Legislature(2011 - 2012)BUTROVICH 205

02/16/2011 01:30 PM Senate HEALTH & SOCIAL SERVICES


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01:31:28 PM Start
01:38:27 PM Alaska Children's Alliance
02:19:21 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation: The Alaska Children's Alliance TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       February 16, 2011                                                                                        
                           1:31 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Bettye Davis, Chair                                                                                                     
Senator Dennis Egan                                                                                                             
Senator Johnny Ellis                                                                                                            
Senator Kevin Meyer                                                                                                             
Senator Fred Dyson                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                              
PRESENTATION BY ALASKA CHILDREN'S ALLIANCE                                                                                      
                                                                                                                              
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
PAM KARALUNAS, Chapter Coordinator                                                                                              
Alaska Children's Alliance                                                                                                      
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Presented report for Alaska Children's                                                                    
Alliance.                                                                                                                       
                                                                                                                                
CORY BRYANT, Program Manager                                                                                                    
Alaska CARES                                                                                                                    
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Presented report for Alaska Children's                                                                    
Alliance.                                                                                                                       
                                                                                                                                
ELENA ALUSKAK, Program Manager                                                                                                  
The Children's Center                                                                                                           
Bethel, AK                                                                                                                      
POSITION STATEMENT: Presented report for Alaska Children's                                                                    
Alliance.                                                                                                                       
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:31:28 PM                                                                                                                    
CHAIR BETTYE DAVIS  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:31 p.m.  Present at the                                                               
call to order were Senators Egan, Ellis, and Chair Davis.                                                                       
                                                                                                                                
                  ^Alaska Children's Alliance                                                                               
                                                                                                                              
                                                                                                                                
CHAIR  DAVIS announced  the first  order of  business would  be a                                                               
report by the Alaska Children's Alliance.                                                                                       
                                                                                                                                
PAM  KARALUNAS, Chapter  Coordinator, Alaska  Children's Alliance                                                               
(ACA),  explained they  would give  an update  on Child  Advocacy                                                               
Centers  (CACs) in  Alaska. She  introduced the  other presenters                                                               
and  explained that  the Alaska  Children's Alliance  is a  state                                                               
chapter of the  national organization, and its job  is to provide                                                               
information,  training, and  support  to  child advocacy  centers                                                               
around the  state, and  to communities  wanting to  develop child                                                               
advocacy  centers.  She   said  they  are  part   of  a  national                                                               
organization that  sets standards  and does  accreditation. There                                                               
are currently three accredited centers in Alaska.                                                                               
                                                                                                                                
MS.  KARALUNAS   explained  her  job  is   to  provide  technical                                                               
assistance and support, state representation  on a regional level                                                               
with the  western region,  as well  as on  a national  level. She                                                               
said they  also receive some  very limited funds through  the ACA                                                               
which they distribute to the CACs.                                                                                              
                                                                                                                                
She  stated they  provide funding  and  support for  a number  of                                                               
statewide  projects, including  the TeleCam  Medical Peer  Review                                                               
and Consultation, which is based  at CARES; a biennial state-wide                                                               
child  maltreatment  conference; forensic  photography  equipment                                                               
and medical treatment  for each CAC; and  coordination of medical                                                               
equipment  and data  collection. They  are working  on developing                                                               
some Alaska-specific  projects, which include a  pilot project in                                                               
the  Copper River  Basin, specialized  support  and training  for                                                               
natural   support  people   in  the   surrounding  villages   and                                                               
communities,  and training  for  tribal entities  on  how to  use                                                               
CACs; and training on developing satellite CACs.                                                                                
                                                                                                                                
CHAIR DAVIS  asked how  many centers  total exist  throughout the                                                               
state.                                                                                                                          
                                                                                                                                
MS. KARALUNAS responded  there are nine, and  one being developed                                                               
in Kodiak.                                                                                                                      
                                                                                                                                
1:38:27 PM                                                                                                                    
SENATOR DYSON joined the meeting.                                                                                               
                                                                                                                                
SENATOR DYSON asked  if the presenters had  explained the mission                                                               
of the child advocacy centers.                                                                                                  
                                                                                                                                
MS. KARALUNAS answered that they save the good stuff for last.                                                                  
                                                                                                                                
CORY BRYANT, Program Manager,  Alaska CARES, Anchorage, explained                                                               
that  the Anchorage  center  serves the  Anchorage  area and  any                                                               
other  areas  that lack  access  to  a  CAC. For  instance,  some                                                               
villages outside  of Dillingham have  to fly to  Anchorage before                                                               
they can  go to  Dillingham, so  they are  seen at  Alaska CARES.                                                               
They see on average 850-900  children per year. Their facility is                                                               
co-located with their  team partners, such as  the Crimes Against                                                               
Children unit of  the Anchorage Police Department  and the Office                                                               
of  Children's Services.  They also  have an  Alaska Native  unit                                                               
housed in  their building. This  makes it easier for  families to                                                               
come to one place. CARES is  a program of the Children's Hospital                                                               
at  Providence,  and is  located  on  the Alaska  Native  Medical                                                               
Center campus.                                                                                                                  
                                                                                                                                
ELENA ALUSKAK,  Program Manager,  The Children's  Center, Bethel,                                                               
said  the center,  also  known  by the  Yupik  name of  "Irniamta                                                               
Ikayurviat" is under  the Tundra Women's Coalition.  This CAC has                                                               
recently moved into  a brand new facility. The  average number of                                                               
children served  per year is 140  -145, and 80 percent  are Yupik                                                               
speakers.  All of  their staff  is bilingual,  English and  Yupik                                                               
speaking.                                                                                                                       
                                                                                                                                
SENATOR  DYSON asked,  of the  145 clients  served per  year, how                                                               
many cases result in indictments.                                                                                               
                                                                                                                                
MS. ALUSKAK responded maybe ten.                                                                                                
                                                                                                                                
MR. KARALUNAS said  the newest CAC is in the  Copper River Basin,                                                               
and they provide forensic interviews on site.                                                                                   
                                                                                                                                
MS. ALUSKAK said  the CAC in Dillingham, also  known as "Nitaput"                                                               
(We hear them),  serves 32 communities, and has  served about 222                                                               
children since they opened in 2003.                                                                                             
                                                                                                                                
MS.  BRYANT  explained  the  Fairbanks CAC  was  started  by  Ms.                                                               
Karalunas. It is  co-located with the State  Troopers, and serves                                                               
about  83  communities. They  have  served  about 1,000  children                                                               
since 2003.                                                                                                                     
                                                                                                                                
MS.  ALUSKAK  said  the  Juneau  CAC is  a  program  of  Catholic                                                               
Community  Services, is  accredited  by  the National  Children's                                                               
Alliance, and serves 19 communities in southeast Alaska.                                                                        
                                                                                                                                
MS. BRYSON  explained the Kenai  Peninsula CAC is in  the process                                                               
of developing  satellite CACs in  Kenai, Homer, and  Seward. They                                                               
have  been open  since 2008  and  have served  over 200  children                                                               
since then.                                                                                                                     
                                                                                                                                
1:42:00 PM                                                                                                                    
MS.  ALUSKAK said  that  Kodiak  has a  developing  CAC, and  the                                                               
summer of 2011 is the projected opening time.                                                                                   
                                                                                                                                
CHAIR DAVIS asked how much funding the Kodiak CAC is receiving.                                                                 
                                                                                                                                
MS. KARALUNAS said  the governor's budget for  next year includes                                                               
about $250,000 for start-up costs.                                                                                              
                                                                                                                                
MS. BRYANT  said the Mat-Su  Valley CAC was established  in 1999,                                                               
and has  recently expanded so that  the troopers' AVI unit  is in                                                               
their facility as well.                                                                                                         
                                                                                                                                
MS. ALUSKAK explained  that the Nome CAC is a  program of Kawerak                                                               
Native  Association. Annaktuq  is  their shelter  name, and  they                                                               
have served since 319 children since opening.                                                                                   
                                                                                                                                
MS. KARALUNAS  emphasized that  CACs provide  a child  and family                                                               
friendly  environment  for   coordination  of  the  investigative                                                               
process in child abuse cases, specifically child sexual abuse.                                                                  
                                                                                                                                
MS. BRYSON said  the first concern is to have  a child and family                                                               
friendly environment.  They try  to make children  as comfortable                                                               
as they can  which sometimes involves feeding  and clothing them;                                                               
they do  whatever it  takes to  meet the needs  of the  child and                                                               
family.                                                                                                                         
                                                                                                                                
MS. ALUSKAK explained  that each CAC has a person  who is trained                                                               
in doing forensic  interviews with child victims,  who is focused                                                               
on  making the  child  feel comfortable.  The  caregiver is  also                                                               
aware of everything the interviewer is doing.                                                                                   
                                                                                                                                
MS. KARALUNAS explained  that in the past, when  an allegation of                                                               
child sexual abuse was received, OCS  would take the child out of                                                               
class, interview the  child, and take the child out  of school to                                                               
be  interviewed at  the  police station,  then  to the  emergency                                                               
room. This process  takes away all that. There  is one interview,                                                               
which  is video  recorded,  and can  be used  in  court. All  the                                                               
adults come  together in one  place, instead of making  the child                                                               
come to  them. The  multidisciplinary response  and investigation                                                               
reduces duplicative interviews.                                                                                                 
                                                                                                                                
1:48:38 PM                                                                                                                    
MS. ALUSKAK  said that  specialized, non-traumatic  medical exams                                                               
can be done  at the CACs. If law enforcement  knows there will be                                                               
a  medical  exam,  a  medical  person will  be  involved  in  the                                                               
interview.                                                                                                                      
                                                                                                                                
CHAIR DAVIS asked which centers have medical exam rooms.                                                                        
                                                                                                                                
MS. KARALUNAS said  most of the centers have  exam rooms on-site,                                                               
but might  not have their own  staff. Providers will come  to the                                                               
center if there  is not staff on-site. Most of  them have on-site                                                               
exam  capability.  This is  not  a  traumatic  exam. It  is  non-                                                               
invasive and  kids often say that  it was their favorite  part of                                                               
the process, because a medical exam  can be reassuring. It is not                                                               
done  if  the  child  refuses, unless  there  is  some  immediate                                                               
medical reason.                                                                                                                 
                                                                                                                                
MS.  BRYANT said  that  because most  children  don't tell  about                                                               
abuse right away, there is  usually not physical evidence present                                                               
on the child.                                                                                                                   
                                                                                                                                
MS.  ALUSKAK  said CACs  also  provide  on-going family  support.                                                               
There are family advocates on staff  to be with the family during                                                               
the initial  interview, and they will  continue providing support                                                               
for  a year.  The  advocate  also makes  referrals  to others  as                                                               
needed. She  explained that  in Bethel  many families  are Yupik,                                                               
and having a Yupik speaking advocate helps them.                                                                                
                                                                                                                                
MS. BRYANT emphasized that cultural  competency is a standard the                                                               
CACs have to meet.                                                                                                              
                                                                                                                                
MS. ALUSKAK said  the CACs also provide  consultation with mental                                                               
health services.  Clients prefer  a relationship where  trust has                                                               
already  been built.  Many clients  will  prefer natural  support                                                               
people instead of mental health  professionals. There is training                                                               
available for these natural support people.                                                                                     
                                                                                                                                
MS. BRYANT  said the Anchorage  CAC has two  part-time therapists                                                               
on  staff to  provide trauma-specific  training for  children and                                                               
families,   specifically  for   those  families   that  have   no                                                               
insurance. She  noted there are  very few resources  for children                                                               
who don't have insurance.                                                                                                       
                                                                                                                                
MS. BRYANT  also explained the  case review process  is different                                                               
at every CAC. In Anchorage, they  do case review once a month and                                                               
they have specific criteria for  disclosure or evidence of abuse.                                                               
Multi-disciplinary team review is the heart of CAC.                                                                             
                                                                                                                                
MS.  ALUSKAK  explained  that  all  CACs  use  the  NCATrak  case                                                               
tracking  system.   This  is  a   national  system   where  basic                                                               
information  is entered,  and it  is useful  for evaluation.  The                                                               
system   helps   pull   out   numbers,   case   information   and                                                               
investigation  outcomes.   Villages  seeing  these   numbers  can                                                               
realize that abuse is everywhere, not just in their village.                                                                    
                                                                                                                                
1:57:23 PM                                                                                                                    
MS.  KARALUNAS added  that it  is difficult  to track  numbers in                                                               
Alaska; OCS  tracks their cases,  but those are only  cases where                                                               
the abuser is within the family  or the family is not protective.                                                               
The  State Troopers  track other  types  of cases.  The CACs  get                                                               
referrals from both entities, so they can track all cases.                                                                      
                                                                                                                                
MS. BRYANT  said that CACs  in each community  provide education,                                                               
outreach,  presentations, and  do whatever  they can  to get  the                                                               
word out.                                                                                                                       
                                                                                                                                
1:58:20 PM                                                                                                                    
MS.  KARALUNAS  explained  that child  sexual  abuse  is  clearly                                                               
linked  with   increased  risks  for  many   problems,  including                                                               
alcoholism,  suicide, violent  behavior, depression,  drug abuse,                                                               
fetal  death, and  even heart  disease and  diabetes. The  annual                                                               
cost of  child abuse in Alaska  is averaged at over  $500 million                                                               
per year.  The CAC model also  has a cost benefit,  because cases                                                               
move more quickly.                                                                                                              
                                                                                                                                
1:59:38 PM                                                                                                                    
SENATOR MEYER joined the meeting.                                                                                               
                                                                                                                                
SENATOR DYSON noted he has  friends who work with the prostitutes                                                               
at Hiland  Mountain. Virtually  all of them  have been  abused as                                                               
children.  Most  perpetrators  were also  abused.  Breaking  that                                                               
cycle is hugely important. It used  to be that about one-third of                                                               
those molested were males.                                                                                                      
                                                                                                                                
MS. BRYANT  said that about 35  percent of the children  they see                                                               
are males.                                                                                                                      
                                                                                                                                
MS. ALUSKAK said the percentage is  a little bit lower in Bethel,                                                               
probably because it is harder for males to disclose.                                                                            
                                                                                                                                
MS. BRYANT added that the CAC  model exists to stop the cycle, by                                                               
providing caring intervention and treatment.                                                                                    
                                                                                                                                
MS. KARALUNAS  noted there  are more reasons  for the  CAC model.                                                               
When kids  are seen  at CACs there  is faster  resolution, faster                                                               
charging decisions, and more cases prosecuted.                                                                                  
                                                                                                                                
2:03:08 PM                                                                                                                    
She also  said the research suggests  that one in four  girls and                                                               
one  in seven  boys will  be the  victim of  some type  of sexual                                                               
abuse or assault  before age 18. Most shocking to  many people is                                                               
the age of the children; 41  percent of those children are one to                                                               
six years  of age, and 36  percent are between the  ages of seven                                                               
and twelve.                                                                                                                     
                                                                                                                                
MS. KARALUNAS then  explained a chart of the  numbers of children                                                               
served at  CACs in Alaska, as  well as the number  of communities                                                               
served. She  said that no CACs  rely solely on state  funding for                                                               
their  existence,  but  that  state   funding  is  essential  for                                                               
sustainability  and  to  leverage  other  funding.  The  need  is                                                               
increasing,  as the  number  of CACs  and  children and  families                                                               
served increases. There  is no increase in their  budget, but the                                                               
need is increasing.  Caseloads are going up;  they need satellite                                                               
centers;  Nome needs  a  nurse examiner;  Copper  River needs  an                                                               
additional  full time  staff  position;  Anchorage needs  partial                                                               
funding  for a  part time  medical director;  Fairbanks needs  an                                                               
increase in contract medical services;  Kenai needs support for a                                                               
satellite CAC in Seward.                                                                                                        
                                                                                                                                
2:06:53 PM                                                                                                                    
MS.  KARALUNAS also  stressed that  all staff  are on  call seven                                                               
days a week, which results in the need for additional funding.                                                                  
                                                                                                                                
2:07:38 PM                                                                                                                    
CHAIR DAVIS asked  what the total amount of their  budget for the                                                               
coming year is, and what the funding sources are.                                                                               
                                                                                                                                
MS.  KARALUNAS  said funding  was  originally  through a  federal                                                               
earmark, and the state started funding  the program in FY 10. The                                                               
amount in  the budget has been  $3.2 million. She thought  it was                                                               
the same amount in the governor's proposed budget this year.                                                                    
                                                                                                                                
CHAIR DAVIS asked if the funding was done under OCS.                                                                            
                                                                                                                                
MS. KARALUNAS responded that it was.                                                                                            
                                                                                                                                
SENATOR DYSON asked how many  probable crimes occurred out of 100                                                               
reported.                                                                                                                       
                                                                                                                                
MS. KARALUNAS  said about  half of  those children  will disclose                                                               
some type  of abuse,  and about  25 percent  of those  cases will                                                               
have some type of prosecution.                                                                                                  
                                                                                                                                
SENATOR  DYSON  said,  "So  out  of 100  kids,  only  50  percent                                                               
disclose."                                                                                                                      
                                                                                                                                
MS.  BRYANT said  that the  other  50 percent  either can't  talk                                                               
about the abuse or nothing has happened.                                                                                        
                                                                                                                                
SENATOR  DYSON  asked  if  about  half result  in  some  type  of                                                               
prosecution.                                                                                                                    
                                                                                                                                
MS.  BRYANT  said  most  children's  cases  don't  go  to  trial;                                                               
prosecutors don't want to put  children in the position of having                                                               
to testify, so they plead down.                                                                                                 
                                                                                                                                
SENATOR  DYSON asked  if the  testimony produced  at the  CACs is                                                               
sufficient.                                                                                                                     
                                                                                                                                
MS.  BRYANT responded  that  the  law requires  the  child to  be                                                               
available to  testify before  the DVD  can be  used in  court. If                                                               
they don't remember, you can play  the video, but they have to be                                                               
available.                                                                                                                      
                                                                                                                                
SENATOR DYSON asked if it is  true that once the probability of a                                                               
crime is established, children don't have to press charges.                                                                     
                                                                                                                                
MS. BRYANT said  the state will press charges but  the victim and                                                               
family have to cooperate.                                                                                                       
                                                                                                                                
SENATOR DYSON asked if anything can  be done to raise the rate of                                                               
convictions.                                                                                                                    
                                                                                                                                
MS. BRYANT said one problem  is not enough prosecutors. Also, the                                                               
court system  is backed up with  cases. Adult cases are  more apt                                                               
to go to trial.                                                                                                                 
                                                                                                                                
2:13:33 PM                                                                                                                    
MS. KARALUNAS said  that more training is  needed for prosecutors                                                               
who handle  these types  of cases. Child  sexual abuse  cases are                                                               
unique, and  require specialized training. Also,  prosecutors are                                                               
overwhelmed, and they don't have time to deal with these cases.                                                                 
                                                                                                                                
MS. ALUSKAK  said that  misunderstanding of  traditional cultural                                                               
language  and lifestyle  makes it  difficult for  prosecutions to                                                               
happen, or even investigations.                                                                                                 
                                                                                                                                
MS. BRYANT  said even judges  need education in this  area. There                                                               
is a  lot of misperception.  Recently a  judge said there  was no                                                               
relationship  between  people  who  view  child  pornography  and                                                               
whether they  will harm a child.  Research shows there is  such a                                                               
relationship.                                                                                                                   
                                                                                                                                
SENATOR DYSON  noted that  many abused  children are  not forced,                                                               
they are seduced.  The perpetrator has used  child pornography as                                                               
an inducement. He  then asked how much support there  is from the                                                               
community leadership in Bethel.                                                                                                 
                                                                                                                                
MS. ALUSKAK  said it  is a  difficult question,  but they  do get                                                               
some support.                                                                                                                   
                                                                                                                                
SENATOR DYSON  said many molesters present  themselves as healthy                                                               
and  successful people,  so  allegations of  child  abuse can  be                                                               
surprising; people assume they must be false accusations.                                                                       
                                                                                                                                
SENATOR EGAN  asked if the CAC  is running any cases  through the                                                               
therapeutic courts in Anchorage.                                                                                                
                                                                                                                                
MS. KARALUNAS responded the therapeutic  courts are not set up to                                                               
handle child sexual abuse cases.                                                                                                
                                                                                                                                
2:18:01 PM                                                                                                                    
CHAIR DAVIS thanked  the presenters. She said she  knows the need                                                               
for CACs is real. She said  the CACs are successful even if cases                                                               
are not prosecuted. Children can still be saved and made whole.                                                                 
                                                                                                                                
2:19:21 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair Davis adjourned the meeting at 2:40 p.m.                                                                                  

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