Legislature(2019 - 2020)CAPITOL 106
02/13/2020 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: 2019 Novel Coronavirus | |
| 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
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 13, 2020
3:04 p.m.
MEMBERS PRESENT
Representative Tiffany Zulkosky, Chair
Representative Ivy Spohnholz, Vice Chair
Representative Matt Claman
Representative Harriet Drummond
Representative Geran Tarr
Representative Sharon Jackson
Representative Lance Pruitt
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
PRESENTATION: 2019 NOVEL CORONAVIRUS
- HEARD
PRESENTATION: ALASKA CHILDREN'S JUSTICE ACT TASK FORCE
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
ANNE ZINK, MD, Chief Medical Officer/ DPH Director
Central Office
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint during the overview
and update of the 2019 Novel Coronavirus.
PAM KARALUNAS
Retired Chapter Coordinator
Alaska Children's Alliance
Chugiak, Alaska
POSITION STATEMENT: Presented a PowerPoint on the Alaska
Children's Justice Act Task Force.
MIKE HOPPER, PhD
Private Practice Psychologist
Fairbanks, Alaska
POSITION STATEMENT: Testified during the PowerPoint
presentation by the Alaska Children's Justice Act Task Force.
GAYLE GARRIGUES, Retired Attorney
Fairbanks, Alaska
POSITION STATEMENT: Testified during the PowerPoint
presentation by the Alaska Children's Justice Act Task Force.
ACTION NARRATIVE
3:04:07 PM
CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 3:04 p.m.
Representatives Zulkosky, Spohnholz, Jackson, Tarr, Claman, and
Drummond were present at the call to order. Representative
Pruitt arrived as the meeting was in progress.
^Presentation: 2019 Novel Coronavirus
Presentation: 2019 Novel Coronavirus
3:04:50 PM
CHAIR ZULKOSKY announced that the first order of business would
be a presentation on the Novel Coronavirus.
3:05:21 PM
ANNE ZINK, M.D., Chief Medical Officer/Director, Central Office,
Division of Public Health, Department of Health and Social
Services, Presented a PowerPoint titled "2019 Novel Coronavirus
Overview and Update." She pointed out that the name of the
virus had been recently changed by the World Health Organization
(WHO) to COVID-19. Dr. Zink stated that there were numerous
corona viruses and she paraphrased slide 1 "Coronaviruses
(general), which read as follows [original punctuation
provided]:
An enveloped RNA virus that may circulate in animal
host or human host
? There are 7 coronaviruses that infect people
? People around the world commonly get infected with
these four human coronaviruses:
? 229E, NL63, OC43, and HKU1.
? These account for 10-30% of common colds every year
? Spread by contact with infected secretions or by
aerosol droplets
DR. ZINK moved on to paraphrase Slide 2, "Coronaviruses
(general), which read as follows [original punctuation
provided]:
Survivability outside the body:
? 1-2 hours on nonporous surfaces (e.g. hard surfaces)
? 8-12 hours on porous surfaces (e.g. soft goods)
DR. ZINK introduced slide 3 "New Coronaviruses, which read as
follows [original punctuation provided]:
? Sometimes coronaviruses that infect animals can
evolve and jump from an animal reservoir to humans,
causing illness and then are identified as a "new
human coronavirus."
? We know of three recent times coronaviruses have
moved from an animal to a human host
? SARS (Severe Acute Respiratory Syndrome)
? MERS (Middle Eastern Respiratory Syndrome)
? The name of this virus is COVID-19. Previously 2019-
nCoV.
3:07:51 PM
DR. ZINK moved on to slide 4, "2019 nCoV,and paraphrased the
slide, which read as follows [original punctuation provided]:
? First reported by Chinese health officials on
December 31, 2019
? Likely very recently moved from an animal reservoir
to humans
? Asymptomatic shedding is still unclear
Incubation is between 2-14 days (mean is about 5
days)
? As of 1/13/20 there are 60,360 cases worldwide and
1,370 deaths (WHO)
? As of 1/13/20 - 15 confirmed cases in the United
States in 7 states
? No deaths in the United States, but one US citizen
died Wuhan City, China
CHAIR ZULKOSKY asked to clarify that the date on the slide
should reflect February 13, 2020.
DR. ZINK expressed her agreement.
3:08:58 PM
DR. ZINK presented slide 5, "Graph of nCoV cases to date,a
graph depicting the number of reported cases worldwide, the
upswing of numbers of reported cases in China, and the number of
recovery cases. She reported that this spike in the upswing of
reported cases in China had occurred since yesterday. She
opined that this was likely because China had changed its
definition of the virus through the use of different tests. She
pointed out that this exponential growth of the virus was not
being seen in the United States as it was in China.
DR. ZINK indicated slide 6, "Case Fatality,which read as
follows [original punctuation provided]:
? SARS had a case fatality rate (CFR) of ~10%
? MERS has a ~35% mortality rate and continues to
circulate in animal reservoirs with sporadic zoonotic
spillover
? Influenza H7N9 (bird flu) had about a 40% fatality
? Influenza averages 0.1% mortality
? H1N1 has a case fatality of ~0.03% fatality
? Ebola has roughly 60% fatality rate
? 2019-nCoV is estimated to have about a 2% mortality
rate
DR. ZINK shared slide 7, "Transmission, which read as follows
[original punctuation provided]:
? Early on, suspected animal-to-person spread
? Now, also known to be person-to-person spread
? Respiratory droplets when an infected person coughs
or sneezes
? Close contact (about 6 feet)
? Unclear if transmitted through touching a surface or
object
? It is unclear how easily or sustainably this virus
is spreading between people
? 2019-nCoV has an R naught of about 2.5 (this means
each infected person will transmit the virus to about
2.5 other people)
? Measles: >12
? SARS: ~3
? 1918 flu: ~2
? 2009 H1H1: ~1.5
? Seasonal Flu: ~1.2
3:12:32 PM
DR. ZINK directed attention to slide 8, "2019 nCoV in the U.S."
a map of the United States which depicted those states in which
the virus had been positively identified. She noted that Texas
had also just been added to those states. She moved on to slide
9, "Signs and Symptoms,which read as follows [original
punctuation provided]:
? May look similar to the common cold or flu
For confirmed 2019-nCoV infections, reported
illnesses have ranged from people with little to no
symptoms to people being severely ill and dying
? Fever
? Cough
? Shortness of breath
? Myalgia / fatigue
? Appears to disproportionally affect the elderly or
those with underlying medical conditions
DR. ZINK spoke about slide 10, "Comparing to the flu,which
compared estimates of the 45 million flu cases, 810,000 flu
hospitalizations, and about 61,000 flu deaths. She reported
that about 40 percent of the U.S. population had received a flu
vaccine, and it was estimated that those vaccines prevented 6.2
million flu illnesses, 91,000 hospitalizations, and 5,700
deaths. She explained that, as the symptoms were similar, this
would put these in context, adding that there was not a vaccine
for this novel coronavirus. She pointed out that a flu shot
could help the hospitals from being overrun by people with
similar symptoms who needed hospitalization.
3:14:05 PM
DR. ZINK directed attention to slide 11, "Testing and
Treatment,which read as follows [original punctuation
provided]:
? CDC has developed a real time Reverse Transcription-
Polymerase Chain Reaction (rRT-PCR) test that can
diagnose 2019-nCoV in respiratory and serum samples
from clinical specimens.
? On January 24, 2020, CDC publicly posted the assay
protocol for this test. Currently, testing for this
virus must take place at CDC.
? Currently testing can only be done at the CDC but on
1/5/2020 the CDC announced they will start to roll out
testing to individual states
? Alaska Labs has been in communication with the CDC
to gear up for testing. At the earliest, Alaska could
start testing by March.
? There is no known treatment except for good
supportive care.
? A vaccine or treatment is likely not going to be
available in the near future.
DR. ZINK introduced slide 12, "CDC Evaluation Flowchart,which
detailed the steps for clinicians and hospitals to identify
whether both exposure and illness were present, and then the
steps to isolate, assess clinical status, inform, instruct, and
advise the patient. She reported that currently there was no
need to test people in Alaska unless they met one of these
criteria.
DR. ZINK shared slide 13, "PUI (Persons Under Investigation),"
which offered criteria for determination whether someone needed
testing.
3:15:58 PM
DR. ZINK spoke about slide 14, "Notes on travel,which read as
follows [original punctuation provided]:
? Jan 1, 2020 Huanan Seafood Wholesale Market was
closed
Jan 23, 2020 Wuhan City shuts down public
transportation
? Jan 31, 2020 Presidential Proclamation suspends
entry into the United States to foreign nationals who
visited Mainland China in the past 14 days. Exempted
persons include immediate family members of U.S.
citizens, legal permanent residents and crew members
of air travel
DR. ZINK reported that the current federal quarantine order
issued for the passengers returning from China was the first
since the 1960s, and she presented slide 15, "Isolation vs.
Quarantine,which read as follows [original punctuation
provided]:
? Isolation and quarantine help protect the public by
preventing exposure to people who have or may have a
contagious disease.
? Isolation separates sick people with a contagious
disease from people who are not sick.
? Quarantine separates and restricts the movement of
people who were exposed to a contagious disease to see
if they become sick.
? In addition to serving as medical functions,
isolation and quarantine also are "police power"
functions, derived from the right of the state to take
action affecting individuals for the benefit of
society.
DR. ZINK added that, in the State of Alaska, the Department of
Health and Social Services had the legal ability to issue
quarantine, which was occasionally used, particularly for
individuals with tuberculosis who posed a risk to others. She
noted that the state had not done a mass quarantine.
3:17:36 PM
DR. ZINK shared slide 16, "Prevention,which read as follows
[original punctuation provided]:
There is currently no vaccine to prevent 2019-nCoV
infection. The best way to prevent infection is to
avoid being exposed to this virus.
CDC always recommends everyday preventive actions to
help prevent the spread of respiratory viruses,
including:
? Avoid touching your eyes, nose, and mouth with
unwashed hands.
? Avoid close contact with people who are sick.
? Stay home when you are sick.
? Cover your cough or sneeze with a tissue, then throw
the tissue in the trash.
? Clean and disinfect frequently touched objects and
surfaces using a regular household cleaning spray or
wipe.
? Wash your hands often with soap and water for at
least 20 seconds, especially after going to the
bathroom; before eating; and after blowing your nose,
coughing, or sneezing.
? If soap and water are not readily available, use an
alcohol-based hand sanitizer with at least 60%
alcohol. Always wash hands with soap and water if
hands are visibly dirty.
DR. ZINK pointed to slide 17, "An Outbreak,which compared a
graph for a pandemic with no intervention to a graph for a
pandemic with rapid intervention, which depicted a reduction to
the overall peak number of cases and the health effects. She
declared, "These viruses don't have passports; we live in a very
international world, and we need to be prepared and ready."
DR. ZINK moved on to slide 18, "Disaster Preparedness,a
workflow chart that listed disaster management plans to respond,
recover, plan and prepare, then mitigate. She added that it was
then necessary to prepare for the next disaster using previous
guidelines from SARS, MERS, and Ebola, slide 19, Preparing for
the next steps, which read as follows [original punctuation
provided]:
? Preparedness is something that we do, practice and
prepare for
? Build on existing structures and lessons learned
from the 1918 flu, H1N1, SARS, MERS, and Ebola
? Have recently updated Pandemic Influenza Plan that
can be used as guidelines
? Exercised planning for a contagious pandemic in the
"Ragin' Contagion" exercise from April 8-13, 2019
? Have active Emergency Medical Countermeasures
Management Plan
? DHSS EOC (Emergency Operations Center) stood up Jan.
24, 2020
? Working closely with other departments, tribal,
federal and local partnerships to run through all of
the "what ifs"
3:19:44 PM
DR. ZINK talked about the flight which landed in Anchorage
bringing U.S. citizens home from China, and she noted that the
14-day quarantine window had closed on Tuesday, [February 11],
ending the concern and risk for anyone working with the flight,
slide 20, "A special case,which read as follows [original
punctuation provided]:
? Asked to assist in the repatriation of up to 240 US
citizens and their families on January 28th, 2020
? Worked closely with federal, local, tribal and state
partners to ensure Alaskans were not at any increased
risk
? Passenger[s] have all cleared their 14 day
quarantine period with no cases
? Alaska is more prepared from having the courage to
carry out this mission
DR. ZINK reported that, because of that repatriation mission,
Alaska was further ahead in planning and preparation than most
other states. She pointed out that it was necessary to keep the
cargo ships and cargo flights moving, as almost 90 percent of
medical equipment came from China, slide 21, "Looking forward
Cruise Ships and Cargo,which read as follows [original
punctuation provided]:
? Anchorage airport is one of the busiest cargo
airports in the world
? Crew members of aircraft have FAA requirements which
are slightly different than the general screening into
the US
? Cruise lines are limiting passengers who are
boarding with pre-boarding screening
DR. ZINK addressed slide 22, "Strengths and Weaknesses,
declaring that it was necessary to keep people informed with
accurate information as we were actually fighting four
epidemics: the novel coronavirus, as well as epidemics of fear,
stigma, and misinformation. She paraphrased the slide, which
read as follows [original punctuation provided]:
? Strong, centralized public health system including
labs, epidemiology, emergency operations center
? Strong state, federal, Tribal, local partnerships
Limited health care capacity and large distances
? Housing and quarantine challenges
? Supply chain challenges
? Rapid spread of fear, stigma and misinformation
3:22:02 PM
DR. ZINK concluded with slide 23, "What is being done,which
read as follows [original punctuation provided]:
? Health provider webinars
? Emergency operations meetings
? Daily national calls with federal partners including
CDC and others
? Public messaging and media
? Interdepartmental preparedness planning including:
? DMVA, DEED, DOT, DOC, DPS and others
DR. ZINK, in response to Representative Claman, explained that
the diagram on slide 17 depicted a "general diagram of
epidemics" to get an estimate of where things were, and not the
coronavirus specifically.
3:22:55 PM
REPRESENTATIVE TARR reflected on the opportunity to test the
system when the plane landed in Anchorage with the repatriated
U.S. citizens, and asked what had been learned that would
strengthen any future response.
DR. ZINK explained that the heightened tension with the national
and international media was a good reminder for how quickly
things can "get spun up." She shared that, upon landing, the
plane had announced a medical emergency which created "a lot of
scrambling and a lot of concern," and turned out to be a minor
injury happening 9 hours earlier. She added that, although the
pilots and crew never got off the plane in China and were in a
separate airspace from the passengers, they left the plane and
went into Anchorage, causing a lot of concern due to the
misinformation.
3:25:28 PM
CHAIR ZULKOSKY stated that the committee would take a brief
recess.
3:25:43 PM
The committee took an at-ease from 3:25 p.m. to 3:38 p.m.
3:38:19 PM
^Presentation: Alaska Children's Justice Act Task Force
Presentation: Alaska Children's Justice Act Task Force
CHAIR ZULKOSKY brought the House Health and Social Services
Standing Committee back to order and announced that the final
order of business would be a PowerPoint presentation by the
Alaska Children's Justice Act Task Force.
3:40:13 PM
PAM KARALUNAS, Retired Chapter Coordinator, Alaska Children's
Alliance, shared that she has worked in the field of child
sexual abuse [prevention] for 35 years, was the founding manager
of the Child Advocacy Center in Fairbanks, Alaska, has worked
with the Alaska Children's Alliance for the past 15 years, and
was a founding member of the Alaska Children's Justice Act
Taskforce. She stated that much of the data and research
presented had been prepared by Dr. Jared Parrish. She shared
slide 2, "Introduction to the Alaska CJATF,and paraphrased the
slide, which read as follows [original punctuation provided]:
• Federally mandated and funded
• Mission: Identify areas where improvement is needed in
the statewide response to child maltreatment,
particularly child sexual abuse, make recommendations
and take action to improve the system.
• Statewide, multidisciplinary membership
• Legislation to improve protection & justice for
children (starvation, serious physical abuse, privacy)
• Focus on education: child abuse in Alaska, mandatory
reporting, & best practices for the multidisciplinary
response to child abuse
MS. KARALUNAS addressed slide 3, "Overview of our presentation,
and reported that Alaska had specific research on Alaska, which
was not common among the states.
3:42:18 PM
The committee took a brief at-ease.
3:43:50 PM
MS. KARALUNAS returned to slide 3, which read as follows
[original punctuation provided]:
Newest research on child abuse and neglect in Alaska
Including impact on state
Opportunities for earlier intervention: Mandated
reporting
Commercial sexual exploitation of children in Alaska
Specific requests for legislative changes
MS. KARALUNAS introduced slide 4, "Adverse Childhood Experiences
(ACEs), a collaborative study between Centers for Disease
Control and Kaiser Permanente of 17,000 people, mostly white,
mostly upper middle income with some college education, and not
considered to be high risk. The graph on slide 4 depicted the
percentage of significant connections between early childhood
adversities and health problems in adults. These childhood
adversities were divided into 10 categories: physical abuse,
sexual abuse, emotional abuse, physical neglect, emotional
neglect, mental illness, incarcerated relative, mother treated
violently, substance abuse in the home, and divorce. Each
category was determined to be one point, no matter the
frequency. She addressed slide 5, "Findings, which stated that
ACEs were very common, especially among people with physical
health problems, and listed the findings by percentage. She
reported that, although everyone had an 87 percent chance of
having at least one ACE, there was a 50 percent chance of having
3 or more ACEs.
3:47:42 PM
MS. KARALUNAS stated that the higher the score, the more likely
it was for an individual to have health risks, slide 6,
"Increased ACE score = increased likelihood:" She added that
recent research had found more of a correlation between high
ACEs score and heart disease than with those more traditional
causes including hypertension and high cholesterol. She added
that a high ACEs score also increased the risk for strokes, lung
disease, osteoporosis related factors, or early death, as well
as an increased risk for smoking, alcoholism, drug use,
depression, suicide attempts, multiple sexual partners, intimate
partner violence, or rape. She declared, the higher the ACEs
score, the more likely to be a victim.
MS. KARALUNAS moved on to slide 8, "Alaska ACEs snapshot,which
listed the percentages of reported problems as analyzed from the
Alaska Behavioral Risk Factor Surveillance System. She
emphasized that, in Alaska, those with four or more ACEs were 49
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. She shared slides 9 and 10, "And
it's not just one bad thing..." an Alaska specific graph which
indicated the co-occurrence of adverse childhood experience
exposures.
3:50:15 PM
MS. KARALUNAS shared slide 11, "Maltreatment burden in Alaska,
declaring that the health care impact was very high. She
reported that annually 10 percent of children in Alaska were
reported to the Office of Children's Services (OCS) and that 34
percent of adults in Alaska had some ACE experience as a child.
She declared that cumulatively 37 percent of the Alaska
population had some childhood trauma. She directed attention to
slide 12, "Trauma impacts can start prior to birth,which
included prenatal exposures and experiences which impact brain
development in utero and genetics. She added that children
exposed to prenatal trauma were much a higher risk for
hospitalization from asthma. She discussed slide 13, "What is
epigenetics?" and reported that childhood trauma impacts genes,
which helps to explain intergenerational trauma. She noted
that, as genes could be turned on and off, people could be
helped after trauma.
3:54:47 PM
MS. KARALUNAS discussed the Alaska Pregnancy Risk Assessment
Monitoring System (PRAMS), which allowed for mothers to be
interviewed in the hospital with a follow up process, slide 14,
"New emerging data resources." She stated that currently more
than 33,000 children born between 2009 and 2011 were being
followed in Alaska for medical issues, law enforcement issues,
and child protection reports, among others. She indicated slide
15, "Pre-birth household dysfunction to predict ACE Score,
reporting that dysfunction during the 12 months prior to birth
and pregnancy generated higher ACE scores.
MS. KARALUNAS moved on to slide 16, "PRAMS questions used to
measure pre-birth household dysfunction ACEs,and stated that
the risk of contact with OCS increased with the increased number
of pre-birth household dysfunctions. She reported that there
was a stepwise association and an accumulation of ACEs with the
more stresses that occurred prenatally, slide 17, "Pre-Birth
Household Dysfunction and ACE Score." She reported that
adjustments for maternal race, education, or age did not change
these outcomes. She introduced slide 18, "Impacts continue
after birth, which compared the synaptic density at birth, at
six years, and at fourteen years. She pointed out that the
synapsis showed a regression at 14 years old, hence a decrease
in the function of the brain, and a high level of vulnerability.
3:59:46 PM
MS. KARALUNAS shared slide 19, "Development influenced by both
negative and positive factors,and stated that brain
development was also influenced by positive factors such as
meaningful relationships. She discussed slide 20, "Adverse
Childhood Experiences (ACE), stating that the more ACEs
documented, the higher risk of developing later health and
social problems.
MS. KARALUNAS pointed to slide 21, "Risk (incidence) among
children,and reported that there was a cumulative incidence of
contact with OCS among children born in Alaska. She stated that
the study had tracked these children for nine years and measured
the cumulative incidences. Moving on to slide 22, "ALCANLink
Study, she relayed that of the children born between 2009 and
2011, before their ninth birthday, one in three had been
reported to OCS, one in four had been screened in to OCS, one in
eight had their OCS case substantiated, and one in sixteen had
been removed from their home by OCS and placed in foster care.
4:02:43 PM
REPRESENTATIVE TARR reported that, in 2019, there were more than
23,000 OCS protective service reports filed in Alaska, and, of
these, more than 11,000 were screened in for investigation.
REPRESENTATIVE JACKSON said that these numbers brought a lot of
questions.
MS. KARALUNAS replied that Alaskans were often hurt. She
explained slide 23, "Types of maltreatment, which read as
follows [original punctuation provided]:
Screened in by OCS in 2019:
Neglect: most common type 59.4%
Most common cause of child deaths
Most commonly linked to parental substance abuse
Mental injury 22.5%
Example: Exposure to DV
Physical abuse 11.4%
Sexual abuse 6.6%
4:07:17 PM
CHAIR ZULKOSKY asked for the definition of "screened in."
MS. KARALUNAS explained that OCS would review a report and then
determine through their records whether there should be further
investigation by an OCS worker.
4:08:00 PM
MIKE HOPPER, PhD, Private Practice Psychologist, introduced
slide 24 "Different life trajectories: Two roads to travel,and
said that, although there were two paths, the path that led
toward trauma and chaos was often hidden. These were people who
had survived multiple ACEs, did not want anyone to know, and
wanted to forget about from where they came. He noted that he
did not know how he could have survived and kept going and
expressed his own amazement that the rate of suicide was low.
He shared a personal anecdote, reading from a book about
immigrants, and suggested replacing the images with those for
children who experience ACEs. He stated that people who had
suffered ACEs felt like strangers who did not belong in our
society, as they had grown up "on very, very unsafe grounds."
He pointed out that, as these individuals tried to be invisible,
it was difficult to pick them out of general society until they
entered jail or a psychiatric hospital. He reminded the
committee that 40 percent of Alaskans had suffered from ACEs.
4:13:49 PM
MS. KARALUNAS continued with slide 24, and explained that the
neural pathways for flight, fight, or freeze can become
hardwired. She declared that there was also resiliency and
rewiring. She moved on to discuss slides 25 and 26,
"Disproportionality: Why?and reported that Alaska
Native/American Indian children were significantly represented
in child maltreatment reports and deaths. She stated that they
were three times more likely to be reported to OCS. She
reported that 48 percent of the children seen at CACs in FY 19
were Alaska Native or American Indian, although they were only
14 percent of the population. She emphasized that new research
had shown this was not a part of the culture. She stated that
it was necessary to adjust for the background of historical
trauma, racism, and the genetic factor, and it was evident that
the risk was related to the social ills, including poverty,
intimate partner violence, substance abuse, and poor mental
health. She declared that Alaska did not have a higher amount
of child abuse in the Alaska Native population because it was
part of the culture, instead it was part of what had been
happening for generations. She emphasized that the question
should not be "what's wrong with you?", but should be "what
happened to you?"
4:17:44 PM
MS. KARALUNAS shared slide 27, "What Does Child Maltreatment
Cost Alaska?" and slide 29, "Alaska estimates:" She
acknowledged the difficulties for balancing budgets, but pointed
out the cost annually for child maltreatment, between $631
million and $10.7 billion. She reported that the cost just for
the substantiated OCS reports was $82 million for childhood
health care, child welfare, and special education. She noted
that almost 41 percent of adult Medicaid enrollment was linked
to ACEs. She suggested that decreasing ACEs and improving the
response to child maltreatment could save Alaska almost $92
million annually. She moved on to slide 30, "Also below the
surface: CSEC, and spoke about the commercial, sexual
exploitation of children.
4:19:34 PM
GAYLE GARRIGUES, Retired Attorney, stated that the commercial
sexual exploitation of children had probably been going on for a
millennium even as law enforcement was just becoming aware of
it, slide 31, "Commercial Sexual Exploitation of Children (CSEC)
is:" which read as follows [original punctuation provided]:
Sexual activity involving a child in exchange for
something of value, or promise thereof, to the child
or another person or persons
Treating a child as a commercial and sexual object
A form of violence against children
Words matter: not "child prostitution"
MS. GARRIGUES declared that, as words conjured images, they
matter, and she paraphrased slide 32, "Sex Trafficking,which
read as follows [original punctuation provided]:
CSEC victims are victims of sex trafficking when there
is a third party exploiter who profits from the
exploitation
Sex trafficking in which a commercial sex act is
induced by force, fraud, or coercion,
or in which the person induced to perform such an act
has not attained 18 years of age (or under 20 in
Alaska)
4:23:21 PM
DR. HOPPER reported on slide 33, "Intersections of Abuse, and
stated that child exploitation already occurred within a secret
environment, as it was behind closed doors, and was a "very,
very hidden part of our society." He offered a comparison with
the difficulty and courage of women to speak out against
powerful men in the MeToo movement, and how difficult it was for
young girls to also speak out. He added that young boys were
also sexually abused at a rate not that far from young girls.
He shared an anecdote of the intersection of child prostitutes
and child sexual exploitation, pointing out that most of the
sexual exploitation was committed by people who did not have to
pay for it.
4:27:02 PM
MS. GARRIGUES shifted to slide 34, "Pathways to Entry:" which
read as follows [original punctuation provided]:
Parents selling/trading children for sex
Violence and force
Kidnapping
Seduction
Fear, coercion, blackmail
False advertising for "modeling," "acting," or
"dancing" opportunities
Peer recruitment
Internet enticement through social media, gaming, or
profile-sharing sites
Survival
MS. GARRIGUES shared anecdotes for each of these pathways.
4:31:12 PM
MS. GARRIGUES spoke about slide 35, "What you need to know:"
which read as follows [original punctuation provided]:
Within 48 hours of becoming homeless, one in three
children will be approached by a trafficker
In Alaska, common age of recruitment is 14-16 years
Average lifespan once recruited is 7 years
MS. GARRIGUES moved on to paraphrase slide 36, "Alaskan Risk
Factors,which read as follows [original punctuation provided]:
Population with high amounts of historical trauma and
trauma exposure
Transient male-dominated industries
Transient male-dominated industries placed in rural
areas next to communities with high amounts of
historical trauma Rural and Urban
Celebrated history of prostitution
MS. GARRIGUES directed attention to the glamour of the
celebrated history of prostitution, offering an example of the
Fairbanks "Golden Days" and the streets named for madams.
MS. GARRIGUES discussed slide 37, "Current Status of CSEC in
Alaska,which read as follows [original punctuation provided]:
Loyola University/Covenant House Study 2016
65 youth surveyed locally (641 Nationally)
1 in 5 Identified as trafficking victims Nationally
1 in 4 Identified as trafficking (labor/sex) victims
locally
1 in 4 females as sex trafficking locally
200 victims served in last two years between 5
Anchorage providers
10 current minor child cases FBI
Law enforcement report an increase of online
recruitment
More cases of traffickers creating explicit
images/videos of minors
MS. GARRIGUES shared that it was necessary to learn the ways to
investigate cases and what to look for. She pointed to some
protocols for examinations of sex traffic victims as this
entailed different questions and questioning techniques. She
pointed out that the images from these cases last forever on the
internet.
4:37:01 PM
REPRESENTATIVE TARR asked about the bills currently introduced
by the governor.
MS. GARRIGUES said that she would speak about that.
MS. KARALUNAS shared that the author of the studies by Loyola
University referenced on slide 37 had indicated that the stories
from children in Alaska were the most horrific.
4:38:23 PM
DR. HOPPER reported on slide 39, "How do we create the best
future for our children's lives?" a graph reflecting the
trajectory of health development from the early ages, 6 months
to 5 years of age. He noted that with the lack of
opportunities, including health service and education, children
were found to not do as well.
DR. HOPPER moved on to slide 40, "What can we do?" which read as
follows [original punctuation provided]:
Reasons for hope:
Healing is possible
Our brains can always learn
We can all help build resilience in children
We can all help protect children
DR. HOPPER expressed his disagreement with any suggestion to
survivors that their brains are damaged, as the brain was
"unbelievably resilient." He reported that these kids protected
their own brains under the worst possible conditions, while
trying to forget because there was nothing they could do about
abuse and neglect. He noted that, however, "down the line it's
a threat that remains ever present, that's what called a
traumatic memory." He referred to these memories as "warning
lights." He added that most people did not recognize these
warnings "of their own past calling to them, warning them of
what can happen." Instead, many people would begin to act as if
this were all happening again. He expressed his awe of the
survivors.
4:44:25 PM
MS. GARRIGUES added that her work with sexual assault and abuse
victims had shown them to be "some of the bravest people because
they had to come into the courtroom and talk cogently about some
of the worst experiences in their lives." She shared slide 42,
Earlier recognition & intervention: Mandatory Reporting, and
slide 43, "Mandatory reporting gaps, stating a desire to
"tinker with the mandatory reporting statute." She paraphrased
from slide 43, which read as follows [original punctuation
provided]:
EMS & paramedics (trainings)
Clergy (multiple cases involving clergy as
perpetrators & protectors of perpetrators)
Animal control & veterinarians (research links between
animal cruelty & child abuse)
Guardians Ad Litem (GALs) (CASA volunteers are
required already)
Judges (recent case reporting not required, no
immediate notification)
4:47:51 PM
REPRESENTATIVE PRUITT asked whether clergy were currently
mandatory reporters for child sexual abuse.
MS. GARRIGUES replied that, in Alaska, clergy were mandatory
reporters for elder abuse but not for child abuse. She said
that the requirement for mandatory reporters varied from state
to state.
REPRESENTATIVE PRUITT shared the story of a confession to a
clergy that was subsequently reported, resulting in a suit from
the confessor.
MS. GARRIGUES acknowledged a case in Alaska when a clergy also
worked as a mental health therapist and reported an abuse. This
had resulted in litigation regarding confessional privilege, but
the law had determined there was not any privilege for a mental
health counselor. She noted that the rules of evidence provided
an exception for mandatory reporting for clergy. She offered
her belief that a clergy exception for mandatory reporting
protected the perpetrator, not the child.
REPRESENTATIVE PRUITT clarified that the incident he relayed had
occurred outside Alaska.
4:51:57 PM
REPRESENTATIVE TARR shared background on a prospective bill she
was drafting for mandatory reporters, which included clergy.
MS. GARRIGUES relayed that in Alaska there were privileges found
for information that may be used in court. She added that each
member of the Alaska Children's Justice Act Task Force was a
subject matter expert if further specific information was
requested.
REPRESENTATIVE TARR shared that animal control and veterinarians
had been considered as aggravators with violent crimes in her
prospective bill.
MS. GARRIGUES replied that aggravators happened after someone
had gone to court, whereas she was working toward early and
effective intervention, prior to going to court.
MS. KARALUNAS stated that there was clear research making the
connection between abused animals and abused children in a home.
DR. HOPPER pointed out that, as dogs would bark when abused,
there were often animal control people investigating before
there were social workers investigating.
4:55:34 PM
MS. KARALUNAS addressed slide 44, "Early & effective
intervention," which read as follows [original punctuation
provided]:
Child Advocacy Centers
Multidisciplinary response
Child focused
Forensic interview
Medical exam
Mental health services
Support & advocacy
Information sharing
Nearly 33,000 children & their families served since
1996
MS. KARALUNAS moved on to paraphrase slide 45, "Protective
Factors: Focus on adults, which read as follows [original
punctuation provided]:
Supportive, nurturing, stable family
Supportive social networks
Caring adults outside family
Household rules, monitoring of child
Parental employment
Adequate housing
Access to health care, other services
Community safety
Community involvement
Cultural connectedness
MS. KARALUNAS addressed slide 46, hat can you do?" which read
as follows [original punctuation provided]:
Realize this affects ALL of us in Alaska
Make your decisions using a trauma-informed lens
"It's not what's wrong with you, it's what
happened to you"
Support community-based & system-wide approaches to
strengthen children and families
4:56:51 PM
MS. GARRIGUES explained slide 50, "SB 165/HB 225: "An Act
relating to sex trafficking..." which had been introduced by the
governor and were related to sex trafficking, bringing the
prosecution up to date. She declared support for the
legislation, especially support for the prosecution that the
patrons had to register as sex offenders. She emphasized that,
although there was support for the recommendation that a victim
of sex trafficking may seek to vacate any prostitution
convictions, this needed to go further as these sex trafficking
victims often committed other crimes, all a result of the
trafficking and not because of their own free will. She urged
that the statute be amended to add more convictions that could
be vacated. She suggested that for more successful prosecutions
of trafficking it would be necessary for safe harbor
protections, such as housing and support, to help the victims
and "go after the real bad guys." She stated that mandatory
training was necessary for law enforcement officers, so they
know what questions to ask, for prosecutors, and for judges to
better understand. She referenced the proposed bills SB 168 and
HB 228 which had come forward primarily because of a decision
made by the Supreme Court that required a way for people on the
sex offender registry to be removed. These bills would set up
the process for this, clear criteria for the courts to consider,
with a clear and convincing standard of proof, and would provide
for victim notification and for the victim to provide input. It
also added other registrable crimes. She declared support for
the proposed bills.
5:01:04 PM
MS. KARALUNAS concluded with slide 53, "How will you be a
champion for Alaskan children & families?"
5:01:27 PM
REPRESENTATIVE SPOHNHOLZ expressed appreciation for the long-
time work addressing child abuse and neglect in Alaska by the
task force. She suggested that there were many additional
preventative measures to reduce the impact for child abuse, such
as additional positive supports for children's lives. She
referenced a federal program, the "Family First Prevention
Services Act," which suggested in-home parenting support, nurse
home visiting programs, and substance abuse and mental health
services. She reported on the investment in after school
prevention programs with supportive adults. She declared that
offering even more positive programs would "save money, save
lives, and have healthier people over time."
5:04:08 PM
DR. HOPPER asked the committee for a dedicated fund for foster
kids to have access with transportation to organized sports,
noting that this "would change thousands of lives."
REPRESENTATIVE JACKSON shared that there was "a massive amount
of money that is coming but the federal government is being very
mindful in how they're going to focus it." She suggested that
investment back into foster kids would break the cycle.
DR. HOPPER expressed his agreement that there were foster kids
who had been identified as "being in the cycle."
5:05:20 PM
CHAIR ZULKOSKY offered her belief that this was a topic of broad
concern and listed some follow up items, which included: how to
address historic trauma, issues of child welfare, and mandatory
reporting.
5:07:02 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:07 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Coronavirus Update - Dr. Zink.pdf |
HHSS 2/13/2020 3:00:00 PM |
Coronavirus Update by Dr. Anne Zink |
| Dispelling Myths about Child Sexual Abuse among Indigenous People.pdf |
HHSS 2/13/2020 3:00:00 PM |
Children's Justice Act Task Force - Dispelling Myths about Child Abuse |
| Children's Justice Act Task Force Presentation.1.pptx |
HHSS 2/13/2020 3:00:00 PM |
Alaska Children's Justice Act Task Force Presentation |