ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  January 13, 2021 10:03 a.m. MEMBERS PRESENT Representative Tiffany Zulkosky, Chair (via teleconference) Representative Matt Claman (via teleconference) Representative Geran Tarr (via teleconference) MEMBERS ABSENT  Representative Ivy Spohnholz, Vice Chair Representative Harriet Drummond Representative Sharon Jackson Representative Lance Pruitt COMMITTEE CALENDAR  PRESENTATION: DISCUSSION OF DHSS REORGANIZATION - HEARD PREVIOUS COMMITTEE ACTION  No previous action to record WITNESS REGISTER AMANDA METIVIER, Director Facing Foster Care in Alaska (FFCA) Anchorage, Alaska POSITION STATEMENT: Provided testimony about FFCA's concerns regarding the proposal to split the Department of Health and Social Services. LYNN BIGGS, Senior Director Casey Family Programs Yakima, Washington POSITION STATEMENT: Provided a PowerPoint presentation titled "Safe Strong Supportive," dated 1/13/21. RICHARD PETERSON, President Central Council of the Tlingit and Haida Indian Tribes of Alaska Juneau, Alaska POSITION STATEMENT: Provided testimony urging that Tlingit and Haida tribes be included and consulted in the proposed reorganization of DHSS. "PJ" POLLACK B. SIMON, JR., Chief/Chairman Tanana Chiefs Conference (TCC) Allakaket, Alaska POSITION STATEMENT: Testified in opposition to the proposed reorganization of the Department of Health & Social Services and urged that TCC and other Alaska tribes be consulted on ways to improve current department services. TAMMY SANDOVAL Anchorage, Alaska POSITION STATEMENT: Testified on behalf of herself in opposition to the proposed DHSS reorganization. JAKE METCALFE, Executive Director Alaska State Employees Association (ASEA) Local 52 Anchorage, Alaska POSITION STATEMENT: Provided testimony about ASEA's concerns with the proposed DHSS reorganization. ACTION NARRATIVE 10:03:35 AM CHAIR TIFFANY ZULKOSKY called the House Health and Social Services Standing Committee meeting to order at 10:03 a.m. Representatives Claman (via teleconference) and Zulkosky (via teleconference) were present at the call to order. Representative Tarr (via teleconference) arrived as the meeting was in progress. ^PRESENTATION: Discussion of DHSS Reorganization PRESENTATION: Discussion of DHSS Reorganization  10:04:29 AM CHAIR ZULKOSKY announced that the only order of business would be discussion of Department of Health and Social Services (DHSS) reorganization. CHAIR ZULKOSKY related that in December 2020 Governor Dunleavy and Commissioner Crum announced plans to split DHSS into two new departments a Department of Health and a Department of Family and Community Services. She said the announcement provided little detail about the plan, what it might cost the State of Alaska, and the impacts to stakeholders and those who utilize DHSS programs. The committee invited Commissioner Crum and the department to participate in today's hearing, she continued but they declined to participate. She announced the witnesses and organizations that would be providing testimony. 10:05:51 AM AMANDA METIVIER, Director, Facing Foster Care in Alaska (FFCA), related that FFCA is a statewide nonprofit comprised of current and former "fosterees." She said she is a foster care alumnus who aged out of the system in Anchorage, she has bachelor's and master's degrees in social work, and she has been a licensed foster parent for about 13 years on and off. She stated she also works at the Office of Youth Empowerment (OYE) and serves with other groups at local, state, and national levels working on child welfare issues and efforts to reform. MS. METIVIER thanked the chair and committee members for holding today's hearing to listen about this issue and what it means for children and families across the state. She noted that a number of foster youths are listening to today's presentations because this has a direct impact on their lives. MS. METIVIER noted there is the larger proposed splitting of the Department of Health and Social Services with multiple divisions within the two new departments. She further noted that there is also a proposed bifurcation of the Office of Children's Services (OCS) into two divisions the Office of Early Intervention and the Office of Family Services. Prior to discussing the proposals, she said she would highlight the state of the current system, the challenges, and the impact of COVID because COVID is relevant for what is currently happening for children, families, staff, and the legal parties working in child protection. She stressed that this is a big proposal on the table for people who are just trying to get through the day-to-day dealing with all the things that come with the pandemic as well as the impacts on the state. MS. METIVIER offered her belief that the proposed bifurcation is coming from a place of good intent in trying to improve the system, but said she doesn't think it's the solution or fix in terms of gaining public trust, especially considering timing and lack of input from stakeholders. She stated it's important to understand what's happing with the Office of Children's Services right now since the COVID-19 pandemic began. She works with young people across the state who are in foster care or making their transition out, she explained, so she is in contact with about 300 young people a year. Since COVID hit it feels like every day is a crisis response to housing and basic needs, she related. Young people everywhere are struggling with the challenges of isolation and all that's happened since the pandemic hit. MS. METIVIER specified that the goal of foster care is to get children out of the foster care system and into what is referred to as permanency within 12-24 months. She said children are returned home to their parents when that is possible or placed with relatives or within their tribe or home community, or moved toward finding an adoptive home or a caregiver who can be a legal guardian long term. She noted that of the more than 3,000 children currently in foster care, 65 percent are Alaska Native. Since the pandemic hit, children are lingering in foster care; everything has been stalled. Most state staff are working from home. Over the past 12 months, OCS has lost 171 foster homes and that doesn't include the ones that are on hold due to the pandemic. She related that as a foster parent herself she gets calls almost daily and she can hear the desperation in the voices of the caseworkers everywhere across the state that are trying to find homes for children. This has created incredible challenge on top of their regular day-to-day casework. 10:11:50 AM MS. METIVIER stated that visits between children, parents, and siblings are mostly done virtually via the phone, internet, through Face Time, or Zoom. This poses challenges for parents and children in more rural areas who don't have good access to a phone, she continued. All the research points to visits between children and their parents early and often leading to a timelier reunification. Visits with OCS caseworkers and children in foster care are also mostly done virtually right now, she added. In-person is happening somewhat more on the frontend for investigation, but children in the system are not being seen every 30 days by a caseworker in their foster home. She warned that this creates potential for danger because things are missed, such as smells, sounds, and other people possibly in the home. Also, children are further isolated when everything else is virtual, they have less contact with the outside world. For example, right now therapy is typically conducted virtually, as is school and doctor visits. These children, she advised, are struggling with the isolation and feel like they are forgotten and don't have access to the outside world. MS. METIVIER said court hearings, team meetings, and other legal proceedings that happen in OCS cases are also happening virtually or telephonically, creating delays and continuances and further lengthening the children's time in foster care. She related that older youth who are transitioning out of foster care and into adulthood are doing so at a time when it is even harder to secure housing, employment, and transportation. She stated that FFCA has started a COVID-19 relief fund to help with rental assistance, utilities, and transportation, which are in addition to help that is offered by the communities in which the youth live. She further stated that FFCA has mostly been supporting young parents who are on the brink in that if they miss one rental payment they will be out and then there will be a domino effect. 10:15:07 AM MS. METIVIER explained she has provided this information to help set the tone for the challenges that the system is already facing related to COVID. Then, there is the proposed reorganization and bifurcation of OCS. MS. METIVIER recalled that FFCA spent two years presenting evidence and data to the legislature in support of House Bill 151, passed in 2018 (Thirtieth Alaska State Legislature, signed into law 6/27/2018), because languishing in foster care is damaging to children. She said the bill was rooted in best practice and modeled on New Jersey's gold standard system where caseworkers are limited in their caseloads and are well trained so that families receive both the support and services they need to quickly move children through the system and into permanency. That bill is now in year three of implementation and legislators will receive the fall [2020] annual report. The report shows a slight jump in turnover for OCS staff, which is currently at 47 percent. She said House Bill 151 was a major effort to overhaul the system and to do that the legislature wanted a lot of evidence to know it was going to work. But, in regard to the proposed bifurcation she hasn't seen much evidence. 10:17:20 AM MS. METIVIER spoke to the proposed bifurcation. She explained that typically child welfare has a culture of collaboration. Experts promote collaboration as best practice to bring in the stakeholders, including young people, parents, foster parents, community partners, and tribes. Everyone is brought to the table to discuss what works, what doesn't work, and what direction to take in terms of change. She said the decision to bifurcate OCS wasn't made in the spirit of collaboration; the stakeholders and most groups were notified after the decision was made to move it forward. The only explanation she received was that it would increase public trust to separate the division into two separate divisions. The many unanswered questions should be looked at and considered, she suggested, especially since House Bill 151 is still being implemented. The state has been working with the tribes for a number of years on the [Alaska Tribal Child Welfare Compact] to provide services to families and child welfare. Also, the state has a program improvement plan that it must follow for the federal government. So, she continued, a lot is happening with OCS and how it is supposed to be operating and responding to all these policy changes and efforts with other agencies, organizations, and the federal government, while there is also the impact of the pandemic. Additionally, given the pandemic, the question is whether this is the right time to move forward a bifurcation. MS. METIVIER stated that another consideration is what is the evidence base for this proposal. There is a lot of evidence and research, she advised, about what works in child protection systems. This needs to be drawn upon as decisions are made on how Alaska's system will operate. She pointed out that this is going to require families and legal parties to potentially deal with two separate agencies. Given the many professionals that are involved, it is already hard for children and parents to know whose role is what, what meeting they're going to, what court hearing they're going to, what professional they're talking to. Having then to deal with multiple systems could be absolutely daunting. Child welfare is meant to be a continuum of families coming into the system because of child abuse and neglect, she explained, and addressing those issues that brought them in in an effort to return children to their home of origin, or to their parents, or into another permanent situation. MS. METIVIER noted that the proposed bifurcation would also return OCS to four regions from the current five. She recounted that the House Health and Social Services Committee created the fifth region, the Western Region, at the recommendation of a citizens' review panel. She recommended that a look be taken at whether going back to four regions is the right thing to do. MS. METIVIER urged that the costs be taken into account for two separate divisions, two separate directors, two separate deputies, and the staff beneath those. She also urged that it be taken into account as to what the overall impact is going to be on children and families. Government systems are really difficult to navigate, she advised, so dealing with two separate systems is going to be daunting for families. She related that in urban areas OCS already has a sort of internal bifurcation. One-unit addresses investigation and assessment ("IA") of families when reports come in, and another unit is family services that deals with further case planning with parents and trying to find permanency for children. In the smaller communities there are generalist workers that work a case all the way from the initial assessment through whatever the permanent plan is. She said she therefore isn't sure how a bifurcation of OCS into two divisions is any different than the internal split in urban areas. Ms. Metivier concluded by pointing out that fosterees are listening to today's hearing. She said the opportunity for youth to hear this issue is important, given all that they are facing with being in foster care right now. 10:23:08 AM CHAIR ZULKOSKY thanked Ms. Metivier for her advocacy and personal time for Alaska's youth and families. She requested Ms. Metivier to speak to the disparity of services felt by rural Alaska Native youth in the system. MS. METIVIER replied that 65 percent of children in foster care are Alaska Native, which is disproportionate because they make up about 20 percent of Alaska's overall child population. In some communities they make up 100 percent of the children that are in foster care or out-of-home care. She said the challenges with the pandemic have been even greater for Alaska Native children and the state's ability to follow the Indian Child Welfare Act (ICWA). She related that she is getting calls from across the state to take placement of children in foster care. She pointed out that there is a placement preference standard that is supposed to be followed under ICWA that says to first place with relatives or to look within a tribe or the child's community, and to then move to stranger foster care as a last ditch effort. The desperation, lack of homes, and people overwhelmed by all that is happening in the system is making it even harder to follow that. MS. METIVIER stated that FFCA sees youth who come from rural areas into more urban communities like Anchorage, the Mat-Su Valley, and Fairbanks. They're coming in to live in a foster home or a residential program and it is a further culture shock well beyond separation and the grief and the loss of being removed from their family. Now they've been removed from their community and all they know and all that they are used to. Once that happens, she specified, even bigger challenges are seen on the backend for those youth who then become adults and are transitioning out into the world. They have their own children and family but are still dealing with the trauma and repercussions of what has happened in terms of being removed from their community, especially if they lived a subsistence lifestyle or lived in a much smaller community. MS. METIVIER further related that many of the older youth coming into Anchorage are placed in the downtown shelter at the Covenant House. Covenant House does a great job and tries to respond to the needs of youth, she said, but in a shelter setting the youth become even more vulnerable, especially when they come from a small community to the city. The shelter is a target of traffickers for sex trafficking, and there is a lot of substance abuse and drug use, so these youth are made even more vulnerable. This is often seen a lot with older youth as they transition to adulthood because they've lost their sense of identity and who they are related to their culture. 10:27:45 AM CHAIR ZULKOSKY recalled Ms. Metivier's statement that the proposal for bifurcation was not made in the spirit of collaboration. She noted that there is a type of engagement where people are invited in and notified of a decision or there is an opportunity for meaningful consultation to talk through the impacts and evaluate evidence-based information. She asked Ms. Metivier to speak to the type of engagement that occurred prior to the announcement and FFCA's involvement in discussions following the announcement of the intention to reorganize the department and to bifurcate OCS. MS. METIVIER responded that she heard remnants that DHSS would be announcing reorganization. She said Commissioner Crum called her to notify FFCA that the department would be making the announcement the next day. It was during this call that she first learned of the proposed OCS bifurcation. She offered her belief that the commissioner's intentions were genuine and good in letting her know so that young people would know this was coming and it wouldn't be a surprise. However, she noted, she hasn't received much information since that call. She has seen the proposed organization chart outlining the proposed bifurcation of OCS into two divisions. She said Angel Gonzales, FFCA's board president, participated the following week in the Tribal State Collaboration Group where she learned more about what it looked like and then shared that information with her. No effort has been made [by DHSS] to directly engage young people or foster parents in the process. So, she continued, FFCA has sent out this information and it has caused panic in some young people who are already feeling isolated along with the impacts of the pandemic. In the past when big changes have come or been proposed, the department has held meetings or forums with the stakeholders. That didn't happen in this case, instead notification was received that this decision was made and is happening, so it was a shock. 10:31:18 AM CHAIR ZULKOSKY reiterated that DHSS and the commissioner declined the committee's invitation to participate in today's meeting. She said that subsequently the department shared a letter dated [1/6/20] that stated the proposed timeline for bifurcating OCS was delayed from the [7/1/20] timeframe and that DHSS intends to begin a consultation process in February 2021. She recalled that Ms. Metivier talked about the current conditions at OCS and the significant disparity of Alaska Native youth in the system, and the challenges the department has had. Chair Zulkosky related that during her brief time in the legislature there has been a constant struggle around continuity of caseworkers, people who work within the system, and the challenging environment. She requested Ms. Metivier to speak to the impacts of such a significant reorganization amidst a department that is challenged in meeting its current mission. MS. METIVIER answered that the timing is not the best to propose such a big shift and big undertaking while most people are working from home. She said a number of caseworkers at OCS and frontline staff has told her that they are worried about this and want to give input, but are struggling to complete their daily work because of COVID-19 impacts and the lack of placement options for children in the system. Everything is being done virtually and employees are potentially working at home and trying to homeschool their own children. She stated that public trust was the reason given to her for the proposed OCS bifurcation. It is obvious and known by most people that the public doesn't trust child protection, she said, but it isn't an Alaska specific issue, it's everywhere. This agency has a lot of authority over families to make decisions around removal, but it also has to have that authority because of child abuse and neglect. It's hard to instill trust in the public for an agency that can come in and remove someone's child. Most of the caseworkers and people at OCS don't come in wanting to damage and tear apart families; they come in because they care, want to make a difference, and want to work with families. In terms of public trust, she advised, people connect to people, they don't connect to programs, and so it's really about relationship. The division can be split in two and a fancy new name given to each new side, but she doesn't know that that is going to change how the public looks at it, especially the arm that does the assessment and investigation of child abuse and neglect; it's bigger than that. A part of building trust, she opined, is engaging with the stakeholders and the community around big decisions, like a bifurcation. 10:35:53 AM CHAIR ZULKOSKY invited the next speaker to provide testimony. 10:36:45 AM LYNN BIGGS, Senior Director, Casey Family Programs, provided a PowerPoint presentation titled "Safe Strong Supportive," dated 1/13/21. She stated she has been with Casey Family Programs for 32 years, and for the past 10 years she has worked with state tribes, Facing Foster Care in Alaska, and others. She displayed slide 2 and noted that the Casey Family Programs is the nation's largest operating foundation focused on safely reducing the need for foster care and building communities of hope for children and families. Created in 1966 by Jim Casey, founder of United Parcel Service, the foundation has worked to influence long- lasting improvements to the safety and success of children, families, and the communities where they live. She said the foundation operates in all 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. The foundation's Indian Child Welfare Program has direct agreements with 16 tribes, including three in Alaska. In addition, the foundation has nine field offices that provide direct services to youth in care. MS. BIGGS moved to slide 3 and said Casey Family Programs has been working and investing in Alaska since 2000. It has worked with the state, tribes, philanthropic organizations, the university, Facing Foster Care in Alaska, and others to effect positive, improved outcomes for Alaska children and families. Casey Family Programs, she continued, has sponsored statewide efforts to address adverse childhood experiences in Alaska and to safely reduce the need for foster care. MS. BIGGS spoke to slide 4. She related that a presentation was given last week at the Tribal State Collaboration Group titled "The Mechanisms of American Indian and Alaska Native Inequality in Child Welfare Across the United States." She said two pieces of data provided for Alaska were striking: 1) An Alaska Native infant (age 1 or younger) has a 15 percent chance of being the subject of a child abuse and neglect investigation, which is highest in the nation; and 2) An Alaska Native child has an 80 percent chance of being the subject of a child abuse and neglect investigation by age 18, also the highest in the nation. She stated that the Casey Family Programs has actively supported efforts to reduce this disproportionality of Native children in foster care in Alaska. The foundation sponsored Alaska's 2016- 2020 strategic plan, "Transforming Child Welfare Outcomes for Alaska Native Children." This was a forerunner to the Alaska Tribal Child Welfare Compact, she explained, of which the foundation believes the full implementation would help with the disproportionality and other issues. The foundation also participates in Alaska's Tribal State Collaboration Group. 10:41:18 AM MS. BIGGS pointed out on slide 5 that different states have different configurations for administering child and family services. She said one is a multiple cabinet-level agency, another is a single consolidated health and human services agency, and others consist of various agency combinations of child welfare, juvenile justice, early childhood programs, behavioral and mental health, substance abuse prevention and treatment, public health, and financial assistance. MS. BIGGS moved to slide 6 and stated that there is no research evidence of an ideal organizational structure. Governors and state legislatures have long reorganized state agencies in an effort to improve outcomes, she said. Research is lacking and the limited research that there is, along with extensive state experiences tells that: 1) there is no ideal structure, every approach has pros and cons; 2) positive child and family outcomes cannot be attributed to a particular model; 3) there is no research evidence of improved accountability or service quality with reorganization; and 4) organizational climate and culture (low conflict, cooperation, role clarity) may contribute more to outcomes than interagency coordination structures. MS. BIGGS displayed slide 7, which outlined the pros and cons of a single consolidated health and human services agency. She turned to slide 8 and related that some states have a cabinet- level child and family agency. These states are Arizona, Illinois, Massachusetts, Mississippi, Indiana, Tennessee, New Mexico, Rhode Island, Washington, and New Jersey. Speaking to slide 9, she said states with a child and family agency are Connecticut, Delaware, Wisconsin, Florida, Wyoming, and Vermont. There are lessons learned from these examples, she continued. She then showed slide 10, which outlined the pros and cons of state child and family agencies. MS. BIGGS highlighted the recent reorganization depicted on slide 11 of the Washington State Department of Children, Youth & Families. She said this reorganization began in 2016 when the Washington governor created a Blue Ribbon Commission to recommend the organizational structure for a new cabinet-level department focused solely on children and families. Commission membership included a key legislative committee chair and a retired judge as the co-chairs, along with state legislators, tribal representatives, administrators of existing programs, a court administrator, a state employee union representative, and issue experts. She noted that the commission spent nine months studying the models of other states, developing guiding principles and desired outcomes for the new department, and considering the input of tribes and other stakeholders, data, and financing approaches. 10:45:05 AM MS. BIGGS skipped to slide 13 and discussed some of the lessons learned in regard to state agency reorganization. One lesson is how important it is to review existing data, she said, and there is a lot of data that Alaska could look at and use to determine the agency priorities and desired outcomes for Alaska Native and other Alaska children and families. She stated that the ends determine the means consider how the priorities and the desired outcomes should drive the structure. Reorganization cannot provide support for needed reforms, she advised; tribes, communities, and those with lived experience should be involved in planning from the beginning and throughout [reorganization]. In Alaska particularly, she continued, the involvement and inclusion of the tribes at every step of the way is essential through tribal consultation. At last week's Tribal State Collaboration Group meeting there was a presentation with considerable dialogue between the state and tribes about this. There is realization about how much the tribes need to be involved at every step of the way. She said another lesson learned is to ensure that agency resources are aligned with desired outcomes. Build on and expand existing strengths, successes, and capacity, like the [Alaska Tribal Child Welfare Compact], prevention, and family strengthening. Transition to the new structure typically takes two to five years, she stated. It takes one year or more for planning and preparing, and up to five years for implementation. Targeted efforts are necessary to sustain the momentum and support for change, she added. MS. BIGGS displayed slide 14 and continued her discussion of lessons learned about reorganization. Reorganization is usually disruptive to some extent, she pointed out, with the current pandemic adding to the complexity. It is essential to have shared vision, clear direction, and necessary resources for planning and implementation. She said another lesson is to plan carefully for the separation from a single consolidated health and human services agency. Further, it needs to be ensured that resources are adequate. There is no evidence or experience that new structures save money. Instead there are additional costs associated with the reorganization process and often with new infrastructure. She advised that during the transition it might be necessary to allow for possible redundancy. Another lesson learned is that strong leadership, continuous improvement systems, and accountability mechanisms are important regardless of structure. 10:48:10 AM MS. BIGGS concluded by stating that there is much work to be done in Alaska. She said the Casey Family Programs is most interested in improving outcomes for children and families and to finally see the disproportionality reduced after there being so many efforts. She offered her belief that Alaska has strong, capable, effective tribes and people that are willing and able to take care of their own children in their own communities. Full implementation of the [Alaska Tribal Child Welfare Compact], she continued, would be a very helpful pathway toward the kind of transformation and improved outcomes that the State of Alaska is looking for. 10:49:09 AM CHAIR ZULKOSKY returned to slide 13 and the lesson learned that the transition usually takes two to five years. She asked whether there is any evidence that identifies the impacts to outcomes for children and families that may be experienced during this transition timeframe. MS. BIGGS offered her belief that it puts children and families at more risk. Given the 48 percent turnover rate and the pandemic, there is already a lot of uncertainty and instability, and so she thinks that during such a transition the impact on children and families would be negative. 10:50:20 AM CHAIR ZULKOSKY invited the next witness to testify. 10:50:56 AM RICHARD PETERSON, President, Central Council of the Tlingit and Haida Indian Tribes of Alaska, noted that the Central Council of the Tlingit and Haida Indian Tribes of Alaska Tlingit and Haida is the largest tribe in Alaska with over 32,000 enrolled citizens across the state, nation, and world. He said the proposed changes to DHSS impact the tribe significantly in more than just one area. It is hard to talk about the division of DHSS and not discuss negative impacts to tribal programs. He explained that tribal programs span across the department, each one connected to the other as children and families are served. He recognized that each division has a tremendous task, but said Tlingit and Haida families, whether in a 24/7 facility or receiving prevention services, are all connected. MR. PETERSON pointed out that Tlingit and Haida has partnered with the Department of Health and Social Services and the Office of Children's Services (OCS) for many years to better serve its children and families. He related that Tlingit and Haida is proud to be one of the tribes that signed the historic compact with OCS in 2017, which took many years of consultation and cooperation to achieve. Tribes have demonstrated a willingness to put in the hard work to develop a child welfare compact, recognizing that 65 percent of the children in custody are Alaska Native. He expressed Tlingit and Haida's hope that any changes at OCS would not undermine the current compact or the true government-to-government process in which it was created. Expanded compacting with tribes could be a win-win for both the state and for the children and families served by OCS, he said. It was created as a model for other state departments to follow when working with tribes. MR. PETERSON requested the state to consider and include tribes when planning to elevate the [Alaska Tribal] Child Welfare Compact to the Office of the Commissioner in the spirit that it was created. He said it is unclear whether the compact will be elevated to the commissioner's office, but that if it is elevated, who would oversee the compact? He urged that this person be familiar with working with tribes, child welfare, and have direct connection to the day-to-day operations at OCS. MR. PETERSON related that the rationale given by the Office of the Commissioner to split DHSS is because the department is huge and it's hard to get the time needed in front of the legislature, along with budget considerations and making the department easier to manage. He suggested that an alternative is to engage tribes and community stakeholders familiar with the work, and that more cost-efficient alternatives could be found to address the issues cited rather than splitting the department into two. He said there appears to be duplications between the divisions and administrative operations in both the DHSS and OCS divisions, that it likely would be far more costly, and that the time to find a new commissioner, directors, and staff will be a challenge. The state already struggles to fill the current vacancies, he pointed out, leaving many programs and families not receiving the attention they deserve. He said the tribes are focused on the whole person and family, and he asked who will be looking at the whole family and the client as more and more departments work singularly and not holistically with the DHSS. He further asked whether changes are being made to better serve the family or for other reasons. MR. PETERSON stressed the importance of tribal consultation before significant changes like these are made. He reiterated that tribes partner with DHSS to provide holistic services to their shared citizens. He said the Central Council of the Tlingit and Haida Indian Tribes of Alaska stands ready to engage in consultation with DHSS, especially regarding any proposed changes to how the state addresses child welfare. Tribal consultation in the creation of such an impactful change could make the conclusion stronger and more effective, he stated, and the governor has an obligation to consult with tribes based on DHSS policy that remains in effect. He offered his belief that the current situation is because of systemic racism and this is reflected in the fact that 65 percent of the children in the State of Alaska's care are Alaska Native. It will only get worse if the tribes are not involved, he added. Tlingit and Haida stands committed to partnering with the state and looks forward to engaging further in the process to fix the system. 10:56:10 AM CHAIR ZULKOSKY requested Mr. Peterson to speak to the status of the Alaska Tribal Child Welfare Compact, particularly what was previously proposed for expanded scopes of work with Alaska tribes. She further asked whether those have been pursued and whether there have been related funding agreements to ensure that there are the levels of support needed for tribes to be successful in those scopes of work through the compact. MR. PETERSON deferred an answer to Mary Johnson who represents Tlingit and Haida on the compact. He said he would speak to her and get back to the committee. 10:57:20 AM CHAIR ZULKOSKY inquired about the department's level of engagement with Mr. Peterson's tribe in the existing compact. MR. PETERSON replied that at times it was difficult, and work is being done to get through those. He related that in last week's working group meeting with Commissioner Crum he stressed to the commissioner that coming to the table and announcing the decision that has already been made isn't at all government-to- government consultation. He said he further stressed to the commissioner that with 65 percent of the children in state care being Alaska Native, Tlingit and Haida should be in the discussion at the beginning rather than being told the outcome. 10:58:26 AM CHAIR ZULKOSKY recalled Ms. Biggs' statement that a transition takes two to five years. She requested Mr. Peterson to speak to his on-the-ground experience with families that are currently in these programs and systems and his thoughts about impacts to their experience and wellbeing through a transition process. MR. PETERSON responded that this division is being proposed because it is so difficult to administer now. "Well, what's going to happen while they are trying to figure it out?" he asked. He said he is worried about the children and the families that are going to fall between the cracks. These are the children's formative years, he pointed out, and these children don't have five years or even one year for it to be figured out. This needs to be figured out before it is implemented, and he doesn't trust that it has been. 10:59:55 AM CHAIR ZULKOSKY recalled Mr. Peterson mentioning the impact of institutional inequity and structural racism. She asked Mr. Peterson to talk about what that means and the impact that he sees it having on Alaskans through families that need to utilize programs like this. MR. PETERSON answered that the systemic racism goes back as part of the inter-generational trauma that was created through colonization, boarding schools, and religious organizations, and so that is passed down. "Now, when you have a system that is not made up of our people, it can continue," he said. "So, I think that the solution is to have ... compacting and having us be the solution." He continued: I think we are the solution and I think compacting is a way that we can better serve our families and assure that systemic racism doesn't continue. And I don't think sometimes that systemic racism isn't intentional, but ... it's what happens when you don't know, and you don't understand. Alaska is a diverse area, our communities were made up of diverse people, and I think ... if the institution serving our people doesn't reflect the people it serves that unintentionally you're going to see that that systemic racism continues. 11:01:33 AM CHAIR ZULKOSKY concurred and recalled former Lieutenant Governor Davidson's mantra, "Nothing about us without us." MR. PETERSON replied, "Exactly." He added: I think there is an opportunity for us to work in partnership on solutions and I think given the opportunity we can do that. ... I think having true consultation with the governor's office, with Commissioner Crum, I think we could really develop what real solutions look like. But I really believe if it continues the way it has, that's just not going to happen. 11:02:20 AM CHAIR ZULKOSKY invited the next witness to testify. 11:02:41 AM "PJ" POLLACK B. SIMON, JR., Chief/Chairman, Tanana Chiefs Conference (TCC), related that TCC is a nonprofit intertribal consortium of 37 federally recognized Indian tribes and 41 Alaska Native communities located across Interior Alaska, including Fairbanks. He said TCC serves 16,000 Alaska Natives located in Fairbanks and in the rural villages located along the 1,400-mile-long Yukon River and its tributaries, and that TCC's service area encompasses 235,000 square miles. CHIEF SIMON noted that TCC's members utilize services from every division of the Department of Health & Social Services (DHSS) and are dis-appropriately represented as beneficiaries of many of these programs. He pointed out that TCC is a co-signer to the Alaska Tribal Health Compact and the Alaska Tribal [Child] Welfare Compact and that TCC's employees have worked alongside state personnel through many administrations on various work groups and collaborations. He said TCC will necessarily be impacted by the administration's proposal to split the department, and so TCC is willing to work with the commissioner to achieve the best results for Alaska. CHIEF SIMON stressed that TCC does not support the proposed division of DHSS as it would place a separation between programs and services that are necessarily intertwined. The proposed separation of the Office of Children's Services (OCS), and the Division of Public Assistance, and Division of Behavioral Health, is baffling, he said. He asked how OCS would support families in a time of crisis without working with the divisions that have the resources to provide wraparound services. The OCS must provide active efforts to prevent the breakup of tribal families, he stated, and those efforts nearly always include counseling, support to provide safe homes and environments with the safe homes, and other services operated by the divisions that would remain in the proposed Department of Health. He said similar comments could be made about the Division of Juvenile Justice, which is placed within DHSS, based on the understanding that these youth, Alaska Native youth, need behavioral help and prevention. He further asked what the justification is for splitting the Division of Alaska Pioneer Homes and the Division of Senior and Disability Services. 11:06:20 AM CHIEF SIMON contended that the proposed split of the department is not at all responsive to the relationship that necessarily exists between the various divisions and the services they provide. He pointed out that TCC is both a health and social service agency, a one-stop shop for its tribal members. One system makes sense, he explained, because TCC is able to provide holistic, wraparound, and patient-centered services. At TCC there is more efficiency and less bureaucracy, and TCC achieves less overhead and a reduction in positions by keeping services underneath one roof. A patient presenting at the clinic, and who has a food security issue, can be connected by the case manager to TCC's client services division and provided the necessary services. A parent who is a party to tribal child protection can be connected to the necessary health assessments and follow-up services. A TCC client currently benefitting from assistance can be connected with employment and training or educational services to step down from government assistance. CHIEF SIMON stated that the department's frequently asked questions document indicates this change is being made to streamline the focus of the Department of Health and to make meaningful interventions for those Alaskans who are experiencing crises or are supporting their loved ones. He said it's unclear how this proposal will meet either objective, especially in a time when the state budget is in crisis. He further stated that the frequently asked questions document explains that there will be better delivery of essential services thanks to the use of statistics and data analysis, and creation of new health analytics data and information systems within the proposed Department of Health. However, he noted, there's no information on how additional data analysis or this new unit will lead to better health care delivery. The department already collects and maintains a broad array of data about health programs, Chief Simon continued, and has ready access to tribal partner data and analysis through the tribal epicenter. If the department wants to hire a consultant to help analyze that data in a new way, then it can certainly do so. But, he argued, that goal doesn't seem to justify the creation of a new department, which means a new commissioner, plus staffing and facility costs related to that new commissioner's office, a new finance and management division to support the department, additional strain on the state's existing generalized administrative services to support the new department, and the creation of a new health analytics unit. More importantly, all these new units, staff, and needs cost money; money the state simply does not have right now. 11:10:05 AM CHIEF SIMON recounted that for the past few years Alaska has been in a crisis due to declining oil revenues and the insufficiency of other revenue sources to support basic state services. Year after year [Alaskans] have suffered mass budget cuts including large-scale cuts championed by this administration and have been told that people need to accept reductions in services as a reality given the state's fiscal situation. Yet, he continued, in the midst of this financial environment the administration seeks to separate the department, create parallel and duplicate administrative structures, add a new unit, and a new commissioner's office. This does not make sense and will lead to larger cuts in services down the road. CHIEF SIMON stated that TCC seeks to work with the commissioner to ensure that any reorganization of DHSS benefits Alaskans. He related that the frequently asked questions document also claims that the proposed reorganization will amount to minimal additional cost. All the units already exist, he pointed out, but not existing are the new commissioner's office, the new financial and management division, and the new health analytics unit. These costs will be more than minimal, he contended. CHIEF SIMON further related that the frequently asked questions document states that the entire goal of the proposed reorganization is to provide services to Alaskans better and more efficiently. He questioned how creating a duplicate department is efficient, and further questioned how this would lead to better services if funds were averted from actual services to administration. The administration, he continued, says its proposed reorganization is meant to improve services, but it does not explain how. It separates programs and facilities from divisions that provide the services and resources to support these programs. 11:12:46 AM CHIEF SIMON pointed out that while the press releases focus on efficiency, one could not help but notice that the programs in the new Department of Family and Community Service are those the administration has tried to privatize or place on the chopping block in the past. He said it is time for the State of Alaska to provide these programs with the support they need, stabilize their leadership and operations, and stop trying to pass responsibility on to someone else or expecting a private operator to do better. CHIEF SIMON concluded by stating that Tanana Chiefs Conference does not support the proposed reorganization and believes it would lead to worse outcomes than the status quo. He said Tanana Chiefs Conference is happy to collaborate with the state on ways to actually improve outcomes, increase efficiency, and strengthen service delivery, and hopes that TCC and other tribes around the state are adequately consulted before future similar proposals are announced. 11:14:33 AM REPRESENTATIVE TARR shared that she too noticed the split includes items that have previously been on the chopping block or considered for privatization. She suggested that this is something the committee needs to keep in mind as it explores the philosophy behind this proposal. CHIEF SIMON thanked Representative Tarr. He expressed his concern that with the current status quo of the pandemic, TCC doesn't want [the proposed division] to happen in the Office of Children's Services. As a First Chief of a tribe, he said he knows full well the tribal courts, the meetings with families, and separating families, and that's tough enough already. The proposed division, he added, only complicates a complicated service trying to deliver a high level of service in a remote location in a nonstandard fashion. 11:16:17 AM CHAIR ZULKOSKY recalled Chief Simon talking about the importance of meaningful consultation, particularly as a tribal agency provider that works in tandem with the State of Alaska and complements much of its work. She asked him to talk about the experience that TCC had in consultation, discussion, and deliberation with the department and the governor in the lead-up to this particular announcement about the proposal. CHIEF SIMON replied, "None." He added that in years past in dealing with OCS and taking children, boys and girls, from homes, there were meetings with the director of OCS. He related that on behalf of the tribes he always thanked the director for her time because OCS is such a difficult department to run, given it takes kids from family, all they know, and puts them somewhere else. It is a tough go all the way around, he said, and this proposed split would make it even harder. 11:18:06 AM CHAIR ZULKOSKY invited the next witness to testify. 11:18:29 AM TAMMY SANDOVAL, stated that according to OCS data, the number of children in care this month is 3,057, and 1,988 of those children are Alaska Native. She said she is before the committee as an expert in child welfare, having begun her career on the frontlines 37 years ago. She noted that she has a Master's of Social Work, has worked in child welfare in three states, has consulted and trained in several states, and served as the OCS director from 2005 to 2010. Since then she has been the director of the Child Welfare Academy, the agency within UAA that trains all the new OCS workers, social service associates, and supervisors, as well as stakeholders statewide. MS. SANDOVAL explained she has taken time off this morning to provide this testimony. The opinions she is providing are her own, she emphasized, and she is not testifying as an employee of UAA nor the Child Welfare Academy. MS. SANDOVAL stated that like many others outside of the state system, she was shocked to learn that DHSS was planning to split OCS into two divisions. While she tends to be someone who loves the idea of innovation, all she could think about was how the split would affect children, youth, and families, as well as the workers who serve those families. She has given this a great deal of thought, she said, and she cannot see a way to make it work for those most affected families and frontline workers. 11:20:28 AM MS. SANDOVAL advised that a family having to negotiate one system is nearly impossible as it is, and there would be no chance if there were two divisions. She explained that the child welfare system isn't just OCS. It's court parties and service providers, and with 65 percent of the children in state custody being Alaska Native it's tribal agencies as well. A family in crisis having to figure out who does what in two divisions instead of one would be debilitating, she stated. MS. SANDOVAL contended that the worst thing about this proposal is that it came out without stakeholder input, seemingly like it was a done deal. She offered her belief that, if asked, parents and youth would have had plenty to say about how best to design a system to better prevent the need for intervention, serve them when they do, and create efficiencies in the process. She asked whether there was any consumer input, because in her vast career she has never heard of a state splitting itself such as what is being proposed. She related that in an online search she only found one state that has tried it in the past, and in 2001 the Nevada State Legislature concluded that Nevada's bifurcated system was not conducive to promoting positive outcomes for children and families. MS. SANDOVAL said she agrees with wanting families to be served in a respectful, efficient way by caring OCS staff. However, she argued, splitting the system would only contribute to the chaos and the hoops to jump through. She urged that instead the real issue be dealt with, and stated that the most pervasive reasons "OCS doesn't work" are not enough resources to prevent the need for child welfare to begin with, inequities among disadvantaged people, and the lack of a workforce in Alaska to provide necessary services to those who need it. MS. SANDOVAL related that in her experience, reorganization almost never works to fix the real issues. Bifurcation is just smoke and mirrors, she charged. Not enough child maltreatment prevention effort, lack of workforce, and racial inequities will still be the elephant sitting in the middle of the state left unaddressed. She stated that for the sake of those things that are going well now in the midst of a worldwide pandemic, she sincerely hopes that this doesn't happen. 11:23:12 AM CHAIR ZULKOSKY invited the next witness to testify. 11:23:47 AM JAKE METCALFE, Executive Director, Alaska State Employees Association (ASEA) Local 52, noted that at 8,000 members ASEA is one of the largest public employee unions and represents both state and municipal employees in Alaska. He said DHSS employees make up the largest number of ASEA members. He pointed out that public employees deliver essential public services 24 hours a day, 7 days a week, 365 days a year. Further, he continued, public service is more than a job - it's a passion, a calling, and a commitment to serving Alaska and Alaska communities. MR. METCALFE related that ASEA reached out to its members about any concerns they might have regarding the governor's proposal. Like others, ASEA doesn't have a lot of clarity about this proposal or how it will impact the dedicated public workers in this department. He said ASEA agrees with the other witnesses that there was no consultation or bringing together of folks to ask their opinions before this happened; ASEA was told about this after it happened. MR. METCALFE said ASEA is disappointed that the administration chose not to come before the committee today. He made it clear that ASEA supports any efforts to improve services and efficiency so long as the changes abide by the contract called the Collective Bargaining Agreement, and so long as those changes are not at the expense of working people or, most importantly, to the detriment of Alaska's children, men, and women who need these essential public services. These changes must also not come at the detriment of Alaska, he added. 11:26:44 AM MR. METCALFE stated that ASEA and its members are concerned the administration may be setting up this department for outsourcing these essential services, in which case this work would leave Alaska. It would undoubtedly impact the quality of services, he argued, which are sensitive in nature and require local based knowledge for the administration to service it. MR. METCALFE provided the background for why ASEA and its members have this concern. He explained that ASEA members work at the Alaska Psychiatric Institute (API), Alaska Pioneer Homes across the state, and the Department of Health & Social Services where employees are tracking the pandemic. Over the length of this administration, ASEA has seen these services contracted out. He said ASEA had to litigate to stop that from happening at API. Alaska Pioneer Homes has seen its cafeteria workers privatized and there is concern that the administration wants to privatize more of the services the homes provide to seniors. Most recently, ASEA has seen this administration outsource work regarding the pandemic. The administration hasn't followed the ASEA contract to do any of that, he pointed out, which is a really serious concern because ASEA has an agreement, is a business partner, with the State of Alaska. Outsourcing and subcontracting can happen if the administration does what it is supposed to under the contract and has a study, gets input, and engages with its stakeholders, but the administration has never chosen to do that. He stated that this is especially important when there is a government-to-government relationship for health and social services and children's services. That is no longer had when those services go to a multi-national corporation located outside of Alaska. When this work is outsourced, he continued, the people running those services do not have the needed local knowledge. It is extremely important to know the local cultures of the state and the ways of doing things, especially with this kind of family work, which isn't had with outsourcing. MR. METCALFE pointed out that in addition to the outsourcing problems, the work is going to private companies that don't provide benefits. In an economy like Alaska's, jobs need to stay in the state and provide benefits, so people aren't going on public assistance and have healthcare, especially during a pandemic. There is no control over that when work is outsourced, he continued, and in most cases the benefits of public employees do not follow along. This issue has popped up with tele-work because tele-work opens it up for outsourcing and having people provide services who don't live in Alaska. He said ASEA is concerned about that and thinks the state needs to police what work is being done by tele-work and what work is being outsourced because it has significant impact on policies and ability to provide services. 11:31:29 AM MR. METCALFE referenced the articles he submitted to the record about the state of Texas, which tried to outsource children's services work. He urged committee members to read the articles and see what happens when a state tries to outsource its work, which usually doesn't end well, if ever. The motivation of public services, he opined, should be serving the public and serving the public in a way to have a healthy and whole society. Public work should never be driven by profit, especially when the persons receiving those services are the most vulnerable citizens like seniors, children, and Alaskans struggling with behavioral and mental health conditions. MR. METCALFE expressed ASEA's concerns about the logistics. He said a specific question that needs to be discussed is how the proposed split will impact OCS eligibility technicians. These employees deal with Medicaid and community services, including legal, custody, and child placement issues. He said another concern relates to OCS and coordinating with tribal governments and tribal state compact agreements. He reported that ASEA staff and union members are concerned about how this will work since there wasn't any notice, consulting, or engaging with stakeholders, which needs to happen for this to work right. He said he's sorry the administration didn't choose to come talk about this today because part of what makes government work is when the different branches of government are talking to each other and to the public. That needs to happen for this to work, he continued, and it hasn't happened, and it seems to be a done deal. It isn't in the best interest of the State of Alaska when it doesn't engage its stakeholders and business partners. 11:34:46 AM REPRESENTATIVE TARR said she recalls the API lawsuit. She asked whether there are any currently active lawsuits related to these labor disputes or questionable proposals. MR. METCALFE replied that ASEA has finished some of the API related litigation, but part of the case is still in the court system. He reported that Wellpath, the private contractor that came into API, has ended, and that ASEA is continuing to watch what API is going to do as far as management. There has been a good organization set up within API that is looking at how it is going to be managed and ASEA continues to try to actively participate in that group. He said there is other litigation involving the state and ASEA. He stated that ASEA follows the outsourcing of work and has one ongoing issue with DHSS over outsourcing COVID related work, which is not in court but is within the dispute resolution process of the contract. It must be ensured that the contract is followed, he explained, and ASEA would rather sit down with the state and try to work these issues out ahead of time than to find out about them after the fact because that causes all kinds of costs and resource use and delays processes. MR. METCALFE continued his answer. He related that ASEA has reached out from the beginning of this administration and said that ASEA wants to consult and engage with the state beforehand on any questions or ideas to ensure any change or management decision is going to be done right under the ASEA contract. He said ASEA knows management has the right to do a lot of decision making, but that it works better when management consults with ASEA ahead of time. It's no different than the tribal governments; ASEA is a stakeholder and a business partner, and there will be fewer problems if the state works with ASEA rather than informing ASEA after the fact. MR. METCALFE specified that ASEA wants the state to operate well and for people to have good jobs and good benefits and ASEA will do everything it can to work with the state to make sure that that happens. He said ASEA doesn't want to get involved with litigation or the dispute resolution process because that's not healthy or good for the services that ASEA provides or for the State of Alaska. The goal of ASEA is to communicate, consult, and engage with its business partner, the State of Alaska, as much as possible. He urged that the State of Alaska engage in that kind of process with ASEA and all other stakeholders. 11:39:32 AM CHAIR ZULKOSKY noted that what hasn't been discussed today is the impact of splitting health and social services apart. She requested Chief Simon, Ms. Metivier, Ms. Sandoval, and President Peterson to speak to integration of the current system within Alaska, and how spitting health from family and community services and putting them into two separate entities would be cumbersome for individuals. CHIEF SIMON replied that TCC already has a difficult job of providing services for its children. Whether someone makes a great decision or a terrible decision, TCC provides the services to take care of these kids. He said he is a firm believer in being upstream or proactive of the problem. For example, mental health issues can lead to an individual being traumatized for the rest of their life. Being downstream of mental health issues leads to sending people away from their villages to the Alaska Psychiatric Institute, which he understands is no longer open. He urged the State of Alaska to consider locating an API in Fairbanks, given that 8,000 of the Athabascan Nation's 20,000 people live in Fairbanks and some of them need these services. This would help the situation tremendously, he added, and would serve the existing need of Native people for these services. 11:43:55 AM MS. METIVIER responded that the larger implications of splitting DHSS fall around the questions of evidence based and the how and why this could work. She stated that public systems, when they work together, tend to be better in terms of serving families. She posed an example of a child in the custody of children's services who is placed in a therapeutic foster home with another agency that works in and bills Medicaid. That child would then be under the guise of two separate departments because Medicaid would fall on one side and OCS would fall on the other. In the same way that bifurcation of OCS would create complications for families in terms of communicating with public agencies, she continued, the same would happen at a larger scale with the split of the two departments. Even now, she pointed out, all the divisions within DHSS don't always communicate well with each other but they communicate enough so that families can still navigate and get through things. MS. METIVIER further responded that when young people age out of the system and leave foster care, they are eligible under the Affordable Care Act for Medicaid until age 26. One of the challenges for youth, she explained, is this gap between when they leave foster care and apply for public assistance for themselves. Right now, there is a system in place for OCS to communicate directly to Public Assistance. She said it is unknown whether [in the proposal] these on-the-ground details within the department would change, but she thinks it would further separate the resources and supports for families. There should be a move toward more communication, she opined, and being able to do early intervention and identifying families early. For example, an effort to identify families early that are on public assistance because those are the families that may eventually come on the radar of child protection. So, she continued, it makes sense to have them all within one department, but the information and details are missing as to what this proposal looks like. 11:46:55 AM MS. SANDOVAL offered her agreement with Ms. Metivier. She related that when she was in DHSS a lot of work was done on confidentiality and sharing of information between divisions. She said there was an opportunity to talk with other divisions about families that were shared in common. She expressed her worry that this would become even more difficult if there were two departments. She concurred that DHSS is huge but said that being underneath one roof creates some relationships that might not otherwise be there. MS. SANDOVAL stated that it is important to understand why this is being proposed and how the decision was made with regard to division, because there are synergies now that may not happen if the department is split into two. She reiterated that she worries about reorganization in general, especially now during the pandemic. In her experience, she continued, reorganization is really messy and currently it's already a really messy time in the country. She said she questions the timing, information, and lack of transparency in the decisions that are being made. 11:48:46 AM MR. PETERSON pointed out that resources are already limited and difficult to access for children and families. The partnerships with Public Health and Behavioral Health are depended upon, not only to identify at-risk families but also to find a way to get people the help they need. 11:49:17 AM CHAIR ZULKOSKY said she knows from her experience in health care that many healthcare systems are moving into integrated models of care, wrapping services around patients. She stated she hears from today's testimony the concern around disenfranchising Alaskans from essential critical services that many of the witnesses advocate for and provide in their communities. She thanked the witnesses for their work and their time before the committee and added that the committee will invite the department to speak when another time presents itself. 11:50:08 AM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 11:50 a.m.