ALASKA STATE LEGISLATURE  HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE  January 17, 2006 3:09 p.m. MEMBERS PRESENT Representative Paul Seaton, Vice Chair Representative Tom Anderson Representative Carl Gatto Representative Sharon Cissna Representative Berta Gardner MEMBERS ABSENT  Representative Peggy Wilson, Chair Representative Vic Kohring OTHER LEGISLATORS PRESENT  Senator Charlie Huggins COMMITTEE CALENDAR OVERVIEW: PETERSBURG MENTAL HEALTH SERVICES - ADOLESCENTS IN TREATMENT FOR CHRONIC MENTAL ILLNESS OR ADDICTION PREVIOUS COMMITTEE ACTION No previous action to record WITNESS REGISTER SUSAN OHMER, Licensed Clinical Social Worker (LCSW), Chemical Dependency Counselor I (CDC I), Executive Director Petersburg Mental Health Services (PMHS) Petersburg, Alaska POSITION STATEMENT: Presented the overview of PMHS and introduced client witnesses. REPRESENTATIVE NANCY DAHLSTROM Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Asked questions of the testifying witnesses. MICHAEL BOSEMAN Petersburg, Alaska POSITION STATEMENT: Presented an oral memoir and answered questions regarding services received from Petersburg Mental Health Services. JESSICA GREENE Petersburg, Alaska POSITION STATEMENT: Presented a digital memoir and answered questions regarding services received from Petersburg Mental Health Services. MICHAEL BIGGERS Petersburg, Alaska POSITION STATEMENT: Presented a digital memoir and answered questions regarding services received from Petersburg Mental Health Services. KATIE EDFELT Petersburg, Alaska POSITION STATEMENT: Her digital memoir was presented by Susan Ohmer. ACTION NARRATIVE VICE-CHAIR PAUL SEATON called the House Health, Education and Social Services Standing Committee meeting to order at 3:09:12 PM. Present at the call to order were Representatives Gatto, Cissna, Gardner, and Anderson. Representative Wilson was excused. Senator Huggins was also in attendance. ^OVERVIEW: PETERSBURG MENTAL HEALTH SERVICES 3:10:12 PM VICE-CHAIR SEATON announced that the only order of business would be the overview from Petersburg Mental Health Services. SUSAN OHMER, Licensed Clinical Social Worker (LCSW), Chemical Dependency Counselor I (CDC I) Executive Director, Petersburg Mental Health Services (PMHS), presented the overview from a seven-page document, available in the committee packet. Ms. Ohmer described Petersburg, Alaska: location, industry, ethnic makeup, and approximate population of 3,400. Ms. Ohmer provided a history of the mental health care versus the current activities and services available in Petersburg at PMHS. MS. OHMER spoke from her document stating: You [the legislature] help fund our center, and Petersburg Mental Health [Services] belongs in part to you, ... we wanted to come up here today and let you know the difference your investment makes, ... not to ask you for anything other than to listen, and basically hear what our stories are. ... We're funded at the base rate of a center in a rural Alaska setting. This means that we're one of the lower- funded centers in Alaska, but we are not complaining. We want you to know what kind of bang for your buck that you get, when you send money down to our community. MS. OHMER outlined the disposition of the PMHS office and caseload, contrasting how it has evolved during her twelve-year tenure. MS. OHMER went on to describe how stigmas are attached to mental health care recipients. However, she stated that by servicing a large percentage of the community, stigmas are dispelled. 3:16:02 PM MS. OHMER described the center's cross training efforts, the "no wrong door policy", PMHS's community relationships, the center's joint work with local law enforcement, and PMHS' goal mandate to do "whatever works." MS. OHMER highlighted the programs offered at PMHS: Connecting Threads Crafts program; Wellness program; Community Garden program; Buprenorphine program; Prime of Life Prevention and Education program; Fully-Connected program; and programs categorized as "Other". MS. OHMER said she attributes the keys to PMHS's success to innovative staffing efforts, and effective outreach programs. She commended each staff member as being dedicated to the goal of keeping clients out of prison, from being hospitalized, and from committing suicide. 3:21:46 PM VICE-CHAIR SEATON requested a more in-depth description of the buprenorphine program. MS. OHMER detailed this opiate drug addiction program, it's development, and application. Further, she stated that clients, who might otherwise be institutionalized in jail, hospitalized, or admitted to a long-term care facility, are not due to this program's effectiveness. MS. OHMER introduced the day's presentations, describing them as an example of the Fully-Connected program, which allows clients to illustrate their experiences, learn a computer skill, and create an artistic/educational presentation. She warned the committee about the graphic nature of the presentation, which consists of three, client-produced, two-minute videos; a fourth client will present oral testimony. 3:24:21 PM MS. OHMER named PMHS's eight current staff members, their hours, and the hours of operation for the center. Many hours, evenings and weekends, are "investment hours" volunteered by the staff, she noted. She then thanked the presenters for forfeiting their confidentiality, for their courage, and for their work with PMHS. 3:25:53 PM MS. OHMER, in response to questions, said fishing is the predominate industry; that the economy is also supported by Alaska Department of Fish & Game (ADF&G), and United States Forest Service (USFS) offices; and that Petersburg has one elementary school, a middle school, and a high school. In response to further questions, she explained that students must leave the community if they want to obtain a college education; that alcohol and addiction problems exist in Petersburg schools; and that there is a methamphetamine ("meth") presence in Petersburg. 3:28:43 PM VICE-CHAIR SEATON asked if the forthcoming presentation has been circulated in Petersburg and used there to any benefit. MS. OHMER answered that only the governing board of PMHS has had the opportunity to view the productions, and so this would be their premier presentation. She then introduced the first presenter. MICHAEL BOSEMAN gave an oral presentation regarding difficulties he experienced while growing up; the eight-page transcript was made part of the committee packet. He concluded his delivery by crediting Petersburg Mental Health with saving his life, despite his attempts to avoid being helped. 3:40:37 PM REPRESENTATIVE GATTO asked whether if Mr. Boseman had written the presentation himself, and whether he considers himself to be a good student and a good influence on other students. MR. BOSEMAN replied that he had written the presentation himself, that he has been clean for two and a half months and no longer deals in drugs, and that he hopes that he is a good influence on those around him. 3:42:52 PM REPRESENTATIVE GARDNER asked Mr. Boseman whether earlier intervention [in Utah] might have had a beneficial effect on his life. MR. BOSEMAN credited the Petersburg police with doing their job; that is how he arrived at PMHS and, and then proceeded to change his life. 3:44:08 PM REPRESENTATIVE ANDERSON asked Mr. Boseman whether he could see PMHS being of help to other high school students; and whether expanding the PMHS facility would be of service to the community. MR. BOSEMAN stated, "Definitely." 3:46:12 PM REPRESENTATIVE GATTO inquired if it is possible for incorrigible children to be helped by the experiences of others. MR. BOSEMAN opined that everyone has to go through his/her own experiences. 3:48:08 PM VICE-CHAIR SEATON referred to Mr. Boseman's statement regarding the acceptance of drug and alcohol use in Petersburg compared to Utah, and asked Mr. Boseman to describe any differences that he experienced. MR. BOSEMAN said he had experienced underage alcohol use to be widely accepted in [Petersburg] Alaska, and that although in use, drugs are not spoken about or seem to be ignored. He said he recalls hearing adults justify and accept juvenile drinking parties by rationalizing that "it's going to happen any way, it might as well be now" and that "kids will be kids"; however if drugs are involved, not much is said. 3:50:45 PM MR. BOSEMAN, in response to more questions, confirmed that he primarily received his drugs and alcohol from adults, and that suppliers whom he has known are still in operation. He went on to say that he has made no attempts to identify these suppliers for law enforcement, stating, "I'm not out to get anyone in trouble". 3:53:20 PM REPRESENTATIVE GATTO returned to Mr. Boseman's earlier statement that in regards to alcohol, adults justify the issue by saying, "it's going to happen anyway, and it might as well be now". He asked whether this statement applies to underage sexual activity. MR. BOSEMAN noted that in his experience, it is a statement commonly made by adults rationalizing underage drinking. He is not able to speak to the point of whether it translates as a pressure statement for young girls to have sex. 3:55:26 PM MS. OHMER informed the committee that under age sexual activity, particularly as it relates to substance abuse and young girls, is a concern in the community. Also, PMHS works hard to intervene in substance abuse situations as early as possible. In response to questions, she offered her belief that when a teen is found to be in possession of an illegal substance it would indicate a history of use. MS. OHMER, in response to another question, offered her understanding that schools do have policies regarding drug use incidents, and that if a student is caught, suspension from an athletic team may occur. She opined, however, that many are using who are not being caught, and that athletic involvement is no longer the deterrent that it once was. 3:59:39 PM MICHAEL BIGGERS indicated that the basis for his [digital] presentation centered around divorce and the damage that it can cause to those involved; the presentation consisted of a slide show entitled "Goodbye Asshole". [Some technical difficulties with part of the visual aspect of the presentation occurred, providing audio only.] 4:03:22 PM JESSICA GREENE introduced her digital presentation, which she indicated focused on a drug program that she attended in Burien, Washington, and the help that she has received from PMHS as an outpatient. In response to a question she said that things are going [well] for her now. 4:07:49 PM REPRESENTATIVE ANDERSON said he would like to see these presentations made available as part of a deterrent program for other students. 4:10:33 PM VICE-CHAIR SEATON asked Ms. Greene about substance abuse in Petersburg, and the focus of the rehabilitation center she attended. He also said he was interested in what she had experienced as being the accepted drug(s) of choice in Petersburg. MS. GREENE said that the treatment center in Burien was for drug and alcohol rehabilitation, and that according to her experience, painkillers and alcohol are the drugs of choice, and that juvenile use of alcohol is widely accepted. In response to further questions she said that adults with relationships to minors buy alcohol for them, or often an unknown adult would be asked to do it. 4:13:49 PM VICE-CHAIR SEATON asked Ms. Greene what was "in it" for the suppliers. MS. GREENE answered that regarding alcohol, most suppliers hang around for a while and just share a couple of drinks. Regarding prescription painkillers, the dealers receive money for finding the requested drugs. She went on to say that with regard to prescription drugs, they have become available via extensions of refill authorizations, prescriptions given for minor ailments, and stealing from the elders. MR. BIGGERS, in response to questions, reported that he is no longer angry with his father, and that he has learned effective coping skills with the help of PMHS staff. In a follow up response he described how anger episodes effect his life today versus when he first began receiving services from PMHS. 4:23:41 PM REPRESENTATIVE GATTO hypothesized moving the Petersburg community to the Seattle area. If given the various choices of a more cosmopolitan location, he asked, would Mr. Biggers still have utilized, and stayed with, the program at PMHS. MR. BIGGERS praised the Petersburg staff, and stated that the support he has found at PMHS could not easily be replaced. 4:24:43 PM KATIE EDFELT had her [digital] presentation shown by Ms. Ohmer. 4:27:30 PM VICE-CHAIR SEATON expressed his appreciation for the work being done in Petersburg by PMHS. REPRESENTATIVE DAHLSTROM asked if statistics could be provided focusing on the points that were brought up today, including any available statistics regarding [underage] sexual activity. MS. OHMER indicated that she would get that information to the committee. 4:29:26 PM VICE-CHAIR SEATON requested that Ms. Ohmer identify areas of the current system that could be altered to help PMHS be more effective in dealing with the identified community problems. He asked if she could specify any constraints or overbearing requirements. MS. OHMER identified the administrative and documentation requirements that have increased in the last two years to the point of becoming burdensome. These prevent her from having the client contact hours that she normally carries which in turn creates a reduction in client services. She stated that due to the time consumed fulfilling documentation requirements, the number of clients served at PMHS this year will be reduced from 400 to 200. She then outlined, and provided examples of, the documentation that is necessary to secure funding, indicating how the requirement hampers day-to-day operations. Ms. Ohmer asked that a streamlined system be developed to certify and record the casework. VICE-CHAIR SEATON acknowledged that attempts to streamline can often, as in this case, go in the opposite direction. However, he said he is appalled that the documentation requirement would so drastically reduce the number of clients served. 4:34:28 PM MS. OHMER went on to describe what she considers to be a very disturbing requisite, that being the state-imposed requirement of entering personal client information onto a database. Due to the accessibility of this database, Ms. Ohmer said she considers this requirement to be in violation of patient confidentiality, and a breach of doctor-client trust. In addition to being objectionable, she remarked, the requirement has also proven to be extremely time consuming, given what she characterized as the current dysfunctional computer system. VICE-CHAIR SEATON wondered if this requirement is intended to maintain compliance with the Health Insurance Portability and Accountability Act, (HIPAA). MS. OHMER replied that whether it is for HIPAA compliance or not, it is her understanding that the database entry must be done in order to receive funding and to keep PMHS's doors open. 4:35:52 PM REPRESENTATIVE CISSNA said she would like to understand from which direction the mandate for documentation is most demanding: federal or state. MS. OHMER characterized the federal requirements as being manageable. She said that according to her experience, the State of Alaska mandates are the biggest problem. Ms. Ohmer in response to a question explained why the majority of the federal information cannot be interfaced with the state requirements. Additionally, federal funds funneled through the state are held up, awaiting additional statistical information prior to being released to the center; this serves to slow down the funding process. 4:39:31 PM MS. OHMER in response to a question, stepped through the details of dealing with involuntary commitments in the Petersburg community, where patients may [ultimately] be transported to Juneau, or, if space is not available, moved north to the Alaska Psychiatric Institute (API) in Anchorage. She also outlined the impacts on the budget of dealing with "ex parte" patients. 4:45:26 PM VICE-CHAIR SEATON asked Ms. Ohmer if there are any other issues that are "dragging down the system of providing mental health treatment" in Petersburg. MS. OHMER said she expects that the lifting of the aforementioned burdens and stressors would rejuvenate PMHS and other similar centers statewide. She reported that for the first time in her twelve-year tenure, the perception in Petersburg is that the legislature would like to discontinue the PMHS funding. Although Ms. Ohmer said she sees this as a possibly skewed perception, the support for these services, as experienced in the past, is not currently evident, nor does it seem that an appreciation exists for what PMHS offers. In summary she stated: I do believe that this type of service doesn't just save lives, but it saves money. We keep people out of hospitals and we keep people out of prison. ... That was one of the reasons that we wanted to communicate that the dollars you send us, and they are a significant amount of dollars, make a difference. Because of that I believe that [PMHS] belongs to each of you as well as to those of us on the front lines. ... 4:47:06 PM REPRESENTATIVE CISSNA asked whether payroll issues are still a problem. Going on, she called for her colleagues on the committee to join with her in viewing non-profits as partners to the state. Representative Cissna said she would expect such a view to maximize the best, quality service from non-profits. She asked Ms. Ohmer how the legislature could further that image with PMHS. MS. OHMER stated that the sense of partnership PMHS previously established with the state has dissolved over time, and said that she looks forward to receiving whatever support the legislature deems possible. 4:49:47 PM VICE-CHAIR SEATON admitted that the committee does not necessarily have a way to identify the most effective programs. He encouraged Ms. Ohmer, and directors of centers who may be listening throughout the state, to speak with committee members and other representatives on an individual basis to inform them about effective and ineffective programs. MS. OHMER reiterated that she "would love to see more people and do less paperwork", if that's possible. 4:52:04 PM REPRESENTATIVE GATTO queried whether paper records are a requirement, and whether digital records might be more expedient and helpful. MS. OHMER confirmed that paper records are required and, in her office, preferred. She went on to express her concern for confidentiality when utilizing digital records. Other problems arise as well, when entering digital records: computer glitches, database crashes, and lengthy hours of work lost due to a dysfunctional computer system. VICE-CHAIR SEATON said he has been aware of computer problems at API. He asked if PMHS's computer system has been improved and if high-speed access is available. 4:53:32 PM MS. OHMER specified that a "T-1" line would be required for PMHS to be on high speed and there is not currently a subsidy to make it affordable. She described how it can take an hour to load a page of documentation. She said she does understand the need for accurate, detailed documentation. VICE-CHAIR SEATON expressed his understanding that these computer problems had been solved in Homer and elsewhere, but acknowledged that perhaps they have not been solved. He expressed his appreciation for the presentations, and relayed apologies from Representative Wilson for her absence. ADJOURNMENT  4:55:57 PM There being no further business before the committee, the House Health, Education and Social Services Standing Committee meeting was adjourned at 4:55 p.m.