Legislature(2023 - 2024)BUTROVICH 205
01/25/2024 03:30 PM Senate HEALTH & SOCIAL SERVICES
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Presentation: Department of Family and Community Services Legislative Overview | |
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ALASKA STATE LEGISLATURE SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE January 25, 2024 3:31 p.m. MEMBERS PRESENT Senator David Wilson, Chair Senator James Kaufman, Vice Chair Senator Forrest Dunbar Senator Cathy Giessel MEMBERS ABSENT Senator Löki Tobin COMMITTEE CALENDAR PRESENTATION: DEPARTMENT OF FAMILY AND COMMUNITY SERVICES LEGISLATIVE OVERVIEW - HEARD PREVIOUS COMMITTEE ACTION No previous action to record WITNESS REGISTER KIM KOVOL, Commissioner Department of Family and Community Services Anchorage, Alaska POSITION STATEMENT: Co-presented a legislative departmental overview. MARIAN SWEET, Assistant Commissioner Department of Family and Social Services Juneau, Alaska POSITION STATEMENT: Co-presented a legislative departmental overview. CLINTON LASLEY, Deputy Commissioner Department of Family and Community Services Juneau, Alaska POSITION STATEMENT: Co-presented a legislative departmental overview. ACTION NARRATIVE 3:31:05 PM CHAIR DAVID WILSON called the Senate Health and Social Services Standing Committee meeting to order at 3:31 p.m. Present at the call to order were Senators Dunbar, Giessel, Kaufman, and Chair Wilson. ^Presentation: Department of Family and Community Services Legislative Overview PRESENTATION: DEPARTMENT OF FAMILY AND COMMUNITY SERVICES LEGISLATIVE OVERVIEW 3:31:34 PM CHAIR WILSON announced the consideration of a legislative overview by the Department of Family and Community Services. 3:31:58 PM KIM KOVOL, Commissioner, Department of Family and Community Services (DFCS), Anchorage, Alaska, moved to slide 2 and provided the mission of the department and its four direct service division and a newly organized component: [Original punctuation provided.] To provide support, safety, and personal well-being for vulnerable Alaskans • Alaska Pioneer Homes • Division of Juvenile Justice • Alaska Psychiatric Institute • Office of Children's Services • Coordinated Health & Complex Care 3:32:42 PM COMMISSIONER KOVOL moved to slide 3 and spoke to the four guiding principles of DFCS: [Original punctuation provided.] At DFCS 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 wellbeing of our workforce. Mobilize innovative solutions to complex challenges 3:33:08 PM COMMISSIONER KOVOL turned the time over to Ms. Sweet to discuss the innovative creation of the Talent Acquisition Team that Ms. Sweet and Ms. Ferber have spearheaded. 3:33:29 PM MARIAN SWEET, Assistant Commissioner, Department of Family and Community Services, Juneau, Alaska, moved to slide 4 and discussed issues and solutions of personnel recruitment and the creation of the Talent Acquisition Team (TAT). [Original punctuation provided.] Talent Acquisition Team • Dedicated human resources team to improve recruitment and retention • Expedited recruitment and hiring an • Personal engagement with candidates throughout process • Specialized on-boarding support and orientation training • Phased implementation - started with Office of Children's Services 3:37:49 PM CHAIR WILSON asked if the TAT program is used by departments outside of DFCS. MS. SWEET replied that DFCS spoke with staff from other departments and expanded on their positive outcome ideas. TAT staff will be fully engaged in the recruitment process from start to finish. It is DFCS's pilot program. CHAIR WILSON stated it seems like a good program for other departments. 3:38:54 PM COMMISSIONER KOVOL said the idea for TAT was pitched to the administration after researching the Child Protective Services program in Oklahoma. DFCS is excited about the results they are experiencing. 3:39:15 PM MS. SWEET moved to slide 5 and said that although TAT has just started, the department received its first job posting in December 2023. The response time from referral to hiring decreased from 34 days in June 2023 to 10 days in December 2023. Several key performance indicators (KPIs) were identified to track the project's success. She expects next year's update to include data from the Division of Juvenile Justice. Success comes through teamwork between Recruitment Services, Talent Acquisition teams, and division and department leadership. 3:40:35 PM COMMISSIONER KOVOL moved to slide 6 addressed points on the slide regarding internships and practicum placements: Workforce Innovations Internships and Practicum Placements • 35 student interns and practicum placements across the department • 11 different colleges and universities • Pharmacy interns at Pioneer Homes • Doctoral and Masters clinical interns at Alaska Psychiatric Institute • Bachelors and Masters in Social Work practicum students in Commissioners Office, Office of Children's Services, and Division of Juvenile Justice 3:41:59 PM CHAIR WILSON asked, since Alaska doesn't have many colleges and universities, how many of the internships and practicum placements are filled by students from out of state. 3:42:05 PM COMMISSIONER KOVOL replied there are a variety of reasons out of state students come to Alaska for their internships. Some students have indicated a desire to return to Alaska after finishing their schooling. 3:42:27 PM COMMISSIONER KOVOL moved to slide 7, illustrating the support the four divisions of DFCS receive from other departments through the Complex Care Unit. She highlighted the success that an extremely troubled youth and his family achieved through collaboration and creative problem-solving. She said this example is one of many complex situations that have driven systematic changes, including a transitional youth pilot program, policy review, and the adoption of programs to meet Alaska's evolving needs. 3:45:08 PM COMMISSIONER KOVOL moved to slide 8 and further discussed the Complex Care Unit and Transitional Youth Pilot Program: [Original punctuation provided.] Complex Care Unit • Identifying solutions to address systemic gaps in care for individuals with complex needs • Data-informed decisions, streamline state system processes, and improve case outcomes Transitional Youth Pilot Program • Limited step-down options for youth discharged from API • Home-like setting staffed to support successful transition • FY25 budget request 3:48:02 PM SENATOR DUNBAR asked if the Complex Care Unit and the Transitional Youth Pilot Program are part of the agency's response to reports concerning the North Star Behavioral Health System and, if so, he would like to know the agency's policy response to the investigation. 3:48:45 PM COMMISSIONER KOVOL asked if he is referring to the report by the Department of Justice or North Star as a private entity that DFCS utilizes. SENATOR DUNBAR said he is referring to the media report, "Inside the Psychiatric Hospital Where Foster Kids are a Gold Mine." 3:49:07 PM COMMISSIONER KOVOL said North Star is the only high-acuity youth hospital in Alaska, aside from the Alaska Psychiatric Institute (API), which has 10 youth beds. North Star currently has about 43 beds but is expected to increase to 60 beds soon. At present, the Office of Children's Services (OCS) has four youth admitted to North Star, which is among the lowest numbers in its history. These four youths are soon to be discharged. The department uses North Star as a last resort, meaning there is no other in-state service that could provide the necessary level of care. This also means the child did not have to leave the state to receive services. 3:50:10 PM SENATOR DUNBAR said he is not attacking North Star but agrees that it should be a last resort. He asked what the agency is doing to expand options and avoid use of the last resort. COMMISSIONER KOVOL said the Division of Family and Community Services (DFCS) has worked with the Department of Health (DOH) on the behavioral health road map and is identifying service gaps statewide. The department visited five regions to learn community needs from residents and providers and determine where it can help with regulations and policies. She said that, from a service delivery standpoint, DFCS has the same custodial care needs as parents not involved with the department. Both DFCS and non-OCS parents rely heavily on community providers. She supports identifying and making it easier for providers to offer services. DFCS is using out-of-state institutions less and tries to keep youth in their communities, avoiding institutionalization unless as a last resort. 3:51:55 PM SENATOR GIESSEL said that, in the context of community services and avoiding institutionalization, it sounds like these youth could benefit from partial hospitalization programs. 3:52:06 PM COMMISSIONER KOVOL agreed, noting that care is always customized to the needs of youth with complex needs. She explained that there will always be some youth whose needs exceed Alaska's resources, such as those with eating disorders. DFCS assesses needs on a case-by-case basis but aims to explore more options in a median area of step-down care. This would support youth transitioning into or out of the community, providing additional options. GIESSEL stated she absolutely agreed. 3:52:54 PM CHAIR WILSON asked for more details about the Transitional Youth Program, such as the number of kids it would serve, if it would serve discharged kids from API, and what the potential locations are. COMMISSIONER KOVOL replied that the program is in its infancy and plans are being set up. It will start with a very small population. Currently, API has 10 beds for youth, but it is not at full capacity due to the high need for one-to-one or two-to- one care ratios, which reduces the census. Initially, the program will serve fewer than a handful of youth with very complex needs to prevent institutionalization. CHAIR WILSON asked if DFCS is seeking funding in the current fiscal year's budget process for the transitional program. COMMISSIONER KOVOL replied yes. 3:53:55 PM MS. SWEET moved to slide 9: [Original punctuation provided.] Technical Innovations • Data Lake • Mobile Device Management Standardization • Artificial Intelligence (AI) • ImageSource • ILINX • Electronic Health Record • Tiger Connect • WiFi in Facilities MS. SWEET said DFCS is committed to using data to drive decisions and increase collaboration with divisions and stakeholders. The department is leveraging technology for this purpose, partnering with Microsoft to pilot a program for the complex care unit. This initiative will integrate data sources within the organization to help pull analytics on complex cases and identify service gaps in Alaska. DFCS is also implementing ImageSource software in several programs. The Alaska Pioneer Homes launched an online waitlist application through the ImageSource contract on October 31, and an electronic document management system for historical files is in development. Additionally, the Office of Children's Services launched an electronic document management system for the subsidized adoption and guardianship program on January 9. MS. SWEET highlighted the implementation of mobile device management (MDM) for secure access to mobile devices for state employees, enhancing field operations. DFCS is standardizing IT applications and technology across facilities statewide. The department implemented TigerConnect, a HIPAA-compliant clinical collaboration platform, at API, Pioneer Homes, and within the complex care unit. This platform allows secure communication with internal and external partners to share information and collaborate on patient needs. MS. SWEET said the department is also exploring artificial intelligence (AI) to build efficiencies and processes, forming a governance committee to guide its use. DFCS successfully implemented the MCO Wi-Fi system at all Pioneer Homes and API, providing residents and patients with internet access for family communication and rehabilitation support. Lastly, DFCS is implementing two electronic health record systems through Netsmart, with the Pioneer Homes system expected to go live in February and the API system in August. 3:57:45 PM CLINTON LASLEY, Deputy Commissioner, Department of Family and Community Services, Juneau, Alaska, moved to slide 10 and provided an overview of significant achievements within DFCS's four divisions over the past year. He emphasized that when DFCS reorganized it committed itself to meaningful connections, person-centered care, innovation, and staff support: [Original punctuation provided.] Pioneer Homes • Alzheimer's Disease and Dementia Services • Safety and Wellness • Wi-Fi in Facilities • Electronic Health Record • Online Admission and Waitlist Enrollment MR. LASLEY highlighted that Alaska Pioneer Homes serve individuals with higher acuity needs and co-occurring conditions, noting needs have changed from a hundred years ago. Approximately 50 percent of residents are diagnosed with dementia, with 75-85 percent showing signs of the condition. To address this, Pioneer Homes have adopted a national model of a positive approach to care. Since 2017, 36 staff members have been trained as trainers, enhancing staff awareness and care for elders with dementia. The dementia specialty apprenticeship program, in place for seven years, has provided additional training to Certified Nursing Aides and Assisted Living Aides, resulting in a one-step pay increase for the voluntary participants. This program has had 85 apprentices since 2017, with 71 still employed, demonstrating its effectiveness as a retention tool. MR. LASLEY also discussed efforts to standardize systems across the department, citing the example of consolidating contracts for electronic health records and other systems to save money and improve efficiency. The Netsmart contract, used in both API and Pioneer Homes, allows IT staff to work across programs more effectively. Additionally, the department transitioned from paper applications to an electronic system for the Pioneer Homes' waitlist, representing another innovative improvement over the past year. 4:02:38 PM SENATOR DUNBAR stated he is glad to hear Pioneer Homes offer dementia-specific training. He asked two questions. First, he inquired about any relationship between Pioneer Homes and Adult Protective Services (APS), specifically if any individuals who come to the attention of APS end up in Pioneer Homes. Second, he mentioned advocates who want APS to have more dementia-specific training and wondered if there are opportunities to collaborate on training to save money, or if the needs of APS and Pioneer Homes are too distinct. 4:03:39 PM MR. LASLEY replied to the first part of the question, stating that individuals who come to the attention of Adult Protective Services (APS) do sometimes end up in Pioneer Homes. He noted that Pioneer Homes have a unique system where individuals enter onto a waitlist, which is long, but there are those who have entered Pioneer Homes needing assistance from APS. Regarding collaboration with other entities, he mentioned that while it is not often discussed, it happens frequently. The department is committed to using state resources to benefit the greater community, citing ongoing collaboration efforts with the API and other departments. He emphasized the value of such collaboration. 4:04:40 PM CHAIR WILSON asked about the status of the Fairbanks Pioneer Home and last year's discussions on the need for either a complete renovation or purchasing a new facility. He inquired if the department has made any decisions and requested a brief update, noting that this will be a subject in the upcoming subcommittee process. 4:05:07 PM MR. LASLEY stated that a contractor was hired to evaluate the possibility of either a complete renovation or a combination of renovation and new construction for the Fairbanks Pioneer Home. The evaluation included utilizing part of the existing building and constructing new sections, or a complete rebuild on the same property. Both options were more expensive than anticipated, with estimates around the $100 million range. The report on these findings was submitted to the committee. MR. LASLEY said one option considered was to build new resident rooms while renovating some common areas of the old building. However, he noted that this decision is ultimately up to the legislature. He suggested that a new build might be a better option if costs are similar, as it would offer greater energy efficiency and avoid the disruption of a phased renovation, making it less disruptive for the residents. 4:06:42 PM SENATOR DUNBAR asked whether there is a use for the old building if the department does pursue the new build option. MR. LASLEY stated the building is 60 years old, needs its roof replaced, and has the smallest size room in the Pioneer Home network. He said the decision will ultimately be based on whether the building meets the needs of residents and if it is cost-effective. 4:07:40 PM MR. LASLEY moved to slide 11: [Original punctuation provided.] Alaska Psychiatric Institute • Community and Jail Based Restoration Programs • Discharge Planning and Support • Automatic Medication Dispensing Machines • Electronic Health Record and Wireless Internet • Beacon Award- Alaska Hospital and Healthcare Association MR. LASLEY stated that the committee is likely aware of the Alaska Psychiatric Institute's (API) status in 2018. He commended the staff and administration for their dedication and efforts in transforming API's culture and operations. API typically operates at full capacity but sometimes lowers the census for complex cases. Although it is an 80-bed facility, the census is generally maintained at around 73-74 beds. MR. LASLEY highlighted the forensic restoration program, which has 10 beds for individuals charged with crimes who need to understand the court process and assist in their own defense. Due to high demand, there has been a significant backlog, especially for those charged with misdemeanors. To address this, API collaborated with the Department of Corrections to create a 10-seat jail-based restoration program and recently launched a 10-seat outpatient restoration program for people with misdemeanors. This expansion has increased capacity from 10 to 30 seats, helping reduce the waitlist and providing necessary services more efficiently. 4:10:19 PM MR. LASLEY also mentioned the complex placement transition program developed by Dr. Oswald. This program aims to reduce failed discharges from API by supporting individuals as they transition back into the community. Previously, about 25 percent of discharges failed, but with the new discharge, planning, and support program, this rate has dropped significantly, with only one failed discharge in the 30-day post-discharge period. Furthermore, API has implemented automated medication dispensing through API's pharmacy, enhancing medication management, and reducing errors. This technology provides 24/7 medication access across all units, improving efficiency and safety. MR. LASLEY noted that the Alaska Psychiatric Institute received the 2023 Beacon Award from the Alaska Hospital and Health Care Association. API recognized that a significant portion of patient-on-staff and patient-on-patient assaults involved individuals with co-occurring disabilities. To address this, they created the Denali Unit, which specializes in managing these patients, reducing the need for manual restraint, seclusion, and behavioral emergencies by 62 percent. 4:14:05 PM MR. LASLEY moved to slide 12: [Original punctuation provided.] Division of Juvenile Justice • Traumatic Brain Injury Project • Job Training and Traditional Skill Building • Community Engagement • Employee Wellness Program MR. LASLEY praised the Division of Juvenile Justice (DJJ) efforts in addressing brain injuries among 40 percent of the youth in the system. Collaborating with public health and the Southeast Regional Resource Center, they developed the Traumatic Brain Injury Project and a rapid assessment tool. This initiative identifies and provides support for youth with brain injuries, ensuring they receive necessary treatment. Initially launched in Fairbanks, the program plans to expand to Bethel, Dillingham, and Kenai. 4:15:32 PM MR. LASLEY said DJJ has also focused on providing vocational opportunities for youth, including engine repair, gardening, and barista training, to help them develop skills for successful futures. Additionally, they have created community engagement programs, such as partnering with Alaska Pioneer Homes. Youth earn the opportunity to participate in activities with the elderly, fostering social skills, communication, and understanding. These interactions benefit both the youth and the elderly, creating a positive and supportive environment. 4:17:25 PM SENATOR DUNBAR asked whether McLaughlin Youth Center is a DJJ facility. MR. LASLEY replied that McLaughlin is a state-run juvenile justice facility. He noted that all DJJ facilities have a school program within them. SENATOR DUNBAR said his district had the opportunity to tour the tremendous facility and noted the incredible work being done. He mentioned that collaboration with the Anchorage School District is going very well. However, there are noticeable problems with the physical plant, particularly in the intake area where the court system is located. These issues affect the flow of patients, and there are areas that could benefit from renovation. He asked if there are plans to make changes or if a capital request to improve the facility has been made. MR. LASLEY replied that he and the commissioner will be touring the facility on the eighth, specifically examining the intake area and cottages. He emphasized that while the state has many great facilities, they are aging, and McLaughlin is no exception. He noted that the section in question used to be a 32-bed unit but is currently unused due to needing repairs and has been repurposed for other services, including the court program. Addressing these issues is a priority for both the commissioner and him. They plan to spend time with the director to thoroughly evaluate the facility and possible opportunities. SENATOR DUNBAR agreed that there are many opportunities for improvement at the facility, which serves the entire state. He noted that the impressive 42-acre facility has significant potential for enhancement. He expressed approval that there is consideration for a capital request to address its aging infrastructure and changing uses. MR. LASLEY emphasized the importance of collaboration, noting that API is nearby and there is significant interaction between the two facilities. He stressed that inadequate facilities for youth present problems, which is why improving it is a priority. 4:21:19 PM MR. LASLEY moved to slide 13: Office of Childrens Services • Foster Care Base Rate • Tribal Compact Expansion • Adoption File Modernization • Teams App for Youth • CarePortal • Placement Search and Support MR. LASLEY discussed the Office of Children's Services (OCS) and the importance of resource families, also known as foster care, in Alaska. During the pandemic, the state lost many resource families, prompting a review of base rates to ensure they align with the services provided. This year's budget includes a $5 million request for foster care base rates, which will increase funding by almost 30 percent. The allocation includes $3.6 million from the general fund and $1.4 million from federal funds. MR. LASLEY he opined that a review of the rate should occur annually. The last increase was in 2019, which highlights the need for regular evaluations and adjustments. Additionally, through the Alaska Tribal Child Welfare Compact, the state has expanded funding and collaboration with tribes, aiming to address the disproportionate representation of tribal children in the child welfare system. Funding was increased from $1.6 million to $5 million through the legislative process. Twenty tribes or tribal organizations, representing 170 tribes statewide, have joined the compact, focusing on prevention and reducing the number of children entering the system. Regarding innovation, OCS is digitizing historical adoption records to improve accessibility and reduce physical storage. They have also developed a secure app for real-time communication with resource families, enhancing collaboration and productivity. MR. LASLEY said two additional initiatives were mentioned: the CarePortal and the Placement Services Support Unit. The CarePortal, inspired by a visit to Oklahoma, is an online tool managed by Beacon Hill that connects tribal partners, nonprofits, faith-based organizations, and others with resource families to provide immediate needs like diapers, cribs, and clothing. The Placement Services Support Unit assists resource parents by answering questions, providing necessary documents, and connecting them with community resources. This unit aims to better support resource families and will be further reported on next year. 4:27:50 PM SENATOR GIESSEL asked if Alaska Impact Alliance was participating with CarePortal. MR. LASLEY said it is doing a lot of great work in the community but is not specifically working with CarePortal. 4:28:22 PM SENATOR DUNBAR jokingly stated that being in foster care is hard enough without making kids use Microsoft Teams. MR. LASLEY replied that it is more for the resource families to communicate and receive answers to questions in real time. DFCS is dedicated to innovation. 4:29:10 PM CHAIR WILSON said that last year, there was a conversation about having respite care within foster care to give families breaks. He noted that private subcontractors and organizations like Presbyterian Hospitality Homes in Fairbanks, and other therapeutic foster homes can provide respite care. However, he was surprised that OCS and the regular system do not offer this, as it results in additional placements and negatively impacts statistics. He asked if a solution has been found to allow for respite care without counting it as multiple placements, making the system more workable for families. 4:30:15 PM MR. LASLEY said that while respite care was not a primary focus this year, it remains a top priority. The department has aimed to achieve many improvements across systems, not just within OCS. He emphasized that he and the commissioner are committed to serving people over worrying about statistics. Their goal is to do the best for resource families, children, and Alaskans, even if it means addressing statistical challenges later. He acknowledged that reporting to the federal government remains a challenge but reiterated their commitment to prioritizing the needs of families. 4:31:16 PM COMMISSIONER KOVOL stated that DFCS leadership visited Arizona to study best practices and its child safety unit. They examined Arizona's new welcoming center, which provides stabilization for youth before placement, including full medical screenings and respite care for any family, not just those in the custodial system. DFCS is exploring how to implement a similar system and reviewing Arizona's data on both custodial and non-custodial family participation. 4:32:24 PM CHAIR WILSON asked how soon the Online Resource for the Children of Alaska (ORCA) system would end. 4:32:46 PM MR. LASLEY replied that the ORCA system, like many other facilities and systems, is aging and needs replacement. Although he did not recall the exact year of its development, he noted significant technological advancements since then. A study estimated the cost of replacing ORCA at about $50 million, with implementation taking four to five years. Various models were considered, including off-the-shelf and custom solutions, and they found a suitable off-the-shelf model with some tweaks and add-ons. The cost is estimated at $25 million in state funds and $25 million from the federal government. CHAIR WILSON stated that during their travels with NCSL, they met with organizations that work with similar platforms in other states. They are considering inviting one to Alaska for a presentation on using federal funds and other methodologies to fund a new implementation. He emphasized the importance of preventing system failure to avoid putting vulnerable youth at risk and creating backlogs that hassle families. Wilson noted that today's presentation was encouraging and praised the new initiatives, especially in recruitment, which has reduced the hiring process to 10 days. He expressed hope that other departments will adopt similar improvements and looked forward to further updates. He thanked the participants for their updates and contributions to the committee hearing. 4:36:51 PM There being no further business to come before the committee, Chair Wilson adjourned the Senate Health and Social Services Standing Committee meeting at 4:36 p.m.
Document Name | Date/Time | Subjects |
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DFCS SHSS Overview (1-25-24).pdf |
SHSS 1/25/2024 3:30:00 PM |
Dept of Family and Community Services Overview SHSS 1.25.24 |