HOUSE TASK FORCE ON ALCOHOL AND ALCOHOL ABUSE Nome, Alaska September 21, 1993 9:00 a.m. MEMBERS PRESENT Representative Brian Porter, Chairman Representative Eldon Mulder Representative Jim Nordlund Representative Richard Foster MEMBERS ABSENT Representative Joe Sitton COMMITTEE CALENDAR Public testimony on alcohol abuse. WITNESS REGISTER LOREN JONES, Director Division of Alcoholism and Drug Abuse Department of Health and Social Services P.O. Box 110607 Juneau, AK 99801 465-2071 VIRGINIA TURNER Alcohol Use Prevention Coordinator Department of Corrections P.O. Box 2145 Bethel, AK 99559 543-5389 CRISTY WILLER TILDEN Program Director Bristol Bay Area Health Corp. P.O. Box 130 Bristol Bay, AK 99576 842-5266 LOUIE JONES Police Officer Dillingham Police Department P.O. Box 130 Dillingham, AK 99576 842-5266 REGGIE JOULE P.O. Box 51 Kotzebue, AK 99752 442-3601 DIANA FREEMAN Norton Sound Health Corp. P.O. Box 966 Nome, AK 99762 443-3344 ARDYCE TURNER Substance Abuse Education andPrevention Department YKHC P.O. Box 1153 Bethel, AK 99559 543-4061 ELIZABETH SUNNYBOY YKHC P.O. Box 1568 Bethel, AK 99559 543-3854 SOPHIE NOTHSTINE KAWERAK P.O. Box 948 Nome, AK 99762 443-5150 DUFFY HALLADAY, Manager Turning Point Detox Center P.O. Box 1890 Nome, AK 99762 443-5577 ACTION NARRATIVE TAPE ONE, SIDE A Number 000 The meeting was called to order by Chairman Porter at 9:50 a.m. Chairman Porter gave his opening remarks. CHAIRMAN PORTER: First of all, thank you very much to Representative Foster for coming and getting us and providing the logistical support for the first of the task force's meetings here in Nome. This Alcohol Task Force is comprised of myself, Representative Brian Porter. And the other task force members are Representative Richard Foster here from Nome, Representative Eldon Mulder from Anchorage, Representative Joe Sitton, who is not able to be with us today from Fairbanks, and Representative Jim Nordlund is here. I would also like to initially call the task force members' attention to the task force book that we have prepared by the staff of my office. The staff of my office happens to be the one person sitting right behind us, Eric Musser, and I would like to thank him very much for compiling a very comprehensive book to get us a very firm foundation of examining the problem of substance abuse and alcohol abuse within the state. I would like to, if you haven't already, call the members' attention to the Ombudsman's Investigative Report which calls to our attention the need for evaluation programs -- the Department of Corrections' substance abuse program, which during this year's session we have heard an awful lot of testimony about the requirements of the Department of Corrections and indications that apparently most of the inmates therein are there as a result of substance abuse problems. Within the framework of that, we (inaudible) information especially from the testimony that was received by the sentencing commission. The Alaska Judicial Council report is also very interesting. That basis really was the inspiration for House Speaker Barnes to appoint this task force, to look at the overall state policy, statutes and law that are aimed at dealing with the state's alcohol abuse problems. We have, as I've discussed with most of you, we have no fixed agenda. We're not going in with any presumptions about the extent of the problem or what is really necessary to correct it, with the exception I think of two assumptions and one conclusion that are somewhat fundamental. One of the assumptions is that Alaska has had and still has a myriad of problems caused by alcohol abuse and more problems that are exacerbated by alcohol, the abuse of alcohol and other substances. While these problems continue, as with the case with state programs, resources to address these problems are diminishing. Consequently, it would appear mandatory that this task force look for programs that will provide measurable results that can identify potential as well as existing problems and individuals and deter potential alcohol abusers and redirect those primary abusers. I guess it's also fair to observe that the problem that we are attempting to deal with is one that has plagued this state and our nation, for that matter, for decades and that there is no one quick and single answer. Existing responses to the symptoms or the problems, whichever they turn out to be, can be found in the philosophies of the field of education, health service, public safety, social programs and many others. What we would like to do is hear from as many of these disciplines as possible and learn their perspectives of the problems and their solutions and to get perspectives from as many members of the public as possible. (Inaudible) this information we would like to see if there are any obvious directions for the state to take in terms of coordination, innovation, or for that matter, elimination of programs. At the very least, we would like to see this task force develop a list of items of apparent promise and to deal with these individually during 1994. I would like to note our recognition of the work presently being done by the Alaska Natives Commission, the joint federal/state board looking at all issues affecting Alaska Natives and look to receive their input as it would relate to the same topics that we're addressing. With that in mind, we will begin taking testimony. That is as I hope is appropriate, and we appreciate his presence, the Director of the State Division of Alcohol and Substance Abuse, Mr. Loren Jones. Welcome Mr. Jones and please turn yourself on and talk to us. LOREN JONES: Okay, thank you Representative Porter. For the record, my name is Loren Jones. I am the Director of the Division of Alcoholism and Drug Abuse for the Department of Health and Social Services. We welcome this task force, uh the division, uh is always attempting to determine from local programs and from local providers and the public what kinds of services we should provide and what the local programs need and want to address those pressing issues locally. I was scheduled for an hour of testimony. I don't think I'll take that long, but I would like to just sort of give you a little bit of background on the division, how we're organized, what some of our purposes are, to describe some of the efforts we have done to address some of the issues raised in the Ombudsman's report, as well as to address issues we feel are facing the field of alcohol and drug abuse and inhalant abuse, and then to take a minute to describe some of the resources available, some of the programs available in the communities, that I believe are on the teleconference or potentially on the teleconference today, so that you have an idea as you listen to the people from the various communities what kinds of services are available there and where we feel they may be lacking services and what kinds of issues are there. I also have brought with me as much information as I could sort of glom onto to hopefully answer any questions that you might have either after my testimony or during the day if the opportunity presents itself. The division is a division within the Department of Health and Social Services. We became a division in 1990 by executive order. Prior to that we were an Office of Alcoholism and Drug Abuse. We have an advisory board that is made up of 12 citizens appointed by the Governor. There are currently 11 members on that advisory board. The statutory authority for our division is found in AS 47.37, which lays out the duties, responsibilities of the division, lays out the philosophy of the state regarding alcoholism and intoxicated persons. Within that chapter is also the involuntary commitment act for those persons who do not seek treatment on their own and for whom individuals responsible for them feel that they need to be committed, give guidance to the court as the courts reach that decision as to whether to involuntary commit. Our board has a status under AS 44.29. That again lays out the duties of that board which are basically to advise the department and the commissioner on issues relating to alcohol abuse, drug abuse and inhalant abuse. This task force is set up as an alcohol and alcohol abuse task force. My division also has responsibilities for drug abuse issues and inhalant issues. At the federal level we are now being required, as a result of federal block grant funding, to be somewhat responsible for tobacco, even though within our department of Health and Social Services tobacco is structurally under the Division of Public Health. Along with CDC's recommendation, the Center for Disease Control, and other federal officials, we are now being required to do some things in terms of violence prevention as well as its related to use of substance abuse in schools, weapons in schools, the advent of gangs, those kinds of things, youth violence. We're slowly being required at the federal level to deal with that as part of our overall prevention efforts. The other task forces (inaudible) in terms of alcohol and alcohol abuse. My division's responsibilities are quite broad. We are basically organized into three sections. We have an office in Juneau that is basically the policy section, the management information section and our administrative section where we do all the grants management. We have two offices in Anchorage. One our Anchorage field office which has seven staff members that is responsible for the quality assurance program and responsible for providing the technical assistance and grant support to all the various local programs that are funded out of our division. AS 37.37 also requires us to establish standards for quality treatment programs and to apply those standards to both public and private treatment agencies. So we do an on-site to give a certificate of approval to every program that says they provide alcohol or drug abuse treatment. CHAIRMAN PORTER: What title is that now? LOREN JONES: AS 37.37.130 I believe. So we do review the programs at Providence, Charter, private psychologists, private programs like that as well as state grant funded programs. Our third office in Anchorage is the Anchorage Alcohol Safety Action Program and it's located in the Court building. They have two responsibilities: one is to provide direct services to the Anchorage court system for misdemeanant offenders referred by the court system. The Alcohol Safety Action Program started out to be programs that dealt with drunk drivers. Currently the Anchorage court system in particular and many courts around the state are now sending other alcohol related misdemeanant offenders. Our Anchorage case load is about 50% drunk driving offenders and 50% other misdemeanant offenders. Step down felonies that deal with alcohol related violence, domestic violence cases, assault, burglaries, those kind of misdemeanor cases that are in fact alcohol related are referred to the ASAP office. That has made our case load there increase in the last six or seven years by almost 200% with no increase in staff. Also these (inaudible) ASAP programs around the state to various nonprofit agencies, they do the same function. The second function of the Anchorage ASAP office is to provide technical assistance, quality assurance and oversight of the other grantee programs that do the Alcohol Safety Action Program. The task of the ASAP is to assure there is continuity and that we offer the same services to each court system. We have a standardized assessment process, standardized protocol for handling the cases, referring them on for other treatment or education and also getting back to the court if they are noncompliant with either their treatment or their education. That is the only direct service that the division operates. All services provided in the State of Alaska for the direct prevention, intervention or treatment of alcoholism, alcohol abuse, drug abuse and inhalant abuse are done through local nonprofit grantees or municipal government. The grant in aid authority that we operate under is AS 47.30.475-500. It lays out the conditions for granting funds to local programs. It lays out the match requirement, which is 10%, and they also lay out the requirement for local plans, local needs assessment that are required of the local programs. We're only allowed to grant to nonprofits or municipal arms of government. We may not provide any funds to profit corporations, and by federal law we cannot provide any funds to inpatient treatment. The inpatient that is available in Alaska as within the private sector and it is funded through either private health insurance or first party pay. We recently in FY 92, toward the end the legislature, passed HB 545 which permitted Medicaid to begin paying for substance abuse treatment. To date, regulations have not received approval to implement that program and so no program has yet to receive any Medicaid funding. It is now authorized and we are trying to get the regulations through. That would provide Medicaid funding for some residential care and mostly outpatient treatment care for those individuals who are on Medicaid. However, the way in which the Medicaid program operates, under the program refinancing scheme, we will be required to pay the match to Medicaid, which means that we reduce the grants to the local program in the amount we think they will achieve when they start billing Medicaid. So that there is some gain we are basically replacing general fund dollars with 50% federal and 50% general fund instead of 100% general fund; but under that scheme of trying to refinance, we're not able to increase the amount of services available. We're basically staying flat. Our budget, and I know it's in the book that Eric had put together, a budget summary for you from about 1984 forward, and as you'll notice we reached a relative high in FY 92 and in FY 93 we took a decrease of about $1.2 - 1.3 million, and for FY 94 we took an additional decrease of $500,000. Some of that was in state money and some of that was in federal funds. The legislature has also changed the nature of our funding, as has the federal government. We receive a federal block grant from the Center for Substance Abuse Treatment. The Center for Substance Abuse Treatment is within the Substance Abuse and Mental Health Services Administration in the Department of Health and Human Services within the federal government. Prior to FY 93 the block grant was combined with mental health. In FY 93, under the reauthorization of block grant was split between mental health on one side, as a separate block grant, and alcohol and drug abuse service as a separate block grant. When we did that, we had a reduction in funds come to us because they took a higher percentage of that money for the mental health block grant that had previously been done. At the same time, the legislature over the last three or four years has continued to increase the amount of general fund dollars that come from the mental health trust into our budget and decrease the amount of general fund. In the largest grant component in my BRU, I have about $900,000 of general funds out of $17 million. $2 million is federal, the rest is from the mental health trust. What this has done is to... One of the criticisms of the Ombudsman's report was that our mission statement didn't necessarily give us a direction to go that we could show that we had some impact and we didn't do very much of a needs based assessment and we didn't put our money where there's the best chance of having a good return come from. One of the federal statutes and federal block grant requirements, ...we have to spend 20% of our federal block grant on prevention. We have to spend 35% of our block grant on alcohol abuse programs. We must spend 35% of our block grant on drug abuse programs, and increasing to 20% now on women's only services. If you add that up it comes to 105%. We're also allowed to take 5% for administrative costs, which we do. We can double count in the fact that people who do receive alcohol services may be getting prevention services, women may be getting drug abuse services, and those kinds of services give the ability to double count. But it does place some restrictions on how we can spend the money, irrespective of what our plan might say, irrespective of what we might desire. We might want to spend 90% of our money on alcohol, but we are precluded from doing so. In addition, under the mental health proposed settlement and under the court ruling, the beneficiary of the mental health trust is the chronic alcoholic with psychosis. There is a definition of law. There is no clinical definition of a chronic alcoholic with... therefore, the mental health board, acting as trustee, believes the legislature has erred in assigning 86 to 90% of my budget to the mental health trust because they feel that less than 25% of the clients we serve are in fact chronic alcoholics with psychosis. Therefore, we tried desperately not to fund prevention efforts from the mental health trust dollars and try to use general fund dollars. Specifically, drugs are not mentioned in the mental health trust settlement so we try to use general fund and federal dollars for drug abuse funds as well. That is increasingly hard to do when you have a decreasing general fund dollar and an increase in mental health trust dollars to honor the basic law from the court that says the beneficiary of the trust is a chronic alcoholic with psychosis. So we've sort of been placed in a box that makes it difficult to put the funding where individuals feel it is best needed, to make sure that the programs, as they serve the client, who doesn't care if they are a beneficiary of the mental health trust, doesn't care if they are in a box at the federal funding level, but do care that they get the appropriate service that they want to solve their issue they have with alcohol and drug abuse or inhalants. That is a problem that we faced that we don't know a ready solution to. The administration's position is that the legislature has established that policy that alcohol services will be funded from the trust, that by their appropriation of those funds they have expanded the beneficiary. The mental health board feels that is not the case, that the legislature needs to pass a statute that says their standing as the beneficiaries of the trust which under the court ruling they are allowed to do. So then, trying to plan down to the level of services under some of the recommendations of the Ombudsman, we do run into some of those financial considerations that pose a problem for us. In addition to the fact that inflation eats into the treatment and prevention dollars of the local programs, the fact that we reduced their programs the last two years in a row, you can add to that whatever inflationary factor. We went back and looked at our budget from 1984 forward to 1994 and we started out in 1984 and we just added a simple 3% inflationary factor so that you get a basic... if we had gotten a 3% increase every year... what our funding level would be, we are well below that level with FY 94, so that the impact of inflation, the impact on increased health care costs, the impact on fixed costs for residential costs where you have fuel oil dollars that go up and electricity costs that go up and you have staff costs that go up and you have increasing social security costs that go up and an increasing costs of doing business and a decreasing amount of funds coming into local programs, has really put a lot of programs on the brink. Just not being able to provide the level of service they currently provide and certainly not the comprehensive level of service they think they need to adequately serve their particular areas. Under 47.37 the legislature has laid out what they feel is a comprehensive program and this comprehensive program must include an emergency care, it must include residential treatment, it must include outpatient care and it must include after care and follow-up. We attempt to provide that level of care and at least Level 3 communities and Level 4 communities. Level 1 and Level 2 communities we have a reduced level of that care. Within health planning Level 1 communities would be small villages, Level 2 communities would be health communities, I believe that Nome falls under a Level 3 community, a population over 2500 to 3000, so we do have a level of care that sort of determines what we are willing to support in a local community. Within those realms then the local communities have some ability to change services to make those services more appropriate for the local community and I'll explain a little of that in a minute. We have many issues that face our division and face the alcohol and drug abuse and inhalant field in the next few years. The issue of the increasing realization of the dually diagnosed population, those who are mentally ill and are also substance abusers, there are liberal debate raging at various places, not as heavy in Alaska as it is in other places, over what the extent of that population is and what's the appropriate way to address and treat that population. There are definitely a significant number of individuals who are mentally ill that abuse alcohol and drugs. They do that as part of their mental illness, they do that as a method to medicate themselves, they do that as a method to try to solve some of the mental health problems; they may also be physically addicted to alcohol or drugs and also be diagnosed as suffering from alcoholism or drug addiction. In addition, there are significant number of persons who are alcoholic or drug addicts who are not mentally ill, who do not have a diagnosable mental illness, and they may exhibit at times the same diagnostic characteristics. But periods of absence and a quality recovery program and those symptoms tend to go away. It's a difficult process in some communities so separate those two and that is an issue that we are constantly dealing with, both at the federal level and within Alaska. Emergency care is a problem in that we try to provide some level of detox or emergency care within most of the hub communities, but that is expensive and not always available. And there are differences of opinion as to how you should provide that. Anchorage is a prime example, where several years ago they used a public inebriate reception center, tried to hold people there. It was relatively inexpensive. There's a lot of individuals who didn't want to go on for detox, which is more expensive level of care. They dropped that and now have expanded the size of their detox, trying to sort out how to deal with the homeless population, trying to deal with the street people. In a community like Nome... they have a five bed detox in this community that refers people into a residential treatment program. In Bethel there is no detox program. They have... its been a difficult process for the community of Bethel to decide whether they want one, how they would operate it, how it wouldn't be (inaudible) just a revolving door institution for people who were ill, who needed to go on to further treatment, but simply use this to be safe in the wintertime and to get a little bit of their health back and then who refuse to go on to further treatment. That is a relative expensive level of care. There are many communities that would like to use the involuntary commitment act that is part of AS 47.37. They have asked that we as a division look at revising that portion of the statute. With all of our other priorities we have not had a lot of time to look at that. Several years ago, then Senator Uehling had a bill in that would have changed that. It ran into some significant problems with some communities over the way it was worded. It ran into some problems with confidentiality issues and what could be shared in a court hearing from clinical treatment records and what could be not and some of those issues just didn't get resolved before the Senator was no longer in office. Some communities use it very well, other communities do not. Two or three of the major problems with it is that it does not guarantee treatment. If you were mentally ill and you were committed under the mental health commitment statute you have a right to treatment. If you can't be treated in the local community, than you can be committed to API. That is their final back-up if they can't use the local hospital, if they can't use the hospital in Fairbanks, then their backup is API. Under the alcohol commitment statute there is no right to treatment. If the court commits the individual and there is no treatment available in that community, then they have to try to find another bed someplace else, and if that's not possible, then the individual does not get admitted even though the court has involuntary committed them to a treatment program. We're not funded to guarantee that there's beds available. We're not funded to pay for the transportation. As an example, you could have an individual in Wrangell that has an outpatient program. You get the individual care committed, there's no beds in Juneau, there's no beds in Ketchikan, there is a bed in Fairbanks. How you pay for the transportation to get that individual from Wrangell to Fairbanks, that's not part of our current budget stream, it's not something that we have felt the statute gives us the responsibility for. Sometimes they'll get that donated, sometimes the person can pay part way, sometimes the program pays, sometimes the program will pay half the cost, the one way ticket. After the person's been through treatment, then the person's responsible for the return flight. So those are a couple of the issues facing them. Also, because it's not within the same (inaudible) as the mental health, if the local program does the commitment, they have to get their own attorney. Under the mental health statute, it's the state that is committing this person to the community mental health center and the state Attorney General's Office represents the state's interest in committing this individual. That is not the case under the involuntary commitment for alcoholics. It may be an issue that this committee may want to look at more closely or ask some questions of those who do use the commitment act. I believe that John Dapcivich from the City and Borough of Juneau has done a look at the involuntary commitment act and looked at public inebriate services and I think he sent that report up to Representative Porter's office. If he didn't, I'd be sure to get another copy. He looked at those issues as they were done in Sitka, Petersburg, Ketchikan, Anchorage and Fairbanks. I came to Anchorage and just had a meeting and I'll get you a copy of that. I thought that he had said that he had sent that up. In addition, I think you'll hear during the course of this testimony, even though this is on alcohol and alcohol abuse, I think you'll hear increasing requests for services to young children for inhalant abuse. It is a growing problem in recognition and I think in actuality, in rural Alaska especially, but some in the urban community, we have been attempting to deal with that existing services with existing programs and I don't think that we are being very successful. We have the Norton Sound Health Corporation here in Nome apply to us, to the federal government for a inhalant treatment program at White Mountain. We have some indication that there might be a chance that might be funded. We should know hopefully be the end of this month, the first part of October. If that happens, it will be one of only the second inhalant abuse treatment programs that have been funded by the federal government. One is in South Dakota, a program called Our Home or Our House and so the Nome area would have the second one in the nation that was funded specifically for inhalant abuse. We still have the recurring issues of drug abuse, ups and downs, some increasing cocaine issues facing treatment providers. That seems to be an increasing drug of choice as people come into treatment. It is still overwhelmingly alcohol, but we are seeing more of that. Even though some of the public safety issues and some of the major arrest issues and stuff are down somewhat. We are continuing to see an increase in people that are coming into treatment for cocaine use. We have attempted in the six or eight months since the Ombudsman's report came out and since we went through legislative hearings in the budget process to answer some of the questions, and Representative Porter certainly raised it this morning in terms of finding out which programs work, what the emphasis of the programs are, how effective they are. We have done this in three ways. First of all, the House Finance Subcommittee had originally proposed some intent in the budget that would have required all of the programs to do outcome research and to determine the efficacy of their individual programs. That intent never made into the final budget process, but we did put a special condition in all of our treatment grants that asked them if they had done follow-up studies, if they have checked on clients after treatment, if they have done any of that research, that they are to submit a report to us by the first of December so that we can compile that information and present it to the legislature in some summary form. Also, so that we can look at are they using a common definition of outcomes, are they using the same approach, is there something here that we might be able to learn from and could institute that across all of our programs? We hope that we will get a good report from that. Secondly, we hired a college intern this summer who has been working in our Anchorage ASAP office. She has been taking a sample of cases that were referred to the ASAP office in 1989 and then using the public safety's computer system, the Alaska Justice Information System, she has been going through and seeing if any of these individuals have repeated the offense for which they were sent to ASAP; i.e., have they done another drunk driving offense, have they committed any other offenses over the years 90, 91 and 92? That data analysis should be completed by the first part of October. We then applied to the Department of Public Safety, through the Highway Safety Planning Agency, for money for a professor at the University of Alaska to analyze that data. Just as I was leaving yesterday, I found out that that will probably be funded, but we won't know for another week. And if that is funded, then hopefully by the time the legislature comes in we will have that report available from the University in terms of how well at least the Anchorage ASAP office is doing. CHAIRMAN PORTER: Who's is that Professor? LOREN JONES: Sharon O'Raji CHAIRMAN PORTER: What University? LOREN JONES: Sociology Department, University of Alaska Anchorage. And third, we were able to convince both the Commissioner and the Office of Management and Budget to use a portion of capital funds that were earmarked for Mental Health Trust facilities for beneficiaries, to use some of that money to put together a more standardized follow-up project for both rural and urban out-patient and residential programs. We have set aside $250,000, we have received authority from General Services and Supply to sole source this contract with a program called New Standards Incorporated out of Minnesota. They used to go by the name CATOR, which is a Comprehensive Alcohol Treatment Outcome Research Project. It is a firm that has gained a significant reputation in the field and among other states starting out first in the private sector and now working more in the public sector in attempting to do some standardized treatment follow-up that allows you to compare both between programs and compare programs of like in other states, in other places. They have maintained a fairly large, expansive data base of services. We are in the process of negotiating that contract now. Hopefully the data collection will start in December. The final, final results will be 2-1/2 years from that time. The reason for this is that follow-up studies are extensive, expensive and need a lot of time. We are going to collect data for a year. That means that when a person enters the treatment programs that we select, they will be given the standard assessment that that program does, as well as a standard assessment from CATOR. If they're in a residential program, they will be given the same instrument at discharge from the residential program. If they are in an outpatient program they will pick a time certain, usually a month or two months after they begin treatment, and they will do this discharge summary. Then all that information is collected at the local program level and sent to CATOR. They put those all into their computer data base and begin the analysis of, What is the profile of the client as they come in the door? What is their employment status, their health status, their legal status, their diagnostic categories, educational level, marital and family status, use of social services agencies, all of those things that are harmed within a person's life by their substance abuse. They will then contact that person at six months and 12 months from the time of discharge to determine what their status is on all those same variables so we can see how they've improved, which clients improved the best within what kinds of treatment and also what information will be available back at the programs. Some preliminary data will be able to come out at nine months and 12 months because we will at least have intake information and we will know what our client population looks like, different from our management information system. To do that level of follow-up to give you the scientific validity, that you did the appropriate sampling, that you got enough clients so that you're statistically correct, that if this is not an anomaly, takes a significant amount of time and effort. We are going to try, I think, to collect the initial information on roughly 1,400 clients. CATOR is hoping that 700 to 800 will still be able to be found and followed up 12 months after their discharge from treatment. We do expect some attrition. People will refuse, they'll change their mind, they won't want to talk on the telephone, there will be all kinds of other issues that will be raised for people who drop out, but we're hoping that effort will come about. We will have that contract and the scope of the work available when the legislature... so we will be able to walk that through the budget committee and the other legislative committees if they're interested. In addition, we have put together a group of individuals called our Strategic Planning Team that represent the providers in the field, that represent the Departments of Corrections, the Department of Education, within our department the Division of Public Health, the Division of Family and Youth Services and the Division of Mental Health into a strategic planning team that has been looking at three things: one, at our mission statement, what we're about, why we exist, where we should go from here, and to basically try to put together a strategic plan for our division that will both push and pull us into the future and not keep us mired as much in the past as I think some of our plans have been rightly criticized for being. The first draft of that plan will be presented to our advisory board in Fairbanks on Thursday. On Friday and Saturday they will be holding public hearings in Fairbanks on that plan. We are reviewing it within themselves, making comments back to us. We will then take the month of October to finalize writing it. The last two days in October, I think the 28th and 29th of October, we will bring our strategic planning team back together to take one more look at that product and then by statute that product will then go back to the commissioner's office and then to the Governor. I believe it's AS 47.37.040(10), requires us to develop a plan for the Governor, and so this plan will be presented to the Governor and hopefully he will accept that plan and then we will be on our way to basing our fees for the next budget cycle, the next grant cycle. Hopefully that will address some of the issues addressed in the Ombudsman's report. CHAIRMAN PORTER: Let me interject here if I may and I hope (inaudible) vote that my voice is not getting all the way to Bethel. I hope it is now. I'm a little closer to the mike. If not, let me know and I'll put it in the back of my head. I recognize that obviously for final approval that that draft plan for your division would have to go the Governor's office. I would appreciate it if you could find out for us whether or not this task force could be made aware of what that plan contains prior to that with whatever restrictions the Governor's office might want to put on it, to the extent that we could perhaps have input from the information that we're gaining to suggest inclusions for dilution's or amendments to that plan before it gets etched in stone and has to go through another lengthy process. LOREN JONES: I have assumed that at the October 4th meeting, which was after our board had met that, 1) there may be some testimony from those who attended that meeting, at least the front section I believe I was going to try to get to the task force. What we had the most difficult time crunch on is when you get down to the nitty gritty of defining the goals and trying to put those in the appropriate outcome measures. It's harder to get agreement and that is the weakest part of the draft to date and that is the part we will work on through October and the end of October at the strategic meeting, (inaudible) and then philosophy on some of the research and the background behind that, I'm planning to provide the task force on October 4th, after our board had looked at it and made their comments and so we will provide that. And then as soon as that plan has been approved by the strategic planning committee, if the Commissioner desires, I will make sure you have it as early in November as I can before your December 1st hearing to make sure you do have that available. Just a couple other things and I guess I will stop for some questions and allow other people to testify. I have an opportunity through several other hearings to say other things. One of the issues that you talked about in terms of coordination and cooperation between other programs... This division, with it's divisional status, certainly does attempt to coordinate as best we can with other divisions within our own department. Sometimes that's easier and sometimes it's harder. We do have some projects jointly with the Division of Mental Health. One of those projects is the dually diagnosed projects... (end of tape) TAPE ONE, SIDE B Number 000 ...by the Division of Alcoholism and Drug Abuse. It provides for rural human service workers in the villages, people that can provide, like a community health aide does, providing primary health care in the village and like the (inaudible) providing primary public safety that the human services worker would be able to provide substance abuse services, mental health services, referral, after care, education, prevention work within each of the villages. The Niel Corporation in Kotzebue and the Dillingham/Bristol Bay Area Health Corporation are two grantees under that program that may be on this teleconference and that is a joint funded program that provides for additional services in the villages. One of the lacking of some of the services as I described those will be that lack of services into the communities. In addition, the Department of Corrections we have work with in terms of providing counselors within each of the jails. The Norton Sound Health Corporation here has a contract, has a contract, with the Department of Corrections to provide a counselor at Anvil Mountain. Those grants used to come from us. Corrections gave us the money several years ago. The Department of Corrections opted to want to run that more in house of their department rather than our division. We have been in the process of reversing that and we were going to RSA them money. The legislature deleted that money in the FY 94 budget so the entire inmate substance abuse program within the Department of Corrections is solely funded with the Department of Corrections funds. We have encouraged them and they have continued to use local providers rather than hiring alcohol counselors on state salaries. We feel the local programs provide ample expertise and abilities to provide those services in the jail and to (inaudible) substance abuse costs to the Department of Corrections. However, the Department of Corrections is still using us to fund community treatment beds for inmates who are getting out on furlough or getting out on parole that need a residential level of care once they have left the institution, and so we do have a relationship with them and then we grant that money out to local providers and communities that the Department of Corrections desires, and that money then flows out to the local treatment programs to provide bed space and treatment capacities for persons leaving the Department of Corrections. Within the Department of Education, they have a federal program called the Drug Free Schools in which the federal government gives the State of Alaska a certain money. That money is then sent out to the local school districts on a per capita basis with formula basis based on their average daily census within the schools. As part of that there is a requirement that they have an advisory board that advises the Department of Education on the plan and some of their distribution. I am a member of that, as well as a member from the Governor's office. In addition, the Governor has awarded discretionary funds under the drug free schools act, and I think some other bureau of justice system that the governor's of each state has the ability to give where they want to provide whatever services. Governor Hickel, Governor Cowper before him, opted to give that money to the Department of Education and that is put out in prevention grants to local school districts, to some local providers. They are all prevention efforts. They subsidize DARE programs, the Drug Abuse Resistance Education programs that are operated by local police officers, and we fund some of those directly. So we do in many cases opt to work with other divisions and other departments in order to better coordinate services for the client. I understand in the book you were given a map that people on teleconference won't be able to see, but basically lays out our regions. Also on the map that gives you an idea what our funding percentages are based on that population. One group of people I'm leaving out are the Indian Health Service which does provide a considerable amount of money directly to local programs, mostly 638 contractors, although they do have some funds that they call bi-Indian money. But most of them are 638 funds as federal public law that allows for Indian self determination and the Indian Health Services funds from (inaudible) corporations for primary medical care. Substance abuse prevention, I think some FAS funds, health care community health aids, a lot of that is under the 638. If I might, I could just sort of go down the regions that may be on the teleconference and if I can a little bit from memory give you an idea of the (inaudible) of the bill. If you start of the top, Region 6 is basically the North Slope Borough. The major grantee is the North Slope Borough Health Department. They receive funds for both outpatient and outreach efforts in Barrow and the other communities. They are funded for a six bed detox program and a 16 bed residential program in Barrow. We are probably a minor contributor in terms of funds. I believe we contribute roughly $500,000; I think the Borough probably puts in another $1.5 million in order to fund that program at the level at which they do fund it. Region 5 -- as you go down the left side, is in the Manilik region. The Manilik Association receives funding through the budget request region, the Manilik BRU. They do not receive funding out of our grant budget. They provide for village outreach, a level of outpatient care. They have a detox program and a 12 bed residential program. They also do some of the prevention work in the schools. Also, as part of Region 5, is the Norton Sound Health Corporation Region that's headquartered here in Nome. The Norton Sound Health Corporation also is funded from a Budget Request Unit. It is not funded out of our budget. I believe they primarily use our money for their residential program, Northern Lights Recovery Center. Indian Health Service money pays for their prevention effort, some of their outreach effort. I know that there's one representative here in the room that has testified. She could probably better describe that program better than I can. I'm probably not doing justice to it. Region 7 -- which is the YK Health Corporation, the Bethel Region. They are funded in two ways. They get some money from our grant, the majority of money from our grant program. They also have their rural services, they are village counselors, there are nine, are funded through the budget request unit for YK (Yukon-Kuskokwim). The City of Bethel used to operate the treatment program there and the YK Health Corporation did the rural services. About two years ago the City of Bethel opted to no longer perform those services and so YK Health Corporation has taken over. The money has just never moved into their BRU, but I suspect that this year we will be coming in with a request to do that. Region 2 covers the Dillingham area. The Bristol Bay Area Health Corporation is the provider there. They provide mostly outpatient services. They provide alcohol safety action programs. We pay for services in the villages, village counselors. The Indian Health Service supports that, as does the rural human services project. They just recently opened up sort of a transitional residential place for those who have been, say in Anchorage or Fairbanks for treatment. On their way back to their village they may stay in Dillingham for two or three days to sort of adjust back, to talk to the local people, make contact with the provider there, before they go back to their local community. It's also a transition for those who are leaving their local community, maybe going to treatment elsewhere, to come in from a outlying village into Dillingham, spend three or four days talking with the staff there, and then moving on. I do believe when I talked to the program director there yesterday that she was going to try to, during the day, to testify and I'm sure that Dillingham will do that. Region 9 is mostly the interior. It's the Tanana Chiefs/Doyon Region. I don't know if you are teleconferenced to either Galena, McGrath or Aniak, but within that river system, sort of the mid-interior, we do have a project in Galena, we do have a project at McGrath to serve all those villages there and then Aniak serves the villages of the Kuskokwim Natives Association which is called the Yukon/Kuskokwim Health Corporation District, but they do have a separate program for the seven or eight villages along the Kuskokwim River out of Aniak. As you can see by the map, it describes basically the population and the percent of dollars. These are a low population area. They get a considerable number of resources. Region 6 has one percent of the state's population and they get three percent of our grant funds and Indian Health Service money. When you combine all the money provided out there they get three percent. Region 5 has three percent of the population, nine percent of the funding. Region 7 has four percent of the population, seven percent of the funding. Region 2 has three percent of the population and four percent of the funding. We feel that this distribution is justified in many ways. It is very difficult to provide services out here. It is very costly to provide services. When you're in the Nome area and you try to serve St. Lawrence Island and you have to fly people out and fly clients in, prevention efforts out, salaries are higher, travel costs are higher. There are real significant issues with that. I guess with that as an overview, I'll give you an idea of whom might be testifying. I can either answer questions now or as the day proceeds, whatever you desire. Thank you very much Mr. Chairman. CHAIRMAN PORTER: Thank you Loren, very much, for that very comprehensive overview of where we are and what's going on. I would recognize over the teleconference network that we have, I believe, Kotzebue, Bethel, we have people here in Nome of course, and Dillingham. I think I'll ask the committee now if there are any specific questions of Loren and if we can get a few of those taken care of. Loren, you will be here with us during the day? LOREN JONES: Yes, sir, I'll be here all day. CHAIRMAN PORTER: So we don't have to exhaust him right now and could get some quick ones taken care of and then we'll go out and rotate through the teleconference and here in Nome people who would like to talk to the task force. Representative Mulder. REPRESENTATIVE MULDER: Thank you Mr. Chairman. Loren, starting at the beginning point, the assumption for every BRU, or every division -- if only I had more money, we could do a better job. I recognize that in one hand it's kind of the senseless question to ask you if you had more money could you do a better job because a good bureaucrat is always going to say you bet. Being very critical Loren, at what level funding does it begin to drop off. You know, there is a point where you just can't overcome a problem or you are looking at it from a different direction or a wrong direction. The question is really a general one. Does more money mean a better program in your sense? LOREN JONES: I believe the answer is yes, for several reasons. One is that we do a very good job given the resources we have available. I think that any outcome research we would do or anybody else would do would show that the programs are working for a majority of the individuals who come through treatment. We are as comparable with any comparable programs anywhere in the nation. I think where we could improve -- and I can't answer the question, When is enough, enough? -- in terms of when does the treatment foul up. There are a lot of issues that make treatment less successful than it could be and thus cost money. When you take an individual from a rural community and bring them into Nome, provide quality treatment, they leave here full of hope, they are feeling good about themselves, they've got a better self concept. Physically they are healthier, and they go back to that village, and they're back in the same housing situation with other people who may or may not be in recovery, who may still be actively drinking, they are still in the same economic conditions as they were before. Some people who, because of the treatment and because of the aftercare provided, stay in recovery and some don't. Some relapse and need to be brought back. In a more urban setting a lot of the individuals that are treated in the public sector are homeless, marginally housed. Treatment doesn't change that. Some funds for housing might, some funds to build housing that's not available in the Anchorage area or a Juneau area where these individuals, maybe more half-way houses for these individuals that are some place to go after primary treatment that are less expensive. Job training, vocational training, long term care for some of the hard core public inebriate, those are expensive for a small portion of the population. I'm not sure where the economic benefit stops in terms of getting better results out of the treatment program. But, we are sending people back into the rural areas from treatment programs in the communities that have no support for them. There is no aftercare worker out there. There is no VPSO out there. There is a community health aide possible. It's very difficult for that person. Programs do it by telephone. They try to contact the person by phone, but that's difficult to do. Placing people out in those villages, maintaining them, training them, providing them their clinical support, is expensive and we're not funded at a level sufficient enough to do that. So, yes, more resources would make the treatment system better because we could do some of the things beyond treatment, beyond the physical period of sixty or ninety days in a treatment program, beyond the actual outpatient counseling that might be able to give that person the stability they might need to maintain themselves. CHAIRMAN PORTER: Representative Nordlund. REPRESENTATIVE NORDLUND: Just to follow-up on Eldon's question, too. I had another question. I guess we don't really know, frankly, how well these programs are working because there is some outcome research done, but the criticism in the Ombudsman's was that it's not very adequate and I think Loren's willing to admit that there is a better job that can be done. So, until we have that component, we are not going to be sure that the politics of the treatment is. Then I have a question. We have the research that's been done, or the contract that's been let to CATOR to develop their outcomes research, and at the same time you have the strategic plan to determine the future of the division. I guess my question is, How is the CATOR working, the standards by which CATOR is judging the outcomes going to be determined if you haven't done your plan yet? In other words, what is the ultimate objective you are trying to achieve, even in terms of social costs versus simply the amount of personal (inaudible)? LOREN JONES: Two-fold. One, is the outcome research is very clinically oriented to the individual. There is a body of literature and a body of research that is very extensive in the Lower Forty-Eight, very extensive by the federal government, that describes those things that drive people into treatment for things that happen to people while they are using substances: loss of employment, loss of skills, marriage break-ups, over use of emergency rooms at hospitals, loss of jobs, loss of family, dropping out of school, not finishing your education, having failed personal health. There are all kinds of issues that revolve around an individual who is alcoholic and/or a drug addict who uses. Youth, in terms of their completion of school, staying out of trouble, drunk driving for adults and kids, criminal behavior, all kinds of things that we relate to alcohol. Individually, you can measure how a person's experiences in those various areas and you can determine a year after treatment if those areas have improved. If their health has improved, they are using ER's less. That's what CATOR is to do. There is a standard body of knowledge out there and they pretty well standardized this so that we can look at comparable programs in the Lower Forty-Eight that they have the data base on. We can find programs that serve the same kinds of clients, the same age groups, the same racial breakdown, the same sex breakdown, the same level of debility or nondebility if you are talking about out-patient clients. So we can compare how we're doing irrespective of what the strategic plan is. I can tell you that in the strategic plan one of the issues is to develop a more on-going maintenance of that kind of follow-up effort so that we don't have to wait two and one-half years to get a result so that hopefully by the time CATOR is done we will have taken that information, instituted that on a routine basis, so that each year we will have continuing information. So a strategic plan is to push us ahead. We agree that there is not formalized outcome research done in this state. We have not done a (inaudible), a telephone study in 82' or '83. We have not made a very good effort at that partly because we have been under a lot of pressure, we feel rightly so, to expand some services. When we have asked for increments to fund that, generally services have been funded and not research, and we have opted not to take money from the grantees in order to do that research and that's a choice we made and the Ombudsman called us on it. At the same time, there is a body of evidence that certain kinds of programs are more effective, that programs that have these kinds of services, that provide treatment for a certain length of time, cover those subjects, provide the aftercare, make the referral to self-help groups, are the kinds of programs that are evaluated. We do have a process to determine that those are kinds of programs that are being operated. So we have an intuitive feel, we have a process feel and the programs understand. The people here in Nome know whether they have been successful or not because the people they treat live here, the people they treat are in their villages. They see those people and they make the adjustments in their program as are required. So, we think that we do know what is needed to operate a quality program, that we have put in place programs that meet those standards, that give us every indication that they are being successful in what they are doing. We just do not have the organized, scientific research that will satisfy a (inaudible) maybe even satisfy myself and certainly not have satisfied the Ombudsman. But, we think we've got enough of that in place to be able to come together with our funds. REPRESENTATIVE NORDLUND: Loren, I've got a question regarding the strategic plan and just how in the long-term this is going to work. What assurance do we have, the legislature and the citizens, that once a certain length of time is often accepted, including the strategic plan, that it's going to continue to be that way, that there is some longevity to it. We could have changes in the administration, a change in philosophy and turn the division upside down. Is there something we can put in statute once this is developed, or what sort of assurance do we have that there is some longevity to it? LOREN JONES: I'm not sure if there is a statutory answer. The answer is, is there longevity to it to the extent that the local programs are being funded to the extend that we did hold some public hearings and we could combine? I would hope that they would be able to force any changes of administration to look at that plan and to try to accept it, but I have no guarantees. I've watched the Division of Family and Youth Services develop their strategic plan, and then a change of administration and that plan got shelved. There is a statutory requirement that there is a plan. There is a statutory requirement that it be approved by the Governor. When this administration came in, they accepted the plan that was in place and I would expect that if we've done a quality job and there is a lot of buy-off, that the next administration would look at that. They might not want to implement all of it. They may want to push it ahead. In terms of are there guarantees for the legislature? No. That's why the legislature has one, the Ombudsman's Office, and two, legislative committees like this. That's your control over us that we're doing our job correctly. If you read the Ombudsman's report, we felt, and I felt when I was interviewed, and I still feel, that we have tried to honor the requirements of the statute. The statute gives nineteen shalls that we shall do and we have a staff of 28. We have a lot of programs out here that try to provide quality services and we try to provide them with as much support as we can. The statute gives us the ability to define what is in a comprehensive program, from emergency care to residential care to outpatient care to aftercare and follow-up, and we felt that we were trying to honor that. It gives us the philosophy. It tells us what our mission is. It tells us who our clients are: alcoholics, intoxicated persons, drug abusers and inhalant abusers, and yet the Ombudsman felt that that wasn't sufficient, that we have not maybe lived up to that and that we had not gone beyond that statute. So, even having it in statute does not necessarily keep a program from either not meeting a certain set of standards that somebody else places or maybe even not meeting the standards that were set for itself. REPRESENTATIVE NORDLUND: I guess one of the comments in the Ombudsman's report, one of the main things was that there is no mission statement and I think I can sympathize with that. Over time and with changes in administration, the division could gravitate, you know, or respond to political whims, more so than if it had more of a state ironclad mission. Not that a mission like that couldn't change over time, but maybe you look at maybe some sort of statutory requirement that there would be in (inaudible) of the strategic plan. LOREN JONES: We will get the first part of the report, which is the mission statement. The team worked very hard to develop that and I think it does answer what the Ombudsman would like us to answer, and in fact will give us some real direction. CHAIRMAN PORTER: Thank you Representative Nordlund. This is Representative Porter. I'm going to go to plan C here and try and get my voice to Bethel and use the button instead of the switch. If that still doesn't work, I'll trade mics I guess. Loren, if I might follow-up really on what Representative Nordlund was mentioning. In reading the Ombudsman's report, it appeared to me that part of the ability of the Ombudsman had to criticize was that there had very recently been criteria developed nationally, or at least recognized nationally, begin to be recognized nationally, of new methods of evaluation and new emphasis in that area. With that in mind, and I'm sure you are now looking at those methods to incorporate into your plan, if it is the Title 47 that sets up standards for program, it may well be that there is a need for statutory change and I know that I would echo what Representative Nordlund just said that we would be very interested in any recommendations that your division, or all of the other people telling you what to do, bring to you in regards to an inability that you may have that could be rectified by statute or specificity in what you should be doing that could be rectified by statute. In that regard, also, I may have some experience in program evaluation requirements within this state. I know that one of the things, if you haven't already, that a really comprehensive evaluation system is going to run into is the problems of gathering data from other agencies, other departments, as a result of confidentiality problems. When those hit, I say when, not if, we would also be very willing to look at what might be required to overcome those obstacles. LOREN JONES: Thank you very much. We will get you some recommendations. It may well be, in terms of evaluation, mandated. I believe that it is part of the statute, whether it is specific or not, I don't know. We will take a look at that and maybe be able to make some recommendations at the October 4th meeting. In terms of what the Ombudsman said about other states, one in particular they talked about, South Dakota, had opted to use local funds to do that. They are contracting to CATOR, the same agency that we are now contacting with. The state of Ohio has just recently contracted with CATOR also. So, some of the programs that some of those states were mentioned in the Ombudsman's report are using new standards. CHAIRMAN PORTER: I think that the Kelso report ten years ago, and now CATOR, will be able to, at quite an expense, ferret out information using confidentiality, or having the ability to overcome confidentiality programs with the research exceptions and those kinds of things. What you need to do, as you mentioned, is set up the ability to provide ongoing reception of this information so that you can continue this work with Kelso and CATOR go away. These are the kinds of requirements that are going to be bring these problems to bear. And as I say, when they get there, let us know. REPRESENTATIVE NORDLUND: This is on the funding question. I need to just get some clarification here and maybe a chance for you to address the Ombudsman's point. Your funding right now is oh 85 to 90 percent out of the mental health trust income account. LOREN JONES: That's right. REPRESENTATIVE NORDLUND: And according to that, the beneficiary groups of that are current alcoholics with psychosis. LOREN JONES: That's correct. REPRESENTATIVE NORDLUND: Now let's say that you're trying to serve, what, 85 to 90 percent of your budget serves chronic alcoholics with psychosis? LOREN JONES: No. We have an agreement to disagree with the mental health board in that we try to be as clear as we can that we don't fund drug only programs, such as methadone programs, drug free outpatient, uh, programs whose purpose is primary drug of choice is other than alcohol from the trust. We use federal funds and general funds to do that. We do not fund prevention programs directly from the trust. There is a prevention component to a lot of programs. The Norton Sound Health Corporation has a prevention effort funded by the Indian Health Service, but some of their local alcohol effort comes from the state through their BRU, which is also mental health trust, probably funds a little bit of community prevention, a speaker's bureau, whatever. But, we try not to fund directly. We do, however, fund women's services. We do fund some youth services. We do fund other programs that are not directly related to a chronic alcoholic with psychosis. The mental health board has accepted women's only services because if you provide services to a woman of child bearing age or a woman who is pregnant, and you can prevent a child from being born that is FAS, then you have prevented a new beneficiary to the mental health trust; a developmentally disabled child. So, they have agreed that services targeted toward women of child bearing age and services to pregnant women is a legitimate use of the trust. We've sort of reached that compromise over time. But it is a difficult process to look at the definition, and now what is Chapter 66, which will become effective if and when the mental health trust ever gets settled. There is a pretty strict definition in that statute of what is a chronic alcoholic with psychosis and a teenager in treatment; a person with inhalant abuse, a young pregnant woman, even a young male, probably is not going to fit that definition very well. REPRESENTATIVE NORDLUND: How does that amount that this thing is arrived at, which is a huge share of your budget, that seems unreasonable. It seems to me that an alternate way... I mean, we all understand how the mental health trust income accounting is somewhat of a shell game. It would seem to me to be more forthright, straightforward, to just determine the amount of your budget that actually do serve those clients and ascribe that percentage that's coming from the trust. LOREN JONES: The rationale for the legislative action happened just before I took over. If you look at the budget summary that's in your book, you will see where the mental health trust funding started out at very low levels, two or three million the first year, and about three years later it was up to thirteen or fourteen million. The legislature did it at a time when there was increasing pressure to decrease the general fund expenditures and the mental health was beyond the cap set for general fund expenditures. There was an audit by the Office of Management and Budget that came out just shortly after, about six months, eight months, after I got this job, that basically felt that most of our services should be under the trust. They felt that the definition was unduly narrow from the court and even felt that our Alcohol Safety Action Program, which deals with a lot of these individual who are not alcoholic or abusers who at one time got caught drunk driving, could be funded from the trust. So there was that audit among the Office of Management and Budget that the legislature may have used. But the significant increase... this year they didn't decrease our mental health trust, but the legislature decreased our general fund. That raised the percentage without increasing the dollars. So, I'm not sure what the rationale of the legislature was at the time because I was not in this position then. But, they've maintained that because it's a way to maintain the budget without breaking the general fund cap when they deal with general fund dollars. CHAIRMAN PORTER: Okay. Loren, thank you very much and we appreciate your being able to be with us so that if other questions come up during the day you can jump back in. I'll now uh, Representative Foster? REPRESENTATIVE FOSTER: I just wanted to know if you would be available when the people here from Nome, if they've got any questions later when they testify, if they can address them? LOREN JONES: Yes. I'll be here all day. REPRESENTATIVE FOSTER: Okay. CHAIRMAN PORTER: I have arbitrarily decided to go alphabetically. I'm going to start with the first person in the first city in the alphabet that I have, and that's Bethel, and ask if Virginia Turner is in Bethel and can testify? VIRGINIA TURNER: Yes, I am. CHAIRMAN PORTER: Welcome Virginia. Please give us your full name for the record and we'd be anxious to hear from you. VIRGINIA TURNER: My name is Virginia Turner. I've been an Alaska resident for eighteen years and a Bethel resident for the past year. In the past ten years I've worked for the Department of Corrections in an alcohol use prevention program for pregnant and post-partum women and their infants for the prevention of FAS/FAE children. In these two work settings I've become familiar with some of the issues that arise surrounding cultural differences in physical settings. In corrections, the issue was probationary supervision and follow-up for the Alaskan released from prison and returning to a village. In the alcohol prevention program, the issue from the women's stand-point was similar -- appropriate follow-up and support services in the village after treatment. Oftentimes treatment was deferred because these clients felt the residential programs available to them were not sufficiently cognizant of their needs for strong active support and follow-up upon their return to their homes in the village. I wanted to go on record with these concerns for village based probation and alcohol use prevention programs and follow-up so legislators will be sort of in tune with the needs of rural villages. In both the correctional setting and alcohol prevention, in the Department of Corrections, inmates who are Native, an extremely high majority of them have been incarcerated due to alcohol related crimes and so alcohol is at the base of even this probationary follow through, and I just wanted to say whatever efforts the government can make, this is just an extra voice saying please support village based programs. Thank you. CHAIRMAN PORTER: Virginia, thank you. Are there any questions? Seeing none, Virginia, thank you very much. We have written down your comments. I'd next like to go to Dillingham, the next one in the alphabet and ask if Ms. Cristy Willer Tilden is ready to testify? CRISTY WILLER TILDEN: Yes. This is Cristy Willer Tilden in Dillingham. I am the program director of the Bristol Bay Area Health Corporation drug and alcohol program, also running as Loren pointed out earlier a new transitional care unit called Jake's Place. I didn't know exactly how to frame remarks today, but I figured that one dramatic line that would appeal was cost effectiveness. So, I was just jotting some notes here about what, from our experience here in Bristol Bay, would be some of the more cost effective and generally effective ways to go with the continuation of our drug and alcohol services. For instance, as Loren also mentioned, we lose patients and lose money when people returning from treatment don't have follow-up and aftercare, which is a primary reason for going to transitional care in the first place. People returning to villages who go back into the same environment that they left, who don't have any time to hone skills, who don't have any support networks in villages, can and often do bounce right back to treatment. It seems important and reasonable to assume that having more supports in the villages makes sense and makes fiscal sense as well. For that reason, we and our mental health program are fielding more family services workers through some funding we got from the Division of Mental Health and Developmental Disabilities, but in total we have only about fourteen such workers in a region the size of Ohio with 32 villages. That doesn't cut it and it doesn't cut it for the people we have in villages who are doing the best they can with limited resources, many of them half-time and many of them without other supports outside of health aides and occasionally VPSO's to work on what everybody recognizes is our largest health and social problem. Sorely, its widely recognized that prevention and early intervention are methods that, in the long run, are extremely cost effective in terms of impacting the larger problems of alcoholism and drug abuse. Currently, we have funding, we're about a third funded through the Division of Alcoholism, a third through IHS, and a third through local revenues to the health corporation's hospital unit. We have one youth coordinator position, again for all of Bristol Bay. It's, and I'm in an enviable spot for anybody to be in to try to provide both treatment and prevention services for all of the young people in this very large region which, although the population is low perhaps relatively to urban areas, is spread out and we have a lot of young people here, who if we could directly effect their developing lives, to a better extent, might well not ever wind up in our treatment or your treatment programs. One person covering all those villages is not enough. Another way to impact our situation is to train more local people in those jobs. As I say, one way to do that is to work through our rural human services program that's been, I think, effective. It's a new program but we've enjoyed and I think are helping to build it along with the other four regions that are involved in it. But to the extent that we could continue to work with training, hire local people in our programs, we would cut into turnover costs, travel costs, bringing people in from outside and in addition build the local programs and the local population. You mentioned the Title 47 laws impacting the statutory changes in that. How many of, and I know this is right, but so many of our resources are sucked into the problem of dealing with public inebriates, but to change those laws so that we could all respond more effectively and less intensively would help us to deliver more appropriate services, I believe. That was really what I had on my list. In sum, the least effective way to deal with these problems is to ignore them, of course, and to hope that they'll go away. If you assume that at this point we're not sure exactly what works then we can't fund anything. We, I think, are reasonably sure that we know what works. We are very happy to know that we'll be involved in more outcome studies and are initiating some of our own follow-up and assessment studies throughout the region to make that more concrete. We are pleased with the work of the division. We want to continue being a part of that and looking forward to your support. I'll be here for questions too. CHAIRMAN PORTER: Cristy, thank you very much. If I might ask, as Mr. Jones mentioned, and it would appear to me and certainly I would agree that it's areas like Dillingham and Nome and even smaller areas that really know whether a program has worked or not; to that end, especially considering your needs in the villages, are there any villages that have shown what you would say is a success in either early intervention or aftercare programs that could be used in others? CRISTY WILLER TILDEN: Yes. I think issues run in cycles too. To some extent there are several villages in this region that over time have, some with our direct assistance and some more on their own, have developed programs under the general Arabic of community development that have been replicated in other villages. In fact, we're working on an idea of having some sister villages where we can build communication with between those that have and those that haven't got strong programs. One in particular I was thinking of has made it their business to send large numbers of village residents to statewide conferences, such as rural providers conference, to build a kind of home base of people who have thereby received a similar vocabulary and experience in healing from the larger group of people in this state who are involved in the sobriety movement. They and some other villages are getting... (end of tape) TAPE TWO, SIDE A Number 000 ...(inaudible) different ways in which to respond. But, unless this answers your question that there are several villages who have different responses. I have with me one of our counselors, Louie Jones, and he might have another response to that question if you would like to hear it. CHAIRMAN PORTER: Certainly. LOUIE JONES: Yes. High everybody. I am from the Dillingham Police Department and when they have hired a counselor in my village, our office in Nome, I believe solely on the Title 47's for that village and the time that counsel was hired there, there is quite a number of decreases, and whether they are effective in that part or not I don't know, but there was definitely a decrease in the number of Title 47's from that area. CHAIRMAN PORTER: I appreciate that. If you have it in hand, I'd like to get it. If not, if you could send it to us the name of those villages and perhaps a contact person that we could get some additional information from. LOUIE JONES: Yes. I'll try and do that, but I would like to work with Dillingham's police department on that because at that time I was working for the Dillingham Police Department under their public inebriate program and now I'm working for Jake's Place. I'd also like to give a little testimony here on the plans there are on probationary that include that they either work with us during that time or if they are a success and we could discharge them. We here in Dillingham are in the process of working with the courts, with other different agencies here in Dillingham, and we are talking about what our problems are and they in turn are telling us what's going on and now we are trying to work together. Another group we are working with also is the Location Rehabilitation Program that (inaudible) in finding out what is going on and also that they may be able to go to say like vocational training. I just wanted to mention that had... what is successful that they found out through their program that the court deferral were more success than the self- referral. Why, I don't know. And also on the issue about, ah, I heard some people trying to set up a program for cocaine, inhalants and alcohol and other programs. I think it's coming to that time where we need to look at climatic conditions. I am talking about on a personal level that I was into cocaine, marijuana, alcohol, inhalants, hallucinate drugs, but I found out through the counselor that they are able to find out the causes and conditions of those that when you start doing the counselor to help the client that's in their village and not send them somewhere else. This is a need for some people, but for those of people (inaudible) sit down in those areas and (inaudible). CHAIRMAN PORTER: Okay. Louie, thank you very much. If there are no questions, and I see none, I'd like to move if we could to Kotzebue and see if Reggie Joule is ready to testify? REGGIE JOULE: Can you year me? CHAIRMAN PORTER: Yes, we can. REGGIE JOULE: Good morning. This is Reggie Joule in Kotzebue. Currently I am the chairman of the Advisory and Drug Abuse for the State of Alaska. I'd like to present my testimony wearing that hat. I guess prior to addressing some of the issues a couple of items I'd like to bring up... I guess a question was posed to Loren about the level of funding. In regards to the substance abuse, it's been a known fact for a while that alcohol, other drug and other inhalant abuse is Alaska's number one health problem. Unfortunately, the funds haven't really followed that. In fact, we kind of got a decrease over the last year. I think it is kind of a knee jerk reaction to the Ombudsman's report and I'd just like to point out that, you know, with regards to dollars that flow to AIDA and this being Alaska's so-called number one health problem, I guess if I were to use an analogy, it would be to take a look at the kinds of dollars that flow to DOT, the Department of Transportation, for preventive road maintenance, that kind of stuff, and when there are pot holes that are really, really bad, you know, they move basically right in there to fix them to protect the life and safety of all the motorists, which is very, very understandable. And also, another analogy is that inflation-proofing the permanent fund, you know, that's just money and we're talking about real lives and real people in a life, health, safety issue with regards to alcohol and drugs. I'd like to talk a little bit about our current structure because right now we have... the advisory is made up of twelve members, two members who are licensed to practice medicine in this state, one of whom is certified in psychiatry. That particular seat, I believe, is still empty so we have currently eleven active members. One member who was admitted to practice law in the state of Alaska, eight members from the public at large who've expressed an interest in the problem of alcohol and other drug abuse, and one member who is a representative of the liquor industry, and these are all appointed by the Governor, as they should be. Our duties, and I'd like to point these out because there is some legislation and there is something that your task force can make recommendation on to the legislature, but the duties of the board are to act in an advisory capacity to the Commissioner of Health and Social Services in the following manners: 1) special problems effecting mental health with alcoholism or drug abuse may present, 2) educational research and public informational activities conducted by the Department of Health and Social Services and others in respect to the problems presented by alcoholism or drug abuse, 3) social problems that effect rehabilitation of alcoholics and drug abusers, 4) legal processes that affect the rehabilitation and treatment of alcoholics and drug abusers, 5) development of programs of prevention, treatment and rehabilitation for alcoholics and drug abusers, 6) review applications and subsequent recommendations to the Commissioner of Health and Social Services for use of funds for grants for local alcoholism and drug abuse projects and programs, and finally 7) evaluation of effectiveness of alcoholism and drug abuse programs in this state. I give you that background because some of you may be familiar with Senate Bill 65, which deals with the mental health lands trust issue that's being held up in court. When we read that document, Chapter 66, there is some proposals in there that directly affect the Division of Alcoholism and Drug Abuse, and specifically, the advisory board. There would be a new waivers to go through and this is something that the legislature could single out of Senate Bill 65 and do this through the legislative process, is to go ahead and make some changes, changes I believe that are needed, and shouldn't be made to wait until the courts come up with a decision on the mental health lands trust. One of the priorities of the member, the change of the board would increase from twelve members to fifteen members. One member would be licensed to practice medicine in this state. One member practice law in this state; four members who are chronic alcoholics with psychosis who are recovering. We would like to suggest there is, that those numbers, is that maybe we strike the word psychosis and leave it open to four members who are chronic alcoholics who are recovering. Then it goes on to three members who are substance abuse treatment professionals who represent public and private providers of substance abuse prevention and treatment services, and five members who have shown an interest in the problems of alcoholism, mental and drug abuse, who have knowledge of social problems associated with these substances. In there it also means that if you've been adding the numbers, you come up with fourteen. It also means the director of the Division of Alcohol and Drug Abuse would be an ex-officio member of this board and would we would like to propose there is that we strike ex-officio and just make that individual, Loren in this case, a full member of that board. Staffing, at one point when SB 65 was initially proposed, I think this was in the last legislative session, not this last year but the year prior, some funding had been set aside in anticipation that this was going to be going through for staffing, and we not talking about staffing, what I'm talking about is staffing for the board. Currently, the advisory board has no staff, and so a lot of the things we are supposed to get to, we make an attempt but the division, Loren and his staff, they have their hands full as you can well imagine from his testimony this morning. So they have a full plate to deal with and the fact of the matter is, you know, the Mental Health Board, the Council on Domestic Violence, some of the other people and parties that were named in the mental health trust, not only do they have their own boards or councils, but they are stacked as well with their executive directors, you know, people who are there to take some slack off the executive directors who's day-to-day work, research, and those kinds of things, as well as secretarial help, and we have none of that and so that would be a big help. And as I mentioned before, funding had been appropriated and then it was deleted so that funding is not there. So basically what we're talking about is a staff for the board of three people, an executive director, an analyst and then some secretarial help. The other thing that needs to happen, as you are well aware from Loren's testimony, is that not only are we charged with addressing the issues of alcoholism and drug abuse, but also inhalant abuse, and nowhere in this Chapter 66, SB 65 is inhalant abuse addressed, but yet from prior statutes that is part of our responsibility and so that language needs to be included if these changes are to be made. And I guess just a note to that to kind of reinforce what Loren had been saying a little bit earlier, and that is that while the division has been given the responsibility to deal with inhalant abuse, as well as alcoholism and other drugs, no money has come forth from the legislature to address that issue and I guess the expectation has been to do that with the existing dollars and from Loren's description of the programs and types of services you could see that would be kind of hard to do, especially if inhalant abusers are not mentioned in the mental health lands trust as a beneficiary. Also while you're changing it, I'd like to recommend to this committee, to this task force with regards to... is that currently we are in an advisory board capacity. What we would like to propose is that we drop advisory and so that this board is in fact just more than one that gives advise and that the duties that are here would not necessarily focus us in on the commissioner as we are now, but that we would deal in policy issues and address some of the issues that you have concerns over and that, quite frankly, the Ombudsman has some concerns over and to also deal with budgetary and working on the budgets that the division has to work through. The new duties of this board, as proposed, would be to act in an advisory capacity to the legislator, the Governor, and state agencies in the following matters: a) special problems affecting mental health and alcoholism or drug abuse may present, b) educational research and public informational activities in respect to the problems presented by alcoholism or drug abuse, c) social problems that affect rehabilitation and alcoholics and drug abusers, d) legal processes that affect the treatment and rehabilitation of alcoholics and drug abusers, e) development of programs of prevention, treatment and rehabilitation for alcoholics and drug abusers, f) evaluation of effectiveness of alcoholism and drug abuse programs in the state. Divide the mental health trust authority for its review and consideration recommendations concerning the integrated comprehensive mental health program for people who are described in AS 47.40.056(b)(3), I'm not sure that's the right jargon to describe that, and concerning the use of money in the mental health trust income account in a manner consistent with regulations adopted under AS 47.30.031. The board is the state planning and coordinating body for purposes of federal and state laws relating to alcohol and drug and other substance abuse prevention and treatment services and, finally, the board shall prepare and maintain a comprehensive plan of service for the prevention and treatment of alcohol, drug and other substance abuses. So, as you can see that the current language that if in fact the statutes are amended as we should have to address inhalant abuse that inhalant abuse needs to be added to the parts that say alcohol and drug abuse. That about raps up my testimony, and if there are any questions, I'd be happy to try and answer them. Thank you for your time. I really appreciate it and I'm glad that you are doing this issue with this focus at this time. CHAIRMAN PORTER: Mr. Joule, thank you. I see no questions right now, but I would add that as was mentioned we will certainly be looking at any proposed legislation that might have a specific or general effect on this area and would be happy to look at the proposal you just read to us. Within that, I had hoped to ask this question of Mr. Jones, either here or at a subsequent committee meeting but, since you are the chairman of that advisory group, while there is obviously a different approach as is required by criminal law to alcohol abuse and drug abuse, I have read that and seem reasonably convinced at this stage of my learning that substance abuse appears to be substance abuse, whether it's alcohol, drugs, inhalants, or whatever they come up with next year, and I'm wondering if your advisory committee, from the standpoint of the individual and collective social and health adverse effects from substance abuse, might want to look at it in that manner. REGGIE JOULE: As long as I guess those areas that we are mandated, you know, if we're going to call it substance abuse, then there needs to be a glossary somewhere that defines substance abuse because substance abuse also, I think, could include something like cigarettes, which are in another division within the same department; and so, if we were talking about substance abuse, I think we need to, just so that anybody whose turf that their in knows what we're talking about when we talk about substances and that it's more clear what's being covered there. CHAIRMAN PORTER: Well, I certainly would agree. Having quit smoking a few years ago myself I know the trauma is just as much there, I would guess, as an alcoholic, but what I think perhaps would be a reasonable start at a definition would be substances that would alter conscious awareness, which I guess if I recall as a teenager, cigarettes did for a while, but they quickly went. In any event, I appreciate your testimony and if I may I would like to move back to Nome and ask if Diana Freeman is still with us and can testify? Diana, you can push the button down so that everybody can hear you. DIANA FREEMAN: My name is Diana Freeman. I have been working in treatment for five years. I work at the Northern Lights Recovery Center, which is part of the Norton Sound Health Corporation, and I have lived in Nome, Alaska, nine years I believe. I do hear the concern about inhalant abuse and we, as a program, have tried to meet that unmet need by writing grants and seeking other funding. Another part that I agree with, the lady from Dillingham talked about village based services, and we also feel the need for that also and have been working through alternative funding through the Robert Wood Johnson Grant Foundation to receive a scope of programs through them that would identify a village person to respond and to counsel and kind of be a first responder. Another unmet need that I see is transitional living program, which we have pursued funding for three or four years, five years. We would like to see more halfway houses, especially one here in Nome. If we bring people in from the villages and they get stabilized and they get real solid in treatment, and they go back out to that same village and enter that same environment, and they don't have a job, their recovery rate is low. So, I think that would help us in a way and we are continually trying to strive to do that by doing alternative funding. We also do initiate follow-up work. We did an extensive follow-up of our program for three years, 1989, 90, 91, and found out a lot of information from doing that. We do believe our program and it is like Loren says. I've been in treatment five years so I see the people that come back. I know them, I see them out in the community. I see that they are getting sober and I do believe that we do have a strong sobriety movement. Also, what has helped us here in the Nome area is the putting in of the detox center. When I first started working with Northern Lights Recovery Center, we did not have such an entity in Nome. Now we work together quite closely and it is a good team effort to try to get these people into treatment. One of the villages that we do have that has taken the initiative upon themselves is Savoonga. They have created a suicide crisis response team and I did hear about two cases. One, they responded to a young woman with suicide iviation and they stayed with her continually through the night. The other one was a young man using inhalants and they put him in a closed quarters and stayed in there with him until he came off the gasoline. These people are not paid. They do it as a part of wanting to help their own community and I could give you information on who to contact there later. Also with the Northern Lights Recovery Center we do have a prevention unit and some of the more innovative things that they do are in the fall of the year and the spring of the year, they put on two large workshops where they bring in people from the villages to create awareness and we've had different workshops on FAS, FAE, inhalants. This fall we're having anacoral conference. It's the Alaska Native Children of Alcoholics conference that's going to be coming up so they do things like that to initially create the awareness. Another thing that I had identified specifically from the needs assessment that has been something that I have been wanting to do for a long time, but we do need assistance with funding, is to create a support group by the mechanism that we are all listening to this conversation. That is to have a support group that all the villages could link up to on a bridge that could be a teleconference that could be something that is consistent for these people in the way of support and so we are looking at trying to get some type of funding for that also. I think that's initially what I had to say. CHAIRMAN PORTER: Thank you very much, Diana. Is the group in Savoonga, how long have they been in existence? DIANA FREEMAN: I would say probably about six months. CHAIRMAN PORTER: Are they in any way receiving any training or anything in terms of peer counseling? DIANA FREEMAN: I think they receive training through the, uh, we have a crisis response team through Norton Sound of professionals that go out when suicide or some kinds of devastating thing effects the village. These same people work closely with them. They also worked closely with R.E. Oder, the new director of mental health. She did herself go out there and give them several training sessions. I think this team arised from the, uh, there were several suicides in this village and from that they decided to deal with the problem themselves, which I think is really good and they need more of that. CHAIRMAN PORTER: Thank you. Representative Nordlund. REPRESENTATIVE NORDLUND: Diana or Diane? DIANA FREEMAN: Diana. REPRESENTATIVE NORDLUND: I saw you nodding your head in the back when Loren was saying that it is easy to tell in smaller communities, especially in the villages, whether or not programs are effective. I was wondering if you could comment on how you determine if your treatment programs are working or not. Is it pretty much anecdotal or has there been some follow-up? DIANA FREEMAN: Okay. We did, since I've been in this position that I've been in, which is about two years now, I did an in- depth study which asked them the kinds of things Loren went over, like basically what has changed in your life? Have you been employed? Have you been in trouble with the law? Have you violated your probation? Are you having trouble with issues that they had in treatment like, grief is the big thing, overcoming grief, and oppression, for here in this region is a very large obstacle in their treatment. Through this, you know, I was amazed at the response and I was amazed at some of the feedback that they gave me. From what I could gather from those that responded, 76 percent of our people were still sober. Also, there has been, since I have been here doing this five years. In the beginning there was a minimal amount of people at sobriety functions and also at support meetings. Now we have to have bigger meeting places and we can have sobriety dances two or three times a month or once every week and people do come and enjoy themselves in an alcohol free environment. So the people that come tell you that yes, they have changed. So I see these people, most of them on a daily basis. REPRESENTATIVE NORDLUND: Ms. Freeman. So, it's an ongoing situation you noted. Is it something like being checked on a year later, two years later, three years later, or is it more informal than that? DIANA FREEMAN: I would say most of the people that receive treatment from this region, I would see them more than once in the last three years and most of these people come together and serve on committees and get involved. You know, we are talking about people that have changed their lives so they are wanting to care, especially for that other person. So, they make themselves available and I see them everywhere from the grocery store to taking classes with them at the local college. It is a diverse kind of a thing. CHAIRMAN PORTER: Diana, if you have any documentation on that study you did that indicated that 76 percent of your people are still sober, I'd sure like the committee to receive that if you can. DIANA FREEMAN: That's no problem. I have a copy and I'll go get one. CHAIRMAN PORTER: Okay, thank you very much Diana. Before I go through the list again, I would like to recognize that we have several staff people from the offices of Representative MacLean, Senator Jacko and Senator Leman that are on the teleconference network listening in and taking information back to their respective legislators. Okay, if I could go back then to Bethel and ask if Ardyce Turner is still there? ARDYCE TURNER: Yes, I am. CHAIRMAN PORTER: Welcome Ardyce. We'd be happy to hear from you now. ARDYCE TURNER: Okay. My name is Ardyce Turner of the Substance Abuse Education and Prevention Department. I started last year. I transferred from the Substance Abuse Services, which is with the teenagers of the villages. I am a recovering alcoholic myself. It's been like four years myself. I graduated from PATC in the outpatient program, so I would like to let Diana know there are people in Bethel who have maintained their sobriety each day and move on into bigger and better things to help other people. But as far as when I'm with these out in the villages, I've heard other people saying village based workers, when I worked for the alcohol department there were 10 village alcohol education counselors. Now there are nine. There's one Hooper Bay office that funding was cut. The things at villages are, there are at least two or three or even four villages besides their own, and they really need a lot of help out there. It's theirs to fulfill for them, and as far as coming out of PATC, the clients that go back out to the villages need a lot of support. And what I would like to see more of is more comprehensive support for them out in the villages because our main concern here with Substance Abuse Education and Prevention Department is maintaining sobriety or at least increasing the high rate of alcoholism, inhalant abuse and other drugs, as mentioned earlier. But I really support any funding towards that, towards the villages because they are really in much need. As far as training also, there needs to be village alcohol board members, like in the past they used to come in and train. I think I heard someone mention training. They did come in and train, so there were people that did go back into their villages and contact the resource people in the village and they were one of them. Like in the past, they did receive training and they would go back to the villages, having more help so they can help their local people once they return back to the villages. So, I would just like to please, please ask for more funding towards the village based workers. Thank you very much. CHAIRMAN PORTER: Ardys, thank you. If I could ask you a question, or any of the other people there in Bethel, we haven't had any real discussion or testimony regarding the differences in some villages that opted to be dry and others that aren't. Do you see that as a significant difference in the problems that exist in villages, or does it have any effect or not? ARDYCE TURNER: Yes, it does. CHAIRMAN PORTER: I'm going to assume that you mean by that, that if a village is dry that it has fewer problems than those that aren't? ARDYCE TURNER: Yes, that is so. Like in some villages, the ones that are dry, some of them have requested for support by talking to a support group or a substance abuse, such as alcohol, inhalant abuse, chewing tobacco. We just started this year with chewing tobacco, which I am very glad that they requested for that. There are different people out there who do try in their community to keep prevention as one of their main priorities. CHAIRMAN PORTER: Thank you. Representative Mulder? REPRESENTATIVE MULDER: Yes. I think that is really a pertinent question. As you know we have been laboring throughout this state for a number of years. The whole question is to go damp or dry and we really credit the village leaders for placing it such a priority. But, I think it would be interesting from the committee's standpoint and from mine personally if one or other people would bring the community or the corporation, the Native corporations who have been pushing for it, if there is any statistical information to show what effect it's had so far. Maybe it's recency where it hasn't had time to take hold. But I think it's appropriate information because it's a radical departure, a radical change from the standard operating procedure in the way we've been treating alcoholism or drug abuse in our communities, and if that's the kind of change that is bringing on the desired effect, well then maybe those are some avenues we should be looking at. CHAIRMAN PORTER: We're sure going to see Director Jones, frantically writing things to do. LOREN JONES: Yes. There was a study several years ago. We will try to dig it out of our shelves on this. It's not one that has gone through a lot of scrutiny in terms of villages. But, if you do talk to the police officers, you talk to the village public safety officers, there is a significant difference. I know in communities that are damp, there is a significant decrease in police calls, a decrease in some of the violence in the communities, that at least have been reported. To my knowledge nobody has officially, in any of the villages, either local people, department of state troopers, ever taken a real serious look at it. There was one done several years ago and we will dig out that study and let you know. REPRESENTATIVE NORDLUND?: If I could continue, Mr. Chairman? Loren, have you worked conjunctively with our university to look at doing some studies along these lines. It seems like you have a wealth of information, or a resource there you might be able to tap into. Being an old grad student, you're always looking for a good project to explore or cut your teeth on. This certainly seems like an avenue that's on the cutting edge of, not only Alaska and our rural communities, but also throughout the United States. This one would seem to be a natural. LOREN JONES: There is within the University of Alaska, Anchorage, a center for alcohol and addiction studies that years ago did a considerable amount of research. That has been cut back over the recent years with university reductions as well. They primarily look for us for funding and we have not had the funding. They are currently doing a research project on AIDS and on AIDS prevention that is funded by the National Institute of Drug Abuse in Anchorage. But, they are not active out in the community, nor is either the psychology or the sociology department to institute (inaudible) generally be available. The university affiliated program within the University of Alaska, Anchorage, is active but it is active in the area of the developmentally disabled and also some of the mental health community. It is an avenue we would like to be able to work with the university as well. CHAIRMAN PORTER: I think Sophie Nothstine just left the room so we'll have to skip over her real quickly and ask if Elizabeth Sunnyboy is still available to testify from Bethel? ELIZABETH SUNNYBOY: Yes. This is Elizabeth Sunnyboy. I've been with the last seven years with PATC for five years and in the substance abuse field many moons. In listening this morning, as usual when we talk about alcohol problems and substance abuse problems, it is draining. We hear that over and over. What has made a difference, when I transferred over to community development program, what has made a difference in going to communities is that we have done a team approach, we have addressed problems and stayed with the community for a week, you know, in providing services. When they request services we provide those services and stay with the community like for a week and that has made a difference in many communities. And what started off, like when we work with the village alcohol education counselors, in the beginning it was very stressful, very challenging. Many of our alcohol education counselors felt defeated because there seemed to be no support, nobody; even the court referred people refused to VAC's offices and what happened to that group of people, they decided to get creative with their ideas and to start making changes to attract more people. What they did in the beginning was they talked with their elders. They spent time with their elders, talked with their elders. I've been hired to work with our people that have alcohol and drug problems but nobody's coming, and the elders suggested that's the problem, you're (inaudible) on your door, its alcohol or drug education counselor. With the help of the elders and the village people, they got suggestions of how to make a difference in their community and with that they changed the name of the door, the name of their titles which made it more attractive. Many people responded to them better. And so just a name change made a difference with a lot of alcohol education counselors. I mean with that avenue they were able to give more education prevention types of activities, alternative activities that include alcohol free dances and they got more responses from the community people because peoples are involved in their activities. In our department of community holistic development program we have four positions, community youth advocates. They are village based workers and they work mainly with students and young people in their communities to provide alternative activities in their communities that are alcohol and drug free. These group of people, because (inaudible) errors in the beginning, they are instructed right from the beginning to utilize their elders, to utilize the people in their community... (end of side A) TAPE TWO, SIDE B Number 000 ...to use community aide advocates that are working in these villages have support, even from a home full of people, have their support in place because they work with people, they work with the young people, giving input affecting living together. So, its causing all to, beginning with the village based workers, we are able to work with the community aides allowing the kids to be more effective in their communities. I understand also that mental health has started village based workers and they are in the process of getting screening, and so the earlier concern that Ardyse Turner and the other people that have spoken, if the support that these people need (inaudible) the training monies for the village based alcohol education counselors has been completely cut out and they don't have any training money whatsoever. They have a handicap there because they need the additional training to be more effective in serving their people. And so the training moneys there was completely cut off and that's the biggest concern that they have with the village alcohol education counselors funded under PATC and the community aides advocates funded under YKHC community holistic development program. So that's the concern that we have is the training moneys that were cut off. We are fortunate that the community aide advocates have no training moneys due to a declining and limited budget, we have to... One of my community aide advocates from Hooper Bay community was cut because we don't have the budgets to keep her on. That's again, putting the, taking away from the community a service that is needed. Earlier, people were talking about activities and different villages that are making a difference in their community. As you all know, there's been a big history of suicide in one of our communities in the Yukon area. The community today is doing different activities within that community. At first we used to go in on a crises approach, especially with the long history of suicides in that village community. Crisis counselors came one day and left and finally that community decided to have their own support group and to support people way after a crisis has happened, to work with family, to follow up on the family that had a loss, to work with that family. That group is called the Snow Flakes Support Group. It's really active, it does many activities with the community. They provide workshops, they provide Eskimo dancing, honoring the young people for their first dances. They provide basketball tournaments. So, they're very active in that community. They've had setbacks on several occasions where even after the suicides have gone down in that community, again they have had a couple of suicides later on, but the difference here is that the support is still there in that community and that's what's making a difference in some communities, so it goes back to empowering the people themselves. When we do go into communities that request us, most of our activities in community holistic development program is upon village requests for services and we honor that request and we do travel to that community and specifically ask, what are your needs, what do you want? We honor that request. We just don't go in because some community is having problems. We honor that request from a community to travel to a community and in this way it's like we're honoring a community and working with what their needs are. That tells me the difference also. Cost effective suggestions I would make is for like treatment programs. One of the things that I feel that strongly needs to happen is not to send one person from a community because again we're talking about lack of support in the community because of no education or prevention activities or maybe that community hasn't gotten active. So one suggestion I would make is for treatment programs to get more than one person within a community to go into treatment, you know, as a group, so that group of people, when they go back, they will support themselves. Or involve family members in that treatment because with no family involvement it's like you are just treating one part of the whole thing, just one part of that thing, and it doesn't usually work. There is no balance. It creates unbalance so that chaos again and when the person goes back they are right back in the chaos. So if treatment program is going to be effective, they need to involve families, they need to involve cultural activities that are relevant to the people they're serving. Vocational skills, parenting skills. Another person talked about addressing the grief and recovery process. Only after you stop drinking is when you start becoming aware of unresolved griefs, and because those aren't addressed, the person will go back to drinking because that's too much to handle. People need to know and address unresolved grief. Work through those as a group, not on an individual basis. Those are some of the things we try to address. I also have a question on this confidentiality. We have problems with that left and right. In schools, in villages, in treatment programs, a lot of times I question, you know, confidentiality on whose terms? In one community that we went to and did a community workshop, three or four of the parents in that community were in tears because of confidentiality. The teachers or the school counselors wouldn't tell the parents what kinds of problems their child was having in school or even at home so that maybe if they were involved they would correct it together. At that meeting all the counselors talked about was no, we couldn't contact you because of confidentiality rules. If we're going to help families and if we're going to send the children back to the families, I think we need to reword or change, or whatever we need to do, especially on that confidentiality issue, because when they are an alcoholic or into drugs everybody knows that. Maybe you're the one that denies you're the one that has the problem. So confidentiality needs to be studied, worked (inaudible) recovery activity, people need to work together and address the problem and find solutions together. Communities have resources that they can resolve the problem. All we need to do is work with them and have them find their resources, their strengths, their ability to find solutions to their problem and they have that. So in that sense we try to work with communities knowing that these communities have their resources, they have their strengths, they have their skills and they have knowledge to correct their problems and all we need to do is to be there to support them and to put this into action. So these are the things I wanted to bring out. And here in YK Bethel we also have a talk show that we hold every month. There are different agencies that hold talk shows and we do hook up to Nome station and we do education prevention, sharing through the neighbors. We do different types of preventative education. We talk about grief and recovery or different topics that people will listen to, ask questions about. That also makes a difference in Bethel because KYUK radio station will also have monthly input of our activities and our jobs, what we do with providing services with communities. In the community holistic development program we work with agencies, we work with villages, we work with private councils, we also work in the schools and these are with patients. These are the types of activities we are doing at YKHC. One of the things that I will bring up which has created some confusion, and I feel is a contradicting message, is that the cuts that are happening to the social service programs, alcohol programs, human service programs. You know, the contradicting message that I get is that the Governor is cutting these services that are needed in our communities and his wife is talking and seems supportive of these programs and that seems contradicting to me that he would cut and cut and cut these programs, but his wife is talking and seems to be supporting these kinds of programs. I look at that as contradicting. You know, it's confusing, and so I just wanted to bring that out and you can put it on record if you want to. That has been one of my concerns, because like somebody else brought out, the Governor is really supporting economic growth, but if we don't have people in recover or support for people promoting recovery, its like its defeating what we are trying to do. We need that support. Thank you very much. CHAIRMAN PORTER: Well, Elizabeth, thank you very much. I think it's very helpful to the committee to be able to hear from people like yourself. If perhaps this isn't a totally unsolvable problem and we have people motivated like you that are out there working on it. I would like to ask you one question if I may. In your experience, do you think that there is a direct relationship between the village suicide problem and substance abuse? ELIZABETH TURNER: Yes, there is. Also, there are also other factors involved in suicide. There's language, the breakdown of language, the communication, there's traditional values that are not taught any more. Whether our elders are speaking Yupiik, Indian people mostly speak English, and so the communication is cut off. Our traditional activities are not often practiced in communities. Maybe there's also denomination effects, you know, different church denominations that got a lot to do with the breakdown of communication, or even the breakdown in families. In my own family line, relations are Russian Orthodox. I have relations that are Catholic, I have relations that are married and these are all direct relations that are divided in religion. You know, and so there's different denominations that have their own rules and own functions, and so again, that creates conflict within family units. Yes, alcohol and drugs will have suicide, but there's other things also that because of the pain or the hurt that lead people to drinking or to using drugs. CHAIRMAN PORTER: Okay Elizabeth, thank you very much. Now the very patient Sophie Nothstine. SOPHIE NOTHSTINE: Thank you. I am Sophie Nothstine and I am from Prince of Whales and I have been very reluctant to talk on this microphone. In order to give a class, I want to say that I'm going to have to get back to Alcoholics Anonymous and also it's so important to me because I have been sober 18 years and going on 19. If you take, um, I was partially raised in Nome and the biggest places I've gotten drunk was in Nome. (Inaudible). Humility and I guess the futility. (Inaudible). The only other thing I wanted to say is that the anarchy of the villages, (Inaudible) and that's the villages I went to recently, they have suicide in their village and they wanted to get some help for their village. They want to learn how to do things for their own village. But what I'm getting at is what everybody has mentioned already is the village people are going to help there. The loss of culture, the loss education by the elders, is a very important factor as the loss of language and the loss of dances. I have advised my Prince of Wales in dances a (Inaudible). In order to get back to that, a person that is in the system needs education, spirituality. The best way to get a feel... the treatment centers are very important. I've gotten well by Alcoholics Anonymous and I am talking about the village people that go to treatment that go in and out. The people that are in the village are getting back to the people. (Inaudible). Some of them are (inaudible). The whole village at a time is not well. They have alcohol and drug problems and some of my relatives are not well. Some of the village elders of mine sent the school system, and the village has the right when they are growing up. I am 65. My elders quit teaching. They have turned it over to the agencies to teach me and it needs to stop. It needs to get back to the Native system and I don't know how to put that into words. Alcohol, I see some of the villages that are drunk, the whole town, from children to adults, and I have heard about the FAE and FAS and what I was hoping is that a FAE adult or child is very difficult for the treatment such as the (inaudible) FAE person cannot themselves be able to function. They have to have somebody to help them and this is difficult. (Inaudible) I was thinking that the politics in order to help a person effectively in the agency, sometimes the agency gets lost in order to appear as they are okay in the system they use that, uh, they are working with that client. I guess that what I'm saying is that it is hard to work with a person in treatment centers. We need village based things because the systems approach that does not recognize the way of traditional approaches. All the things that I heard is (inaudible) third world country that is minorities, that is poor countries. I didn't realize that the Native persons that are minorities, that is poor. Mostly in my village when I was growing up my father was a big hunter and I was sent there as a very rich child and when I came to Nome I was considered a very poor child. I guess getting back to court system I said earlier is that I believe in the court referral as the agency most qualified to work with parents. (inaudible) to work with. You don't have much to work with as a person who is sick. The children, I like the idea of having the half-way houses here for the parents that are not ready to go back to the village because most of the village is still wet and some of the villagers are still drinking and staying in the bars and I don't believe... I have a doctor and I just met her last week and she said (inaudible) and if you have clients that you are dealing with even though you aren't drinking alcohol you are still wet. To be alcohol free for a person who is dealing with a client it is important at his level of understanding to work the steps. By the way, the Native ways are twelve steps of AA but they're not written and sometimes traditional (inaudible). I think we need to educate some of our Native leaders to learn to be alcohol free. (Inaudible) It is a lot better. They really ought to have a FAE or FAS child teaching a mother that is FAE, who is still drinking and drugging, (inaudible). And this is all hard news since white man has settled or Russians or so and it's still very (inaudible). There's rules and regulations we are dealing with under the white system approach and I think we need to have more Native culture's approach too. Also, helping with the VPSO, health aides, and our councils in the villages, I feel it is very important to mostly attach some of the other village people. I (inaudible) a person who is a board member might feel (inaudible) in order to deal with the problem of not being able to talk to someone or whatever it is that cultural transitioning seems to be the biggest factor for me to get drunk in the village. Another thing to be overcome is resentment and anger toward people, places and things. Native way is to forgive, but Native people need to learn to speak up and say what they want. CHAIRMAN PORTER: Sophie, thank you very much. Your testimony is right from the heart and has behind it a lot of experience and observations. One of the questions that has always plagued me as regards the alcohol problem in Alaska Native culture, and I would ask you, do you think alcohol abuse is the problem or is a symptom of the problem that Alaska Natives have, as you described in cultural difficulties and transitional values, traditional values, problems and self-esteem? SOPHIE NOTHSTINE: I think the answer to your question is Native person like me have very low self-esteem and self- worth. Until a person is shown that they're okay. My first family is like people in Anchorage and in order to deal with them as one family I had to have somebody else to help out that is not of my immediate family. I think that alcohol should be attacked first and later on the culture, depending on where the person is coming from, what they are dealing with. They should deal with what is causing them to drink and use drugs or what is causing them to commit suicide. I think that alcohol is the first factor of the people. Children of alcoholics, the ones who have parents as alcoholic. Alcoholics are the people who have never learned how to live. They have to be shown how to hunt, dance, how to face life after this, learn how to talk, raise their children, little kids, one years old or two years old. You have a 65 year old like me, there is a child that is still temper tantrum and some parents (inaudible) you really can't deal with it, it just comes out. You have to learn how to put a stop to it. Alcoholic is a person who has never learned how to deal with those things, so it's very difficult to learn how to deal with that person on step one. That's why they have drinking alcohol only once, the rest is learning how to live. CHAIRMAN PORTER: From one 55 year-old to another, thank you very much. REPRESENTATIVE MULDER: Thank you, Mr. Chairman. Just a few things here. Representative Foster and I are co-chairs of Military and Veterans Affairs. The offices of the National Guard. As you know, the Guard in Alaska takes on many roles throughout the state, performing different missions in the urban areas as the rural areas. One of the things that really struck me about the Guard in rural Alaska is that it provides a very strong role model for the kids growing up in the villages. It seems they have a positive outlook. It gives them something to aspire to and towards. The kids and their values and self-worth, something that is very important for all of us, especially kids growing up, and I would welcome the Chairman and Eric for subsequent meetings, to call someone from the Guard. They have a number of programs they are pursuing and looking at that I think are worthwhile for this committee to pursue and to look at and perhaps including recommendations for consideration and to give testimony about their programs because they work hand and glove with what Sophie was outlining. CHAIRMAN PORTER: Very good suggestion. Perhaps the October meeting in Fairbanks would be a good place to hear from them? REPRESENTATIVE MULDER: I think that would be fine. I know they would love to talk about it because they are very excited about the things they are doing in the villages. They've had an uphill climb as well and they are beginning to see success through their efforts. They've got some ideas on how to expand those efforts into the schools and into the instructional units. That's real important because kids, when you get down to education, is the best way of preventative medicine and will save us a lot of cost in the long run. CHAIRMAN PORTER: Very good. I'll ask Eric to touch base with you and get the right names to invite to the Fairbanks meeting. Sophie, thank you again. That seems to be the end of the list of people who I had indicated that wanted to testify. I now ask if there is anyone else in Bethel that wishes to testify? Hearing none, how about Dillingham? And Kotzebue? UNIDENTIFIED: No sir. CHAIRMAN PORTER: Okay. Thank you very much, all of you for your participation, it has been good. Is there anyone else here in Nome that would like to address us? There is. Please come forward, sir. DUFFY HALLADAY: My name is Duffy Halladay. I'm the chief manager at Turning Point Detox Center. I'll try and be brief. This has been a long meeting. I have just two points I want to get across. Both of these are pertinent information. At the Turning Point Detox about 10 percent of our clients come from the emergency room and maybe 10 percent are Title 47 who are on hold and perhaps, I'd say perhaps 80 percent are self admits, and in fact, some who are on hold, brought in by the police. There are 16 villages that come into Nome, and after a few times from the police they will come in on their own. It's like they do want to sober up. We show alcohol videos and take people to the AA meetings on a nightly basis. (inaudible) AA meetings are supposed to be separate, but in the villages people most of the time do not have AA meetings in the smaller villages to go to and I think that would be a real positive step. We have an AA register and we can give it to people and the clients are going back to their own villages. They stay with us for five days and they are willing to go to AA meetings that are in the village. Like I say, they are willing to follow, but they're not willing to start an AA meeting and it would be nice if all the small villages would have a group. I don't know what the answer to that is. It might be something the task force could look into, trying to get that going. Just recently, we've been open for four years in January, and in the last eight weeks the court system has started to give us court referrals, 72 hour holds, and we have had perhaps five in the last eight weeks. It's working very well. We're getting a whole different group of clientele with jobs, family, cars and basically they're having their drivers license held hostage. It's the choice of going up to Anvill Mountain for 72 hours or to a detox center and so they're going to detox. We're glad to have them too. One point I'd like the task force to consider is funding that's continually been cut, as you well know, and we're just taking on the additional responsibilities and (inaudible). But we might have to consider that the court system is going to give us additional responsibility, hopefully there would not be a cut in funding in order to offset the 72 hour hold. I've been in Nome all this time and I'm not familiar with Mr. Jones, but I just never work (inaudible) he definitely understands things from the trenches, he understands where the problems are, so in the future hearings you can take testimony from everybody, but if you just scratch your head and figure out what to you, we can certainly speak for our detox center because we do understand the issues. We are hitting the nail on the head quite often and that's all I have to say. CHAIRMAN PORTER: Thank you. As one of the people who used to bring in the orangutans I can sympathize with you and the transaction. Representative Mulder? REPRESENTATIVE MULDER: Thank you, Mr. Chairman. Duffy, quick question on the percentage. You said that 80 percent were self- admit. Of those 80 percent, how many of those would you consider to be chronic repeaters; you know, those people who are coming in and self-admitting themselves repeatedly? DUFFY HALLADAY: These are people who are trying to get well. I wouldn't say that is a problem according to percentage, but the first words out of the board of directors is that they did not want to be a revolving door, whereas when the bar closed down they would come and sleep and then get up in the morning and leave. We don't send people away, but we are asking them to commit themselves for five days. That's pretty big if they want to go drink tomorrow. It's like they are going to go to AA meetings and such and so they are going to weed themselves out if they are just looking for a bed. REPRESENTATIVE MULDER: Would you say that half of that 80 percent are repeaters more than twice. In other words, been in there three or more times. DUFFY HALLADAY: Certainly. We do have some that I know their birthdays. They are in there quite often, but staying sober for five days, and there are usually two counselors per shift, and they get along with one or the other, they would open and talk to somebody. When we first started bed utilization and the referrals, about 75 percent we could actually refer on to Northern Lights or the other treatment centers. Where they went from there, whether they walked away or they complete it or not, or you would have 75 percent who would just go out the door and 25 percent of those who would actually try some treatment. CHAIRMAN PORTER: Duffy, if you wanted to try to evaluate your system and you referred people on to Northern Lights, can Northern Lights tell you what your people did, or is that confidential? DUFFY HALLADAY: Yes, they do. We have a reciprocating agreement. The clients sign confidentiality and understand that we do the follow-ups and such, and so that is not a problem. CHAIRMAN PORTER: I think you are one of the few communities that (inaudible) the problem. Make sure I understand, when you say that you're getting, from whom are you getting the referrals, rather than the 72 hour hold, the court or...? DUFFY HALLADAY: The bulk of them are the police department who will take people in Title 47, 12 hour hold. CHAIRMAN PORTER: But the 72 hour hold. That has to process through a court? DUFFY HALLADAY: Yes. We just recently started that and the judges were giving the choice, either you are going out to Anvill Mountain Correctional Center or you are going to the detox center. CHAIRMAN PORTER: But this is the Title 47 as opposed to a sentence like DWI or something like that? DUFFY HALLADAY: It is a DWI, and we have to report back to the court, did they spend 72 hours they spent with us, how many substance abuse videos did they watch, and did they go the AA meetings? We don't fiscally restrain them if they want to walk out before the 72 hours is up. Basically, we just report back to the court and the court decides to give the license back, or whatever. It's working very well so far. In fact, I believe Bethel, no Kotzebue's, detox center felt it was working well with our detox center so. CHAIRMAN PORTER: Let me suggest that if I understand you correctly that it's a court referral as an alternative to 72 hours in jail for DWI that you talk with DOC because they should be helping you out with the cost of your program. REPRESENTATIVE MULDER?: I'm sorry, Mr. Chairman, but I urge you (inaudible). We were all involved in the alternative sentencing for DWI's. Is this a relative new program, Duffy? Is it an outgrowth of that legislation, and basically are you acting as a so-called halfway house? Or are you providing an alternative location for sentencing instead of a correctional institution? DUFFY HALLADAY: Correct. I was told at the last staff meeting there's a repeat offender who was there fourteen days. What my concern is that down in the states they're getting really tough on them, and Alaska as well may change the laws. My brother who's working on the Oklahoma for six months, and he gets to go home on weekends to see his wife and four children. My point is that Alaska may in the future, at least on DWI's, and it will affect our program, and you need to consider that for your funding. CHAIRMAN PORTER: Duffy, thank you. Diana, please help us. DIANA FREEMAN: I was involved in a meeting with Judge Kenley, Magistrate Jayder and Susie Kanler and we came up with a vehicle to provide services for DWI offender in lieu of... Most often they would insist they do 72 hours and attend five AA meetings. Well,.... (end of tape) TAPE THREE, SIDE A Number 000 ...by law that they would do. So not only are they housed there, they're watching videos and they are working on a treatment plan and so that (inaudible) that comes from. CHAIRMAN PORTER: But that plan is as opposed to having to go down to the mountain for a few days? DIANA FREEMAN: That's correct. CHAIRMAN PORTER: That's great that someone's doing that. Representative Nordlund? REPRESENTATIVE NORDLUND: What does it cost you to keep these folks in for 72 hours? Part of the idea of the bill Representative Mulder sponsored was to, for a low cost sentencing alternative to DWI offenders with the idea that it would cost the state less money, as well as provide more treatment. One, what is it costing you to hold these people and treat them? And two, are you developing any new treatment methods that might be more appropriate to treat the DWI? DUFFY HALLADAY: Basically we funded through the state Division of Alcoholism and they are treated as our regular clients. We have a sliding fee scale and wherever they fit in there, and if they don't have a penny in their pockets, we will still let them in. We don't turn people away. It's new for us and we are still working things out. The court has said (inaudible) if the person said up and the answer was no, they got a bench warrant and I suppose they are going to Anvil Mountain. You had the choice and you didn't show up. We just report back to the court and they take it from there. CHAIRMAN PORTER: Diana? DIANA FREEMAN: We have two bills by Corrections that we initiated negotiations in January, me and the former director of the program, and now we have in place since July two pay beds: one is for furloughs and one is for probationary people. Throughout I had noted that we would get a lot of furloughs and those people don't pay their bills. So we initiated a price of 49 dollars a day. That's what we get to house them. CHAIRMAN PORTER, REPRESENTATIVES NORDLUND, MULDER: Discussion. REPRESENTATIVE MULDER: I might also remind this committee though that part of the bill provided that people pay for it themselves when they are financially available, if they're not, the court is able to go in and tap their permanent fund dividend, and if that has been tapped then they come back to the state. By and large, that 49 dollars, as opposed to what it is at Anvil Mountain, 49 (inaudible). CHAIRMAN PORTER: I see no one else here. I ask one more time if there is anyone else on the teleconference network that wishes to testify? I see none. Let me say then that we will conclude the teleconference and the committee hearing. I appreciate very much the committee members, the task force members, and all those people who testified. I think we have had a very good beginning and gotten some good regional information from this district of our state and will continue to gather that as we move around and put it all together when we get to Juneau and see if we can't come up with something. Again, thank you very much and that will be it. Meeting adjourned at 1:04 p.m.