Legislature(2017 - 2018)CAPITOL 106
02/13/2018 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| Presentation: Alaska Children's Justice Act Task Force | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
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ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 13, 2018
3:06 p.m.
MEMBERS PRESENT
Representative Sam Kito
Representative Geran Tarr
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
Representative Matt Claman (alternate)
MEMBERS ABSENT
Representative Ivy Spohnholz, Chair
Representative Bryce Edgmon, Vice Chair
Representative David Eastman
Representative Dan Saddler (alternate)
COMMITTEE CALENDAR
PRESENTATION: ALASKA CHILDREN'S JUSTICE ACT TASK FORCE
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
B.J. COOPES, Medical Director
Inpatient Pediatrics
The Children's Hospital at Providence
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint on the Alaska
Children's Justice Act Task Force.
JARED PARRISH, PhD, Senior Epidemiologist
Alaska Division of Public Health
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint on the Alaska
Children's Justice Act Task Force.
KIM GUAY, Child Welfare Administrator
Central Office
Office of Children's Services
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during the
presentation by the Alaska Children's Justice Act Task Force.
JOSH LAWRES, Covenant House International
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation.
ACTION NARRATIVE
3:06:32 PM
CHAIR GERAN TARR called the House Health and Social Services
Standing Committee meeting to order at 3:06 p.m.
Representatives Tarr, Kito, Johnston, and Claman (alternate)
were present at the call to order. Representative Sullivan-
Leonard arrived as the meeting was in progress. [As Chair
Spohnholz and Vice Chair Edgmon were not able to be present,
Representative Tarr was acting Chair]
^Presentation: Alaska Children's Justice Act Task Force
Presentation: Alaska Children's Justice Act Task Force
3:07:21 PM
CHAIR TARR announced that the only order of business would be a
presentation by the Alaska Children's Justice Act Task Force.
3:07:47 PM
B.J. COOPES, Medical Director, Inpatient Pediatrics, The
Children's Hospital at Providence, shared her background as a
pediatrician, a pediatric intensivist, and palliative care in
Hospice physician. She noted that she was also the Medical
Director at the Matanuska-Susitna Paramedic College and other
outreach programs. She offered her background for work with the
Alaska Children's Justice Act Task Force, stating that her role
as a pediatric ICU [intensive care unit] doctor included the
responsibility to look at illness and cause of death for
children. She reported that, upon review, she had found that 30
- 40 percent of the children who died in the intensive care unit
at Providence [Alaska Medical Center] were under the age of two
years and had been beaten to death. She acknowledged that,
although this did not mean that 40 percent of children in Alaska
were dying from abuse, she was looking for preventative factors
to help minimize the injuries and death rate. This led to her
involvement with the Alaska Children's Justice Act Task Force.
She shared an overview of the agenda, which included an overview
of the child abuse data, as well as some options and needs when
addressing these issues. She declared that the Alaska
Children's Justice Act Task Force was a federally mandated and
funded committee with a mission to identify areas where
improvement was needed in a statewide response to child
maltreatment, particularly child sex abuse, to make
recommendations, and to take actions to improve the entire
system. She pointed out that the task force membership was
statewide and multidisciplinary. She introduced many of the
members of the task force, slide 4.
3:11:23 PM
JARED PARRISH, Senior Epidemiologist, Alaska Division of Public
Health, introduced slide 6, "Perception, observation, and
statistics." He acknowledged that, as data could be
overwhelming, it was best to provide a few numbers to get some
context with our personal experiences and understanding. He
said that statistics were used to summarize observations, to
confirm, inform, re-frame or dispute our own individual
perceptions, and then gain knowledge and formulate our
understandings. He shared an anecdote of explaining hikes to
friends as an example of perception. He offered to provide
multiple images for the context of child maltreatment to
"potentially see it for what it is in our state." He introduced
slide 7, "Annual prevalence - 3 estimates," which listed the
prevalence of child maltreatment for children from ages 0 - 17
years, as evidenced by reports to the Office of Children's
Services (OCS). He explained that "reports" were a call for a
suspicion of harm, "screened in" were the reports that met the
OCS classification for investigation, and that "substantiation"
met certain parameters. He pointed out that, although the
contacts to OCS and the screen ins had significantly increased
since 2008, the substantiated rate had remained constant. He
allowed that there was not a known reason for why this had
remained constant, but he offered some hypotheses including OCS
work load capacity and its ability to investigate, as well as
other challenges due to the size of the state. He lauded that
the numbers generated hypothesis, and "gets you hungry for
another number to start answering that." He added that, in any
given year, about 10 percent of the child population had contact
with child welfare.
REPRESENTATIVE SULLIVAN-LEONARD referenced the average of 15,000
children reported for possible child maltreatment on slide 7,
followed by the screening process, and then the substantiation.
She asked, as this reporting was a high number, how it was
possible to ascertain what was really happening.
3:16:14 PM
DR. PARRISH pointed out that he was in public health and not in
child welfare. He explained that he did not have this
information.
CHAIR TARR reported that there had been about 20,000 reports of
harm, for 15,000 individual children.
3:17:28 PM
KIM GUAY, Child Welfare Administrator, Central Office, Office of
Children's Services, Department of Health and Social Services,
in response to Representative Sullivan-Leonard, said that there
was a matrix to screen the information during the call-ins of
child abuse reports. She added that family history was also
considered. She explained that OCS took all the information to
make a determination for whether it met the statutory
requirement for abuse. If so, a worker would recommend a
screen-in, and then a supervisor would make the final
determination for an investigation.
REPRESENTATIVE SULLIVAN-LEONARD asked to clarify that every call
was recorded.
MS. GUAY said that was correct, and noted that in the last year,
21,000 reports had been called in.
3:19:24 PM
DR. PARRISH stated that they were most interested in
understanding a sentinel event. He reported that, from a Public
Health aspect, nationwide and international research had shown
that kids experiencing at least one report had outcomes more
similar to those kids with a substantiated report than those
with no report. He stated that this showed that there was
something potentially going on in that child's life where
optimal health and development was not being supported. He
compared this research to the challenge of putting together a
puzzle without all the pieces. He moved on to slides 8 and 9,
"Adverse Childhood Experiences (ACEs)," and offered a brief
overview. He reported that this study, conducted in the late
1990s, was a joint venture between Kaiser Permanente and the
Centers for Disease Control and Prevention. He added that this
group of about 17,000 participants was very homogeneous, was
older, and about 75 percent had some college education. They
were asked to recall or reflect on a series of questions related
to physical, emotional, or sexual abuse or neglect and their
experiences as children up to age 17 years. He added that there
was also a series of questions regarding household dysfunction:
mental illness, mother treated violently, divorce, substance
abuse, or incarceration of a relative or family member. He
reported that two-thirds of the group had experienced at least
one of those "adverse childhood experiences." He stated that,
although the sheer volume of this was shocking, the relationship
between accumulation of these adverse childhood experiences and
multiple negative health consequences was even more shocking.
He shared that emerging research had started to formulate the
causal etiology between experiencing some of these adverse
childhood experiences and the connection with cancer and other
health issues. Continuing research had affirmed that the more
of these adverse experiences accumulated in childhood, the more
likely to experience negative life events.
3:23:09 PM
DR. PARRISH moved on to slide 10, "Alaska ACEs snapshot," and
reported that the information was drawn from the Alaska
Behavioral Risk Factor Surveillance System in the Division of
Public Health. He pointed out those people who reported four or
more of these adverse childhood experiences were 50 percent more
likely to be unemployed, 274 percent more likely to be unable to
work, 92 percent more likely to earn less than $20,000 annually,
and significantly more likely to report poor physical and mental
health. He pointed to the association between more of these
adverse childhood experiences and the increased likelihood to
have poor health outcomes and limited economic attainability.
He explained that there was now research "looking up stream to
your early childhood experiences" to better understand and
prevent chronic diseases. He pointed out that appropriate
intervention turned into prevention for the next generation.
3:25:30 PM
DR. PARRISH shared slide 11, "Life course perspective." He
shared that he had no memory of being one year old and
acknowledged that "there could be some fogginess" when adults
were asked to remember their childhood. He reported that things
that occur early on during the developmental trajectory could
impact the overall trajectory. He offered an analogy for flying
a plane, pointing out that being off one degree would not make
that large a difference on a short flight relative to the impact
on a long-distance flight. He stated that a course correction
early on could mitigate the negative consequences. He pointed
out that toxic stress, related to adverse childhood experiences,
could have adverse effects on health. He reported that the
Alaska Division of Public Health was now trying to measure
things as they were occurring in children over time, to better
inform the decisions for how they target the interventions.
3:27:25 PM
DR. PARRISH introduced slide 12, "New emerging data resources,"
and directed attention to the Alaska Longitudinal Child Abuse
and Neglect Linkage Project (ALCANLink). He said that this was
a new measure and he directed attention to the Alaska Pregnancy
Risk Assessment Monitoring System (Alaska PRAMS), a complex,
federally funded survey representative of all the births in the
state each year, even though it only sampled about 1500 mothers
each year, and it had been conducted since the late 1980s. He
reported that the mothers answered questions related to the
maternal experience and gave consent to have this information
integrated with other information. He explained that the
information from the 2009, 2010, and 2011 Alaska PRAMS was used
to develop the ALCANLink. He pointed out that ALCANLink was now
connected to the Child Protective Services records, which
offered a better life time risk report. He moved on to slide
13, "ALCANLink - lifetime risk," and reported that 32 percent of
kids born between 2009 and 2011 would experience a report to the
OCS, 27 percent would experience a report that was screened in,
and 10 percent would experience a substantiated report to OCS.
He pointed out that this eliminated duplicative reports from the
first report and projected something potentially going on in the
home that would lead to a report of harm.
3:31:10 PM
DR. PARRISH addressed slide 14, "ALCANLink - crude proportion by
birth cohort," which linked all the children born in Alaska
between 2008 and 2015, who had contact with OCS before age 2
years. He reported that the lifetime burden for being reported
to OCS had not changed and had the same probability for
experiencing contact with child welfare. He declared that this
was another piece of information to better understand the
potential burden that children in Alaska were currently
experiencing.
CHAIR TARR relayed that the number of children in foster care
had been rising, although with a small dip in the last two
years. She asked if this suggested a constant with the first
report to OCS.
DR. PARRISH said there was now a data source to start
investigation for the answers to some of these questions. He
declared that there was a challenge for "continually trying to
do less with more." He declared that more partnerships were
being formulated to answer some of these questions.
3:33:16 PM
REPRESENTATIVE SULLIVAN-LEONARD referenced the 15,000 reports of
child abuse to OCS and asked if a phone call would be a data
marker, regardless of whether it was determined to be abuse.
DR. PARRISH stated that the contact with OCS was a sentinel
event, even though it was not clearly defined for which age
group was reported.
REPRESENTATIVE SULLIVAN-LEONARD asked if it was possible to have
contact with OCS without a need for services because of abuse.
3:35:59 PM
DR. COOPES explained that these reports were considered risk
factors with an indication of a potential problem in the future.
She pointed out that statisticians did not think about guilt,
they just determined an association. Any report to OCS had the
same risk factor whether substantiated or not.
REPRESENTATIVE SULLIVAN-LEONARD mused that it would be a risk
factor regardless of the outcome.
DR. COOPES reiterated that a report to OCS was simply a risk
factor, not a judgement.
DR. PARRISH said that a lot of national research used
measurements based on the first report of child abuse because of
the association and similarities with the risk factors. He
noted that a researcher in North Carolina was reviewing the
chronicity of these reports, and he acknowledged the difficulty
for measurement of something that "usually occurs behind closed
doors, whatever maltreatment or abuse or neglect might look
like." He added that any support to families could potentially
reduce the reports to child welfare and allow a greater focus on
abuse.
3:39:18 PM
DR. PARRISH directed attention to slide 15, "Maltreatment
burden." He shared the annual prevalence of reports to OCS,
which averaged about 10 percent of the child population. He
then spoke about the cumulative incidence measure, a lifetime
measure which indicated that 32 percent of children will be
reported to child welfare before the age of 8 years. He
reported that 34 percent of adults reported an experience of
physical or sexual abuse, physical neglect, or emotional neglect
before the age of 17 years. He pointed out that this was very
close to the estimates for the lifetime burden, similar to the
contacts with child welfare. He said these estimates were much
closer than with an annual prevalence estimate. He moved on to
slide 16, "Household dysfunction," and addressed the 13 life
event experiences asked of mothers prior to childbirth in the
Alaska PRAMS study, pointing out the similarity to the household
dysfunction questions in the ACEs study. He relayed that the
more stressors reported by a mother prior to childbirth, the
more likely the child would have contact with child welfare
before the age of 8 years. He stated that this would allow them
to begin interventions and preventions prior to birth. He
pointed out that 21 percent of the mothers reported experiencing
4 or more of these events, and that 1 out of every 2 births in
that group had contact with child welfare. He stated that this
offered potential areas for focused prevention efforts. He
lauded the collection of data to more adequately evaluate "what
we are doing."
3:42:42 PM
DR. PARRISH addressed slide 17, "It's usually not just one
thing!" He spoke about protective factors and risk factors,
those things that supported health and development and those
things that detracted. He reported that for a child born to a
mother with less than 12 years of education, there was 3.5 times
the likelihood for a report to child welfare prior to the age of
8 years. He declared that education appeared to be one of the
protective factors for offspring. He pointed out that, if
intimate partner violence was interjected into the lower risk
group of mothers with at least 12 years of education, that
protective factor was "obliterated" and the risk for those
offspring became 3.9 times as likely to be reported. He stated
that a focus on one protective factor would not solve the issue,
as it needed a comprehensive understanding.
3:44:41 PM
DR. PARRISH spoke about slide 18, "Disparity and risk." He
shared that there was a distinction between a risk factor, a
protective factor, and a population at risk. He stated that a
population at risk was a group of people that could not be
changed, with a disproportionate burden of these risk and
protective factors that were out of balance. He offered an
example of white children and Alaska Native children and the
relative risks that could be modified to reduce the independent
association for race. He declared that "race doesn't define
risk, rather the disproportionate load of factors that are
modifiable and preventable." He pointed out that it was
important to not misinterpret or misrepresent the information
for risk and protective factors as it could do more harm.
3:46:44 PM
DR. COOPES shared slide 19, "Addressing this issue," and lauded
the work being done and the resources available for the public.
She moved on to slide 20, "Costs to Alaska: $82 million
ANNUALLY," the substantiated cost of child abuse in Alaska,
which included the economic impact for taking care of children.
She acknowledged how frustrating it appeared, slide 21, "What
can we do?" but emphasized that it was not hopeless. She
explained that the purpose of the ACEs study was to identify
risk factors very early in life. She pointed out that the
changes needed to "go through the life trajectory" and be
continually brought back in line. She reported that the toxic
stresses of child abuse really did affect child brains.
3:50:51 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if this was the adrenaline
process that caused this toxic stress.
DR. COOPES said that, although there was not any direct evidence
in children, this was the case in adults for heart disease,
colon cancer, breast cancer, and others from toxic stresses.
3:51:38 PM
DR. COOPES reported that the Alaska Children's Justice Act Task
Force had drafted and improved laws to protect children, slide
22. She stated that the multidisciplinary guidelines were
indispensable for statewide reform and the standards for child
advocacy centers, slide 23 "Prior Projects." She noted that the
task force supported education with scholarships, sponsorships,
and on-line programs, slide 24, "Ongoing Projects: Education."
3:53:50 PM
DR. COOPES addressed slide 25, "Advocacy & Partnerships," and
lauded the child advocacy centers (CACs). She pointed to the
data on slide 26, "Children seen at Alaska CACs," which listed
the CACs around the state, noting that although this data was
for kids of all ages, more than two-thirds of them were under
the age of 12 years. She moved on to slide 27, "Labor and Sex
Trafficking Among Homeless Youth," and reported that one in four
homeless youth in Alaska were sex or labor trafficked, pointing
out that boys were also sexually abused. She referenced the
studies through Covenant House International, a service for
homeless youth and teens which helped them with jobs, homes and
services, slide 28, "Results of Loyola University Study:"
3:56:04 PM
DR. COOPES said that the system needed multiple people to
evaluate kids and get them help, slide 30, "What can you do?"
She declared that "redundancy is critical!" She emphasized
that, although the culture tends to blame victims, that needed
to be mitigated to help change the trajectory. She listed
programs that were doing excellent work, slide 31, "What can you
do?" She spoke in favor of HCR 2, Adverse Childhood Experiences
resolution, and in favor of HB 151, training on foster care
licensing and sibling contact, slide 32, "What can you do?" She
declared that it was necessary to keep siblings together.
3:58:32 PM
DR. COOPES discussed slide 34, "CJATF focus this year," and
reported that there was a focus on exploring barriers for
information sharing to initiate services earlier. She noted
that they were working with communities to arrive at individual
programs. She addressed the unintended consequence of
overloading a system when reporting possible child abuse,
stating that it was necessary to build a system that would
accommodate the kids. She declared that they would also focus
on trafficking and safe harbor laws in collaboration with other
national groups.
3:59:25 PM
REPRESENTATIVE SULLIVAN-LEONARD referenced presentations in her
community about child trafficking, which revealed that kids were
being brought in to the Port of Anchorage. She asked if there
had been any discussion about this.
DR. COOPES said that it was very hard to get the data because
the kids hide. She pointed out that putting a prostitute in
jail was punishing the victim, and that much of this started
with child trafficking.
4:01:19 PM
JOSH LAWRES, Covenant House International, spoke about sex
trafficking. He said they had partnered with JOY International
and that both sex and labor trafficking were large,
underreported issues in Alaska.
4:03:22 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:03 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| CJATF 2018 Presentation to House H&SS REVISED.pdf |
HHSS 2/13/2018 3:00:00 PM |
Children's Justice Act Task Force |