HCR 2-RESPOND TO ADVERSE CHILDHOOD EXPERIENCES   3:06:19 PM CHAIR KREISS-TOMKINS announced that the first order of business would be HOUSE CONCURRENT RESOLUTION NO. 2, 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. [Before the committee, adopted as a work draft on 2/6/18, was the committee substitute (CS) for HCR 2, Version 30-LS0277\J, Glover, 1/17/18.] 3:06:54 PM CHAIR KREISS-TOMKINS opened public testimony on HCR 2. 3:07:08 PM SAMANTHA SAVAGE, Fairbanks Wellness Coalition (FWC), testified that that the mission of FWC is to foster wellness through primary prevention advocacy. Its two current projects are focused on suicide prevention and heroine and prescription opioid misuse among teens and young adults. She offered that FWC recognizes the importance of working together as a community and as a state to prevent childhood trauma because of its enormous impact on the issues that the coalition seeks to prevent. She said that according to Linda Chamberlain, PhD, Director of the Alaska Family Violence Prevention Project (AFVPP), studies have shown that nearly two-thirds of suicide attempts of adults can be attributed to adverse childhood experiences (ACEs), and nearly 80 percent of suicide attempts during childhood and adolescence are attributed to ACEs. She stated that research gathered by the Alaska Children's Trust (ACT) reported that a person with four or more ACEs is 12 times more likely to attempt suicide and 10 times more likely to use injection drugs. She relayed that FWC supports the state's efforts to recognize childhood trauma as an important factor in building wellness in the community. 3:08:35 PM ELSIE BOUDREAU, Alaska Resilience Initiative (ARI); President, Arctic Winds Healing Winds (AWHW), testified that AWHW is a non- profit organization dedicated to bringing healing and wellness to villages throughout Alaska. She mentioned that she is an Alaska Native who grew up in the village of St. Mary's. She expressed her belief that establishing statewide policy is important considering so many Alaska Native children are in foster care; for many, this is due to ACEs and historical trauma. She emphasized the importance of funding to research statewide solutions. She maintained that it is imperative at this point in Alaska Native history that Alaska residents come together and create effective and meaningful solutions to make a difference in the lives of Alaska Native children so that ACEs are no longer prevalent. She asserted that ACEs are devastating and create havoc for all Alaskans. She urged the governor and the committee to support HCR 2. 3:10:43 PM REPRESENTATIVE BIRCH asked about the cultural differences as they apply to foster children and posed two scenarios: the first is a foster child graduating from high school after living in a dozen different foster homes; the second is a child in rural Alaska moving upriver or downriver with one family until adulthood. He opined that the prevailing opinion is that a child is always better off with his/her natural birth family, as opposed to with a foster care family. He asked Ms. Boudreau for her thoughts on how the state could do a better job in that regard. MS. BOUDREAU responded that as a social worker, she worked for the Division of Family and Youth Services [now the Office of Children's Services (OCS). She reported that most of the foster care children she saw wanted to return to their families. She maintained that children who grow up closer to their cultural connections do better in the long run, because they are no longer seeking "who am I in this world?"; they have a connection to their cultures, their identities, and their origins, which is important for all children. She opined that the state should be more culturally "humble" when imposing foster care requirements on rural communities. It should create safety beyond the presentation of the home and look at other factors influencing a child's well-being, such as cultural and spiritual factors. 3:13:38 PM REPRESENTATIVE BIRCH responded that he agreed and referred to "cultural continuation". He said that a child may be raised by an extended family member in a nearby community; he/she stays there; and there is no "big push" to remove that child to go back into "what might not be a good environment." 3:14:20 PM JOSH ARVISTON, Director, Alaska Child Trauma Center (ACTC), Anchorage Community Mental Health Services, Inc. (ACMHS), testified that the [original] ACE study data is now 20 years old and has been supported by follow-up research highlighting the links between ACEs and long-term health, mental health, substance abuse, education, and occupational outcomes. He expressed his belief that it is critical for Alaska to have a systematic approach to addressing this issue; such an approach would have financial health benefits for the State of Alaska and for the state's residents. He stated that in the subsequent 20 years since the original research, the emerging science of traumatic stress, how traumatic stress impacts behavior and physiology, and brain imaging studies have directed us to effective interventions and approaches that can help achieve better outcomes for Alaskans. 3:16:05 PM LAURA NORTON-CRUZ, Director, Alaska Resilience Initiative (ARI), testified that she supports HCR 2 because as the director of ARI, a former teacher, a mother, and a community member, she shares the value that all of Alaska's children deserve to be safe, to be cared for, and to have the opportunity to grow into healthy contributing adults. She stated that as the director of a statewide network of people who are actively addressing ACEs, it is her job to learn about and connect people to the efforts already occurring across Alaska. She relayed that there are hundreds of groups using ACEs to guide their work in trauma and have been doing so for decades. Alaska is at the forefront of this movement and considered a national leader: it was chosen as one of 14 pilot sites (indisc.); Alaskan tribes are doing powerful work, including the Aleut community, St. Paul, that was featured in today's issue of The Guardian; there is a coalition in the Matanuska-Susitna ("Mat-Su") Valley that is leading creative and innovative OSC (indisc.) improvements; the Ketchikan Shipyard of the international company Vigor [Industrial] is the safest shipyard in the entire company and is the model for the Seattle Shipyard because of its implementation of (indisc.) practices; and Alaska's Division of Juvenile Justice (DJJ) is one of the first in the country to undergo transformation to a "trauma-informed" agency. MS. NORTON-CRUZ maintained that Alaskans are creative and innovative. She said, "We've really taken this on and we're running with it, and yet we have so far to go." She referred to the many grim statistics about Alaska's child welfare system, medical spending, and the opioid crisis. She relayed that to make this effort work across all sectors as effectively as possible, Alaska needs shared commitment and shared language from the Alaska legislature and the governor to help set the tone and set priorities. MS. NORTON-CRUZ reported that the way Wisconsin has prioritized ACEs and trauma-informed work at the state government level, led by Wisconsin First Lady Tonette Walker, has allowed for trauma and resilience work in Wisconsin to flourish across the state, resulting in significant improvements in academic, health, and social outcomes, as well as radical cost savings for state and local government. MS. NORTON-CRUZ maintained that the proposed resolution would set the tone for new policy-makers and new commissioners and make a statement that legislators care about this. The use of ACEs is necessary to save the state money and to have a healthy workforce; and it can result in improvements in the major troublesome issues, such as the opioid epidemic and the child welfare system. She concluded by saying, "You setting this tone, you providing this leadership, can result in moving towards an Alaska where values are manifested." 3:19:34 PM REPRESENTATIVE BIRCH referred to ACEs, toxic stress, and childhood trauma, and he mentioned that as a child, he was spanked and experienced some significant events that were traumatic. He asked for a brief explanation for how one's ACE is measured. MS. NORTON-CRUZ suggested that one way of thinking about it is envisioning a teeter-totter: on one end is chronic and persistent stress weighing a person down and having an effect on his/her brain and body; on the other end are protective factors, such as supportive adult relationships, meaningful work, community engagement, and (indisc.) identity, that provide balance, can be protective against adversity, or help build resilience. She explained that where the fulcrum is positioned can affect which side is weighted heavier; it may represent a person's genetics or events that occurred during pregnancy. MS. NORTON-CRUZ maintained that there are many factors that determine outcomes after a person experiences adversity. She said that the ACE study was a crude measure; it asked, "Did these things happen to you?" and counted the number of those things that happened. She maintained that what researchers found was incredibly powerful epidemiology. They measured five forms of household disfunction and five forms of child maltreatment, abuse, and neglect; they found that the more adversities a person had, the greater the risk of a myriad of health and social problems. She reminded the committee that because of the protective and environmental factors, a high ACE score is not absolutely predictive. She stated that using the ACE lens leads to opportunities for promoting protective factors and preventing or reducing initial traumas. 3:22:29 PM REPRESENTATIVE BIRCH asked whether any of the ACEs rise to the level of being illegal, reportable, and punishable, such as physical child abuse, or if they are lower level experiences, such as alcoholic problems in the home. He inquired as to the range of traumatic issues. MS. NORTON-CRUZ responded that the original ACE study, conducted by [health maintenance organization (HMO)] Kaiser Permanente in California and replicated in Alaska, asks about five criminal behaviors and five forms of household disfunction. The criminal behaviors are: physical and emotional neglect; and physical, sexual, and verbal abuse. The five forms of household disfunction consist of: a household member who is incarcerated, a household member who has mental illness or substance abuse, domestic violence in the household, and parents who have separated or divorced. She maintained that not all ACEs are criminal and not all are necessarily a trauma, such as a divorce; however, given the circumstances surrounding such an event, it could create an environment of chronic stress for the child. She added that there are many other forms of stress that can affect a child's developing brain and body that are not counted in the study, but have been identified by other research, such as chronic bullying, chronic discrimination, or hunger. 3:24:21 PM CHARLES MCKEE testified that he had a traumatic experience in Fairbanks, Alaska, when he was 14 years of age during the Fairbanks flood [of 1967]; he was hospitalized at Bassett Army Community Hospital, which saved his life. He relayed that later his father hired a secretary to manage his business; the secretary was married to an U.S. Internal Revenue Service (IRS) agent; and she and the IRS agent set Mr. McKee's father up for a major financial calamity. Mr. McKee's father was not aware of what was happening until his checks started "bouncing". Mr. McKee maintained that the IRS seized his father's account to get him to sell the Alaska distributorship for Kirby Company of Alaska. He summarized by saying that this situation is still ongoing; "this structural organization is run by the Bar Association and it's corrupt." 3:26:58 PM ARICA PAQUETTE, Prevention Manager, Women in Safe Homes (WISH), testified that she is a coordinator for the Revilla Island Resilience Initiative (RIRI), which is working to prevent trauma and promote resilience through collective action. She relayed that the goal of her department at WISH is to prevent violence through primary prevention strategies before it starts. Research has shown that childhood trauma, including witnessing domestic violence in the home, is a risk factor for violence being experienced across the lifespan. She said that WISH's programs typically target youth - elementary through high school - but it often engages in primary prevention too late, because children are being impacted by ACEs prior to entering the school system. MS. PAQUETTE maintained that cross sector collaboration is instrumental in the implementation of effective strategies in the communities; it creates a measurable reduction in both the perpetration of violence and victimization. She offered that through the lens of trauma-informed care, WISH can build connections between sectors to engage in projects or implement programs that impact multiple social problems and not just intimate partner and sexual violence. Currently WISH is working with the school district to support integrating a trauma- informed approach in all the schools by helping teachers to identify support and promote healing among the victims of childhood trauma. Trauma is passed through generations, so that supporting both parents and children is critical for ending the (indisc.). She maintained that the state can further support these efforts by officially supporting local and statewide initiatives encouraging cross sector collaboration to prevent all forms of childhood trauma and to build resilience in families and communities. 3:29:09 PM CARMEN LOWRY, Executive Director, Alaska Network on Domestic Violence and Sexual Assault (ANDVSA), testified that ANDVSA is constituted through 24 domestic violence and sexual assault (DVSA) agencies across the state. It has been an active partner with the Alaska State Legislature since 1980. She stated that ANDVSA fully supports the proposed resolution and appreciates the call to establish statewide policies that address the devastating impacts of ACEs. She relayed that in fiscal year 2017 (FY 17), ANDVSA programs responded to about 7,700 women who reached out for services; (indisc.) and approximately 1,800 children. She maintained that the multiple ACE studies conducted since 2000 are clear: 1) there are substantiated links between a child witnessing violence against his/her mother and developing risk factors that have negative impacts for that child's well-being as an adult; and 2) there are substantiated correlations between (indisc.) domestic violence and the likelihood of that child being physically abused. She asserted that the bottom line is that a child's exposure to domestic violence has a profound impact on that child, and that impact reverberates into their adult lives; the impacts and reverberations have social and physical implications for the state. MS. LOWRY stated that ANDVSA and the state can work together to do the following: 1) continue to support and provide lifesaving shelter and emergency services to victims and their children; 2) expand and learn from community-based prevention activities; and 3) assess the state policies currently in place with an eye to what needs to be revised or created to adequately address those larger social factors that contribute to Alaska's current condition, which is that 40 percent of Alaska's adult female population, their children, their partners, and their communities experience domestic violence. She offered full support for HCR 2. 3:31:58 PM CHAIR KREISS-TOMKINS closed public testimony on HCR 2. 3:32:17 PM REPRESENTATIVE TUCK commented that he was unfamiliar with ACE until his discussions with Representative Tarr and California physician [Dr. Vincent Felitti], during which he was able to learn what ACE is, how people are affected by ACE, and some simple treatments to help people overcome the effects of ACE. He maintained that he was amazed at the value of asking the ACE questions during a physical exam for significantly improving a person's health and reducing costs. He mentioned that he saw a Technology, Entertainment, Design (TED) talk on YouTube in which a physician emphasized the importance of a full physical exam, getting a complete history, and discovering ACEs to improve the overall health of patients. He maintained that awareness of ACE alone will have a significant impact on communities and families. 3:34:36 PM REPRESENTATIVE WOOL commented that the issue is two-fold: preventing the experiences that cause high ACE scores; and treating people who have experienced ACEs. He agreed that asking the ACE questions gives people the opportunity to explain what happened to them and to understand the reasons behind the difficulties they are having; and as a by-product, it saves on state expenditures. 3:35:32 PM REPRESENTATIVE WOOL moved to report the CS for HCR 2, Version 30-LS0277\J, Glover, 1/17/18, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHCR 2(STA) was reported from the House State Affairs Standing Committee.