ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  March 27, 2025 3:33 p.m. MEMBERS PRESENT Representative Genevieve Mina, Chair Representative Andrew Gray Representative Zack Fields Representative Donna Mears Representative Mike Prax Representative Justin Ruffridge Representative Rebecca Schwanke MEMBERS ABSENT  All members present COMMITTEE CALENDAR  PRESENTATION(S): CITIZENS REVIEW PANEL AND OFFICE OF CHILDREN'S SERVICES RESPONSE - HEARD CONFIRMATION HEARING(S): State Medical Board Samantha Smith - Anchorage - CONFIRMATION(S) ADVANCED PREVIOUS COMMITTEE ACTION  No previous action to record WITNESS REGISTER RETCHENDA GEORGE-BETTISWORTH, DSW, Chair Alaska Citizens Review Panel Fairbanks, Alaska POSITION STATEMENT: Co-offered the Citizens Review Panel and Office of Children's Services Response presentation. KIM GUAY, Director Office of Children's Services Department of Family & Community Services Anchorage, Alaska POSITION STATEMENT: Co-offered the Citizens Review Panel and Office of Children's Services Response presentation. SAMANTHA SMITH, PA, Appointee State Medical Board Anchorage, Alaska POSITION STATEMENT: Testified as appointee to the State Medical Board. ACTION NARRATIVE  3:33:45 PM    CHAIR GENEVIEVE MINA called the House Health and Social Services Standing Committee meeting to order at 3:33 p.m. Representatives Prax, Ruffridge, Schwanke, Mears, Gray, and Mina were present at the call to order. Representative Fields arrived as the meeting was in progress. ^PRESENTATION(S): Citizens Review Panel and Office of Children's Services Response   PRESENTATION(S): Citizens Review Panel and Office of Children's  Services Response    3:34:31 PM CHAIR MINA announced that the first order of business would be the Citizens Review Panel and Office of Children's Services Response presentation. 3:35:05 PM RETCHENDA GEORGE-BETTISWORTH, DSW, Chair, Alaska Citizens Review Panel, as co-presenter of the Citizens Review Panel and Office of Children's Services Response presentation, began a PowerPoint, titled "CRP Alaska Citizen Review Panel," [hard copy included in the committee file]. She explained that Congress created citizen review panels (CRPs) as part of the Child Abuse Prevention and Treatment Act (CAPTA) to make child protection systems more responsive to community needs. She described the federal and state mandates on CRPs and the structure of the Alaska CRP. Dr. George-Bettisworth explained the three primary functions of the Alaska CRP: evaluation, public outreach, and advocacy. She described the common activities of the CRP, including regular meetings, national conferences, and work plan activities. 3:41:44 PM DR. GEORGE-BETTISWORTH described the annual report for fiscal year 2024 (FY 24), [hard copy included in the committee file], including both findings and recommendations from this report. She said the annual report also includes prevention efforts, specifically screened-out reports, and referrals to support services. She said that the CRP organizes its focus areas into two phases: education and knowledge building; action and implementation. The CRP's current focus areas include mandatory reporting and out-of-home placement. She said that in spring 2025, the CRP will develop a set of recommendations based on findings from its focus areas to be included in an annual report. 3:51:08 PM DR. GEORGE-BETTISWORTH, in response to a series of questions from Representative Gray, distinguished "removal of children" from "intervention by OCS." She said that some cases may be screened out after intervention by OCS, without removal occurring. She said that she cannot remember Minnesota's procedures regarding screened-out reports, to compare to Alaska's procedures. Dr. George-Bettisworth explained that privacy and confidentiality are both barriers to OCS' ability to connect at-risk families to community providers. 3:59:07 PM REPRESENTATIVE PRAX said that it would be helpful if more people could ask for help without leading to intervention. 4:00:20 PM DR. GEORGE-BETTISWORTH, in response to a series of questions from Chair Mina, explained that every state is different, with different activities regarding their child protection systems. She said that the CRP has recently began collaborating with the Children's Justice Act (CJA). She said that the CRP is fully volunteer-run, while members of the CJA task force are identified by specific individuals from agencies within the child protection system. 4:03:44 PM DR. GEORGE-BETTISWORTH, in response to questions from Representative Fields, said that the scope of the CRP primarily includes OCS. She said that depending on the expertise of the committee, different perspectives regarding child welfare are brought to the CRP, but their work primarily focuses on children impacted by the child protection system. 4:06:50 PM REPRESENTATIVE PRAX said that he is very impressed by the CJA task force and recommends that others attend their meetings. 4:07:49 PM DR. GEORGE-BETTISWORTH, in response to questions from Representative Gray, emphasized the need for a community shift to better care for children. She said the CRP is working towards reducing the number of families at risk at all. 4:11:07 PM KIM GUAY, Director, Office of Children's Services (OCS), Department of Family & Community Services (DFCS), as co- presenter, began the next part of the Citizens Review Panel and Office of Children's Services Response presentation with a PowerPoint, titled "Office of Children's Services Response to FY2024 Citizen Review Panel Report," [hard copy included in the committee file]. She said that recruitment and retention have been ongoing issues for OCS for numerous years. She described the OCS's strategies for improvement, including expanding their social media presence and paying for internships. Ms. Guay said that in 2022, OCS adopted a framework from the US Attorney General to improve staff retention. She described some retention strategies including improving the safety of OCS staff and providing more opportunities for growth within the agency. She said each year OCS does an annual survey of the entire staff to receive direct feedback. Ms. Guay differentiated between the "threshold of risk" and children who are unsafe. She emphasized the need for prevention measures, which would require more community involvement. She acknowledged that there is a stigma surrounding OCS. 4:24:24 PM MS. GUAY, in response to questions from Representative Fields, stated that over 80 percent of OCS cases are due to substance misuse. She explained that many factors determine whether a report is screened in or screened out. She described the OCS process that follows a report being made. She said she does not know the number of child neglect cases that are due to economic circumstances. 4:27:23 PM REPRESENTATIVE PRAX thanked Ms. Guay for the improvements made to OCS over the last five years. He expressed curiosity about potential informal connections that could made between families and community providers. 4:30:00 PM MS. GUAY, in response to questions from Representative Gray, said that 21,590 is typical for the number of protective services reports received within a year, excluding the years during the pandemic where less mandated reporters were working with children. She said that OCS struggles to fill positions in rural Alaska and Anchorage and that this may cause OCS to miss children who may be at risk. Ms. Guay explained that it can be difficult to convince individuals that they need services. She emphasized the need to remove the stigma from receiving services and asking for help. Ms. Guay said the need for staff is a barrier to prevention work. 4:38:17 PM MS. GUAY, in response to a question from Representative Fields, explained that OCS has a variety of strategies with the Department of Health (DOH) but she does not know if there is one specific to substance abuse. 4:40:37 PM MS. GUAY, in response to questions from Chair Mina, said that OCS has been building out its complex care coordination infrastructure. She said that the Division of Public Assistance (DPA) is also involved in this work and there are a lot of interconnectivities between agencies. 4:42:33 PM REPRESENTATIVE PRAX said that he took the mandatory reporter training, but he does not want to be a mandatory reporter. He asked for more instructions for representatives on what they can and cannot do to help people. MS. GUAY described the 907 Navigation application ("app") to connect individuals with resources. CHAIR MINA said she will help show Representative Prax how to use the app. 4:45:46 PM MS. GUAY, in response to questions from Representative Schwanke, described the process for determining whether a case involves a child who is Alaska Native. She explained how OCS collaborates with the tribe of a child who is Alaska Native. She said that OCS is mandated to do its own investigation if a report is made, although the tribe may conduct its own additional investigation. 4:51:10 PM MS. GUAY, in response to a question from Chair Mina, said that in certain communities, OCS hires letters of agreement (LOA) staff who work one week on/one week off. She said that even in Anchorage, Alaska, OCS is struggling to meet the needs of children who need services because of the recruitment and retention issues the office is facing. 4:53:18 PM MS. GUAY, in response to questions from Representative Fields, said that OCS has done some recruiting for staff in high schools but could do more. She said she is interested in doing more community engagement in rural areas. 4:56:00 PM MS. GUAY, in response to questions from Chair Mina, said OCS needs to build into its management training. She said that OCS does have some culturally relevant practices, including connecting with regional Indian Child Welfare Act (ICWA) specialists and partnering with tribes for community events. She also recognized a need for improved technology. 5:00:07 PM MS. GUAY, in response to questions from Representative Gray, said that she has initial concerns regarding legislation other states have regarding child welfare and she would need more information on the legislation Representative Gray referenced. ^CONFIRMATION HEARING(S):  CONFIRMATION HEARING(S)    ^State Medical Board State Medical Board    5:03:30 PM CHAIR MINA announced that the final order of business would be the confirmation hearing for the governor's appointee to the State Medical Board. 5:04:52 PM SAMANTHA SMITH, PA, Appointee, State Medical Board, in response to questions from Representative Ruffridge, said that licenses need to be inspected more. She explained that if aspects of a licensure application raise concern, those aspects must be followed up on and more information must be received by the State Medical Board. Ms. Smith said that emergent board concern regarding patient safety cannot wait 30 days. She emphasized that the individuals that practice medicine in this state must have the patients' best interest in mind. She described the process that the State Medical Board takes after receiving a complaint. 5:15:07 PM MS. SMITH, in response to questions from Representative Schwanke, said that she has not worked in rural Alaska, but she has worked with patients who live in rural Alaska. She said that most of her work is in functional practice, and she focuses on treating the immune system. She said she agrees with the principle of SB 98 but she thinks that two years of practice may not be sufficient to protect the safety of patients in very remote areas. She emphasized the need for well-rounded physicians. 5:22:10 PM MS. SMITH, in response to questions from Representative Fields, described functional medicine. She said that functional medicine looks at a problem area and seeks to answer why and how that problem occurred. She said she examines the body as a whole system in her work. She also expanded on her previous statement that Alaska has "subpar medicine" by providing examples that she has witnessed of patients not receiving the proper care they needed or receiving care that worsened a condition. Ms. Smith said that she may not be the most qualified PA for the board but emphasized her commitment to serving patients in Alaska. 5:31:09 PM REPRESENTATIVE GRAY gave context to the Alaska Academy of Physician Assistants, emphasizing the volunteer efforts of the professional organization. He responded to Ms. Smith's comment regarding Alaska having "subpar medicine" by describing his positive experiences with physicians in Alaska. He asked Ms. Smith if she understands what the next steps of this confirmation process are. MS. SMITH responded that confirmation would occur at the joint meeting in May. She said she will continue to serve on the State Medical Board until that hearing, after which she will either continue serving or be removed from the board. 5:36:43 PM CHAIR MINA stated that the House Health and Social Services Standing Committee has reviewed the qualifications of the governor's appointee and recommends that the following name be forwarded to a joint session for consideration: Samantha Smith, State Medical Board. She said that signing the report regarding appointments to boards and commissions in no way reflects an individual member's approval or disapproval of the appointee, and the nomination is merely forwarded to the full legislature for confirmation or rejection. 5:37:12 PM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 5:37 p.m.