TESTIMONY OF COMMISSIONER MYRA M. MUNSON SENATE SELECT COMMITTEE ON INDIAN AFFAIRS Dear Mr. Chairman and Members of the Committee: My name Myra M. Munson and I am the Commissioner of the Alaska Department of Health & Social Services. First, I would like to thank you for the chance to furnish this written testimony, and to welcome you back to Alaska. understand that an important purpose of these hearings is to afford people who were unable to testify in Washington, D.C. chance to have their oral statements heard. Respecting that need, I have not asked to be given a chance to speak before the committee, preferring instead, to submit written testimony. a the on The Department of Health & Social Services recognizes seriousness of the problems emphasized in the recent Report the Status of Alaska Natives: A Call for Action written by the Alaska Federation of Natives (AFN). While individual pieces of data often are compelling and have provided the underpinnings for our program initiatives, when pulled together into a single report on the status and lives of Alaska Natives a formidable picture is presented. This emphatic depiction demands action by both the state and federal governments, as well as Alaska Natives themselves. It is critical, however, that duplication of effort be avoided; by working together we can each enhance the efforts of the others. It is in this spirit of seeking cooperative action, that I am providing the following testimony describing selected programs within the Department of Health & Social Services (DHSS) to try to improve the well being of Alaska Native people and other citizens of Alaska. These programs provide some new insights, raise new questions, and afford information which we hope will be helpful to the Committee and to Congress as it develops its own plan of action to address AFN's "Call for Action. FETAL ALCOHOL SYNDROME INITIATIVE In 1987 the Alaska Native Health Board (ANHB) came to the department asking that we join in their efforts to respond to Fetal Alcohol Syndrome (FAS). FAS and alcohol related birth defects are the only completely preventable birth defect. Studies have demonstrated that more Alaska Native children impacted by FAS than other Alaskan children. In addition, the Governor's Commission on Children (GICCY) identified FAS prevention as a state priority. and Youth are A working group was convened by the Office of the Commissioner, including representatives from ANHB, the Indian Health Service (IHS), the State Office of Alcohol and Drug Abuse, the Division of Family and Youth Services (DFYS), the Division of Public Health's Section of Family and Maternal Health, and the Division of Mental Health and Developmental Disabilities. Our first accomplishment was the addition of two FAS outreach counselors, one at Anchorage's Clitheroe Center and the other at the Fairbanks Native Association's (FNA) Treatment Facility, to bring high-risk women into treatment and insure that their needs are being met while in treatment. In addition, FNA's program also received money to provide child care services for mothers in treatment. These counselors and services supplement those already available through IHS and ANHB. We are also launching a multi-media campaign which will present radio and television public service announcements to both rural and urban audiences. The messages are designed to educate the public, stressing that drinking while pregnant is harmful and that there is help available. The campaign also will disseminate media kits to help educate reporters and media workers So they will be educated and sensitized to the issues when report. that they Our next task will be to assist in implementation of new legislation adopted by the Alaska Legislature requiring that warnings about the risks of FAS be posted in all establishments that sell liquor, including restraunts. CHILDREN OF ALCOHOLICS INITIATIVE Studies have indicated that the children of alcoholics are at greater risk for alcoholism than children of non-alcoholics. Alaska's population is much younger than the national average and has a higher percentage of alcoholics which results in a higher rate of children of alcoholics. Again, with urging from GICCY, the department received funding for a new component of our alcoholism prevention grants to fund five new and innovative projects designed to address the needs of children of alcoholics. The grants went to programs in Aniak, St. Mary's, Juneau, Wasilla, and to a state-wide project. PUBLIC INEBRIATES Alaska adopted the Model Uniform Alcoholism, Intoxication, and Treatment Act in the mid 1970s. The Act, which recognized alcoholism as a disease, most appropriately treated in a health setting, also decriminalized public drunkenness. Despite this change, over 5,000 intoxicated Alaskans were detained in jails in "protective custody," in 1988. Alaska Natives are over represented in this group, with the having 1,300 "protective custody" cases. rural community of Bethel Much more remains to be done, however. Through our treatment and prevention grants, we support a variety of community development projects carried out by Native organizations and the Rural Community Action Program. Through these activities, and others, we try to assist communities in initiating and guiding their own development. Alaska has responded to the problem by appropriating an additional one million dollars for Fiscal Year 1990 to address the public inebriate problem. ALCOHOL COUNSELOR CERTIFICATION In 1985 Alaska implemented a model alcohol counselor certification process designed to assure Alaska Native participation. It has become apparent, however, that Alaska Natives and other minorities are not being certified at the same rate as non-Natives. The Office of the Commissioner and the Alcoholism and Drug Abuse Advisory Board with SOADA, is undertaking a review of the criteria for alcohol counselor certification. Plans are underway for the creation of a working group to review the test, the training curriculum, as well as the relationship of certification to the administration of grant programs. Our objectives will be to sustain alcohol counselor certification, while guaranteeing that Alaska Natives from village and urban settings can achieve certification and fully participate in all aspects of the provision of treatment of alcoholism. ALASKA YOUTH INITIATIVE For three years, the department has been piloting a major effort to better serve the most disturbed children and adolescents. This project, the Alaska Youth Initiative, has focused on preventing the removal of Alaska Native youth with severe mental illnesses from their communities and avoiding placements in institutions outside of Alaska. This effort is based on a process of creating highly specialized, individualized treatment programs in the village itself, using local treatment teams and locally determined definitions of mental health and illness. Carefully documented evaluation has shown that these special youth can be treated in the village, averting the trauma would result from uprooting them from their homes. that In addition, the department has collaborated with the National Institute of Mental Health to establish mental health programs for children in six villages on Kodiak Island. The project is based on the idea that the villagers themselves should determine the scope and nature of service. As a result, four villages have successfully launched intervention programs to help Native youth who were previously at high risk of long term emotional disability. GRANTS PROJECT With support from GICCY and the Alaska Senate Special Committee on Suicide, the department has undertaken a review of the rigorous and unwieldy framework of our various grants programs. The Special Assistant for Grants Administration, whose position is funded only for the two year span of this project, has been conducting public meetings in all regions of the state to gather information from community providers about perceived problems with the grants system and proposed solutions. Our hope is to find a way to allow coordinated, predictable funding for locally developed programs without jeopardizing priorities for vulnerable client populations. A major, unresolved challenge is how to make our state programs more integrated with the IHS and Bureau of Indian Affairs funded programs, especially since we operate on different fiscal years. COMMUNITY-BASED SUICIDE PREVENTION PROGRAM The Community-Based Suicide Prevention Program is another initiative that arose from the findings of the Senate Special Committee on Suicide and GICCY. Most villages must rely on itinerant service delivery, in which health professionals and mental health service providers are based in regional hubs. Itinerant delivery cannot fully meet the community needs, nor does it encourage community based solutions and healing. The Community-Based Suicide Prevention Program is an interactive grant program in which small grants are made to communities to develop or carry out plans of their own design to help reduce suicide. Assistance in developing the application is made available and grants are awarded only to communities that demonstrate widely diverse participation in the development process. 48 communities, mostly villages, have projects underway in the first year and second year applications are being received. This program has demonstrated the importance of having local involvement in every phase of a project. From planning to implementation and evaluation, promotion of local, community participation often sparked activity that went beyond the reach of project funding. ALASKA NATIVE HIRE Our department serves thousands of Alaska Native clients. In an effort to provide the best, and most culturally appropriate, service to Alaska Native clients, the department has been trying to improve our efforts to recruit, hire, and retain Alaska Native employees. The Division of Family and Youth Services has seen dramatic improvements in recent months in Bethel where Our efforts have been intensive. We have nearly tripled the number of Alaska Natives hired as youth counselors for our juvenile detention facilities recently. Every division director in the department has made a commitment to report monthly on Equal Employment Opportunity activities beginning July 1st. WELFARE REFORM Alaska Native participation in welfare reform implementation affords an opportunity for rural communities and villages, that historically have suffered from the lack of employment and training resources, to shape the economic futures of their respective communities. The department has been working cooperatively with Alaska Native regional non-profit corporations concerning opportunities for these non-profits to operate programs to meet training and employment requirements mandated under the federal welfare reform legislation. INDIAN CHILD WELFARE ACT AGREEMENT The department remains committed to ongoing negotiations to develop state-tribal agreements under the Indian Child Welfare Act (ICWA). The next meeting of the state and tribal drafting groups is scheduled for June 1st and 2nd. Having been personally involved in the implementation of ICWA almost from its enactment, I am committed to achieving consensus about agreement prior to the end of Governor Cowper's term. Through these agreements, we can further define and clarify the means through which state and Alaska Native authorities and service providers work cooperatively to assure the well-being of Alaska Native children and the integrity of their families and cultures. "MEGA" MEETINGS Our For many years, the department has met on a quarterly basis with IHS officials in Alaska and on an invitational basis with the ANHB. Less than a year ago, the department signed an agreement with IHS and ANHB to hold a tripartite meeting twice a year. goals are to further effective communication, coordination, and advocacy. After having held two meetings, I believe we are in agreement about the value of these regular meetings. The department has a formal agreement with the Ministry of Health for Canada to share information and foster collaboration about the provision of health and social services in northern and arctic environs. The Canadian officials are using our existing relationships with Native organizations and IHS as a conduit for establishing a link for gathering more information about the experiences in Alaska concerning community development and transfer of authority for service delivery. |