HCR 21-RESPOND TO ADVERSE CHILDHOOD EXPERIENCES  2:42:11 PM CHAIR SEATON announced that the next order of business would be HOUSE CONCURRENT RESOLUTION NO. 21, Urging Governor Bill Walker to join with the Alaska State Legislature to respond to the public and behavioral health epidemic of adverse childhood experiences by establishing a statewide policy and providing programs to address this epidemic. 2:42:40 PM The committee took an at-ease from 2:42 p.m. to 2:43 p.m. 2:43:26 PM REPRESENTATIVE TARR offered a PowerPoint presentation titled, "Adverse Childhood Experience," [referred to slides 1-9] and reminded the committee that these issues had been discussed in committee previously. She noted that Dr. Hirschfeld's presentation discussed the origins of the ACEs study and developing an ACEs score and she said she would skip over those topics. Previously, members had been asked to take their ACEs score and pointed out that in asking people to take their ACEs score it rises awareness and assists in understanding the issues better. Key findings within the Alaska work is that childhood trauma is far more common, it lasts over a lifetime, and impacts generations. Research has shown that approximately $1.4 billion is spent every year in Alaska on substance abuse related issues from treatment to the court system to law enforcement, and she referred to Dr. Hirschfeld's presentation regarding some of the cost reductions that can be associated with reducing Alaska's ACEs scores. REPRESENTATIVE TARR explained that HCR 21 calls on the legislature and the governor to work together to do more on policy level changes. Last year, the legislature worked hard on Erin's Law and Bree's Law, and the legislature discussed ACEs through those bills. She then stressed the importance of keeping that conversation going this year, to keep the conversation going as more awareness needs to be developed with education and some of this can be done without funding. She pointed to slides 6-9, and advised that these are some of the opportunities for prevention, and that during the interim the committee will continue looking at policy alternative. In working through the implementation of Erin's Law and Bree's Law, she wants to make sure the legislature is part of the effort to build a statewide network of people concerned about the issues and come together. 2:45:57 PM REPRESENTATIVE TARR advised there are 27 letters of support from organizations across the state, such as the Children's Trust, Suicide Prevention Council, Mental Health Board, Best Beginnings, and also approximately 200 hundred individuals signed petitions from different early learning conferences she attended, from the Dr. Felitti event, and from the "Go Blue Day" Child Abuse Prevention rally yesterday. In bringing all of these groups together, she noted that her hope is to bring together a network of people to determine that it isn't just about spending more money on something, but more about having a deeper understanding of these ACEs issues, and its impacts. ACEs is about connecting the dots and within the letters of support there are individuals working on mental health, early learning, substance abuse, or suicide prevention. In understanding ACEs it brings a new opportunity for connecting the dots between the negative health outcomes and looking back at the origins and determining what the origins of those problems are. REPRESENTATIVE TARR referred to an additional slide in the committee packets from the All Alaska Pediatric Partnership regarding ACEs accumulation and read, "Young Alaskans have acquired HALF of their accumulated ACEs by the age of 3." She explained that it speaks to the importance of the early intervention programs. As Dr. Hirschfeld discussed, pediatricians and other health care providers can be frontline in that effort, and she added that early education folks such as Best Beginnings are working on early education. There was a time it was believed there was a protected wall around the fetus and that the mother smoking and drinking was okay. It was also believed that children in the pre-verbal times were unimpressed by things, and that events could be happening around them and there wasn't a big impact. To put this in context, she related, the study referenced was published in 1989, and when thinking about how recent that's been for people to learn about that data and then start doing their own research, there really hasn't been an opportunity to implement it into the state's policies in a manner that can be implemented to have a tremendous impact. This slide shows that a lot of the bad stuff is happening at the time people previously believed children would not be impacted by the behaviors around them, or even be aware of violence or substance abuse, she said. 2:49:23 PM REPRESENTATIVE TARR related that building awareness is part of the effort that can be accomplished without funding a new program, and through the efforts this month of child abuse prevention and organizations hosting many different activities sharing information and, hopefully, get more people involved. Working with educators and practitioners and the government in creating policy alternatives is the next step, she remarked. 2:49:56 PM REPRESENTATIVE FOSTER expressed his support and that he appreciated Dr. Hirschfeld's presentation and learning of his efforts in his practice in Nome as it makes it more tangible for him. REPRESENTATIVE TARR related that these are long term investments and as Dr. Hirschfeld related, within every step along the way the state has opportunities to work with children when they are in school, and that there are screening tools when meeting with families. One big opportunity is just in changing the language when there is a child with behavioral problems. The child acting out is not asked what is wrong with them, but rather the child is asked what happened to them. Things like this give her hope and that even without a lot of funding, moving toward something where most of it is simply understanding the opportunities, and the different places that can be engaged in sharing this information. CHAIR SEATON noted his appreciation for both presentations and that he found Dr. Hirschfeld's comments interesting because he was unsure how much the medical community and quasi-medical community had been involved with those types of care coordination efforts with families. He related that it is good to hear that they are not just looking at the child, but the situation the child is in. 2:52:20 PM REPRESENTATIVE FOSTER moved to report HCR 21, labeled 29- LS1398\A out of committee with individual recommendations with no fiscal notes. CHAIR SEATON objected for discussion and read into the record the language on page 3, lines 14-22, as follows: BE IT RESOLVED that the state's policy decision acknowledge and take into account the principles of early childhood brain development and, whenever possible, consider the concepts of toxic stress, early adversity, and buffering relationships, and be it  FURTHER RESOLVED that early intervention and investment in early childhood years are important strategies to achieve a lasting foundation for a more prosperous and sustainable state through investing in human capital; and be it FURTHER RESOLVED that the Governor join with the Alaska State Legislature and address the presence of adverse childhood experiences as factors for many societal issues and to fund research for statewide solutions. CHAIR SEATON opened public testimony 2:52:20 PM TREVOR STORRS, Executive Director, Alaska Children's Trust, said the Alaska Children's Trust is focused on the prevention of childhood abuse and neglect. He related that the Alaska Children's Trust is also partnering with groups around the concept of reducing trauma and building resiliency in the child, the family, and the community. He noted that what has been presented today is a complex issue and what the committee does with this information is not about enacting one specific thing, but it is the framework to help promote the concept of reducing trauma adversity to not only the child, but a community and cultures within Alaska. When these issues are addressed, not only does it save money, it builds communities that can withstand trauma which is a natural part of the circle of life, but child abuse and neglect are not a natural part of the circle of life. It is resiliency that glues that circle together and the role of the community is to be certain the glue being used is the strongest and best glue so everyone benefits, he said. REPRESENTATIVE TARR asked Mr. Storrs to send information to the committee members about the Resiliency Initiative. MR. STORRS agreed. 2:56:37 PM DON ROBERTS described himself as an adult survivor of these adverse childhood experiences and in listening to the presentations he noted that the system tends to forget that there are many adults dealing with this in their lives with no resources available to them. He agreed that the programs can be initiated, but they are for children and families and he is 58 years old. He took the ACEs test and had a score of 7, although it would have been higher if it asked a few other questions. Adult programs need to be integrated so when adults get into the system they are not just sidelined due to no services out there because the legislature didn't put it in, he related. Due to his adverse childhood experiences, having intimate family relationships is troublesome because he doesn't want to be the kind of parents he had where basically his childhood was filled with anger and violence. He opined that this needs to be included in the legislation. There are other services, such as peer support services that are not necessarily part of the mainstream clinical experience people should be able to use and, he opined, peer support services are often given short shrift when they tend to be far more effective in helping people deal with these issues in their lives. CHAIR SEATON offered support for his testimony and related that there is definitely no one point in which addressing these issues can be stopped. 3:00:28 PM PATRICK ANDERSON, Senior Research Fellow, Sealaska Heritage Institute, said he is a Senior Research Fellow in the area of childhood trauma and health restoration, and has been engaged in research and advocacy around adverse childhood experiences since 2008 when he was the CEO of an Alaska Native Rural Health System. As a consequence of his advocacy he is a member of both the American Indian and Alaska Native Task Force on suicide prevention and president of the Native American Children's Alliance (NACA), assisted in the drafting of this resolution, and that his ACEs score is 6. He described the understanding of the existence of real and identifiable childhood trauma being linked to adult health and negative behaviors as an exciting new arena of public policy. He then referred to Dr. Hirschfeld's presentation and said that if childhood trauma can be identified early in a child's life it can be addressed before it becomes a true problem and prevention becomes a real option because parents can be taught how to avoid the behaviors that cause the development of this trauma in children. He referred to the perception that the resolution addresses early childhood prevention only, but that was not the intent. He referred to HCR 21, page 3, lines 14-16, which read: BE IT RESOLVED that the state's policy decision acknowledge and take into account the principles of early childhood brain development and, whenever possible, consider the concepts of toxic stress, early adversity, and buffering relationships, and bit it MR. ANDERSON pointed out that it is directed toward adult health and behaviors as well as early children's brain development, health, and behaviors. He advised he has spent the last four or five years looking for a systemic approach that addresses both the parenting generation's behaviors and children's behaviors in a family and community context. Mr. Anderson opined that the goal is to introduce a program that effectively identifies behaviors early enough to begin the healing process. Within the City of Nome, where Dr. Hirschfeld practices, there has been a discussion in the last few years around ACEs that has advanced to the point of serious consideration. During the recent convention of the National Congress of American Indians, presentations were offered on the topic including a plenary presentation by Dr. Vincent Felitti. Tribal groups in Alaska have started the process of understanding and using ACEs and are following examples from the lower-48. Dr. Ann Bullock is employed by an Indian tribal health system addressing diabetes through programs that identified and treated traumatic or toxic stress. Dr. Donald Warne is an American Indian physician who has been active through the Great Plains Tribal Chairman's Health Board in addressing ACEs and there are many other who are following their lead. MR. ANDERSON referred to the Behavior Risk Factor Surveillance System (BRFSS) and emphasized that Alaska Natives have a 4 or more ACEs at a rate which is almost double that of the non- Native population according to BRFSS. As a result, many of the Alaska Native communities view this area as a priority to address. When Dr. Felitti was in Juneau, they took the opportunity to meet with Governor Bill Walker, Lieutenant Governor Byron Mallott, Commissioner Dean Williams of the Department of Corrections, and Jay Butler the Alaska Chief Medical Officer. They briefed Governor Walker on this issue, made him aware of the legislation, and asked Governor Walker to support it. Mr. Anderson opined that this resolution has great potential for encouraging a wider discussion of ACEs in Alaska and if it leads to more programing to address prevention, earlier intervention, and healing that would be fantastic. He then asked that the committee pass HCR 21 out of committee and encouraged the adoption of the resolution by the legislature. 3:05:58 PM MAUREEN HALL, School Nurse, said she is a school nurse in Juneau and she fully supports this resolution because [nurses] daily see children on the frontline in their offices. These children typically have a high ACEs score, and are seen most often which carries over into adult medicine when they leave the school setting. These individuals, she said, are the heaviest users of the health care system, are most apt to have poor educational outcomes, and end up engaging with the criminal justice system. As far as the savings being 20 years down the road, she argued that the savings will be immediate because those children will not be as sick as their peers when they have a lower ACEs score. It will prevent a lot of the adversity and they'll be healthier, and be better able to learn once they do get to school. She pointed out that this is important in raising awareness throughout our state, and she would like every school in the state become a trauma informed school, as well as Alaska's communities. By every police officer and teacher understanding how the adverse childhood experiences affect a person, she opined that it would go a long way toward preventing and increasing awareness, and helping that person be more successful down the road. CHAIR SEATON removed his objection. There being no objection, HCR 21, Version 29-LS1398\A, with no fiscal notes, passed from the House Health, Education and Social Services Standing Committee.