate, cooperate, and
coordinate suicide prevention efforts; have immediate access to
the necessary prevention, treatment, and recovery services, as
access to health care was critical; and support survivors in
healing. She shared that there was quality data and research
available for use in planning, implementation, and evaluation of
the suicide prevention efforts.
3:21:14 PM
MS. BURKHART explained that the council had created six regional
suicide prevention teams, which allowed the work to be aligned
most closely with each community's values and needs, slide 8,
"regional teams." Each regional team could decide which of the
aforementioned goals were most appropriate for its efforts.
Every other year, a statewide summit with all of the regional
teams allowed for each plan to be refined.
3:21:55 PM
MS. BURKHART said that the data collected by the Bureau of Vital
Statistics revealed that the suicide rate in Alaska had remained
steady for many years, slide 9, "suicide data." She stated that
Alaska was now only the fourth highest rate of suicide in the
US. She opined that this steadiness could reflect that the
prevention efforts were "something right in that we have held
steady while other similarly situated states have experienced a
rise in their rate." She shared that there was also data
collected for veterans' deaths.
3:23:37 PM
MS. BURKHART shared some of the strategies under the state plan,
which included that Alaskans know about Careline and other
community crisis lines, and that the information is shared,
slide 10, "crisis intervention." She pointed out that every
strategy had a performance indicator for measurement of progress
toward the goals, and that this was measured by looking at the
numbers of calls to Careline. She said that the calls to
Careline had risen from about 6,000 in 2013 to more than 10,000
in 2014. She noted that, should all the responders on Careline
be busy, the calls would roll over to a nationally accredited
member of the suicide prevention lifeline network, ensuring a
trained response. She stated that more than 80 percent of the
callers disclosed a current mental health or substance use
disorder.
3:25:19 PM
MS. BURKHART shared that another plan strategy was for the State
of Alaska and its partners to make training in evidence based
suicide prevention and intervention models accessible to all
interested Alaskans, slide 11, "training." She reported that,
in 2014, over 5000 people were trained, as training was now
available to educators and school district staff through the
Department of Education and Early Development.
3:26:38 PM
MS. BURKHART lauded Dr. Jay Butler for coining the term, "web of
causality," slide 12. She said that this term offered a
description for the many factors which lead to the contemplation
or attempt of suicide, pointing out that there were also social
and economic factors. She shared that suicide was not the
result of one factor.
3:27:52 PM
MS. BURKHART explained "childhood trauma" and its impact, slides
13 - 15. She reported that the data collected came from the
Adverse Childhood Experiences (ACEs), those traumatic events,
such as abuse, neglect, domestic violence, mental illness,
substance abuse, incarceration, or divorce within a household,
which occurred to individuals or their immediate family, while
young. The Behavioral Risk Factor Surveillance Survey (BRFSS)
data on ACEs offered a more specific understanding for how many
Alaskans were dealing with the ramifications of this childhood
trauma. This survey showed that 64 percent of Alaskan adults
had at least one of these experiences, and 27.4 percent had
three or more of these experiences. She declared there was a
correlation between the number of these adverse experiences
(ACEs) and the likelihood of negative health and social
experiences later in life; the higher the ACEs number, the
higher the likelihood of risks for suicide attempts. She shared
that a complete analysis of this BRFSS data was on-line, and
that research at the national level showed this increase to be
exponential. She said that nearly two thirds of suicide
attempts among adults were attributable to adverse childhood
experiences (ACEs). She directed attention to a graph depicting
the exponential increase of risks per suicide, slide 15.
3:30:44 PM
MS. BURKHART shared that there was a lot of success for the
school based suicide prevention efforts, slides 16 - 18, "what's
working." She referenced the Teck-John Baker Youth Leaders
Program in the Northwest Arctic, modeled after an evidence based
natural helper's model, but refined to include Inupiaq
traditions and values for greater cultural relevance to the
local students. She said that they had greater success for
preventing adolescent suicide than most other communities.
There was a focus on the strength and the resiliency of the
youth, and the youth were connected with adult mentors who
taught their heritage and culture. She reported that the
council partnered with the Department of Education and Early
Development to fund grants for school based suicide prevention
and that there were currently 10 grantees, all offering evidence
based suicide prevention training and access to mental health
services. She shared that at risk students were most often
attending alternative schools. In Juneau, the local suicide
prevention coalition partnered with the school district for a
peer leadership model, Sources of Strength. She shared that
this program also had successes similar to the aforementioned
program in the Arctic. She reported on a program in the Lower
Kuskokwim School District which had a very successful program,
as well. She stated that, as access to mental health care
services was integral to preventing suicide, the State had
supported the development of culturally relevant programs to
ensure that indigenous people had access to meaningful suicide
prevention. She spoke about "Doorway to a Sacred Place," a
traditional healing model funded by the Department of Health and
Social Services.
3:34:01 PM
REPRESENTATIVE FOSTER declared that he was a big supporter of
the Qungasvik Project in the Lower Yukon area. He asked if the
intent was for these programs, if successful, to be used in
other regions. He suggested that both funding and awareness was
necessary, and he asked if Department of Health and Social
Services was helping to get the word out.
MS. BURKHART replied that these projects had an organic quality
that was culturally relevant to the area. She reported that the
funding organization had been invited in by the community, and
after a long, very careful process, a model was developed that
was effective in that community and in that culture. Because of
this success, the state had allocated resources to the Yukon-
Kuskokwim Health Corporation to help spread this model
throughout that area of cultural relevance. She expressed
concern for the availability of state resources to develop a
similar organic process in another part of the state.
3:36:22 PM
MS. BURKHART concluded with slide 19, "what's next." She said
that they would continue to develop and support increased access
to evidence based suicide prevention training. She noted that
more Alaskans understood the importance of Careline. She stated
that there was not a robust curriculum or training in helping
professions, and that suicide prevention was not a major
component in many mental health curriculums. The council was
working to make evidence based training available on line for
continuing education credits for social workers, psychologists,
and nurses. They would continue to encourage suicide screening
and intervention in primary care practices and would encourage
support services and resources for parents and families to
ensure that all Alaskan children grow up in healthy and stable
environments. The council wanted to expand the suicide
knowledge and research base in Alaska, and refine its
communication strategies to take advantage of emerging outlets.
She declared that it would be necessary in the next few years to
sit down and evaluate its progress so that the next planning
phase would build on what was successful.
3:39:44 PM
CHAIR SEATON expressed his appreciation for casting the net
upstream to relate to underlying health issues. He asked about
the 2013 US military study on suicide, which found that the
likelihood for suicide was doubled when Vitamin D levels were
below 15 ng/ml. He asked if the council had considered this for
any recommendations.
MS. BURKHART replied that the council had read the study and
acknowledged the need for more research, as there was a clear
association between Vitamin D deficiencies and depression. She
pointed out that it was unclear whether this was causative, as
all the subjects in the military study had been deployed. She
pointed out that women and people living in poverty were also
populations that tended to have lower Vitamin D. She
acknowledged this association and that this information was in
conversations by the council. She stated that the council, as
it wanted communities to address suicide in a way that fit with
what they were seeing, tended to not tell the communities how to
deal with it. She compared studies of Vitamin D to studies on
sugar in various population groups. She mentioned the
disruptions in light and time caused by daylight savings time,
and its relationship to the risk of suicide.
3:43:20 PM
REPRESENTATIVE WOOL asked whether the number of suicides in
Alaska during 2014 had decreased.
MS. BURKHART replied that this was still unknown, as the Bureau
of Vital Statistics collected the information, but there was a
delay for the notification of Alaskans dying outside of Alaska.
This resulted in a nine month lag for the release of the final
data.
3:45:04 PM
The committee took an at-ease from 3:45 p.m. to 3:47 p.m.
3:47:36 PM
^PRESENTATION: BECOMING A TRAUMA INFORMED SYSTEM, DIVISION OF
JUVENILE JUSTICE
PRESENTATION: BECOMING A TRAUMA INFORMED SYSTEM, DIVISION OF
JUVENILE JUSTICE
CHAIR SEATON announced that the next order of business would be
a presentation on trauma informed care.
3:48:04 PM
KAREN FORREST, Director, Division of Juvenile Justice,
Department of Health and Social Services, explained that
Division of Juvenile Justice had been working on trauma-informed
care for several years, since a successful pilot project at the
McLaughlin Youth Center in Anchorage had resulted in a
significant drop in youth isolation and youth restraint due to
behaviors. She explained that a trauma informed agency was one
which: realized the wide spread impact of trauma, noting the
importance in the Division of Juvenile Justice as so many of its
youth had adverse childhood experiences; recognized the signs of
trauma in its youth, as well as its staff, who could experience
secondary trauma from working with these youth; and, adopted
policies, programs, and procedures which take into account the
trauma and adverse life experiences. She stated that the
division had a better understanding of how to intervene, and had
a better relationship with youth. She pointed out that youth
felt safer and were able to develop coping skills to address the
traumatic stress reactions. She stated that this care could
improve the overall outcomes and decrease the recidivism rate.
She shared that Department of Health and Social Services was
working on this care through the Office of Children's Services
and the Division of Behavioral Health.
3:53:11 PM
SHANNON CROSS-AZBILL, Clinical Director, Division of Juvenile
Justice, Department of Health and Social Services, explained
that its youth population had experienced many of the
aforementioned 10 points of the Adverse Childhood Experiences
(ACEs), as well as other traumas including homelessness and
bullying. She presented slide 1, "Trauma Informed Care," from a
PowerPoint titled, "Becoming a Trauma Informed System." She
declared that this was a process, a culture change, and not a
program. She allowed that although anyone can be trauma
informed, it was necessary to take the information and utilize
it. She said that Division of Juvenile Justice (DJJ) was
working through a change in its program from isolation to
relationship based. She emphasized that forming the
relationship was the most important aspect of trauma informed
care, as a therapeutic relationship allowed for accountability
and safety.
3:57:33 PM
MS. CROSS-AZBILL moved on to slide 2, "First and Foremost:
Support From Administration," and declared that, without this
support, everything would be very difficult. She pointed to
slide 3, "Becoming a Trauma Informed System..." which was a
reminder that two steps forward and one step back was still one
step forward. She offered an anecdote of the difficulty she had
faced with the distribution of coping toys to one of her
patients, noting that this was now an accepted tactic.
4:00:59 PM
MS. CROSS-AZBILL addressed slide 4, "Why Learn About Trauma?"
She stressed that it was now accepted that traumatic experiences
did impact a person's brain and body. She compared pictures of
brains that had and had not been exposed to neglect, similar to
the development of brains exposed to alcohol. She reported, as
staff now better understood the physiological, emotional, and
neurological impact of traumatic experiences that relationships
could be enhanced and treatment could be improved.
4:01:58 PM
MS. CROSS-AZBILL shared slide 5, "Long-Term Impact of Trauma,"
and pointed out that the long term impacts from trauma included
mental health issues, substance abuse, and physical health
issues such as diabetes, heart attacks, and cancer.
MS. CROSS-AZBILL moved on to slide 6, "Safety," and declared
that this was the most important aspect of any service system
that worked with violence and trauma. She shared that
improvement to facilities and youth required review for trauma
informed care to enhance safety. Directing attention to slides
7 - 8, she reiterated that good relationships allowed for better
accountability. She said that they created safety and provided
structure and consistency to help create the environment in the
TIC.
MS. CROSS-AZBILL introduced slide 9, "Training and Professional
Development," which listed the staff trainings. She stated that
the staff pairings were inter-departmental so it would not
appear to be just "a mental health thing," and this had also
helped to build those relationships. She said that the
clinicians had worked on trauma focused therapies, and that
secondary trauma training was enhanced to better help the staff.
She referenced the integrated life story assessment (ILSA),
similar to a time line of the subject's life, slide 10, which
was also used by the probation staff. She declared the need to
focus on strengths and the necessity to implement those when
moving forward.
MS. CROSS-AZBILL directed attention to slide 12, "Disrupted
Brain Development from Childhood Neglect," noting that these
were pictures of the two brains she had mentioned earlier.
Focusing on slide 14, "ACEs and suicide attempts," she offered
an anecdote about a youth detainee who had attempted suicide,
was then sent to Alaska Psychiatric Institute, and then returned
to the Anchorage youth facility where he had made other suicide
attempts. She relayed that staff viewed this behavior as
conduct disorder, whereas the clinicians declared that this was
post-traumatic stress disorder with a bi-polar diagnosis. This
brought discussion and disagreement for the means of treatment.
When the ACE diagnosis was assessed, it was discovered that he
had experienced six of the ten adverse childhood experiences.
She directed attention to the corresponding data, which showed
that this would increase the risk for suicide attempts by 28
times. She pointed out that it was inconsequential for the
reasons to the suicide attempts; that it was more important to
look at the basics of what happened to him, build on his
strengths, and work on the relationships. She offered an
anecdote for recent interactions with this same youth.
4:14:13 PM
BERNARD GATEWOOD, Superintendent, Fairbanks Youth Facility,
Youth Facilities, Division of Juvenile Justice, Department of
Health and Social Services, reported that he had introduced
trauma informed care into the Fairbanks youth facility. He
declared that, as he always wanted to make the facility better
and that everyone had the right to be treated with dignity and
respect, it was necessary to focus on respect when forming the
relationship. He stated that the kids still had the ability to
bounce back and be productive citizens, although they often
needed some help. He shared that it was necessary to take a
step back, review what happened to cause these actions, and look
at the kids as human beings. He opined that it was from this
point that progress would begin. He shared that all of the
staff, including teachers, maintenance, and nurses, were trained
in the introduction phase of the TIC program, so that all the
staff understood trauma and its effects on the clients in the
facility. He said that TIC allowed people to focus on their own
triggers, better understand their own reactions, and develop
better coping skills, so there would be better relationships.
4:19:13 PM
CHAIR SEATON asked how the numbers on an ACEs assessment were
used in the treatment decision.
MR. GATEWOOD replied that the number was irrelevant, that it was
important to know the traumatic events which lead to the current
state. It was most important to treat the person with respect,
build relationships, and work on resilience.
CHAIR SEATON reflected on past testimony about the importance of
ACEs, which seemed to focus on the numbers.
REPRESENTATIVE WOOL asked about the aforementioned point system
that was no longer in use.
MR. GATEWOOD replied that this system had been based on points
for behavior. He opined that, although points were artificial
as there were not points in the real world, points gave both
kids and staff a barometer, and something was necessary if
points were going to be replaced.
4:22:07 PM
MS. CROSS-AZBILL explained that it was necessary to recognize
the traumas and adverse experiences, and then look at how they
earn points to help them become successful.
^PRESENTATION: 24/7 SOBRIETY MONITORING PROGRAM
PRESENTATION: 24/7 SOBRIETY MONITORING PROGRAM
4:22:39 PM
CHAIR SEATON announced that the next order of business would be
a presentation on the 24/7 sobriety monitoring program.
4:23:55 PM
TONY PIPER, Coordinator, Alcohol Safety Action Program (ASAP),
Division of Behavioral Health, Department of Health and Social
Services, said that the 24/7 sobriety monitoring program was one
of the smart justice evidence based initiatives passed the
previous legislative session, through Senate Bill 64. As this
concept had been successfully used in several areas around the
country, the 24/7 sobriety monitoring program was modeled on
these other programs. He explained that the program allowed
qualified participants to be actively involved in their
community, and to take care of their obligations instead of
sitting in an institution. He reported that, as the
participants were tested twice daily for alcohol with a breath
analysis every 12 hours, the public was also safe. If there
were any action that was not positive, there was an immediate
follow up action, which most often resulted in immediately being
remanded to the institution. He shared that Senate Bill 64
allowed this 24/7 program to be used in a variety of ways,
including bail, probation, parole, and children in need of aid
programs. He noted that the program had started in July, and
shortly thereafter a tour for judges and attorneys had been
instrumental in spreading the program information and increasing
the referrals. He reported that there had been 218 participants
through the end of December, with 89 active participants. He
said there had been more than 11,000 successful breath tests,
with only 26 failed breath tests. He shared that there had been
more than 1300 successful drug tests, with only 16 failures.
These failure rates were lower than those in other areas with
similar programs. He pointed out that all of the 42 patients
who had failed, were now re-entered into the program, and were
currently successful. He explained that participants were
released to the program, with instructions for where to go and
how the program worked. He reported that drug testing was
randomly done two or three times each week, with participants
calling in each morning. The alcohol testing was conducted in
both the morning and the evening and attendance was mandatory.
He allowed that some adjustments to the timing had been made to
allow for bus schedules. He reported that 64 people had now
completed the program with no violations. He said that the
program was now being expanded into Fairbanks and the Kenai.
The per person cost for participation in the program was $5 each
day for the breath test, and between $10 and $50 for the drug
test, dependent on the number of drugs and the frequency of
testing. He shared that facial recognition software was also
available for those unable to go to the testing facilities, and
were testing at home.
4:29:26 PM
REPRESENTATIVE STUTES asked about the random scheduling for drug
testing.
MR. PIPER explained that the individual would call in every day
and be advised whether they were scheduled to come in that day.
REPRESENTATIVE STUTES offered her understanding that, with
advance warning, there was the ability to mask the results.
MR. PIPER replied that current drug tests had precautions that
would show tampering or dilution for the normal urine sample.
He added that these tests were witnessed by a representative of
the program.
4:31:10 PM
REPRESENTATIVE STUTES opined that people can ingest "whatever it
is they take" to produce a normal urine sample. She expressed
confusion for the program offering an advance warning.
CHAIR SEATON asked that Representative Stutes research this
further, to identify the chemical and whether this would show up
as a normal sample.
4:33:07 PM
REPRESENTATIVE WOOL asked for the type of offenders in the
program.
MR. PIPER, in response, shared that the bill listed the
qualifying offenses, "more or less misdemeanor offenders," which
included driving under the influence (DUI) and drug offenders.
REPRESENTATIVE WOOL asked if this included first time DUI
offenders.
MR. PIPER replied that a first time offender could be in the
program, though more often it was second and third time
offenders.
REPRESENTATIVE WOOL asked for more information about the ankle
bracelet monitoring system.
MR. PIPER acknowledged the availability of a bracelet, which was
going to be used in the Fairbanks area. He offered his belief
that Department of Corrections used the Sober Link bracelet,
although it was only capable of alcohol testing.
REPRESENTATIVE WOOL opined that the bracelet could eliminate the
need to go twice daily to a facility.
MR. PIPER concurred.
REPRESENTATIVE VAZQUEZ asked about the time lag between the
call-in and testing.
MR. PIPER explained that there was a short time window in the
morning, the call in period began at 6 a.m. and the testing had
to be completed prior to 9 a.m.
REPRESENTATIVE VAZQUEZ asked if there was a designated lab.
MR. PIPER replied that there was a designated facility.
CHAIR SEATON opined that outside monitoring was an added
efficiency for the justice system, as it reduced the cost of
incarceration, it kept earnings going to the family, and it
maintained engagement with the community. He declared that he
was encouraged by the 11,000 positive test results, with only 26
failed tests. He offered his belief that there was a stronger
learning path for learning how to not abuse alcohol out-of-jail
versus in-jail. He expressed his support for the program and
for an increase to the number of non-violent offenders able to
be "back into life, but on that right path."
4:38:05 PM
REPRESENTATIVE VAZQUEZ asked who supervised the program.
MR. PIPER replied that the Department of Health and Social
Services and the Alcohol Safety Action Program (ASAP) office
were overseeing the program. In response to Representative
Vazquez, he added that he was the program manager. He explained
that the current results only reflected the program since its
inception in August, although the South Dakota program had
demonstrated results for a much longer period of time.
4:39:38 PM
ALBERT WALL, Director, Central Office, Division of Behavioral
Health, Department of Health and Social Services, said that the
department would provide the data.
4:39:56 PM
REPRESENTATIVE STUTES asked if, as this was a court mandated
sobriety or drug testing program, there was any time delay or
requirement before an individual would begin the program.
MR. PIPER explained that program participants were given
instructions immediately upon their release from court, which
allowed 12 hours to appear. These instructions included the
testing times, the directions to the facility, and bus routes to
the facility. He said that anyone who took longer than 12 hours
to appear at the testing agency was tested for the length of
time since their court appearance. He shared that, as his
office was immediately notified upon an individual's release
from the court, the testing agency was expecting the individual
within the next 12 hours.
A short video about the program was presented.
4:44:45 PM
MR. WALL explained that the program represented a response by
the Department of Health and Social Services and its
collaborative partners to comply with Senate Bill 64. It was
based on a model that had shown results and had a consistent 100
percent accountability. He pointed out that the program offered
a savings to the system. It addressed the addictive behavior,
while holding the individual accountable and showing them an
alternative way to move forward with their lives.
^OVERVIEW: DIVISION OF BEHAVIORAL HEALTH
OVERVIEW: DIVISION OF BEHAVIORAL HEALTH
4:45:43 PM
CHAIR SEATON announced that the final order of business would be
an overview of the Division of Behavioral Health.
4:46:27 PM
ALBERT WALL, Director, Central Office, Division of Behavioral
Health, Department of Health and Social Services, presented a
PowerPoint titled, "House Health & Social Services| Division
Overview." Directing attention to slide 2, "Behavioral Health
Overview," he said that the division existed to "manage and
integrated and comprehensive behavioral health system based on
sound policy, effective practices, and open partnerships." He
said there were 348 full time positions in the division, and
that the operating budget was about 5.2 percent of the overall
Department of Health and Social Services budget, almost $142
million. The division served about 32,854 people, which did not
include the prevention population.
4:47:49 PM
MR. WALL addressed slide 3, "Organization Chart," which showed
the division structure and a breakout of personnel in each area.
He pointed to the Alaska Psychiatric Institute (API), which he
described as "the anchor of acute care for behavioral health in
the state." He noted that API was located in Anchorage and was
an in-patient facility with 246 staff. API cares for people
with the most extreme need and was based on a therapeutic and
restorative model to return people to their community. Next, he
pointed to the Prevention & Early Intervention Section, which
primarily ran program management for grants, including fetal
alcohol spectrum disorder (FASD) and suicide prevention.
Although this section was primarily housed in Juneau, the grants
were distributed statewide. He moved on to another grant
section, the Treatment & Recovery Section, which represented the
largest financial section after API, and handled grants in four
categories. He referenced the Medicaid & Quality Section, which
had quality oversight and assessment for Medicaid billing for
behavioral health and for the Medicaid providers to behavioral
health. He explained that the Policy & Planning Section handled
the proprietary data base system where grantees entered reports,
which allowed for tracking the information. This section also
performed the research for the division. He noted the
Administrative Support Team, as well as the three boards: the
Alaska Mental Health Board, the Advisory Board on Alcohol & Drug
Abuse, and the Statewide Suicide Prevention Council.
4:50:37 PM
MR. WALL presented slide 4, "Division Core Service Alignment,"
and stated that the division, similar to the department, was
core service driven, and he explained how the core services of
the division fed into the three priorities. He said that the
first core service identified behavioral health needs by
population and geography and developed and implemented a
statewide strategy to meet those needs. He said that the second
core service was to develop and maintain a stable, accessible,
and sustainable system of behavioral healthcare for Alaskans in
partnership with providers and communities. He said that it was
extremely critical for behavioral health services to work
collaboratively with its providers, as the system was designed
and dependent on working together with other groups. He stated
that the third core service was to protect and promote the
improving behavioral health of Alaskans. The fourth core
service was to provide accessible, quality, active inpatient
treatment in a safe and comfortable setting, and the fifth core
service was to provide and coordinate interagency behavioral
healthcare.
4:52:57 PM
MR. WALL presented slide 5, "Continuum of Care," and explained
that the continuum flow began with the prevention and early
intervention efforts, which cost little per contact but had
great value, such as suicide prevention, domestic violence and
FASD. Moving along the continuum, he pointed to the treatment
and recovery services, divided among mental health, such as
mental illness, and behavioral health, such as substance issues.
He noted that the treatment and recovery grants were most often
found in the middle of the continuum. He pointed out that some
of these services received grant dollars, as well as billing for
Medicaid reimbursement for some of the population. Continuing
along the continuum, he spoke about the more intensive services
which included acute psychiatric help, and those high associated
costs. The continuum concluded with the long term residential
psychiatric treatment centers, the most expensive service.
4:55:23 PM
MR. WALL moved on to slide 6, listing the age groups, with the
bulk of service for adults between ages 18 - 64. Presenting
slide 7, "Collaboration," he emphasized the importance of the
collaborative effort across the continuum of care. He declared
that he was impressed with the relationships built with the care
providers. He listed many of the organizations which
represented groups of providers and their representation at
conferences and workshops to ensure the necessary care. He read
from a prepared statement:
The purpose of the Division of Behavioral Health is to
manage an integrated and comprehensive behavior health
system based on sound policy, effective practices, and
open partnerships. This is accomplished through
either performing or providing for mental health and
substance use disorder services, ranging from
prevention to screening, out-patient treatment, and
acute psychiatric care. Those services are
specifically focused on individuals who cannot access
behavioral health services without some form of
assistance and are targeted to the following specific
population groups: these are individuals in severe
psychiatric crisis or in need of de-toxification;
severely emotionally disturbed children and youth;
severely mentally ill adults; substance use disordered
adults and youth; and, or, adults and youth in the
community, specifically services to prevent health
risk factors.
MR. WALL concluded by stating that the division did, in some
ways, provide direct service to some programs. However, most of
the services were indirect, through the provider groups in the
communities, either through grant funding or Medicaid services.
He reported that, in order to accomplish its purpose, the
division provided ongoing prevention and early intervention for
behavioral health issues through grant programs and management,
and he listed many of these programs, which included suicide
awareness, fetal alcohol syndrome, domestic violence, and drug
and tobacco use. He noted that direct care was provided through
the therapeutic courts, the alcohol program, and API. The
division provided for on-going, comprehensive behavior health
treatment and recovery, as well as psychiatric emergency
services for severely disturbed children and youth, severely
mentally ill adults, and substance use disordered youth and
adults. He pointed out that the division provided statewide
access to behavior health care through management and quality
assurance of the behavior health Medicaid system.
5:00:22 PM
CHAIR SEATON noted that, although only 2.5 percent of the
service population was 65 and older, there seemed to be an
increase in dementia and Alzheimer's. He asked whether this
population received much service.
MR. WALL replied that he was working with the Division of Senior
and Disabilities Services, as this was a growing area of
concern.
CHAIR SEATON said that he was supportive of an upstream net and
moving into prevention to delay the onset of Alzheimer's, as it
was a disruption of lives throughout the state.
MR. WALL said that a committee had been formed, as this was a
concern, and it was in on-going discussions.
5:03:00 PM
REPRESENTATIVE VAZQUEZ referred to slide 5, "Continuum of Care,"
and asked about the reference to Acute Psych (Non-API).
MR. WALL explained that some of this population was served by
hospitals in-state and out-of-state. He directed attention to
the Designated Evaluation, Treatment, and Stabilization box, and
explained that this was also done in hospitals.
CHAIR SEATON asked whether Alzheimer's fits into any of these
sections for long term care.
REPRESENTATIVE VAZQUEZ shared that it was a separate waiver.
MR. WALL explained that these were normally cared for under the
Senior and Disabilities waiver.
MR. WALL, in response to Representative Vazquez, explained that
the residential psychiatric treatment centers were long term
care for children with serious emotional disturbance, and that
many of these were located out of state.
REPRESENTATIVE VAZQUEZ asked for a breakdown of the
aforementioned out of state and in-state program expenses.
MR. WALL said that he would provide this.
REPRESENTATIVE VAZQUEZ, referring to slide 5, asked what
prevention services were being offered in this category.
MR. WALL explained that this category included advertisements on
television and radio, as well as printed material, for a variety
of subjects, including under-age drinking, tobacco use, suicide
awareness, and FASD.
REPRESENTATIVE VAZQUEZ asked whether there was any effort to
include nutrition and vitamins as prevention measures, as a lot
of research indicated that severe deficiencies of vitamins could
show up as diseases. She requested more effort in that
direction.
MR. WALL replied that he was unaware of any effort in the
Division of Behavioral Health, although there could be in
Department of Health and Social Services. He would forward that
information.
REPRESENTATIVE VAZQUEZ added that there were studies on the
effects of color on patients and their moods. She stated that
it was necessary "to start thinking out of the box, instead of
taking the most expensive options we have." She suggested that
there were cheaper options to help the healing process.
5:08:48 PM
CHAIR SEATON announced that there would be sessions specifically
to address prevention and strategies to lower costs while
improving the health status of Alaskans.
5:09:14 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:09 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SSPC Overview for House HSS 1-29-15.pdf |
HHSS 1/29/2015 3:00:00 PM |
Presentations by DHSS |
| DJJ Trauma-Informed-Care-Presentation- HHSS 1-29-15.pdf |
HHSS 1/29/2015 3:00:00 PM |
Presentations by DHSS |
| DJJ Trauma-Informed Care Briefing 1-29-15.pdf |
HHSS 1/29/2015 3:00:00 PM |
Presentations by DHSS |
| DBH presentation HHSS 1 29.pdf |
HHSS 1/29/2015 3:00:00 PM |
Presentations by DHSS |
| DHSS DBH 24-7 info sheet - 01_29_2015.pdf |
HHSS 1/29/2015 3:00:00 PM |
Presentations by DHSS |
| CDC quick stats_Suicide rates.pdf |
HHSS 1/29/2015 3:00:00 PM |
Presentations by DHSS |
| Alaska suicide prevention_2014 annual implementation report.pdf |
HHSS 1/29/2015 3:00:00 PM |
Presentations by DHSS |