ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  March 23, 2017 3:05 p.m. MEMBERS PRESENT Representative Ivy Spohnholz, Chair Representative Bryce Edgmon, Vice Chair Representative Sam Kito Representative Geran Tarr Representative David Eastman Representative Jennifer Johnston Representative Colleen Sullivan-Leonard MEMBERS ABSENT  Representative Matt Claman (alternate) Representative Dan Saddler (alternate) COMMITTEE CALENDAR  HOUSE BILL NO. 138 "An Act establishing the month of March as Sobriety Awareness Month." - MOVED HB 138 OUT OF COMMITTEE 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." - MOVED HCR 2 OUT OF COMMITTEE HOUSE CONCURRENT RESOLUTION NO. 3 "Proclaiming April 2017 as Child Abuse Prevention Month; and proclaiming April 7, 2017, as Go Blue Friday." - MOVED HCR 3 OUT OF COMMITTEE HOUSE BILL NO. 151 "An Act relating to the duties of the Department of Health and Social Services; relating to training and workload standards for employees of the Department of Health and Social Services; relating to foster care licensing; relating to placement of a child in need of aid; relating to the rights and responsibilities of foster parents; relating to subsidies for adoption or guardianship of a child in need of aid; requiring the Department of Health and Social Services to provide information to a child or person released from the department's custody; and providing for an effective date." - MOVED CSHB 151(HSS) OUT OF COMMITTEE PREVIOUS COMMITTEE ACTION  BILL: HB 138 SHORT TITLE: MARCH: SOBRIETY AWARENESS MONTH SPONSOR(s): REPRESENTATIVE(s) WESTLAKE 02/22/17 (H) READ THE FIRST TIME - REFERRALS 02/22/17 (H) HSS, CRA 03/07/17 (H) HSS AT 3:00 PM CAPITOL 106 03/07/17 (H) Heard & Held 03/07/17 (H) MINUTE(HSS) 03/23/17 (H) HSS AT 3:00 PM CAPITOL 106 BILL: HCR 2 SHORT TITLE: RESPOND TO ADVERSE CHILDHOOD EXPERIENCES SPONSOR(s): REPRESENTATIVE(s) TARR 01/23/17 (H) READ THE FIRST TIME - REFERRALS 01/23/17 (H) HSS, STA 03/14/17 (H) HSS AT 3:00 PM CAPITOL 106 03/14/17 (H) 03/21/17 (H) HSS AT 3:00 PM CAPITOL 106 03/21/17 (H) Heard & Held 03/21/17 (H) MINUTE(HSS) 03/23/17 (H) HSS AT 3:00 PM CAPITOL 106 BILL: HCR 3 SHORT TITLE: APRIL 2017: CHILD ABUSE PREVENTION MONTH SPONSOR(s): REPRESENTATIVE(s) TARR 01/23/17 (H) READ THE FIRST TIME - REFERRALS 01/23/17 (H) HSS, FIN 03/09/17 (H) HSS AT 3:00 PM CAPITOL 106 03/09/17 (H) Heard & Held 03/09/17 (H) MINUTE(HSS) 03/23/17 (H) HSS AT 3:00 PM CAPITOL 106 BILL: HB 151 SHORT TITLE: DHSS;CINA; FOSTER CARE; CHILD PROTECTION SPONSOR(s): REPRESENTATIVE(s) GARA 03/01/17 (H) READ THE FIRST TIME - REFERRALS 03/01/17 (H) HSS, FIN 03/16/17 (H) HSS AT 3:00 PM CAPITOL 106 03/16/17 (H) Heard & Held 03/16/17 (H) MINUTE(HSS) 03/21/17 (H) HSS AT 3:00 PM CAPITOL 106 03/21/17 (H) Heard & Held 03/21/17 (H) MINUTE(HSS) 03/23/17 (H) HSS AT 3:00 PM CAPITOL 106 WITNESS REGISTER REPRESENTATIVE DEAN WESTLAKE Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Presented HB 138 as the sponsor of the bill. REPRESENTATIVE GERAN TARR Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Presented HCR 2 and HCR 3 as the sponsor of these resolutions. TREVOR STORRS, Executive Director Alaska Children's Trust Anchorage, Alaska POSITION STATEMENT: Testified in support of HCR 2 and in support of HB 151. ALIZA KAZMI, Policy Specialist Alaska Network on Domestic Violence and Sexual Assault Juneau, Alaska POSITION STATEMENT: Testified in support of HCR 3. CAROL EVON Bethel, Alaska POSITION STATEMENT: Testified in support of HCR 3. REPRESENTATIVE LES GARA Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Presented HB 151 as the sponsor of the bill. MARNA SANFORD Tanana Chiefs Conference Alaska Regional Coalition Fairbanks, Alaska POSITION STATEMENT: Testified in support of HB 151. CHRISTY LAWTON, Director Central Office Office of Children's Services Department of Health and Social Services Juneau, Alaska POSITION STATEMENT: Answered questions during the discussion of HB 151. AMANDA METIVIER, Statewide Coordinator Facing Foster Care in Alaska Anchorage, Alaska POSITION STATEMENT: Testified during discussion of HB 151. ACTION NARRATIVE 3:05:29 PM CHAIR IVY SPOHNHOLZ called the House Health and Social Services Standing Committee meeting to order at 3:05 p.m. Representatives Spohnholz, Edgmon, Kito, Tarr, Sullivan-Leonard, and Johnston were present at the call to order. Representative Eastman arrived as the meeting was in progress. HB 138-MARCH: SOBRIETY AWARENESS MONTH  3:06:35 PM CHAIR SPOHNHOLZ announced that the first order of business would be HOUSE BILL NO. 138, "An Act establishing the month of March as Sobriety Awareness Month." 3:06:50 PM REPRESENTATIVE DEAN WESTLAKE, Alaska State Legislature, paraphrased from the sponsor statement, which read: House Bill 138 seeks to have the State of Alaska recognize March as Sobriety Awareness Month. The purpose of Sobriety Awareness Month is to call attention to Alaska's aggregate population of citizens, who practice a positive and healthy non- consumer lifestyle of any mood/mind altering substances. Sobriety Awareness Month is an opportunity for schools, community groups, and other public and private agencies and individuals to recognize, appreciate, and celebrate the existence of all Alaska's citizenry, who by virtue of their freely chosen lifestyle, serve as Living Examples-To-The- Truth (LETTT) that life can be lived and enjoyed without having to consume mood/mind altering substances. Individuals that lead a sober life are an asset to Alaska in that they can help reduce the incidence of alcohol or drug related social ills such as crime, domestic violence, and child abuse & neglect. Please join me in support of recognizing this valuable group of Alaskans and their lifestyle. 3:07:39 PM CHAIR SPOHNHOLZ opened public testimony. 3:07:51 PM CHAIR SPOHNHOLZ closed public testimony. 3:08:11 PM REPRESENTATIVE EDGMON moved to report HB 138 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 138 was moved from the House Health and Social Services Standing Committee. 3:08:31 PM The committee took an at-ease from 3:08 p.m. to 3:11 p.m. HCR 2-RESPOND TO ADVERSE CHILDHOOD EXPERIENCES  3:11:13 PM CHAIR SPOHNHOLZ announced that the next 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. REPRESENTATIVE GERAN TARR, Alaska State Legislature, stated that the proposed resolution urged the governor and the Alaska State Legislature to work together to address the public health crisis from Adverse Childhood Experiences (ACEs) in Alaska. 3:11:39 PM CHAIR SPOHNHOLZ opened public testimony. 3:12:04 PM TREVOR STORRS, Executive Director, Alaska Children's Trust, reported that Alaska Children's Trust was the statewide lead organization focused on the prevention of child abuse and neglect. He stated that adverse childhood experiences (ACEs) had an increasing toll on Alaskans throughout their lives. Those people with high ACE scores were less healthy, earned less, and required more expensive social programs. He stated that a person with 4 or more ACEs was 12 times more likely to attempt suicide, 10 times as likely to use injection drugs, 7 times as likely to be an alcoholic, 3 times more likely to be unable to work and twice as likely to earn $20,000 or less annually. He added that they would be 2 times as likely to drop out of high school. He declared that ACEs had a high cost in human and economic terms. He stated that it was necessary to get to the root cause of the issues or the need for services would increase. He declared that support of HCR 2 would start to change old practices which did not work, and instead encourage investment in programs that got to the root of the issue. He encouraged support for the proposed resolution. 3:14:22 PM CHAIR SPOHNHOLZ closed public testimony. 3:14:40 PM REPRESENTATIVE EDGMON moved to report HCR 2 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HCR 2 was moved from the House Health and Social Services Standing Committee. 3:15:00 PM The committee took a brief at-ease. HCR 3-APRIL 2017: CHILD ABUSE PREVENTION MONTH    3:17:27 PM CHAIR SPOHNHOLZ announced that the next order of business would be HOUSE CONCURRENT RESOLUTION NO. 3, Proclaiming April 2017 as Child Abuse Prevention Month; and proclaiming April 7, 2017, as Go Blue Friday. 3:17:40 PM REPRESENTATIVE GERAN TARR, Alaska State Legislature, declared that the resolution continued the tradition of declaring attention for April as Child Abuse Prevention Month and the need for everyone to work together with community organizations and neighbors. She pointed out that the resolution specifically stated April 7 as Go Blue Friday, a day recognized as an opportunity to talk about child abuse prevention. 3:18:27 PM CHAIR SPOHNHOLZ opened public testimony. 3:18:41 PM ALIZA KAZMI, Policy Specialist, Alaska Network on Domestic Violence and Sexual Assault, stated that the network offered its support for this proposed resolution. She stated that child abuse was a critical problem throughout Alaska and that it was important to build awareness as one tool of prevention. She reminded that violence was preventable, and she encouraged all Alaskans to become more aware and to act to prevent it. 3:19:45 PM CAROL EVON stated that she was a family advocate for the children's advocacy center. She declared that no child should be hurt in any way as it puts a scar on them for the rest of life. She pointed out that children can think it is their fault and withdraw from family and friends. She opined that it was better to talk about these experiences, as it allowed everyone to help the victim. She stated that this was one reason it was so important to have child awareness month, and to work together to make children's lives better. REPRESENTATIVE TARR thanked Ms. Evon and the sensitive work of the child advocacy centers to help the process. 3:21:56 PM CHAIR SPOHNHOLZ closed public testimony. 3:22:15 PM REPRESENTATIVE EDGMON moved to report HCR 3 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HCR 3 was moved from the House Health and Social Services Standing Committee. 3:22:33 PM The committee took an at ease from 3:22 p.m. to 3:25 p.m. HB 151-DHSS;CINA; FOSTER CARE; CHILD PROTECTION    3:25:30 PM CHAIR SPOHNHOLZ announced that the final order of business would be HOUSE BILL NO. 151, "An Act relating to the duties of the Department of Health and Social Services; relating to training and workload standards for employees of the Department of Health and Social Services; relating to foster care licensing; relating to placement of a child in need of aid; relating to the rights and responsibilities of foster parents; relating to subsidies for adoption or guardianship of a child in need of aid; requiring the Department of Health and Social Services to provide information to a child or person released from the department's custody; and providing for an effective date." 3:25:46 PM REPRESENTATIVE LES GARA, Alaska State Legislature, summarized the proposed bill, and paraphrased from the Sponsor Statement [Included in members' packets], which read: Foster youth in Alaska are not getting the chances they deserve. The Children Deserve a Loving Home Act aims to increase the likelihood that foster youth will have the same opportunities in life, and same health and well-being, as their peers. When roughly 40% of our foster youth end up homeless at some point in their lives after leaving care, and roughly 20% end up in jail, it's a call for reform. The nation's leading foster care non-profit, Casey Family Programs, has the correct goal to reduce the number of youth languishing in foster care by 50% by 2020. Alaska should join that effort. We should achieve it not by leaving youth in neglect and abuse to keep our foster care numbers down, but by getting neglected and abused youth out of the foster care system, into a permanent, loving home, much more quickly than we do now. Many Alaskans recognize that our child welfare system has room to improve; this bill seeks to make real positive changes that support youth and families, as well as the caseworkers who serve them. It's been well documented by many sources that when case workers are overworked, outcomes for children and families suffer. The Office of Children's Services (OCS) recommends standards of approximately 12 cases or families per worker but today, most caseworkers are carrying caseloads that vastly exceed that amount (as high as 43 families in Wasilla, 36 in Homer, and 30 or more in six of the state's main OCS offices). Conditions in rural Alaska, especially the challenges of remote travel, make even a 12-family caseload overwhelming for workers in such regions. Beyond the risk of poorer outcomes, high caseloads contribute to high worker turnover, a costly problem that slows timelines to permanency. This bill seeks to improve both caseload levels and worker retention by implementing significant new training and workforce standards. New workers would receive a minimum of six weeks of training and would carry no more than six cases/families in the first three months, and 12 families in the first six months. The bill also provides for the employment of mentors to help caseworkers become more effective and make the transition from training to a full caseload. These standards are recognized to improve outcomes, enable faster timelines to permanency, and allow case workers to perform their duties as intended. In addition, this bill provides for a number of other changes to support the well-being of youth in care, and to promote quicker timelines for children returning to, or finding new, permanent homes. The bill extends subsidies for adoptions and guardianships to age 21, to incentivize permanency and the closing of cases, and promotes contact with siblings and with previous out-of-home caregivers to promote the well- being of children and maintain a network of support for them. Another important tenet of this bill is enacting timelines for waivers to licensing requirements for relatives who may want to care for a child, but are not licensed foster parents. The bill also makes it easier for youth and foster parents to engage in normal day to day activities, such as going on vacation without prior caseworker approval, with fewer requirements. In addition, youth at age 14 are empowered to participate in their case plan with a larger role. This bill also strengthens the requirement to search for relatives before placing a child with foster parents, recognizing that placements with family are often the best and most loving option for youth. Providing support, and a voice, for youth and families who need our help is perhaps one of our most important duties in public service. This bill seeks to give caseworkers the tools they need to carry out their duties to the best of their abilities, and it seeks to support youth and families with provisions that support well-being, make it easier for children to move out of the system and into a permanent home more quickly, and provide the necessary resources for a system that can function well. This bill is intended to create an environment where loving homes are the priority for all youth. CHAIR SPOHNHOLZ directed attention to the attached fiscal note, with additional money for adoption subsidies, and asked if money had been backed out for providing care for those foster children. REPRESENTATIVE GARA replied that he had also thought it "would be a wash," as the daily foster care rate would not be paid although the adoption rate would be paid. He said that the cost was for every child in an adoptive home and they would start getting payments at ages 18 through 20. CHAIR SPOHNHOLZ asked if the language could be changed so as not to be retroactive to previously completed adoptions. REPRESENTATIVE GARA replied that he was not sure if this was allowed under federal law and whether there would be any legal impediments to just using general funds for those few youth over 18 who might benefit from this proposed bill. He said they wanted to ensure there were not any federal penalties, and he offered his belief that there was not an equal protection problem. CHAIR SPOHNHOLZ shared a story of a child her family had adopted about 10 years ago, knowing that the subsidy would end when the child turned 18 years of age. She pointed out that the child did not currently qualify for Medicaid, which was important to pay for her case management and other services. She stated that her family had adopted with full understanding, and they did not expect any compensation. REPRESENTATIVE JOHNSTON asked if the $3 million added to the budget would cover the costs of the bill. REPRESENTATIVE GARA said that this money would "make headway" as it was focused on lowering the caseloads for new case workers, as well as paying for 4 - 6 weeks of training. He declared that this money would not get the caseloads down to the projected low of six cases in the first three months, and twelve in the first six months, although he opined it would "get somewhere a little bit more than half way there." He stated that the money did not address the caseload limits for senior case workers. He added that there was money for a few mentors to new case workers, as well as an increase to the number of supervisors. He declared that the money would not cover the cost of the bill. He stated that this was more aggressive than the proposed bill, although passage would mean the cost of the proposed bill would be less over time. REPRESENTATIVE JOHNSTON asked if, during consideration of the proposed bill, $3 million was considered as financing to get the bill started. REPRESENTATIVE GARA replied that he wanted to get this on the road, as it was going to be a three-year process. 3:38:03 PM CHAIR SPOHNHOLZ opened public testimony. 3:38:21 PM TREVOR STORRS, Executive Director, Alaska Children's Trust, reported that the Trust was a statewide organization focused on the prevention of child abuse and neglect. He stated that abuse and neglect was happening during the most critical time of a child's life, and that children often adopted high risk behaviors to cope with the pain of abuse and neglect. He stated that it was important to ensure the safety net that was designed to protect children. He declared that the high caseloads of Office of Children's Services (OCS) case workers made it difficult to provide the support and attention necessary to overcome this experience. He stated that the proposed bill addressed the court challenges faced by OCS by reducing the high caseloads and high worker turnover to ensure that the purpose of the safety net was achieved, and to help strengthen the system. He declared support for the proposed bill. 3:40:35 PM MARNA SANFORD, Tanana Chiefs Conference, Alaska Regional Coalition, expressed support for the proposed bill from all the members of the conference. 3:41:41 PM CHAIR SPOHNHOLZ closed public testimony. 3:41:49 PM The committee took an at ease from 3:41 p.m. to 3:46 p.m. 3:46:54 PM CHAIR SPOHNHOLZ brought the committee back to order. REPRESENTATIVE JOHNSTON asked that the Office of Children's Services answer questions regarding the fiscal note, and whether this bill met the financial needs included in the house budget. 3:47:58 PM CHRISTY LAWTON, Director, Central Office, Office of Children's Services, Department of Health and Social Services, offered her belief that the $3 million in the amendment to the operating budget was for 33 positions, which included a few mentors, although she was unsure if this also referenced money for an extension of training. She declared that this was only a fraction of the necessary positions identified. She reported that the fiscal note called for 81 positions, although this could be fewer if there was not a need for management staff for the subsidy and certification. She noted that the language of the bill pointed to a need for more case workers with initially reduced caseloads during a training period. She stated that the $3 million would not be sufficient, but "it would certainly go a lot farther." REPRESENTATIVE JOHNSTON asked if the proposed fiscal note was for funding above what was currently budgeted for Fiscal Year 2018. MS. LAWTON said that the fiscal note started from scratch to meet the intent of the bill. REPRESENTATIVE SULLIVAN-LEONARD directed attention to page 5, Section 6, of the proposed bill, and asked for more detail to the change. MS. LAWTON said that the sponsor's intent in the language of the committee substitute, Version R, was that children 14 years of age or older were assured an opportunity to include up to two additional adults as part of the meeting for development of a case plan. REPRESENTATIVE EASTMAN asked if this was an assumption that foster parents would already be part of the meeting, and would not have to be chosen by the child. MS. LAWTON said that, as foster parents were often participants, the idea was to include people who were usually outside the normal circle involved with the child's life. She suggested that this could include a coach, a god parent, or a family friend. 3:52:14 PM AMANDA METIVIER, Statewide Coordinator, Facing Foster Care in Alaska, pointed out that foster parents were not parties to the case, and she explained that the proposed bill reflected federal law which allowed youth the opportunity to allow other adults they were connected with to be part of the team meeting and to help the child better understand what was happening with their case. She pointed out that these other adults could potentially be long term support, and maybe an adoptive parent. REPRESENTATIVE EASTMAN said that this did not address why the child could not choose the foster parent to be part of the process, and he asked for justification for this prohibition. CHAIR SPOHNHOLZ, directing attention to page 5, line 20, stated that this was in addition to the child's foster parents or department employees. She emphasized that the foster parents were not excluded. REPRESENTATIVE JOHNSTON asked about the priority for use of the $3 million funding listed in the fiscal note. MS. LAWTON declared that she would "absolutely use it for positions." REPRESENTATIVE JOHNSTON asked if it would be used in the same manner as spelled out in the proposed bill. MS. LAWTON replied that, regarding the proposed bill, as her priority would be to provide for good case work and for good outcomes for kids and families, she would provide the best optimal training for staff by allowing them the time to do good work, with the support of a mentor, and to reduce the caseloads for all the case workers. 3:57:16 PM REPRESENTATIVE EDGMON moved to report CSHB 151, Version 30- LS0451\R, Glover, 3/7/17, out of committee with individual recommendations and the accompanying fiscal notes. REPRESENTATIVE EASTMAN objected. REPRESENTATIVE SULLIVAN-LEONARD objected. REPRESENTATIVE EASTMAN said that he needed to see an offset to a program somewhere else if this program was going to be expanded. REPRESENTATIVE SULLIVAN-LEONARD said that, although she supported the concept of the proposed bill, the attached fiscal notes were troublesome, especially in light of recent discussions for the operating budget. She offered her belief that this was too much, and she would prefer to see a task force to take on the challenges posed by the foster care system. She suggested to consider the needs after there was comprehensive data to support the need for the positions, as well as a funding source for these particular positions. REPRESENTATIVE EDGMON declared that he also recognized and supported these concerns for the fiscal impact. He stated that he supported a decision to move the bill from a policy aspect, as the committee had done its work, noting that the fiscal aspect would be addressed in the House Finance Committee. He acknowledged that, without more work and explanation, the fiscal notes would "cause myself and maybe everybody else pause." REPRESENTATIVE JOHNSTON opined that a lot of great work had been presented in the proposed bill, but that even the sponsor had said that amendments were necessary. CHAIR SPOHNHOLZ stated that she shared concerns for the fiscal notes, but that the sponsor had committed to work on this in the House Finance Committee. As a former foster parent and now adoptive parent of a foster child, she was impressed by the scope and reforms in the proposed bill. She pointed out that her adoptive daughter had siblings still in foster care, in part because the subsidy would be removed, and they were challenging children with challenging needs. She said that the Medicaid and the foster care subsidies were necessary for them to properly thrive. She noted that it took tenacity to overcome the sibling contact issue. She offered her belief that the case load issue was very serious and that even the most dedicated, professional, and highly qualified case workers were struggling. She offered a personal anecdote about the efforts of her daughter's case worker. She lauded the sponsor for the comprehensiveness of the proposed bill. 4:03:35 PM A roll call vote was taken. Representatives Spohnholz, Kito, Tarr, and Edgmon voted in favor of HB 151. Representatives Sullivan-Leonard, Johnston, and Eastman voted against it. Therefore, CSHB 151 (HSS) was reported out of the House Health and Social Services Standing Committee by a vote of 4 yeas - 3 nays. 4:05:11 PM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 4:05 p.m.