Alaska 2003 | advancingstates.org

<H3>Alaska</H3>   <H4>Task Force</H4> The state Legislature created four planning and advocacy boards that provide policy direction and guide budget decisions related to community-based care. The Alaska Mental Health Trust Authority and state general funds fund the boards. Composed of consumers, public and private providers, and interested members of the public, each planning and advocacy board is responsible for a statewide plan. Although Alaska does not have a specific Olmstead planning group, the state is carrying out Olmstead planning through the boards.   <H4>The Plan</H4> The planning boards collaborated to produce In-Step, Comprehensive Integrated Mental Health Plan, which was released in December 2001. This results-based plan offers a framework for decision makers to determine improvement to state services. Although the title of this plan appears to limit the plans to the mental health system, it actually guides the programs and services provided to Alaskans who are beneficiaries of the Alaska Mental Health Trust Authority. Anyone can be a trust beneficiary who has a mental disorder that creates a risk of hospitalization or a major impairment of self-care, self-direction, social and economic functioning such that he or she needs continuing or intensive services. Alaska Mental Health Trust beneficiaries include people with mental illness, developmental disabilities, chronic alcoholism, and Alzheimer's disease and related disorders. Each designated beneficiary group is represented by one of four advocacy boards: the Alaska Mental Health Board (mental illness), the Governor's Council on Disabilities and Special Education (developmental disabilities), the Advisory Board on Alcoholism and Drug Abuse (chronic alcoholics) and the Alaska Commission on Aging (Alzheimer's disease and related disorders). In Step, Comprehensive Integrated Mental Health Plan is located at <A HREF=\"http://www.hss.state.ak.us/commissioner/instep\">www.hss.state.ak.us/commissioner/instep</A>.   <H4>Implementation</H4> The Alaska Mental Health Trust Authority will require reference to the results-based plan when the planning and advocacy boards and state agencies prepare their budget proposals.   Funding The Alaska Mental Health Trust Authority has provided funding for the Governor's Council on Disabilities and Special Education to address recruitment and retention issues for all its beneficiary groups through the Alaska Alliance for Direct Service Careers. Service recipients, family members and representatives from the four beneficiary groups, state agencies and service providers helped develop the alliance's plan, which is currently being implemented and evaluated. Particular attention is being paid to implementing strategies to increase wages and improve benefits for direct service staff, increasing the awareness of the value of direct service careers, and increasing retention through training for direct service staff and leadership training for front-line supervisors. The Division of Mental Health and Developmental Disabilities received funding in 2002 to implement its \"Real Choice Systems Change\" grant. Project goals are to 1) ensure that a planning, capacity building, monitoring and advocacy structure is in place that will result in real choice systems change; 2) integrate self-determined service delivery into current service delivery systems; and 3) improve access to services through systems reform and the development, implementation and evaluation of consumer-driven care coordination and case management systems. The Alaska Governor's Council on Disabilities and Special Education has a systems change grant, the \"Alaska Works Initiative,\" which is designed to reduce barriers to employment experienced by people with significant disabilities. This project encompasses a number of initiatives, including efforts to increase availability of accessible, affordable housing, coordinated transportation systems, Medicaid waivers and personal assistance regulations and policies. Accomplishments include the creation of the Alaska Consumer Leadership Network (composed of consumers around the state); leadership training for the network; the addition of case managers and benefit counselors to state agencies and providers who work with people who are experiencing disabilities; and provider training regarding federal and state work incentives. Alaska has received a number of other federal grants designed to promote community-based care. The first is the \"Personal Assistance Services and Supports\" grant or the \"Community Integrated PASS Project,\" in the amount of $900,000. This project builds on the recently initiated consumer-directed personal assistance program by providing training programs and technical assistance and by working with consumers to advance concepts of individual choice and consumer control. The second grant, the \"Nursing Facility Transition Grant,\" is for $800,000. This grant will identify Alaskans who want to make the transition from nursing facilities into the community and set the necessary support services in place to promote their transition.   Successes In response to the need for a well-developed continuum of mental health care for Alaska's children and youth, the state has moved forward on a two-phased need assessment. The first phase addresses the demographic and clinical profiles of children in out-of-state care in order to determine what services are needed to bring them back to Alaska. The second phase includes an analysis of capacity, use and gaps in the delivery system and identifies barriers to developing more comprehensive in-state services. As part of the effort to build the critical capacity needed to reduce the number of children in out-of-state residential psychiatric treatment centers, the state has applied for a SAMSHA children's mental health initiative grant and also prepared a proposal to the Alaska Mental Health Trust Authority for a multi-agency, five-year initiative entitled \"Bring the Kids Home.\" Alaska has many successes regarding provision of community-based care for people with disabilities. For the past 20 years, cooperative planning efforts have guided this work. Some of the results include: 1) having one of the nation's highest ratios of assisted living to nursing home beds; 2) being the only state with no state or privately operated ICF/MR (the state institution closed in 1997 in favor of home-like settings and community-based alternatives); and 3) reducing the size of the only state psychiatric institution from 176 beds to 74 beds, made possible by enhancing community-based alternatives and support services.   Challenges Recruitment and Retention: Service providers are finding it increasingly difficult to recruit and retain qualified staff. In the developmental disability system, for example, not only are providers finding it difficult to provide quality services to existing consumers, a 2001 survey indicates that they could serve only 8 percent of the 1,000 children and adults waiting for services who are eligible for Medicaid waiver services. Service Capacity: The number of children and adults with autism has grown considerably during the past few years. Other groups with unmet needs include students with serious emotional disturbances, individuals with behavioral health needs (especially individuals with inappropriate, violent and/or sexual behaviors), individuals with dual diagnoses, and individuals with disabilities who are parents. Self-Determination: Many individuals being served have expressed a desire for more direction and control over their own supports and services. Although a foundation exists with the developmental disability voucher respite option, existing systems do not support self-determination or self-directed services.   Lawsuits There are no lawsuits in Alaska regarding the Olmstead decision.   Next Steps Activities are under way to increase service capacity. For example, the Governor's Council on Disabilities and Special Education helped plan an April 2002 statewide Autism Summit that was convened by the commissioners of the Department of Health and Social Services and the Department of Education and Early Development. Participants represented important stakeholder groups, including parents of children experiencing autism, early childhood educators, infant learning program providers, psychologists, state agency heads, teachers, speech and language providers, protection and advocacy staff, special education directors and advocacy organizations. Priority recommendations included establishing an Autism Resource Center; developing a system of pre-service, in-service and training for providers, educators and parents; and establishing a system for collecting and maintaining data about autism. A workgroup is further refining these recommendations for implementation during the upcoming year. The Governor's Council on Disabilities and Special Education, the State Independent Living Council, the Alaska Mental Health Board, the Alaska Commission on Aging, the Governor's Committee on Employment and Rehabilitation of People with Disabilities, and the Alaska Mental Health Trust Authority currently are planning the second Disability Summit, which is tentatively scheduled for Feb. 12, 2003. Because Alaska has both a new administration and a new Legislature, the February 2003 Summit will provide the disability community with an opportunity to discuss its agenda with new state officials. <BLOCKQUOTE> </BLOCKQUOTE>