Legislature(2015 - 2016)CAPITOL 106
02/19/2015 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Division of Behavioral Health | |
| Presentation: Recidivism Reduction Plan | |
| Presentation: Key Coalition | |
| Presentation: Uaf Bachelor of Social Work Students | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 19, 2015
3:02 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: DIVISION OF BEHAVIORAL HEALTH
- HEARD
PRESENTATION: RECIDIVISM REDUCTION PLAN
- HEARD
PRESENTATION: KEY COALITION
- HEARD
PRESENTATION: UAF BACHELOR OF SOCIAL WORK STUDENTS
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
ALBERT WALL, Director
Central Office
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "Division
Overview."
JEFF JESSEE, Chief Executive Officer
Alaska Mental Health Trust Authority
Department of Revenue
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint entitled, "2015
Recidivism Reduction Plan."
CARMEN GUTIEREZ
Justice Improvement Solutions
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint entitled, "2015
Recidivism Reduction Plan."
EMILY ENNIS, Executive Director
Fairbanks Resource Agency
Key Coalition of Alaska
Fairbanks, Alaska
POSITION STATEMENT: Spoke during the presentation by the Key
Coalition.
JIM BECK
Key Coalition of Alaska
Access Alaska
Palmer, Alaska
POSITION STATEMENT: Spoke during the presentation by the Key
Coalition.
MILLIE RYAN, Executive Director
REACH, Inc.
Key Coalition of Alaska
Juneau, Alaska
POSITION STATEMENT: Spoke during the presentation by the Key
Coalition.
RICK FASSEL
Key Coalition of Alaska
Juneau, Alaska
POSITION STATEMENT: Spoke during the presentation by the Key
Coalition.
DENNIS HAAS
Key Coalition of Alaska
Soldotna, Alaska
POSITION STATEMENT: Spoke during the presentation by the Key
Coalition.
NED MAGEN
Key Coalition of Alaska
Soldotna, Alaska
POSITION STATEMENT: Spoke during the presentation by the Key
Coalition.
CHARLISSA MAGEN
Key Coalition of Alaska
Soldotna, Alaska
POSITION STATEMENT: Spoke during the presentation by the Key
Coalition.
MIKE BAILEY
Key Coalition of Alaska
Anchorage, Alaska
POSITION STATEMENT: Spoke during the presentation by the Key
Coalition.
GLENN SHEEHAN
Key Coalition of Alaska
Barrow, Alaska
POSITION STATEMENT: Spoke during the presentation by the Key
Coalition.
DIANE CASTO, Prevention & Early Intervention Manager
Prevention & Early Intervention Section
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified during the presentation about the
UAF Bachelor of Social Work program.
HEIDI BROCIOUS, Clinical Associate Professor
Department of Social Work
University of Alaska Fairbanks
Fairbanks, Alaska
POSITION STATEMENT: Testified during the presentation about the
UAF Bachelor of Social Work program.
ACTION NARRATIVE
3:02:18 PM
CHAIR PAUL SEATON called the House Health and Social Services
Standing Committee meeting to order at 3:02 p.m.
Representatives Seaton, Wool, Talerico, and Stutes were present
at the call to order. Representatives Tarr, Vazquez, and Foster
arrived as the meeting was in progress.
^PRESENTATION: Division of Behavioral Health
PRESENTATION: Division of Behavioral Health
3:02:45 PM
CHAIR SEATON announced that the first order of business would be
a presentation by the Division of Behavioral Health.
3:05:11 PM
ALBERT WALL, Director, Central Office, Division of Behavioral
Health, Department of Health and Social Services, introduced
slide 2, "Behavioral Health Overview," and stated that the
mission of the division was to "manage an integrated and
comprehensive behavioral health system based on sound policy,
effective practices and partnerships." He stated that the
division was responsible for the behavioral health continuum of
care in Alaska, which included prevention through acute
treatment. He noted that the division had partnerships with the
agencies which were grantees that provided services, and with
tribal entities and the business community which also provided
services. He reported that the division had 348 full time
positions and 26 part time positions, and had a budget of $141.9
million in Fiscal Year (FY) 2015. He pointed out that this
budget did not include treatment through Medicaid expenditures.
This budget was about 5.2 percent of the total Department of
Health and Social Services management plan, and the division
served 32,854 people.
3:07:21 PM
MR. WALL moved on to slide 3, "Organization Chart," which tied
everything to the central purpose of the division, and included
the Statewide Suicide Prevention Council, the Alaska Mental
Health Board and the Advisory Board on Alcohol & Drug Abuse. He
shared that, although he was responsible for tracking the budget
for these three bodies, they were each independent. He spoke
about the Alaska Psychiatric Institute (API), which was "a 24/7
80 bed facility, that is for acute in-patient care for
psychiatric needs in the state." He stated that API was the
only in-patient psychiatric facility for acute care that
accepted all ages. He noted that the bulk of the division
personnel were located at API, and included medical doctors,
psychiatrists, licensed nurses, and psychologists. He pointed
out that, as API was also a certified teaching hospital,
University of Alaska Anchorage (UAA) nursing students were able
to rotate through API and receive training. He moved on to the
Prevention and Early Intervention Section, which had 35 full
time staff, and included program and grant managers, as well as
the therapeutic courts program. He discussed the Policy and
Planning Section, which handled the database system that all the
providers used to enter information to measure and evaluate the
effectiveness of the grant recipients. He jumped to the
Administrative Support Team, declaring them to be
"indispensable" and he declared his pride for the amazing work
from this team. He addressed the Treatment and Recovery
Section, which was the primary section for handling grants. He
relayed that there were only 18 full time staff to handle more
than 100 grants. He described the Medicaid & Quality Section,
which handled the Medicaid claims, approvals and pre-
authorizations.
3:12:33 PM
MR. WALL turned to slide 4, "Division Core Service Alignment,"
and shared that the division had identified those five core
services which were different than those of the divisions in the
department and how those fed into the department's priorities.
He shared that some were specific, citing the core service for
API, "to provide accessible, quality, active in-patient
treatment in a safe and comfortable setting;" whereas others
were very broad, "identifying population and geography needs and
developing a statewide plan."
3:13:41 PM
MR. WALL directed attention to slide 5, "Continuum of Care,"
which ranged from left to right on the chart based on the acuity
or intensity of need. He stated that on the far left were the
prevention services, generally lower cost with a tremendous
statewide impact. He referenced an earlier presentation for
surveys on risk behaviors among youth associated with future
problems, and noted that all the risk numbers had fallen since
2007. He suggested that this decrease correlated with the
prevention efforts by the division. He reported that the
numbers associated with prevention were number of contacts with
prevention messages, and not for individuals served. He
explained that the domestic violence prevention services were
community based in grant based services. He spoke about the
alcohol safety action program, which was associated with the
therapeutic courts. He described the actions of the division to
"either provide for or we perform behavioral health on behalf of
Alaskans." He stated that some services simply provided the
means through a grant to a provider, and other services were
provided by the division. Referencing the organizational chart
on slide 3, he pointed out that prevention and early
intervention had 35 staff, with the bulk of them in the alcohol
safety action program, in direct association with the courts.
He stated that this program held people accountable in treatment
while going through the program. He pointed to the far right of
the continuum, and shared that API was also a direct service.
He declared that the division provided the funding for most of
its programs to other agencies to be performed on behalf of the
division. He moved on to the community behavioral health center
clinics, psychologists, and the Behavioral Rehab Services with
residential care for children and youth. He said that these
were primarily paid for by a combination of Medicaid claims and
grants, although some had private and third party payees. He
stated that the bulk of work by the division was in this area of
the community behavioral health center, with counseling and day-
to-day interaction with clients. He said that these services
ranged from immediate crisis intervention to long term
treatment. He said that some of these services were provided
specifically to children in a clinic. He spoke about the
behavioral rehab services, residential care for children in-
need, which offered ongoing care in facilities with a wide range
to the level of care needed by each individual child. He
reported that needs being met in the community, around the
family, had a lower cost and were statistically proven to be
more effective. He moved to the right on the continuum to the
inpatient and hospital based care, and spoke about designated
evaluation, treatment, and stabilization. He stated that this
was a grant service, where a person with a psychiatric crisis
with an immediate need was taken to a designated evaluation
treatment center, for determination whether they needed to stay
in the hospital or could be treated at a different level of
care. He noted that this was a high cost area. He moved on to
the acute psychiatric care at API, and stated that lengths of
stay and levels of acuity varied greatly. He pointed out that
10 of the 80 beds were specifically designated for children, 10
beds were designated for criminal patients, and another 10 beds
were designated for elderly or dementia patients. He pointed
out that the state only had one acute care psychiatric facility,
API, which accepted all ages, and he described it as the anchor
to the system. He referenced North Star Behavioral Health,
which cared for children with acute needs, and noted that there
were also occasional instances where the needs had to be met out
of state. At the far right of the continuum were the long term
residential psychiatric treatment centers for children with
tremendous needs, usually very complex.
3:23:06 PM
MR. WALL addressed slide 6, "DBH Service Population," and
directed focus to the age groups primarily served, mainly adults
aged 18 - 64.
MR. WALL presented slide 7, "Collaboration," declaring that it
was a huge collaborative effort in behavioral health for groups
to triangulate on individuals and bring the necessary services
to effect change. He declared that he was impressed with the
relationships built with the care providers. He listed many of
the organizations, including the boards and associations which
assisted their partner agencies. He offered his belief that
collaboration was growing. He referenced the upcoming
presentation on recidivism as a collaborative effort across
departments, agencies, and non-state agencies.
MR. WALL referenced slide 8, "Recent Successes," which reflected
collaborative efforts that triaged immediate need for people who
could be stabilized today. He mentioned Parenting with Love &
Limits (PLL) and Opioid Treatment (OTP). He stated that
behavioral health paid attention to outcome measures and the
data driven specifics of what treatment did for the person and
for society, as well as for the cost, as it was important to be
good stewards of the money. He called this outcome based
treatment. He explained the Change Agent Conference, which was
the opportunity for all the providers to discuss things the
grantees needed to know. He shared an in-depth discussion at
the latest conference for outcome measures at the grantee level.
He shared the importance for all the agencies to understand the
value and the impact of outcome based service. He moved on to
slide 9, "Recent Successes, and spoke about the Alaska Tobacco
Retailer Violation Rate (RVR) reported over time. He noted that
since 2004 the violations had stayed below the threshold target.
3:29:28 PM
MR. WALL referenced slide 10, "DBH Current Challenges," and
addressed Designated Evaluation and Treatment, which was growing
rapidly and was paid out of the general fund. He shared that
there were three designated centers, including API, with the
other two in Fairbanks and Juneau. He stated that Anchorage
also had a designated point of entry at Providence Alaska
Medical Center with services somewhat similar to the designated
evaluation and treatment centers. He reported that all travel
and treatment was paid out of the general fund. He pointed out
that API ran at 95 - 100 percent utilization, and that this wear
and tear on the staff needed to be addressed. He spoke about
individuals with dual diagnosis, and that often these occurred
at both ends of the age line. He stated that these complex
problems created gaps in the state service system that needed to
be addressed.
3:32:10 PM
REPRESENTATIVE VAZQUEZ asked about the average patient stay at
API.
MR. WALL offered to provide an overall breakdown on paper as
there were average stays for each of the different units.
REPRESENTATIVE WOOL asked for clarification that the total
Division of Behavioral Health budget of $142 million was 5
percent of the department budget.
MR. WALL explained that this was 5 percent of the operating
budget.
CHAIR SEATON pointed out that the Department of Health and
Social Services had the largest budget in the state.
MR. WALL shared that the difference was whether the Medicaid
budget was included, and that the 5.2 percent provided service
for about 33,000 people.
3:34:13 PM
REPRESENTATIVE VAZQUEZ asked if the $142 million included
Medicaid payments received by Division of Behavioral Health.
MR. WALL directed attention to slide 5, which charted the cost
of Medicaid versus the operating budget. He shared that the
overall direct service cost in grants was $124.5 million and the
overall direct service in Medicaid payments was $166.6 million.
He stated that Medicaid was not included in the $141 million
cost referenced by Representative Vazquez. He said that
Medicaid had a particular structure in the accounting system,
and was not included in the Division of Behavioral Health
budget, although the division did track it and had oversight for
its regulatory authority.
3:35:39 PM
MR. WALL, in response to Representative Wool, relayed that the
24/7 sobriety program was a monitoring program and not
treatment, although it was related to the cross department
efforts to reduce recidivism. He stated that accountability was
key to treatment for substance abuse.
REPRESENTATIVE WOOL asked if his division was responsible for
tracking tobacco enforcement.
MR. WALL clarified that this tracking was for the illegal sale
of tobacco to minors.
REPRESENTATIVE WOOL asked about tobacco use in the continuum of
care.
CHAIR SEATON asked to defer question this to later.
3:38:00 PM
CHAIR SEATON asked if it was possible to expand tele-medicine
behavioral health care.
MR. WALL said that this was an area of success and that it was
used substantially. He noted that API had a tele-behavioral
health hub, which provided consultation among many partners
statewide. He noted that the evaluation for commitment into
care had to be made in-person, although any follow-up and on-
going care could be done through tele-medicine.
3:39:39 PM
CHAIR SEATON relayed that prevention and intervention before a
crisis situation were goals and keys for the committee.
3:40:46 PM
REPRESENTATIVE STUTES asked what type of patient assessments the
division made, and whether these assessments were shared with
other agencies in the department.
MR. WALL replied that there were numerous different types of
assessments in the field of psychology, including assessments
for substance abuse or diagnosis for psychological crisis. He
explained that assessment, in this presentation, was in "the
broadest sense possible." He pointed out that designated
evaluation in terms of a program was very specific for an
individual in crisis, who was often not functioning in society
and was a danger to themselves or others. He explained that the
sharing of information was covered under Health Insurance
Portability and Accountability Act (HIPAA) rules.
3:43:24 PM
REPRESENTATIVE TARR referenced the challenges to dual diagnosis,
and asked if the division was tracking the rates for issues and
the corresponding behavioral interventions, to get a sense of
the trends in Alaska.
MR. WALL said that autism spectrum disorders were very specific,
and could fall between divisions, as it was a disability, as
well. He explained that the complex behavioral health
collaborative was funded by the legislature, and its primary
function was to track these issues and outcomes, as well as to
assist in the placement of individuals at the proper level of
care. He shared that placement was more difficult for the most
acute levels of need, as there was not enough of this care.
^PRESENTATION: Recidivism Reduction Plan
PRESENTATION: Recidivism Reduction Plan
3:45:15 PM
CHAIR SEATON announced that the next order of business would be
a report on recidivism reduction.
3:46:31 PM
JEFF JESSEE, Chief Executive Officer, Alaska Mental Health Trust
Authority, Department of Revenue, explained that there had been
legislative intent language placed in the state budget last year
to begin a review of the increase to prison populations in
Alaska, and the sustainability of this current path or the need
for other alternatives. He declared that this was an issue
where both sides of the political spectrum had come together
with a desire for the same outcome, even though they had
different perspectives and priorities. He shared the desire for
people to come out of corrections and be successful in the
community without a life of crime. He referenced slide 2, a
quote from Grover Norquist, "We want to reduce crimes as rapidly
and as seriously as possible." He pointed out that this
reduction, conducted in the wrong way, would harm families,
communities, and neighborhoods and would spend money that was no
longer available.
3:48:04 PM
MR. JESSEE moved on to slide 3, "HB 266 Legislative Intent
Language," and stated that the intent was to collaboratively
reduce recidivism by gathering data on substance abuse, mental
health, employment, housing, and other services currently
provided, propose some effectiveness and efficiency measures,
and then develop a plan "to work our way out of this." He
offered his belief that the "big jump to light speed" was
recognition by the state legislature that the agencies most
recognized and expected, the Department of Corrections, the
Alaska Court System, Department of Law, and Department of Public
Safety were not going to get the job done. He acknowledged
that, although the Department of Corrections had an important
role, after release there were three things necessary for
successful reentry: housing, employment, and support for
recovery. He stated that it was necessary to include Alaska
Housing Finance Corporation, Department of Labor & Workforce
Development, and Department of Health and Social Services,
specifically the Division of Behavioral Health. He noted that
these agencies had already been working with the Alaska Mental
Health Trust Authority with some good results. He stated that
it was not yet possible to match the prison population with the
need for beds.
CARMEN GUTIEREZ, Justice Improvement Solutions, directed
attention to slide 4, and questioned why it was necessary to
care about recidivism and prison inmates. She said that the
simple matter was that "every offender who comes out of prison
and is successful means one less victim in our communities. It
additionally means we have parents who are supporting their
children, it means we have citizens who are working in our
communities and we have in total much more healthy communities."
She opined that it was necessary to care about improving the
state's high recidivism rate. She reported that the fiscally
conservative world also supported a movement for ways to deal
with criminal justice. She declared that the criminal justice
system in Alaska was not sustainable. She pointed out that the
State of Alaska had spent $250 million to build a prison, with
an additional $50 million to house 1500 inmates added annually
to the Department of Corrections (DOC) budget. She emphasized
that there "is nothing fluffy about any of the prisons in the
State of Alaska." She pointed out that Goose Creek Correctional
Center was geared toward providing individuals with some
rehabilitative needs. She pointed out that, even with this new
prison, DOC was now operating at 101 percent of its general
capacity with a projected annual growth of 3 percent. She
reported that Alaska had the third fastest growing prison
population in the United States which would lead to
overcrowding. This brought Alaska to a crossroads decision,
whether to build a new prison, incarcerate out of state, or
utilize evidence based strategies that other states had
developed that were working to reduce crime, slow recidivism,
and level off the growth rate for prison populations, which had
exceeded the growth rate of the state population. She reported
that there were decreases in both violent and non-violent crime
in the state. She reiterated that, as many other states had
experienced budget deficits similar to Alaska, there was
recognition for the lack of sustainability to corrections
budgets.
3:56:19 PM
MS. GUTIEREZ directed attention to slide 5, "Former Inmates Are
Our Neighbors," and stated that Alaska currently incarcerated
more than 6300 people, which included 1000 people on electronic
monitoring and in halfway houses. She stated that, as 95
percent of the inmate population was eventually released, there
were currently 377 convicted felons released into communities
every month. She reported that the recidivism rate was starting
to drop, down to 63 percent in 2011, and opined that public
safety required a continued reduction to this high rate.
3:57:55 PM
MS. GUTIEREZ presented slide 6, "Have Alaskans Been Receiving
Good Value For The Criminal Justice Dollars Spent?" She noted
that two of three former offenders returned to prison within the
first three years of release, the majority within six months.
She declared that more than 1600 statutes and regulations
provided barriers as a result of criminal convictions, with 746
of these directly related to employment. She shared that it
cost $158 per day per inmate to incarcerate, more than it cost
to go to Harvard. She reported that, in 2009, DOC began to
reinstate some of its reformative programs, which had been
eliminated during a prior administration, and she offered her
belief that this had contributed to the drop in recidivism.
4:00:04 PM
MS. GUTIEREZ shared slide 7, "Alaska Is At A Crossroads," and
stated that Alaska could either build a new prison, recommit to
sending inmates out of state, or follow the lead of 32 other
states and invest in cost effective strategies to reduce crime
and reduce the rate of prison growth, slide 8, "Do We Wish To
Spend $300 Million To Build A New Prison?" She reported that
there was technical assistance to states for help in addressing
these issues. She addressed slide 9, "Invite the Pew Public
Safety Performance Project to Alaska," and said that they could
identify and better understand the factors driving growth in the
state prison population. She said that the Pew approach was to
identify fiscally sound, public safety minded policies that held
offenders accountable and controlled prison costs, while helping
states get a better return on the expenditure of public safety
dollars. She emphasized that this technical assistance was free
to the state. She reported that Pew would work with DOL, DOC,
and DPS using data analysis from similar programs in other
states to identify strategies for each of the factors driving
the prison population growth and to build a recommended plan,
slide 10, "Pew Would Guide Alaska In A Justice Reinvestment
Process."
4:03:28 PM
MS. GUTIEREZ said that many conservative states had had very
positive experiences with this Pew project. She moved on to
slide 13, "Known Factors Driving Alaska's Prison Growth." She
listed these to include: "Increased number of pretrial &
unsentenced inmates," slide 14, showing that almost 40 percent
of the prison population were people arrested but not yet
convicted and noting that there were 18 bail factors for judges
to consider; "Increased percent of non-violent offenders,"
slide 15, which depicted that 64 percent of the prison
population were nonviolent offenders and questioned whether
there were alternatives to the incarceration expense of $158 per
day per inmate for nonviolent offenders; and, "Public opinion
on jailing nonviolent offenders in expensive prison beds," slide
16, which shared that two national public firms hired to talk
with Americans about the over incarceration of non-violent
offenders found that the majority of the public felt that
reformation trumped incarceration for this group, that prisons
should be used for violent offenders, and that too many people
were being incarcerated today, slides 17, 18, and 19.
4:06:59 PM
MS. GUTIEREZ reported that 10 percent of the population was
serving 37 months or more in 2002, whereas almost 25 percent
were serving that same amount of time in 2014, slide 20,
"Increased Average Length Of Stay." She said that another
factor for the increase to prison population was that the number
of petitions to revoke probation, mainly for technical
violations, had almost doubled between 2003 and 2013, slide 21,
"Increased Probation Violations." She reported that only 28
percent of these petitions were because of the alleged
commission of a new crime.
4:08:27 PM
MS. GUTIEREZ spoke about slide 22, "What we know about Alaskans
who recidivate," and reported that people convicted of
misdemeanors and Class B felony offenses, the least serious of
the felony offenses, as well as youthful, male offenders,
recidivated at a higher rate. She described "The Texas
Experience," slide 23, and its decision to find a better use of
public dollars than for building another prison. She noted that
Texas, in 2007, was the first state to move in this direction
because projections for a shortfall of 17,000 prison beds had
been accompanied by an estimated construction cost of
$900,000,000 for only 4,000 beds. The submitted plan was for
identification of the necessary reformative programs to address
the factors leading to criminal behavior, and then invest a
portion of this projected bed cost in evidence based strategies
which had proven to reduce recidivism.
4:10:27 PM
MS. GUTIEREZ reported that investments had been made in drug
courts, intermediate sanction facilities for probationers who
violate probation, residential treatment programs for
probationers having difficulty staying clean and sober, and in-
prison residential treatment programs, slide 24, "Evidence based
investment strategy." She stated that Texas increased the
community-based substance abuse treatment, passed legislation
which provided incentives to encourage probation compliance, and
implemented swift, certain, and proportionate sanctions for
certain probation violations, slide 25, "Evidence based
strategies for probationers." She reported that these swift,
certain sanctions already existed in the Probationer
Accountability with Certain Enforcement (PACE) program in
Alaska. If someone violated a condition of probation, they were
immediately arrested, brought to court within 72 hours, and
given a sanction that day in court. She declared that, as the
sanctions were proportionate, the PACE program had proven very
effective in Alaska.
4:12:06 PM
MS. GUTIEREZ reported that in Texas, as of 2014, recidivism
rates had dropped by 25 percent, the crime rate had dropped 18
percent to its lowest point since 1968, imprisonment had dropped
by 10 percent, and prisons had been closed with a savings of
nearly $3 billion in prison costs, slide 26, "Texas Results."
She shared slide 27, "South Dakota," which depicted a state with
a smaller prison population, primarily composed of non-violent
offenders with a high rate of probation revocations. She
declared that this pattern and practice were not sustainable,
and that South Dakota had decided to invest $53 million in
alternative strategies to reduce recidivism, instead of
investing $207 million on two new prisons. She quoted a comment
by South Dakota Senator Craig Tieszen, slide 30:
We have been putting a lot of people in prison ... but
we have now recognized that we haven't changed
behaviors of those prisoners. Most of them get out of
prison eventually and a very high proportion goes
back, because the main change that took place in
prison is that they became better criminals.
4:14:26 PM
MS. GUTIEREZ directed attention to slide 32, "Reformative
Programs in Alaska," stating that the Alaska Department of
Corrections had no reformative programs in 2007, with the
exception of one federally funded alcohol and substance abuse
treatment program. She reported that the legislature offered
its support in 2009 with the re-implementation of substance
abuse treatment, education and vocational programs, and
cognitive behavioral treatment. She noted that only 2.9 percent
of the DOC budget goes to reformative programing, with the
largest share of its budget spent on personnel services. She
presented slide 33, "Outcome from Investment: Recidivism
Reduction," which reflected the drop of recidivism from 66
percent in 2007 to 63 percent in FY 201. She declared that this
was finally a move in the right direction. She referenced the
recent Legislative Audit Division audit of the DOC in December,
2014, which found that DOC was running fine quality programs
that were serving the inmates, slide 34, "ADOC Runs Quality
Programs."
4:16:19 PM
MS. GUTIEREZ pointed to slide 35, "Washington State Institute of
Public Policy Finds," and shared that the institute was the
premier nationwide cost benefit analysis entity and had done
extensive research on substance abuse treatment programs and the
benefit of educational and vocational programs in a custodial
setting. Their findings of the cost benefit analysis was 100
percent that the benefits would exceed the cost. She stated
that the DOC was working hard to ensure that any inmate
sentenced to 30 days or more would be released from the
institution with a re-entry plan, the Alaska Prisoner Reentry
Framework, designed to help the inmate address their needs that
lead to criminal behavior, slide 36 "Alaska Department of
Corrections." She stated that Department of Health and Social
Services had been a "huge collaborator in this effort to reduce
recidivism," slide 37, "Division of Health & Social Services,"
and she mentioned the Sobriety 24/7 program as a nationally
recognized strategy for holding offenders accountable. She
declared that this was helpful to offenders, as it kept "them on
the straight and narrow, and in early sobriety that can be very
helpful." She noted that Alaska had an outstanding therapeutic
courts program, as well as good community based treatment
programs. She explained that there was more demand for these
treatment programs than there were resources.
4:18:25 PM
MS. GUTIEREZ declared that the Alaska Housing Finance
Corporation (AHFC) had been a great partner in the effort to
reduce recidivism, and information for their work was included
in the Recidivism Reduction Plan [Included in members' packets],
slide 38, "Alaska Housing Finance Corp." She relayed that AHFC
had created housing assistance vouchers which were less than the
cost of prison housing. She stated that the recidivism rate for
those receiving this financial support was 33 percent compared
to the overall 63 percent for the general population. She
directed attention to slide 39, "Labor & Workforce Development
Collaborations," and mentioned that there had been a
collaborative effort between DOC and Department of Labor &
Workforce Development (DOLWD), and that DOLWD had instituted the
WorkKeys certificate reflecting levels of capacity for the
basics of many jobs, which many employers now required. She
pointed out an interesting collaboration with fish processing
plants to hire inmates. She reported that the Alaska Job
Centers now had individuals specially trained to work with the
prison population.
4:21:11 PM
MR. JESSEE introduced slide 41, "What we are doing that works,"
and referenced the DOC efforts to develop reformative programs,
as well as work by the Criminal Justice Commission for issues
around sentencing and barrier crimes. He stated that the
reentry centers were "incredibly successful," that they pulled
together the housing, employment, and support for recovery
services and then customized these for each individual inmate
upon release from incarceration. He pointed out that the agency
had been funded from capital appropriations for the past 18
months. He reported that Department of Health and Social
Services and the Division of Behavioral Services were working to
adjust budgets in order to maintain operation of the reentry
center. He emphasized that DOC had already been working with
AHFC and DOLWD on these programs. He moved on to slide 42,
"Next Steps With Fiscal Component," and emphasized that funding
for the current reformative programs had to be maintained or the
recidivism rate would "start to creep back up." He stated that
it was necessary to maintain support for the DOC reentry
program, and he suggested that a new position for reentry
coordinator be created. He suggested the expansion for
community based substance abuse treatment, and he extolled
Medicaid expansion as being particularly helpful for single
males between 18 - 64 years of age coming out of corrections
with no income, a program being paid for primarily by the
federal government.
4:24:00 PM
MR. JESSEE addressed slide 43, "Next Steps With No Fiscal
Component," and shared that the Criminal Justice Commission was
still working on bail conditions, deferred sentencing, limited
licenses, and a study on barrier crimes. He suggested that the
legislature enact legislation to provide good time credits as a
reward for good behavior and to motivate probationers complying
with their conditions. He allowed that that the quick, certain
consequences were now being addressed, and that a positive
reward would be helpful. He noted that this would also be a
positive step for people on electronic monitoring.
4:24:48 PM
MR. JESSEE pointed to slide 44, "Plan Implementation," reporting
that the groups had reviewed past programs and had developed a
future plan. He emphasized that the Alaska State Legislature
now had the responsibility to set a goal for matching the number
of people in prison to the number of prison beds currently
available, or to choose alternatives. He offered as an
alternative, an implementation plan with a timeline, strategies,
costs, savings, and results. The legislature could then choose
whether to place these increments in the budget.
4:26:31 PM
REPRESENTATIVE TARR asked whether the public defender agency was
part of these conversations.
MS. GUTIEREZ explained that the public defender was an involved
member of the Alaska Criminal Justice Commission. She stated
that, as 40 percent of the prison population were pre-trial
inmates and the vast majority were represented by public
defenders, any cuts to the budget of the public defender agency
would have a ripple effect across the entire criminal justice
system which would include longer time in prison.
4:28:30 PM
CHAIR SEATON asked if bail conditions had to come through the
public defender's office. He noted that bail set on an
individual's Own Recognizance (OR) was working effectively, and
asked if the legislature should become involved with speeding up
the process, as many people were waiting in jail because they
were not financially able to post bail.
MS. GUTIEREZ explained that, as this issue was a dramatic change
from 2002, the Alaska Criminal Justice System was reviewing it.
She explained that, although the bail statute says presumption
for release, there were now 18 conditions added to the bail
statute, which made it more difficult to get out of
incarceration pending trial. She offered her belief that some
lawmakers were also reviewing the bill statute for the
conditions of bail, and that "primarily the fix is legislative."
CHAIR SEATON asked if there was any model legislation enacted by
other states that had been effective for reduction.
MS. GUTIEREZ offered her belief that there was model
legislation, and she would report back to the committee.
4:32:14 PM
REPRESENTATIVE WOOL asked whether mandatory sentencing was one
of the aforementioned barriers.
MS. GUTIEREZ explained that, although crime was decreasing,
there were now longer sentences. She expressed her agreement
with mandatory sentencing for egregious crimes in Alaska. She
questioned the presumptive sentencing and offered an example for
a woman convicted of first time cocaine possession with a six
month sentence. The next time, same crime, as there was
presumptive sentencing, the minimum mandatory sentence was at
least two years. She questioned whether this was an effective
use of a $158 per day bed. She opined that presumptive
sentencing was one of the reasons for an increase to the length
of stay.
4:34:03 PM
MR. JESSEE suggested that a comparison of days to dollars
offered a different perspective, pointing out that a five year
minimum sentence cost almost $300,000. He asked if "we're gonna
spend $300,000 on this person, are we so mad at him that we're
willin' to spend $300,000 to be mad at him for five years." He
asked what would be different when this person was released.
4:35:10 PM
CHAIR SEATON suggested that Vitamin D should be offered in
prisons, as there was not any sunshine exposure or any dietary
supplement. He asked if there were any underlying medical
conditions that the state could help alleviate so "people can
better control themselves." He pointed to the myriad of studies
which showed that low levels of Vitamin D were causal to
depression and anxiety. He stated that addressing this
underlying medical deficiency would move forward to lower the
recidivism rate.
4:36:55 PM
REPRESENTATIVE VAZQUEZ asked if all the requests from House Bill
266 had been addressed.
MR. JESSEE said absolutely, that performance measures and
strategies had been identified.
REPRESENTATIVE VAZQUEZ asked if the call to action legislatively
mandated these.
MR. JESSEE recommended that the House Finance Committee should
have some ownership of the next step, and consider legislative
intent requesting a detailed implementation plan which included
dollars, timeframes, data, and outcomes.
4:38:03 PM
REPRESENTATIVE VAZQUEZ asked if legislation was going to be
submitted to implement this call to action.
MR. JESSEE stated that his plan was to meet with Representative
Neuman to discuss legislative intent language.
^PRESENTATION: Key Coalition
PRESENTATION: Key Coalition
4:38:38 PM
CHAIR SEATON announced that the final order of business would be
a presentation by the Key Coalition.
4:39:12 PM
EMILY ENNIS, Executive Director, Fairbanks Resource Agency, Key
Coalition of Alaska, shared that this was the 28th Key Campaign
whereby the Key Coalition came to the capital to speak about the
issues facing individuals, and their families, with
developmental disabilities. She reported that more than 150
members were attending so they could share the importance of
services to themselves and their families. She noted that there
was a responsibility to speak for Alaskans with disabilities who
were not able to speak for themselves. She said that
intellectual and developmental disabilities was a condition that
occurred before the age of 22, had significant impact on the
areas of major life function, and required lifelong support.
She pointed out that this did not mean that individuals could
not have a full, productive, quality life. She stated that
robust support systems were necessary and the Key Coalition
would present its suggestions for major priorities. She
declared that the first suggestion was for cost savings in the
service system, and she added that all of these services
provided long term cost savings.
4:42:25 PM
JIM BECK, Key Coalition of Alaska, Access Alaska, offered his
recommendation to the legislature, the use of Medicaid funds for
the reuse of durable medical equipment, which he stated was
already happening in other states. He noted that the State of
Alaska currently prohibited use of Medicaid dollars for the
purchase of used equipment, much of which was designed to last
for years. He stated that the federal government did allow
this. He reported that Kansas had shown a return of $3.15 for
every $1 invested in the durable medical equipment re-use
program, and that recipient satisfaction for this program was
very high. In the first year of service in Oklahoma, 74 devices
were reassigned, which represented a costs savings of $31,692.
In Alaska, Access Alaska loaned 2064 pieces of durable medical
equipment in 2014 in Anchorage, which represented a savings to
Medicare, Medicaid and private insurance of $461,685. He shared
that Access Alaska had sanitization programs, and, as it was a
mature industry, it would be "into play in Alaska very quickly
and, I think, recognize great savings and high satisfaction."
4:45:09 PM
MILLIE RYAN, Executive Director, REACH, Inc., Key Coalition of
Alaska, referenced House Bill 211, the employment first bill,
and said that she was working with the state for implementation.
This offered a number of opportunities to lower Medicaid costs
and replace state funded services that people would otherwise
need if they were not working. She said that a number of states
had Medicaid buy-in programs for working people with
disabilities, and she described the successes in Utah and
Kansas. She pointed out that up to one in five no longer
received benefits as they were now earning enough to no longer
be eligible. She shared that the State of Washington had its
costs decrease in the food stamp program, and that the working
disabled Medicaid buy-in in Alaska had resulted in a $12.4
million contribution to the state economy. She reported that
there were 350 - 370 persons participating in the Alaska buy-in
program and that policies which increased this number would
recognize a decrease in health costs, food stamps, and adult
public assistance. She pointed to supported employment, a
program funded through the Medicaid home and community based
waivers. She referenced a research study on the economics of
supported employment by Robert Somora identifying three
recommendations which could reduce Medicaid funded supported
employment costs by 32 - 60 percent and allow service to an
additional 126 - 232 people without any additional state money.
She pointed out that these people would also be contributing to
the economy and paying federal taxes, thereby reducing their
dependence on other public benefits.
RICK FASSEL, Key Coalition of Alaska, said that he would like to
see other people have the opportunity for jobs.
CHAIR SEATON asked that the suggestions and recommendations be
presented in writing.
4:49:27 PM
DENNIS HAAS, Key Coalition of Alaska, stated that the wait list
had always been a top priority. He reported that the list of
people qualifying for services but not receiving them because of
a lack of funding was more than 696 people. He asked for the
state to continue its commitment to remove 200 people from the
list each year. He declared that these programs saved lives,
sharing that, if not for the program, his daughter would be
dead. He emphasized that parents could not do it without help.
4:51:24 PM
NED MAGEN, Key Coalition of Alaska, offered a success story for
the wait list, and shared that his 28 year old son, Daryl, had
developmental disabilities and had been on the wait list for
many years. He noted that, as both he and his wife worked, they
were not able to spend every minute with their son. However,
once Daryl was taken off the wait list, he had staff support to
go swimming and to the gym, he lost 50 pounds, and he became a
Special Olympics champion swimmer. Currently, he had two
different jobs with a job coach, lived in an apartment, and his
self-esteem and his self-confidence had grown. He lauded the
services that Daryl had received and directed much of the credit
toward those services.
CHARLISSA MAGEN, Key Coalition of Alaska, echoed her husband,
Ned, and reported that their son had received 15 years of
services, which had made him "an active and vital part of our
community in Soldotna and Kenai." She shared that she and her
husband were known as "Daryl's parents, not as individuals."
She spoke about her son's work and his volunteering, and she
expressed her hope that the State of Alaska would maintain its
commitment to annually select people still on the wait list.
4:53:35 PM
MIKE BAILEY, Key Coalition of Alaska, stated that he was the CEO
of a provider agency, and he addressed the integrity of the
Medicaid system, declaring his support for Medicaid expansion
and that the savings this would realize would allow for funding
to the wait list without any increase to budget expectations.
He acknowledged the failure of the upgrades to the Medicaid
payment system and the eligibility system. Although each of
these were supposed to create efficiencies, this had not
occurred, and the additional administrative burden detracted
from the services provided. He pointed out that some payments
were 18 months past due, which put a lot of strain on the
providers. He stated that he was still committed to working
toward these efficiencies. He expressed his appreciation to the
minimal cuts to the Department of Health and Social Services
budget, and he recognized the wisdom to not cutting any Medicaid
services with a federal match component. He pointed out that
the rates for Medicaid payments were based on four years of rate
freeze, with some minimal inflationary adjustments. He said
that he was working with the Office of Rate Review to arrive at
a sustainable rates rebasement methodology. He reported that
the Key Coalition was advocating that providers continue to work
with this, as the goal was sustainability. He asked that the
unfunded mandates on providers also be recognized, which
included minimum wage increases and increased administrative
overhead. He stated that the Key Coalition was asking for the
providers to continue to work with the Office of Rate Review to
create a sustainable system. He cautioned that there could be
some compromise necessary. He asked that new legislation be
better assessed for its impact on Medicaid rates.
CHAIR SEATON asked that the providers speak to the legislature
about these impacts.
4:58:24 PM
GLENN SHEEHAN, Key Coalition of Alaska, spoke for his daughter
who had cerebral palsy and severe anxiety, which inhibited her
ability to speak publicly. He addressed a potential change in
state regulations that could "save money and help people." He
said that, although tele-practice was currently in use, the
state did not encourage it for people on waivers. He stated
that the logistics for providing health to people on waivers
could be improved greatly, as there was a huge amount of
professional time spent in travel. He offered some examples for
ways that tele-practice could save money.
CHAIR SEATON acknowledged that the committee did have this "on
our radar screen." He asked that Mr. Sheehan send his comments
regarding an upcoming proposed bill on this subject.
^PRESENTATION: UAF Bachelor of Social Work Students
PRESENTATION: UAF Bachelor of Social Work Students
5:00:14 PM
CHAIR SEATON announced that the final order of business would be
a presentation by the students in the UAF Bachelor of Social
Work program.
DIANE CASTO, Prevention & Early Intervention Manager, Prevention
& Early Intervention Section, Division of Behavioral Health,
Department of Health and Social Services, thanked the committee
for its push toward prevention. She shared that this
partnership between the Division of Behavioral Health and the
University of Alaska had started 10 years prior for bringing
students out into the community and to learn about "macro social
work, which is everything you guys have been talking about
today, the policies, the laws, how all of this works." She
noted that 25 students were in the audience, with half of them
campus based in Fairbanks, while the other half were enrolled in
distance programs.
HEIDI BROCIOUS, Clinical Associate Professor, Department of
Social Work, University of Alaska Fairbanks, reported that the
distance programs allowed students to pursue their education
while staying in their home communities. She shared details of
the handout on the partnership, reporting that students entered
certificate or associate Social Work distance programs [Included
in members' packets]. She offered her belief that students
staying in their home communities fit the prevention aspect, as
educated providers remaining in their home community allowed for
less "shipping out." She directed attention to the graduate
data from the Department of Labor & Workforce Development which
listed the number of social worker graduates employed in the
field of social work [Included in members' packets]. She
emphasized that these programs were creating educated employees
working in the state.
MS. CASTO said that they were preparing a full report with this
data and that they would forward it to the committee.
5:04:58 PM
REPRESENTATIVE TARR shared that there was work currently being
done on prevention legislation, which included Erin's Law, the
child sexual abuse prevention legislation.
MS. CASTO said that the students would get copies of the
recidivism report and information on Erin's Law.
5:05:39 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:05 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Behavioral Health HHSS 02 19 2015 overview.pdf |
HHSS 2/19/2015 3:00:00 PM |
|
| Key Coalition 2015 Legislative Priorities.pdf |
HHSS 2/19/2015 3:00:00 PM |
Presentation- Key Coalition |
| Recidivism RP Presentation.pdf |
HHSS 2/19/2015 3:00:00 PM |
Presentation |
| UAF Behavioral health education numbers.pdf |
HHSS 2/19/2015 3:00:00 PM |
Presentation |