Call to Order and Roll Call
Thethird meeting of the Interim Joint Committee on Health and Welfare was held on Tuesday, September 13, 2011, at 1:30 PM, in Bluegrass Ballroom One at the Lexington Convention Center. Senator Julie Denton, Co-Chair, called the meeting to order at 1:40 p.m., and the secretary called the roll.
Members:Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Tom Buford, Perry B. Clark, Dennis Parrett, and Katie Kratz Stine; Representatives Julie Raque Adams, Brent Housman, Joni L. Jenkins, Mary Lou Marzian, Darryl T. Owens, Ruth Ann Palumbo, Susan Westrom, and Addia Wuchner.
Guests: Jill Seyfred and Jon Copley, Prevent Child Abuse Kentucky; Terry Tolan, Executive Director, Governorís Office of Early Childhood; Pat Wilson, Commissioner, Department for Community Based Services, and Murray Wood, Legislative Liaison, Cabinet for Health and Family Services; Shirley Hedges, Kentucky Foster/Adoptive Care Association; Andrea J. Cornuelle, M.S., R.T. (R), Professor, Radiologic Technology, Northern Kentucky University; Sheryl Abercrombie, Administrative Director, Radiology, University of Kentucky Medical Center; and Carol Scherbak, M.S., R.T.(T), Assistant Professor, Northern Kentucky University, Former Radiation Therapy Program Director, University of Kentucky Medical Center; Jordan Wildermuth, National Association of Social Workers; Peggy Williams, Majority Floor Leaderís Office; Allyson Taylor, Office of Victim Advocacy, Attorney Generalís Office; Cindy Murray, Legislative Research Commission, Betty Marshall, Hand in Hand Family Resource Center; Pam Priddy, Necco; Tammy Gay, Family Resource and Youth Services; Elizabeth Croney, President, KVC Behavioral Health Care Kentucky; Michaela Giles, Office of the State Budget Director; Doug Jones, Family Resource Youth Services Center; Meghan Wright, Kentucky Association of Childrenís Advocacy Centers; Alexandra Kempf, Kentucky Youth Advocates; Barry Salovitz, Casey Family Programs; Brad Richie, Cabinet for Health and Family Services; Sarah S. Nicholson, Kentucky Hospital Association; and Prentice Harvey, Norton Healthcare.
††††††††††† A motion to approve the minutes of the August 17, 2011 meeting was made by Representative Burch, seconded by Senator Parrett, and approved by voice vote.
Comments by Prevent Child Abuse Kentucky
††††††††††† Jill Seyfred, Executive Director, and Jon Copley, PCAK Board Member, stated that fifteenth annual KIDS ARE WORTH IT! Conference is sponsored by Prevent Child Abuse Kentucky (PCAK), a statewide nonpartisan, nonprofit network whose mission is to prevent the abuse and neglect of Kentucky's children through its outreach. PCAK is the only statewide child abuse and neglect organization whose sole mission is to prevent the abuse and neglect of Kentuckyís children. The board members consists of social services professionals, doctors, lawyers, business leaders, law enforcement, and high-level government officials.
Consideration of Referred Administrative Regulations
††††††††††† 201 KAR 8:008E Ė repeals 201 KAR 8:390 related to general anesthesia, deep sedation, and conscious sedation by a dentist; 201 KAR 8:532 & E Ė establishes requirements and procedures for licensure of dentists; 201 KAR 8:562 & E Ė establishes requirements and procedures for the licensure of dental hygienists; and 900 KAR 7:040 Ė establishes the guidelines for distribution and publication of data collected by the Cabinet for Health and Family Services pursuant to 900 KAR 7:030 while maintaining patient confidentiality and further protecting personally identifying information. A motion to accept the administrative regulations was made by Senator Buford, seconded by Senator Parrett, and accepted by voice vote.
††††††††††† In response to a question by Representative Burch, Ms. Seyfred stated that PCAK has partnerships with over 100 different entities statewide and one of them is with schools. The goal of PCAK is to have a strong networking relationship with every school in all 120 counties.
Child Protection Programs and Services - House Joint Resolutions 137 and 17: 2010 Review
††††††††††† Pat Wilson, Commissioner, Department for Community Based Services, Cabinet for Health and Family Services, stated that the threshold for an Ombudsmanís investigation in a particular county relating to DCBS matters is if there are ten justified complaints to the Ombudsmanís Office within a six-month period regarding case issues in a county, that triggers the Ombudsmanís investigation. The investigation consists of all the cases with complaints with action needed that triggered a response and then per protocol the Ombudsmanís Office will review 25 other random cases. January 2010 to June 2010, Fayette County had ten justified cases by the Ombudsmanís Office where action was needed involving 14 actual items. The finding standard by the Ombudsmanís Office is more likely than not, meaning that compliance is measured by preponderance of evidence in the cases reviewed. In Fayette County, the findings of the child protective services investigations were initiated and completed timely and checks for previous reports and history and criminal background was completed. The required monthly standard for DCBS is that every child in foster care and all families with open child protective service cases are to be visited once a month. The findings by the Ombudsmanís Office were that children in out-of-home care were seen monthly and families receiving services were not consistently seen monthly.
††††††††††† Case plan objectives, tasks, status of progress, consequences, and next steps were generally being discussed with children in out-of-home care and their parents. The federal law states that when a child has been in foster care 15 out of last 22 months, the department will take action to move toward a termination of parental rights unless there is a compelling reason not to terminate rights. Compelling reasons are defined in statute but also have to be presented to the court. Documentation on case plans and periodic assessments were completed timely, information on the contact screen in The Workerís Information SysTem (TWIST) data system matched the description in service recordings, but quarterly contact with service providers was not consistently documented. The goal in Fayette County, part of the Southern Bluegrass Region, was to rebalance the workload and provide Fayette County staff an opportunity to rebound from a deficit position. The Ombudsmanís Office reports information in six-month intervals. No counties triggered an investigation from July 2010 to June 2011. New hires not ready to manage high-risk cases were assigned to work on presentation summaries in adoption cases providing a coaching and mentoring opportunity as well as providing relief to caseworkers. Outcomes are linked to the departmentís Continuous Quality Improvement process of analyzing data, including report findings, identifying issues, implementing probable resolutions, and measuring results. Southern Bluegrass/Fayette County utilizes management reports to guide staffing and caseload decisions as well as conducting internal case and process reviews, which is standard practice for DCBS. In July 2011, 96 percent of the approximately 600 Fayette County case plans for children in out-of-home care were completed in a timely manner, up from 66 percent in July 2010. Monthly home visits to families receiving services improved from 79.6 percent in July 2010 to 90 percent in July 2011.
††††††††††† In response to questions by Representative Westrom, Commissioner Wilson stated that one of the challenges for Fayette County has been having a large number of new frontline workers hired. It takes two to three years to become an experienced social worker, so new hires are not assigned high-risk cases immediately. Currently the number of child protective services and out-of-home care cases statewide is 20 to 21. The number of these cases has risen over the past two years because of the recession. Staff turnover has an impact on staff morale because cases are reassigned to the remaining staffís workloads. A high standard of performance is expected from staff which adds pressure to frontline workers, but the families and the children the cases represent deserve no less. She said that she would have to check with the Ombudsmanís Office to see if someone who called the Ombudsmanís Office with a complaint reached a live person or an automated answering system.
††††††††††† In response to questions by Senator Parrett, Commissioner Wilson stated that approximately 42,000 to 43,000 child protective cases were conducted in 2010. Of those investigations 34,000 investigations were moderate to high risk and 10,000 investigations were low risk. In SFY 2011, 29 percent of the cases were substantiated, and the national average is 26 percent.
††††††††††† In response to questions by Representative Marzian, Commissioner Wilson stated that worker exit interviews are conducted on a voluntary basis by another branch of the cabinet and information is sent back in aggregate form with no identifying information to DCBS. The average salary for a social worker is approximately $28,000.
††††††††††† In response to questions by Representative Burch, Commissioner Wilson stated that the cabinet files a petition with the facts of the case in court, because a child cannot be removed from a home without a court order. When the child is committed to the custody of the cabinet, an annual permanency review has to be conducted and a report sent to the court regarding permanency. A relative placement is sought first with the hope of reunification with the biological parent. Approximately 75 percent of children are reunited with a parent. Approximately 24 percent of children placed in foster care are reunited with family within 60 days. When reunification is not attained, it requires a court hearing to change the goal to either adoption or some other form of guardianship. Termination of parental rights is a separate court action. When the goal becomes adoption, the cabinet files the court for termination of parental rights. The court gives the cabinet the discretion to place the child for adoption. After the court grants the termination of parental rights, the child can be legally adopted. The department, guardian ad litem, the prosecuting attorney, a defense attorney, and, if available, a Court Appointed Special Advocate (CASA) volunteer, provide the court with information about a case.
††††††††††† In response to questions by Representative Wuchner, Commissioner Wilson stated that the exit interview aggregate information report is sent to the department at least semi-annually, depending on how many workers leave. Exit questions deal with workload, supervision, and support, and answers do factor into every day practices and how new policies are implemented by the department. She said that it is not uncommon nationally for child welfare agency turnover rates to be as high as 25 percent to 40 percent within a year. Kentuckyís average is 12 percent to 15 percent. She said that she would have to get the percentage of workers who leave that participate in exit interviews.
††††††††††† In response to a question by Representative Palumbo, Commissioner Wilson stated that she would send the committee the percentage of workers who are licensed social workers.
††††††††††† In response to questions by Representative Jenkins, Commissioner Wilson stated that there are approximately 700 adoptions annually, but she did not have information on the number of available children, average age, and weight of each child.
††††††††††† In response to a question by Senator Denton, Commissioner Wilson stated that the 700 children are foster children. Approximately 85 percent of adoptions are by foster parents.
Early Childhood Development: Update
††††††††††† Terry Tolan, Executive Director, Governorís Office of Early Childhood, stated that the Office was created on July 12, 2011. In November 1999, Governor Patton created a 25-member Task Force to submit recommendations on early childhood outcomes. In 2000, House Bill 706 was passed unanimously by both chambers of the legislature establishing the most comprehensive early childhood legislation of its time. The four outcome areas of House Bill 706 are to assure maternal and child health, establish support for families, enhance early care and education, and establish a support structure. The early childhood initiatives were funded with 25 percent of the Tobacco Settlement money. The Early Childhood Development Authority (ECDA) was given responsibilities to establish and fund priorities for early childhood, develop a state plan promulgating administrative regulations, and broadly coordinating and improving early childhood services.
††††††††††† In 2009, Governor Beshear created the Governorís Task Force on Early Childhood Development and Education. The task forceís eight recommendations were: 1) adopt and distribute the school readiness definition to local communities, schools, state agencies, and early childhood advocates; 2) The Kentucky Department of Education (KDE) should work in cooperation with the Early Childhood Advisory Council (ECAC) to identify and implement a screening tool for childrenís transition and entry into kindergarten and coordinate its use with other child assessment requirements; 3) develop a governance model for the system of early childhood services in the Commonwealth; 4) increase opportunities for, and reduce barriers to, collaboration and coordination oat all levels of the early childhood system through provision of technical assistance, use of incentives and development of measures to assess and evaluate collaboration and coordination efforts; 5) ensure that early childhood standards are widely distributed and used effectively in the programming for high quality child care, early care and preschool programs, Head Start, and used across the education community, including postsecondary programs; 6) support the work of KDE in the promotion of a model curriculum framework for public preschools and related review of kindergarten standards; 7) identify strategies including incentives and other supports to increase participation in the STARS for KIDS NOW program to make it more meaningful to parents; and 8) strengthen the role of the Community Early Childhood Councils (CECC) by simplifying the grant process and identifying the needs of each local community to determine support for the local council.
††††††††††† In response to the recommendations, on July 12, 2011 the Governor issued an executive order that created the Governorís Office of Early Childhood Development. The duties and responsibilities of the Office are to promote the vision of Kentuckyís early childhood system, advocate for improved quality of early childhood services, promote the definition of school readiness and expand its use, identify a screening tool for childrenís transition to kindergarten and communicate with providers, analyze and provide recommendations on assessment with KDE, local districts, Head Start, higher education, and CECCs, strengthen state, regional, and local coordination and collaboration, reduce barriers to coordination among existing programs, conduct periodic needs assessments on quality and availability, establish procedures for accountability and measurement, and request reports and progress reports. A high priority is to secure a four-year, $60 million Race to the Top Ė Early Learning Challenge grant. By 2013, the goal is to make sure that every child entering kindergarten has an appropriate developmental screen.
In response to a statement by Representative Wuchner, Ms. Tolan stated that most parents are unaware of the necessary readiness tools needed before a child enters school.
Representative Burch stated that more information on the development of a childís brain is available today than in 1999.
Kentucky Foster/Adoptive Care Association: Update
††††††††††† Shirley Hedges stated that the association collaborates positively with the Department for Community Based Services (DCBS) to insure a childís stay in foster care is positive and successful. The main goal for foster care is for DCBS and the resource parents to return the child to the biological family. If reunification cannot be attained for the child, the next step is adoption. Being a foster parent is a 24-hour a day, seven days a week occupation, but the children benefit by being part of a nurturing family. Hopefully, this will allow the child to break the cycle and have successful families when they are grown. Taking care of Kentuckyís children is the responsibility of all Kentuckians, not just foster and adoptive parents.
Currently, the law provides a biological parent or step-parent to transfer ownership of a vehicle to his or her child without paying sales tax. The association recommends that the statute be amended to exempt children in out-of-home care from paying sales tax. Also, the association recommends that resource homes be allowed to participate in the state medical insurance plan with no cost to the state. The per diem rate for foster parents ranges from $19 to $27 per day for food, shelter, personal hygiene products, childrenís allowance, haircuts, diapers, school supplies, clothing allowance, non-medical mileage, extra-curricular activities, over-the-counter medical supplies, field trip expenses, and one day of respite care per month. With the increase in the cost of living expenses, the association recommends that the per diem rate be raised. Because of the hardship on foster parents to have an annual physical, it is recommended that the physical be required every two years instead of annually.
Licensing for Imaging and Radiation Therapy Professionals
††††††††††† Andrea J. Cornuelle, M.S., R.T. (R), Professor, Radiologic Technology, Northern Kentucky University, Sheryl Abercrombie, Administrative Director, Radiology, University of Kentucky Medical Center, and Carol Scherbak, M.S., R.T. (T), Assistant Professor, Northern Kentucky University, Former Radiation Therapy Program Director, University of Kentucky Medical Center, stated that in 1978, KRS 211.870 and 211.890 implemented the Radiation Operator Certification Program and in 2007, nuclear medicine technologist and radiation therapists were added. Currently there are over 8,000 licensees including radiographers, nuclear medicine technologists, radiation therapists, limited operators, and temporary licensees making it the third largest group of health professionals in Kentucky. Due to growth and the complexity in medical imaging and radiation therapy, radiation imaging and therapy professionals wish to create a professional board that would allow self governance in regulatory and professional disciplinary issues. The board would represent all major geographical areas of Kentucky. The board responsibilities would include issuing and renewing the license of qualified applicants, determining and enforcing established guidelines for continuing education requirements, approving accredited educational programs for the radiation science professions and monitoring compliance with the educational standards established by the individual disciplines, investigating suspected or alleged violations, conducting hearings and recording minutes, resolving the allegations, and, if appropriate, imposing sanctions or penalties, submitting a report of activities to the Governor and the Legislative Research Commission annually, and hiring an executive director and staff to support the Board and licensees, appointing ad hoc committees if necessary. The advantages of a board would be the ability to better oversee the quality of the profession, to respond to changes in the professions more quickly, to increase staff to support the growing number of licensees, and provide licensees with a voice through broader representation. Establishing the board would move oversight of radiation professionals out of the cabinet and into an independent, self-governing peer Board of professional representatives.
††††††††††† In response to a question by Senator Buford, Ms. Cornuelle stated that the licensure fee for two years is approximately $75.
††††††††††† In response to questions by Representative Wuchner, Ms. Cornuelle stated that the disciplinary action and suspension of licenses is done by the cabinet.
††††††††††† In response to a question by Representative Burch, Ms. Cornuelle stated that there is no opposition to the legislation.
††††††††††† There being no further business, a motion to adjourn at 3:55 p.m. was made by Representative Jenkins, seconded by Representative Marzian, and approved by voice vote.