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.
DRAFT
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
• 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
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 of a
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. 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
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 the
department's commitment 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 that 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
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 very small rooms. 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, 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 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 noted that the last increase was in 2019,
highlighting 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. 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 |
|---|---|---|
| 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 |