Legislature(2023 - 2024)DAVIS 106
01/31/2023 03:00 PM House HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Department of Family and Community Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 31, 2023
3:00 p.m.
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative CJ McCormick
Representative Justin Ruffridge
Representative Dan Saddler
Representative Jesse Sumner
Representative Zack Fields
Representative Genevieve Mina
MEMBERS ABSENT
All members present
OTHER LEGISLATORS PRESENT
Representative Will Stapp
COMMITTEE CALENDAR
PRESENTATION(S): DEPARTMENT OF FAMILY AND COMMUNITY SERVICES
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
KIM KOVOL, Deputy Commissioner
Department of Family and Community Services
Juneau, Alaska
POSITION STATEMENT: Co-offered a presentation on the Department
of Family and Community Services.
CLINTON LASLEY, Deputy Commissioner
Department of Family and Community Services
Juneau, Alaska
POSITION STATEMENT: Co-offered a presentation on the Department
of Family and Community Services.
ACTION NARRATIVE
3:00:08 PM
CHAIR MIKE PRAX called the House Health and Social Services
Standing Committee meeting to order at 3:00 p.m.
Representatives McCormick, Ruffridge, Saddler, Sumner, Fields,
Mina, and Prax were present at the call to order.
^PRESENTATION(S): DEPARTMENT OF FAMILY AND COMMUNITY SERVICES
PRESENTATION(S): DEPARTMENT OF FAMILY AND COMMUNITY SERVICES
3:01:28 PM
CHAIR PRAX announced that the only order of business would be a
presentation on the Department of Family and Community Services.
3:02:44 PM
KIM KOVOL, Deputy Commissioner, Department of Family and
Community Services, stated she had over 25 years of experience
in the private sector, executive leadership, management, license
facilities, organizational development and restructure,
logistics, and working with youth and adults. She added that
prior to her current role, she served as Governor Dunleavy's
special assistant with a portfolio focused on domestic violence
and sexual assault, missing and murdered persons, human and sex
trafficking, homelessness, foster child and elder care, opioids
and fentanyl, and suicide prevention.
3:04:45 PM
The committee took an at-ease from 3:05 p.m. to 3:07 p.m.
3:07:49 PM
MS. KOVOL began her PowerPoint presentation [hard copy provided
in committee packet] on slide 2, which read as follows [original
punctuation provided]:
Mission
To provide support, safety, and personal well-being
for vulnerable Alaskans.
Vision
Service First
We will:
Strengthen lives through meaningful connections with
families, communities, Tribes, and providers.
Provide safe, person-centered care with integrity and
dignity to the Alaskans we serve.
Advance an agency culture that prioritizes the well-
being of our workforce.
Mobilize innovative solutions to complex challenges.
MS. KOVOL moved to slide 3, which showed an organizational flow
chart of the Department of Family and Community Services. She
emphasized that the commissioners, directors, and deputy
directors had not left since the reorganization of the
department.
3:09:43 PM
MS. KOVOL continued to slide 4, "Reorganization of DHSS -
Executive Order 121," and stated that the Department of Health
and Social Services had reorganized into two departments: the
Department of Health (DOH) and the Department of Family and
Community Services (DFCS). She added that DFCS had retained the
Alaska Psychiatric Institute, the Division of Juvenile Justice,
Alaska Pioneer Homes, and the Office of Children's Services,
which she emphasized were all direct services and were available
24/7/365.
MS. KOVOL moved to slide 5, "Continuing Collaboration," and said
that DFCS worked closely with DOH, and she emphasized the four
key areas of collaboration. She stated that the complex care
required a continuous and strengthened partnership with DOH, and
both departments are identifying solutions to address systemic
gaps. She said to improve the continuum of care, both
department are looking to establish a coordinated system across
departments to ensure person-centered care. She stated that the
departments are also actively developing an Information
Technology (IT) plan to prioritize projects and minimize delays.
She added that modernizing and utilizing contractors within IT
would ensure a higher quality of service.
MS. KOVOL showed slide 6, "Our Priorities," and emphasized that
DFCS's priorities would change depending on the unique needs of
each family or community. She added that the four main
priorities of the department are: complex care systems, tribal
partnerships, department culture, and workforce innovations.
MS. KOVOL continued to slide 7, "Complex Care Systems," and
stated the frequency of youth and adults requiring complex care
is on the rise, and all four of the direct service divisions are
tasked with finding appropriate levels and location of care.
She said the department is creating a Complex Care Coordination
unit within the Office of the Commissioner, which will establish
a single point of contact for the department and its partners.
She added that the unit will establish a network of placement
options for adults and youth, and will oversee long-term
facilities development. She emphasized that partnering with
healthcare providers, medical centers, and clinics to expand
services would take time. She added that DFCS will work with
providers across the country to support the needs of Alaskans if
there is not appropriate care within the state, and it will work
to make all Alaska facilities Medicaid or third-party payer
eligible.
3:13:25 PM
MS. KOVOL moved to slide 8 and stated care coordination is
complex as it requires coordination from inside and outside the
department. She said that first an assessment is completed to
determine placement, which could require individual or facility
Medicaid, licensed placement medical personnel to manage
medication, wraparound services, transportation, and family
support. Each case is unique and requires collaboration with
many agencies and organizations, and she emphasized the goal is
to prevent anyone from being institutionalized, and to find a
family-like setting to meet every day needs.
MS KOVOL described a story from when she became acting
commissioner after DFCS was formed, regarding a complex care
case of a youth, who had to manage multiple meetings and phone
calls to staff inside DFCS and outside, as there was no single
point of contact. She referred to the diagram on slide 8, which
showed the multiple touch points that the youth had to contact,
and she added that the touch points were ever changing as other
organizations and agencies would be brought in or left out
depending on the case. She highlighted the reduction in
redundancy and improvement in efficiency which having a single
point of contact created.
MS. KOVOL moved to slide 9, "Tribal Partnerships," and stated
DFCS is increasing statewide tribal outreach with a Dedicated
Tribal Liaison, Mariah Seater. She said DFCS would create new
relationships as well as reconnect with long-standing partners.
MS. KOVOL displayed slide 10, "Department Culture," and
emphasized the privacy of families and individuals who work with
DFCS and the emotional impact of staff who work in crisis
response, as many of the scenarios are emotionally heavy and
challenging but the successes are always happy. She stated she
worked on building connection and communication with the public
through social media to provide information and knowledge, and
to spread awareness of the department's successes.
3:18:22 PM
MS. KOVOL moved to slide 11, "Workforce Innovations," which read
as follows [original punctuation provided]:
Governor/Department efforts
People's First Initiative OCS workforce stabilization
incentives for staff
Department-wide workforce stabilization incentives for
staff
Department-wide referral incentives
Rural workforce solutions
Letters of Agreements for alternate/flexible work
schedules
Internships and practicum placements
University of Alaska, Anchorage School of Social
Work
Alaska Psychology Internship
Department of Defense SkillBridge Program
Social Work Practicum and Child Welfare Academy
3:19:22 PM
MS. KOVOL overviewed the Alaska Pioneer Homes on slides 13
through 14. She stated the director of the Alaska Pioneer Homes
is Heidi Hamilton, and the Alaska Pioneer Homes provides
assistance with daily living, nursing services, recreational and
social programs, medication, dietary needs, housekeeping, and
meal preparation. She said the Alaska Pioneer Homes provides a
wide range of services, including to those with dementia or
complex healthcare needs, with its 423 full-time staff and
budget of over $104 million. She emphasized that the Alaska
Pioneer Homes had maintained over 80 percent occupancy from July
to December 2022, and that the Anchorage location was only at 80
percent capacity as a result of renovations to increase safety
and access. She added that within the Juneau location, 90
percent of residents had family involvement with care, while in
the Anchorage location only 50 percent did.
MS. KOVOL showed slide 15, which read as follows [original
punctuation provided]:
Successes
Completion of Complex Care Neighborhood in Anchorage
Resident Wi-Fi installed in four homes
Increased coordination with community providers for
complex care needs
On-line waitlist application development
Challenges
Increasing age and needs of residents
Increased number of elders on waitlists
Building maintenance
Supply chain and workforce challenges delaying
projects
MS. KOVOL moved to slide 16 and stated that the chief executive
officer of the Alaska Psychiatric Institute (API) is Scott York.
She said API has five inpatient units with 80 beds and a budget
of just over $58 million, and is the only location that is able
to provide competence restoration treatment in the state.
MS. KOVOL showed slide 17, which read as follows [original
punctuation provided]:
Initiatives
Development of a comprehensive strategic plan to
ensure that Alaska Psychiatric Institute is meeting
the needs of Alaska in the continuum of care
Outpatient Competency Restoration
Community-based
Jail-based
Procurement of a new electronic health record system
Recruitment and retention of nurses and social workers
MS. KOVOL displayed slide 18, which read as follows [original
punctuation provided]:
Successes
Chilkat Adolescent Unit reopened May 2021
Reopening of the Denali Unit as a dedicated service
location for adults with neurocognitive disabilities
Patient on staff assaults in our adult population
decreased 55% in past year
Becoming a teaching hospital
Clinical site for medical students, nursing students,
and recent reinstatement into the Alaska Psychology
Internship
3:26:00 PM
CLINTON LASLEY, Deputy Commissioner, Department of Family and
Community Services, continued the presentation with slide 19,
and stated that the former Department of Health and Social
Services had reorganized under Executive Order 121. Most of the
former department's functions had been "picked and placed" into
the two new departments, and some functions of the Division of
Behavioral Health had been moved to DFCS. He said the four
functions that had moved from the Division of Behavioral Health
to DFCS were: Disproportionate Share Hospital Funding (DSH),
Designated Evaluation and Stabilization (DES), Designated
Evaluation and Treatment (DET), and Secure Patient Transport
Program. A new DET/DES coordinator, Ashley Christopherson, had
been hired to manage patients who may need stabilization or
treatment. He added that states in the U.S. receive
Disproportionate Share Hospital federal allotment to cover the
cost of DSH hospitals which serve significantly more under
resourced patients, as well as reimburse hospitals for
performing DES and DET services. He explained the difference
between DET and DES as DET hospitals provide psychiatric
evaluation and treatment, while DES facilities provide short-
term stabilization services. He said the 3 hospitals on the
slide, [Bartlett Regional Hospital, Fairbanks Memorial Hospital,
and Mat-Su Regional Hospital,] provide 48 beds to the continuum
of care for the state, and the Secure Patient Transport Program
managed the transportation of patients. He stated the budget of
the four programs was approximately $14.5 million.
3:29:19 PM
MS. KOVOL moved to slide 20, "Office of Children's Services,"
and stated that Kim Guay is the Director of the Office of
Children's Services (OCS) and that the Office is responsible for
ensuring the safety of Alaska's children, investigating reports
of child abuse and neglect, and administering the foster care
system. She added that OCS is spread across five regions and
has 21 offices, over 600 full-time positions, and a budget of
nearly $200 million.
MS. KOVOL showed slide 21, "Tribal Child Welfare Compact," and
stated that the Tribal Child Welfare Compact began in 2017; the
Thirty-Second Alaska State Legislature had codified it with
House Bill 194. She said that the previous budget had increased
funding from $1.6 million to $5 million and was distributed
across 18 co-signers who represented 170 tribes. She stated
that the co-signers are given the flexibility to use the funds
as they see fit, such as the Positive Parenting Indian classes
which teach child rearing in a culturally relevant method.
MS. KOVOL moved to slide 22, "People's First Initiative," which
read as follows [original punctuation provided]:
Manage secondary trauma
Mental Health Clinician 4
Position Expansion
Four new Protective Service Specialist 4 positions
Social Services Associates, Office Assistants, and
Administrative Assistants
Retention incentives
Alaska Impact Alliance
Field training compensation program
Support for older foster youth ages 18-21
Increased vocational opportunities
Increased financial assistance for housing,
transportation, and other identified needs
Complex trauma placement support
MS. KOVOL showed slide 23, "Update of Workforce," which read as
follows [original punctuation provided]:
Turnover rate in frontline caseworkers is decreasing
Currently 55.5%
High of 59.4% in 2021
Continue to have high vacancy rates for case carrying
workers
Regional vacancy rates vary
Smaller offices face challenges balancing caseloads
Continue to evaluate systems processes to reduce
burden on frontline workers
MS. KOVOL added that House Bill 151 from the Thirtieth Alaska
State Legislature required a limit on the caseload for new case
workers, and some regions had high caseloads for veteran case
workers.
3:34:45 PM
The committee took an at-ease from 3:34 p.m. to 3:36 p.m.
3:36:23 PM
MS. KOVOL stated Shannon Dilley is the director of the Division
of Juvenile Justice (DJJ), and she moved to slide 24, "Division
of Juvenile Justice," which read as follows [original
punctuation provided]:
Mission:
Hold juvenile offenders accountable for their
behavior.
Promote the safety and restoration of victims and
communities.
Assist offenders and their families in developing
skills to prevent crime.
Facilities / Offices / Staff:
6 Youth Facilities
13 Probation Offices
426 Full Time Positions
FY2023 Budget: $60,950.5
MS. KOVOL showed slide 25, which read as follows [original
punctuation provided]:
Staffing Shortage:
Combined units at the Johnson Youth Center and
Fairbanks Youth Facility due to critically low
staffing levels
Facility Staff: 51 of 301 positions vacant at
beginning of the year
Program Improvements:
Specialized Treatment Units
Neurofeedback
System improvements in assessments, data, training,
and quality assurance
Workforce Improvement Efforts:
Salary Study for facility staff
Culture improvements
Expanded training
Specialized labor agreements
3:38:31 PM
MS. KOVOL moved to slide 26, "HB105: Detention of Minors -
Implementation," and explained that House Bill 105 [which passed
in the Thirty-Second Alaska State Legislature] updated
definitions on minors who were waved into the adult justice
system. She added that adult facilities that took on minors
were ill prepared and commonly segregated the minors from the
rest of the residents. She stated that since the passing of
House Bill 105, 15 minors have been held in DJJ facilities;
currently only two minors are held in DJJ facilities.
MS. KOVOL concluded on slide 27, "Reflections Day 215," and said
she visited many sites in the first 100 days of her employment,
and she looked forward to rebuilding relationships and programs,
such as Restore, Inc, the Sitka Tribe, the Arctic Slope Native
Association, and True North Recovery. She expressed gratitude
toward the employees who show up to work and address complex
emotional situations, and those who share criticisms to build up
solutions to problems.
3:41:53 PM
DEPUTY COMMISSIONER LASLEY, in response to a question from
Representative Fields about the planned renovations for the
Juneau location for the Alaska Pioneer Homes, stated a new
building was estimated to cost $100 million and a renovation
with expansion was estimated to cost $60 million and would take
three to five years and would require moving elders multiple
times. He emphasized that some rooms are small and make moving
with mobility assistance difficult.
DEPUTY COMMISSIONER LASLEY, in response to a follow up question
from Representative Fields, said Alaska Pioneer Homes is not
looking at opening a facility in Kenai; it is focusing on
improving the current facilities to meet the needs of elders.
3:46:15 PM
MS. KOVOL, in response to a question from Representative Sumner,
emphasized the reduction in OCS turnover was a small victory and
the department is making changes to reduce it further. She
added that roughly 30 percent of case carrying frontline staff
are not degree carrying in social work, and she expressed hope
for partnerships with the University of Alaska Anchorage to
increase undergraduate and graduate degrees in social work over
the long term.
3:48:54 PM
DEPUTY COMMISSIONER LASLEY, in response to a question from
Representative Mina, said OCS is working to innovate solutions
to entice recruitment and work with the University of Alaska
Anchorage to increase the number of qualified candidates. He
stated the next phase was to drive down "employee churn" and
provide opportunities for staff to improve mental health through
time off, mentorship programs, and behavioral health services.
3:52:04 PM
MS. KOVOL, in response to a question from Representative
Ruffridge, stated the workforce shortage has affected the four
divisions, as each one needs more nurses, patient care managers,
and certified nursing assistants, and DJJ specifically needs
more Juvenile Justice Officers. She said the departments are
not able to compete with the higher pay, quicker hiring, and
different incentives of private industry.
MS. KOVOL, in response to a follow-up question from
Representative Ruffridge, said the labor shortages are a top
priority; second is legacy software. She emphasized that the
online resources for the Children of Alaska system and other
software solutions are outdated. She stated all paper records
need to be digitized and made easier to access for staff. She
added that the aging facilities are also an issue for the
department.
3:53:04 PM
MS. KOVOL, in response to a question from Representative
Ruffridge about competency restoration, stated that API has 80
licensed beds, divided into 10 beds for youth, 10 beds for
restorative care, and the rest for the adult population. She
said API needs more beds in the restorative wing but wouldn't
have the staff to operate them.
DEPUTY COMMISSIONER LASLEY continued the response and stated API
has 10 forensic beds and is the only restorative facility with
services available in Alaska. He said individuals who have a
felony conviction are housed at the Department of Corrections
(DOC), and individuals who have a misdemeanor and can't get to
restorative services in time are released on a bond or bail
through DOC. He stated the department had one year to restore
each individual to competency to stand trial. He added that an
individual not restored to competency and not a danger to self
or others is released and then transferred to Title 47 civil
commitment.
3:57:54 PM
DEPUTY COMMISSIONER LASLEY stated the department is actively
working on outpatient restorative services for individuals who
have misdemeanor charges and are deemed not competent to stand
trial. He added that the department is in conversation with DOC
in Anchorage about a jail-based facility with 10 beds.
4:00:56 PM
MS. KOVOL, in response to a question from Representative Fields,
stated that the department is licensed for 80 beds but is unable
to fill all the beds because although each room has two beds,
some patients are unsafe to share a room with others. She
emphasized that the issue isn't just the number of beds, as even
if 30 more restoration beds were added, there would still be a
lengthy list of individuals waiting and the number of Title 47s
filed would increase. She added there is a trend moving towards
community-based beds to avoid institutionalizing patients,
increase the quality of care, and service smaller populations.
4:03:32 PM
REPRESENTATIVE FIELDS noted schools no longer have the capacity
to deal with children who are violent, and he asked whether
school administrators coordinate with DFCS regarding this issue.
MS. KOVOL answered that the department's four divisions are
tasked with "folks that are in our legal care." This raises the
question as to what level of response is to be given when
members of the public call the department regarding crises. She
said it doesn't work to simply hand these people a resource. In
response to a second question from Representative Fields
regarding possible recruitment from the Alaska Primary Care
Association training program and the Alaska Hospital Association
(AHA), she said the department has not looked at that particular
program but has held conversations with AHA, as well as with the
University of Alaska Anchorage; however, she noted there are
just not enough students.
4:08:33 PM
DEPUTY COMMISSIONER LASLEY, in response to a question from
Representative Fields regarding the Alaska Impact Alliance, said
the alliance has been active in bringing together community
partners and developing long-term plans; members of the board
will be in Juneau in a couple of weeks, and he offered to get
the board's most recent report to the committee.
4:09:13 PM
REPRESENTATIVE SADDLER referred to the vision statement from
slide 2, which relays that the department will "strengthen lives
through meaningful connections with families, communities,
Tribes, and providers." He singled out "Tribes," which he
remarked doesn't seem to be "part of that group," and asked Ms.
Kovol to explain the inclusion of Tribes in that part of the
vision statement.
4:09:53 PM
MS. KOVOL responded that it has been vitally important for DEED
to have conversations with Tribes in regard to the [Tribal Child
Welfare] Compact and child welfare. Further, there are other
items to explore, such as eldercare, where there may be
opportunities for partnership with [the Department of] Workforce
and Labor.
4:11:27 PM
DEPUTY COMMISSIONER LASLEY, in response to a follow-up question
from Representative Saddler, expressed that tribal partners are
critically important to the work DEED does. There are a
disproportionate number of tribal members in the department's
services, primarily in OCS. He opined that it is critical to
have tribal representation at the table when looking to expand
services across the state of Alaska. He said the department
wants to make sure it is respecting the sovereignty of Alaska
Native people, as well as providing culturally appropriate
services. He said this is part of what has been done for the
last five years as a result of the Tribal Child Welfare Compact.
The department also abides by Indian Child Welfare Act laws. In
response to a request for specific percentages of tribal
recipients in relation to each division of DEED, he said he
could provide that information at a later date. He offered his
understanding that 66 percent of youth in out-of-home placement
that come into contact with OCS are tribal citizens.
REPRESENTATIVE SADDLER said he also would like to know the
degree to which DEED collaborates with tribal authorities to
provide services.
4:14:20 PM
REPRESENTATIVE MINA referenced the topic of API becoming a
teaching hospital, as shown on slide 18, and she asked about the
timeline and the potential for expansion in the future.
MS. KOVOL said she would get that information to the committee
at a later date.
4:15:34 PM
REPRESENTATIVE RUFFRIDGE turned to the topic of designated
evaluation and treatment, from slide 19, and asked what the
process is to become a DET and now long the system has been in
place.
4:16:03 PM
DEPUTY COMMISSIONER LASLEY explained the process to determine
shorter or longer-term treatment services. He said it is an
easy process. He talked about the current 48 beds and intent to
expand. In response to a follow-up question regarding
incentives, he suggested that the incentive is to provide
service and care for patients where and when they need it.
4:19:20 PM
REPRESENTATIVE FIELDS expressed his hope that federal money
could be sourced to help DEED meet its needs regarding
apprenticeships and other department needs.
4:20:12 PM
CHAIR PRAX mentioned an examination of API, and he asked whether
that is "behind us now or ongoing."
DEPUTY COMMISSIONER LASLEY reviewed that in 2018 API was in
crisis; since then revisions have led to stable leadership. He
said this year is the first he can recall when all the
psychiatric and psychology positions are filled at the hospital.
CHAIR PRAX then asked about a U.S. Department of Justice review
of Alaska's health care. He asked whether the [department] has
any involvement in that.
4:22:20 PM
MS. KOVOL answered yes, although the larger component of this
lies with the Department of Health. She said DFCS is in the
early stages of working with DOH, as well as with the U.S.
Department of Justice no recommendations have yet been made.
4:23:38 PM
MS. KOVOL, in response to Chair Prax, indicated the department
may be following certain legislation but will not be requesting
legislation as of yet. Instead, it will focus on its clients
and staff.
4:24:23 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:25 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HHSS-Family and Community Services-Overview 1.31.23.pdf |
HHSS 1/31/2023 3:00:00 PM |
Family and Community Services |