ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  January 31, 2023 3:00 p.m. MEMBERS PRESENT Representative Mike Prax, Chair Representative CJ McCormick Representative Justin Ruffridge Representative Dan Saddler Representative Jesse Sumner Representative Zack Fields Representative Genevieve Mina MEMBERS ABSENT  All members present   OTHER LEGISLATORS PRESENT  Representative Will Stapp COMMITTEE CALENDAR  PRESENTATION(S): DEPARTMENT OF FAMILY AND COMMUNITY SERVICES - HEARD PREVIOUS COMMITTEE ACTION  No previous action to record WITNESS REGISTER KIM KOVOL, Deputy Commissioner Department of Family and Community Services Juneau, Alaska POSITION STATEMENT: Co-offered a presentation on the Department of Family and Community Services. CLINTON LASLEY, Deputy Commissioner Department of Family and Community Services Juneau, Alaska POSITION STATEMENT: Co-offered a presentation on the Department of Family and Community Services. ACTION NARRATIVE    3:00:08 PM CHAIR MIKE PRAX called the House Health and Social Services Standing Committee meeting to order at 3:00 p.m. Representatives McCormick, Ruffridge, Saddler, Sumner, Fields, Mina, and Prax were present at the call to order. ^PRESENTATION(S): DEPARTMENT OF FAMILY AND COMMUNITY SERVICES PRESENTATION(S): DEPARTMENT OF FAMILY AND COMMUNITY SERVICES    3:01:28 PM CHAIR PRAX announced that the only order of business would be a presentation on the Department of Family and Community Services. 3:02:44 PM KIM KOVOL, Deputy Commissioner, Department of Family and Community Services, stated she had over 25 years of experience in the private sector, executive leadership, management, license facilities, organizational development and restructure, logistics, and working with youth and adults. She added that prior to her current role, she served as Governor Dunleavy's special assistant with a portfolio focused on domestic violence and sexual assault, missing and murdered persons, human and sex trafficking, homelessness, foster child and elder care, opioids and fentanyl, and suicide prevention. 3:04:45 PM The committee took an at-ease from 3:05 p.m. to 3:07 p.m. 3:07:49 PM MS. KOVOL began her PowerPoint presentation [hard copy provided in committee packet] on slide 2, which read as follows [original punctuation provided]: Mission To provide support, safety, and personal well-being for vulnerable Alaskans. Vision Service First We will: Strengthen lives through meaningful connections with families, communities, Tribes, and providers. Provide safe, person-centered care with integrity and dignity to the Alaskans we serve. Advance an agency culture that prioritizes the well- being of our workforce. Mobilize innovative solutions to complex challenges. MS. KOVOL moved to slide 3, which showed an organizational flow chart of the Department of Family and Community Services. She emphasized that the commissioners, directors, and deputy directors had not left since the reorganization of the department. 3:09:43 PM MS. KOVOL continued to slide 4, "Reorganization of DHSS - Executive Order 121," and stated that the Department of Health and Social Services had reorganized into two departments: the Department of Health (DOH) and the Department of Family and Community Services (DFCS). She added that DFCS had retained the Alaska Psychiatric Institute, the Division of Juvenile Justice, Alaska Pioneer Homes, and the Office of Children's Services, which she emphasized were all direct services and were available 24/7/365. MS. KOVOL moved to slide 5, "Continuing Collaboration," and said that DFCS worked closely with DOH, and she emphasized the four key areas of collaboration. She stated that the complex care required a continuous and strengthened partnership with DOH, and both departments are identifying solutions to address systemic gaps. She said to improve the continuum of care, both department are looking to establish a coordinated system across departments to ensure person-centered care. She stated that the departments are also actively developing an Information Technology (IT) plan to prioritize projects and minimize delays. She added that modernizing and utilizing contractors within IT would ensure a higher quality of service. MS. KOVOL showed slide 6, "Our Priorities," and emphasized that DFCS's priorities would change depending on the unique needs of each family or community. She added that the four main priorities of the department are: complex care systems, tribal partnerships, department culture, and workforce innovations. MS. KOVOL continued to slide 7, "Complex Care Systems," and stated the frequency of youth and adults requiring complex care is on the rise, and all four of the direct service divisions are tasked with finding appropriate levels and location of care. She said the department is creating a Complex Care Coordination unit within the Office of the Commissioner, which will establish a single point of contact for the department and its partners. She added that the unit will establish a network of placement options for adults and youth, and will oversee long-term facilities development. She emphasized that partnering with healthcare providers, medical centers, and clinics to expand services would take time. She added that DFCS will work with providers across the country to support the needs of Alaskans if there is not appropriate care within the state, and it will work to make all Alaska facilities Medicaid or third-party payer eligible. 3:13:25 PM MS. KOVOL moved to slide 8 and stated care coordination is complex as it requires coordination from inside and outside the department. She said that first an assessment is completed to determine placement, which could require individual or facility Medicaid, licensed placement medical personnel to manage medication, wraparound services, transportation, and family support. Each case is unique and requires collaboration with many agencies and organizations, and she emphasized the goal is to prevent anyone from being institutionalized, and to find a family-like setting to meet every day needs. MS KOVOL described a story from when she became acting commissioner after DFCS was formed, regarding a complex care case of a youth, who had to manage multiple meetings and phone calls to staff inside DFCS and outside, as there was no single point of contact. She referred to the diagram on slide 8, which showed the multiple touch points that the youth had to contact, and she added that the touch points were ever changing as other organizations and agencies would be brought in or left out depending on the case. She highlighted the reduction in redundancy and improvement in efficiency which having a single point of contact created. MS. KOVOL moved to slide 9, "Tribal Partnerships," and stated DFCS is increasing statewide tribal outreach with a Dedicated Tribal Liaison, Mariah Seater. She said DFCS would create new relationships as well as reconnect with long-standing partners. MS. KOVOL displayed slide 10, "Department Culture," and emphasized the privacy of families and individuals who work with DFCS and the emotional impact of staff who work in crisis response, as many of the scenarios are emotionally heavy and challenging but the successes are always happy. She stated she worked on building connection and communication with the public through social media to provide information and knowledge, and to spread awareness of the department's successes. 3:18:22 PM MS. KOVOL moved to slide 11, "Workforce Innovations," which read as follows [original punctuation provided]: Governor/Department efforts  People's First Initiative OCS workforce stabilization incentives for staff Department-wide workforce stabilization incentives for staff Department-wide referral incentives Rural workforce solutions  Letters of Agreements for alternate/flexible work schedules Internships and practicum placements  University of Alaska, Anchorage School of Social Work Alaska Psychology Internship Department of Defense SkillBridge Program Social Work Practicum and Child Welfare Academy 3:19:22 PM MS. KOVOL overviewed the Alaska Pioneer Homes on slides 13 through 14. She stated the director of the Alaska Pioneer Homes is Heidi Hamilton, and the Alaska Pioneer Homes provides assistance with daily living, nursing services, recreational and social programs, medication, dietary needs, housekeeping, and meal preparation. She said the Alaska Pioneer Homes provides a wide range of services, including to those with dementia or complex healthcare needs, with its 423 full-time staff and budget of over $104 million. She emphasized that the Alaska Pioneer Homes had maintained over 80 percent occupancy from July to December 2022, and that the Anchorage location was only at 80 percent capacity as a result of renovations to increase safety and access. She added that within the Juneau location, 90 percent of residents had family involvement with care, while in the Anchorage location only 50 percent did. MS. KOVOL showed slide 15, which read as follows [original punctuation provided]: Successes Completion of Complex Care Neighborhood in Anchorage Resident Wi-Fi installed in four homes Increased coordination with community providers for complex care needs On-line waitlist application development Challenges Increasing age and needs of residents Increased number of elders on waitlists Building maintenance Supply chain and workforce challenges delaying projects MS. KOVOL moved to slide 16 and stated that the chief executive officer of the Alaska Psychiatric Institute (API) is Scott York. She said API has five inpatient units with 80 beds and a budget of just over $58 million, and is the only location that is able to provide competence restoration treatment in the state. MS. KOVOL showed slide 17, which read as follows [original punctuation provided]: Initiatives Development of a comprehensive strategic plan to ensure that Alaska Psychiatric Institute is meeting the needs of Alaska in the continuum of care Outpatient Competency Restoration Community-based Jail-based Procurement of a new electronic health record system Recruitment and retention of nurses and social workers MS. KOVOL displayed slide 18, which read as follows [original punctuation provided]: Successes Chilkat Adolescent Unit reopened May 2021 Reopening of the Denali Unit as a dedicated service location for adults with neurocognitive disabilities Patient on staff assaults in our adult population decreased 55% in past year Becoming a teaching hospital Clinical site for medical students, nursing students, and recent reinstatement into the Alaska Psychology Internship 3:26:00 PM CLINTON LASLEY, Deputy Commissioner, Department of Family and Community Services, continued the presentation with slide 19, and stated that the former Department of Health and Social Services had reorganized under Executive Order 121. Most of the former department's functions had been "picked and placed" into the two new departments, and some functions of the Division of Behavioral Health had been moved to DFCS. He said the four functions that had moved from the Division of Behavioral Health to DFCS were: Disproportionate Share Hospital Funding (DSH), Designated Evaluation and Stabilization (DES), Designated Evaluation and Treatment (DET), and Secure Patient Transport Program. A new DET/DES coordinator, Ashley Christopherson, had been hired to manage patients who may need stabilization or treatment. He added that states in the U.S. receive Disproportionate Share Hospital federal allotment to cover the cost of DSH hospitals which serve significantly more under resourced patients, as well as reimburse hospitals for performing DES and DET services. He explained the difference between DET and DES as DET hospitals provide psychiatric evaluation and treatment, while DES facilities provide short- term stabilization services. He said the 3 hospitals on the slide, [Bartlett Regional Hospital, Fairbanks Memorial Hospital, and Mat-Su Regional Hospital,] provide 48 beds to the continuum of care for the state, and the Secure Patient Transport Program managed the transportation of patients. He stated the budget of the four programs was approximately $14.5 million. 3:29:19 PM MS. KOVOL moved to slide 20, "Office of Children's Services," and stated that Kim Guay is the Director of the Office of Children's Services (OCS) and that the Office is responsible for ensuring the safety of Alaska's children, investigating reports of child abuse and neglect, and administering the foster care system. She added that OCS is spread across five regions and has 21 offices, over 600 full-time positions, and a budget of nearly $200 million. MS. KOVOL showed slide 21, "Tribal Child Welfare Compact," and stated that the Tribal Child Welfare Compact began in 2017; the Thirty-Second Alaska State Legislature had codified it with House Bill 194. She said that the previous budget had increased funding from $1.6 million to $5 million and was distributed across 18 co-signers who represented 170 tribes. She stated that the co-signers are given the flexibility to use the funds as they see fit, such as the Positive Parenting Indian classes which teach child rearing in a culturally relevant method. MS. KOVOL moved to slide 22, "People's First Initiative," which read as follows [original punctuation provided]: Manage secondary trauma Mental Health Clinician 4 Position Expansion Four new Protective Service Specialist 4 positions Social Services Associates, Office Assistants, and Administrative Assistants Retention incentives Alaska Impact Alliance Field training compensation program Support for older foster youth ages 18-21 Increased vocational opportunities Increased financial assistance for housing, transportation, and other identified needs Complex trauma placement support MS. KOVOL showed slide 23, "Update of Workforce," which read as follows [original punctuation provided]: Turnover rate in frontline caseworkers is decreasing Currently 55.5% High of 59.4% in 2021 Continue to have high vacancy rates for case carrying workers Regional vacancy rates vary Smaller offices face challenges balancing caseloads Continue to evaluate systems processes to reduce burden on frontline workers MS. KOVOL added that House Bill 151 from the Thirtieth Alaska State Legislature required a limit on the caseload for new case workers, and some regions had high caseloads for veteran case workers. 3:34:45 PM The committee took an at-ease from 3:34 p.m. to 3:36 p.m. 3:36:23 PM MS. KOVOL stated Shannon Dilley is the director of the Division of Juvenile Justice (DJJ), and she moved to slide 24, "Division of Juvenile Justice," which read as follows [original punctuation provided]: Mission: Hold juvenile offenders accountable for their behavior. Promote the safety and restoration of victims and communities. Assist offenders and their families in developing skills to prevent crime. Facilities / Offices / Staff: 6 Youth Facilities 13 Probation Offices 426 Full Time Positions FY2023 Budget: $60,950.5 MS. KOVOL showed slide 25, which read as follows [original punctuation provided]: Staffing Shortage: Combined units at the Johnson Youth Center and Fairbanks Youth Facility due to critically low staffing levels Facility Staff: 51 of 301 positions vacant at beginning of the year Program Improvements: Specialized Treatment Units Neurofeedback System improvements in assessments, data, training, and quality assurance Workforce Improvement Efforts: Salary Study for facility staff Culture improvements Expanded training Specialized labor agreements 3:38:31 PM MS. KOVOL moved to slide 26, "HB105: Detention of Minors - Implementation," and explained that House Bill 105 [which passed in the Thirty-Second Alaska State Legislature] updated definitions on minors who were waved into the adult justice system. She added that adult facilities that took on minors were ill prepared and commonly segregated the minors from the rest of the residents. She stated that since the passing of House Bill 105, 15 minors have been held in DJJ facilities; currently only two minors are held in DJJ facilities. MS. KOVOL concluded on slide 27, "Reflections Day 215," and said she visited many sites in the first 100 days of her employment, and she looked forward to rebuilding relationships and programs, such as Restore, Inc, the Sitka Tribe, the Arctic Slope Native Association, and True North Recovery. She expressed gratitude toward the employees who show up to work and address complex emotional situations, and those who share criticisms to build up solutions to problems. 3:41:53 PM DEPUTY COMMISSIONER LASLEY, in response to a question from Representative Fields about the planned renovations for the Juneau location for the Alaska Pioneer Homes, stated a new building was estimated to cost $100 million and a renovation with expansion was estimated to cost $60 million and would take three to five years and would require moving elders multiple times. He emphasized that some rooms are small and make moving with mobility assistance difficult. DEPUTY COMMISSIONER LASLEY, in response to a follow up question from Representative Fields, said Alaska Pioneer Homes is not looking at opening a facility in Kenai; it is focusing on improving the current facilities to meet the needs of elders. 3:46:15 PM MS. KOVOL, in response to a question from Representative Sumner, emphasized the reduction in OCS turnover was a small victory and the department is making changes to reduce it further. She added that roughly 30 percent of case carrying frontline staff are not degree carrying in social work, and she expressed hope for partnerships with the University of Alaska Anchorage to increase undergraduate and graduate degrees in social work over the long term. 3:48:54 PM DEPUTY COMMISSIONER LASLEY, in response to a question from Representative Mina, said OCS is working to innovate solutions to entice recruitment and work with the University of Alaska Anchorage to increase the number of qualified candidates. He stated the next phase was to drive down "employee churn" and provide opportunities for staff to improve mental health through time off, mentorship programs, and behavioral health services. 3:52:04 PM MS. KOVOL, in response to a question from Representative Ruffridge, stated the workforce shortage has affected the four divisions, as each one needs more nurses, patient care managers, and certified nursing assistants, and DJJ specifically needs more Juvenile Justice Officers. She said the departments are not able to compete with the higher pay, quicker hiring, and different incentives of private industry. MS. KOVOL, in response to a follow-up question from Representative Ruffridge, said the labor shortages are a top priority; second is legacy software. She emphasized that the online resources for the Children of Alaska system and other software solutions are outdated. She stated all paper records need to be digitized and made easier to access for staff. She added that the aging facilities are also an issue for the department. 3:53:04 PM MS. KOVOL, in response to a question from Representative Ruffridge about competency restoration, stated that API has 80 licensed beds, divided into 10 beds for youth, 10 beds for restorative care, and the rest for the adult population. She said API needs more beds in the restorative wing but wouldn't have the staff to operate them. DEPUTY COMMISSIONER LASLEY continued the response and stated API has 10 forensic beds and is the only restorative facility with services available in Alaska. He said individuals who have a felony conviction are housed at the Department of Corrections (DOC), and individuals who have a misdemeanor and can't get to restorative services in time are released on a bond or bail through DOC. He stated the department had one year to restore each individual to competency to stand trial. He added that an individual not restored to competency and not a danger to self or others is released and then transferred to Title 47 civil commitment. 3:57:54 PM DEPUTY COMMISSIONER LASLEY stated the department is actively working on outpatient restorative services for individuals who have misdemeanor charges and are deemed not competent to stand trial. He added that the department is in conversation with DOC in Anchorage about a jail-based facility with 10 beds. 4:00:56 PM MS. KOVOL, in response to a question from Representative Fields, stated that the department is licensed for 80 beds but is unable to fill all the beds because although each room has two beds, some patients are unsafe to share a room with others. She emphasized that the issue isn't just the number of beds, as even if 30 more restoration beds were added, there would still be a lengthy list of individuals waiting and the number of Title 47s filed would increase. She added there is a trend moving towards community-based beds to avoid institutionalizing patients, increase the quality of care, and service smaller populations. 4:03:32 PM REPRESENTATIVE FIELDS noted schools no longer have the capacity to deal with children who are violent, and he asked whether school administrators coordinate with DFCS regarding this issue. MS. KOVOL answered that the department's four divisions are tasked with "folks that are in our legal care." This raises the question as to what level of response is to be given when members of the public call the department regarding crises. She said it doesn't work to simply hand these people a resource. In response to a second question from Representative Fields regarding possible recruitment from the Alaska Primary Care Association training program and the Alaska Hospital Association (AHA), she said the department has not looked at that particular program but has held conversations with AHA, as well as with the University of Alaska Anchorage; however, she noted there are just not enough students. 4:08:33 PM DEPUTY COMMISSIONER LASLEY, in response to a question from Representative Fields regarding the Alaska Impact Alliance, said the alliance has been active in bringing together community partners and developing long-term plans; members of the board will be in Juneau in a couple of weeks, and he offered to get the board's most recent report to the committee. 4:09:13 PM REPRESENTATIVE SADDLER referred to the vision statement from slide 2, which relays that the department will "strengthen lives through meaningful connections with families, communities, Tribes, and providers." He singled out "Tribes," which he remarked doesn't seem to be "part of that group," and asked Ms. Kovol to explain the inclusion of Tribes in that part of the vision statement. 4:09:53 PM MS. KOVOL responded that it has been vitally important for DEED to have conversations with Tribes in regard to the [Tribal Child Welfare] Compact and child welfare. Further, there are other items to explore, such as eldercare, where there may be opportunities for partnership with [the Department of] Workforce and Labor. 4:11:27 PM DEPUTY COMMISSIONER LASLEY, in response to a follow-up question from Representative Saddler, expressed that tribal partners are critically important to the work DEED does. There are a disproportionate number of tribal members in the department's services, primarily in OCS. He opined that it is critical to have tribal representation at the table when looking to expand services across the state of Alaska. He said the department wants to make sure it is respecting the sovereignty of Alaska Native people, as well as providing culturally appropriate services. He said this is part of what has been done for the last five years as a result of the Tribal Child Welfare Compact. The department also abides by Indian Child Welfare Act laws. In response to a request for specific percentages of tribal recipients in relation to each division of DEED, he said he could provide that information at a later date. He offered his understanding that 66 percent of youth in out-of-home placement that come into contact with OCS are tribal citizens. REPRESENTATIVE SADDLER said he also would like to know the degree to which DEED collaborates with tribal authorities to provide services. 4:14:20 PM REPRESENTATIVE MINA referenced the topic of API becoming a teaching hospital, as shown on slide 18, and she asked about the timeline and the potential for expansion in the future. MS. KOVOL said she would get that information to the committee at a later date. 4:15:34 PM REPRESENTATIVE RUFFRIDGE turned to the topic of designated evaluation and treatment, from slide 19, and asked what the process is to become a DET and now long the system has been in place. 4:16:03 PM DEPUTY COMMISSIONER LASLEY explained the process to determine shorter or longer-term treatment services. He said it is an easy process. He talked about the current 48 beds and intent to expand. In response to a follow-up question regarding incentives, he suggested that the incentive is to provide service and care for patients where and when they need it. 4:19:20 PM REPRESENTATIVE FIELDS expressed his hope that federal money could be sourced to help DEED meet its needs regarding apprenticeships and other department needs. 4:20:12 PM CHAIR PRAX mentioned an examination of API, and he asked whether that is "behind us now or ongoing." DEPUTY COMMISSIONER LASLEY reviewed that in 2018 API was in crisis; since then revisions have led to stable leadership. He said this year is the first he can recall when all the psychiatric and psychology positions are filled at the hospital. CHAIR PRAX then asked about a U.S. Department of Justice review of Alaska's health care. He asked whether the [department] has any involvement in that. 4:22:20 PM MS. KOVOL answered yes, although the larger component of this lies with the Department of Health. She said DFCS is in the early stages of working with DOH, as well as with the U.S. Department of Justice no recommendations have yet been made. 4:23:38 PM MS. KOVOL, in response to Chair Prax, indicated the department may be following certain legislation but will not be requesting legislation as of yet. Instead, it will focus on its clients and staff. 4:24:23 PM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 4:25 p.m.