Legislature(2015 - 2016)CAPITOL 106

01/29/2015 03:00 PM HEALTH & SOCIAL SERVICES


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03:03:21 PM Start
03:03:52 PM Presentation: the Statewide Suicide Prevention Council
03:48:04 PM Presentation: Becoming a Trauma Informed System, Division of Juvenile Justice
04:22:39 PM Presentation: 24/7 Sobriety Monitoring Program
04:45:43 PM Overview: Division of Behavioral Health
05:09:14 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 39 PUBL EMPL HEALTH INS; WELLNESS COMMITTEE TELECONFERENCED
Scheduled but Not Heard
+ Department Presentations: TELECONFERENCED
Health & Social Services
-- Public Testimony --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                        January 29, 2015                                                                                        
                           3:03 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Paul Seaton, Chair                                                                                               
Representative Liz Vazquez, Vice Chair                                                                                          
Representative Neal Foster                                                                                                      
Representative Louise Stutes                                                                                                    
Representative David Talerico                                                                                                   
Representative Geran Tarr                                                                                                       
Representative Adam Wool                                                                                                        
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION:  THE STATEWIDE SUICIDE PREVENTION COUNCIL                                                                         
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PRESENTATION: BECOMING A TRAUMA INFORMED SYSTEM~ DIVISION OF                                                                    
JUVENILE JUSTICE                                                                                                                
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PRESENTATION: 24/7 SOBRIETY MONITORING PROGRAM                                                                                  
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
OVERVIEW: DIVISION OF BEHAVIORAL HEALTH                                                                                         
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
KATE BURKHART, Executive Director                                                                                               
Statewide Suicide Prevention Council                                                                                            
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented a PowerPoint entitled "The                                                                     
Statewide Suicide Prevention Council."                                                                                          
                                                                                                                                
KAREN FORREST, Director                                                                                                         
Division of Juvenile Justice                                                                                                    
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced the trauma-informed care                                                                      
program.                                                                                                                        
                                                                                                                                
SHANNON CROSS-AZBILL, Clinical Director                                                                                         
Division of Juvenile Justice                                                                                                    
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Introduced a PowerPoint entitled "Becoming                                                               
a Trauma Informed System."                                                                                                      
                                                                                                                                
BERNARD GATEWOOD, Superintendent                                                                                                
Fairbanks Youth Facility                                                                                                        
Youth Facilities                                                                                                                
Division of Juvenile Justice                                                                                                    
Department of Health and Social Services                                                                                        
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified during the discussion on trauma-                                                               
informed care systems.                                                                                                          
                                                                                                                                
TONY PIPER, Coordinator                                                                                                         
Alcohol Safety Action Program (ASAP)                                                                                            
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of the 24/7                                                                  
sobriety monitoring program.                                                                                                    
                                                                                                                                
ALBERT WALL, Director                                                                                                           
Central Office                                                                                                                  
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during discussion on the                                                              
24/7 sobriety monitoring program and presented a PowerPoint                                                                     
overview of the Division of Behavioral Health.                                                                                  
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:03:21 PM                                                                                                                    
                                                                                                                                
CHAIR PAUL  SEATON called  the House  Health and  Social Services                                                             
Standing   Committee    meeting   to    order   at    3:03   p.m.                                                               
Representatives  Seaton, Tarr,  Wool,  Vazquez,  and Foster  were                                                               
present  at the  call  to order.    Representatives Talerico  and                                                               
Stutes arrived as the meeting was in progress.                                                                                  
                                                                                                                                
^PRESENTATION:  THE STATEWIDE SUICIDE PREVENTION COUNCIL                                                                      
    PRESENTATION:  THE STATEWIDE SUICIDE PREVENTION COUNCIL                                                                 
                                                                                                                              
3:03:52 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that the  first order of business would be                                                               
a presentation by the Suicide Prevention Council.                                                                               
                                                                                                                                
3:04:56 PM                                                                                                                    
                                                                                                                                
KATE BURKHART,  Executive Director, Statewide  Suicide Prevention                                                               
Council, Division of Behavioral  Health, Department of Health and                                                               
Social  Services, reported  that the  council was  established by                                                               
the Alaska State  Legislature in 2001, slide 1, in  response to a                                                               
large spate  of deaths by  suicide.   She noted that  the council                                                               
had  13 volunteer  members appointed  by the  governor and  4 ex-                                                               
officio members appointed by the  Legislature.  She said that the                                                               
council offered  guidance and  advice related  to suicide  to the                                                               
executive and legislative branches, as  well as communities.  She                                                               
listed   the  responsibilities   of  the   council  to   include:                                                               
improving  health and  wellness by  reducing suicide,  broadening                                                               
awareness  of  suicide  and  the  role  of  risk  and  protective                                                               
factors,  enhancing  suicide  prevention services  and  programs,                                                               
developing    healthy    communities    through    comprehensive,                                                               
collaborative, community  and faith-based  approaches, developing                                                               
and  implementing  a  statewide   suicide  prevention  plan,  and                                                               
strengthening and  building new  partnerships between  public and                                                               
private entities to advance suicide  prevention efforts.  As this                                                               
was  a massive  responsibility,  in 2010  and  2011, the  council                                                               
reevaluated  its approach  to the  work, and  focused on  greater                                                               
collaboration and  coordination of effort with  communities for a                                                               
more effective suicide prevention program.                                                                                      
                                                                                                                                
3:08:56 PM                                                                                                                    
                                                                                                                                
MS.  BURKHART  directed  attention   to  slide  2,  "coordinate,"                                                               
stating that  coordination was "a  huge part of what  the suicide                                                               
prevention council does."   She shared that the plan,  now in its                                                               
third year, was not a typical  state health program plan, but was                                                               
based  on an  intensive,  participatory process  from  150 -  200                                                               
Alaskans,  including  clergy,   Village  Public  Safety  Officers                                                               
(VPSOs), suicide  attempters, young people, business  owners, and                                                               
the clinicians providing  services.  This process  created a plan                                                               
and strategy  that was fully  endorsed by those who  were served,                                                               
hence  it became  self-implementing.   The  council ensured  that                                                               
communities  were   connected  with  each  other   and  with  the                                                               
necessary resources  to effectively  implement the  strategies in                                                               
the plan.  She shared the  Wall of Hope, which offered resilience                                                               
to young people  for navigating difficult situations  and a place                                                               
to seek  help during  a crisis.   She  reported that  the council                                                               
worked  with school  districts to  organize and  report on  these                                                               
events.                                                                                                                         
                                                                                                                                
3:11:09 PM                                                                                                                    
                                                                                                                                
MS. BURKHART shared slide 3,  "collaborate," and offered examples                                                               
which included a  long standing media campaign with  the Iron Dog                                                               
race.  She  shared the background for the campaign.   She pointed                                                               
out  that  the  word  suicide  was  not  usually  used  in  these                                                               
campaigns, but instead there were  references such as: reasons to                                                               
live, working  together, or  life is  a team  effort.   She noted                                                               
that the  downtown Anchorage Rotary  Club had  identified suicide                                                               
prevention as a priority for  the organization, and had developed                                                               
a training  regimen for  gatekeeper suicide  prevention available                                                               
to all statewide  Rotary Clubs.  She  acknowledged the importance                                                               
of this for  the foundation of the state  suicide prevention plan                                                               
that every Alaskan take responsibility  for preventing suicide by                                                               
identifying  when someone  was  in crisis  and  helping get  them                                                               
connected to  help.   She spoke about  a peer  suicide prevention                                                               
program for high school students, "You are not alone."                                                                          
                                                                                                                                
3:14:19 PM                                                                                                                    
                                                                                                                                
MS. BURKHART  moved on to  slide 4, "communicate,"  and explained                                                               
that the council had developed  a suicide prevention portal which                                                               
allowed information to  be presented at the  community level, and                                                               
minimized the costs  of hosting websites.  She  reported that the                                                               
statewide website was stopsuicidealaska.org.   She mentioned that                                                               
the  council also  partnered with  the state  crisis intervention                                                               
line, Careline,  which was  located in  Fairbanks and  staffed by                                                               
Alaskans trained  to talk with  people in crisis.   Careline also                                                               
provided  follow  up   to  people  who  had   called  and  needed                                                               
additional connection.   She pointed  out that  Careline received                                                               
state funding and was an  integral part of the suicide prevention                                                               
efforts.    Its partnerships  with  Alaska  Native Tribal  Health                                                               
Consortium, Department  of Health and Social  Services, community                                                               
coalitions,  and   the  council   allowed  for   advertising  and                                                               
outreach, with its resources reserved for services.                                                                             
                                                                                                                                
3:16:10 PM                                                                                                                    
                                                                                                                                
MS. BURKHART addressed slide 5,  "warning signs," and listed some                                                               
of  the signs,  which  included:   threatening  to  hurt or  kill                                                               
themselves;  looking  for ways  of  suicide;  talking or  writing                                                               
about death, dying, or suicide;  acting recklessly; dramatic mood                                                               
changes;   and,  expressing   feelings   of  purposelessness   or                                                               
hopelessness.   She  shared  a report  that  stated firearms  and                                                               
suffocation were the two predominant means of suicide.                                                                          
                                                                                                                                
3:18:56 PM                                                                                                                    
                                                                                                                                
MS. BURKHART remarked that the  state suicide prevention plan was                                                               
a plan  of action, instead  of aspiration, slide 6,  "casting the                                                               
net upstream."                                                                                                                  
                                                                                                                                
3:19:42 PM                                                                                                                    
                                                                                                                                
MS. BURKHART directed  attention to slide 7,  "goals," and listed                                                               
the  goals  to  include:    Alaskans  accept  responsibility  for                                                               
preventing  suicide;   respond effectively  and appropriately  to                                                               
people   at  risk   of  suicide;   communicate,  cooperate,   and                                                               
coordinate suicide  prevention efforts; have immediate  access to                                                               
the necessary  prevention, treatment,  and recovery  services, as                                                               
access  to health  care was  critical; and  support survivors  in                                                               
healing.   She shared  that there was  quality data  and research                                                               
available for use in planning,  implementation, and evaluation of                                                               
the suicide prevention efforts.                                                                                                 
                                                                                                                                
3:21:14 PM                                                                                                                    
                                                                                                                                
MS. BURKHART explained that the  council had created six regional                                                               
suicide prevention  teams, which allowed  the work to  be aligned                                                               
most closely  with each  community's values  and needs,  slide 8,                                                               
"regional teams."   Each regional team could decide  which of the                                                               
aforementioned  goals  were  most appropriate  for  its  efforts.                                                               
Every other  year, a  statewide summit with  all of  the regional                                                               
teams allowed for each plan to be refined.                                                                                      
                                                                                                                                
3:21:55 PM                                                                                                                    
                                                                                                                                
MS. BURKHART said that the data  collected by the Bureau of Vital                                                               
Statistics revealed that the suicide  rate in Alaska had remained                                                               
steady for many years, slide 9,  "suicide data."  She stated that                                                               
Alaska was  now only the  fourth highest  rate of suicide  in the                                                               
US.   She  opined that  this  steadiness could  reflect that  the                                                               
prevention efforts  were "something  right in  that we  have held                                                               
steady while  other similarly situated states  have experienced a                                                               
rise  in their  rate."    She shared  that  there  was also  data                                                               
collected for veterans' deaths.                                                                                                 
                                                                                                                                
3:23:37 PM                                                                                                                    
                                                                                                                                
MS. BURKHART shared some of  the strategies under the state plan,                                                               
which  included  that  Alaskans know  about  Careline  and  other                                                               
community  crisis  lines, and  that  the  information is  shared,                                                               
slide  10, "crisis  intervention."   She pointed  out that  every                                                               
strategy had a performance indicator  for measurement of progress                                                               
toward the  goals, and that this  was measured by looking  at the                                                               
numbers  of calls  to  Careline.   She  said  that  the calls  to                                                               
Careline had risen  from about 6,000 in 2013 to  more than 10,000                                                               
in 2014.   She noted that, should all the  responders on Careline                                                               
be busy,  the calls  would roll over  to a  nationally accredited                                                               
member  of the  suicide prevention  lifeline network,  ensuring a                                                               
trained response.   She stated that  more than 80 percent  of the                                                               
callers  disclosed  a  current mental  health  or  substance  use                                                               
disorder.                                                                                                                       
                                                                                                                                
3:25:19 PM                                                                                                                    
                                                                                                                                
MS. BURKHART shared that another  plan strategy was for the State                                                               
of Alaska  and its  partners to make  training in  evidence based                                                               
suicide  prevention and  intervention  models  accessible to  all                                                               
interested Alaskans,  slide 11,  "training."  She  reported that,                                                               
in  2014, over  5000 people  were  trained, as  training was  now                                                               
available  to educators  and school  district  staff through  the                                                               
Department of Education and Early Development.                                                                                  
                                                                                                                                
3:26:38 PM                                                                                                                    
                                                                                                                                
MS. BURKHART lauded Dr. Jay Butler  for coining the term, "web of                                                               
causality,"  slide  12.    She  said that  this  term  offered  a                                                               
description for the many factors  which lead to the contemplation                                                               
or attempt of  suicide, pointing out that there  were also social                                                               
and  economic factors.    She  shared that  suicide  was not  the                                                               
result of one factor.                                                                                                           
                                                                                                                                
3:27:52 PM                                                                                                                    
                                                                                                                                
MS. BURKHART explained "childhood  trauma" and its impact, slides                                                               
13 -  15.   She reported  that the data  collected came  from the                                                               
Adverse  Childhood Experiences  (ACEs),  those traumatic  events,                                                               
such  as  abuse,  neglect,  domestic  violence,  mental  illness,                                                               
substance abuse,  incarceration, or  divorce within  a household,                                                               
which occurred  to individuals or  their immediate  family, while                                                               
young.   The Behavioral Risk  Factor Surveillance  Survey (BRFSS)                                                               
data on ACEs  offered a more specific understanding  for how many                                                               
Alaskans were  dealing with the  ramifications of  this childhood                                                               
trauma.   This survey  showed that 64  percent of  Alaskan adults                                                               
had  at least  one of  these  experiences, and  27.4 percent  had                                                               
three or  more of these  experiences.   She declared there  was a                                                               
correlation  between  the  number of  these  adverse  experiences                                                               
(ACEs)  and   the  likelihood  of  negative   health  and  social                                                               
experiences  later  in life;  the  higher  the ACEs  number,  the                                                               
higher the likelihood of risks  for suicide attempts.  She shared                                                               
that  a complete  analysis of  this BRFSS  data was  on-line, and                                                               
that research  at the national  level showed this increase  to be                                                               
exponential.    She  said  that  nearly  two  thirds  of  suicide                                                               
attempts  among adults  were  attributable  to adverse  childhood                                                               
experiences (ACEs).  She directed  attention to a graph depicting                                                               
the exponential increase of risks per suicide, slide 15.                                                                        
                                                                                                                                
3:30:44 PM                                                                                                                    
                                                                                                                                
MS.  BURKHART shared  that there  was a  lot of  success for  the                                                               
school based suicide prevention efforts,  slides 16 - 18, "what's                                                               
working."    She referenced  the  Teck-John  Baker Youth  Leaders                                                               
Program in the Northwest Arctic,  modeled after an evidence based                                                               
natural   helper's  model,   but  refined   to  include   Inupiaq                                                               
traditions  and  values for  greater  cultural  relevance to  the                                                               
local  students.   She said  that  they had  greater success  for                                                               
preventing  adolescent  suicide   than  most  other  communities.                                                               
There  was a  focus on  the strength  and the  resiliency of  the                                                               
youth,  and  the youth  were  connected  with adult  mentors  who                                                               
taught  their  heritage  and  culture.   She  reported  that  the                                                               
council  partnered with  the Department  of  Education and  Early                                                               
Development to  fund grants for  school based  suicide prevention                                                               
and that there were currently  10 grantees, all offering evidence                                                               
based  suicide prevention  training and  access to  mental health                                                               
services.   She  shared that  at  risk students  were most  often                                                               
attending  alternative schools.    In Juneau,  the local  suicide                                                               
prevention  coalition partnered  with the  school district  for a                                                               
peer  leadership model,  Sources of  Strength.   She shared  that                                                               
this  program also  had successes  similar to  the aforementioned                                                               
program in  the Arctic.  She  reported on a program  in the Lower                                                               
Kuskokwim School  District which  had a very  successful program,                                                               
as  well.   She  stated that,  as access  to  mental health  care                                                               
services  was  integral  to preventing  suicide,  the  State  had                                                               
supported  the development  of  culturally  relevant programs  to                                                               
ensure that  indigenous people had  access to  meaningful suicide                                                               
prevention.   She  spoke about  "Doorway  to a  Sacred Place,"  a                                                               
traditional healing model funded by  the Department of Health and                                                               
Social Services.                                                                                                                
                                                                                                                                
3:34:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FOSTER  declared that  he was  a big  supporter of                                                               
the Qungasvik Project  in the Lower Yukon area.   He asked if the                                                               
intent  was for  these programs,  if  successful, to  be used  in                                                               
other regions.  He suggested  that both funding and awareness was                                                               
necessary,  and  he asked  if  Department  of Health  and  Social                                                               
Services was helping to get the word out.                                                                                       
                                                                                                                                
MS. BURKHART replied  that these projects had  an organic quality                                                               
that was culturally relevant to the  area.  She reported that the                                                               
funding organization  had been invited  in by the  community, and                                                               
after a  long, very careful  process, a model was  developed that                                                               
was effective in that community and  in that culture.  Because of                                                               
this success,  the state  had allocated  resources to  the Yukon-                                                               
Kuskokwim   Health  Corporation   to  help   spread  this   model                                                               
throughout  that  area  of cultural  relevance.    She  expressed                                                               
concern  for the  availability of  state resources  to develop  a                                                               
similar organic process in another part of the state.                                                                           
                                                                                                                                
3:36:22 PM                                                                                                                    
                                                                                                                                
MS. BURKHART  concluded with slide  19, "what's next."   She said                                                               
that they would continue to  develop and support increased access                                                               
to evidence  based suicide prevention  training.  She  noted that                                                               
more Alaskans understood the importance  of Careline.  She stated                                                               
that there  was not  a robust curriculum  or training  in helping                                                               
professions,  and  that  suicide   prevention  was  not  a  major                                                               
component in  many mental  health curriculums.   The  council was                                                               
working to  make evidence  based training  available on  line for                                                               
continuing education  credits for social  workers, psychologists,                                                               
and nurses.   They would continue to  encourage suicide screening                                                               
and intervention  in primary care  practices and  would encourage                                                               
support  services  and  resources  for parents  and  families  to                                                               
ensure that  all Alaskan children  grow up in healthy  and stable                                                               
environments.     The  council  wanted  to   expand  the  suicide                                                               
knowledge   and  research   base  in   Alaska,  and   refine  its                                                               
communication strategies  to take advantage of  emerging outlets.                                                               
She declared that it would be  necessary in the next few years to                                                               
sit  down and  evaluate its  progress so  that the  next planning                                                               
phase would build on what was successful.                                                                                       
                                                                                                                                
3:39:44 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  expressed his  appreciation  for  casting the  net                                                               
upstream to relate  to underlying health issues.   He asked about                                                               
the  2013 US  military study  on  suicide, which  found that  the                                                               
likelihood for  suicide was  doubled when  Vitamin D  levels were                                                               
below 15 ng/ml.  He asked  if the council had considered this for                                                               
any recommendations.                                                                                                            
                                                                                                                                
MS.  BURKHART replied  that the  council had  read the  study and                                                               
acknowledged the  need for  more research, as  there was  a clear                                                               
association between  Vitamin D deficiencies and  depression.  She                                                               
pointed out  that it was  unclear whether this was  causative, as                                                               
all the  subjects in the military  study had been deployed.   She                                                               
pointed out  that women  and people living  in poverty  were also                                                               
populations  that   tended  to  have   lower  Vitamin  D.     She                                                               
acknowledged this  association and  that this information  was in                                                               
conversations by  the council.   She stated that the  council, as                                                               
it wanted communities  to address suicide in a way  that fit with                                                               
what they were seeing, tended to  not tell the communities how to                                                               
deal with  it.  She compared  studies of Vitamin D  to studies on                                                               
sugar  in   various  population   groups.    She   mentioned  the                                                               
disruptions in  light and time  caused by daylight  savings time,                                                               
and its relationship to the risk of suicide.                                                                                    
                                                                                                                                
3:43:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL  asked whether  the  number  of suicides  in                                                               
Alaska during 2014 had decreased.                                                                                               
                                                                                                                                
MS. BURKHART replied  that this was still unknown,  as the Bureau                                                               
of Vital  Statistics collected the  information, but there  was a                                                               
delay for the  notification of Alaskans dying  outside of Alaska.                                                               
This resulted  in a nine month  lag for the release  of the final                                                               
data.                                                                                                                           
                                                                                                                                
3:45:04 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:45 p.m. to 3:47 p.m.                                                                       
                                                                                                                                
3:47:36 PM                                                                                                                      
                                                                                                                                
^PRESENTATION:  BECOMING A  TRAUMA INFORMED  SYSTEM, DIVISION  OF                                                             
JUVENILE JUSTICE                                                                                                              
  PRESENTATION: BECOMING A TRAUMA INFORMED SYSTEM, DIVISION OF                                                              
                        JUVENILE JUSTICE                                                                                    
                                                                                                                                
CHAIR SEATON announced  that the next order of  business would be                                                               
a presentation on trauma informed care.                                                                                         
                                                                                                                                
3:48:04 PM                                                                                                                    
                                                                                                                                
KAREN   FORREST,   Director,   Division  of   Juvenile   Justice,                                                               
Department  of   Health  and  Social  Services,   explained  that                                                               
Division of Juvenile Justice had  been working on trauma-informed                                                               
care for several  years, since a successful pilot  project at the                                                               
McLaughlin  Youth   Center  in   Anchorage  had  resulted   in  a                                                               
significant drop  in youth isolation  and youth restraint  due to                                                               
behaviors.  She  explained that a trauma informed  agency was one                                                               
which:  realized the  wide spread  impact of  trauma, noting  the                                                               
importance in the Division of Juvenile  Justice as so many of its                                                               
youth had adverse childhood experiences;  recognized the signs of                                                               
trauma in its  youth, as well as its staff,  who could experience                                                               
secondary  trauma from  working  with these  youth; and,  adopted                                                               
policies, programs,  and procedures  which take into  account the                                                               
trauma  and  adverse  life  experiences.   She  stated  that  the                                                               
division had a better understanding  of how to intervene, and had                                                               
a better  relationship with  youth.  She  pointed out  that youth                                                               
felt safer and were able to  develop coping skills to address the                                                               
traumatic  stress reactions.   She  stated that  this care  could                                                               
improve the  overall outcomes and  decrease the  recidivism rate.                                                               
She  shared that  Department of  Health and  Social Services  was                                                               
working on  this care through  the Office of  Children's Services                                                               
and the Division of Behavioral Health.                                                                                          
                                                                                                                                
3:53:11 PM                                                                                                                    
                                                                                                                                
SHANNON  CROSS-AZBILL, Clinical  Director,  Division of  Juvenile                                                               
Justice,  Department of  Health  and  Social Services,  explained                                                               
that   its  youth   population  had   experienced  many   of  the                                                               
aforementioned  10 points  of the  Adverse Childhood  Experiences                                                               
(ACEs),  as  well as  other  traumas  including homelessness  and                                                               
bullying.  She presented slide  1, "Trauma Informed Care," from a                                                               
PowerPoint  titled, "Becoming  a  Trauma Informed  System."   She                                                               
declared that  this was a  process, a  culture change, and  not a                                                               
program.    She  allowed  that  although  anyone  can  be  trauma                                                               
informed, it  was necessary to  take the information  and utilize                                                               
it.    She said  that  Division  of  Juvenile Justice  (DJJ)  was                                                               
working  through  a  change  in its  program  from  isolation  to                                                               
relationship   based.      She  emphasized   that   forming   the                                                               
relationship  was the  most important  aspect of  trauma informed                                                               
care, as  a therapeutic  relationship allowed  for accountability                                                               
and safety.                                                                                                                     
                                                                                                                                
3:57:33 PM                                                                                                                    
                                                                                                                                
MS.  CROSS-AZBILL  moved on  to  slide  2, "First  and  Foremost:                                                               
Support  From Administration,"  and declared  that, without  this                                                               
support,  everything would  be very  difficult.   She pointed  to                                                               
slide  3, "Becoming  a  Trauma Informed  System..."  which was  a                                                               
reminder that two  steps forward and one step back  was still one                                                               
step forward.  She offered an  anecdote of the difficulty she had                                                               
faced  with  the  distribution  of  coping toys  to  one  of  her                                                               
patients, noting that this was now an accepted tactic.                                                                          
                                                                                                                                
4:00:59 PM                                                                                                                    
                                                                                                                                
MS.  CROSS-AZBILL addressed  slide 4,  "Why Learn  About Trauma?"                                                               
She stressed that it was  now accepted that traumatic experiences                                                               
did impact a  person's brain and body.  She  compared pictures of                                                               
brains that had  and had not been exposed to  neglect, similar to                                                               
the development of  brains exposed to alcohol.   She reported, as                                                               
staff  now better  understood the  physiological, emotional,  and                                                               
neurological impact  of traumatic experiences  that relationships                                                               
could be enhanced and treatment could be improved.                                                                              
                                                                                                                                
4:01:58 PM                                                                                                                    
                                                                                                                                
MS. CROSS-AZBILL  shared slide 5,  "Long-Term Impact  of Trauma,"                                                               
and pointed out  that the long term impacts  from trauma included                                                               
mental  health  issues,  substance  abuse,  and  physical  health                                                               
issues such as diabetes, heart attacks, and cancer.                                                                             
                                                                                                                                
MS.  CROSS-AZBILL moved  on to  slide 6,  "Safety," and  declared                                                               
that this  was the  most important aspect  of any  service system                                                               
that  worked  with   violence  and  trauma.     She  shared  that                                                               
improvement to  facilities and youth  required review  for trauma                                                               
informed care to  enhance safety.  Directing  attention to slides                                                               
7 - 8, she reiterated  that good relationships allowed for better                                                               
accountability.  She  said that they created  safety and provided                                                               
structure and consistency  to help create the  environment in the                                                               
TIC.                                                                                                                            
                                                                                                                                
MS. CROSS-AZBILL  introduced slide 9, "Training  and Professional                                                               
Development," which listed the staff  trainings.  She stated that                                                               
the  staff  pairings  were inter-departmental  so  it  would  not                                                               
appear to  be just  "a mental  health thing,"  and this  had also                                                               
helped  to  build  those  relationships.     She  said  that  the                                                               
clinicians  had  worked on  trauma  focused  therapies, and  that                                                               
secondary trauma training was enhanced  to better help the staff.                                                               
She  referenced  the  integrated life  story  assessment  (ILSA),                                                               
similar to  a time line  of the  subject's life, slide  10, which                                                               
was also used  by the probation staff.  She  declared the need to                                                               
focus  on strengths  and the  necessity to  implement those  when                                                               
moving forward.                                                                                                                 
                                                                                                                                
MS.  CROSS-AZBILL  directed  attention to  slide  12,  "Disrupted                                                               
Brain  Development from  Childhood  Neglect,"  noting that  these                                                               
were  pictures  of the  two  brains  she had  mentioned  earlier.                                                               
Focusing on  slide 14, "ACEs  and suicide attempts,"  she offered                                                               
an anecdote  about a  youth detainee  who had  attempted suicide,                                                               
was then sent to Alaska  Psychiatric Institute, and then returned                                                               
to the Anchorage  youth facility where he had  made other suicide                                                               
attempts.    She  relayed  that staff  viewed  this  behavior  as                                                               
conduct disorder,  whereas the clinicians declared  that this was                                                               
post-traumatic stress  disorder with a bi-polar  diagnosis.  This                                                               
brought discussion  and disagreement for the  means of treatment.                                                               
When the  ACE diagnosis was  assessed, it was discovered  that he                                                               
had  experienced six  of the  ten adverse  childhood experiences.                                                               
She directed  attention to the  corresponding data,  which showed                                                               
that  this would  increase the  risk for  suicide attempts  by 28                                                               
times.   She  pointed out  that  it was  inconsequential for  the                                                               
reasons to  the suicide attempts;  that it was more  important to                                                               
look  at  the basics  of  what  happened  to  him, build  on  his                                                               
strengths,  and  work  on  the relationships.    She  offered  an                                                               
anecdote for recent interactions with this same youth.                                                                          
                                                                                                                                
4:14:13 PM                                                                                                                    
                                                                                                                                
BERNARD  GATEWOOD,  Superintendent,   Fairbanks  Youth  Facility,                                                               
Youth  Facilities, Division  of Juvenile  Justice, Department  of                                                               
Health  and  Social Services,  reported  that  he had  introduced                                                               
trauma  informed care  into  the Fairbanks  youth  facility.   He                                                               
declared that,  as he always  wanted to make the  facility better                                                               
and that  everyone had the right  to be treated with  dignity and                                                               
respect, it  was necessary to  focus on respect when  forming the                                                               
relationship.  He  stated that the kids still had  the ability to                                                               
bounce  back  and be  productive  citizens,  although they  often                                                               
needed some  help.   He shared  that it was  necessary to  take a                                                               
step back, review what happened  to cause these actions, and look                                                               
at the  kids as human  beings.  He opined  that it was  from this                                                               
point  that progress  would begin.   He  shared that  all of  the                                                               
staff, including teachers, maintenance,  and nurses, were trained                                                               
in the  introduction phase of  the TIC  program, so that  all the                                                               
staff understood  trauma and  its effects on  the clients  in the                                                               
facility.  He said that TIC  allowed people to focus on their own                                                               
triggers,  better understand  their  own  reactions, and  develop                                                               
better coping skills, so there would be better relationships.                                                                   
                                                                                                                                
4:19:13 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  asked how  the numbers on  an ACEs  assessment were                                                               
used in the treatment decision.                                                                                                 
                                                                                                                                
MR. GATEWOOD replied that the  number was irrelevant, that it was                                                               
important to know the traumatic  events which lead to the current                                                               
state.  It  was most important to treat the  person with respect,                                                               
build relationships, and work on resilience.                                                                                    
                                                                                                                                
CHAIR SEATON reflected on past  testimony about the importance of                                                               
ACEs, which seemed to focus on the numbers.                                                                                     
                                                                                                                                
REPRESENTATIVE WOOL  asked about the aforementioned  point system                                                               
that was no longer in use.                                                                                                      
                                                                                                                                
MR. GATEWOOD  replied that this  system had been based  on points                                                               
for behavior.   He opined  that, although points  were artificial                                                               
as there  were not  points in  the real  world, points  gave both                                                               
kids  and  staff a  barometer,  and  something was  necessary  if                                                               
points were going to be replaced.                                                                                               
                                                                                                                                
4:22:07 PM                                                                                                                    
                                                                                                                                
MS.  CROSS-AZBILL explained  that it  was necessary  to recognize                                                               
the traumas  and adverse experiences,  and then look at  how they                                                               
earn points to help them become successful.                                                                                     
                                                                                                                                
^PRESENTATION: 24/7 SOBRIETY MONITORING PROGRAM                                                                               
         PRESENTATION: 24/7 SOBRIETY MONITORING PROGRAM                                                                     
                                                                                                                              
4:22:39 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced  that the next order of  business would be                                                               
a presentation on the 24/7 sobriety monitoring program.                                                                         
                                                                                                                                
4:23:55 PM                                                                                                                    
                                                                                                                                
TONY PIPER,  Coordinator, Alcohol  Safety Action  Program (ASAP),                                                               
Division of  Behavioral Health, Department  of Health  and Social                                                               
Services, said that the 24/7  sobriety monitoring program was one                                                               
of  the  smart  justice  evidence based  initiatives  passed  the                                                               
previous legislative  session, through Senate  Bill 64.   As this                                                               
concept had  been successfully used  in several areas  around the                                                               
country,  the 24/7  sobriety monitoring  program  was modeled  on                                                               
these  other programs.   He  explained that  the program  allowed                                                               
qualified  participants   to  be   actively  involved   in  their                                                               
community,  and to  take  care of  their  obligations instead  of                                                               
sitting  in   an  institution.     He   reported  that,   as  the                                                               
participants were  tested twice daily  for alcohol with  a breath                                                               
analysis every  12 hours,  the public  was also  safe.   If there                                                               
were any  action that  was not positive,  there was  an immediate                                                               
follow up action, which most  often resulted in immediately being                                                               
remanded  to the  institution.   He  shared that  Senate Bill  64                                                               
allowed  this 24/7  program  to be  used in  a  variety of  ways,                                                               
including bail,  probation, parole, and  children in need  of aid                                                               
programs.   He noted that  the program  had started in  July, and                                                               
shortly  thereafter a  tour  for judges  and  attorneys had  been                                                               
instrumental in spreading the  program information and increasing                                                               
the referrals.  He reported  that there had been 218 participants                                                               
through the  end of  December, with 89  active participants.   He                                                               
said there  had been  more than  11,000 successful  breath tests,                                                               
with only 26 failed breath tests.   He shared that there had been                                                               
more  than 1300  successful drug  tests, with  only 16  failures.                                                               
These failure  rates were  lower than those  in other  areas with                                                               
similar programs.   He pointed  out that  all of the  42 patients                                                               
who had  failed, were now  re-entered into the program,  and were                                                               
currently  successful.    He  explained  that  participants  were                                                               
released to  the program, with  instructions for where to  go and                                                               
how  the program  worked.    He reported  that  drug testing  was                                                               
randomly done  two or  three times  each week,  with participants                                                               
calling in  each morning.   The alcohol testing was  conducted in                                                               
both the  morning and the  evening and attendance  was mandatory.                                                               
He allowed that  some adjustments to the timing had  been made to                                                               
allow for  bus schedules.   He  reported that  64 people  had now                                                               
completed  the program  with no  violations.   He  said that  the                                                               
program  was now  being expanded  into Fairbanks  and the  Kenai.                                                               
The per person cost for participation  in the program was $5 each                                                               
day for  the breath test,  and between $10  and $50 for  the drug                                                               
test,  dependent on  the number  of  drugs and  the frequency  of                                                               
testing.   He shared  that facial  recognition software  was also                                                               
available for those  unable to go to the  testing facilities, and                                                               
were testing at home.                                                                                                           
                                                                                                                                
4:29:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES asked about  the random scheduling for drug                                                               
testing.                                                                                                                        
                                                                                                                                
MR. PIPER explained  that the individual would call  in every day                                                               
and be advised whether they were scheduled to come in that day.                                                                 
                                                                                                                                
REPRESENTATIVE  STUTES  offered   her  understanding  that,  with                                                               
advance warning, there was the ability to mask the results.                                                                     
                                                                                                                                
MR. PIPER  replied that current  drug tests had  precautions that                                                               
would show  tampering or  dilution for  the normal  urine sample.                                                               
He added that  these tests were witnessed by  a representative of                                                               
the program.                                                                                                                    
                                                                                                                                
4:31:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES opined that  people can ingest "whatever it                                                               
is they  take" to produce a  normal urine sample.   She expressed                                                               
confusion for the program offering an advance warning.                                                                          
                                                                                                                                
CHAIR  SEATON  asked  that Representative  Stutes  research  this                                                               
further, to identify the chemical  and whether this would show up                                                               
as a normal sample.                                                                                                             
                                                                                                                                
4:33:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL  asked for  the  type  of offenders  in  the                                                               
program.                                                                                                                        
                                                                                                                                
MR.  PIPER,  in  response,  shared   that  the  bill  listed  the                                                               
qualifying offenses, "more or  less misdemeanor offenders," which                                                               
included driving under the influence (DUI) and drug offenders.                                                                  
                                                                                                                                
REPRESENTATIVE  WOOL  asked  if  this  included  first  time  DUI                                                               
offenders.                                                                                                                      
                                                                                                                                
MR. PIPER  replied that  a first  time offender  could be  in the                                                               
program,  though  more  often  it   was  second  and  third  time                                                               
offenders.                                                                                                                      
                                                                                                                                
REPRESENTATIVE WOOL  asked for more  information about  the ankle                                                               
bracelet monitoring system.                                                                                                     
                                                                                                                                
MR. PIPER acknowledged the availability  of a bracelet, which was                                                               
going to  be used in the  Fairbanks area.  He  offered his belief                                                               
that  Department of  Corrections  used the  Sober Link  bracelet,                                                               
although it was only capable of alcohol testing.                                                                                
                                                                                                                                
REPRESENTATIVE WOOL opined that  the bracelet could eliminate the                                                               
need to go twice daily to a facility.                                                                                           
                                                                                                                                
MR. PIPER concurred.                                                                                                            
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  asked about  the  time  lag between  the                                                               
call-in and testing.                                                                                                            
                                                                                                                                
MR. PIPER  explained that there  was a  short time window  in the                                                               
morning, the call  in period began at 6 a.m.  and the testing had                                                               
to be completed prior to 9 a.m.                                                                                                 
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked if there was a designated lab.                                                                     
                                                                                                                                
MR. PIPER replied that there was a designated facility.                                                                         
                                                                                                                                
CHAIR  SEATON  opined  that  outside   monitoring  was  an  added                                                               
efficiency  for the  justice system,  as it  reduced the  cost of                                                               
incarceration,  it kept  earnings  going to  the  family, and  it                                                               
maintained engagement  with the community.   He declared  that he                                                               
was encouraged by the 11,000  positive test results, with only 26                                                               
failed tests.   He offered his  belief that there was  a stronger                                                               
learning path for  learning how to not  abuse alcohol out-of-jail                                                               
versus in-jail.   He  expressed his support  for the  program and                                                               
for an  increase to the  number of non-violent offenders  able to                                                               
be "back into life, but on that right path."                                                                                    
                                                                                                                                
4:38:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked who supervised the program.                                                                        
                                                                                                                                
MR.  PIPER  replied that  the  Department  of Health  and  Social                                                               
Services  and the  Alcohol Safety  Action  Program (ASAP)  office                                                               
were  overseeing  the program.    In  response to  Representative                                                               
Vazquez, he added that he was  the program manager.  He explained                                                               
that the  current results  only reflected  the program  since its                                                               
inception  in  August,  although  the South  Dakota  program  had                                                               
demonstrated results for a much longer period of time.                                                                          
                                                                                                                                
4:39:38 PM                                                                                                                    
                                                                                                                                
ALBERT  WALL, Director,  Central Office,  Division of  Behavioral                                                               
Health, Department of  Health and Social Services,  said that the                                                               
department would provide the data.                                                                                              
                                                                                                                                
4:39:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES asked  if, as  this was  a court  mandated                                                               
sobriety or  drug testing  program, there was  any time  delay or                                                               
requirement before an individual would begin the program.                                                                       
                                                                                                                                
MR.  PIPER   explained  that  program  participants   were  given                                                               
instructions  immediately upon  their release  from court,  which                                                               
allowed  12 hours  to appear.   These  instructions included  the                                                               
testing times, the directions to  the facility, and bus routes to                                                               
the facility.  He said that  anyone who took longer than 12 hours                                                               
to appear  at the  testing agency  was tested  for the  length of                                                               
time  since their  court  appearance.   He  shared  that, as  his                                                               
office  was immediately  notified  upon  an individual's  release                                                               
from the court,  the testing agency was  expecting the individual                                                               
within the next 12 hours.                                                                                                       
                                                                                                                                
A short video about the program was presented.                                                                                  
                                                                                                                                
4:44:45 PM                                                                                                                    
                                                                                                                                
MR. WALL  explained that  the program  represented a  response by                                                               
the   Department  of   Health   and  Social   Services  and   its                                                               
collaborative partners  to comply  with Senate Bill  64.   It was                                                               
based on a model that had  shown results and had a consistent 100                                                               
percent accountability.  He pointed  out that the program offered                                                               
a savings  to the system.   It addressed the  addictive behavior,                                                               
while  holding the  individual accountable  and  showing them  an                                                               
alternative way to move forward with their lives.                                                                               
                                                                                                                                
^OVERVIEW: DIVISION OF BEHAVIORAL HEALTH                                                                                      
            OVERVIEW: DIVISION OF BEHAVIORAL HEALTH                                                                         
                                                                                                                              
4:45:43 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that the  final order of business would be                                                               
an overview of the Division of Behavioral Health.                                                                               
                                                                                                                                
4:46:27 PM                                                                                                                    
                                                                                                                                
ALBERT  WALL, Director,  Central Office,  Division of  Behavioral                                                               
Health,  Department of  Health and  Social Services,  presented a                                                               
PowerPoint  titled, "House  Health  &  Social Services|  Division                                                               
Overview."   Directing attention  to slide 2,  "Behavioral Health                                                               
Overview,"  he said  that  the division  existed  to "manage  and                                                               
integrated and  comprehensive behavioral  health system  based on                                                               
sound policy,  effective practices,  and open partnerships."   He                                                               
said  there were  348 full  time positions  in the  division, and                                                               
that the  operating budget was  about 5.2 percent of  the overall                                                               
Department  of Health  and Social  Services  budget, almost  $142                                                               
million.  The division served  about 32,854 people, which did not                                                               
include the prevention population.                                                                                              
                                                                                                                                
4:47:49 PM                                                                                                                    
                                                                                                                                
MR. WALL  addressed slide 3,  "Organization Chart,"  which showed                                                               
the division structure and a  breakout of personnel in each area.                                                               
He pointed  to the Alaska  Psychiatric Institute (API),  which he                                                               
described as "the  anchor of acute care for  behavioral health in                                                               
the state."   He noted that API was located  in Anchorage and was                                                               
an  in-patient facility  with 246  staff.   API cares  for people                                                               
with the  most extreme need  and was  based on a  therapeutic and                                                               
restorative model to return people  to their community.  Next, he                                                               
pointed  to the  Prevention &  Early Intervention  Section, which                                                               
primarily  ran program  management  for  grants, including  fetal                                                               
alcohol   spectrum  disorder   (FASD)  and   suicide  prevention.                                                               
Although this section was primarily  housed in Juneau, the grants                                                               
were  distributed  statewide.    He moved  on  to  another  grant                                                               
section, the Treatment & Recovery  Section, which represented the                                                               
largest financial section  after API, and handled  grants in four                                                               
categories.  He referenced the  Medicaid & Quality Section, which                                                               
had  quality oversight  and assessment  for Medicaid  billing for                                                               
behavioral health  and for the  Medicaid providers  to behavioral                                                               
health.  He explained that  the Policy & Planning Section handled                                                               
the proprietary data base system  where grantees entered reports,                                                               
which allowed  for tracking the  information.  This  section also                                                               
performed  the  research   for  the  division.     He  noted  the                                                               
Administrative Support  Team, as  well as  the three  boards: the                                                               
Alaska Mental Health Board, the  Advisory Board on Alcohol & Drug                                                               
Abuse, and the Statewide Suicide Prevention Council.                                                                            
                                                                                                                                
4:50:37 PM                                                                                                                    
                                                                                                                                
MR. WALL  presented slide 4,  "Division Core  Service Alignment,"                                                               
and  stated that  the division,  similar to  the department,  was                                                               
core service  driven, and he  explained how the core  services of                                                               
the division  fed into the  three priorities.   He said  that the                                                               
first  core   service  identified  behavioral  health   needs  by                                                               
population  and   geography  and  developed  and   implemented  a                                                               
statewide strategy to meet those needs.   He said that the second                                                               
core service  was to develop  and maintain a  stable, accessible,                                                               
and sustainable  system of behavioral healthcare  for Alaskans in                                                               
partnership with providers and communities.   He said that it was                                                               
extremely  critical  for  behavioral   health  services  to  work                                                               
collaboratively with  its providers,  as the system  was designed                                                               
and dependent on  working together with other groups.   He stated                                                               
that  the third  core  service  was to  protect  and promote  the                                                               
improving  behavioral  health  of  Alaskans.    The  fourth  core                                                               
service  was to  provide  accessible,  quality, active  inpatient                                                               
treatment in a  safe and comfortable setting, and  the fifth core                                                               
service  was to  provide  and  coordinate interagency  behavioral                                                               
healthcare.                                                                                                                     
                                                                                                                                
4:52:57 PM                                                                                                                    
                                                                                                                                
MR. WALL  presented slide 5,  "Continuum of Care,"  and explained                                                               
that  the continuum  flow  began with  the  prevention and  early                                                               
intervention  efforts,  which cost  little  per  contact but  had                                                               
great value,  such as suicide  prevention, domestic  violence and                                                               
FASD.   Moving along the  continuum, he pointed to  the treatment                                                               
and  recovery  services, divided  among  mental  health, such  as                                                               
mental illness, and behavioral health,  such as substance issues.                                                               
He noted that  the treatment and recovery grants  were most often                                                               
found in the  middle of the continuum.  He  pointed out that some                                                               
of these services received grant  dollars, as well as billing for                                                               
Medicaid reimbursement  for some  of the population.   Continuing                                                               
along the continuum,  he spoke about the  more intensive services                                                               
which included acute psychiatric  help, and those high associated                                                               
costs.   The continuum concluded  with the long  term residential                                                               
psychiatric treatment centers, the most expensive service.                                                                      
                                                                                                                                
4:55:23 PM                                                                                                                    
                                                                                                                                
MR. WALL  moved on to slide  6, listing the age  groups, with the                                                               
bulk of  service for  adults between  ages 18  - 64.   Presenting                                                               
slide  7, "Collaboration,"  he emphasized  the importance  of the                                                               
collaborative effort across  the continuum of care.   He declared                                                               
that he was impressed with  the relationships built with the care                                                               
providers.     He   listed  many   of  the   organizations  which                                                               
represented  groups  of  providers and  their  representation  at                                                               
conferences and workshops to ensure  the necessary care.  He read                                                               
from a prepared statement:                                                                                                      
                                                                                                                                
     The purpose of the Division  of Behavioral Health is to                                                                    
     manage an integrated  and comprehensive behavior health                                                                    
     system based on sound  policy, effective practices, and                                                                    
     open  partnerships.     This  is  accomplished  through                                                                    
     either performing  or providing  for mental  health and                                                                    
     substance   use   disorder   services,   ranging   from                                                                    
     prevention  to  screening, out-patient  treatment,  and                                                                    
     acute   psychiatric   care.      Those   services   are                                                                    
     specifically focused  on individuals who  cannot access                                                                    
     behavioral  health   services  without  some   form  of                                                                    
     assistance and  are targeted to the  following specific                                                                    
     population  groups:   these are  individuals in  severe                                                                    
     psychiatric  crisis  or  in  need  of  de-toxification;                                                                    
     severely  emotionally  disturbed  children  and  youth;                                                                    
     severely mentally ill  adults; substance use disordered                                                                    
     adults  and youth;  and, or,  adults and  youth in  the                                                                    
     community,  specifically  services  to  prevent  health                                                                    
     risk factors.                                                                                                              
                                                                                                                                
MR.  WALL concluded  by stating  that the  division did,  in some                                                               
ways, provide direct service to  some programs.  However, most of                                                               
the services  were indirect, through  the provider groups  in the                                                               
communities, either  through grant funding or  Medicaid services.                                                               
He  reported  that,  in  order to  accomplish  its  purpose,  the                                                               
division provided  ongoing prevention and early  intervention for                                                               
behavioral health  issues through grant programs  and management,                                                               
and  he listed  many of  these programs,  which included  suicide                                                               
awareness, fetal  alcohol syndrome,  domestic violence,  and drug                                                               
and tobacco use.  He noted  that direct care was provided through                                                               
the  therapeutic  courts, the  alcohol  program,  and API.    The                                                               
division  provided for  on-going,  comprehensive behavior  health                                                               
treatment  and   recovery,  as  well  as   psychiatric  emergency                                                               
services  for severely  disturbed  children  and youth,  severely                                                               
mentally  ill  adults, and  substance  use  disordered youth  and                                                               
adults.   He  pointed out  that the  division provided  statewide                                                               
access  to behavior  health care  through management  and quality                                                               
assurance of the behavior health Medicaid system.                                                                               
                                                                                                                                
5:00:22 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  noted  that,  although only  2.5  percent  of  the                                                               
service  population was  65  and  older, there  seemed  to be  an                                                               
increase  in dementia  and Alzheimer's.   He  asked whether  this                                                               
population received much service.                                                                                               
                                                                                                                                
MR. WALL replied that he was  working with the Division of Senior                                                               
and  Disabilities  Services,  as  this  was  a  growing  area  of                                                               
concern.                                                                                                                        
                                                                                                                                
CHAIR SEATON said  that he was supportive of an  upstream net and                                                               
moving into prevention  to delay the onset of  Alzheimer's, as it                                                               
was a disruption of lives throughout the state.                                                                                 
                                                                                                                                
MR. WALL  said that a  committee had been  formed, as this  was a                                                               
concern, and it was in on-going discussions.                                                                                    
                                                                                                                                
5:03:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ referred to  slide 5, "Continuum of Care,"                                                               
and asked about the reference to Acute Psych (Non-API).                                                                         
                                                                                                                                
MR. WALL  explained that  some of this  population was  served by                                                               
hospitals in-state  and out-of-state.   He directed  attention to                                                               
the Designated Evaluation, Treatment,  and Stabilization box, and                                                               
explained that this was also done in hospitals.                                                                                 
                                                                                                                                
CHAIR SEATON  asked whether  Alzheimer's fits  into any  of these                                                               
sections for long term care.                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ shared that it was a separate waiver.                                                                    
                                                                                                                                
MR. WALL explained  that these were normally cared  for under the                                                               
Senior and Disabilities waiver.                                                                                                 
                                                                                                                                
MR. WALL,  in response to Representative  Vazquez, explained that                                                               
the  residential psychiatric  treatment  centers  were long  term                                                               
care for  children with serious  emotional disturbance,  and that                                                               
many of these were located out of state.                                                                                        
                                                                                                                                
REPRESENTATIVE   VAZQUEZ   asked   for   a   breakdown   of   the                                                               
aforementioned out of state and in-state program expenses.                                                                      
                                                                                                                                
MR. WALL said that he would provide this.                                                                                       
                                                                                                                                
REPRESENTATIVE  VAZQUEZ,   referring  to  slide  5,   asked  what                                                               
prevention services were being offered in this category.                                                                        
                                                                                                                                
MR. WALL explained that this  category included advertisements on                                                               
television and radio, as well  as printed material, for a variety                                                               
of subjects,  including under-age drinking, tobacco  use, suicide                                                               
awareness, and FASD.                                                                                                            
                                                                                                                                
REPRESENTATIVE  VAZQUEZ asked  whether  there was  any effort  to                                                               
include nutrition and  vitamins as prevention measures,  as a lot                                                               
of research indicated that severe  deficiencies of vitamins could                                                               
show  up  as  diseases.    She  requested  more  effort  in  that                                                               
direction.                                                                                                                      
                                                                                                                                
MR.  WALL replied  that  he  was unaware  of  any  effort in  the                                                               
Division  of  Behavioral  Health,  although  there  could  be  in                                                               
Department of Health and Social  Services.  He would forward that                                                               
information.                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  added that  there  were  studies on  the                                                               
effects of  color on patients and  their moods.  She  stated that                                                               
it was  necessary "to start thinking  out of the box,  instead of                                                               
taking the most  expensive options we have."   She suggested that                                                               
there were cheaper options to help the healing process.                                                                         
                                                                                                                                
5:08:48 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that there  would be sessions specifically                                                               
to  address  prevention  and  strategies  to  lower  costs  while                                                               
improving the health status of Alaskans.                                                                                        
                                                                                                                                
5:09:14 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 5:09 p.m.                                                                                                          

Document Name Date/Time Subjects
SSPC Overview for House HSS 1-29-15.pdf HHSS 1/29/2015 3:00:00 PM
Presentations by DHSS
DJJ Trauma-Informed-Care-Presentation- HHSS 1-29-15.pdf HHSS 1/29/2015 3:00:00 PM
Presentations by DHSS
DJJ Trauma-Informed Care Briefing 1-29-15.pdf HHSS 1/29/2015 3:00:00 PM
Presentations by DHSS
DBH presentation HHSS 1 29.pdf HHSS 1/29/2015 3:00:00 PM
Presentations by DHSS
DHSS DBH 24-7 info sheet - 01_29_2015.pdf HHSS 1/29/2015 3:00:00 PM
Presentations by DHSS
CDC quick stats_Suicide rates.pdf HHSS 1/29/2015 3:00:00 PM
Presentations by DHSS
Alaska suicide prevention_2014 annual implementation report.pdf HHSS 1/29/2015 3:00:00 PM
Presentations by DHSS