GOVERNOR'S COUNCIL ON DISABILITIES AND SPECIAL EDUCATION. Early Intervention Committee MINUTES

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GOVERNOR'S COUNCIL ON DISABILITIES AND SPECIAL EDUCATION

Early Intervention Committee MINUTES

VIDEOCONFERENCE HOST Governor's Council

550 W. 7

^th

Avenue, Suite 1230 Anchorage, Alaska

Videoconference

Meeting Date

Wednesday, June 17, 2020 10:00 a.m.

Attendees:

Christian Muntean, chair Maureen Harwood

Molly McManamin Annette Callies Emily Urlacher Rebecca Vickrey Jimael Johnson Chelsea Burke Cecilia Miller Carmen Wenger Charlotte Bender Dr. Matt Hirschfeld

Amy Simpson Kathy Berry Kristin Spencer Susan Kessler Meghan Johnson Fabrice Evengue Eric Talbert

Genevieve Casey Nona Safra

Don Enoch

Supanika Ackerman Bunti Reed

Staff:

Elena Markova

Prepared by: Paula DiPaolo, Peninsula Reporting

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Governor’s Council on Disabilities EIC Committee Meeting

and Special Education June 17, 2020 Page 2

CALL TO ORDER – 10:00 a.m.

ROLL CALL – Quorum not established ANNOUNCEMENTS AND GOOD NEWS

Christian Muntean welcomed committee members to the meeting, and noted that this will be his last meeting. He stated that Molly McManamin will become the new chair.

Christian Muntean asked meeting participants to introduce themselves to the group.

Maureen Harwood announced that all 15 infant learning programs (ILPs) have been able to move their services to phone or video platforms, and they have been able to maintain continuity of services. ILPs have been receiving new protocols for testing measures and evidence-based practices that they can implement and use in different platforms. She stated that both providers and families have really risen to the occasion during the pandemic, and she believes that should be celebrated.

Maureen Harwood also announced that through the 1135 Medicaid process, they were able to add an additional targeted case management billing to ensure that infant

learning programs could continue to make contacts and remain fiscally solvent.

Genevieve Casey announced that under the guidance of Dr. Zink, the Division of Behavioral Health (DBH) has developed the Alaska Responder’s Relief Line in response to what they know is the intense stress that first responders are under. It includes anyone whose role in a medical or social service field puts them at risk for exposure to COVID-19. They now have the opportunity to call a 1-800 number 24 hours a day and immediately speak to a clinician about the experiences they are having. Callers can receive follow up and six to eight phone calls, and there has been tremendous outreach from private providers who are willing to act as referral sources. It is one of the biggest collaborations she has ever seen between the Department of Health and Social Services (DHSS) and private providers.

DECLARATION OF CONFLICT OF INTEREST

No conflicts of interest were declared.

APPROVAL OF AGENDA AND APPROVAL OF PAST MINUTES

Quorum was not achieved to approve the agenda and past meeting minutes.

CHAIR'S REPORT

Christian Muntean shared his appreciation for his experience being on the Council. As a parent, he recognizes the complexity of the system, and he acknowledged the hard work of the organizations that have membership on this committee in terms of providing a better world for his daughter and for parents.

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STAFF REPORT

Elena Markova stated that the membership of this committee has been a concern for months. They have been trying different avenues trying to recruit volunteer Council members to join the committee, and they have not had much luck so far. Another route to increase membership would be for the Council chair to start appointing Council members to this committee. She has been working on this with the Council leadership so the EIC is able to get the mandatory number of five Council members.

Elena Markova reported that they are also starting to work on the transition from

Christian Muntean to Molly McManamin as the EIC chair. Anyone with questions on the chair transition should direct their questions to Elena.

Elena welcomed Rebecca Vickrey as a new EIC member filling the parent seat. She also noted that they have recruited Zack Fields to fill the legislative seat on the committee.

Elena Markova stated that the Council is preparing for the 30^th celebration of the Americans with Disabilities Act (ADA). They are creating a webpage on the Council’s website that will contain information about the ADA legislation. They are also proposing a proclamation from the Governor for ADA day on July 26^th. Elena is soliciting personal stories from people that have been impacted by the ADA legislation, which will help to personalize the webpage.

Elena Markova stated that they are planning to hold the Interagency Coordinating Council (ICC) meeting in August on the social emotional indicator. She has been working on collecting feedback from stakeholders on how to improve on this indicator.

Elena reported that she will be sending out the last call for the expulsion and

suspension survey for caregivers and parents of children between the ages of 3 to 8 years old. The deadline is June 20^th.

Christian Muntean stated that for the past year-and-a-half this committee has been working on the plan within the EIC as well as more recently this year changing the structure of how the meeting works to mostly be about reporting against the plan.

Another change that they have begun that will be starting now is to actually separate out the EIC from the ICC a little bit. Right now the two are collapsed together, which he believes creates some confusion about how the EIC and the ICC work and fit together.

The duties of each will be separated out with alternating or quarterly meetings for each with the intent of trying to be more effective and clearer about who is participating in what with the right committee members attending relevant meetings.

Elena Markova added that the ICC meetings will revolve around issues on assisting and advising the lead agency, which is the state Early Intervention/Infant Learning Program.

The ICC has mandatory activities under the IDEA that they need to address such as issues on Child Find activities and review of indicators. Elena stated she will be putting together an ICC agenda, and she will list all the tasks. Maureen Harwood further

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clarified that some of the members present for this meeting are required members of the ICC, but the Governor’s Council has two authorities they respond to, one is the

Developmental Disabilities Act, which looks at infants and toddlers in multiple settings in the state of Alaska, but under the code of federal regulations, the Part C program has an Interagency Coordinating Council to advise and assist. The Council has been trying to separate when they are reporting under their federal authority for the DD Act and when they are doing activities for the ICC. The activities somewhat overlap, but the ICC is very specific to the functions of Infant Learning Programs.

Christian Muntean encouraged members of the committee to share their ideas on the meeting structure with Elena and Molly.

NEW BUSINESS

Development of the Trust FY’22 – ’23 Budget

Jimael Johnson directed members of the committee to her PowerPoint presentation and stated that for the past few months, the Trust has been soliciting partner and

stakeholder feedback as they are developing their next two-year budget. She reviewed her PowerPoint as follows:

Mission:

It is the duty of the Alaska Mental Health Trust Authority to provide leadership in the advocacy, planning, implementing and funding of services and programs for Trust beneficiaries.

Trust Beneficiaries:

Beneficiaries of the Trust include the following broad groups of Alaskans with:

 Mental illness

 Developmental disabilities

 Chronic alcohol or drug addiction

 Alzheimer’s disease and related dementia

 Traumatic brain injuries.

The Trust also works in prevention and early intervention services for individuals at risk of becoming beneficiaries. The Trust considers prevention of these conditions, where possible, to be part of its mandate.

Alaska’s Comprehensive Integrated Mental Health Program Plan, 2020-2024

Foundational Goal: The State of Alaska will provide adequate resources and funding to support a comprehensive behavioral health service system promoting independent, healthy, Alaskans so that they may live meaningful lives in communities of their choosing.

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Goals:

1. Early Childhood 2. Healthcare

3. Economic and Social Wellbeing

4. Substance Use Disorder and Prevention 5. Suicide Prevention

6. Protect Vulnerable Alaskans

7. Service in Least Restrictive Setting 8. Services in Institutional Setting 9. Workforce, Data, and Funding Project LAUNCH Model

• Screening and assessment

• Behavioral health in primary care

• Mental health consultation in early care and education

• Enhanced home visiting

• Family strengthening

Goal 1 (Early Childhood):

Programs serving young children promote resiliency, prevent and address trauma, and provide access to early intervention services.

1.1 Objective: Promote practice-informed, universal screening efforts and early intervention services.

1.2 Objective: Provide ongoing support to ensure accurate identification and

treatment of social-emotional needs for children and their caregivers, congruent with their cultural identification.

1.3 Objective: Reduce the instances and impact of Adverse Childhood Experiences (ACEs) through community engagement and by improving social determinants of health.

Goal 6 (Protecting Vulnerable Alaskans):

Alaskans are free from abuse, neglect, self-neglect, and exploitation.

6.1 Objective: Prevent child maltreatment by ensuring resilient families.

6.2 Objective: Promote early intervention in maltreatment and with families at risk for maltreatment.

6.3 Objective: Ensure individuals who suspect potential abuse understand the role of protective agencies and how to report potential abuse and neglect.

6.4 Objective: Increase timely access to protective services statewide.

6.5 Objective: Ensure vulnerable Alaskans understand their rights and responsibilities.

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Alaska Mental Health Trust Focus Areas

 Substance Abuse Prevention and Treatment

 Housing and Long-Term Services and Supports

 Disability Justice

 Beneficiary Employment and Engagement

Other Concentrated Work:

• Workforce Development

• Early Childhood Intervention and Prevention Early Childhood Intervention and Prevention

Concentration since “Bring the Kids Home” focus area lessons learned (2004-2012):

Why is this work critical for beneficiaries?

• Early interventions for beneficiaries with delays or disabilities improve educational and health outcomes.

• Trauma early in life is highly correlated with beneficiary groups.

• Highest return on investment (ROI) from earliest investments in children – up to 14% ROI for birth to 5-year old programs.

Comp Plan Key Strategies Addressed:

• Objective 1.1: Promote practice-informed, universal screening efforts and early intervention services.

• Objective 6.1: Prevent child maltreatment by ensuring resilient families.

Key Partners: Advisory Boards, Division of Behavioral Health, Senior and Disabilities Services, Department of Education and Early Development, All Alaska Pediatric Partnership, Alaska Association for Infant and Early Childhood Mental Health, Southcentral Foundation, Rasmuson, Alaska Children’s Trust, and more.

Positive impacts/successes examples of Trust partnerships:

• Expansion of supports in the 1115 Medicaid waiver.

• Partnership Access Line – Pediatric Alaska (PAL-PAK) mental health consultation with Seattle Children’s Hospital.

• Trauma-informed schools pilot and framework.

Budget information:

To further develop partnerships and strategies related to early childhood intervention and prevention, Trustees have authorized a budget of $880,000 for FY’21 activities consistent with Comp Plan strategies.

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Current and Future Efforts:

• Screening and assessment

• Integration of behavioral health into primary care settings

• Trauma-engaged practice and behavioral health in education settings

• Infant and early childhood mental health capacity building

• Enhanced home visiting supports

• Data development and evaluation.

Jimael Johnson stated that as the Trust is planning for its next budget cycle, they would like feedback from stakeholders to assist the Trust in building on what they have been doing as well as directing the Trust as to how to increase access to supports for young children and their families. She then asked the committee members to consider the following questions:

1. Where are the greatest early childhood systems gaps?

2. What needs to change to improve services for young beneficiaries and their families?

3. What investments should the Trust make that will have the greatest positive impact on young beneficiaries’ lives?

4. Are there promising practices or evidence-based practices that the Trust should invest in piloting?

5. Are there current projects that need formal evaluation or other investments to be replicated or brought to a statewide scale?

Committee members provided the following feedback:

• The current environment has really highlighted some of the gaps. Although grateful for the infrastructure in place for ILPs to do telework and virtual visits with families, the gaps in Alaska seem to deal primarily with geographical issues.

• Services are offered to families that they don’t accept.

• Services look really different depending on the geographic region.

• Each of the infant learning provider agencies now have some rural service areas, which has helped them to see how services differ in regions, but it is very

complicated.

• Lessons learned through the integrated model with Infant Learning and their Project LAUNCH Grant:

• One of the purposes of Project LAUNCH is to break down silos. There are two parts of their program, the official ILP part and the Project LAUNCH part that is available and integrated into ILP. They have realized there are many barriers in place because most of the ILP programs are mostly focused on an individual child, and the child has to be eligible for a certain service. Project LAUNCH allows ILPs to serve whole families including siblings, which the child-focused delivery system is unable to do.

• There is a lot of freedom with Project LAUNCH for ILPs to see and meet needs. Lesson learned is that they see a huge need for greater flexibility within systems.

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• For the very challenging families to serve, it has been beneficial to move families over to the Project LAUNCH side to serve them through Circle of Security Parenting without having to evaluate the child or jump through multiple hoops. Slowly they are able to then move the child into an ILP developmental evaluation for services once they have built a relationship with the family through the grant. This is an example of how the flexibility of this grant is an opportunity to serve families in a way that works for the family. The more barriers to enrollment and engagement they put up, the fewer families ILP is able to help.

• Systems navigation is still a mystery for families, even when they are currently being served and are well-versed in the system. Some sort of a map created for families that explains the resources would be useful.

• It takes a lot of parental time to take advantage of services, and work constrictions may impact a lot of peoples’ ability to receive services.

• From a parent perspective, anybody who can provide services and bill for them will always tell them services need to be provided. Parents don’t know how to differentiate between which services or providers are more beneficial for their child.

• Priorities of services – parents tend to gravitate toward whatever services are the easiest to deal with, even if that may not be the most important place for the child to be at that moment. Need something that would simplify how to navigate or understand the services that are out there that gives parents a sense of priorities.

• Within weeks of a child’s diagnosis at birth, parents can be bombarded with phone calls from agencies for services the child had been referred to by the doctors that parents didn’t even know existed.

• Without help from ILP, new parents wouldn’t know how to navigate the system.

• Difficult to advocate for a child who doesn’t look like they have a disability.

• It would be very helpful for parents to have a map as they try to navigate the systems.

• The above comments highlight the importance of good care coordination and case management for families. The Trust could work to develop systems that can support case management and care coordination reimbursement for providers so it can become a robust working group that parents can access easily.

• There are many silos, which are difficult to break down. Some sort of

governance structure to look at early intervention and early childhood and figure out how to break down silos so that everyone is working together in the same direction on these issues is needed in this state. The Trust’s leadership will be very important for the next generation of children to have better access to all of the great services that are available in Alaska in a way that maximally benefits all kids in the state.

• Infant Learning gets all the referrals for children that have had substantiated instances of abuse, and they are often the hardest group to keep current contacts with and follow up on because OCS is so overworked. Perhaps a campaign that even though parents may have gone through a rough point, there are still great services available to them. They need to consider the right avenue to attract these families into services for assistance with long-term social

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emotional outcomes for the children, because right now these families are very difficult to engage.

• SDS had the Preschool Development grant, and one of the evidence-based practices was Circle of Security, which was recognized as being very helpful for parents. Continuation of that project may be a direction the Trust may want to explore.

• Parents Inc. was an agency in Alaska that had monthly training events for parents, and they had parent trainers in most of the larger communities in the state, and they also had parent trainers that traveled to different communities.

This agency was a godsend to parents. Parent’s groups were held in Juneau and were very well attended. That agency and those opportunities are no longer, and recently parents have commented that there are no other similar resources.

• Previously worked in a child abuse and neglect prevention program, which was a home visiting program to serve families who had risk factors. It was an

opportunity to provide one-on-one support and care coordination to some degree.

• DHSS and DBH are looking at ways to serve this population again with the information gleaned from the ACEs study and social determinants of health.

Capturing families in those early years is crucial, and they are striving for more integration of behavioral health and physical health factors that impact children.

• Objective 1.1 around data and early detection and screening is an area that’s been worked on heavily by a lot of groups, including the Governor’s Council’s task force and Help Me Grow. A report will be coming out from Help Me Grow that looks at how screening data can be better utilized in the state as well as unifying universal screening efforts.

• The work of Help Me Grow with the developmental screening report has been very helpful for the Early Childhood Comprehensive Systems (ECCS) grant.

Women’s Children’s and Family Health has been talking about next steps in relation to that report.

Jimael Johnson expressed her appreciation to the committee for their comments today and invited anyone to contact her to provide additional feedback.

Jimael Johnson asked for further discussion on infant and early childhood mental health workforce. She asked for feedback on what the Trust can do to better support that, and committee members provided feedback as follows:

• Workforce development is huge.

• Infant learning has worked really hard to integrate infant mental health and trauma-informed care into everything they do, but sometimes it takes time. It would be helpful to have infant mental health integrated into training programs.

• Need more providers such as PTs and OTs in the state that provide services to children and families to be trained in infant mental health. This needs to be integrated into the work that all providers do with infants and toddlers.

• Need to be able to support the whole family in service provision.

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Elena Markova asked Jimael Johnson to briefly explain some of the requirements of Trust grant applications. Jimael Johnson explained that there are a couple of sources of Trust funding, one being MHTAAR, Mental Health Trust Authority Authorized

Receipts, which is funding that goes back into state government agencies. This money is built into the Trust’s budget and the recipients and purposes are pre-defined. The Trust also has authority grants, which is a more flexible source of funding. Authorized grants go out to community partners, which can also be named in the budget with specific recipients and specific dollar amounts, but it can also be flexible and allocated in categories that can be applied for. The Trust also has partnership grants, which is the most flexible type of funding. It is a set-aside pot of money which is allocated through an application process on a rolling basis throughout the year. Partnership grants are to address specific projects that are identified by organizations as an area of need as seen on an agency or community level. The Trust’s website has a lot of detail about how to apply for the partnership grants, and Jimael will forward the link for that.

Jimael Johnson concluded her presentation by stating that they will be presenting their budget recommendations to the board of Trustees in July.

OLD BUSINESS

Current Work Plan Actions in Progress

This agenda item was postponed in the interest of time for today’s meeting.

UPDATES FROM EIC MEMBERS AND PARTNERS

Christian Muntean reminded members of the committee that the EIC has now moved to receiving updates in written format. He noted that they have not been receiving many written reports from partners, and he encouraged people to share announcements and training opportunities for distribution to the committee members.

GOOD OF THE ORDER AND ADJOURNMENT

Christian Muntean thanked the committee for the opportunity to participate with them for the past three years.

The meeting ended at 11:38 a.m.