Legislature(2023 - 2024)BUTROVICH 205

01/26/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES

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03:30:15 PM Start
03:30:40 PM Overview Department of Family and Community Services
04:43:03 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Department of Family and Community Services - TELECONFERENCED
Overview
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                        January 26, 2023                                                                                        
                           3:30 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator James Kaufman, Vice Chair                                                                                               
Senator Löki Tobin                                                                                                              
Senator Forrest Dunbar                                                                                                          
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Cathy Giessel                                                                                                           
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
OVERVIEW DEPARTMENT OF FAMILY AND COMMUNITY SERVICES                                                                            
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
KIM KOVOL, Acting Commissioner                                                                                                  
Department of Family and Community Services (DFCS)                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Provided an overview on the Alaska                                                                        
Department of Family and Community Services                                                                                     
                                                                                                                                
MARIAN SWEET, Assistant Commissioner                                                                                            
Department of Family and Community Services                                                                                     
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions concerning the Office of                                                               
Children's Services during the overview of the Department of                                                                    
Family and Community Services.                                                                                                  
                                                                                                                                
CLINTON LASLEY, Deputy Commissioner                                                                                             
Department of Family and Community Services                                                                                     
Juneau, Alaska                                                                                                                  
POSITION   STATEMENT:   Provided    information   on   Designated                                                             
Evaluation and  Treatment Facilities  during the overview  of the                                                               
Department of Family and Community Services.                                                                                    
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:30:15 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 3:30 p.m.  Present at the                                                               
call to  order were  Senators Dunbar,  Tobin, Kaufman,  and Chair                                                               
Wilson.                                                                                                                         
                                                                                                                                
^OVERVIEW DEPARTMENT OF FAMILY AND COMMUNITY SERVICES                                                                           
                            OVERVIEW                                                                                        
          DEPARTMENT OF FAMILY AND COMMUNITY SERVICES                                                                       
                                                                                                                              
3:30:40 PM                                                                                                                    
CHAIR WILSON  announced the consideration  of an overview  by the                                                               
Department of Family and Community Services.                                                                                    
                                                                                                                                
3:31:40 PM                                                                                                                    
KIM  KOVOL,   Acting  Commissioner,  Department  of   Family  and                                                               
Community Services (DFCS), Anchorage,  Alaska, stated that she is                                                               
new to the commissioner position  for the newly formed Department                                                               
of  Family and  Community Services  (DFCS). She  said she  has 25                                                               
years  of   experience  in  the   private  sector   in  executive                                                               
leadership,   management,  licensed   facilities,  organizational                                                               
development  and restructuring,  logistics,  and  working in  the                                                               
human and social  services realm with youth and  adults. She also                                                               
served  as Governor  Dunleavy's  Special  Assistant, focusing  on                                                               
domestic  violence  and  sexual  assault,  missing  and  murdered                                                               
indigenous  persons,  human  and sex  trafficking,  homelessness,                                                               
foster  care, childcare,  eldercare,  opioids  and fentanyl,  and                                                               
suicide prevention. She is committed  to helping Alaskan families                                                               
facing challenging circumstances in  their lives navigate complex                                                               
systems.  She   expressed  appreciation   for  the   support  and                                                               
dedication of  others working  at DFCS.  She spoke  about various                                                               
hobbies she enjoys.                                                                                                             
                                                                                                                                
3:33:31 PM                                                                                                                    
ACTING COMMISSIONER KOVOL turned to  slide 2 and said the mission                                                               
of DFCS is  "To provide support, safety,  and personal well-being                                                               
for vulnerable  Alaskans." She met with  department leadership to                                                               
discuss  what   the  mission  means  and   together  developed  a                                                               
department  vision  and  guiding  principles  that  support  each                                                               
division and reinforce the department's commitment to Alaskans:                                                                 
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
                             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                                                                      
                                                                                                                                
                                                                                                                                
3:34:44 PM                                                                                                                    
ACTING  COMMISSIONER KOVOL  moved to  slide 3,  an organizational                                                               
chart of DFCS. She noted  that directors and deputy directors are                                                               
a  consistent presence  in each  division since  the department's                                                               
reorganization,  including   leadership  in   the  Commissioner's                                                               
Office.                                                                                                                         
                                                                                                                                
3:35:11 PM                                                                                                                    
ACTING  COMMISSIONER  KOVOL moved  to  slide  4 and  said  DFCS's                                                               
divisions are:                                                                                                                  
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     Commissioner's Office                                                                                                      
     Finance & Management Services                                                                                              
     Alaska Psychiatric Institute (API)                                                                                         
     Division of Juvenile Justice (DJJ)                                                                                         
     Alaska Pioneer Homes (APH)                                                                                                 
     Office of Children's Services (OCS)                                                                                        
                                                                                                                                
API,  DJJ, APH,  and  OCS provide  direct  services available  24                                                               
hours a day, seven days a  week, 365 days a year. Most department                                                               
staff   work  directly   with  constituents   and  providers   in                                                               
facilities or the community.                                                                                                    
                                                                                                                                
3:35:52 PM                                                                                                                    
ACTING COMMISSIONER KOVOL  turned to slide 5 and  spoke to DFCS's                                                               
collaboration with DOH in 4 areas:                                                                                              
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     Complex Care                                                                                                             
   • Identifying solutions to address systemic gaps in                                                                          
     access to care for Alaskans with complex needs                                                                             
   •                                                                                                                            
     Improving the continuum of care                                                                                          
   • Establishing a coordinated system across departments                                                                       
     to ensure person-centered care                                                                                             
   •                                                                                                                            
     Shared IT Resources                                                                                                      
   • Developing a roadmap to separating resources                                                                               
   •                                                                                                                            
     Information Technology Debt                                                                                              
   • Seeking contractors and modernizing systems to improve                                                                     
     efficiency and quality of service                                                                                          
                                                                                                                                
3:36:59 PM                                                                                                                    
ACTING  COMMISSIONER KOVOL  said  that a  department focusing  on                                                               
families  and communities  would encompass  many priorities  that                                                               
ebb and  flow because  communities and  families are  unique. Her                                                               
office  conversed with  frontline  staff, supervisors,  executive                                                               
leadership,  community  partners,  residents,  and  clients.  The                                                               
conversations  identified  four  key   priorities  to  focus  on:                                                               
complex care  systems, tribal partnerships, the  culture of DFCS,                                                               
and workforce support.                                                                                                          
                                                                                                                                
3:37:31 PM                                                                                                                    
ACTING COMMISSIONER  KOVOL advanced  to slide  7 and  stated that                                                               
complex care placement for youth and  adults is rising. It is not                                                               
a new concern,  but the complexity of acute  needs has magnified.                                                               
All  four  of  the  department's direct  service  divisions  find                                                               
appropriate levels  of care and  care locations  for individuals.                                                               
The  Commissioner's Office  created a  Complex Care  Coordination                                                               
Unit. This unit will establish a  single point of contact for the                                                               
department and its  partners. It will be  central to coordinating                                                               
complex  care  and  placement activities  within  DFCS's  service                                                               
divisions.  The  unit  will  establish   a  network  of  existing                                                               
placement  options  for adults  and  youth  while endeavoring  to                                                               
oversee   long-term  facility   development  within   the  state.                                                               
Partnering  with  healthcare   providers,  medical  centers,  and                                                               
clinics to  expand services will  take time. DFCS will  work with                                                               
providers across  the country  to support  the needs  of Alaskans                                                               
when appropriate placement within the state is not possible.                                                                    
                                                                                                                                
ACTING COMMISSIONER KOVOL said DFCS  works with all facilities in                                                               
becoming  Medicaid or  Third-Party payor  eligible to  reduce the                                                               
use of  Alaska's General Fund.  Complex Care  Systems Coordinator                                                               
Makayla Viray is  the first employee to hold the  position and is                                                               
working hard  with support from DFCS's  Family Coordinator Tammie                                                               
Wilson.  Through the  Governor's FY  2024 budget,  the department                                                               
will continue  to build on the  complex care unit. It  will add a                                                               
complex  care system  coordinator, a  social services  associate,                                                               
and a deputy director of operations.                                                                                            
                                                                                                                                
3:38:55 PM                                                                                                                    
ACTING  COMMISSIONER  KOVOL  stated  that  care  coordination  is                                                               
complex  because it  requires internal  and external  assistance.                                                               
Every   client's  case   is   unique   and  requires   thoughtful                                                               
consideration   and   collaboration   with  many   agencies   and                                                               
organizations.  The   goal  is  to  prevent   anyone  from  being                                                               
institutionalized and  find a family-like setting  that meets the                                                               
individual's everyday needs. She  provided an experience from her                                                               
first day  as acting commissioner  to demonstrate  the importance                                                               
of  having  a coordinator  to  eliminate  redundancy and  improve                                                               
service efficiency. Slide  8 depicts the number  of entities DFCS                                                               
staff may connect to assist one individual.                                                                                     
                                                                                                                                
3:41:39 PM                                                                                                                    
ACTING COMMISSIONER KOVOL advanced to  slide 9 and said that DFCS                                                               
is  increasing  its statewide  connections  and  outreach. It  is                                                               
encouraging  the  department's  tribal  liaison  to  lead  tribal                                                               
engagements  by creating  new relationships  and connecting  with                                                               
long-standing  partners.  Department representatives  attend  the                                                               
Alaska  Federation of  Natives Convention,  the Bureau  of Indian                                                               
Affairs Provider's  Conference, and  the National  Indian Nations                                                               
Conference.  DFCS  is  excited about  forthcoming  opportunities.                                                               
Each  division   within  DFCS  provides   positive  life-changing                                                               
services  to   Alaskans.  The  staff  works   with  families  and                                                               
individuals   needing  support,   resources,  and   solutions.  A                                                               
comprehensive communication plan is  being developed, including a                                                               
calendar  of important  dates, community  events, and  a Facebook                                                               
platform.  The department  is  also  changing the  organization's                                                               
internal culture by increasing  efficiencies and empowering staff                                                               
through mentorships.                                                                                                            
                                                                                                                                
3:42:26 PM                                                                                                                    
CHAIR WILSON  said the  Tribal Child  Welfare Compact  within the                                                               
Office of  Children's Services (OCS)  began with five  tribes and                                                               
expanded. He  asked whether OCS  plans to continue  the expansion                                                               
of the compact.                                                                                                                 
                                                                                                                                
3:42:50 PM                                                                                                                    
ACTING  COMMISSIONER  KOVOL  responded   that  the  Tribal  Child                                                               
Welfare Compact would be discussed later in the presentation.                                                                   
                                                                                                                                
3:43:01 PM                                                                                                                    
SENATOR TOBIN asked what Alaska plans  to do if the Supreme Court                                                               
reverses the decision in Haaland v. Brackeen.                                                                                 
                                                                                                                                
3:43:16 PM                                                                                                                    
ACTING  COMMISSIONER KOVOL  replied  that the  case is  currently                                                               
under  review  with  the  Supreme Court.  DFCS  listened  to  the                                                               
hearing in  November and learned  that the court would  decide by                                                               
June.  DFCS  has  determined  it will  follow  the  Indian  Child                                                               
Welfare Act (ICWA) until changes occur.                                                                                         
                                                                                                                                
3:44:09 PM                                                                                                                    
ACTING COMMISSIONER KOVOL  turned to slide 10  and said divisions                                                               
within DFCS  provide positive life-changing services  to Alaskans                                                               
with 24-hour crisis response comes  many challenges. Families and                                                               
staff  face  difficult  and emotional  scenarios.  Community  and                                                               
connectivity are  initiatives the department is  addressing. DFCS                                                               
is developing  a comprehensive communication plan.  A calendar to                                                               
document and celebrate important  department and community events                                                               
is on  the department's website.  Also, there is a  Facebook page                                                               
showcasing   public   services.   Stakeholder   involvement   has                                                               
increased  statewide.  The  department  has  asked  Alaskans  for                                                               
suggestions  on optimizing  their time  when seeking  assistance.                                                               
Residents  responded that  they want  to know  what services  the                                                               
department offers.  So, the department  is sharing  knowledge and                                                               
information.  It is  tearing down  barriers  to efficiencies  and                                                               
empowering staff through mentorships.                                                                                           
                                                                                                                                
3:45:54 PM                                                                                                                    
ACTING COMMISSIONER  KOVOL moved  to slide  11 and  said Governor                                                               
Dunleavy's   People    First   Initiative    provided   workforce                                                               
stabilization incentives  for the  Office of  Children's Services                                                               
staff.  Other  divisions  are evaluating  similar  programs.    A                                                               
department referral  program to stabilize the  workforce is being                                                               
developed.   Rural   sites   are  offering   alternate   workweek                                                               
agreements  and flexible  work schedules.  Partnerships with  the                                                               
University of  Alaska, the Alaska Psychiatric  Institute, and the                                                               
Child Welfare Academy are forming  to foster practicum placements                                                               
and  internships. DFCS  is applying  for SkillBridge  through the                                                               
Department  of  Defense  (DOD).   SkillBridge  continues  to  pay                                                               
service  members their  salaries for  up to  180 days  while they                                                               
receive full-time training in programs outside of the military.                                                                 
                                                                                                                                
3:46:55 PM                                                                                                                    
CHAIR WILSON  asked if OCS  still has its loan  repayment program                                                               
as part of its workforce innovations.                                                                                           
3:47:06 PM                                                                                                                    
ACTING COMMISSIONER KOVOL deferred the question to Ms. Sweet.                                                                   
                                                                                                                                
3:47:23 PM                                                                                                                    
MARIAN SWEET,  Assistant Commissioner,  Department of  Family and                                                               
Community Services,  Juneau, Alaska,  replied that OCS  no longer                                                               
has the  loan repayment program.  However, it is  considering the                                                               
Support-for-Service to Health Care  Practitioners III (SHARP III)                                                               
program. The program  offers an option to pay off  a student loan                                                               
directly or receive incentive bonuses to pay off the loan.                                                                      
                                                                                                                                
3:49:08 PM                                                                                                                    
CHAIR WILSON  commented that  use by the  government was  not the                                                               
initial intent of  the SHARP program. Private  entities would pay                                                               
the  state of  Alaska to  receive a  tax benefit,  which in  turn                                                               
benefited private individuals. He opined  that there now would be                                                               
a cost  to the  state. He  found SHARP's  development interesting                                                               
and suggested the SHARP committee speak to the legislature.                                                                     
                                                                                                                                
3:49:56 PM                                                                                                                    
ACTING  COMMISSIONER KOVOL  moved  to slide  13  and stated  that                                                               
Heidi Hamilton  is the Alaska  Pioneer Homes (APH)  director. Ms.                                                               
Hamilton  oversees 400  positions within  APH. The  homes provide                                                               
activities of  daily living,  nursing services,  recreational and                                                               
social   programs,   medication    assistance,   dietary   needs,                                                               
housekeeping, and  meal preparation. There are  several levels of                                                               
assistance offered.  The division has  a budget of  $1.4 million.                                                               
Alaska has  six homes with occupancy  rates ranging from 80  - 97                                                               
percent. The Anchorage home maintained  the lowest occupancy rate                                                               
since 22 of  its rooms are vacant for remodeling  and fire safety                                                               
improvements.  Only  50 percent  of  residents  in the  Anchorage                                                               
Pioneer Home have  family living nearby. There  are fewer options                                                               
for elders living outside of Anchorage and Mat-Su.                                                                              
                                                                                                                                
CHAIR  TOBIN requested  that DFCS  send the  committee a  list of                                                               
deferred maintenance needs.                                                                                                     
                                                                                                                                
3:52:23 PM                                                                                                                    
ACTING COMMISSIONER  KOVOL turned  to slide 15  and spoke  to the                                                               
successes and challenges facing Alaska Pioneer Homes:                                                                           
                                                                                                                                
[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                                                                                                              
                                                                                                                                
3:54:47 PM                                                                                                                    
SENATOR  DUNBAR  said  he  supported the  idea  of  complex  care                                                               
neighborhoods and asked for its location in Anchorage.                                                                          
                                                                                                                                
3:55:03 PM                                                                                                                    
ACTING COMMISSIONER KOVOL stated the  complex care unit is in the                                                               
Anchorage Pioneer Home on the fourth floor.                                                                                     
                                                                                                                                
SENATOR DUNBAR said  he thought she was referring  to small homes                                                               
in a neighborhood.                                                                                                              
                                                                                                                                
ACTING  COMMISSIONER  KOVOL  clarified   that  wings  within  APH                                                               
buildings have neighborhood names.                                                                                              
                                                                                                                                
3:55:36 PM                                                                                                                    
SENATOR  DUNBAR stated  that as  a  child in  Cordova he  recalls                                                               
visiting  a care  facility. He  asked whether  an Alaska  Pioneer                                                               
Home was ever located in Cordova.                                                                                               
                                                                                                                                
ACTING COMMISSIONER KOVOL stated her  belief that it was not part                                                               
of the state system.                                                                                                            
                                                                                                                                
3:56:04 PM                                                                                                                    
CHAIR WILSON asked  for the wait time for entry  into a home once                                                               
a person is on the active list.                                                                                                 
                                                                                                                                
3:56:28 PM                                                                                                                    
ACTING COMMISSIONER  KOVOL said  the answer  would depend  on the                                                               
facility's location so  the data would be sent  to the committee.                                                               
She  commented  that the  age  of  people  moving to  the  active                                                               
waitlist has  increased and it is  taking longer to enter  an APH                                                               
facility.                                                                                                                       
                                                                                                                                
3:57:09 PM                                                                                                                    
CHAIR WILSON  asked if the  rate increase schedule passed  by the                                                               
legislature   a  couple   of   years  ago   meets  pioneer   home                                                               
expectations.                                                                                                                   
                                                                                                                                
3:57:35 PM                                                                                                                    
ACTING COMMISSIONER KOVOL deferred the question to Mr. Lasley.                                                                  
                                                                                                                                
3:57:40 PM                                                                                                                    
CLINTON  LASLEY, Deputy  Commissioner, Department  of Family  and                                                               
Community  Services, Juneau,  Alaska,  stated  the rate  increase                                                               
went into  effect in  2021. It  has done  well. The  pioneer home                                                               
waitlist  has  continued to  grow.  The  active waitlist  numbers                                                               
among the  various homes range  between 60  and 115. There  was a                                                               
concern when the rate increase  went into effect that there would                                                               
be  a downturn  in  the  number of  individuals  applying to  the                                                               
waitlists.  The monetary  increases  passed  by legislation  have                                                               
kept pace with the cost-of-living increases.                                                                                    
                                                                                                                                
3:58:53 PM                                                                                                                    
CHAIR  WILSON asked  how  the new  Social  Security increase  has                                                               
affected the percentage of change to residents' rates.                                                                          
                                                                                                                                
3:59:09 PM                                                                                                                    
MR. LASLEY answered that the  amount varies based on the resident                                                               
and their level  of care. There was an 8.5  percent rate increase                                                               
through Social  Security. However, APH rates  are slightly higher                                                               
due  to   fuel,  transportation,  and  contract   increases.  The                                                               
increase APH  received was significant  and is keeping  pace with                                                               
inflation so that services can continue to be received.                                                                         
                                                                                                                                
4:00:14 PM                                                                                                                    
ACTING  COMMISSIONER KOVOL  moved  to slide  16  and stated  that                                                               
Chief   Executive  Officer   Scott  York   has  led   the  Alaska                                                               
Psychiatric  Institute (API)  since 2020.  He has  four years  of                                                               
behavioral health and corporate  leadership experience. There are                                                               
five  inpatient units  with 80  licensed beds  and 323  full-time                                                               
positions  at API.  API  is currently  the  only location  within                                                               
Alaska  that   provides  competency  restoration   treatment  for                                                               
individuals the  court finds  to be  incompetent to  stand trial.                                                               
Its  budget for  FY 23  is over  $58 million.  As of  January 26,                                                               
2023, API's census  is 74, the highest since 2019.  API has begun                                                               
developing  a  comprehensive plan  to  ensure  it meets  Alaska's                                                               
needs  in continual  care.  Community  and jail-based  outpatient                                                               
competency restoration programs  are developing partnerships with                                                               
the Department of Corrections.                                                                                                  
                                                                                                                                
4:01:35 PM                                                                                                                    
ACTING COMMISSIONER  KOVOL moved to  slide 18 and stated  some of                                                               
API's successes:                                                                                                                
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
   • 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                                                                                                      
                                                                                                                                
4:02:43 PM                                                                                                                    
MR.  LASLEY  turned  to  slide   19  and  said  that  during  the                                                               
Department of  Health and Social  Services' bifurcation,  most of                                                               
what moved  to the  Department of  Family and  Community Services                                                               
(DFCS) was  "pick and  place." DFCS  acquired some  services from                                                               
the Division  of Behavioral  Health by  Executive Order  121. The                                                               
services included:                                                                                                              
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     Designated Evaluation and Treatment Facilities (DET)                                                                     
     • Bartlett Regional Hospital  12 beds                                                                                      
     • Fairbanks Memorial Hospital  20 beds                                                                                     
     • Mat-Su Regional Hospital  16 beds                                                                                        
                                                                                                                                
     Designated Evaluation and Stabilization (DES)                                                                            
     • Ketchikan Medical Center                                                                                                 
                                                                                                                                
     Disproportionate Share Hospital Funding (DSH)                                                                            
                                                                                                                                
     Secure Patient Transport Program                                                                                         
                                                                                                                              
The work  of these services  aligned with the  divisions assigned                                                               
to DFCS. In  2020 Ashley Christopherson was  named the Designated                                                               
Evaluation, Stabilization, and  Treatment Coordinator. Mr. Lasley                                                               
likened the  position to  that of an  air traffic  controller who                                                               
watches  over  individuals in  crisis  throughout  the system  to                                                               
ensure  that   none  are  languishing   in  emergency   rooms  or                                                               
correction facilities.  Instead, individuals  are placed  into an                                                               
appropriate facility as quickly as possible.                                                                                    
                                                                                                                                
MR.  LASLEY said  the state  receives an  annual disproportionate                                                               
share  hospital  federal  allotment  to cover  the  cost  of  DSH                                                               
hospitals that  serve a significantly disproportionate  number of                                                               
under   resourced  individuals.   The  funding   helps  reimburse                                                               
hospitals  that meet  the criteria  and  perform the  evaluation,                                                               
stabilization, and treatment services for the state.                                                                            
                                                                                                                                
Designated facilities provide  psychiatric inpatient services for                                                               
individuals  experiencing  a  psychiatric  crisis who  are  on  a                                                               
voluntary   or  involuntary   hold.  Designated   evaluation  and                                                               
treatment  facilities  provide  both psychiatric  evaluation  and                                                               
treatment, while designated  evaluation and stabilization centers                                                               
only  provide   evaluation  and  stabilization   services.  State                                                               
hospital-designated  facilities provide  critical  service and  a                                                               
continuum  of care  for Alaskans  by supplying  an additional  40                                                               
beds  for evaluation  and  treatment  services. Some  individuals                                                               
requiring these  services need secure  transport to  deliver them                                                               
to  a facility  safely. DFCS  staff coordinate  transportation as                                                               
needed.  The budget  for this  component  that moved  to DFCS  is                                                               
approximately $14.5 million.                                                                                                    
                                                                                                                                
4:05:44 PM                                                                                                                    
SENATOR DUNBAR asked that funding  for the share hospital fund be                                                               
clarified.                                                                                                                      
                                                                                                                                
4:06:01 PM                                                                                                                    
MR. LASLEY replied that it  is federal funding that was initially                                                               
in  the Department  of Health  and Social  Services, Division  of                                                               
Behavioral Health.  It is pass-through  funding. The  funding was                                                               
moved  to the  new Department  of Family  and Community  Services                                                               
(DFCS) to  manage the contracts. There  are a variety of  DET and                                                               
DES  facilities in  hospitals across  the state  that DFCS  works                                                               
with  listed on  slide 19.  DFCS also  has agreements  with other                                                               
hospitals  in Alaska.  Out of  the $14.5  million, DFCS  provides                                                               
about $7 million to hospitals to support individuals in crisis.                                                                 
                                                                                                                                
4:06:55 PM                                                                                                                    
CHAIR WILSON asked that eligibility  requirements for DSH funding                                                               
be shared.                                                                                                                      
                                                                                                                                
4:07:09 PM                                                                                                                    
MR.  LASLEY  stated  he  would provide  the  committee  with  the                                                               
eligibility requirements for DSH funding.                                                                                       
                                                                                                                                
4:07:31 PM                                                                                                                    
CHAIR  WILSON stated  the information  could be  useful when  the                                                               
committee holds  another hearing on  the Certificate of  Need. He                                                               
said   Alaska   Psychiatric   Institute   (API)   had   undergone                                                               
significant  changes since  2019 when  it was  at risk  of losing                                                               
accreditation  through  the  Centers for  Medicaid  and  Medicare                                                               
Services (CMS). He asked for an update on API.                                                                                  
                                                                                                                                
4:08:08 PM                                                                                                                    
MR.  LASLEY replied  that the  API's census  score speaks  to the                                                               
stabilization  it has  achieved  due  to the  great  work of  its                                                               
employees.  Since 2018  when  the hospital  was  in crisis,  many                                                               
systems have  been put  in place to  improve daily  operations at                                                               
the hospital. An  active governing board meets  monthly and works                                                               
directly  with   the  hospital's   leadership.  CMS   visits  the                                                               
hospital, but there have been no significant findings.                                                                          
                                                                                                                                
4:09:08 PM                                                                                                                    
ACTING COMMISSIONER  KOVOL moved  to slide 20  and said  Kim Guay                                                               
has worked  for the  Office of Children's  Services (OCS)  for 22                                                               
years  and  has been  the  director  since  2021. The  agency  is                                                               
primarily  responsible  for  ensuring   the  safety  of  Alaska's                                                               
children.  It investigates  child abuse  and neglect  reports and                                                               
administers the  foster care system.  OCS has 21 offices  in five                                                               
regions  statewide.  The  locations   of  the  main  offices  are                                                               
Anchorage,  Wasilla,  Bethel,   Fairbanks,  and  Juneau.  Smaller                                                               
offices  in areas  such as  Kenai, Saint  Mary's, Utqiagvik,  and                                                               
Sitka exist.  OCS has over 600  positions and a budget  of nearly                                                               
$200 million.                                                                                                                   
                                                                                                                                
4:10:08 PM                                                                                                                    
SENATOR  TOBIN  said   that  in  2012  she   participated  in  an                                                               
insightful  program called  Knowing  Who You  Are.  She said  she                                                               
recognizes that  children with  foster parents  may not  have the                                                               
same  ethnic identity.  Children  need to  feel  seen and  heard.                                                               
Parents  need  the  support  of  resources.  The  program  helped                                                               
fulfill these needs  but has not been offered for  two years. She                                                               
asked for an update on the program.                                                                                             
                                                                                                                                
4:11:05 PM                                                                                                                    
ACTING COMMISSIONER  KOVOL said  she would provide  the committee                                                               
with a list of programs the department oversees.                                                                                
                                                                                                                                
4:11:35 PM                                                                                                                    
ACTING COMMISSIONER KOVOL turned to  slide 21 and said the Alaska                                                               
Tribal Child Welfare Compact began  in 2017. The 32nd legislature                                                               
passed  House  Bill  184,  which codified  it.  She  thanked  the                                                               
legislature  for  passing  an operating  budget  last  year  that                                                               
included an  amendment to increase  the budget for  this compact.                                                               
Along with the increased funding  that Governor Dunleavy pledged,                                                               
the budget for the compact went  from $1.6 million to $5 million.                                                               
Negotiated   funding  emphasized   prevention   to  address   the                                                               
disproportionate number of Alaskan Native  children who come into                                                               
state  custody.  Eighteen  cosigners,  representing  170  tribes,                                                               
share the  funding. Cosigners can  be creative and  innovative in                                                               
utilizing prevention funds. For  example, cosigners can use these                                                               
funds  to  offer the  Positive  Indian  Parenting classes,  which                                                               
include culturally relevant  components, child-rearing practices,                                                               
strength-based  cultural  approaches  to passing  down  parenting                                                               
skills,  traditional behavior  management, and  a support  group,                                                               
all  while  engaging  in  cultural  and  healing  activities  and                                                               
crafts.                                                                                                                         
                                                                                                                                
4:12:48 PM                                                                                                                    
CHAIR  WILSON  recalled  that  another  portion  of  the  compact                                                               
focused  on kinship  care placement.  He  asked that  information                                                               
about kinship placement be shared  with the committee since it is                                                               
less traumatizing  for a  child and  more cost-effective  for the                                                               
state.                                                                                                                          
                                                                                                                                
4:13:22 PM                                                                                                                    
ACTING  COMMISSIONER   KOVOL  replied   she  would   provide  the                                                               
information to the committee.                                                                                                   
                                                                                                                                
4:13:28 PM                                                                                                                    
ACTING  COMMISSIONER KOVOL  moved  to slide  22  and stated  that                                                               
Governor  Dunleavy's People's  First Initiative  included several                                                               
items to  support the  efforts of OCS  in managing  the secondary                                                               
trauma that  its frontline staff  experience. The division  has a                                                               
mental  health  clinician  to  support  employee  well-being  and                                                               
provide  critical incident  debriefing. OCS  offers a  variety of                                                               
positions  and  has  created 26  positions  that  are  undergoing                                                               
recruitment.   Retention  incentives   and  the   field  training                                                               
compensation program  are in  the final  stages of  approval with                                                               
the Department of Administration.                                                                                               
                                                                                                                                
ACTING COMMISSIONER  KOVOL said the  Alaska Impact Alliance  is a                                                               
coalition of community, partners,  tribes, and the state focusing                                                               
on  child  welfare  and  prevention   work,  which  the  Alliance                                                               
facilitates.  Governor   Dunleavy's  initiative   supports  older                                                               
foster  youth ages  18 to  21 to  help them  as they  begin their                                                               
adult  lives. The  initiative bolsters  support  for foster  care                                                               
providers who  take in children  with complex needs.  The funding                                                               
increases vocational  opportunities and financial  assistance for                                                               
housing, transportation, and other identified needs.                                                                            
                                                                                                                                
4:14:45 PM                                                                                                                    
ACTING COMMISSIONER KOVOL  moved to slide 23 and  stated that OCS                                                               
is  starting to  see a  decrease  following a  rapid increase  in                                                               
case-carrying  staff turnover  from late  2019 through  2021. The                                                               
turnover  rate for  case-carrying  staff decreased  from 59.4  to                                                               
55.5 percent. OCS  still needs to address the  high vacancy rates                                                               
for case-carrying  positions. Stability  in the workforce  at OCS                                                               
means consistency for families. House  Bill 151, enacted in 2018,                                                               
requires caseloads to  be assigned based on the  number of months                                                               
an employee has worked for OCS:                                                                                                 
                                                                                                                                
Months    Maximum Caseload                                                                                                  
0-3       6                                                                                                                     
4-6       12                                                                                                                    
6+        13                                                                                                                    
                                                                                                                                
However,   due  to   vacancies  from   turnover,  the   statutory                                                               
requirements  are  difficult to  achieve  for  case workers  past                                                               
their  six  months  of  employment.   Some  regions  have  higher                                                               
caseloads  than others,  which  means  more seasoned  caseworkers                                                               
have  caseloads higher  than 13.  It is  challenging for  smaller                                                               
offices to  balance caseloads. OCS consistently  evaluates how to                                                               
reduce the  burden on  frontline workers,  including centralizing                                                               
administrative functions  and utilizing Letters of  Agreement for                                                               
alternative and flexible work schedules.                                                                                        
                                                                                                                                
4:16:24 PM                                                                                                                    
SENATOR DUNBAR  commented that 55 percent  turnover is shockingly                                                               
high, rendering a workforce  almost nonfunctioning. He recognizes                                                               
the difficulty  of the  environment. He  asked what  solutions to                                                               
lowering the  turnover rate staff  suggested. He opined  that the                                                               
compensation package does not match employees' stress levels.                                                                   
                                                                                                                                
4:17:38 PM                                                                                                                    
ACTING COMMISSIONER  KOVOL replied that DFCS  has constant dialog                                                               
and feedback  with frontline  staff. There  are many  reasons for                                                               
the  high turnover.  Staff can  commute by  plane to  accommodate                                                               
them  for the  high  cost  of housing  in  rural areas.  However,                                                               
commuting  is  tiring, and  some  communities  prefer to  have  a                                                               
caseworker who  lives in the  area. In Bethel,  transportation to                                                               
one outlying village  is by a ramshackle skiff, but  it is faster                                                               
than flying.  The department  tries to address  the needs  of the                                                               
community and  staff. For seven  months, the department  has been                                                               
working on creating  retention bonuses and will be  able to offer                                                               
them  soon. Fewer  people  with social  service  degrees or  like                                                               
service are  applying for positions  with the  department. Thirty                                                               
percent of current frontline staff  do not have a social services                                                               
degree.  DFCS  is hopeful  that  its  partnership with  UAA  will                                                               
increase that  percentage. There are opportunities,  but they can                                                               
not  happen fast  enough to  meet the  need. Labor  shortages and                                                               
recruitment are problems that the nation is facing.                                                                             
                                                                                                                                
4:21:20 PM                                                                                                                    
SENATOR TOBIN  echoed Senator Dunbar's comment  on high turnover.                                                               
However,   it  is   exciting  to   see   the  implementation   of                                                               
opportunities and  solutions that were  put forth by  past career                                                               
staff. Progress is on the horizon.                                                                                              
                                                                                                                                
4:22:08 PM                                                                                                                    
CHAIR  WILSON  stated  that  when  he  began  in  2017-2018,  the                                                               
legislature passed  House Bill 151  by former  Representative Les                                                               
Gara.  A recently  released report  on House  Bill 151  discusses                                                               
workforce caseloads  and high turnover.  A lot of money  has gone                                                               
into fixing  issues that  OCS faces.  He stated he  has a  lot of                                                               
concerns and that there will  be a joint presentation on February                                                               
14th by the Citizens Review Panel,  and OCS will be able to reply                                                               
to the review.                                                                                                                  
                                                                                                                                
CHAIR  WILSON  opined  that there  are  culture  problems  within                                                               
Alaska's workforce. He asked how DFCS measures culture change.                                                                  
                                                                                                                                
4:24:14 PM                                                                                                                    
ACTING  COMMISSIONER KOVOL  stated she  had been  a newly  formed                                                               
department commissioner for 210 days  and did not have an answer.                                                               
She opined that leadership has  stayed with the department and is                                                               
willing to work to improve the  issues that it is facing. She has                                                               
traveled  statewide listening  to staff,  clients, and  partners'                                                               
concerns  and  is  ready  to address  the  problems  and  support                                                               
individuals. She looks forward to  the future when she reports to                                                               
the  committee  that  retention  rates   are  up,  there  are  no                                                               
vacancies, staff  are satisfied,  and fewer  children are  in the                                                               
state's legal care.                                                                                                             
                                                                                                                                
4:26:08 PM                                                                                                                    
SENATOR KAUFMAN  asked for an  overview of how  deployment stages                                                               
for needed improvements and initiatives are managed.                                                                            
                                                                                                                                
4:26:49 PM                                                                                                                    
ACTING  COMMISSIONER KOVOL  replied  that complex  care had  been                                                               
DFCS's  biggest kickoff.  She  recounted a  hectic  event on  her                                                               
first  day   as  commissioner  that  led   to  addressing  agency                                                               
communication.   She  stated   that   at   the  Improving   Lives                                                               
Conference, her keynote speech centered  on a child that utilized                                                               
social service programs for 17  years and a mother that struggled                                                               
to navigate  the system to  help her  child. She declared  she is                                                               
passionate about  improving the department because  that child is                                                               
her son.                                                                                                                        
                                                                                                                                
4:29:19 PM                                                                                                                    
SENATOR  KAUFMAN   asked  if  the  department   has  a  strategic                                                               
management plan with a timetable for development and deployment.                                                                
                                                                                                                                
4:29:50 PM                                                                                                                    
ACTING  COMMISSIONER  KOVOL  replied   that  the  department  had                                                               
established  guiding  principles and  settled  on  a vision.  The                                                               
principles  will be  shared with  staff and  be a  part of  daily                                                               
work. The department hopes to  develop one, three, five, and ten-                                                               
year strategic plans while being creative with its budget.                                                                      
                                                                                                                                
4:30:30 PM                                                                                                                    
ACTING COMMISSIONER  KOVOL moved  to slide  24 and  said Director                                                               
Shannon Dilley  has worked for  the Division of  Juvenile Justice                                                               
(DJJ)  for  25  years  and  provided  information  about  DJJ  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                                                                                                   
                                                                                                                                
4:31:55 PM                                                                                                                    
ACTING COMMISSIONER  KOVOL turned to  slide 25 and  said critical                                                               
staffing  shortages   forced  DJJ  to  temporarily   combine  the                                                               
detention and treatment  units at Johnson Youth  Center in Juneau                                                               
and  the Fairbanks  Youth  Facility  in 2022.    One  in six  DJJ                                                               
facility positions  is vacant. The staff  have handled challenges                                                               
well.  They  continue  to   prioritize  and  provide  innovative,                                                               
evidenced-based services for youth.                                                                                             
                                                                                                                                
ACTING COMMISSIONER  KOVOL said  DJJ has  taken several  steps to                                                               
address  staffing  challenges,  including   a  salary  study  for                                                               
Juvenile Justice Officers that started  in January 2023. Internal                                                               
workgroups focus  on recruitment strategies, agency  culture, and                                                               
other   improvement   efforts.   Program   improvements   include                                                               
specialized  treatment  units  for  females,  violent  offenders,                                                               
substance  abuse,  and   neurobehavioral  units.  These  programs                                                               
address the individualized needs of the youth in Alaska's care.                                                                 
                                                                                                                                
4:32:53 PM                                                                                                                    
ACTING  COMMISSIONER KOVOL  advanced  to slide  26 and  expressed                                                               
appreciation  to  Senator  Wilson  and  his  colleagues  for  the                                                               
passage of HB 105 that went  into effect July 1, 2021. House Bill                                                               
105  was  an  omnibus  piece  of  legislation  that  updated  the                                                               
definition of  DJJ staff and  facilities and brought  Alaska into                                                               
compliance with  federal law  related to  minors waived  into the                                                               
adult justice system. Previously minors  16 or older arrested for                                                               
certain serious  crimes were sent  directly to adult  jail. Adult                                                               
facilities have  difficulty managing  these youth,  often housing                                                               
them  in segregation  units. Since  the  implementation of  House                                                               
Bill 105, 15 minors facing  adult criminal charges have been held                                                               
in DJJ facilities pending the  outcome of their criminal cases or                                                               
upon reaching the age of 18.  Two waived minors are housed in DJJ                                                               
facilities at  this time. DFCS appreciates  its partnerships with                                                               
the   Department  of   Public  Safety   and  the   Department  of                                                               
Corrections in this effort.                                                                                                     
                                                                                                                                
4:33:58 PM                                                                                                                    
CHAIR WILSON  asked if the  closing of  the DJJ facility  in Nome                                                               
has  impacted villages  in the  surrounding area  and where  Nome                                                               
youth are housed.                                                                                                               
                                                                                                                                
ACTING  COMMISSIONER KOVOL  replied that  closing facilities  and                                                               
services  impacts communities.  Youths are  transported to  other                                                               
facilities depending  on charges,  treatment plans,  and staffing                                                               
levels.                                                                                                                         
                                                                                                                                
4:34:59 PM                                                                                                                    
ACTING COMMISSIONER KOVOL  said she brings a heart  of service to                                                               
the  commissioner   position.  She  has  connected   with  staff,                                                               
partners, and constituents at sites  throughout Alaska. She looks                                                               
forward to  collaborating with current partners  and establishing                                                               
new  ones.  She is  grateful  for  resilient employees  who  help                                                               
Alaskans  address  very  stressful and  complex  situations.  She                                                               
noted  it  is humbling  to  listen  to individuals  express  both                                                               
accolades and criticisms  as DFCS explores solutions  that are in                                                               
the best interests of individuals.                                                                                              
                                                                                                                                
4:37:08 PM                                                                                                                    
SENATOR DUNBAR asked for a  summary of any information technology                                                               
(IT)   challenges  DFCS   may  be   experiencing  following   the                                                               
bifurcation of the Health and Social Services Department.                                                                       
                                                                                                                                
4:37:42 PM                                                                                                                    
ACTING COMMISSIONER KOVOL replied  that DFCS is facing technology                                                               
challenges. Like  DOH, DFCS faces  a technology debt  with legacy                                                               
issues  that need  addressing. OCS  is finishing  a study  of its                                                               
Online Resource for  the Children of Alaska  (ORCA) system. There                                                               
are opportunities for matching federal  and state funds to offset                                                               
the cost of replacing the system.  The new system must be able to                                                               
communicate with partner  systems to avoid delays  in services to                                                               
constituents.  DFCS and  DOH are  working together  to prioritize                                                               
needs as implementations begin.                                                                                                 
                                                                                                                                
4:39:21 PM                                                                                                                    
SENATOR DUNBAR stated he appreciates  DFCS's push to offer online                                                               
applications. IT upgrades are expensive but crucial.                                                                            
                                                                                                                                
4:40:14 PM                                                                                                                    
SENATOR TOBIN  stated that keeping children  in their communities                                                               
is important to her, and she appreciates the department's work.                                                                 
                                                                                                                                
4:41:05 PM                                                                                                                    
CHAIR WILSON thanked DFCS for  the update. He stated the services                                                               
the department provides are crucial and should be supported.                                                                    
                                                                                                                                
4:43:03 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee meeting at 4:43 p.m.                                                                                         

Document Name Date/Time Subjects
SHSS-Family and Community Services-Overview 1.26.23 final.pdf SHSS 1/26/2023 3:30:00 PM
Department of Family and Community Services Overview 1.26.23