Legislature(2001 - 2002)
03/21/2001 01:40 PM Senate HES
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ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE
March 21, 2001
1:40 p.m.
MEMBERS PRESENT
Senator Lyda Green, Chair
Senator Jerry Ward
Senator Bettye Davis
MEMBERS ABSENT
Senator Loren Leman, Vice Chair
Senator Gary Wilken
COMMITTEE CALENDAR
BUILDING BRIDGES CAMPAIGN
Jan McGillivary, Coordinator
David Roquet, Anchorage
Mary Messner, Barrow
Tracy Barbee, Anchorage
Vic Dull, New Stuyahok
Bob Miller, Fairbanks
Robert Bower, Kodiak
Mr. Doug Feet, Craig
ACTION NARRATIVE
TAPE 01-27, SIDE A
Number 001
CHAIRWOMAN LYDA GREEN called the Senate Health, Education &
Social Services Committee meeting to order at 1:40 p.m. Present
were Senators Ward, Davis and Green. She asked Ms. Jan
McGillivary from the Building Bridges Campaign to address the
committee.
BUILDING BRIDGES CAMPAIGN
MS. JAN MCGILLIVARY informed committee members that the Building
Bridges Campaign is holding its eighth annual fly-in to Juneau.
Building Bridges is a group of mental health consumers, family
members, providers and advocates working to continually improve
community based services. She informed committee members that
the presenters would introduce themselves.
MR. DAVID ROQUET, a mental health consumer, informed the
committee that a recent government survey has found one in four
Americans to have a mental illness. Mental illness must be
treated like any other illness. He is the operations manager for
the Alaska Mental Health Consumer Web (AkMHCW). With a state
grant, AkMHCW is putting consumers to work using a clubhouse-
setting run by and for consumers. AkMHCW helps consumers work on
their choices to receive services in their communities. Many of
its clients are homeless people who are running away from "the
system" because of its high level of coerciveness. Some clients
have been in and out of jail and referred by the mental health
court; others have been in the Alaska Psychiatric Institute
(API). Although the AkMHCW does not provide treatment, AkMHCW
staff has dealt with mental illness and is trusted by clients.
AkMHCW has found it very important to coordinate with all of the
agencies in Anchorage.
MR. ROQUET said that API serves a vital need; it is a place for
people to go who need help. He urged legislators to get the API
project "off the table" so that a new facility can be built. He
pointed out that in conjunction with API, the community outreach
programs work. AkMHCW has numbers to prove that it keeps people
out of API because they have somewhere else to go. AkMHCW is
open 8 a.m. to 5 p.m., seven days per week and will soon be open
until 8 p.m. AkMHCW has heard from people around the state who
want a similar organization in their locales.
MR. ROQUET said the website name is AkMHCW.org. AkMHCW helps
people find housing, jobs and choose health care professionals.
He noted that AkMHCW has found consumers to be resourceful if
they are given choices.
MS. MARY MESSNER, a Public Health nurse from Barrow, read the
following testimony.
My name is Mary Messner. My home has been Barrow for
about nine years. I've worked most of these years as a
public health nurse specializing in children with
special needs. I am also a consumer and the mother of
a consumer. I'm here today because of the great need
in our state for services for children and adolescents.
Undiagnosed brain disorders in children and adolescents
are common. Inadequate sub-optimal treatment of child
and adolescent mental health disorders is also common.
Studies show that some 60 percent or more of children
in the juvenile justice system suffer from undiagnosed
brain disorders.
For a person with bipolar disorder, also known as manic
depression, the average length of time it takes to get
correctly diagnosed and treated, from the time they
begin to seek help, is eight years. As the Surgeon
General has informed us, most children in our schools
with serious emotional disturbance, i.e., brain
disorders, do not get identified until after age 10, if
then.
So what do we need? As a state, we are abysmally
behind in school-based health clinic services which
provide health care, including mental health care by
child and adolescent specialized mental health
clinicians in collaboration with other specialists like
child psychiatrists, developmental pediatricians, child
psychologists. We have a wonderful statewide public
health nursing system, which reaches all of the
villages in our state. We need to integrate mental
health services into the system in the form of
psychiatric nurse practitioners, which have
prescriptive authority by virtue of their specialized
education and licensure. We need to aggressively
recruit child and adolescent specialized mental health
providers, offering incentives such as 100 percent loan
repayment. We need to grow our own.
We also need legislation that prevents schools from
labeling kids with services excluding diagnoses, such
as conduct disorder, without referring for a complete
diagnostic work-up by a child psychologist or a
developmental pediatrician. Thank you for your time
today.
MS. MESSNER explained that in the past, she has worked with a
child psychiatrist and a developmental pediatrician and has
advocated in schools for the needs of kids with mental health
diagnoses as diverse as attention disorder or minor depression.
Conduct disorder is an educational diagnosis made by a school
psychologist who excludes the child from receiving specialized
services because the child is deemed to be socially maladjusted
rather than mentally ill or needing help.
CHAIRWOMAN GREEN asked if such a diagnosis is made by a school
psychologist who observes a student in a classroom and that it is
not a medical term.
MS. MESSNER said the educational diagnosis is not a clinical
diagnosis.
CHAIRWOMAN GREEN asked Ms. Messner how pervasive the problem is.
Number 738
MS. MESSNER said she can only speak for the school district in
which she lives, but she believes the problem is nationwide.
CHAIRWOMAN GREEN asked Ms. Messner what the legal implications
are for school districts and states and whether enrollment is
ever forbidden.
MS. MESSNER said their enrollment, in her experience, is often
prevented by a series of continuous suspensions and they have no
legal protection. These students are labeled as "conduct
disordered," which equates to burgeoning criminal. The danger is
that many disorders include behaviors that could be viewed as
conduct disorders. For example, a person with untreated manic-
depression can be very agitated.
CHAIRWOMAN GREEN asked Ms. Messner if she feels a parent should
get further testing and diagnoses for his or her child through an
independent psychologist and present that information to the
school.
MS. MESSNER said the law says that anyone in the community who
sees a child as having difficulties, which may impair their
ability to learn in school, should inform the school. The school
is then mandated to evaluate the child.
CHAIRWOMAN GREEN asked if an appeal process exists.
MS. MESSNER said parents can request an independent educational
evaluation. The Department of Education's approved list of
specialists contains the names of people connected with the
system, so that can present problems when seeking an independent
educational evaluation. Parents can also request a hearing but
they would need an attorney to have any hope of prevailing at
that hearing.
Number 1002
CHAIRWOMAN GREEN asked if the root of the problem is with the
Department of Education, the state board of education, or with
the statutory definition of how children are identified.
MS. MESSNER said she is very familiar with the Individuals with
Disabilities Education Act (IDEA) and is a member of several
disability advocacy groups. She believes the problem is not
statutory. She informed the committee that on February 28,
[U.S.] Senator Dan Burton held hearings on the implementation of
IDEA. Senator Burton, as the grandparent of an autistic child,
has been shocked at his grandchild's treatment by the school
system.
SENATOR WARD asked Ms. Messner to elaborate on her statement
about offering 100 percent student loan forgiveness.
MS. MESSNER said she raised the idea as a way to aggressively
attract and "grow our own" providers. She pointed out that
another issue for Alaska is cultural competence.
CHAIRWOMAN GREEN thanked Ms. Messner and called Ms. Barbee to
testify.
Number 1142
MS. TRACY BARBEE, an Anchorage parent, read the following
testimony.
My husband and I struggled for many years trying to
find the appropriate help for our 14-year old bi-polar,
ADHD, learning disabled son. Our biggest struggles
have regarded the school district and the medical,
psychiatric and therapy professions. In our
circumstance, and in many others I'm aware of, we've
found the schools at a loss in their attempts to deal
with mental health issues in children. Many of the
districts seem to be genuinely concerned, however most
lack the knowledge and experience necessary to handle
children like our son.
Similarly, we have found many of the mental health care
professionals in Anchorage to fall short on their
ability to appropriately diagnosis and treat children
with mental health issues. Unfortunately, many
families like ours that have to educate themselves
essentially diagnosed their own children, educate the
professionals and then completely oversee their
children's medication issues. Over the course of five
years, our son was hospitalized twice, misdiagnosed
many times over, essentially kicked out of four
schools, and eventually was recommended by an Anchorage
psychiatrist to be placed in a long term care facility.
Not willing to do that, we took him outside of Alaska
to Johns Hopkins in Baltimore and finally received the
appropriate diagnosis of bi-polar disorder. After
getting him up to therapeutic levels on the proper
medications, we have been able to move forward with his
education and growth, and he is currently a successful
freshman at Service High School. He is still not an
easy child but loving and manageable.
My son attended the Walley (ph) Center in Anchorage for
1½ years. This is a school in Anchorage for children
with severe emotional and behavioral issues. During
that time, I volunteered at the school and saw so many
children that obviously had undiagnosed mental health
issues. We seriously need an early detection program
for these children. Without it, they will continue to
be lost to drugs, jails, and the streets.
One method of testing that is already being used in a
Juneau teen center is the [National Institute of Mental
Health] NIMH disk. It's an easily used computer
questionnaire that is also cost effective. Please
implement this or another suitable method of early
childhood testing and detection. So many of our
children are counting on us. A diagnostic such as this
could have made a tremendous difference in my son's
formative years.
CHAIRWOMAN GREEN asked Ms. Barbee if the NIMH disk offers an
introductory identification to be followed up with other tools.
MS. BARBEE said she has seen the written diagnostic, which
consists of about 40 questions. It is used as an initial screen.
CHAIRWOMAN GREEN asked if the NIMH disk is also used in a
physician's office.
MS. BARBEE said she has seen many checklists given to her son by
doctors similar to the NIMH questionnaire. To her understanding,
the NIMH questionnaire is a particularly good diagnostic.
CHAIRWOMAN GREEN asked Ms. Barbee if she is aware of any budget
requests for the NIMH program.
MS. JAN GUERTIN, a Juneau resident, said the NIMH assessment is
given at the Juneau Douglas High school. The high school has
been using it for about one year in conjunction with a university
in New York. About 40 youth have used it. It has been well
received by the Juneau school board.
SENATOR WARD asked Ms. Barbee what assessment was used during her
son's diagnosis.
MS. BARBEE explained that after six years of doctors,
psychiatrists, psychologists, and behavior modification
techniques, she took him to Johns Hopkins when he was 11 after a
local psychiatrist recommended that he be placed in a long-term
care facility. Her son had been misdiagnosed for years.
SENATOR WARD asked what tests he was given.
MS. BARBEE said her son saw a neurologist and a psychiatrist at
Johns Hopkins. She pointed out that the mental health
professionals in Alaska are a little bit behind on understanding
that children can be diagnosed with certain mental health
disorders. The Johns Hopkins psychiatrist recognized the bipolar
disorder right away. Ten years ago, children were not diagnosed
with certain mental illnesses until the age of 16. Now bipolar
disorder can be diagnosed at age 5.
MS. GUERTIN indicated that the NIMH assessment uses the DSM-IV
diagnoses. She noted that school districts cannot handle the
entire caseload because of funding shortages so students may have
to go outside of the school to private counselors to get help.
CHAIRWOMAN GREEN stated that one of the things that legislators
have had to look at is how each of the programs under
consideration by the legislature impacts the overall picture, be
it Medicaid or something else. In addition, legislators have to
look at whether there is too great an expectation on the system
because if services increase exponentially, cutbacks will have to
occur. She said she believes the legislature has to rely on the
expectation that parents have a role in the child's life. She
also noted that diagnoses have become more fine tuned and are not
quite as categorized as they used to be.
MS. GUERTIN said she has a child who was diagnosed with autism at
age 5 and at age 14 he has been classified as having Asperger's
Syndrome. Like most everything, it is a spectrum disorder so the
degree with which it manifests itself in a child's behavior
differs from child to child. She stated that IDEA requires
behavioral plans for children so that they are not kicked out of
school and can receive an appropriate education. She does not
believe it is working in Alaska although the situation has
improved over the last 10 years.
CHAIRWOMAN GREEN thanked Ms. Guertin.
MR. VIC DULL, a mental health counselor from New Stuyahok,
discussed the lack of village-based counselors in rural Alaska.
Of the 33 villages served by the Bristol Bay Area Health
Corporation, only seven have village-based counselors. These
counselors serve as advocates who do prevention activities,
crisis intervention, educate families, and assist other agencies,
such as DFYS.
CHAIRWOMAN GREEN asked Mr. Dull who he is employed by.
MR. DULL said he is employed by the Bristol Bay Area Health
Corporation, a non-profit organization. He explained that
Dillingham has a community mental health center, which has seven
counselors who travel to villages in Bristol Bay. They
specialize in youth issues and anger management. A total of 14
counselors travel every two or three months, weather permitting.
That schedule does not adequately serve the needs of the
communities, particularly when a crisis occurs. Each community
has specific needs, and it takes someone who is involved with the
community to understand those needs. He asked the committee to
consider funding more counseling positions for rural Alaska.
CHAIRWOMAN GREEN asked how large the area is that Mr. Dull is
referring to and how many people would be served.
MR. DULL said the Southwest area of Alaska stretches from
Goodnews Bay to Pedro Bay down to the Peninsula toward Pt.
Heiden.
MS. MCGILLIVARY said it is as large as the state of Ohio.
MR. DULL said the area he and another counselor serve (the
Nushagak River) has three main villages with about 800 people.
SENATOR WARD asked Mr. Dull what role he sees for people without
formal education but a desire to become a provider who live in
the community and how the state can provide a mechanism to enable
those people to practice.
MR. DULL said the University of Alaska Fairbanks has a Rural
Human Services Program in which a traditional council chooses a
person from the community who, if accepted, attends a three-week
training program in Fairbanks.
SENATOR WARD asked how many people have attended that program.
MR. DULL said of the seven counselors he spoke of, he is the only
one who hasn't.
SENATOR WARD asked if that program is working in other areas of
the state.
MR. DULL thought people from the Nome area have participated in
that program.
CHAIRWOMAN GREEN asked whether any agency employees, such as
village public safety officers (VPSO), have been cross-trained.
MR. DULL said he is not aware of any. He explained that in his
community, the VPSO does some of the interventions.
CHAIRWOMAN GREEN assumed they get some training.
MR. DULL said he does not think they do; the local counselors
give presentations to the State Troopers about conditions in the
villages.
CHAIRWOMAN GREEN thanked Mr. Dull.
MR. ROBERT BOWERS told the committee he is from Kodiak. He was
diagnosed with mental illness three years ago and has sought help
three times. He is 19.
CHAIRWOMAN GREEN asked if he was in school when he was diagnosed.
MR. BOWERS said he was, but he was moving a lot at the time.
Regarding the construction of a new building for API, he
suggested that smaller units be built in communities like
Dillingham so that people do not have to travel to Anchorage.
CHAIRWOMAN GREEN said that moving to a large city for treatment
may compound the problem.
MR. BOB MILLER informed the committee that he was born with
cerebral palsy and has been diagnosed with many other disorders
and illnesses. He informed committee members that dual diagnosis
is common among people with mental illness. He believes that
many people with mental illness self-medicate with alcohol or
other drugs. He is on the board of directors at Fairbanks
Community Mental Health and is the vice president of NAMI in
Fairbanks. He has been studying social work at the University of
Alaska Fairbanks. He encouraged committee members to provide for
early intervention to avoid larger problems.
MR. MILLER said that treatment services for the mentally ill in
Fairbanks have been inconsistent. Very few psychiatrists have
spent more than a year in Fairbanks. He asked that legislators
consider student loan forgiveness for social workers and mental
health providers to encourage people to stay. Regarding drugs
and alcohol, he referred to a recent article in Newsweek that
described alcoholism as a brain disorder rather than a
personality or behavioral problem.
MS. MCGILLIVARY informed committee members that the Building
Bridges Campaign has focused on rural issues this year. She
asked that Doug Veet present to the committee.
TAPE 01-27, SIDE B
MR. DOUG VEET, representing the Rural Mental Health Providers
Association, said one of the significant problems with the Rural
Human Services Program, discussed by Mr. Dull, is that those
services are not recognized by Medicaid so development and
expansion of that program always comes out of local budgets and
general funds.
CHAIRWOMAN GREEN asked if those services are not recognized
because the service providers are not credentialed.
MR. VEET said that is correct. He explained that having a
credentialed supervisor does not qualify the service either. He
said the second thing about those service providers is that they
are just as subject to job stress as other providers and, working
in their own community and having no escape becomes a problem.
He believes that having only one provider in each community will
not work because those providers would be overwhelmed.
SENATOR WARD asked how many of the 12 regional non-profit Native
organizations have such a program.
MR. VEET said he would provide that number at a later date.
CHAIRWOMAN GREEN thanked all presenters and adjourned the
meeting.
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